Objectives: To evaluate the role of bcl-2 and apoptotic index in the progre
ssion from primary to metastatic breast carcinoma and their influence on pr
ognosis. Methods: bcl-2 expression was examined by immunohistochemistry and
apoptotic index by in situ end-labelling in 116 surgical breast carcinomas
and lymph node metastases from 50 patients. Results: bcl-2 was observed in
69 cases (59.4%) of primitive carcinomas and 26 cases (65%) of metastatic
breast carcinomas and there was agreement of bcl-2 expression between prima
ry and metastatic sites except in 3 cases. bcl-2 expression was significant
ly associated with several favourable prognostic features, such as small tu
mour size (p = 0.03) and oestrogen and progesterone-receptor positivity (p
< 0.01 and p < 0.001, respectively). A high apoptotic index was significant
ly associated with a number of poor prognostic factors, including poorly di
fferentiated carcinomas, large tumour size, high Ki67 expression and high m
itotic count (p < 0.001 in all cases). The mean apoptotic index was higher
in lymph node metastasis than in primary carcinomas (1.19 vs. 0.69, p < 0.0
1). A low bcl-2 expression and a high apoptotic index were significantly as
sociated with short-relapse free survival rates (p = 0.02 and p < 0.01, res
pectively), but only apoptotic extent provided independent prognostic infor
mation by multivariate analysis. Conclusions: The evaluation of bcl-2 expre
ssion and extent of apoptosis may provide useful prognostic information on
breast cancer patients; however while increased apoptosis is strongly assoc
iated with the progression from primary carcinomas to lymph node metastases
, bcl-2 does not seem to play a significant role in this process. Copyright
<(c)> 2001 S. Karger AG, Basel.