40.
The p53 gene located at chromosome 17pl3 is found to be altered (allelic loss or other mutation) in multiple human cancers,
including osteosarcomas. The mutated gene produces a protein with a prolonged half-life thus rendering it detectable by conventional
immunohistochemistry. We examined the correlation between p53 expression and clinical prognosis as well as response to therapy.
Twentyone patients with previously untreated and histologically verified highly malignant osteosarcoma were used for this
study. Biopsy material taken both prior to the start of COSS 91 protocol and at the time of surgery (ten weeks later) was
examined for alterations in p53 protein expression and drug resistance. Two patients who had strong (+++) p53 protein expression
and three others who became positive during the chemotherapy had significantly worse prognosis (all of them died within one
year) than those who showed no p53 expression both at biopsy and after chemotherapy (all 11 patients are alive, average follow-up
time: 3.5 years). All patients who showed any kind of positive p53 protein expression on initial biopsy were non-respon-ders
to chemotherapy. In contrast, 69% (9 out of 13) of those who exhibited no p53 expression on initial biopsy were responders
or intermediate responders to chemotherapy. We concluded that p53 expression may be a useful prognostic factor in osteosarcomas.
The direct correlation between p53 positive expression and resistance to therapy can help in identifying patients who are
in need of a more vigorous or different chemotherapeutical protocol.
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