Evaluation of the usefulness of testing for p53 mutations in colorectal cancer surveillance for ulcerative colitis

Am J Gastroenterol. 1999 Feb;94(2):456-62. doi: 10.1111/j.1572-0241.1999.877_f.x.


Objective: Immunohistochemical staining for p53 suppressor gene mutations is sensitive and, therefore, has potential for use as a complementary test for dysplasia to improve ulcerative colitis (UC) cancer surveillance program performance.

Methods: A cohort of 95 patients with long standing pan-UC enrolled in a surveillance program was studied. Archival colonic biopsy specimens were stained for p53 mutations and clinical information was obtained from medical records.

Results: The 37 patients who developed p53 mutations were significantly more likely to develop dysplasia or cancer (relative risk [RR] 4.53, 95% confidence interval [CI] 2.16-9.48). The p53 mutations developed approximately 8 months before low grade dysplasia, 26 months before high grade dysplasia, and 38 months before cancer. Three of seven cancer patients with p53 mutations had Dukes' stage C or D, whereas only one of five cancer patients without p53 mutations had Dukes' C or D; all three patients who died from metastatic cancer had p53 mutations (three of 37 vs 0 of 58, p < 0.03). Folic acid supplementation had a small, significant protective effect for p53 mutations (RR 0.97, CI 0.94-1.00).

Conclusion: p53 Mutations 1) are associated with, and likely precede, dysplasia and cancer, 2) are associated with cancer-related mortality, and 3) may possibly be prevented by folic acid supplementation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Cohort Studies
  • Colitis, Ulcerative / complications*
  • Colon / pathology
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / genetics
  • Evaluation Studies as Topic
  • Female
  • Genes, p53 / genetics*
  • Humans
  • Immunohistochemistry
  • Male
  • Mutation
  • Prognosis
  • Risk Factors
  • Time Factors