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Tóth Z, Lőczi L, Sebők B, Merkely P, Keszthelyi E, Lintner B, Ács N, Keszthelyi A, Várbíró S, Tóth R, Keszthelyi M. Neutrophil/Lymphocyte Ratio (NLR) as a Predictive Marker for p16 Positivity and Cervical Cancer Progression: Insights from the SCOPE Study. Cancers (Basel) 2025; 17:921. [PMID: 40149258 PMCID: PMC11939862 DOI: 10.3390/cancers17060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 02/28/2025] [Accepted: 03/04/2025] [Indexed: 03/29/2025] Open
Abstract
Background: Cervical cancer, primarily driven by persistent high-risk human papillomavirus (HPV) infections, remains a significant global health challenge. Systemic inflammatory markers, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR), may reflect disease progression. This study examines the association between these markers and p16 positivity in cervical intraepithelial neoplasia (CIN) cases. Methods: This retrospective analysis included 395 patients undergoing LEEP conization. Data on HPV status, p16 immunostaining, and hematological parameters were collected. Statistical analyses, including Mann-Whitney U and chi-square tests, assessed relationships between markers and outcomes, with significance set at p < 0.05. Results: Elevated NLR was significantly associated with p16 positivity (p = 0.011) and HPV DNA positivity (p = 0.04). HPV-positive individuals showed higher mean NLR (2.15) compared to HPV-negative individuals (1.61). Receiver operating characteristic (ROC) analysis demonstrated moderate diagnostic accuracy for NLR (AUC = 0.610), highlighting its potential as a biomarker. No significant associations were observed for PLR or LMR with p16 positivity. These findings suggest systemic inflammation, indicated by NLR, contributes to HPV persistence and CIN progression. Conclusions: NLR is a valuable prognostic biomarker for HPV-related cervical disease, correlating with both p16 and HPV DNA positivity. Incorporating hematological and immunohistochemical markers may enhance personalized cervical cancer management.
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Affiliation(s)
- Zsófia Tóth
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Lotti Lőczi
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Barbara Sebők
- Workgroup of Research Management, Doctoral School, Semmelweis University, 1085 Budapest, Hungary;
| | - Petra Merkely
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Emese Keszthelyi
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Balázs Lintner
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Attila Keszthelyi
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary;
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
- Workgroup of Research Management, Doctoral School, Semmelweis University, 1085 Budapest, Hungary;
- Department of Obstetrics and Gynecology, University of Szeged, 6725 Szeged, Hungary
| | - Richárd Tóth
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
| | - Márton Keszthelyi
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (Z.T.); (L.L.); (P.M.); (E.K.); (B.L.); (N.Á.); (S.V.); (R.T.)
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Wu J, Wang R, Chen W, Wu Y, Xiao L. Immunohistochemical markers Ki67 and P16 help predict prognosis in locally advanced cervical cancer. Eur J Obstet Gynecol Reprod Biol 2024; 294:210-216. [PMID: 38301499 DOI: 10.1016/j.ejogrb.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To investigate the relationship between Ki-67 and P16 expression levels after neoadjuvant chemotherapy, and the clinicopathological characteristics and prognosis of patients with locally advanced cervical cancer. METHODS Patients with FIGO 2009 stage IB2 or IIA2 cervical cancer, who underwent neoadjuvant chemotherapy combined with radical hysterectomy at the First Affiliated Hospital of Chongqing Medical University between January 2015 and December 2019, were identified retrospectively to correlate postoperative Ki-67 and P16 expression levels with clinicopathological factors. The optimal threshold for predicting recurrence was analysed using receiver operating characteristic (ROC) curves for the Ki-67 index, and univariate and multi-factorial Cox regression analysis were used to investigate the association between clinicpathological features including Ki-67 and P16 and recurrence-free survival. RESULTS In total, 334 patients were included after screening. The cut-off value of Ki-67 for determining recurrence was 67.5 % according to the ROC curve. On multi-factorial Cox analysis, lymphatic vascular space (p = 0.003) and Ki-67 index (p = 0.005) were shown to increase the risk of recurrence, and were independent prognostic factors for recurrence, while the expression of P16 was not significantly associated with the risk of recurrence (p = 0.097, odds ratio = 0.319). Patients with cervical cancer in the high Ki-67 expression group (Ki-67 ≥ 67.5 %) had lower recurrence-free survival and overall survival than patients in the low Ki-67 expression group (Ki-67 < 67.5 %) (p = 0.001 and 0.036, respectively). CONCLUSION The expression levels of Ki-67 and P16 after neoadjuvant chemotherapy for locally advanced cervical cancer correlated with tumour differentiation. High expression of Ki-67 (Ki-67 ≥ 67.5 %) may indicate poorer recurrence-free survival and overall survival.
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Affiliation(s)
- Jialin Wu
- Department of Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Wang
- Department of Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanli Chen
- Department of Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingyu Wu
- Department of Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Xiao
- Department of Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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da Mata S, Ferreira J, Nicolás I, Esteves S, Esteves G, Lérias S, Silva F, Saco A, Cochicho D, Cunha M, del Pino M, Ordi J, Félix A. P16 and HPV Genotype Significance in HPV-Associated Cervical Cancer-A Large Cohort of Two Tertiary Referral Centers. Int J Mol Sci 2021; 22:ijms22052294. [PMID: 33669021 PMCID: PMC7956391 DOI: 10.3390/ijms22052294] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023] Open
Abstract
The expression of p16 is a good surrogate of human papillomavirus (HPV) infection in HPV-associated cancers. The significance of p16 expression, HPV genotype and genera in the outcome of patients with HPV-associated cervical cancer (CC) is unclear. Our aim is to ascertain the prognostic significance of these factors. Data from 348 patients (median age: 47.5 years old) with CC, diagnosed in two referral centers, were retrospectively collected. Advanced disease (FIGO2018 IB2-IV) was present in 68% of patients. A single HPV genotype was identified in 82.8% of patients. The most common HPVs were HPV16 (69%) and HPV18 (14%). HPV genera reflected this distribution. HPV16 tumors presented at an earlier stage. P16 was negative in 18 cases (5.2%), 83.3% of which were squamous cell carcinomas. These cases occurred in older patients who tended to have advanced disease. In the univariate analysis, HPV16 (HR: 0.58; p = 0.0198), α-9 genera (HR: 0.37; p = 0.0106) and p16 overexpression (HR: 0.54; p = 0.032) were associated with better survival. HPV16 (HR: 0.63; p = 0.0174) and α-9 genera (HR: 0.57; p = 0.0286) were associated with less relapse. In the multivariate analysis, only the International Federation of Gynecology and Obstetrics (FIGO) stage retained an independent prognostic value. HPV16, α-9 genera and p16 overexpression were associated with better survival, although not as independent prognostic factors. Patients with p16-negative HPV-associated CC were older, presented with advanced disease and had worse prognosis.
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Affiliation(s)
- Sara da Mata
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (S.d.M.); (J.F.); (S.L.)
- Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal;
| | - Joana Ferreira
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (S.d.M.); (J.F.); (S.L.)
- Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal;
| | - Inmaculada Nicolás
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (I.N.); (M.d.P.)
| | - Susana Esteves
- Clinical Investigation Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal;
| | - Gonçalo Esteves
- Department of Pathology, Centro Hospitalar e Universitário de Lisboa Central, 1150-199 Lisboa, Portugal;
| | - Sofia Lérias
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (S.d.M.); (J.F.); (S.L.)
| | - Fernanda Silva
- Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal;
| | - Adela Saco
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (A.S.); (J.O.)
| | - Daniela Cochicho
- Department of Virology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (D.C.); (M.C.)
| | - Mário Cunha
- Department of Virology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (D.C.); (M.C.)
| | - Marta del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic—Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (I.N.); (M.d.P.)
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (A.S.); (J.O.)
- Institut de Salut Global de Barcelona (ISGlobal), 08036 Barcelona, Spain
| | - Ana Félix
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal; (S.d.M.); (J.F.); (S.L.)
- Nova Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal;
- Correspondence:
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Veena MS, Raychaudhuri S, Basak SK, Venkatesan N, Kumar P, Biswas R, Chakrabarti R, Lu J, Su T, Gallagher-Jones M, Morselli M, Fu H, Pellegrini M, Goldstein T, Aladjem MI, Rettig MB, Wilczynski SP, Shin DS, Srivatsan ES. Dysregulation of hsa-miR-34a and hsa-miR-449a leads to overexpression of PACS-1 and loss of DNA damage response (DDR) in cervical cancer. J Biol Chem 2020; 295:17169-17186. [PMID: 33028635 PMCID: PMC7863911 DOI: 10.1074/jbc.ra120.014048] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
We have observed overexpression of PACS-1, a cytosolic sorting protein in primary cervical tumors. Absence of exonic mutations and overexpression at the RNA level suggested a transcriptional and/or posttranscriptional regulation. University of California Santa Cruz genome browser analysis of PACS-1 micro RNAs (miR), revealed two 8-base target sequences at the 3' terminus for hsa-miR-34a and hsa-miR-449a. Quantitative RT-PCR and Northern blotting studies showed reduced or loss of expression of the two microRNAs in cervical cancer cell lines and primary tumors, indicating dysregulation of these two microRNAs in cervical cancer. Loss of PACS-1 with siRNA or exogenous expression of hsa-miR-34a or hsa-miR-449a in HeLa and SiHa cervical cancer cell lines resulted in DNA damage response, S-phase cell cycle arrest, and reduction in cell growth. Furthermore, the siRNA studies showed that loss of PACS-1 expression was accompanied by increased nuclear γH2AX expression, Lys382-p53 acetylation, and genomic instability. PACS-1 re-expression through LNA-hsa-anti-miR-34a or -449a or through PACS-1 cDNA transfection led to the reversal of DNA damage response and restoration of cell growth. Release of cells post 24-h serum starvation showed PACS-1 nuclear localization at G1-S phase of the cell cycle. Our results therefore indicate that the loss of hsa-miR-34a and hsa-miR-449a expression in cervical cancer leads to overexpression of PACS-1 and suppression of DNA damage response, resulting in the development of chemo-resistant tumors.
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Affiliation(s)
- Mysore S Veena
- Department of Surgery, VAGLAHS West Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Santanu Raychaudhuri
- Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Saroj K Basak
- Department of Surgery, VAGLAHS West Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Natarajan Venkatesan
- Department of Surgery, VAGLAHS West Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Parameet Kumar
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Roopa Biswas
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rita Chakrabarti
- Department of Surgery, VAGLAHS West Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jing Lu
- Department of Molecular, Cell, and Developmental Biology, UCLA, Los Angeles, California, USA
| | - Trent Su
- Institute for Quantitative and Computational Biology and Department of Biological Chemistry, UCLA, Los Angeles, California, USA
| | | | - Marco Morselli
- Department of Molecular, Cell, and Developmental Biology, UCLA, Los Angeles, California, USA
| | - Haiqing Fu
- Developmental Therapeutics Branch, Center for Cancer Research, NCI, National Institutes of Health, Bethesda, Maryland, USA
| | - Matteo Pellegrini
- Department of Molecular, Cell, and Developmental Biology, UCLA, Los Angeles, California, USA
| | - Theodore Goldstein
- Institute of Computational Sciences, University of California San Francisco, San Francisco, California, USA
| | - Mirit I Aladjem
- Developmental Therapeutics Branch, Center for Cancer Research, NCI, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew B Rettig
- Department of Medicine, VAGLAHS/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sharon P Wilczynski
- Department of Pathology, City of Hope Medical Center, Duarte, California, USA
| | - Daniel Sanghoon Shin
- Department of Medicine, VAGLAHS/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Eri S Srivatsan
- Department of Surgery, VAGLAHS West Los Angeles and David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Nicolás I, Saco A, Barnadas E, Marimon L, Rakislova N, Fusté P, Rovirosa A, Gaba L, Buñesch L, Gil-Ibañez B, Pahisa J, Díaz-Feijoo B, Torne A, Ordi J, Del Pino M. Prognostic implications of genotyping and p16 immunostaining in HPV-positive tumors of the uterine cervix. Mod Pathol 2020; 33:128-137. [PMID: 31492932 DOI: 10.1038/s41379-019-0360-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/09/2022]
Abstract
Human papillomaviruses (HPVs) are the causative agents of carcinoma of the uterine cervix. A number of HPV genotypes have been associated with cervical cancer and almost all tumors associated with HPV show strong p16 expression. However, there is little information on the possible impact of the HPV genotype and p16 immunostaining on the clinicopathological features or their prognostic value in cervical carcinoma. We evaluated a series of 194 patients with HPV-positive cervical cancers treated at our institution, focusing on the clinicopathological features and the relationship of the HPV genotypes and p16 immunostaining with the prognosis. A single HPV type was identified in 149 (77%) tumors, multiple HPV infection was detected in 30 cases (15%), and undetermined HPV type/s were identified in 15 (8%) carcinomas. HPV 16 and/or 18 were detected in 156 (80%) tumors. p16 was positive in 186 (96%) carcinomas, but eight tumors (4%) were negative for p16 (seven squamous cell carcinomas, one adenocarcinoma); 5/8 caused by HPV 16 and/or 18. Patients with HPV 16 and/or 18 were younger (49 ± 15 vs. 57 ± 17 years, p < 0.01) and more frequently had nonsquamous tumors than patients with other HPV types (24% [37/156] vs. 0% [0/38]; p = 0.01). Neither the HPV type nor multiple infection showed any prognostic impact. Patients with p16-negative tumors showed a significantly worse overall survival than women with p16-positive carcinomas (45 vs. 156 months, p = 0.03), although no significant differences in disease-free survival were observed. In the multivariate analysis, negative p16 immunostaining was associated with a worse overall survival together with advanced FIGO stage and lymph node metastases. In conclusion, the HPV genotype has limited clinical utility and does not seem to have prognostic value in cervical cancer. In contrast, a negative p16 result in patients with HPV-positive tumors is a prognostic marker associated with a poor overall survival.
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Affiliation(s)
- Inmaculada Nicolás
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esther Barnadas
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Lorena Marimon
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Natalia Rakislova
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Pere Fusté
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Angeles Rovirosa
- Department of Radiation Oncology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lydia Gaba
- Department of Medical Oncology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Buñesch
- Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Blanca Gil-Ibañez
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jaume Pahisa
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Aureli Torne
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Fu HC, Chuang IC, Yang YC, Chuang PC, Lin H, Ou YC, Chang Chien CC, Huang HS, Kang HY. Low P16 INK4A Expression Associated with High Expression of Cancer Stem Cell Markers Predicts Poor Prognosis in Cervical Cancer after Radiotherapy. Int J Mol Sci 2018; 19:ijms19092541. [PMID: 30150594 PMCID: PMC6164400 DOI: 10.3390/ijms19092541] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/08/2018] [Accepted: 08/24/2018] [Indexed: 01/13/2023] Open
Abstract
Previous studies have suggested that cancer stem cells (CSCs) resisted radiotherapy and chemotherapy. P16INK4A is a biomarker for cervical carcinogenesis and reduces proliferation of stem cells. We aimed to investigate the expression and clinical significance of cyclin-dependent kinase inhibitor 2A (P16INK4A), sex determining region Y-box 2 (SOX2), and Aldehyde dehydrogenase 1 family, member A1 (ALDH1A1) in cervical cancer treated with radiotherapy and cervical cell line models. The expressions of P16INK4A, SOX2, and ALDH1A1 were performed by immunohistochemical staining of tumor samples from 139 cervical cancer patients with International Federation of Gynecology and Obstetrics stages Ib to IV. The staining showed high expression in 100, 107, and 13 patients with P16INK4A (>80%), SOX2 (≥10%), and ALDH1A1 (50%), respectively. The high-P16INK4A group had a higher five-year overall survival (OS) rate and disease-free survival (DFS) than the low-P16INK4A group (OS: 62.0% and 35.2%, p = 0.016; DFS: 60.0% and 31.2%, p = 0.002). The low-P16INK4A/high-SOX2 and low-P16INK4A/high-ALDH1A1 groups had a worse five-year OS and DFS rate than the high-P16INK4A/low-SOX2 and high-P16INK4A/low-ALDH1A1 groups, respectively. Depletion of P16INK4A promoted chemoresistance and radioresistance of cervical cancer cells increased the expression of SOX2 and ALDH1A1 and exhibited higher self-renewal ability. These results suggest that lower P16INK4A expression associated with higher CSC markers predicts poor prognostic outcomes and is a promising target in patients with cervical cancer.
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Affiliation(s)
- Hung-Chun Fu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - I-Chieh Chuang
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Yi-Chien Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Pei-Chin Chuang
- Stem Cell Research Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Chan-Chao Chang Chien
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Hui-Shan Huang
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
| | - Hong-Yo Kang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
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Tong R, Yang Q, Wang C, Bi F, Jiang B. OVCA1 expression and its correlation with the expression levels of cyclin D1 and p16 in cervical cancer and intraepithelial neoplasia. Oncol Lett 2017; 13:2929-2936. [PMID: 28521400 PMCID: PMC5431343 DOI: 10.3892/ol.2017.5848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/02/2016] [Indexed: 11/08/2022] Open
Abstract
The present study aimed to examine the associations between the protein and mRNA expression levels of ovarian cancer gene 1 (OVCA1), cyclin D1 and p16 and high-risk human papillomavirus (HR-HPV) infection in cervical lesions. The protein expression levels of OVCA1, cyclin D1 and p16 in 66 cases of cervical cancer, 64 cases of cervical intraepithelial neoplasia (CIN) and 34 normal cervix tissues were detected using immunohistochemistry. The mRNA expression levels of OVCA1, cyclin D1 and p16 in cervical cancer and normal cervix cells were detected using real-time polymerase chain reaction. The results revealed that the protein expression levels of OVCA1 increased gradually, whereas its mRNA expression levels decreased gradually, in the progression from normal cervix tissue to CIN and cervical cancer (P<0.01). In addition, significant differences in the protein expression levels of OVCA1 between low-and high-level CIN, as well as between the early and advanced stages of cervical cancer, were observed (P<0.05). No significant associations were detected between the protein and mRNA expression levels of OVCA1 and the pathological type of cervical cancer or the presence of lymph node metastasis (P>0.05). The expression levels of OVCA1 mRNA and protein were positively correlated with the levels of p16 expression (P<0.01). Significant differences were also observed in the OVCA1 protein and mRNA expression levels between the HR-HPV (+) and HR-HPV (−) groups (P<0.05). Therefore, aberrant expression of OVCA1 protein and mRNA may be important during the development of cervical lesions, particularly in the early stages. In addition, the mechanisms underlying the effects of OVCA1 during cervical cancer development may involve p16 and HPV, as the levels of OVCA1 in cervical lesions were correlated with abnormal expression of p16 and HR-HPV infection.
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Affiliation(s)
- Rui Tong
- Ward One of Minimally Invasive Gynecology, Nanhu Branch of Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China.,Ward Four of Tumor Gynecology, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Qing Yang
- Ward One of Minimally Invasive Gynecology, Nanhu Branch of Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Chunyan Wang
- Ward Four of Tumor Gynecology, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Fangfang Bi
- Ward One of Minimally Invasive Gynecology, Nanhu Branch of Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Bing Jiang
- Pathology Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
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De Rienzo A, Archer MA, Yeap BY, Dao N, Sciaranghella D, Sideris AC, Zheng Y, Holman AG, Wang YE, Dal Cin PS, Fletcher JA, Rubio R, Croft L, Quackenbush J, Sugarbaker PE, Munir KJ, Battilana JR, Gustafson CE, Chirieac LR, Ching SM, Wong J, Tay LC, Rudd S, Hercus R, Sugarbaker DJ, Richards WG, Bueno R. Gender-Specific Molecular and Clinical Features Underlie Malignant Pleural Mesothelioma. Cancer Res 2015; 76:319-28. [PMID: 26554828 DOI: 10.1158/0008-5472.can-15-0751] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/19/2015] [Indexed: 12/29/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive cancer that occurs more frequently in men, but is associated with longer survival in women. Insight into the survival advantage of female patients may advance the molecular understanding of MPM and identify therapeutic interventions that will improve the prognosis for all MPM patients. In this study, we performed whole-genome sequencing of tumor specimens from 10 MPM patients and matched control samples to identify potential driver mutations underlying MPM. We identified molecular differences associated with gender and histology. Specifically, single-nucleotide variants of BAP1 were observed in 21% of cases, with lower mutation rates observed in sarcomatoid MPM (P < 0.001). Chromosome 22q loss was more frequently associated with the epithelioid than that nonepitheliod histology (P = 0.037), whereas CDKN2A deletions occurred more frequently in nonepithelioid subtypes among men (P = 0.021) and were correlated with shorter overall survival for the entire cohort (P = 0.002) and for men (P = 0.012). Furthermore, women were more likely to harbor TP53 mutations (P = 0.004). Novel mutations were found in genes associated with the integrin-linked kinase pathway, including MYH9 and RHOA. Moreover, expression levels of BAP1, MYH9, and RHOA were significantly higher in nonepithelioid tumors, and were associated with significant reduction in survival of the entire cohort and across gender subgroups. Collectively, our findings indicate that diverse mechanisms highly related to gender and histology appear to drive MPM.
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Affiliation(s)
- Assunta De Rienzo
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
| | - Michael A Archer
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nhien Dao
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Daniele Sciaranghella
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Antonios C Sideris
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Yifan Zheng
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Alexander G Holman
- Center for Cancer Computational Biology, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, Massachusetts
| | - Yaoyu E Wang
- Center for Cancer Computational Biology, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, Massachusetts
| | - Paola S Dal Cin
- Departments of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Jonathan A Fletcher
- Departments of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Renee Rubio
- Center for Cancer Computational Biology, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, Massachusetts
| | - Larry Croft
- Malaysian Genomics Resource Centre, Kuala Lumpur, Malaysia
| | - John Quackenbush
- Center for Cancer Computational Biology, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard School of Public Health, Boston, Massachusetts
| | - Peter E Sugarbaker
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Kiara J Munir
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Jesse R Battilana
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Corinne E Gustafson
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Lucian R Chirieac
- Departments of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Soo Meng Ching
- Malaysian Genomics Resource Centre, Kuala Lumpur, Malaysia
| | - James Wong
- Malaysian Genomics Resource Centre, Kuala Lumpur, Malaysia
| | | | - Stephen Rudd
- Malaysian Genomics Resource Centre, Kuala Lumpur, Malaysia
| | - Robert Hercus
- Malaysian Genomics Resource Centre, Kuala Lumpur, Malaysia
| | - David J Sugarbaker
- Debakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - William G Richards
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Raphael Bueno
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program, Division of Thoracic Surgery and the Lung Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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