We investigated the immunohistochemical espression of bcl-2 and the genetic assessment of the bcl-2 gene in relation to responsiveness to first line chemotherapy and to the clinical outcome in advanced ovarian carcinoma patients. We have compared 17 patients, with FIGO stage III C, ovarian serous carcinomas, G3, living with no evident disease five years after primary surgical treatment; to 19 patients who had died of progression of disease no later than two years after primary surgical treatment. The correlation of bcl-2 expression with the survival and the clinical responsiveness to chemotherapy, were analysed with the logistic regression. We observed a bcl-2 expression in tumor cells in 25% of the cases. Molecular genetic analysis of the bcl-2 gene was performed for all the bcl-2 immunohistochimical positive cases. No traslocation t(14;18)(q32;q21) of the gene bcl-2 were found. The bcl-2 over-expression was found to be a significant independent predictor of responsiveness to chemotherapy (p = 0.04), but it was not correlated with the overall survival of the ovarian cancer patients. The prognostic value of bcl-2 espression may help in the management of ovarian cancer patients permitting the selection of more aggressive first line chemotherapy. In addition, the knowledge of the molecular mechanism, which is responsible of the over-expression of bcl-2, may help in the understanding of mechanisms responsible for chemoresistance. Further studies in this area will help clarify this therapeutic possibility.