title: Can we improve the clinical risk score? The prognostic value of p53, Ki-67 and thymidylate synthase in patients undergoing radical resection of colorectal liver metastases.
abstract: OBJECTIVE
  The aim of this study was to assess whether biological markers can provide prognostic information additional to that supplied by the clinical risk score (CRS) in patients with colorectal liver metastases.
  
  
  METHODS
  A retrospective review of a prospectively maintained database was conducted. Patients selected for this study were treated between 1996 and 2011 with potentially curative liver surgery. Expressions of p53, Ki-67 and thymidylate synthase were assayed using immunohistochemical techniques on tissue microarrays.
  
  
  RESULTS
  A total of 98 (24%) of 406 patients met the inclusion criteria. The median follow-up was 103 months. Analysis revealed a correlation between p53 protein overexpression and high CRS (P = 0.058). Following multivariate analysis, only high CRS remained as an independent negative prognostic predictor of survival (P = 0.018), as well as an indicator of early recurrence of disease (P = 0.010). Of the biological markers investigated, only Ki-67 overexpression was identified as a positive predictor of survival on multivariate analysis (P = 0.038).
  
  
  CONCLUSIONS
  Ki-67 overexpression was a positive predictor of survival. Only high CRS remained an independent negative prognostic predictor.
authors.affiliation: Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Arpad
authors.initials: A
authors.lastname: Ivanecz
authors.forename: Rajko
authors.initials: R
authors.lastname: Kavalar
authors.forename: Miroslav
authors.initials: M
authors.lastname: Palfy
authors.forename: Vid
authors.initials: V
authors.lastname: Pivec
authors.forename: Marko
authors.initials: M
authors.lastname: Sremec
authors.forename: Matjaž
authors.initials: M
authors.lastname: Horvat
authors.forename: Stojan
authors.initials: S
authors.lastname: Potrč
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000032:analysis*; D008113:Liver Neoplasms / Q000201:enzymology / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013940:Thymidylate Synthase / Q000032:analysis*; D013997:Time Factors; D046888:Tissue Array Analysis; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
chemical_list: D019394:Ki-67 Antigen; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; D013940:Thymidylate Synthase