Relationship between the long-term effects of intraperitoneal chemotherapy and the expression of p53 and p21 in patients with gastric carcinoma at stage IIIa and stage IIIb.
BACKGROUND
The relationship between the expression of p53 and p21 in cases of advanced gastric cancer (t3) with lymph node metastasis [n1(+) or n2 (+)] and the long-term effects of continuous hyperthermic peritoneal perfusion (CHPP) immediately after resection was evaluated.


METHODS
Between 1983 and 1989, 74 patients with gastric cancer [t3, n1(+) or n2(+)] underwent curative gastrectomy and survived without postoperative complications. These patients were followed up for at least six years.


RESULTS
Thirty-seven patients died from recurrence of cancer. In 34 patients who had tumors designated p53-/p21+ or p53+/p21+, CHPP reduced the percentage of patients who died from recurrence of cancer from 10/20 (50%) to 3/14 (21.4%, P = 0.184). However, in 40 patients who had tumors designated p53-/p21- or p53+/p21-, the percentage of patients who were treated with or without CHPP and died from recurrence of cancer was the same, 6/10 (60%) and 18/30 (60%). In the case of patients who had p21-positive tumors, the 5-year survival rate of 11 patients who were treated with CHPP (72.7%) was higher than that of 17 patients who were not treated with CHPP (41.2%, p = 0.027). However, in the case of patients with p21-negative tumors, the 5-year survival rate of 10 patients who were treated with CHPP (50%) was not very different from that of 28 patients who were not treated with CHPP (42.9%, p = 0.308).


CONCLUSIONS
These results indicate that the CHPP might be effective in preventing the recurrence of cancer in patients with p21-positive regardless of the expression of p53.
Ikeguchi
M
M
Department of Surgery I, Faculty of Medicine, Tottori University, Yonago, Japan.
Saito
H
H
Katano
K
K
Gomyo
Y
Y
Tsujitani
S
S
Maeta
M
M
Kaibara
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015689:Oncogene Protein p21(ras) / Q000096:biosynthesis*; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis*
D000970:Antineoplastic Agents; D016159:Tumor Suppressor Protein p53; D015689:Oncogene Protein p21(ras)