Apoptotic protein expression in favorable-histology Wilms tumor correlates with tumor recurrence

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Abstract
Purpose Outcome for patients with Wilms tumor (WT) with favorable histology is good. Deletions of chromosomes 1p and 16q impart a poorer outcome. Value of apoptotic protein expression is not clear. Methods Expression of four immunohistochemically detectable apoptosis-regulating proteins (bcl-2, bcl-x, bax and p53) were analyzed in 30 specimens of WT and compared to recurrence and recurrence-free survival (RFS). Results The 30 patients included ranged from 4 to 72 months in age (mean 31). The mean available follow-up was 35.3 months (range 1–54). Six patients developed recurrence. The 5-year RFS for blastema-predominant tumors was 40% as compared to 91% for triphasic histology which was significant (p = 0.048). The 5-year RFS in patients with bcl-2 negative tumors was 63% as compared to 100% for bcl-2 positive tumors, the difference being significant (p = 0.019). The 5-year RFS in patients with p-53 positive tumors was 27% as compared to 91% for p-53 negative tumors; however, this difference in the RFS was not statistically significant (p = 0.143). bax and bcl-x expression were not related to the RFS. Conclusions Tumors that are bcl-2 negative have a relatively higher recurrence rate and a poorer RFS. They may benefit from a more intensive follow-up regime for early detection of recurrence.

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