The Correlation of Clinical Profiles with Expression of p53, Rb, bcl-2 and Bax Gene in Uterine Sarcoma

Oh, S I; Park, I A; Lee, H P

Abstract

Uterine sarcoma is a rare gynecologic cancer characterized by rapid clinical progression and poor prognosis. Because of limited clinical data and no valueable tumor markers, its management has been a challenge. The purpose of this study was to investigate the clinical features of uterine sarcoma and to identify the role of p53, Rb, bcl-2 and Bax gene expression in the prognosis of uterine sarcoma. Clinical records of 25 patients with histologically proven uterine sarcoma have been reviewed and their clinical profiles were analyzed. Immunohistochemical staining was used to detect the expression of p53, Rb, bal-2 and Bax with paraffin embedded tissues. There were 15 cases[60.0%] of leiomyosarcoma[LMS], 7 cases[28.0%] of endometrial stromal sarcoma[ESS], and 3 cases[12.0%] of malignant mixed mesodermal tumor[MMMT]. Mean age was 44.4[range; 28-65] years and there was no difference in age and FIGO atage among histologic subgroups. Sixteen patients[64.0%] were managed by surgery only, 8 patiendts[32.0%] by surgery and adjuvant chemotherapy, and 1 patients[4.0%] by surgery and adjuvant radiation therapy. The overall five year survival of MMMt was significantly worse than that of LMS or ESS[p=0.0025, Log rank test]. FIGO stage and menopause status appeared to be a main prognostic factor[p=0.0052, 0.0007], but treatment modality and mitotic count of LMS were not significant prognostic factors in uterine sarcoma. Immunohistochemical staining for p53 was positive in 6 cases[24.0%], 4 cases[26.7%] of LMS, 2 cases[66.7%] of MMMT, butnone of ESS. Immunohistochemical staining for pRb was positive in 9 cases[36.0%], 5 cases[33.3%] of LMS, 1 cases[14.3%] of ESS and all the 3 cases of MMMT. Immunohisochemical staining for Bax was positive in 4 cases[16.0%], 2 cases[13.3%] of LMS, 2 cases[66.7%] of MMMT, but none of ESS. There was no significance in association of expression of p53, Rb, bcl-2 and Bax according to FIGO statge or mitotic count of LMS. The patient who showed overexpression of Rb revealed poor prognosis than who did not[p=0.0246]. This study showed that FIGO stage, histologic type and menopause status are good prognostic factors in uterine sarcoma. Although apoptosis related genes such as p53, Rb, Bax and bcl-2 are suggested to be involved in tumorigenesis of uterine sarcoma, the correlation among them and clinical implication as an useful prognostic factor is yet to be established.