Evidence map›Paper›PMID 36948887›Full record

ArticleThe journal of pathology. Clinical research2023

p53 and ovarian carcinoma survival: an Ovarian Tumor Tissue Analysis consortium study.

Martin Köbel, Eun-Young Kang, Ashley Weir, Peter F Rambau, Cheng-Han Lee, Gregg S Nelson, Prafull Ghatage, Nicola S Meagher, Marjorie J Riggan, Jennifer Alsop and 100 more

Open access · goldAbstract read
In one paragraph

Article in The journal of pathology. Clinical research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
6.3field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 23 citations in OpenAlex.

  1. Article
  2. p53 Normal and p53 Abnormal Clear Cell Ovarian Carcinomas: Clinical Characteristics and Biomarker Profiles.International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2026
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  9. BeyondmedRxiv : the preprint server for health sciences · 2025
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  11. The -124C>T Mutation of theCurrent oncology (Toronto, Ont.) · 2025
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  12. JCO precision oncology · 2025
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  15. Concurrent RB1 Loss and BRCA Deficiency Predicts Enhanced Immunologic Response and Long-term Survival in Tubo-ovarian High-grade Serous Carcinoma.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024
    Article
  16. Article
  17. Gene polymorphisms ofJournal of Cancer · 2024
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  18. Concurrent RB1 loss andmedRxiv : the preprint server for health sciences · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

110 authors at 20 institutions in 12 countries.

Martin KöbelDepartment of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, Calgary, AB, Canada.ORCID 0000-0002-6615-2037
Eun-Young KangDepartment of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, Calgary, AB, Canada.
Ashley WeirSchool of Clinical Medicine, UNSW Medicine and Health, University of NSW Sydney, Sydney, New South Wales, Australia.ORCID 0000-0002-3072-2616
Peter F RambauDepartment of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, Calgary, AB, Canada.
Cheng-Han LeeDepartment of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada.
Gregg S NelsonDepartment of Oncology, Division of Gynecologic Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Prafull GhatageDepartment of Oncology, Division of Gynecologic Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Nicola S MeagherSchool of Clinical Medicine, UNSW Medicine and Health, University of NSW Sydney, Sydney, New South Wales, Australia.
Marjorie J RigganDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA.
Jennifer AlsopCentre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
Michael S AnglesioDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0003-1639-5003
Matthias W BeckmannDepartment of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.
Christiani BisinottoDepartment of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Michelle BoisenDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jessica BorosCentre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Alison H BrandDepartment of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
Angela Brooks-WilsonCanada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.
Michael E CarneyDepartment of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Penny CoulsonDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Madeleine Courtney-BrooksDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Kara L Cushing-HaugenProgram in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Cezary CybulskiDepartment of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
Suha DeenDepartment of Histopathology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Mona A El-BahrawyDepartment of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Hospital, London, UK.
Esther ElishaevDepartment of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ramona ErberInstitute of Pathology, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.ORCID 0000-0003-0315-1229
Sian FeredayPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
AOCS GroupCentre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Anna FischerInstitute of Pathology and Neuropathology, Tuebingen University Hospital, Tuebingen, Germany.
Simon A GaytherCenter for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics Core, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Arantzazu Barquin-GarciaHM Sanchinarro Centro Integral Oncológico Clara Campal, University Hospital, Madrid, Spain.
Aleksandra Gentry-MaharajMRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK.
C Blake GilksDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0001-7889-8250
Helena GronwaldDepartment of Propaedeutics, Physical Diagnostics and Dental Physiotherapy, Pomeranian Medical University, Szczecin, Poland.
Marcel GrubeDepartment of Women's Health, Tuebingen University Hospital, Tuebingen, Germany.
Paul R HarnettDiscipline of Obstetrics and Gynaecology, The University of Sydney, Sydney, New South Wales, Australia.
Holly R HarrisProgram in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Andreas D HartkopfDepartment of Women's Health, Tuebingen University Hospital, Tuebingen, Germany.
Arndt HartmannInstitute of Pathology, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.
Alexander HeinDepartment of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.
Joy HendleyPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Brenda Y HernandezCancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
Yajue HuangDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Anna JakubowskaDepartment of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
Mercedes Jimenez-LinanDepartment of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
Michael E JonesDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Catherine J KennedyCentre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Tomasz KluzDepartment of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland.
Jennifer M KoziakAlberta Health Services-Cancer Care, Calgary, AB, Canada.
Jaime LesnockDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jenny LesterDavid Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA.
Jan LubińskiDepartment of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
Teri A LongacreDepartment of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
Maria LyckeDepartment of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
Constantina MateoiuDepartment of Pathology, University of Gothenburg, Gothenburg, Sweden.
Bryan M McCauleyDepartment of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.
Valerie McGuireDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
Britta NeyInstitute of Pathology and Neuropathology, Tuebingen University Hospital, Tuebingen, Germany.
Alexander OlawaiyeDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Sandra OrsulicDavid Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA.
Ana OsorioGenetics Service, Fundación Jiménez Díaz, Madrid, Spain.
Luis Paz-AresH12O-CNIO Lung Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
Teresa Ramón Y CajalMedical Oncology Service, Hospital Sant Pau, Barcelona, Spain.
Joseph H RothsteinDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Matthias RuebnerDepartment of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.
Minouk J SchoemakerDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Mitul ShahCentre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
Raghwa SharmaTissue Pathology and Diagnostic Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
Mark E ShermanDepartment of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA.
Yurii B ShvetsovCancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.ORCID 0000-0001-5131-9618
Naveena SinghDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Helen SteedDivision of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
Sarah J StorrNottingham Breast Cancer Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, UK.
Aline TalhoukDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
Nadia TraficantePeter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Chen WangDepartment of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, USA.
Alice S WhittemoreDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
Martin WidschwendterEUTOPS Institute, University of Innsbruck, Innsbruck, Austria.
Lynne R WilkensCancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
Stacey J WinhamDepartment of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, USA.
Javier BenitezCentre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
Andrew BerchuckDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, USA.
David D BowtellPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Francisco J Candido Dos ReisDepartment of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Ian CampbellPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia.ORCID 0000-0002-7773-4155
Linda S CookEpidemiology, School of Public Health, University of Colorado, Aurora, CO, USA.
Anna DeFazioThe Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.
Jennifer A DohertyHuntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
Peter A FaschingDepartment of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany.
Renée T FortnerDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
María J GarcíaComputational Oncology Group, Structural Biology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
Marc T GoodmanCancer Prevention and Control Program, Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ellen L GoodeDepartment of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.
Jacek GronwaldDepartment of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
David G HuntsmanDepartment of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0003-4934-3322
Beth Y KarlanDavid Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, CA, USA.
Linda E KelemenDivision of Acute Disease Epidemiology, South Carolina Department of Health & Environmental Control, Columbia, SC, USA.
Stefan KommossDepartment of Women's Health, Tuebingen University Hospital, Tuebingen, Germany.
Nhu D LeCancer Control Research, BC Cancer Agency, Vancouver, BC, Canada.
Stewart G MartinNottingham Breast Cancer Research Centre, Biodiscovery Institute, University of Nottingham, Nottingham, UK.
Usha MenonMRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK.
Francesmary ModugnoDivision of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Paul Dp PharoahCentre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
Joellen M SchildkrautDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Weiva SiehDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Annette StaeblerInstitute of Pathology and Neuropathology, Tuebingen University Hospital, Tuebingen, Germany.
Karin SundfeldtDepartment of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Center for Cancer Research, University of Gothenburg, Gothenburg, Sweden.
Anthony J SwerdlowDivision of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
Susan J RamusSchool of Clinical Medicine, UNSW Medicine and Health, University of NSW Sydney, Sydney, New South Wales, Australia.
James D BrentonCancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.
The University of Sydney · AUUniversity of British Columbia · CAUniversity of Hawaiʻi at Mānoa · USCedars-Sinai Medical Center · USInstitute of Cancer Research · GBThe University of Melbourne · AUUniversitätsklinikum Erlangen · DEUniversity of Calgary · CAUniversity of Pittsburgh · USAlberta Health Services · CAMayo Clinic in Florida · USUniversity of California, Los Angeles · USUniversity of Cambridge · GBInstituto de Salud Carlos III · ESUniversity of Tübingen · DEBC Cancer Agency · CAGerman Cancer Research Center · DEHospital de Sant Pau · ESInternational Hereditary Cancer Center · PLSahlgrenska University Hospital · SE

Funding

VECTOR CORE FACILITYP30CA047904 · NCI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI CHRISTOPHER J. BAKKENIST · 1988 to 2026
$158.0M
Women's Cancer ProgramP30CA015083 · NCI · MAYO CLINIC ROCHESTER · PI Lila J. Rutten · 1985 to 2026
$151.3M
UCLA Clinical Translational Science InstituteUL1TR001881 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI ARLEEN F. BROWN, ARASH NAEIM · 2016 to 2026
$118.1M
UCLA Clinical and Translational Science InstituteUL1TR000124 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$57.0M
University of Hawaii Cancer Center CCSGP30CA071789 · NCI · UNIVERSITY OF HAWAII AT MANOA · PI Pallav Pokhrel · 1996 to 2026
$56.2M
Use of microfluidic tumor cultures to enable clinical trials of therapies for ovarian cancerP50CA136393 · NCI · MAYO CLINIC ROCHESTER · PI SCOTT H KAUFMANN · 2009 to 2026
$37.0M
WITHIN SUBJ VARIABILITY IN MEASUREMENTS DRUG METABOL ENZYMES IN HLTY SUBJM01RR000056 · NCRR · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI LEVINE, ARTHUR S · 1985 to 2006
$29.2M
Northern California Cooperative Family Registry for Breast CancerU01CA069417 · NCI · NORTHERN CALIFORNIA CANCER CENTER · PI JOHN, ESTHER M. · 1995 to 2010
$22.4M
Relating Molecular Subgroups of Endometriosis-Associated Ovarian Cancers to Survival and RiskR01CA248288 · NCI · MAYO CLINIC ROCHESTER · PI Stacey J Winham · 2021 to 2026
$4.8M
COLLABORATIVE STUDY OF OVARIAN CANCER IN TWO RISK GROUPSR01CA058598 · NCI · UNIVERSITY OF HAWAII AT MANOA · PI GOODMAN, MARC T · 1993 to 2012
$4.6M
Sequencing Familial Lung CancerR01CA243483 · NCI · UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR · PI Christopher I. Amos, DIPTASRI M MANDAL · 2023 to 2026
$4.2M
Epidemiology of Ovarian Cancer:New HypothesesR01CA087538 · NCI · FRED HUTCHINSON CANCER RESEARCH CENTER · PI ROSSING, MARY ANNE · 2002 to 2006
$3.5M
Breast Cancer NowCancer Research UK 15601Cancer Research UK 22905Cancer Research UK C490/A16561Department of HealthMedical Research Council MC_UU_00004/01NCATS NIH HHS UL1 TR000124NCATS NIH HHS UL1TR000124NCATS NIH HHS UL1 TR001881NCI NIH HHS K07 CA080668NCI NIH HHS N01 CA015083NCI NIH HHS P30 CA015083NCI NIH HHS P30 CA047904NCI NIH HHS P30 CA071789NCI NIH HHS P50 CA136393NCI NIH HHS R01 CA058598NCI NIH HHS R01 CA087538NCI NIH HHS R01 CA095023NCI NIH HHS R01 CA112523NCI NIH HHS R01 CA122443NCI NIH HHS R01 CA160669NCI NIH HHS R01 CA168758NCI NIH HHS R01 CA243483NCI NIH HHS R01 CA248288NCI NIH HHS U01 CA069417NCI NIH HHS U01 CA243483NCRR NIH HHS M01 RR000056NIH HHS P30-CA15083NIH HHS P50-CA136393NIH HHS R01-CA122443NIH HHS R01-CA243483
6 · The paper itself

Abstract

Our objective was to test whether p53 expression status is associated with survival for women diagnosed with the most common ovarian carcinoma histotypes (high-grade serous carcinoma [HGSC], endometrioid carcinoma [EC], and clear cell carcinoma [CCC]) using a large multi-institutional cohort from the Ovarian Tumor Tissue Analysis (OTTA) consortium. p53 expression was assessed on 6,678 cases represented on tissue microarrays from 25 participating OTTA study sites using a previously validated immunohistochemical (IHC) assay as a surrogate for the presence and functional effect of TP53 mutations. Three abnormal expression patterns (overexpression, complete absence, and cytoplasmic) and the normal (wild type) pattern were recorded. Survival analyses were performed by histotype. The frequency of abnormal p53 expression was 93.4% (4,630/4,957) in HGSC compared to 11.9% (116/973) in EC and 11.5% (86/748) in CCC. In HGSC, there were no differences in overall survival across the abnormal p53 expression patterns. However, in EC and CCC, abnormal p53 expression was associated with an increased risk of death for women diagnosed with EC in multivariate analysis compared to normal p53 as the reference (hazard ratio [HR] = 2.18, 95% confidence interval [CI] 1.36-3.47, p = 0.0011) and with CCC (HR = 1.57, 95% CI 1.11-2.22, p = 0.012). Abnormal p53 was also associated with shorter overall survival in The International Federation of Gynecology and Obstetrics stage I/II EC and CCC. Our study provides further evidence that functional groups of TP53 mutations assessed by abnormal surrogate p53 IHC patterns are not associated with survival in HGSC. In contrast, we validate that abnormal p53 IHC is a strong independent prognostic marker for EC and demonstrate for the first time an independent prognostic association of abnormal p53 IHC with overall survival in patients with CCC.

Indexed as

Carcinoma, EndometrioidOvarian NeoplasmsCarcinoma, Ovarian EpithelialFemaleHumansTumor Suppressor Protein p53Tumor Suppressor Protein p53clear cellendometrioidhigh-grade serous carcinomaovarian cancerp53prognosisTP53

Identifiers

PMID36948887
PMCPMC10073933
OpenAlexW4353029051

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.