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食道癌におけるp２１およびp２７の免疫組織学的検討：ニタマルセロエイジ、名川弘一、富永治、津野ネルソン、松田圭二、藤井真、竹上智浩、武藤徹一郎（東大・医・外）

Low p21Waf1/Cip1 expression may be a novel prognostic factor in radically resected esophageal squamous cell carcinoma. Marcelo E.Nita, Hirokazu Nagawa, Osamu Tominaga, Nelson Tsuno, Keiji Matsuda, Shin Fujii, Tomohiro Takenoue Tetsuichiro Muto. (Dept.Surg. Oncology, University of Tokyo)

AIM: p21Waf1/Cip1 (p21) and p27Kip1 (p27) were reported to influence the outcome of gastric and colon cancer. We tested the hypothesis that immmunohistochemical expression of p21 and p27 can be used to predict overall survival of patients with esophageal squamous cell carcinoma (ESC). MATERIAL: 65 patients curatively(R0)-resected ESC tumors specimens obtained between 1985 and 1991 were stained with specific antibodies for p21, p27, p53 and Rb. The proteins expressions were statistically compared with postoperative overall survival. RESULTS: The median (range) expressions of p21, p27, p53 and Rb were 17%(0-76), 12%(0-78), 31.5%(0-92) and 49.5%(0-95) respectively. These median values were used as cutpoints to define low and high expressions groups of each protein. p27, p53 and Rb did not show any correlation with overall survival. However, the mean survival time was 31 months for patients with p21 levels less than 17% (low expression) and 52 months for those with p21 levels greater than 17% (high expression) (p=0.0072). Patients were categorized into 4 groups based upon the p21 expression level (low and high expression groups) and lymph nodes status (pN category) and the survival curves of these combinations were significantly different (p=0.0171). Moreover, a more statistically signigicant difference was observed when compared the pN negative and high-p21 group with pN positive and low-p21 patients (p=0.0003), considering that lymph nodes (pN) positive versus negative was p=0.0135. CONCLUSION: These results suggest that immunohistochemically determined low expression of p21 is associated with poorer prognosis.