PROGNOSTIC-SIGNIFICANCE OF BCL-2 EXPRESSION IN LOCALIZED SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK

This study was conducted to determine whether Bcl-2 overexpression in localized squamous cell carcinoma of the head and neck (SCCHN) might s erve as a marker for tumors unlikely to respond to standard treatment. Tissue samples from 33 patients undergoing surgery or irradiation for early-stage SCCHN during the years 1977 to 1992 were stained for Bcl- 2. All patients had either T1N0 lesions of the oral cavity, pharynx, o r larynx or T1N0 or T2N0 lesions of the true vocal cords. Of the 33 pa tients, 26 remained disease-free after at least 3 years of follow-up; the remaining 7 patients developed either tumor recurrence or a second primary tumor, 4 of which were fatal. Twelve patients had tissue spec imens staining positive for Bcl-2; 6 of these patients had a poor outc ome, and 6 had a good outcome. The relationship between poor outcome a nd overexpression of Bcl-2 in turner cells was statistically significa nt (p = .0047 by Fisher's exact test). For tumors overexpressing Bcl-2 , there was no significant difference in recurrence rate between those undergoing surgery and those undergoing radiotherapy as the primary m ode of treatment. The overexpression of Bcl-2 in early lesions in this study predicted a cure rate: of 50%, as opposed to the generally expe cted 90%, suggesting that Bcl-2 is a significant prognostic indicator in early SCCHN. Future studies will determine if altering the treatmen t will improve outcome in these patients.