eISSN: 2299-0038
ISSN: 1643-8876
Menopause Review/Przegląd Menopauzalny
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vol. 23
Original paper

Utility of expression of 4-hydroxynonenal tested by immunohistochemistry for cervical cancer

Eva Tsoneva
Polina Dimitrova
Metodi Metodiev
Velizar Shivarov
Mariela Vasileva-Slaveva
Angel Yordanov
Stoyan Kostov

  1. Dr. Shterev” Hospital, Sofia, Bulgaria
  2. Department of Pathology, Medical University Pleven, Pleven, Bulgaria
  3. University of Essex, Essex, United Kingdom
  4. Research Institute, Medical University Pleven, Pleven, Bulgaria
  5. Bulgarian Breast Cancer Association, Sofia, Bulgaria
  6. Department of Gynaecological Oncology, Medical University Pleven, Pleven, Bulgaria
  7. Department of Gynaecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, Varna, Bulgaria
Menopause Rev 2024; 23(1): 6-13
Online publish date: 2024/03/18
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Cervical cancer (CC) is a leading cause of mortality in women around the world, with the highest incidence rate still being in developing countries. The most common aetiological factor is infection with high-risk human papilloma virus viral strains. Oxidative stress through generation of reactive oxygen species leads to lipid peroxidation and DNA damage. Studies show that reactive lipid electrophiles such as 4-hydroxynonenal (4-HNE) produced in the process play an important role in cancer signalling pathways and are a good biomarker for oxidative stress. We aim to investigate the prognostic role of 4-HNE as a biomarker for oxidative stress in patients in early and advanced stages of CC measured by immunohistochemistry.

Material and methods
This is a retrospective study of 69 patients treated at our Department of Oncogynaecology. Paraffin embedded tumour tissues were immunohistochemically tested for the levels of expression of 4-HNE. The results for H-score, Allred score, and combined score were investigated for association with tumour size, lymph node status, and FIGO stage.

4-hydroxynonenal showed higher expression in more advanced stages of CC and in cases with involved lymph nodes. Tumour size was not associated with the levels of 4-HNE.

To best of our knowledge, this is the first study to use immunohistochemistry to examine the expression of 4-HNE as a prognostic factor in CC. The 3 score systems showed similar results. The pattern of 4-HNE histological appearance is dependent on the histological origin of cancer and is not universal.


4-HNE, cervical cancer, ROS, lipid metabolism, oxidative stress

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