ADAM9 Expression in Uterine Cervical Cancer and Its Associated Factors

Abstract

Background: Cervical cancer is a preventable disease caused by human papillomaviruses. It is the third most<br />common cancer to occur in women of reproductive age. The ADAM9 protein plays a role in basement membrane<br />degradation and tumour metastasis in certain types of tumour. Thus, it has the potential to become a new targeted<br />therapy. The objective of this study was to investigate ADAM9 expression in cervical cancer and to determine the<br />factors associated with ADAM9-positive expression. Methods: This cross-sectional study was conducted in Hospital<br />Universiti Sains Malaysia (HUSM) Kelantan, Malaysia from December 2010 to December 2012. Histological slides<br />obtained from 95 cervical cancer cases diagnosed and/or treated in HUSM from 2000 to 2010 were analysed. The<br />ADAM9 immunostain was then performed on the paraffin blocks. The statistical data entry and analysis were done<br />using SPSS version 18.0. Multiple logistic regression analysis was performed to determine the factors associated with<br />ADAM9-positive expression. Result: Of the 95 cervical cancer patients included in the study, 72 (75.8%) patients showed<br />positive ADAM9 expression. The mean age of the patients was 53.89 (10.83) years old. Squamous cell carcinoma was<br />the most common type of cervical cancer (n = 67, 70.5%). Factors that showed a statistically significant association<br />with ADAM9-positive expression were tumour size (adjusted odds ratio [adj. OR]: 1.08; 95% confidence interval<br />[CI]: 1.02, 1.13; p = 0.004), distant metastasis (adj. OR: 12.82; 95% CI: 1.91, 86.13; p = 0.009) and the histological<br />type of cervical cancer (i.e. squamous cell carcinoma) (adj. OR: 7.39; 95% CI: 1.42, 38.51; p = 0.017). Conclusion:<br />The ADAM9 immunostain was consistently positive in malignant cells. Thus, ADAM9 expression can be used as a<br />prognostic/therapeutic indicator in aiding clinician decision-making regarding patient treatment (targeted therapy).