Evaluation of p53 and Bcl-2 expression as prognostic markers in invasive cervical carcinoma stage IIb/III patients treated by radiotherapy.
OBJECTIVE
The objective was to evaluate the immunohistochemical expression of p53 and Bcl-2 proteins as prognostic markers in locally advanced [FIGO Stage IIb/III] invasive squamous cell carcinoma of the uterine cervix. It was also our aim to determine if they had any relationship to each other and to the pretreatment levels of apoptosis determined morphologically.


METHODS
Seventy-six consecutive cases of invasive squamous cell carcinoma of the cervix diagnosed in 1995 were analyzed retrospectively for the apoptotic index and p53 and Bcl-2 expression determined immunohistochemically and correlated to the patient outcome at the end of a 5-year follow-up period.


RESULTS
The overall cumulative 5-year survival was 52.63%. p53 immunoreactivity was seen in 53.9% cases with variable levels of expression. By univariate analysis, p53 positivity correlated with poor survival [chi-square P = 0.029; log-rank test P = 0.0468] but not upon multivariate analysis. The apoptotic index which ranged from 0 to 40 and Bcl-2 expression seen in 38.1% cases showed no correlation to survival. Neither p53 nor Bcl-2 expression correlated with the apoptotic index or with each other. Seven cases with the immunophenotype p53-/Bcl-2+ had an excellent survival.


CONCLUSIONS
Neither p53 nor Bcl-2 expression are independent predictors of prognosis in locally advanced cervical squamous cancers. However, evaluation of their combined expression may affect clinical outcome and needs further investigation.
Jain
Deepali
D
Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Srinivasan
Radhika
R
Patel
Firuza D
FD
Kumari Gupta
Subhash
S
D017209:Apoptosis / Q000502:physiology; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000096:biosynthesis*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis*; D002583:Uterine Cervical Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000532:radiotherapy*
D014408:Biomarkers, Tumor; D019253:Proto-Oncogene Proteins c-bcl-2; D016159:Tumor Suppressor Protein p53