Prognostic Value and Computer Image Analysis of P53 in Mantle Cell Lymphoma

Background: P53 has different prognostic cutoff 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 cutoff value of p53 for predicting prognosis and the possible use of computer image analysis to identify the positive rate of p53 in patients with MCL. Methods: We used QuPath software to determine the p53 positive rate and compared it to the data obtained by manual counting and semiquantitative estimation. Using the Youden index and Kaplan–Meier survival curve analysis, we generated survival curves. The chi-squared (χ 2 ) test was used to compare MCL cell morphology with p53. Spearman rank correlation test and Bland–Altman analysis were used to compare manual counting, computer image analysis and semiquantitative estimation. Results: The optimal cutoff value of p53 for predicting prognosis was 20% in MCL patients. Patients with p53 ≥ 20% had a significantly worse overall survival (OS) than those with p53 < 20% (P < 0.0001). MCL patients with blastoid/pleomorphic variant cell morphology had more p53 ≥ 20% than the classical type (P < 0.0001). There was a strong correlation between computer image analysis and manual counting of p53 from the same areas in MCL tissues (Spearman's rho = 0.966, P < 0.0001). Conclusions: MCL patients with p53 ≥ 20% have a shorter OS and a tendency toward the blastoid/pleomorphic variant. Computer image analysis could determine the actual positive rate of p53 and is a more attractive alternative than semiquantitative estimation in MCL.