Prognostic significance of p53, bax and bcl-2 gene expression in patients with laryngeal carcinoma

Aim: This study was designed to examine the prognostic significance of the coexpression of three genes (bax, bcl-2 and p53) which play a critical role in the apoptotic mechanisms in patients with squamous cell laryngeal carcinoma.(1-3) Materials and Methods: The immunohistochemical expression of bcl-2, bax and p53 genes was retrospectively examined in 38 patients with squarrous cell laryngeal carcinoma and in five controls (necrotomic tissue). Tissue specimens were obtained both during the diagnostic biopsy and at the time of surgery. Clinicopathological and survival data were correlated with the staining results. Results: Bcl-2 protein expression (P=0.0472), stage (P=0.0087) and lymph-node involvement (P=0.0488) were found to be independent prognostic factors. Increased bcl-2 protein expression correlated with a better 5-year survival (P=0.0472). Patients who were bcl-2(-)/p53(-) (n=25) or bax(+)/bcl-2(-) (n = 13) had a significantly worse overall survival (P=0.0305 andP=0.0482, respectively). Similarly, patients who were bax(+)/bcl-2(-)/p53(-) (n = 11) also had a worse 5-year survival compared with the rest of the group (P=0.0088). Changes that were noticed in bax and p53 protein expression from the time of biopsy until the time of surgery did not correlate with a significant increase in the overall survival. Conclusions: The expression of bcl-2 gene appears to be an independent prognostic factor for patients with laryngeal carcinoma. The coexpression of the genes studied can be used to determine aggressive clinical phenotypes. (C) 2001 Harcourt Publishers Ltd.