Immunohistochemical expression of BCL-2 in colorectal cancer and its association with clinicopathological parameters: a cross-sectional study from an Indian tertiary care center
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254381Keywords:
Colorectal carcinoma, Bcl-2, Immunohistochemistry, Clinicopathological correlation, ApoptosisAbstract
Background: Colorectal cancer (CRC) is among the leading causes of global cancer mortality and is steadily increasing in India. Despite advances in multimodal therapy, treatment resistance and recurrence remain major challenges. BCl-2, an anti-apoptotic protein, has emerged as a potential biomarker of tumor aggressiveness and therapeutic response. Objectives were to evaluate BCl-2 immunoexpression in CRC tissues and correlate expression levels with key clinicopathological features.
Methods: A cross-sectional observational study was conducted on 60 histopathologically confirmed CRC cases. Formalin-fixed paraffin-embedded samples were stained using standard immunohistochemistry protocols. BCl-2 expression was scored based on percentage of positively stained tumor cells. Clinical data and pathological variables, including tumor location, histological subtype, grade, stage, and lymph node involvement, were recorded. Statistical significance was evaluated using chi-square/Fisher’s exact test (p<0.05).
Results: BCl-2 positivity was identified in 96.7% of CRC cases, with 46.7% demonstrating strong cytoplasmic staining. A significant association was observed between BCl-2 expression and tumor location (rectum) as well as histological subtype (adenocarcinoma NOS). Although higher BCl-2 expression was noted in moderately differentiated tumors, this relationship did not reach statistical significance. No significant associations were found with tumor grade, stage, lymph node status, age, or sex.
Conclusions: BCl-2 is frequently expressed in colorectal carcinoma, indicating its role in tumor survival; however, its limited correlation with clinicopathological parameters suggests it is not an independent prognostic marker. Further studies integrating additional apoptotic and molecular markers are needed to clarify its prognostic and therapeutic value.
Metrics
References
Global cancer burden growing, amidst mounting need for services. Available at: https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services. Accessed on 15 November 2025.
Shivshankar S, Patil PS, Deodhar K, Budukh AM. Epidemiology of colorectal cancer: A review with special emphasis on India. Indian J Gastroenterol. 2025;44(2):142. DOI: https://doi.org/10.1007/s12664-024-01726-8
Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review. Eur J Cancer. 2010;46(16):2879-88. DOI: https://doi.org/10.1016/j.ejca.2010.06.010
Marchewczyk P, Costeira B, da Silva FB, Cavadas D, Abecasis N, Limbert M, et al. Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center. Qual Life Res. 2025;34(5):1501. DOI: https://doi.org/10.1007/s11136-025-03918-x
Fernández-Martínez D, Rodríguez-Infante A, Otero-Díez JL, Baldonedo-Cernuda RF, Mosteiro-Díaz MP, García-Flórez LJ. Is my life going to change?-a review of quality of life after rectal resection. J Gastrointest Oncol. 2020;11(1):91-101. DOI: https://doi.org/10.21037/jgo.2019.10.03
Sörensson M, Asplund D, Matthiessen P, Rosenberg J, Hallgren T, Rosander C, et al. Self-reported sexual dysfunction in patients with rectal cancer. Colorectal Dis. Colorectal Dis. 2020;22(5):500-12. DOI: https://doi.org/10.1111/codi.14907
Kumar A, Gautam V, Sandhu A, Rawat K, Sharma A, Saha L. Current and emerging therapeutic approaches for colorectal cancer: A comprehensive review. World J Gastrointest Surg. 2023;15(4):495. DOI: https://doi.org/10.4240/wjgs.v15.i4.495
Liu J, Guo B. RNA-based therapeutics for colorectal cancer: Updates and future directions. Pharmacol Res. 2020;152:104550. DOI: https://doi.org/10.1016/j.phrs.2019.104550
Vogler M, Braun Y, Smith VM, Westhoff MA, Pereira RS, Pieper NM, et al. The BCL2 family: from apoptosis mechanisms to new advances in targeted therapy. Signal Transduct Targeted Ther. 2025;10(1):91. DOI: https://doi.org/10.1038/s41392-025-02176-0
Palabiyik AA. The role of Bcl 2 in controlling the transition between autophagy and apoptosis (Review). Mol Med Rep. 2025;32(1):172. DOI: https://doi.org/10.3892/mmr.2025.13537
Zheng C, Liu T, Liu H, Wang J. Role of BCL-2 Family Proteins in Apoptosis and its Regulation by Nutrients. Curr Protein Pept Sci. 2020;21(8):799-806. DOI: https://doi.org/10.2174/1389203721666191227122252
Banjara S, Suraweera CD, Hinds MG, Kvansakul M. The Bcl-2 Family: Ancient Origins, Conserved Structures, and Divergent Mechanisms. Biomolecules. 2020;10(1):128. DOI: https://doi.org/10.3390/biom10010128
Sharma R, Abbasi-Kangevari M, Abd-Rabu R, Abidi H, Abu-Gharbieh E, Acuna JM, et al. Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol. 2022;7(7):627-47. DOI: https://doi.org/10.1016/S2468-1253(22)00044-9
Cancer Today. Available at: https://gco.iarc.who.int/today/en. Accessed on 15 November 2025.
Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-54. DOI: https://doi.org/10.3322/caac.21772
Popescu-Vâlceanu HC, Stoicea MC, Enache V, Bratu RM, Mustăţea P, Drăguţ RM, et al. Bcl-2 and p53 immunophenotypes in colorectal adenocarcinoma in type 2 diabetes mellitus versus non-diabetic patients. Romanian J Morphol Embryol. 2022;63(3):521. DOI: https://doi.org/10.47162/RJME.63.3.06
Jamai D, Kallel I, Mekrezi S, Walha M, Gharsallah M, Khabir A, et al. Prognostic value of combining E-cadherin, p53, Bcl-2 and Bcl-xL expression and survival in Tunisian colorectal adenocarcinoma patients. Cell Mol Biol (Noisy-le-grand). Cell Mol Biol. 2022;68(4):93-107. DOI: https://doi.org/10.14715/cmb/2022.68.4.12
Rahadiani N, Effendi K, Stephanie M, Manatar AF, Krisnuhoni E, Rahadiani N, et al. From biomarkers to outcomes investigating DEK, p53, and Bcl2 expression and their role in colorectal cancer stage and lymph node metastasis. Gastrointestinal Tumors. 2024;1:e005. DOI: https://doi.org/10.48130/git-0024-0005
O’Connell E, Reynolds IS, Lindner AU, Salvucci M, O’Grady T, Bacon O, et al. Apoptotic and Necroptotic Mediators are Differentially Expressed in Mucinous and Non-Mucinous Colorectal Cancer. Front Oncol. 2022;12:815001. DOI: https://doi.org/10.3389/fonc.2022.815001
Downloads
Published
How to Cite
Issue
Section
