HIF1a, Ki-67, CA-9, GLUT1 expression do not predict outcomes in advanced cervical cancer

A recent study has shown that hypoxia inducible factor 1a (HIF1a), Ki-67, carbonic anhydrase-9 (CA-9), and glucose transporter 1 (GLUT1) protein expression are not predictive of treatment response or outcomes in locally advanced cervical cancer patients treated definitively with chemoradiation therapy. In addition, a nonstatistically significant trend towards worse outcomes has been observed with p53 expression.

Three pathologists, blinded to treatment outcomes, assessed and scored 28 patients treated definitively and consecutively for cervical cancer with chemoradiation therapy had p53, HIF1a, Ki-67, CA-9, and GLUT1 protein expression. Outcomes were stratified as follows: p53 (H-score: <15 vs ≥15), HIF1a (H-score: <95 vs ≥95), Ki-67 (labeling index: <41 percent vs ≥41 percent), CA-9 (H-score: <15 vs ≥15), and GLUT1 (H-score: <175 vs ≥175) expression.

The authors calculated overall survival (OS), progression-free survival (PFS), local-regional control (LC), and distant metastases-free survival (DMFS) using the Kaplan-Meier method, and evaluated differences between groups using the log-rank test.

Clinical characteristics of the cohort were as follows: median age, 51 years; FIGO stage IIB disease, 57.2 percent; clinical node-negative disease, 64.3 percent; squamous cell carcinoma, 89.3 percent; adenocarcinoma, 10.7 percent. Five-year OS was 57.2 percent, PFS 48.1 percent, LC 72.1 percent, and DMFS 62.9 percent.

Survival was comparable across gene expressions. For HIF1a H-score <95 and ≥95, the 5-year OS (52.0 percent and 68.4 percent; p=0.58), PFS (53.0 percent and 40.9 percent; p=0.75), LC (71.6 percent and 68.2 percent; p=0.92), and DMFS (59.7 percent and 52.0 percent; p=0.91) were not significantly different. For Ki-67 labeling index <41 percent and ≥41 percent, no significant difference was seen in the 5-year OS (44.9 percent and 66.6 percent; p=0.35), PFS (38.9 percent and 55.4 percent; p=0.53), LC (57.7 percent and 85.7 percent; p=0.22), and DMFS (67.3 percent and 61.0 percent; p=0.94).

The 5-year OS (54.4 percent and 66.7 percent; p=0.39), PFS (57.3 percent and 40.0 percent; p=0.87), LC (70.0 percent and 70.0 percent; p=0.95), and DMFS (70.0 percent and 46.7 percent; p=0.94) for CA-9 H-score <15 and ≥15 were also statistically comparable. For GLUT1 H-score <175 and ≥175, the 5-year OS (43.6 percent and 43.6 percent, P=0.32), PFS (55.6 percent and 49.5 percent; p=0.72), LC (72.9 percent and 71.5 percent; p=0.97), and DMFS (62.5 percent and 59.6 percent; p=0.76) were likewise not significantly different.

For p53 H-score <15 and ≥15, the 5-year OS was 62 percent and 53 percent, PFS 63 percent and 30.3 percent, LC 87.5 percent and 52 percent, and DMFS 79.6 percent and 41.6 percent, respectively.