Glut-1 expression in small cervical biopsies is prognostic in cervical cancers treated with chemoradiation
AuthorKanjanapan, Y; Deb, S; Young, RJ; Bressel, M; Mileshkin, L; Rischin, D; Hofman, MS; Narayan, K; Siva, S
Source TitleClinical and Translational Radiation Oncology
PublisherELSEVIER IRELAND LTD
University of Melbourne Author/sHofman, Michael; Rischin, Danny; Siva, Shankar; Mileshkin, Linda; Narayan, Kailash
Obstetrics and Gynaecology
Medicine and Radiology
Sir Peter MacCallum Department of Oncology
Document TypeJournal Article
CitationsKanjanapan, Y., Deb, S., Young, R. J., Bressel, M., Mileshkin, L., Rischin, D., Hofman, M. S., Narayan, K. & Siva, S. (2017). Glut-1 expression in small cervical biopsies is prognostic in cervical cancers treated with chemoradiation. CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, 2, pp.53-58. https://doi.org/10.1016/j.ctro.2017.01.003.
Access StatusOpen Access
Background/purpose: Chemoradiation (CRT) is standard therapy for locally advanced cervical cancer (LACC). However, there is a lack of biomarkers to identify patients at high relapse-risk. We examine metabolic (glucose transporter-1 [Glut-1]), hypoxic (hypoxia inducible factor [HIF-1α]; carbonic anhydrase [CA-9]) and proliferative (Ki-67) markers for prognostic utility in LACC. Materials/methods: 60 LACC patients treated with CRT had pre-treatment biopsies. Immunohistochemistry was performed for Glut-1, HIF-1a and CA-9, to generate a histoscore from intensity and percentage staining; and Ki-67 scored by percentage of positive cells. For each biomarker, treatment response and survival was compared between low and high-staining groups by logrank testing and multivariate analyses. Results: High Glut-1 expression was associated with inferior progression-free survival (PFS), (hazard ratio [HR] 2.8, p = 0.049) and overall survival (OS), (HR 5.0, p = 0.011) on multifactor analysis adjusting for stage, node positivity, tumour volume and uterine corpus invasion. High Glut-1 correlated with increased risk of distant failure (HR 14.6, p = 0.001) but not local failure. Low Glut-1 was associated with higher complete metabolic response rate on post-therapy positron emission tomography scan (odds ratio 3.4, p = 0.048). Ki-67 was significantly associated with PFS only (HR 1.19 per 10 units increase, p = 0.033). Biomarkers for hypoxia were not associated with outcome. Conclusions: High Glut-1 in LACC is associated with poor outcome post CRT. If prospectively validated, Glut-1 may help select patients for more intensive treatment regimens.
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