Role of Epithelial-mesenchymal Transition in Utero-cervical Carcinoma: An Immunohistochemical Cross-sectional Study

Abstract

Introduction: During the Epithelial-mesenchymal Transition (EMT) process, cells undergo a transformation in which they lose their epithelial characteristics and acquire mesenchymal traits. This phenomenon was observed during the metastatic stage of neoplastic disorders, such as cervical cancer. Certain indicators are present during EMT. Aim: To evaluate the role of EMT in utero-cervical carcinoma by analysing the expressions of E-cadherin and vimentin in histopathologically confirmed cases. Materials and Methods: This retrospective cross-sectional study was conducted over a period of two years, from January 1, 2013, to December 31, 2014, at the Department of Pathology in a tertiary care centre and referral hospital. A total of 50 histopathologically confirmed cases of utero-cervical Squamous Cell Carcinoma (SCC) were included in this study. These case were analysed focusing on variables such as age, age at marriage, parity, family history, and hormonal intake. Tumour stages and grades were assessed alongside E-cadherin and vimentin expressions using Immunohistochemistry (IHC). Results were statistically analysed, and the database was created in MS Excel (Version 2007) and analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics software version 20.0, with significance set at p<0.05. Results: Most cases occurred in the seventh decade of life (42%, 21/50). Out of the 50 tumours studied, 7 (14%) had a positive history of cervical carcinoma, and 6 (12%) had a positive history of hormonal intake. The cervical tumour stages and grades showed statistical significance in relation to family history (p-value=0.001, p-value=0.007) and hormonal intake (p-value<0.001), strongly indicating evidence against the null hypothesis. A total of 4 (8%) cases showed positive lymph node involvement, all of which were in stage 3; among these, 3 (75%) were in grade 3 and 1 (25%) was in grade 2. E-cadherin expression was higher in lower grade and lower stage tumours, while vimentin expression was higher in higher grade and higher stage tumours, as well as in all four lymph node-positive cases. Therefore, the downregulation of E-cadherin and the upregulation of vimentin expression signify EMT. Conclusion: The study concludes that E-cadherin and vimentin play crucial roles in EMT in cervical tumours. E-cadherin was more prevalent in lower grade and stage tumours, while vimentin was more common in higher grade and stage tumours, as well as in all lymph node-positive cases. Cervical tumour stages and grades were significantly associated with family history and hormonal intake. Despite contradictory findings in clinical trials, EMT markers like E-cadherin and vimentin will remain important in future research on cervical carcinoma.

Keywords

• biomarkers
• cancer staging
• cell adhesion
• prognosis
• tumour progression