Background and aims: The adjunctive use of p53 immunohistochemistry (IHC) has been proposed as a potential tool to improve risk stratification in Barrett’s esophagus (BE) with conflicting results. We performed a systematic review and meta-analysis to evaluate the performance of p53 in predicting progression to advanced neoplasia high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) among patients with BE. Methods: We searched multiple databases for studies that evaluated the use of aberrant p53 in esophageal biopsies among BE patients and reported progression rates to HGD/EAC. The outcomes were p53 test characteristics and incidence and risk ratio (RR) for progression to HGD/EAC in patients with and without aberrant p53 using random effects models. Results: Among the 27 included studies, the proportion of patients with aberrant p53 expression at baseline was 20% (95% CI: 14%, 27%). The rate of progression with and without aberrant p53 was 8 per 100 person-years (95% CI: 6, 11) and 0.3 per 100 person-years (95% CI: 0.1, 0.6), respectively. Compared to patients without aberrant p53 expression, those with aberrant p53 had a higher risk for progression to HGD/EAC in cohort studies RR = 10.2 (95% CI: 6.9, 15.0) and case control studies RR = 3.3 (95% CI: 2.5, 4.4). The sensitivity for progression for NDBE and low-grade dysplasia/indefinite for dysplasia was 42% and 77% and specificity was 96% and 76%, respectively. Conclusion: While aberrant p53 expression has been associated with an increased risk of progression to advanced neoplasia in BE patients undergoing surveillance, the diagnostic characteristics are suboptimal precluding uniform clinical adoption. Prospective studies with standardized grading protocols are needed to determine whether p53-guided surveillance strategies can meaningfully improve patient outcomes.
Sawas et al. (Wed,) studied this question.