Bcl-2 expression is a poor predictor for hepatocellular carcinoma prognosis of andropause-age patients.
OBJECTIVE
The expression of B-cell lymphoma 2 (Bcl-2) seems to be influenced by the endocrine environment. Numerous reports demonstrate the diverse expression of Bcl-2 family members under sex steroid regulation. With the exception of estrogen-related tumors, androgen-related tumors have shown their characteristics in Bcl-2 expression. In this study, the status of Bcl-2 expression in male hepatocellular carcinoma (HCC) patients was examined to verify the high incidence of HCC in males.


METHODS
Tumor tissue microarray was used to examine Bcl-2 expression levels in 374 HCC cases including 306 males and 68 females. Kaplan-Meier method, log-rank test, and Cox proportional hazards model were applied to investigate the predictive value of Bcl-2 in HCC patients.


RESULTS
Immunohistochemistry analysis showed that male patients with higher Bcl-2 levels had significantly longer median survival time and recurrence time than those with lower levels. However, no significant differences in outcomes were found between different Bcl-2 levels in female patients. When the male patients were stratified into several age points, the level of Bcl-2 expression showed poorer predictive efficiency in the 45-49 and 55-60 age groups in andropause-age patients compared with other age groups. Bcl-2 was an independent prognostic factor for both overall survival (P< 0.0001) and recurrence time (P= 0.0001) in male patients. After excluding male patients in the 45-60 age group, the predictive efficiency was enhanced (n= 147, OS,P= 0.0002, TTR,P< 0.0001).


CONCLUSIONS
Bcl-2 expression is an independent predictor of survival and recurrence in male HCC. Bcl-2 levels may also be regulated by androgens or androgen receptors in male HCC patients. Bcl-2 levels change and exhibit poor predictive efficiency when androgen levels vary dramatically (andropause age).
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Xiao-Fei
XF
Zhang
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Xin
X
Yang
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Hu-Liang
HL
Jia
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Wen-Wei
WW
Zhu
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Lu
L
Lu
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Wei
W
Shi
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Hao
H
Zhang
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Jin-Hong
JH
Chen
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Yi-Feng
YF
Tao
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Zheng-Xin
ZX
Wang
Department of General Surgery, Qidong Hospital, Qidong 226200, China.
Jun
J
Yang
Department of General Surgery, Qidong Hospital, Qidong 226200, China.
Lian-Xin
LX
Wang
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Ming
M
Lu
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Yan
Y
Zheng
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China.
Jing
J
Zhao
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China; Cancer Research Center, Institutes of Biomedical Science, Fudan University, Shanghai 200032, China.
Qiong-Zhu
QZ
Dong
Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai 200040, China; Cancer Research Center, Institutes of Biomedical Science, Fudan University, Shanghai 200032, China.
Lun-Xiu
LX
Qin
Bcl-2; Hepatocellular carcinoma; androgen; andropause; prognosis