Title: P53 marker expression in epithelial ovarian tumours in a centre in Nigeria – A descriptive
study
Version: 1 Date: 11 Oct 2024
Reviewer:  Yuquan Chen
Reviewer's report:
The article titled "P53 Marker Expression in Epithelial Ovarian Tumours in a Centre in Nigeria"
offers important insights into the pattern of p53 expression in epithelial ovarian tumors (EOTs),
specifically focusing on African women—a population that is often underrepresented in such
studies. Despite its potential contribution to the global understanding of ovarian cancer, the study
requires significant improvements to strengthen its scientific validity and impact.
Firstly, the authors do not provide a sufficient justification for the sample size of 51 cases,
considering the retrospective design and the varied histological subtypes of EOTs. It is necessary
to discuss whether this sample size is statistically adequate and, if not, to provide a power
analysis to support their findings. Furthermore, there are inconsistencies in the histological
classification of tumors, particularly with the reclassification of an adenosquamous carcinoma
case as an endometrioid carcinoma. The criteria for this reclassification are not clearly explained,
leaving ambiguity about the accuracy of the diagnoses made, especially in the context of limited
molecular testing capabilities in the study setting.
Additionally, the immunohistochemical analysis section does not mention the use of proper
positive and negative controls for each staining session, which raises concerns about the
reliability of the p53 expression results. Immunohistochemistry is a method that requires
consistent controls to validate the findings, and without these, the interpretation of the results
remains questionable. Furthermore, the authors’ approach to identifying "wild-type" and
"mutant" p53 expression based solely on staining patterns is problematic. A more detailed
explanation or genetic validation, such as sequencing, is necessary to distinguish these variants
accurately, as p53 mutations may not always correlate directly with immunohistochemical
results.
The statistical analysis presented is also ambiguous. While the authors briefly mention using a
chi-square test, they do not provide details on assumptions, effect sizes, or confidence intervals.
Including such information would clarify whether the statistical approach was appropriate for
the study's aims and whether other methods could have been applied to reinforce the association
between p53 expression and histological subtypes. Moreover, the discussion section does not
adequately contextualize the findings with existing literature. Although several studies are cited,
the comparison with international and regional data lacks depth. A more critical analysis of these
comparisons would enhance the understanding of p53 expression patterns and their implications
for patient outcomes in Nigeria versus other regions.
Another significant limitation is the absence of tumor staging information, which limits the
ability to correlate p53 expression with clinical outcomes. Incorporating tumor staging data
would allow for a more comprehensive analysis of how p53 expression patterns relate to disease
progression and prognosis. Finally, the limitations section is not adequately detailed. While the
authors mention the small sample size and cross-sectional nature, they do not discuss other
crucial limitations, such as the lack of molecular techniques beyond immunohistochemistry,
biases inherent in a retrospective design, and variability in tissue processing. Addressing these
issues comprehensively would provide clarity and guide future research efforts.