The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

The objective of this study was to evaluate the value of platelet count, p5 3, MDM2, c-erbB-2, and cathepsin D immunoreactivity as predictors of lymph node metastasis (LNM) as well as their prognostic significance in patients with stage IB cervical cancer treated by radical hysterectomy between 1991 through 1995. We also report on the outcome of a protocol considering lymph -vascular space invasion (LVSI) in addition to LNM as a strong motivation f or adjuvant radiotherapy. A total of 93 patients were the subject of this r etrospective study. The incidence of positive nodes was high (30.1%), Throm bocytosis (greater than or equal to 400.000/mm(3)) was present in 6.7% of p atients. Positive immunostaining was Pound for p53 (50.6%), MDM2 (21.7%), c -erbB-2 (14.5%), and cathepsin D (45.8%), but none of them was able to pred ict LNM. Only thrombocytosis was associated with an unfavorable prognosis: a statistically significant association was shown with relapse-free and ove rall survival in an univariate analysis (P = 0.0431 and P = 0.0012, respect ively) with a tendency to significance in multivariate analysis (P = 0.079 and P = 0.0882 respectively). We postulate that thrombocytosis in early sta ge cervical cancer could be a marker for subclinical tumor burden. LVSI,reg arded as an indication for adjuvant radiotherapy, was no longer associated with poor relapse-free or overall survival, but resulted in a 41% postopera tive irradiation rate. Further research is needed to establish the value of LVSI in postoperative radiotherapy decision making.