p53 alteration in regional lymph node metastases from prostate carcinoma -A marker for progression?

BACKGROUND, Alterations of the p53 tumor suppressor gene are associated wit h advanced stage prostate carcinoma. The biologic significance of p53 nucle ar accumulation in prostate cancer patients with regional lymph node metast ases is uncertain. METHODS. The authors investigated p53 alterations by immunohistochemistry i n 220 lymph node positive patients who were treated with radical prostatect omy, bilateral pelvic lymphadenectomy, and androgen deprivation therapy bet ween 1987-1992 at the Mayo Clinic. The mean follow-up was 6.3 years. Tumor volume of lymph node metastases was measured using the grid method. RESULTS, p53 immunoreactivity was detected in 109 of 211 primary tumors (52 %) and 83 of 144 matched regional lymph node metastases (58%); this express ion was strongly concordant (correlation coefficient = 0.53; P = 0.0001). O verexpression of p53 protein in lymph node metastases was associated with d istant metastasis free survival by univariate analysis (P = 0.03), but did not reach statistical significance by multivariate analysis (P = 0.07). Reg ional lymph node cancer volume was the single most important predictor of d istant metastases after adjusting for Gleason score, DNA ploidy, and p53 ex pression. CONCLUSIONS. The findings of the current study suggest that assessment of b iologic changes (including p53 alterations in regional lymph node metastase s) could be of value in the assessment of the biologic aggressiveness of pr ostate carcinoma, whereas p53 expression in the primary tumor does not appe ar to influence patient outcome. Cancer 1999;85:2455-9. (C) 1999 American C ancer Society.