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Aberrant p53 Immunostaining in Barrett's Esophagus Predicts Neoplastic Progression: Systematic Review and
Patrick Snyder1, Kerry Dunbar2,3, Daisha J Cipher4
1Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
Digestive Diseases and Sciences
|March 27, 2019
Summary
Aberrant p53 immunostaining in Barrett's esophagus (BE) biopsies strongly predicts neoplastic progression. This systematic review and meta-analysis supports its use as an adjunct diagnostic tool for BE patients.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Barrett's esophagus (BE) risk stratification relies on dysplasia grading, limited by sampling errors and inter-pathologist variability.
- Current guidelines do not recommend p53 immunostaining due to insufficient evidence of prognostic value.
- Aberrant p53 expression is a potential biomarker for neoplastic progression in BE.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic value of p53 immunostaining in BE patients.
- To clarify the association between aberrant p53 expression and subsequent neoplastic progression.
- To evaluate p53 immunostaining as an adjunct tool for risk stratification in BE.
Main Methods:
- Systematic review and meta-analysis of studies using immunohistochemistry for p53 expression in BE biopsies.
- Separate meta-analyses conducted for case-control and cohort studies.
- Identified 14 relevant reports (8 case-control, 7 cohort studies) involving 1435 and 582 patients, respectively.
Main Results:
- Case-control meta-analysis showed significant odds ratios (OR 3.84-5.95) for neoplasia with aberrant p53 expression.
- Cohort meta-analysis revealed significant relative risks (RR 14.25-17.31) for neoplastic progression.
- Consistent, strong, and significant associations found between aberrant p53 immunostaining and progression to high-grade dysplasia or esophageal adenocarcinoma.
Conclusions:
- Aberrant p53 immunostaining is a strong and significant predictor of neoplastic progression in BE.
- Findings support the use of p53 immunostaining as an adjunct to routine diagnosis for dysplasia in BE.
- p53 immunostaining can improve risk stratification and patient management in BE.