TY - JOUR T1 - Aberrant p53 protein expression is associated with an increased risk of neoplastic progression in patients with Barrett's oesophagus JF - Gut JO - Gut SP - 1676 LP - 1683 DO - 10.1136/gutjnl-2012-303594 VL - 62 IS - 12 AU - Florine Kastelein AU - Katharina Biermann AU - Ewout W Steyerberg AU - Joanne Verheij AU - Marit Kalisvaart AU - Leendert H J Looijenga AU - Hans A Stoop AU - Laurens Walter AU - Ernst J Kuipers AU - Manon C W Spaander AU - Marco J Bruno AU - on behalf of the ProBar-study group Y1 - 2013/12/01 UR - http://gut.bmj.com/content/62/12/1676.abstract N2 - Objective The value of surveillance for patients with Barrett's oesophagus (BO) is under discussion given the overall low incidence of neoplastic progression and lack of discriminative tests for risk stratification. Histological diagnosis of low-grade dysplasia (LGD) is the only accepted predictor for progression to date, but has a low predictive value. The aim of this study was therefore to evaluate the value of p53 immunohistochemistry for predicting neoplastic progression in patients with BO. Design We conducted a case–control study within a prospective cohort of 720 patients with BO. Patients who developed high-grade dysplasia (HGD) or oesophageal adenocarcinoma (OAC) were classified as cases and patients without neoplastic progression were classified as controls. P53 protein expression was determined by immunohistochemistry in more than 12 000 biopsies from 635 patients and was scored independently by two expert pathologists who were blinded to long-term outcome. Results During follow-up, 49 (8%) patients developed HGD or OAC. P53 overexpression was associated with an increased risk of neoplastic progression in patients with BO after adjusting for age, gender, Barrett length and oesophagitis (adjusted relative risks (RRa) 5.6; 95% CI 3.1 to 10.3), but the risk was even higher with loss of p53 expression (RRa 14.0; 95% CI 5.3 to 37.2). The positive predictive value for neoplastic progression increased from 15% with histological diagnosis of LGD to 33% with LGD and concurrent aberrant p53 expression. Conclusions Aberrant p53 protein expression is associated with an increased risk of neoplastic progression in patients with BO and appears to be a more powerful predictor of neoplastic progression than histological diagnosis of LGD. ER -