Aberrant p53 Immunostaining in Barrett’s Esophagus Predicts Neoplastic Progression: Systematic Review and Meta-Analyses

• Published in: Digestive diseases and sciences 2019-05, Vol.64 (5), p.1089-1097
• Main Authors: Snyder, Patrick, Dunbar, Kerry, Cipher, Daisha J., Souza, Rhonda F., Spechler, Stuart Jon, Konda, Vani J. A.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - metabolism; Analysis; Antimitotic agents; Antineoplastic agents; Barrett Esophagus - diagnosis; Barrett Esophagus - metabolism; Biochemistry; Biomarkers, Tumor - analysis; Biomarkers, Tumor - biosynthesis; Biomarkers, Tumor - immunology; Case-Control Studies; Development and progression; Disease Progression; Dysplasia; Esophageal cancer; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - metabolism; Esophagus; Gastroenterology; Health risk assessment; Hepatology; Histopathology; Humans; Immunohistochemistry; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Meta-analysis; Oncology; Predictive Value of Tests; Prognosis; Prospective Studies; Retrospective Studies; Review; Sampling error; Staining and Labeling - methods; Systematic review; Transplant Surgery; Tumor proteins; Tumor Suppressor Protein p53 - analysis; Tumor Suppressor Protein p53 - biosynthesis; Tumor Suppressor Protein p53 - immunology
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05586-7

Risk stratification of patients with Barrett’s esophagus (BE) presently relies on the histopathologic grade of dysplasia found in esophageal biopsies, which is limited by sampling error and inter-pathologist variability. p53 immunostaining of BE biopsies has shown promise as an adjunct tool but is not recommended by American gastroenterology societies, who cite insufficient evidence of its prognostic value. We have conducted a systematic review and meta-analyses to clarify this value. We searched for studies that: (1) used immunohistochemistry to assess p53 expression in esophageal biopsies of BE patients and (2) reported subsequent neoplastic progression. We performed separate meta-analyses of case-control studies and cohort studies. We identified 14 relevant reports describing 8 case-control studies comprising 1435 patients and 7 cohort studies comprising 582 patients. In the case-control study meta-analysis of the risk of neoplasia with aberrant p53 expression, the fixed- and random-effect estimates of average effect size with aberrant p53 expression were OR 3.84, p