p53 alteration independently predicts poor outcomes in patients with endometrial cancer: A clinicopathologic study of 131 cases and literature review

Objective: The aim of this study was to evaluate the prognostic impact of p53 alteration in human uterine endometrial adenocarcinoma. Methods: One hundred and thirty-one patients with primary endometrial adenocarcinoma were included in the study. The p53 mutation and/or protein expression were evaluated by polymerase chain reaction-single-strand conformational polymorphism and by immunohistochemical analysis, respectively. Clinical and pathological parameters were obtained from medical records. Survival data were estimated using Kaplan-Meier estimates and compared with the log-rank test where indicated. Multivariate analysis was performed using the Cox regression method. Results: Thirty nine cases (29.8%) containing p53 alterations had a lower disease specific-survival rate and disease-free survival rate than those without p53 alterations. Statistically significant correlations were seen between p53 alteration and non-endometrioid histology type, high grade tumors, and the absence of progesterone receptor. Multivariate analyses showed that both p53 alteration and FIGO stage at diagnosis were adverse prognostic factors. The group of women with p53 alteration had an 11.0-fold increased risk of disease specific death (95% confidence interval: 1.008-120.765) compared to women whose tumors lacked p53 alteration. Conclusion: p53 alteration defines a subset of endometrial adenocarcinoma with highly aggressive behavior and predicts lower survival in patients with endometrial adenocarcinoma.