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Introduction
Biomarkers yield important information for early diagnosis of cervical cancer. However, they
are rarely applied for prognosis of cervical cancer in Tanzania, where visual inspection
assay with acetic acid or Lugol’s iodine and Pap test are being used as the standard screening/ diagnostic methods.
Methods
This was a retrospective hospital-based cross-sectional study that was conducted to assess
cyclin-dependent kinase inhibitor (p16) and topoisomerase II-alpha (TOP2A) proteins
expression among women seeking cervical cancer care at Kilimanjaro Christian Medical
Centre, Tanzania between May 1, 2017 and May 10, 2018. Immunohistochemistry technique was used to detect the expressions of p16 and TOP2A proteins from the retrieved formalin-fixed and paraffin-embedded (FFPE) cervical biopsies.
Results
A total of 145 patients, with a mean age of 52.1 ± 12.9 years, were included in this study.
Upon immunohistochemistry staining, 103 (71.0%) and 90 (62.1%) were p16 and TOP2A
positive respectively. There was a strong association between histopathological class and
p16/TOP2A expression levels (Fisher’s exact test, p<0.001). Moreover, there was a strong
positive correlation between p16/TOP2A and cancerous cervical lesions (Spearman’s rank
correlation coefficients = 0.833 and 0.687, p = 0.006 and 0.005, respectively). The ageadjusted odds ratio for predicting cervical cancer lesions were independently significant for
p16/TOP2A biomarkers in FFPE cervical tissues [p16: OR = 1.142 (95% CI: 1.059–1.232,
p<0.001) and TOP2A: OR = 1.046 (95% CI: 1.008–1.085, p = 0.015)]. Importantly, thediagnostic performance of p16 was higher than that of TOP2A in the diagnosis of cancerous
lesions from non-cancerous cervical lesions (sensitivity: 97.2% versus 77.6%, accuracy:
92.8% versus 87.8%, respectively).
Conclusion
Our study has highlighted that over-expression of TOP2A is related to the grade of cervical
intraepithelial neoplasia but does not predict prognosis in cervical cancer. Similarly, expression of p16 is related to degree of histological dysplasia and malignancy, suggesting its
prognostic and predictive value in the management of cervical cancers. Further bigger studies are needed to validate their applications in the early diagnosis of cervical cancer. |
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