Bcl-2 expression and other clinicopathologic parameters in uterine leiomyosarcoma.

Background: The bcl-2 protein, which is involved in cell-cycle regulation and apoptosis, seems to play an important role in the growth of tumors. Until recently, only one study described the frequent expression of bcl-2 in uterine leiomyosarcomas (LMS) and indicated its important prognostic role. Thus, the aims of the present study were to examine bcl-2 expression in patients with uterine LMS and to determine if the expression of this protein would influence the prognosis. In addition, a possible association between bcl-2 expression and various clinicopathologic parameters was evaluated.

Patients And Methods: Bcl-2 expression was investigated using immunohistochemical techniques on paraffin-embedded tissue from 21 patients with uterine LMS. The immunohistochemical findings were correlated with different clinicopathologic parameters (FIGO stage, age, vascular-space involvement and recurrence of disease) of the patients.

Results: Bcl-2 was expressed in 57% (12/21) of uterine LMS: 3/12 (25%) stained weakly positive, 3/12 (25%) stained moderately positive and 6/12 (50%) stained strongly positive. Nine (43%) cases were negative. Evaluation of the correlation between bcl-2 expression and several clinicopathologic parameters identified a significant negative correlation between vascular-space involvement and bcl-2 expression (p=0.04). The relationship between bcl-2 expression and FIGO stage, age and recurrence of disease did not reach statistical significance. A univariate Cox model revealed significantly longer overall survival in women with bcl-2-positive LMS compared with women with bcl-2-negative LMS (p=0.03).

Conclusions: Significant negative correlation was found between bcl-2 expression and vascular-space involvement and improved survival rates in patients with bcl-2-positive tumors. Though limited by the small number of patients, these data indicate the role of bcl-2 expression in uterine LMS.