PROGNOSTIC-SIGNIFICANCE OF THE BCL-2 APOPTOTIC FAMILY OF PROTEINS IN PRIMARY AND RECURRENT CERVICAL-CANCER

bcl-2 is one of a family of genes that control the apoptotic threshold of a cell. bcl-2 protein and its anti-apoptotic homologue, mcl-1, wit h the pro-apoptotic protein, bar, are thought to function by forming h omo- and heterotypic dimers that then control the progression to apopt osis, p53 is also involved as a down-regulator of bcl-2 and a promoter of bar. To determine the effect of these apoptotic mechanisms, we use d immunohistochemistry to determine the prognostic significance of the expression of bcl-2, mcl-1, bar and p53 in primary and recurrent cerv ical cancer. Tissues from 46 patients with primary cervical cancer and 28 women with recurrent carcinoma were stained for bcl-2, mcl-1, bar and p53, Kaplan-Meier survival analysis was performed using the log-ra nk test for differences between groups. In the primary disease group, positive staining for bcl-2 was associated with a better 5-year surviv al (bcl-2 +ve, 84% vs bcl-2 -ve, 53%, P = 0.03), Positive staining for p53 was associated with a survival disadvantage (p53 +ve, 4-year surv ival 38% vs p53 -ve, 4-year survival 78%, P = 0.02), mcl-1 and bar sta ining were not useful as prognostic indicators in primary disease. No marker was prognostic in recurrent disease. Positive bcl-2 staining de fines a group of patients with primary disease with a good prognosis. p53, an activator of the bar promoter, identifies a group with a worse outcome. In recurrent disease, none of the markers reflected prognosi s.