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Prognostic Impact of Concomitant p53 and PTEN on Outcome in Early Stage (FIGO I-II) Epithelial Ovarian Cancer
  1. Ingirídur Skírnisdóttir, MD, PhD* and
  2. Tomas Seidal, MD, PhD
  1. *Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, Uppsala; and
  2. Department of Pathology, Halmstad Medical Center Hospital, Halmstad, Sweden.
  1. Address correspondence and reprint requests to Ingirídur Skírnisdóttir, MD, PhD, Department of Gynecology and Obstetrics, University Hospital, Akademiska sjukhuset, SE-751 85 Uppsala, Sweden. E-mail: ingiridur.skirnisdottir{at}


Introduction: The objective of the study was to evaluate the prognostic effect of p53, PTEN, and concomitant p53 PTEN status on clinicopathologic features, recurrent disease, and disease-free survival (DFS) of 131 patients in FIGO stages I to II with epithelial ovarian cancer.

Methods: The technique of tissue microarray and immunohistochemistry was used for the detection of positivity of the biologic markers p53 and PTEN.

Results: In the complete series, the 5-year DFS rate was 68%, and the overall survival rate was 71%. Positive staining for p53 and PTEN was detected in 25% and 22% of cases, respectively. Positivity of p53 was associated with tumor grade in the total series but not in the subgroup of serous tumors. In survival analysis, there was worse survival (P = 0.003) in the group of patients with p53-positive tumors compared with the group of patients with p53-negative tumors with DFS of 62% and 82%, respectively. Furthermore, DFS was 15% for the subgroup of patients with concomitant p53-positivity and PTEN-negativity of tumors compared with DFS of 62% for others in 1 group (p53+PTEN+, p53−PTEN+, p53−PTEN−) at 100 months. The difference was highly significant (P = 0.006). FIGO stage (odds ratio = 8.0) and p53 PTEN status (odds ratio = 0.6) were predictive factors for tumor recurrences in a logistic regression and prognostic factors with hazard ratios (HRs) of 4.0 and 0.6, respectively, in a multivariate Cox regression analysis. In a separate Cox regression analysis, FIGO stage (HR = 3.6) and p53 status (HR = 2.0) were prognostic factors for DFS. For serous tumors (n = 51) recurrent disease was associated with FIGO stage (P = 0.013), and p53 loss (P = 0.029) but not with FIGO grade (P = 0.169).

Conclusions: p53 status divides ovarian carcinomas into 2 subgroups after prognosis, also in serous tumors. Presence of PTEN in p53-positive tumors seems to protect from bad prognosis and absence of PTEN seems to worsen prognosis in early stages.

  • Ovarian cancer
  • Early stages
  • Prognosis
  • Serous tumors
  • p53
  • PTEN
  • p53 PTEN

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