Prognostic significance of uPA and uPAR expression in patients with cervical cancer undergoing radiotherapy
- Danupon Nantajit
- Piyawan Chailapakul
- Sarinya Bawornpatarapakorn
- Sasikarn Chamchod
- Kanyanee Laebua
Affiliations: Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok 10210, Thailand, Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok 10210, Thailand
- Published online on: March 29, 2021 https://doi.org/10.3892/ol.2021.12684
Copyright: © Nantajit
et al. This is an open access article distributed under the
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Cervical cancer remains a major health threat. Urokinase serves as a marker of metastatic tumors. The present study aimed to determine whether the expression levels of urokinase plasminogen activator (uPA) and urokinase plasminogen activator receptor (uPAR), before and during the course of radiotherapy, serve as prognostic markers for patients with cervical cancer. Cervical tumor tissue biopsies were collected from 72 patients before radiotherapy and after the completion of external beam radiotherapy (EBRT) before intracavitary brachytherapy. The levels of uPA and uPAR were determined using ELISA assays. The significance of the associations between the protein expression levels and the clinical outcomes of patients was determined. Although irradiation enhanced uPA and uPAR expression in cervical cancer cell lines, average uPA levels significantly decreased in tumors, and uPAR levels significantly increased after EBRT. The levels of uPA increased in 12 patients and decreased in 26 patients; and those of uPAR increased in 13 patients and decreased in two patients. Cox regression analysis revealed that increased expression of uPAR was significantly associated with 5‑year overall survival rate [hazard ratio (HR), 3.65; 95% confidence interval (CI), 1.18‑11.30]. However, the levels of both proteins before radiotherapy failed to predict clinical outcomes. Other significant predictive factors were partial response (HR 7.22; 95% CI 1.17‑44.73) and disease progression (HR, 13.41; 95% CI, 1.17‑153.07). These findings indicated that increased expression of uPAR in cervical tumor tissue during radiotherapy may serve as a prognostic marker for patients with cervical cancer.