BCL-2 AUTOMATED AND QUANTITATIVE IMMUNOCYTOCHEMICAL ASSAYS IN BREAST CARCINOMAS - CORRELATION WITH 10-YEAR FOLLOW-UP

Purpose: bcl-2 protein is detectable in human cancers and may be invol ved in the response to antineoplastic drugs or endocrine therapy in br east carcinomas. In a previous study, we had developed optimal technic al conditions for bcl-2 immunodetection, The aim of the present report was to determine the prognostic significance of bcl-2 expression in b reast carcinomas by the use of a similar immunocytochemical procedure. Methods: bcl-2 immunocytochemical assays were performed on frozen sec tions by automated immunoperoxidase technique (Ventana) and computer-a ssisted analysis of digitized colored microscopic images (SAMBA) in a series of 170 breast carcinomas, The results of automated quantitative immunocytochemical assays were correlated with patient follow-up (120 months). Results: Intense bcl-2 immunocytochemical expression in tumo rs (cutpoint, 15%) significantly correlated with longer disease-free s urvival and longer recurrence-free survival in the entire cohort of pa tients (P = .028 and P = .035, respectively) and also in node-negative subgroups of patients (P = .028 and P = .01; Kaplan-Meier log-rank te st; NCSS 6.0.1 software). But bcl-2 immunostained surfaces (cutpoint, 15%) did not correlate with overall survival. In multivariate analysis (proportional hazards regression, Cox model), bcl-2 prognostic signif icance in terms of disease-free survival was only independent of the t umor size and grade and histoprognostic index (Nottingham prognostic i ndex [NPI]),Conclusion: bcl-2 immunohistochemical expression is a sign ificant indicator of favorable outcome only in terms of disease-free a nd local recurrence-free survival. However, bcl-2 expression in tumors is an independent weakly prognostic indicator in breast carcinomas. b cl-2 immunodetection assessed in optimal technical conditions (frozen samples, automation, quantitative analysis, scatter diagram cutoffs) m ay have some limited practical clinical relevance for the management o f patient with breast carcinomas.