Published in Cancer Detection and Prevention 2000; 24(Supplement 1).

Role of Bcl-2 positivity on survival in patients with lung cancer: a meta-analysis with qualitative assessment of the literature

T Berghmans MD, B Martin PhD, M Paesmans MSc, F Branle MD, A Burniat MD, L Ghisdal MD, JJ Lafitte MD, C Mascaux MD, AP Meert MD, E Steels MD, F Vallot MD, JM Verdebout MD, JP Sculier MD

Institut Bordet, Bruxelles, Belgium,

AIM: The role of the cell cycle regulator Bcl-2 in lung cancer remains controversial. We performed a systematic review of the literature in order to clarify its impact on survival in small (SCLC) and non-small cell lung carcinoma (NSCLC). METHODS: Eligible trials had to deal with Bcl-2 assessment on lung cancer only and to report a survival comparison according to Bcl-2 status. Survival results were aggregated after having performed a methodological evaluation of the study design, methods (including laboratory) and analysis, using a specific quality scale. RESULTS: Among 29 studies, 12 identified Bcl-2 as a favorable prognostic factor and 3 as a poor one; 14 trials were inconclusive. No quality difference was detected between the studies except that significantly higher scores were found in the trials with the largest sample sizes. Twenty-four trials, including 3184 patients, provided sufficient information to perform the meta-analysis whose results are the following: Group n trials n patients HR 95% CI NSCLC stage I/II 7 1204 0.78 0.62-0.97 NSCLC surgical stages 10 1097 0.41 0.32-0.52 NSCLC all stages 5 563 0.57 0.37-0.88 Squamous cell 5 370 0.57 0.41-0.78 NSCLC Immunohistochemistry-Clone 100 4 336 0.47 0.31-0.70 NSCLC Immunohistochemistry Clone 124 15 2445 0.66 0.57-0.77 SCLC 4 317 0.92 0.73-1.16 Neuroendocrine tumours 3 86 0.67 0.31-1.44 HR (hazard ratio) < 1 means a survival advantage for Bcl-2 + patients; CI = confidence interval CONCLUSIONS: Overall, Bcl-2 expression was associated with a better prognosis although this positive impact on survival is found in NSCLC only.

KEY WORDS: Bcl-2, lung cancer.

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Paper presented at the International Symposium on Impact of Biotechnology on Cancer Diagnostic & Prognostic Indicators; Geneva, Switzerland; October 28 - 31, 2000; in the section on prognostic markers.