Abstract

<div>Abstract<p><b>Purpose:</b> Presence of pelvic lymph node metastases is the main prognostic factor in early-stage cervical cancer patients, primarily treated with surgery. Aim of this study was to identify cellular tumor pathways associated with pelvic lymph node metastasis in early-stage cervical cancer.</p><p><b>Experimental Design:</b> Gene expression profiles (Affymetrix U133 plus 2.0) of 20 patients with negative (N<sub>0</sub>) and 19 with positive lymph nodes (N<sub>+</sub>), were compared with gene sets that represent all 285 presently available pathway signatures. Validation immunostaining of tumors of 274 consecutive early-stage cervical cancer patients was performed for representatives of the identified pathways.</p><p><b>Results:</b> Analysis of 285 pathways resulted in identification of five pathways (TGF-β, NFAT, ALK, BAD, and PAR1) that were dysregulated in the N<sub>0</sub>, and two pathways (β-catenin and Glycosphingolipid Biosynthesis Neo Lactoseries) in the N<sub>+</sub> group. Class comparison analysis revealed that five of 149 genes that were most significantly differentially expressed between N<sub>0</sub> and N<sub>+</sub> tumors (<i>P</i> < 0.001) were involved in β-catenin signaling (TCF4, CTNNAL1, CTNND1/p120, DKK3, and WNT5a). Immunohistochemical validation of two well-known cellular tumor pathways (TGF-β and β-catenin) confirmed that the TGF-β pathway (positivity of Smad4) was related to N<sub>0</sub> (OR: 0.20, 95% CI: 0.06–0.66) and the β-catenin pathway (p120 positivity) to N<sub>+</sub> (OR: 1.79, 95%CI: 1.05–3.05).</p><p><b>Conclusions:</b> Our study provides new, validated insights in the molecular mechanism of lymph node metastasis in cervical cancer. Pathway analysis of the microarray expression profile suggested that the TGF-β and p120-associated noncanonical β-catenin pathways are important in pelvic lymph node metastasis in early-stage cervical cancer. <i>Clin Cancer Res; 17(6); 1317–30. ©2011 AACR</i>.</p></div>

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