Prevalence of p21 immunohistochemical expression in esophageal adenocarcinoma

Abstract

-Background -In western societies, the prevalence of adenocarcinoma of the gastroesophageal junction has increased in recent years. It is commonly accepted today that esophageal adenocarcinoma develops from a premalignant lesion: Barrett's esophagus. This type of carcinoma is hardly diagnosed at early stages, which results in signifi cant mortality. Molecular biology studies have shown that most malignant tumors originate from the interaction between inherited characteristics and external factors, which may cause genetic changes that interfere with the control over the differentiation and growth of cells in susceptible individuals. p21 (WAF1/CIP1) has a key role in the regulation of the cell cycle, and its immunohistochemical expression has been investigated in several tumors, showing that it infl uences the prognosis of various neoplasms. Aim -To check the prevalence of p21 protein expression in patients with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of "Hospital de Clínicas de Porto Alegre", RS, Brazil. Methods -The study population consisted of 42 patients with esophageal adenocarcinoma diagnosed by the Group for Surgeries of the Esophagus and Stomach between January 1998 and December 2002. The expression of p21 protein was determined by immunohistochemistry using primary antibody, p21, clone SX118, code M7202 (Dako), and assessed according to the immunoreactive scoring system. Results -Of 42 analyzed patients, 83.3% were male and older than 40 years. Among these, 56.2% were submitted to curative resection: total gastrectomy and transhiatal esophagogastrectomy. The remaining patients were submitted to palliative surgery or did not undergo any surgical treatment. Only fi ve patients received adjuvant chemotherapy and radiation therapy, either alone or combined. Advanced disease (stages III and IV) was detected in 78.6% of the patients. Only nine patients were positive for p21, according to the immunoreactive scoring system. Conclusion -p21 was expressed in 9 of 42 patients (21.4%) with esophageal adenocarcinoma diagnosed in the last 5 years by the Group for Surgeries of the Esophagus and Stomach of Hospital de Clínicas de Porto Alegre. In our patient population, the accumulation of p21 did not play a key role in the carcinogenesis of esophageal adenocarcinoma. HEADINGS -Esophageal neoplasms. Adenocarcinoma. Cyclin-dependent kinase inhibitor p21.

p21 Gene Expression Evaluation in Esophageal Cancer Patients

“…According to the evaluation systems of active immunity, only 9 patients were positive for p21 . Ultimately, the researchers found that accumulation of p21 did not play a key role in glandular epithelial esophageal cancers in the patient population [22] . This result is consistent with the results obtained in the current study.…”

“…It is generally accepted that multistage genetic and epigenetic changes cause normal cells to mutate into malignant cells. This causes the cells to act independently of the proliferative regulation and cell death cycle and also stimulates the proliferative, infiltrative, and metastatic capacity of cells [22] .…”

“…Villwock et al [22] considered the prevalence of p21 immunohistochemistry in the epithelial tumor of the esophagus. Their results indicated that among 42 patients, 83.3% were male and older than 40 years.…”