Introduction/Background Nanog is a well-known transcription factor regulating an embryonic stem cell maintenance. Recently, many evidences have been accumulated that overexpression of Nanog is intimately involved in tumorigenesis. However, the role of Nanog in cervical cancer has not been elucidated yet. Thus, we investigated the expression and clinical significance of Nanog in cervical cancer.

Methodology To evaluate the expression level of NANOG and CRY1, the immunohistochemistry on 170 cervical cancers and 263 cervical intraepithelial neoplasia (CIN) samples and the clinicopathologic variables of cervical cancer patients were compared to evaluate the significance of Nanog and CRY1 in cervical cancer. Also, in vitro assessment was performed by using Nanog knock down cervical cancer cell lines.

Results Nanog and CRY1 expression was higher in cervical cancer tissues than in CIN tissues and normal epithelial tissues (both p < 0.001). Importantly, Nanog and CRY1 overexpression was associated with poor chemoradiation response (p < 0.035, p < 0.003, respectively). Multivariate survival analysis revealed that overexpression of Nanog (hazard ratio = 0.016; 95% confidence interval [CI]: 1.25–9.27), p = 0.016) as an independent prognostic factor for overall survival. Also, the combination of high Nanog and CRY1 expression showed the highest hazard ratio (5.87; 95% CI: 2.18–15.82, p < 0.001) for overall survival. In vitro results also demonstrated the knockdown of Nanog was associated with increased cell viability (p < 0.001), migration (p<0.001) and growth (p < 0.001) supporting the oncogenic role of Nanog in cervical cancer.

Conclusion This study showed that overexpression of Nanog could be a good biomarker for the prediction of chemoradiation response. The results of survival analysis suggest a strong association between Nanog as well as CRY1 expression and poor overall survival, indicative of the potential role of this combination as a prognostic marker in clinical assessment.

Disclosures To the best of our knowledge, the named authors have no conflict of interest, financial or otherwise.