The relationship between molecular abnormalities and neoplasm has been extensively reviewed and there is strong evidence that abnormalities of p53 gene represent the most common molecular change in human cancer. Such abnormalities can be detected in a number of ways. Several prior studies have revealed p53 protein expression via immunohistochemistry (IHC) in 42Ð69% of colorectal cancers (Scott et al, 1991;Auvinen et al, 1994). However, the prognostic value of this protein remains to be defined, probably due to variability of detection and retrieval systems (Wynford-Thomas, 1994). To be clinically useful, prognostic markers should be accessible to analysis with simple and reproducible procedures appropriate for routine use. We have adapted the recently developed luminometric immunoassay (LIA) (Borg et al, 1995), to quantitate p53 protein in archival colorectal cytosols.The purpose of the present study was: (1) to evaluate the relationship between p53 overexpression and clinicopathological data and (2) to assess the value of p53 as a biological marker of prognosis within each TNM class in a series of patients resected for colorectal cancer with a long follow-up.
PATIENTS AND METHODS
PatientsA series of 111 patients underwent surgical resection for primary colorectal adenocarcinoma at the II Department of Surgery, University Hospital ÔSan CarlosÕ, Madrid, between 1990 and 1992. Each patient is regularly followed up at 6-monthly intervals for a minimum of 5 years. Cases in which resections have been performed for metachronous carcinoma, carcinoma arising in familial adenomatous polyposis and ulcerative colitis are excluded. None of the patients had received preoperative radiotherapy or chemotherapy. Since 1992, stage III patients younger than 70 received adjuvant chemotherapy with 5-fluorouracil (5-FU) and leucovorin according to the prevailing protocol (four patients). Clinical staging was done on the basis of the TNM classification. Survival time was calculated from the date of surgery to the date of death or last follow-up, with times censored for patients dying of causes unrelated to colorectal cancer and those surviving. Median follow-up was 5 years.
Tissue specimensSections from the colorectal adenocarcinoma and normal mucosa at the proximal/distal resection margins were obtained at surgical resection. These specimens were stored in liquid nitrogen and, prior to being pulverized in the frozen state and homogenized for the preparation of cytosols for protein measurement, cryostat sections were evaluated; all tumour samples used contained more than 80% tumour cells.
Luminometric assayThe LIA is based on a combination of two monoclonal antibodies, Ab 1801 and DO 1, which detect both wild-type and mutant p53 protein in a sandwich-type assay. The Ab1801, which is immobilized onto a solid phase, is used for catching. Ab DO 1, labelled with a chemiluminescent compound (ABEI), is used for detection. The immunoassay was performed by incubating either 100 µl of p53 standard, controls or tumour cytosols, together with 10...