Adjunctive Use of p53 Immunohistochemistry for Risk Stratification in Barrett's Esophagus: A Systematic Review and Meta-Analysis.
Tarek Sawas, Perica Davitkov, Margaret Zhou et al.
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In 30 seconds
This systematic review and meta-analysis assessed whether aberrant p53 immunohistochemistry in esophageal biopsies predicts progression to high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett’s esophagus. Across 27 studies, progression rates were 8 per 100 person-years with aberrant p53 and 0.3 per 100 person-years without it. Cohort studies found a higher progression risk with aberrant p53 (RR = 10.2 [95% CI: 6.9, 15.0]). Despite this association, test characteristics varied by baseline histology, and the authors judged them insufficient to support uniform clinical adoption.
Key findings
- Aberrant p53 was present at baseline in 20% (95% CI: 14%, 27%) of patients.
- Progression rates were 8 per 100 person-years with aberrant p53 versus 0.3 per 100 person-years without it.
- In cohort studies, aberrant p53 was associated with higher progression risk (RR = 10.2 [95% CI: 6.9, 15.0]).
- Sensitivity and specificity were 42% and 96% for non-dysplastic Barrett’s esophagus, and 77% and 76% for low-grade dysplasia/indefinite for dysplasia.
Why it matters
Aberrant p53 expression identifies a group with substantially higher observed progression rates, suggesting potential value for risk stratification during Barrett’s surveillance. However, its diagnostic performance differs by baseline histology and is not sufficient for consistent clinical adoption. Establishing standardized interpretation and whether p53-guided surveillance improves patient outcomes remains important.
What to keep in mind
The meta-analysis combined studies with differing designs and diagnostic performance by baseline histology; the authors note that standardized grading protocols and prospective studies are needed.