F20 Apoptoticproteins asprognostic markers and indicators of radiochemosensitivity in stage II/III rectal cancers

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Aim: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.Method: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.Results: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).Conclusion: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.

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