Immunohistochemical study of p16INK4Aand survivin expressions in cervical squamous neoplasm

Prognostic impact of human papillomavirus infection on cervical dysplasia, cancer, and patient survival in Saudi Arabia: A 10-year retrospective analysis

BACKGROUND

Data on human papillomavirus (HPV) prevalence and survival rates among HPV-infected women are scarce in Saudi Arabia.

OBJECTIVE

Assess the prevalence of HPV genotypes in cervical biopsy specimens and its effect on survival over a 10-year timeframe.

DESIGN

Retrospective, cross-sectional.

SETTINGS

Saudi referral hospital.

PATIENTS AND METHODS

Cervical biopsy specimens were collected from women aged 23-95 years old who underwent HPV detection, HPV genotyping, p16^INK4a expression measurement using immunohistochemistry. Kaplan-Meier plots were constructed to analyze overall survival rates.

MAIN OUTCOME MEASURES

Survival rate of HPV-positive cervical cancer patients.

SAMPLE SIZE

315 cervical biopsy specimens.

RESULTS

HPV was detected in 96 patients (30.4%): 37.3% had cervical cancer; 14.2% cervical intraepithelial neoplasia (CIN) III, 4.1% CIN II, and 17.0% CIN I. A significant association was found between HPV presence and cervical cancer (χ²=56.78; P<.001). The expression of p16^INK4a was a significant predictor of survival: women who had p16^INK4a overexpression had poorer survival rates (multivariate Cox regression, hazard ratio, 3.2; 95% CI, 1.1-8.8). In addition, multivariate models with HPV status and cervical cancer diagnosis showed that HPV status was a significant predictor of survival: HPV-positive women had better survival rates than HPV-negative women.

CONCLUSION

These findings suggest that implementing cervical and HPV screening programs may decrease cervical cancer rates and improve survival rates of women in Saudi Arabia.

LIMITATION

Single center and small sample size.

CONFLICT OF INTEREST

None.

Expression of p16INK4A Protein in Cervical Intraepithelial Neoplasia and Invasive Carcinoma of Uterine Cervix

Introduction

Cervical cancer still ranks as the most frequent cancer among women in India. Infection with Human Papilloma Virus (HPV) results in precancerous lesions and invasive cervical cancer. Interaction of HPV oncogenic proteins with cellular regulatory proteins leads to upregulation of p16INK4A, a cyclin dependent kinase inhibitor. Therefore, p16INK4A overexpression is a surrogate biomarker of HPV infection making it useful in evaluating HPV associated premalignant and malignant lesions of gynaecological tract.

Aim

This study was conducted to evaluate the usefulness of p16INK4A as a biomarker in dysplastic and malignant alteration of cervical epithelium.Materials and Methods: A total of 57 specimens diagnosed histopathologically as cervical dysplasia or malignancy were included in this prospective study of two year duration. Immunohistochemical (IHC) study of p16INK4A expression was performed on normal cervical tissue samples, Cervical Intraepithelial Neoplasia (CIN) 1, CIN 2, CIN 3, squamous cell carcinoma, adenocarcinoma. Expression was scored by two methods. One was simple positive versus negative p16INK4A staining and the other method was a semi-quantitative IHC scoring (0 to 8 points) according to the intensity of staining and the proportion of stained cells. The collected data was entered in excel sheet and analysed using Statistical Package For Social Science (SPSS) 16.0 software and the descriptive statistics, Chi-square test. The p-value of <0.05 was considered statistically significant.

Results

Nuclear and/or cytoplasmic p16INK4A immunoreactivity was absent in normal cervical tissue, while immunopositivity was 25% in CIN 1, 50% in CIN 2, 75% in CIN 3, 75% and 100% in squamous cell carcinoma and adenocarcinoma respectively. All normal cervical samples had low scores (0 to 2 points), while number of cases with high scores was proportional to the degree of cervical dysplasia or invasive carcinoma. p16INK4A immunostaining with higher expression (score>5) was observed in 75% cases of carcinoma cervix.

Conclusion

IHC expression of p16INK4A is related to degree of histological dysplasia and malignancy, suggesting its prognostic and predictive value in the management of cervical cancers.

Clinicopathological significance of survivin expression in patients with cervical cancer: A systematic meta-analysis

BACKGROUND

Survivin has been shown to play an important role in cancer pathogenesis. However, its role in cervical cancer development is still controversial. This study was performed to evaluate the clinical significance of survivin expression in cervical cancer.

METHODS

Search of some online electronic databases was conducted to identify available studies. The pooled odds ratios (ORs) with its 95% confidence intervals (CIs) were calculated and analyzed.

RESULTS

Finally, 18 eligible studies with 791 cervical cancer patients, 1,013 cervical intraepithelial neoplasia (CIN) lesions, 199 normal cervical tissues, and 95 samples with chronic cervicitis were identified in this analysis. The pooled OR of survivin expression was found to be significantly higher in the samples from cervical cancer than in those from CIN lesions, normal cervical tissues, and chronic cervicitis. When cervical cancer was compared to CIN lesions, the subgroup analysis by ethnicity showed that survivin expression was associated with a risk of cervical cancer in Asians (P < 0.001), but not in Caucasians (P = 0.659). In addition, survivin was significantly more overexpressed in high-grade cervical cancer than in low-grade cervical cancer. Its expression was also more elevated in advanced-stage patients than in early-stage patients, in lymph node metastasis than in lymph node without metastasis, and in squamous cell carcinoma (SCC) than in adenocarcinoma (AC).

CONCLUSIONS

The expression of survivin may play a key role in the carcinogenesis, progression, and metastasis of cervical cancer. However, survivin expression may be involved in the progression of CIN lesions only in the Asian population. Survivin expression is associated with an increased risk of SCC. Additional studies with larger sample sizes are needed in the future to confirm our findings.

Role of p16, CK17, p63, and human papillomavirus in diagnosis of cervical intraepithelial neoplasia and distinction from its mimics

BACKGROUND

Diagnosis of cervical intraepithelial neoplasia (CIN), the precursor forms of cervical cancer, can be tricky and it has led to discrepancy between pathologists in distinguishing them from its mimics such as atypical immature metaplasia (AIM), immature squamous metaplasia (ISM), reactive atypia (RA), atrophy, and basal cell hyperplasia (BCH). To overcome this problem this study aims at using immunohistochemical (IHC) markers p16, p63, CK17, and human papillomavirus (HPV) to differentiate CIN from its mimics.

MATERIALS AND METHODS

This study analyzed 350 cervical samples with histomorphological diagnosis of CIN and its mimics and the utility of IHC markers p16, p63, CK17, and HPV in distinction was analyzed.

RESULTS

p16 showed 67.76% sensitivity and 99.4% specificity whereas HPV showed 57.9% sensitivity and 91.6% specificity in detecting CIN. CK17 and p63 did not show any significance in distinguishing CIN from its mimics. After IHC of AIM cases, 66.7% were reclassified as CIN III, 27.8% as ISM with reactive atypia (ISMRA), and 5.5% case as immature condyloma. In total, 3.7% of diagnosis was upgraded to CIN and 0.6% of pre-IHC diagnosis was downgraded from CIN to reactive lesions.

CONCLUSION

IHC panel comprising p16, p63, CK17, and HPV are useful adjuncts in distinguishing CIN from its mimics particularly when histomorphology has overlapping morphological features.

Scoring system and management algorithm assessing the role of survivin expression in predicting progressivity of HPV infections in precancerous cervical lesions

BACKGROUND

To identify the risk factors and assess the role of survivin in predicting progessivity precancerous cervical lesions.

MATERIALS AND METHODS

This case-control study was conducted from October 2009 until May 2010. We obtained 74 samples, classified according to the degree of cervical intraepithelial neoplasia (CIN): 19 samples for CIN 1, 18 samples for CIN 2, 18 samples for CIN 3, and 19 samples as controls. Demographic profiles and risk factors assesment, histopathologic examination, HPV DNA tests, immunocytochemistry (ICC) and immunohistochemistry (IHC) staining for survivin expression were performed on all samples. Data was analyzed with bivariate and multivariate analysis.

RESULTS

Multivariate analysis revealed significant risk factors for developing precancerous cervical lesions are age <41 years, women with ≥2 sexual partners, course of education ≥13 years, use of oral contraceptives, positive high-risk HPV DNA, and high survivin expression by ICC or IHC staining. These factors were fit to a prediction model and we obtained a scoring system to predict the progressivity of CIN lesions.

CONCLUSIONS

Determination of survivin expression by immunocytochemistry staining, along with other significant risk factors, can be used in a scoring system to predict the progressivity of CIN lesions. Application of this scoring system may be beneficial in determining the action of therapy towards the patient.

Expression of survivin, CD117, and C-erbB-2 in neuroendocrine carcinoma of the uterine cervix

OBJECTIVE

To evaluate the expression and prognostic significance of survivin, CD117, and C-erbB-2 in neuroendocrine carcinoma of the uterine cervix.

MATERIALS AND METHODS

Immunohistochemical stains of survivin, CD117, and C-erbB-2 were evaluated in 100 cases of cervical neuroendocrine carcinoma. The findings were correlated with clinicopathologic variables and disease-free survival.

RESULTS

Expressions of survivin, CD117, and C-erbB-2 were detected in 27.0%, 12.0%, and 2.0% of the cases, respectively. Survivin-positive patients had a significantly younger mean age than the survivin-negative group (P=0.033). In early-stage cases, tumor recurrence was significantly associated with lymph node metastasis (P=0.005), depth of invasion (P=0.028), and the presence of lymphovascular space invasion (P=0.031) but not with the expression of survivin or CD117. Subgroup analysis in early-stage cases without lymph node metastasis (n=32) showed that only survivin expression had a significant association with decreased disease-free survival (P=0.041).

CONCLUSIONS

Survivin expression may be a prognostic indicator for survival in early-stage neuroendocrine carcinoma of the uterine cervix without lymph node metastasis. Adjuvant survivin-targeted therapy may have potential benefit in patients with this tumor.