Galectin-7 levels predict radiation response in squamous cell carcinoma of the cervix ☆ Chiaojung Jillian Tsai a , Erik P. Sulman a , Patricia J. Eifel a , Anuja Jhingran a , Pamela K. Allen a , Michael T. Deavers b , Ann H. Klopp a, ⁎ a Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA b Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA HIGHLIGHTS • We investigated the association between pretreatment galectin-7 expression and radiation response in patients with cervical squamous cell carcinoma (SCC). • Immunohistochemical staining of galectin-7 was performed on 161 patients with cervical SCC treated with definitive radiation therapy. • Elevated galectin-7 expression is associated with improved distant metastasis-free survival, disease-specific survival, and overall survival. abstract article info Article history: Received 20 February 2013 Accepted 23 April 2013 Available online 30 April 2013 Keywords: Cervical cancer Radiation Galectin-7 Galectin Survival Microarray Objective. We previously found that galectin-7 was upregulated in patients with cervical cancer who remained recurrence-free after chemoradiation. We hypothesized that pretreatment levels of galectin-7 predict radiation re- sponse in patients with squamous cell carcinoma (SCC) of the cervix. Methods. Galectin-7 expression was assessed by immunohistochemical staining of a tissue microarray of paraffin-embedded specimens from 161 patients with cervical SCC treated with definitive radiation therapy in 1980–1999. Galectin-7 expression was scored as absent or present. Distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were computed using the Kaplan–Meier method and log-rank tests. Results. The median age at diagnosis was 45 years (range 21–85) and median follow-up interval was 71 months (range 0–285). Of the 161 patients, 105 (65%) had FIGO stage IB disease, 18 (11%) stage IIA, and 38 (24%) stage IIB. Median tumor diameter was 5.5 cm (range 3.5–8). Seven patients (4%) received concurrent chemotherapy; 139 patients (86%) had galectin-7-positive tumors and 22 (14%) galectin-7-negative tumors. Five-year DMFS rates for patients with galectin-7-positive versus -negative tumors were 73% and 55% (p = 0.05); DSS, 65% and 36% (p = 0.004); and OS, 64% and 36% (p = 0.005). In multivariate analysis adjusting for age, stage, and tumor diameter, galectin-7 expression remained a significant predictor of DMFS (hazard ratio [HR] = 0.43, p = 0.03), DSS (HR = 0.34, p = 0.001), and OS (HR = 0.34, p = 0.001). Conclusions. Elevated galectin-7 expression is associated with improved outcomes after radiation therapy for cervical cancer. Further studies are required to validate these findings and clarify the role of galectin-7 in disease progression and radiation response. © 2013 Published by Elsevier Inc. Introduction Cervical cancer is the third most common type of cancer worldwide, with an estimated incidence of 529,800 new cases and 275,100 deaths in 2008 [1]. In the United States alone, 12,170 new cervical cancer cases and 4220 cervical cancer deaths are estimated to occur in 2012 [2]. The standard treatment for women with stage IB2–IVA cervical cancer is con- current cisplatin-based chemotherapy with radiation followed by intracavitary brachytherapy. The addition of concurrent platinum-based therapy significantly improves local control and overall survival [3–5]. Nevertheless, recurrence rates are still high for patients with large tu- mors, and treatment intensification with dose escalation or additional chemotherapy agents is limited by treatment-related toxicity. Tools to better predict outcome could be useful for individualizing treatment. The ideal biomarker could be used to predict outcome independent of well-established clinical factors such as tumor size, stage, and nodal Gynecologic Oncology 131 (2013) 645–649 ☆ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. ⁎ Corresponding author at: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 97, Houston, TX 77030, USA. Fax: + 1 713 606 2293. E-mail address: aklopp@mdanderson.org (A.H. Klopp). 0090-8258/$ – see front matter © 2013 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.ygyno.2013.04.056 Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno