Regulation of apoptosis in squamous cell carcinoma of the vulva

OBJECTIVE: To analyze the expression of Bcl-2, Bax and ICH-1-L in squamous cell cancer of ther vulva. STUDY DESIGN: Slides of 72 vulvar squamous cell carcinomas were stained imm unohistologically for Bcl-2, Bax and ICH-1-L. They were analyzed for the pe rcentage of positive tumor cells, staining intensity and pattern, and amoun t of Bcl-2-positive lymphocytes around the tumor. Results were analyzed for correlations with clinical and histologic characteristics. Disease-free an d overall survival wee evaluated by Kaplan-Meier curves with the log-rank t est. RESULTS: Strong expression of Bcl-2 was present in 15% of tumors. Carcinoma s with high Bcl-2 expression more frequently had lymph node metastasis (P=. 03), without significant differences in other clinical or histologic parame ters, disease-free and overall survival. Strong Bax expression was observed in 57%, without prognostic significance. Carcinomas showed high ICH-1-L ex pression in 35%. These tumors seemed to have longer disease-free survival, while overall survival was significantly longer (P=.02). A strong Bcl-2-pos itive inflammatory infiltrate was highly predictive of lymph node metastasi s (P=.02) and disease-free survival (P=.03). CONCLUSION: In squamous cell carcinoma of the vulva, inhibition of apoptosi s is associated with a more-aggressive phenotype, and a Bcl-2-positive infl ammatory infiltrate is predictive of prognosis. A study with more patients should confirm the importance of apoptosis in vulvar carcinoma.