Prognostic Value and Computer Image Analysis of p53 in Mantle Cell Lymphoma
Abstract Background: P53 has different prognostic cut-off values in different mantle cell lymphoma (MCL) studies, and p53 immunohistochemistry (IHC) interpretation is still based on semiquantitative estimation，which might be inaccurate. This study aimed to investigate the optimal cut-off value of p53 for predicting prognosis and the possibility of computer image analysis identifying the positive rate of p53 in patients with mantle cell lymphoma (MCL). Methods: We used QuPath software to determining the p53 positive rate and compared it to the data obtained by manual counting and semiquantitative estimation. Using Youden index and Kaplan-Meier survival curve analysis, we generated survival curves. Chi-squared (χ2) test was used to compared MCL cell morphology with p53. Spearman rank correlation test and Bland-Altman analysis were used to compared manual counting, computer image analysis and semiquantitative estimation.Results: The optimal cut-off value of p53 for predicting prognosis was 20% in MCL patients. Patients with p53 ≥ 20% had a significantly worse overall survival (OS) compared to p53 < 20% (P < 0.0001). MCL patients with blastoid/pleomorphic variant cell morphology had more p53 ≥ 20% than classical type (P < 0.0001). And a strong correlation between computer image analysis and manual counting p53 in the same areas in MCL patients (spearman's rho = 0.966, P < 0.0001). Conclusions: MCL patients with p53 ≥ 20% have a shorter OS, and a blastoid/pleomorphic variant tendency. Computer image analysis could reflect the actual positive rate of p53 and is a more attractive alternative than semiquantitative estimation in MCL.
