Higher HIF-1α Level in Cervical Cancer Worsen the Outcome of Radiotherapy in Stage IIIB Squamous Cell Carcinoma of the Cervix

Objective: To assess and evaluate HIF-1α levels as predictors of radiotherapy outcomes for patients with stage IIIB cervical cancer. Methods: This retrospective cohort study was conducted in the Gynecology Oncology Division, Department of Obstetrics and Gynecology at FKUI, RSCM Jakarta. Biopsy data from 76 patients were analyzed to investigate HIF-1α levels using ELISA. Subsequently, these patients underwent complete radiotherapy, and outcomes were assessed using magnetic resonance imaging (MRI). Outcomes were categorized as positive response (disappearance of all lesions or a ≥30% decrease in the sum of the longest diameter compared to before radiotherapy) or negative response (lack of positive response criteria and a ≥20% increase in the smallest sum or new lesions). The one-year survival rate according to HIF-1α levels was also calculated. Data were analyzed accordingly. Results: Among the 76 samples, 49 (61.8%) patients exhibited positive (complete and partial) responses, while 27 (38.2%) exhibited negative (progressive and stable disease) responses. The HIF-1α cut-off level ranged from 0.001 to 0.297 pg/mg, with the cut-off set at 0.019 pg/mg. We observed that higher HIF-1α levels worsened the outcomes of radiotherapy in patients with stage IIIB squamous cell carcinoma (SCC) cervical cancer (p = 0.044, RR= 1.909, 1.07- 3.75, 95% CI). A low HIF-1α level was associated with a better one-year survival rate (p=0.011). Conclusion: Patients with stage IIIB squamous cell carcinoma cervical cancer and higher HIF-1α levels are at a 1.909-fold increased risk of experiencing negative radiotherapy responses compared to those with lower HIF-1α levels.