The prognostic role of apoptosis mediators in rectal adenocarcinoma.

Background/aims: Genes included in apoptosis may be involved in tumor biology and identify specific groups of patients with individual therapy. The aim of this study was to evaluate the prognostic value of some apoptosis markers in conjunction with pathological factors in operable rectal cancer patients.

Methodology: Tumor samples from 87 patients with rectal adenocarcinoma were analyzed retrospectively. The immunohistochemistry from 'tissue array' for the expression of p53, p21, Bcl-2 and cycline D1, combined with pathological features were correlated with the survival data. The mean postoperative follow-up was 48 months.

Results: Five-year cancer-specific survival (CSS) was 44.9%. Independent prognostic factors for CSS were the p53 and p21 proteins, whereas for cancer-free survival (CFS) p21 was a positive independent factor. When pathological factors were also introduced in the analysis, the positive prognostic role on CSS was obtained for p21 and lymphatic invasion; CFS was positively influenced by the presence of p21 protein and lymphatic invasion. For patients with pN0, p21 protein was an independent predictive marker for CSS and CFS.

Conclusions: Molecular markers of apoptosis, such as p53 and p21, had significant prognostic role in rectal cancer patients, together with lymphatic invasion. The presence of p21 protein in pN0 patient outcome may influence management, but needs further evaluation.