title: bcl-2 expression in head and neck cancer: an enigmatic prognostic marker.
abstract: OBJECTIVE
  The role of bcl-2 overexpression in cancer presents a paradox. In some tumor types, it is associated with favorable outcome, whereas in others the reverse is true. The purpose of this study was to explore the influence of bcl-2 in a large series of head and neck cancer patients treated in the CHART randomized trial.
  
  
  METHODS
  Histologic material was obtained from 400 patients; bcl-2 expression was assessed by immunohistochemistry as either positive or negative cytoplasmic staining.
  
  
  RESULTS
  Positivity of bcl-2 was recorded in 12.8% (9.5-16.5%, 95% confidence limits) of tumors. There were significant differences in positive tumors within different sites with nasopharynx showing the highest incidence (46.2%). A multivariate logistic regression analysis showed that bcl-2 was strongly associated with histologic dedifferentiation, as well as increasing N stage and female gender. In univariate analyses, bcl-2 positive patients had a lower locoregional relapse rate (RR 0.57, p = 0.02) and improved survival (RR 0.49, p = 0.004) compared to bcl-2 negative patients; this became more significant in multivariate analysis.
  
  
  CONCLUSIONS
  These data demonstrate that bcl-2 overexpression is a marker of what is considered to be more advanced and aggressive disease yet it is associated with a more favorable outcome irrespective of the treatment schedule.
authors.affiliation: Gray Laboratory CRT, Mount Vernon Hospital, Northwood, Middlesex, UK. gwilson@graylab.ac.uk
authors.forename: G D
authors.initials: GD
authors.lastname: Wilson
authors.forename: M I
authors.initials: MI
authors.lastname: Saunders
authors.forename: S
authors.initials: S
authors.lastname: Dische
authors.forename: P I
authors.initials: PI
authors.lastname: Richman
authors.forename: F M
authors.initials: FM
authors.lastname: Daley
authors.forename: S M
authors.initials: SM
authors.lastname: Bentzen
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006258:Head and Neck Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008297:Male; D009363:Neoplasm Proteins / Q000378:metabolism*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism*; D012044:Regression Analysis
chemical_list: D009363:Neoplasm Proteins; D019253:Proto-Oncogene Proteins c-bcl-2