title: Elevated CAIX Expression is Associated with an Increased Risk of Distant Failure in Early-Stage Cervical Cancer.
abstract: Tumor hypoxia is associated with adverse outcome in many malignancies. The goal of this study was to determine if elevated expression of carbonic anhydrase IX (CAIX), a biomarker of hypoxia, predicts for recurrence in early-stage cervical cancer. The charts of all patients with early-stage cervical cancer, primarily FIGO IB, treated by radical hysterectomy at our institution from 1988-2001 were reviewed. Adequate pathologic specimens from patients who recurred or who had at least three years follow-up and remained disease-free were stained for CAIX. An immunohistochemical score (IHC) was generated from the extent/intensity of staining. Outcome, as measured by freedom from recurrence (FFR), distant metastases (FFDM) and local recurrence (FFLR), was analyzed as a function of age, IHC, lymph node status (LN) and histology. Forty-two relapsing patients and 76 non-relapsing patients were evaluated. In univariate analysis, +LN, though not IHC or histology, was a significant predictor of any recurrence. Both +LN and higher IHC were associated with decreased FFDM but not FFLR. Patients with both +LN and elevated IHC more frequently exhibited distant metastases as first site of failure (5-year FFDM 50%) than patients with only +LN, elevated IHC or neither feature (70, 85 and 95%, respectively, p = 0.0004). In multivariable analysis, only +LN was significantly associated with poorer FFDM (hazard ratio 4.6, p = 0.0015) though there was a strong trend with elevated CAIX expression (p = 0.069). Elevated CAIX expression is associated with more frequent distant metastases in early-stage cervical cancer, suggesting that patients with this characteristic may benefit from more aggressive treatment.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, U.S.A. 27710.
authors: John P
authors: JP
authors: Kirkpatrick
authors: Zahid N
authors: ZN
authors: Rabbani
authors: Rex C
authors: RC
authors: Bentley
authors: Matt E
authors: ME
authors: Hardee
authors: Seth
authors: S
authors: Karol
authors: Jeffrey
authors: J
authors: Meyer
authors: Egbert
authors: E
authors: Oosterwijk
authors: Laura
authors: L
authors: Havrilesky
authors: Angeles Alvarez
authors: AA
authors: Secord
authors: Zeljko
authors: Z
authors: Vujaskovic
authors: Mark W
authors: MW
authors: Dewhirst
authors: Ellen L
authors: EL
authors: Jones