Apoptosis regulating genes, bcl-2 and bax, and human telomerase reverse transcriptase messenger RNA expression in adrenal tumors: Possible diagnostic and prognostic importance

Background. Apoptosis-suppressing gene, bcl-2, and apoptosis-inducing gene, bax, are expressed in various tumors. Human telomerase reverse transcriptase (hTERT) expression is increased in many cancers. The purpose of this investigation was to determine whether bcl-2 or bax gene expression differs between benign and malignant adrenal tumors, and whether hTERT gene expression correlates with the prognosis of patients with adrenal cancer. Methods. Expression of bcl-2 and bax from 52 adrenal surgical specimens was analyzed by reverse transcription-polymerase chain reaction. Expression of hTERT was analyzed by real-time quantitative reverse transcription-polymerase chain reaction, and expressed using the delta-delta threshold cycle method. Results. All normal adrenal tissues (n = 7) and benign adrenal tumors (n = 41) expressed bcl-2 and bax, whereas all adrenocortical cancers (n = 4) expressed bcl-2 but not bax. Expression of hTERT was increased in adrenocortical cancers compared with that in normal tissues (P < .05), cortical adenomas (n = 17) (P < .05), cortical hyperplasias (n = 4) (P < .05), and pheochromocytomas (n = 20) (P < .05). The one patient with an adrenocortical cancer without increased hTERT expression is alive with distant metastasis 5 years after adrenalectomy. The other 3 patients with adrenocortical cancer died 5 to 24 months after adrenalectomy. Conclusions. Expression of bax gene appears to distinguish adrenal cancer from benign adrenal tumors. Gene expression of hTERT should be investigated as a prognostic marker in adrenal cortical cancers.