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Overexpression of Hypoxia-Inducible Factor-1α Is a Predictor of Poor Prognosis in Cervical Cancer: A Clinicopathologic Study and a Meta-analysis
  1. Miaoling Huang, MD*,
  2. Qing Chen, MD*,
  3. Jianpeng Xiao, MD,
  4. Tingting Yao, MD, PhD*,
  5. Lijuan Bian, MD,
  6. Changhao Liu, MD* and
  7. Zhongqiu Lin, MD*
  1. *Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University;
  2. Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention; and
  3. Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
  1. Address correspondence and reprint requests to Qing Chen, MD, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang Road 107, Guangzhou, China, 510120. E-mail: sumsqing{at}


Background Published data on the prognostic value of hypoxia-inducible factor-1α (HIF-1α) expression in cervical cancer are conflicting and heterogeneous. We aimed to derive a more precise estimation of them.

Methods We conducted a clinicopathologic study in 74 patients with early-stage cervical cancer treated through surgery and performed a meta-analysis among patients with cervical cancer of all stages to estimate the prognostic importance of HIF-1α expression for disease-free survival (DFS) and overall survival (OS). Expression of HIF-1α was evaluated through immunohistochemistry.

Results A positive nuclear expression of HIF-1α was found in 94.6% of all specimens. There were significant associations between HIF-1α expression and International Federation of Gynecology and Obstetrics stage (P = 0.024), tumor size (P = 0.003), and anemia (P = 0.010), respectively. Log-rank tests revealed significant correlations between HIF-1α expression, International Federation of Gynecology and Obstetrics stages, tumor grade, tumor size and DFS/OS, respectively. The multivariate Cox regression analyses revealed HIF-1α overexpression and high tumor grade to be independent predictors for impaired DFS (HIF-1α overexpression: hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.10–6.47; high tumor grade: HR, 5.56; 95% CI, 1.47–21.13) and OS (HIF-1α overexpression: HR, 2.57; 95% CI, 1.06–6.23; high tumor grade: HR, 6.23; 95% CI, 1.49–25.97). The results of 10 studies indicated that HIF-1α overexpression predicted poor DFS (HR, 1.98; 95% CI, 1.22–3.21) and OS (HR, 2.58; 95% CI, 1.86–3.56) for cervical cancer.

Conclusions The present clinicopathologic study and meta-analysis showed that HIF-1α overexpression is associated with poor survival of cervical cancer and emphasized the importance of HIF-1α as a predictor for cervical cancer.

  • Cervical cancer
  • HIF-1α
  • Meta-analysis
  • Prognosis
  • Survival

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  • Supported by Guangdong Province Medical Science Technology grant (B2013118) and Guangdong Pharmaceutical Association Fund (Bristol-Myers Squibb Fund) (2012D04).

  • The authors declare no conflicts of interest.