The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients

Abstract

ter Harmsel B, van Muyden R, Smedts F, Hermans J, Kuijpers J, Raikhlin N, Petrov S, Lebedev A, Ramaekers F, Trimbos B. The significance of cell type and tumor growth markers in the prognosis of unscreened cervical cancer patients. Int J Gynecol Cancer 1998; 8: 336–344. The clinical significance of p53, Ki-67-Ag, and BCL-2 as markers for patient prognosis in cervical carcinoma was compared to established prognostic tumor parameters. The examined population consisted of 159 unscreened Russian women, presenting with Stage I (n= 74) and Stage II (n= 85) cervical carcinoma. Relevant clinical information was available in all cases. Thirty-five percent of cases were either adenocarcinoma or contained an adenocarcinomatous component. Lymph node status and stage of disease appeared to be statistically significant parameters for patient survival. Depth of tumor infiltration was a significant indicator of 5-year relapse risk, while tumor size and histologic classification were not predictive. When analyzed separately, p53, Ki-67-Ag, and BCL-2 were not significantly correlated with clinical parameters. However, high Ki-67-Ag combined with high BCL-2 indices predicted a shorter relapse-free interval than did low Ki-67-Ag combined with low BCL-2 index. We conclude that the relatively high incidence of cervical adenocarcinomas is merely due to an increased awareness in the histologic classification criteria of this tumor subtype. Furthermore, histologic parameters are not of value in predicting patient outcome. Although tumor stage and lymph node status are superior to individual markers of tumor growth and genomic instability in determining patient prognosis, a combination of markers for proliferation index and protection from apoptotic cell death shows a tendency to predict clinical outcome.