The prognostic value of p53 immunostaining in node-negative breast carcinoma.

BACKGROUND: P53 plays a key role in cell cycle arrest, apoptosis, DNA repair, and angiogenesis. Although some studies have reported as prognostic factor for poor survival in node-positive breast cancer, controversy about possible prognostic index for node-negative still exists. OBJECTIVES: To look for correlations between the expression of the p53 protein and clinicopathological parameters, and to assess its prognostic value in node-negative invasive ductal breast carcinoma. MATERIAL AND METHOD: Immunohistochemistry using formalin-fixed, paraffin-embedded sections from 71 node-negative breast carcinomas in Songklanagarind Hospital. Data were analyzed with respect to tumor size, estrogen receptor, and survival. RESULTS: P53 mutations were found in 12 patients (17%). Expression of p53 was not associated with tumor size, estrogen receptor, and overall survival. Mean follow-up time was 164.4 months (median 163 months). CONCLUSION: P53 expression was not a significant prognostic factor for survival in node-negative breast carcinoma.

Endoscopic stenting versus surgical bypass in advanced malignant distal bile duct obstruction: cost-effectiveness analysis.

OBJECTIVE: Palliative treatment of obstructive jaundice from advanced tumour of the distal bile duct is controversial. The aim of this study was to compare the clinical outcomes and costs between endoscopic stent insertion and surgery. METHODS: The clinical data for 116 patients treated with either endoscopic plastic stenting (65 patients) or surgical bypass (51 patients) were reviewed and analysed. RESULTS: No significant difference was found between the two groups in terms of the length of hospital stay, survival time, cost, effectiveness, and early complications. However, late complications were significantly more common in the stenting group (p = 0.007). Jaundice recurred in 15 stented patients at a median time of 3 months due to stent blockage, and one surgical patient had recurrent jaundice from anastomosis stricture. Late gastric outlet obstruction occurred in one of 36 surgical patients who did not undergo prophylactic gastroenterostomy and one of 65 stented patients developed this complication. CONCLUSION: Both techniques are equally effective in biliary drainage, but stenting has a higher rate of recurrent jaundice. We recommend surgery for patients with low surgical risks and endoscopic stent in those with a short life expectancy or those unfit for surgery.