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The expression ofproapoptotic(Bax) and antiapoptotic(mutated p53, Bcl-2, Bclxl)proteins inpretreatment biopsy samples of rectal cancer patients treated with/withoutpreoperative chemoradiation was determined by immunohistochemistry, to investigate their role asprognostic markers and indicators of radiochemosensitivity.Biopsy samples of sixty seven patients operated on for stages II and III rectal cancer were enrolled in an active follow upprogram were examined after 8-10 years from operation. Thirty-three patients (Group I) had been treated with immediate surgery followed, in selected cases, by adjuvant postoperative chemoradiation. Thirty-four (Group II) had been submitted topreoperative chemoradiation. Immunohistochemical stainingprocedures were conducted using an automated immunostainer on sections of paraffin-embedded tissue.On multivariate regression analysis by stepwise selection, pN status (HR 3.82; 95%CI 1.67- 8.73) and high level of Bclxl positivity(HR 4.75; 95%CI 2.10-10.72) emerged as independentprognostic factors for death from rectal cancer. Bax expression was associated with downstaging and higher survival in irradiated patients (P = 0.0004).Pretreatment evaluation of apoptotic Bax and antiapoptotic Bclxl factors in biopsy samples of stages II/III rectal cancers may be helpful in selecting tumours responding to chemoradiation or patients with cancers which will have limited benefit from current treatments and should be directed toward a more aggressive systemic regimen.