p53 as a significant prognostic marker in endometrial carcinoma

Although several studies have reported that p53 overexpression is associate d with poor survival from endometrial cancer, this relationship might be co nfounded by a number of possible factors. The objective of this study was t o examine the prognostic role of p53 overexpression in endometrial cancer w hen a panel of well-selected potential confounding factors were controlled. One hundred and twenty-five endometrial cancers were examined for p53 over expression by immunohistochemistry (IHC). Demographic and clinical data, in cluding age at diagnosis, race, residence, tumor grade, surgical stage, and other possible confounding factors for endometrial cancer such as diabetes , family history of cancer, hypertension, hormone replacement therapy (HRT) , and obesity were collected from medical charts and pathologic reports. Su rvival status was determined at the end of follow-up. The Kaplan-Meier meth od was used to derive the survival curve, while the log-rank test was used to compare curves for two or more groups of patients. The proportional haza rds regression model was used to obtain maximum likelihood estimates of rel ative risks (RR) and their 95% confidence intervals. Compared to the p53 nonaltered group, the presence of p53 overexpression in endometrial carcinoma was related to significantly decreased patient survi val. High nuclear grade and high FIGO stage were associated with poor survi val. No obvious association was found between survival and study site, race , age, and other potential risk factors of endometrial cancer. Only two var iables (p53 and stage) were significantly associated with poor survival in the multivariate proportional hazards analysis. Overexpression of p53 was f ound to be the most significant predictor of specific survival. The relativ e risk for p53 overexpression was 7.46 (95% CI: 4.26-13.1) and for late sta ge was 4.35 (95% CI: 1.91-9.92). We conclude that p53 overexpression is the most important predictor for patient survival when a panel of well-selecte d potential confounding factors are taken into account. Patients with endom etrial cancers who have p53 overexpression have a seven-fold higher risk of dying from disease compared to those without p53 overexpression. Whether d etection of p53 alteration may serve as an indicator of high-risk patients for whom more aggressive adjuvant chemotherapy may be considered needs to b e explored in the future.