EXPRESSION OF BCL-2 IN INVASIVE AND IN-SITU CARCINOMA OF THE UTERINE CERVIX

OBJECTIVE: The oncoprotein bcl-2 inhibits apoptosis. The purpose of th is study was to assess the expression of bcl-2 in human cervical carci noma and to correlate this with clinicopathologic parameters. STUDY DE SIGN: Immunohistochemical staining for bcl-2 protein (MoAB clone 124) was performed on operative tissue specimens from 22 patients with carc inoma in situ of the cervix and from 137 patients with invasive cervic al carcinoma (International Federation of Gynecology and Obstetrics st ages I to IV). The immunoreactivity of bcl-2 was scored as positive (g reater than or equal to 5% staining cells) or negative (<5% staining c ells). RESULTS: Eighty-two percent of in situ carcinomas and 61% of in vasive cervical carcinomas were bcl-2 positive. Expression of bcl-2 wa s correlated to tumor stage (p < 0.001) and to presence of vascular (p < 0.005) or lymphatic tumor (p < 0.023) permeation. In univariate ana lysis there was a strong relationship between bcl-2 expression and ove rall survival (p < 0.001). In multivariate analysis bcl-2 expression ( p < 0.001), international Federation of Gynecology and Obstetrics stag e (p = 0.011), and presence of lymphatic permeation (p = 0.014) proved to be independent prognostic factors. CONCLUSIONS: Expression of bcl- 2 is lost during tumor progression and is a strong prognostic paramete r, suggesting that the regulation of apoptosis plays an important role in the behavior of cervical carcinomas. Better understanding of the m echanisms involved may lead to improved medical treatment strategies.