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Eur J Cardiothorac Surg 2003;23:221-228
© 2003 Elsevier Science NL

Prognostic prediction of the immunohistochemical expression of p53 and p16 in resected non-small cell lung cancer

^a Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
^b Graduate Institution of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC
^c Molecular Biology Laboratory, Department of Pathology, Tzu-Chi General Hospital, Hualien, Taiwan, ROC
^d Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
^e Department of Mathematics, Tamkang University, Tamsui, Taipei, Taiwan, ROC
^f Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

Received 8 July 2002; received in revised form 25 October 2002; accepted 5 November 2002.

* Corresponding author. Tel.: +886-2-87927190; fax: +886-2-23644697
e-mail: cpyupath{at}ndmctsgh.edu.tw

Objective: p53 and p16(INK4) are the common and important tumor suppressor genes. Aberrant expression of p53 or p16 protein has been reported in various malignancies including lung cancer. Our aim was to investigate the association of p53 and p16 expression in resected non-small cell lung carcinoma (NSCLC) and evaluated their correlation with clinocopathologic features and survival. Methods: p16 and p53 expression were detected by immunohistochemical analysis of 90 paraffin specimens of resected NSCLC, including 35 squamous cell carcinoma, 47 adenocarcinoma, and eight large cell carcinoma, between stages I and IV. The immunohistochemical study was performed using the labeled streptavidine–biotin method with anti-p53 and anti-p16 monoclonal antibodies. Results: Fifty-two (57.8%) and 36 (40%) of 90 patients revealed aberrant immunostaining for p53 (p53+) and p16 (p16+), respectively. While 19 cases (21.1%) showed abnormal immunoreactivity for both p16 and p53. (p53+/p16+). There was no correlation of p53 or p16 expression with the clinicopathologic features. The Kaplan–Meier survival analysis demonstrated that patients with p16+, p53+, late stages, and nodal or distal metastasis had poor survival status (P=0.006, 0.013, <0.001, <0.001 and 0.018, respectively). Further analysis demonstrated that p53 status was a significant prognostic factor in stage I NSCLCs (P<0.001), and p16 status in stage I and II NSCLCs (P<0.001, P=0.003, respectively). Furthermore, patients whose tumors were both p53 and p16 aberrant expression had worse outcome compared with those whose tumors were both normal expression of p53 and p16 (5-year survival rate: 5 vs. 76%, P<0.001). In Cox's regression model, the aberrant expression of p16, p53, advanced stages and combined aberrant expression of p53/p16 survived for a significant shorter period. Conclusions: The results indicated that aberrant expression of p16 and p53 are significant and independent, predictable prognostic factors for resected NSCLC, especially in early stage of NSCLCs. The worst prognosis was seen in patients whose tumors had both aberrant expression of p53 and p16. Further prospective trials may be aimed at confirming and validating these results.

Key Words: Non-small cell lung cancer • p16 • p53 • Immonohistochemical analysis • Prognosis

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