Diagnostic and prognostic value of Bcl-2 in uterine leiomyosarcoma

• Published in: Archives of gynecology and obstetrics Vol. 307; no. 2; pp. 379 - 386
• Main Authors: Travaglino, Antonio, Raffone, Antonio, Raimondo, Diego, Gencarelli, Annarita, Esposito, Italia, Gallo, Cinzia, Improda, Francesco Paolo, Vitale, Salvatore Giovanni, Mollo, Antonio, Casadio, Paolo, Seracchioli, Renato, Zullo, Fulvio, Insabato, Luigi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2023; Springer Nature B.V
• Subjects: Bias; Cancer; Data analysis; Dentistry; Endocrinology; Female; Fibroids; Gynecology; Human Genetics; Humans; Leiomyoma - pathology; Leiomyosarcoma - diagnosis; Leiomyosarcoma - pathology; Lymphoma; Medical prognosis; Medicine; Medicine & Public Health; Muscular system; Obstetrics; Obstetrics/Perinatology/Midwifery; Patients; Pelvic Neoplasms; Prognosis; Review; Systematic review; Tumors; Uterine Neoplasms - diagnosis; Immunohistochemistry; Leiomyoma; bcl2; Smooth-muscle tumor; Prognosis
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06531-2

Background
Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and an unfavorable prognostic marker in uLMS.
Objective
To define the diagnostic and prognostic value of Bcl-2 loss in uLMS through a systematic review and meta-analysis.
Methods
Electronic databases were searched from their inception to May 2020 for all studies assessing the diagnostic and prognostic value of Bcl-2 loss of immunohistochemical expression in uLMS. Data were extracted to calculate odds ratio (OR) for the association of Bcl-2 with uLMS
vs
leiomyoma variants and smooth-muscle tumors of uncertain malignant potential (STUMP), and hazard ratio (HR) for overall survival; a
p
value < 0.05 was considered significant.
Results
Eight studies with 388 patients were included. Loss of Bcl-2 expression in uLMS was not significantly associated with a diagnosis of uLMS
vs
leiomyoma variants and STUMP (OR = 2.981;
p
 = 0.48). Bcl-2 loss was significantly associated with shorter overall survival in uLMS (HR = 3.722;
p
 = 0.006). High statistical heterogeneity was observed in both analyses.
Conclusion
Loss of Bcl-2 expression appears as a significant prognostic but not diagnostic marker in uLMS. The high heterogeneity observed highlights the need for further research and larger studies.