Association of p21, p21 p27 and p21 p53 Status to Histological Subtypes and Prognosis in Low-stage Epithelial Ovarian Cancer

Aim: The objective of this study was to evaluate the prognostic value of p21 alone and in combination with p53 or p27 for different histological subtypes of epithelial ovarian cancer and disease-free survival. Patients and Methods: The specimens were obtained at primary surgery from a series of 129 ovarian carcinomas in FIGO stages I-II. The technique of tissue microarray and immunohistochemistry was used for detection of positivity of the markers. Results: Positive staining for p21, p27 and p53 was detected in 36%, 58% and 25% of cases, respectively. The p21 status, p27 status and concomitant p21 p27 and p21 p53 status in four subgroups were related to histological subtypes (p=0.016, p=0.036, p=0.004 and p=0.001). Mucinous tumors mostly stained negatively for p27 and concomitantly negatively for p21 and p53. Clear cell tumors generally stained positively for p21 and p27 but negatively for p53. Serous tumors usually stained concomitantly negatively for p21 and positively for p53. In a multivariate Cox regression analysis, FIGO stage, p21 p53 and p53 status were independent prognostic factors for disease-free survival. Conclusion: A subgroup, constituting 25/129 (19%) of the patients with predominantly serous tumors with concomitant p21 negativity and p53 positivity had a poor survival. Another subgroup of 11/129 (9%) patients with non-serous tumors with concomitant p21 and p27 positivity had excellent survival.