Predictive value of microvessel features for the clinical response to neoadjuvant chemotherapy in cervical squamous carcinoma and the associations with prognosis

Abstract

Background: Neoadjuvant chemotherapy (NACT) may help reduce the difficulty of surgery and eliminate tiny tumor metastatic foci. It has been reported that 69.4% to 95% of patients with cervical cancer respond to NACT. The aim of this study was to evaluate the value of microvessel features in the prediction of response of cervical carcinoma to NACT and its association with the prognosis. Methods: In all, 106 patients (FIGO stage IB2 and IIA2) received NACT followed by radical hysterectomy. Pre-treatment biopsy specimens and post-treatment surgical specimens were stained by immunohistochemistry using CD31 and CD105 antibodies and were counted by quantitative stereology. The correlation between microvessel features [microvessel density (MVD) and volume density (Vv)] and the clinical response and prognosis were determined using the Mann-Whitney U-test and logistic multivariate analysis. Results: Of the 106 patients, 74 (69.4%) responded to NACT. The chemotherapeutic response was more favorable in patients with poor pathological grades and tumors larger than 5 cm (P=0.047, P<0.010). According to the pretreatment tumor size and the pathological grade, the patients were divided into six subgroups. In the subgroup of patients with a pretreatment tumor size ≥5 cm and tumors of moderate pathologic grade, the pre-NACT CD31-Vv was higher in NACT nonresponders than in responders (P=0.028). The area under the ROC curve for CD31-Vv was 0.767. In the logistic multivariate analysis, CD31-Vv was not an independent factor that affected the clinical response. The survival analysis showed that although higher post-treatment CD31-Vv was associated with a worse prognosis, Cox proportional hazards regression analysis did not indicate that microvessel features are prognostic predictors (P>0.05). Both pathological grade and invasive depth were independent predictors of survival. Conclusions: Pre-treatment CD31-Vv could be a predictor of chemosensitivity in one specific subgroup (pre-treatment tumor size ≥5 cm and moderate pathological grade). Post-treatment CD31-Vv is associated with a worse prognosis but is not an independent factor for overall survival.