RESUMO
Platinum-based, arterial infusion chemotherapy as a neoadjuvant chemotherapy (NACT) followed by hysterectomy may be efficient for the treatment of locally advanced cervical cancer and improve prognosis. It is important to predict whether the NACT would be effective before it is launched. Hypoxia inducible factor-1α (HIF-1α) is the master transcriptional regulator of the cellular response to altered oxygen concentration. HIF-1α protein expression is elevated in numerous human malignancies, contributes to poor disease outcome, and has been reported to induce tumorigenesis and chemoresistance. In the present study, patients with International Federation of Gynecology and Obstetrics stage IIB-IIIB cervical cancer (n=59) between 2008 and 2014 were assessed for HIF-1α expression by immunohistochemistry. Tumor samples were obtained by biopsy before any treatment. A double-path chemotherapy regimen, paclitaxel (intravenous) plus cisplatin (intra-arterial injection into the uterine region), was used as NACT. The patients were then separated into two groups according to NACT response: One group comprised patients with NACT, for whom the response to treatment was efficient resulting in complete/partial remission of the tumor (CR + PR group; n=52), the other group contained patients with NACT, for whom the result of the treatment was a stable/progressive disease (SD + PD group; n=7). HIF-1α expression was tested in paraffin-embedded sections using immunohistochemistry. HIF-1α expression was significantly higher in the SD + PD group compared with the CR + PR group (P=0.029). The overall survival time was significantly longer in the CR + PR group compared with the SD + PD group (P<0.001). When the patients were divided into two groups based on HIF-1α expression levels. Low (weighted score ≤4, n=39) and high (weighted score ≥6, n=20) expression level groups; the low HIF-1α expression group was significantly more susceptible to NACT treatment (P=0.025). Cox hazard analysis revealed that a high level of HIF-1α expression and lymph node metastases were significant independent predictors of poor overall survival (P=0.025, HR=6.354; P=0.020, HR=6.909, respectively). These results indicated that the expression of HIF-1α may be able to predict the efficiency of NACT and may be considered an independent prognostic factor for stage IIB-IIIB cervical cancer.
RESUMO
OBJECTIVE: To study the clinical characteristics, treatment modalities and prognosis of cervical adenosquamous carcinoma. METHODS: The data of 21 patients with adenosquamous cervical cancer who were admitted into Zhongnan Hospital, Wuhan University from Jan 2001 to Dec 2005 were analyzed retrospectively. Six patients received surgical therapy only and 15 patients received combined therapy. RESULTS: Seven cases were with positive pelvic lymph node metastases and 3 cases were with ovarian metastases. The median survival time of the combined therapy group and surgical therapy group was 54 and 20 months, respectively. In stage I and stage II patients, the median survival time of the combined therapy group and surgical therapy group was 66 and 20 months, respectively. The difference was significant between the two groups (P < 0.05). CONCLUSIONS: Combined therapy should be given to patients with adenosquamous carcinoma of the cervix. Surgical therapy and chemotherapy play an important role in the management and prognosis of adenoquamous carcinoma of cervix. Preserve of ovary for patients with adenosquamous carcinoma of the cervix should only be done when the ovary is confirmed free from any malignant involvement by pathology.