Prognostic significance of VEGF expression in patients with bulky cervical carcinoma undergoing neoadjuvant chemotherapy

To this end, the expression of VEGF was analyzed by immunohistochemistry using paraffin-embedded pre-treatment cervical biopsy tissues. This study included 29 patients with bulky IB to IIA cervical squamous cell carcinoma treated with neoadjuvant chemotherapy.Fifteen (51.7%) of 29 patients were scored as VEGF-positive. Response to chemotherapy (complete response or residual tumor with less than 3 mm stromal invasion) was observed in eight patients (27.6%), and it was negatively associated with VEGF expression (P = 0.009). With logistic regression analysis, VEGF positivity continued to be an independent predictor for poor response (P = 0.032). In addition, the progression-free survival rate was significantly lower in patients with VEGF-positive tumors (P = 0.033).Pretreatment assessment of VEGF expression may provide additional information for identification of patients with cervical cancer who had a low likelihood of response to neoadjuvant chemotherapy and an unfavorable prognosis.Carcinoma of the uterine cervix is the second most common cancer in women, but the prognosis remains very poor in bulky or locally advanced disease [1]. Although concurrent chemoradiation (CCRT) is now considered standard treatment, neoadjuvant chemotherapy (NAC) has been adopted to improve the prognosis for these cases [2,3]. The development of convenient and reliable biomarkers predicting the treatment response would be valuable for patient management. If non-responsive tumors could be identified before NAC, using predictive biological factors, these patients could be allocated to CCRT. Furthermore, it would be reinforced if the biological factors found do not affect the response to CCRT.The correlation of angiogenesis with either metastasis or a poor prognosis has been reported in various cancers [4-6]. Among the angiogenic factors, vascular endothelial growth factor (VEGF) has been shown to have a pivotal role in tumor angiogenesis. However, the correlation between VEGF expression and