Immunohistochemical Expression of Survivin and Vascular Endothelial Growth Factor in Cervical Squamous Cell Carcinoma

Abstract

Uterine cervical cancer is the fourth leading cause of cancer death in women worldwide as per GLOBOCON (2020). In view of the higher incidence in the developing world and poor prognosis in cases presenting at advanced stage, there is an unmet need to explore new therapeutic targets for this neoplasm. Herein we sought to analyze and compare the immunoexpression of survivin (antiapoptotic factor) and vascular endothelial growth factor (VEGF). The study was conducted in the Department of Pathology at a tertiary care teaching institute from November 2018 to April 2020. Immunohistochemical (IHC) expression of survivin and VEGF was evaluated in 75 cervical squamous cell carcinomas (CSCC). The immunostaining was evaluated semi-quantitatively for its intensity (mild = 1; moderate = 2; intense = 3) and proportion of positivity (< 5% = 0; 5 to 25% = 1; 26 to 50% = 2; > 50% = 3). IHC score was calculated by multiplying the two scores as low positive (1-3), medium positive (4-6) and strong positive (7-9). Immunoexpression of survivin and VEGF was correlated using the Fisher's exact test and Kendall rank correlation coefficient. The median age of the CSCC patients was 55 years. Survivin expression was found in 98.6% while VEGF expression was observed in 68% of cases. A significant positive correlation (p - 0.001, τ - 0.404) was found between immunoexpression of survivin and VEGF. Our study results highlight the proposed role of survivin in angiogenesis by promoting VEGF expression. Hence, in view of survivin being an antiapoptotic protein and having a role in angiogenesis, targeted therapy against survivin might be of use for treatment and better prognostic outcomes in cervical squamous cell carcinomas.

Keywords: Immunohistochemical expression; Positive correlation; Survivin; VEGF.