p53 and Ki-67 in Barrett's carcinoma: is there any value to predict recurrence after circumferential endoscopic mucosal resection?
BACKGROUND
There are situations in which the specimens obtained after endoscopic mucosal resection of superficial adenocarcinoma arising from Barrett's esophagus are not adequate for histopathological assessment of the margins. In these cases, immunohistochemistry might be an useful tool for predicting cancer recurrence.


OBJECTIVE
To evaluate the value of p53 and Ki-67 immunohistochemistry in predicting the cancer recurrence in patients with Barrett's esophagus-related cancer referred to circumferential endoscopic mucosal resection.


METHODS
Mucosectomy specimens from 41 patients were analyzed. All endoscopic biopsies prior to endoscopic mucosal resection presented high-grade dysplasia and cancer was detected in 23 of them. Positive reactions were considered the intense coloration in the nuclei of at least 90% of the cells in each high-power magnification field, and immunostaining could be classified as superficial or diffuse according to the mucosal distribution of the stained nuclei.


RESULTS
Endoscopic mucosal resection samples detected cancer in 21 cases. In these cases, p53 immunohistochemistry revealed a diffuse positivity for the great majority of these cancers (90.5% vs. 20%), and Ki-67 showed a diffuse pattern for all cases (100% vs. 30%); conversely, patients without cancer revealed a superficial or negative pattern for p53 (80% vs. 9.5%) and Ki-67 (70% vs. 0%). During a mean follow-up of 31.6 months, 5 (12.2%) patients developed six episodes of recurrent cancer. Endoscopic mucosal resection specimens did not show any significant difference in the p53 and Ki-67 expression for patients developing cancer after endoscopic treatment.


CONCLUSIONS
p53 and Ki-67 immunohistochemistry were useful to confirm the cancer; however, they had not value for predicting the recurrent carcinoma after circumferential endoscopic mucosal resection of Barrett's carcinoma.
Lopes
César Vivian
CV
Endoscopy Unit and Department of Biopathology, Paoli-Calmettes Institute, Marseille, France. cevele@redemeta.com.br
Mnif
Hela
H
Pesenti
Christian
C
Bories
Erwan
E
Monges
Genevieve
G
Giovannini
Marc
M
D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis*; D008297:Male; D009092:Mucous Membrane / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011230:Precancerous Conditions / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53