Impact of the expression of cyclin-dependent kinase inhibitor p27(Kip1) and apoptosis in tumor cells on the overall survival of patients with non-early stage gastric carcinoma

BACKGROUND. The expression of p27(Kip1) and apoptosis have been implicated in tumor aggressiveness and proved to be prognostic predictors for several human malignancies. In this study, the authors sought to investigate the ex pression of p27(Kip1) and apoptosis and their potential significance in det ermining the prognosis of patients with non-early stage gastric carcinoma. METHODS. Primary gastric tumor specimens from 225 patients were investigate d by immunohistochemistry with anti-p27(Kip1) and anti-Ki-67 antibodies, an d their apoptotic indices were determined with the use of an Apop-Tag in si tu detection kit. RESULTS, The median p27(Kip1) labeling index (LI) was 48.4%. There was a si gnificant association between the p27 LIs and the apoptotic indices (AIs). However, there was no association between the p27 LIs and the Ki-67 LIs. p2 7 LI was demonstrated to be one of the most significant and independent pro gnostic factors in multivariate analysis. Although Al: was found to be prog nostically significant in univariate analysis, it failed to retain an indep endent and significant value regarding overall survival in multivariate ana lysis. CONCLUSIONS. Decreased expression of p27(Kip1) and reduction of apoptotic p otential were two of the most important factors in predicting a poor progno sis for patients with non-early stage gastric carcinoma. These findings sup port the hypothesis that decreased p27(Kip1) expression, which may reflect a decreased rate of apoptosis, is closely related to the aggressiveness of gastric carcinoma. Therefore, the assessment of p27(Kip1) expression and ap optotic potential may prove valuable in identifying patients with gastric c arcinoma who are at high risk for recurrence and would benefit from adjuvan t therapy. (C) 1999 American Cancer Society.