Lymph node metastases, not human telomerase reverse transcriptase or p53 proteins, as the strongest prognostic factor for survival in early stage cervical cancer

Aim: Human telomerase reverse transcriptase (hTERT) is known to be significantly activated during immortalization, and p53 is thought to be a guardian of that apoptosis pathway in most cancer cells. The aim of this study was to assess the relationships among hTERT, p53 and various clinicopathological parameters of cervical cancer patients and overall survival. Methods: We used immunohistochemical methods to examine the expression of hTERT and p53 proteins in 45 paraffin-embedded pathological samples of early stage (IA-IIA) cervical cancer. Results: Thirty-seven of 45 (82.2%) cervical cancer slides exhibited hTERT activation. Twenty-eight of these slides with activated hTERT (75.7%) were also found to be positive for mutant p53 protein (P < 0.05). Neither of both was found to be prognostic in Kaplan-Meier curves (Figs 2,3). The survival rate varied greatly (from 86.54% to 42.86%) in a particular order: hTERT activation > mutated p53 > deep stromal invasion > pelvic nodal metastases. The findings also demonstrated that stromal invasion was no longer a significant prognostic factor (P = 0.16), but that nodal status was an adverse prognostic with a hazard ratio of 8.48 (1.89-37.98) after adjustment. Conclusions: Although expression of both hTERT and mutant p53 increase in early stage cervical cancer, neither was found to be prognostic. Lymph node metastases was the most powerful prognostic factor associated with survival among hTERT, p53 and various clinicopathological parameters.