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Clinicopathologic Implications of the Epidermal Growth Factor Receptor, Cyclooxygenase 2 Expression, and Human Papillomavirus Status in Squamous Cell Carcinoma of the Uterine Cervix in the Elderly
  1. Giovanna Giordano, MD, PhD*,
  2. Tiziana D'Adda, BSc*,
  3. Barbara Dal Bello, MD,
  4. Francesca Brigati, BSc*,
  5. Alessandra Bersiga, MD,
  6. Nicoletta Campanini, BSc*,
  7. Roberto Berretta, MD§,
  8. Alba Rocco, MD and
  9. Carla Merisio, MD§
  1. * Department of Pathology and Medicine of Laboratory, Section of Pathology, Parma University Parma;
  2. Policlinico San Matteo, Pavia University, Pavia;
  3. Pathology Section of Cremona Hospital, Cremona;
  4. § Department of Obstetrics and Gynaecologic Sciences and Neonatology, Parma University, Parma; and
  5. Department of Clinical and Experimental Medicine, Federico II Naples University, Naples, Italy.
  1. Address correspondence and reprint requests to Giovanna Giordano, MD, PhD, Dipartimento di Patologia e Medicina di Laboratorio, Sezione di Anatomia ed Istologia Patologica, Universita' di Parma, Viale A. Gramsci, 14, 43100 Parma, Italy. E-mail: giovanna.giordano{at}


Objectives: To find information on invasive squamous cervical carcinoma in the elderly, 110 invasive squamous cervical carcinomas obtained from 2 groups of patients (aged <60 and >60 years) were analyzed for human papillomavirus (HPV) status by polymerase chain reaction study, for immunohistochemical epidermal growth factor receptor (EGFR), cyclooxygenase 2 (Cox-2) expression, and clinicopathologic features.

Methods: The HPV status and the expression of Cox-2 and EGFR in the younger and older women were compared and correlated with the grading, staging neoplasm, and lymph nodal status, using Fisher test and Spearman nonparametric correlation test. Overall survival curves were drawn using Kaplan-Meier estimates and were compared using log-rank tests in the whole series of 110 patients. Multinomial logistic regression was also used.

Results and Conclusions: The number of neoplasms with higher staging was significantly greater than those in the younger women (P = 0.04). The mortality was higher in the older group than in the younger patients (P = 0.006).

In the elderly, the presence of HPV DNA in 65% of cases, and in the absence of sexual activity, could be due to reactivation of latent HPV infection, which might be due to an impairment of host immunologic response.

The overexpression of Cox-2 in a number of cases was significantly higher in the older group than in the younger group (P = 0.032, Fisher exact test), but this immunoreactivity is not related to the staging, grading, EGFR expression, or to the presence of HPV.

The simultaneous expression of Cox-2 and EGFR had a poor prognostic significance, showing lower survival rates than cases without this immunoreactivity (P = 0.002), on univariate analysis.

On multivariate analysis, Cox-2 and EGFR immunopositivity did not reveal any correlation between these markers and prognosis probably because the number of cases considered was not particularly high.

  • Human papillomavirus (HPV)
  • Cyclooxygenase 2 (Cox-2)
  • Epidermal growth factor receptor (EGFR) immunoreactivity
  • Invasive squamous cervical carcinoma

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