p53 YABANİ TİP ENDOMETRİYOİD ENDOMETRİYUM KARSİNOMUNDA p53 İMMÜNOHİSTOKİMYASAL EKSPRESYONUNUN NİCEL OLARAK DEĞERLENDİRİLMESİ, OLUMSUZ KLİNİKOPATOLOJİK ÖZELLİKLERLE İLİŞKİLİDİR

Öz

Amaç: Endometrioid endometrial karsinom (EEC) genel olarak olumlu bir prognoza sahiptir; ancak bazı vakalar, standart parametrelerle açıklanamayan agresif bir davranış sergilemektedir. p53 immünohistokimyası (IHC) öncelikle TP53 mutasyonlarının bir göstergesi olarak kullanılsa da, wild tip (wt) kategorisi içindeki kantitatif varyasyonlar prognostik değer taşıyabilir. Bu çalışmada, p53-pozitif tümör hücrelerinin oranının, p53-wt EEC'de prognostik parametrelerle korelasyon gösterip göstermediği araştırılmıştır. Yöntem: 2022-2024 yılları arasındaki 88 p53-wt EEC histerektomi örneği retrospektif olarak analiz edildi. p53 nükleer pozitiflik yüzdeleri iki patolog tarafından bağımsız olarak belirlendi. Tümör derecesi, tümör boyutu, miyometriyal invazyon, servikal tutulum, lenfovasküler invazyon (LVI) ve mikrosatellit instabilitesi (MSI) durumu dahil olmak üzere klinikopatolojik veriler analiz edildi. p53 ekspresyonu için optimal eşik değeri, ROC analizi yoluyla belirlendi. Bulgular: p53 pozitifliği %1 ile %90 arasında değişmekteydi. ROC analizi sonucunda %4’lük bir eşik değeri belirlendi ve vakalar düşük (≤%4, n=36) ve yüksek (>%4, n=52) ekspresyon gruplarına ayrıldı. Yüksek p53 ekspresyonu, LVI (p=0,0049), daha yüksek tümör derecesi (p<0,0001) ve yüksek MSI durumu (p=0,0064) ile anlamlı bir şekilde ilişkiliydi. Tümör boyutu, miyometriyal invazyon derinliği veya servikal tutulum ile anlamlı bir ilişki saptanmadı. Sonuç: p53-wt EEC’de, daha yüksek p53 ekspresyonu, olumsuz klinikopatolojik özelliklerle ilişkilidir. Kantitatif p53 IHC değerlendirmesi, biyolojik açıdan farklı alt grupları belirleyebilir ve rutin uygulamada tamamlayıcı prognostik bilgiler sağlayabilir.

Anahtar Kelimeler

• endometrioid karsinom
• tümör supresor gen p53
• endometrial neoplaziler
• biyobelirteçler

QUANTITATIVE ASSESSMENT OF P53 IMMUNOHISTOCHEMICAL EXPRESSION IS ASSOCIATED WITH ADVERSE CLINICOPATHOLOGIC FEATURES IN P53 WILD-TYPE ENDOMETRIOID ENDOMETRIAL CARCINOMA

Öz

Objective: Endometrioid endometrial carcinoma (EEC) generally has a favorable prognosis, yet some cases exhibit aggressive behavior unexplained by standard parameters. Although p53 immunohistochemistry (IHC) primarily serves as a surrogate for TP53 mutations, quantitative variation within the wild-type (wt) category may hold prognostic value. This study investigated whether the proportion of p53-positive tumor cells correlates with established prognostic parameters in p53-wt EEC. Methods: Eighty-eight p53-wt EEC hysterectomy specimens (2022–2024) were retrospectively analyzed. Two pathologists independently evaluated p53 nuclear positivity percentages. Clinicopathological data, including grade, tumor size, myometrial invasion, cervical involvement, lymphovascular invasion (LVI), and microsatellite instability (MSI) status, were analyzed. An optimal cutoff for p53 expression was determined via Receiver Operating Characteristic (ROC) analysis. Results: p53 positivity ranged from 1% to 90%. ROC analysis identified a 4% cutoff, stratifying cases into low (≤4%, n=36) and high (>4%, n=52) expression groups. High p53 expression was significantly associated with LVI (p=0.0049), higher tumor grade (p<0.0001), and MSI-high status (p=0.0064). No significant associations were found with tumor size, myometrial invasion depth, or cervical involvement. Conclusion: In p53-wt EEC, higher p53 expression correlates with adverse clinicopathological features. Quantitative p53 IHC assessment may identify biologically distinct subgroups and provide complementary prognostic information in routine practice.

Anahtar Kelimeler

• endometrioid carcinoma
• tumor suppressor protein p53
• endometrial neoplasms
• biomarkers

Kaynakça

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