P53, bcl-2, and bax: Their relationship and effect on prognosis in early stage epithelial ovarian carcinoma

The prognosis of ovarian carcinoma, even in the early stages (FIGO I-II), c ontinues to present a challenge despite advances in the understanding of pa thophysiology and treatment. In a series of 106 patients with epithelial ca rcinomas in FIGO stages IA-IIC, a number of prognostic factors (age, FIGO s tage, histopathologic type, and tumor grade) were studied in relation to im portant regulators of apoptosis (p53, bcl-2, and bax). Immunohistochemical techniques were used. All the patients received adjuvant radiotherapy after the primary surgery. Univariate analysis showed that expression of p53 was highly significantly associated with tumor grade (P = 0.007) and survival status (P = 0.046). Positive bcl-2 staining was associated with serous (P = 0.0002) and endometrioid tumor subtypes, but not with the survival rate. A positive bax status was associated with younger age (P = 0.012) and a more favorable probability of survival. A significant association between the b cl-2 and bax status of the tumors and histopathologic subtypes and grades w as noted. The most favorable subgroup of tumors was that with a combination of positive bax staining and negative p53 staining. In a multivariate Cox analysis, tumor grade (P = 0.0006) and bax status (P = 0.020) were independ ent and significant prognostic factors.