Risk Grouping In Stage Ib1-iib Cervical Carcinoma With Positive Lymph Node And The Correlation Of Zeb1 And Snail In The Metastasis Of Cervical Cancer

Objectives:The purpose of this study was to identify risk factors in the patients with surgically treated node-positiveâ… B1-â…¡B cervical carcinoma, established a predictive model for relapse free survival (RFS) and overall survival (OS), and evaluate the prognostic performance of 5 existing prognostic models in this population.Methods:A total of 170 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for node-positive International Federation of Obstetrics and Gynecology (FIGO) stageâ… B1-â…¡B cervical carcinoma from January 2002 to December 2008 were retrospectively analyzed. The performance of 5 published prognostic models was verified in this population.Results:The variables including common iliac lymph node metastasis, parametrial invasion and FIGO stage were independent predictors of outcome in multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk) were defined using these variables. Five-year relapse free survival (RFS) rates for the low, intermediate, and high risk groups were 79.9%,54.9%, and 34.2%, respectively (P< 0.001), and overall survival (OS) rates were 87.5%,63.1%, and 34.3%, respectively (P< 0.001). For the existing model, Only two models performed reasonably well in our population. The use of more than three prognostic categories in the models was not meaningful.Conclusions:A model containing assessable variables for predicting the prognoses of patients with node-positive stageâ… B1-â…¡B cervical carcinoma was formulated. Subsets of patients for whom postoperative chemotherapy or radiotherapy might be beneficial were identified. Only 2 of the 5 prognostic models for patients with early-stage cervical cancer were valid for the prediction of the recurrence-free or disease specific survival in our patient population. Background:Epithelial mesenchymal transition (EMT) is a process where epithelial cells obtain fibroblastic traits and are thus capable of invading neighboring tissues. Transcriptional factors ZEB1 and SNAIL regulate EMT. Methods:We used immunohistochemistry to evaluate the expression of ZEB1, SNAIL and VIMENTIN in tumor and stromal compartments in a large set of cervical carcinomas. The results were compared with age, differentiation grade, FIGO stage, TNM status, and lympn node metastasis of the patients. Results:Negative, moderate and strong nuclear expression for ZEB1 was seen in tumor cells in 2.86%,22.86,74.29% respectively; and negative, moderate and strong nuclear expression for SNAIL was seen in tumor cell s in 5.71%, 21.43%,72.86% respectively; Nuclear expression of ZEB1 in the tumor cell was positively associated with FIGO stage(P=0.001), lymph node metastasis(P=0.026); Nuclear expression of SNAIL in the tumor cell was positively associated with FIGO stage (P=0.019), tumor differentiation (P=0.034). Expression of VIMENTIN in the tumor cells was positively associated with lymph node metastasis (P=0.019). Conclusions:Nuclear expression of ZEB1 and SNAIL are important in the spread of cervical carcinoma. Moreover, induction of aberrant expression of VIMENTIN might be the consequence of ZEB1 and SNAIL up-regulation, which was involved in the progression of cervical cancer. In the light of these findings, we considered that ZEB1 and SNAIL has the potential to be a novel predictor of pelvic lymph node metastasis as well as a promising therapeutic target in cervical cancer patients.