Prognostic value of bax, bcl-2, and p53 staining in primary osteosarcoma.

BACKGROUND AND OBJECTIVES: To investigate the immunohistochemical expression of three apoptosis-related genes (bax, bcl-2, and p53) and apoptosis (TUNEL) in patients with primary osteosarcoma, and examine potential correlations between gene expression and clinicopathological characteristics in these patients. MATERIALS AND METHODS: Thirty-five primary osteosarcoma specimens and 18 tissue specimens deriving from non-malignant osseous lesions were immunohistochemically stained for bax, bcl-2, and p53 proteins, while apoptosis was investigated by the TUNEL method. The results were statistically analyzed. RESULTS: P53, bax, and bcl-2 protein expression was observed in 22 (62.9%), 29 (82.9%), and 18 (51.4%) osteosarcoma patients, respectively. Non-specific positive TUNEL staining (+/-) was observed in two primary osteosarcoma cases (5.7%). None of the benign controls expressed any of the genes studied. None of the apoptosis-related genes studied was able to predict overall or disease-free survival in our group of patients. Nevertheless, increased bax/bcl-2 protein expression ratio was associated with a decreased 4-year survival and disease free survival (P = 0.0229 and P = 0.0370, respectively). Furthermore, all the patients who were bax(+)/bcl-2(-)/p53(+) relapsed within the 4-year follow-up period (P = 0.0385). CONCLUSIONS: The increased apoptotic rate as determined by an elevated bax/bcl-2 protein expression ratio or by the bax(+)/bcl-2(-)/p53(+) protein expression pattern, appears to identify groups of osteosarcoma patients with unfavorable prognosis.

Prognostic value of bax, cytochrome C, and caspase-8 protein expression in primary osteosarcoma.

The prognostic significance of bax, cytochrome c, and caspase-8 in patients with primary osteosarcoma is unknown. We examined the immunohistochemical expression of these genes in 35 surgically treated patients with primary osteosarcoma. Clinicopathological and survival data were correlated with the staining result. Eighteen tissue specimens from non-malignant osseous lesions were used as controls. Bax, cytochrome c, and caspase-8 positive staining was observed in 29 (82.9%), 16 (45.7%), and 0 (0%) patients, respectively, but did not stain any of the 18 benign osseous lesions used as controls. None of the genes studied predicted overall or disease-free survival. Patients, however, bearing bax(+)/cytochrome c(+) or bax(+)/cytochrome c(+ +) tumors had a decreased 4-year disease-free survival rate compared to the rest of the group (p = 0.0489 and p = 0.0208, respectively), identifying two groups of patients where more intensive adjuvant treatment could possibly be applied to prevent high postoperative recurrence rates.

Midterm results of a modified evans repair for chronic lateral ankle instability.

Twenty-eight ankles in 27 patients with chronic instability were treated with a modification of the Evans procedure during a 10-year period. The diagnosis was assessed by clinical evaluation and radiographic stress tests. The reconstruction procedure consists of using the peroneal brevis tendon to repair ankle instability and restore the loss of anatomic integrity of the injured structures. Twenty-five patients (26 ankles) were available at a mean followup of 99.6 months or 8.3 years (range, 28-117 months). Midterm results were evaluated using the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society, and postoperative radiographic stress tests. According to this scoring system, the current reconstruction procedure resulted in 92.64 points (range, 63-100 points). However, moderate restriction in hindfoot inversion was seen in nine patients (34.61%). Three ankles (11.5%) had a positive anterior drawer sign (> 8 mm). In five ankles (19.2%), there were mild degenerative joint changes. Therefore, the current reconstruction method led to a satisfactory clinical and functional midterm outcome shown by a numeric scale.