DOI: 10.4103/ijpm.ijpm_123_26 ISSN: 0377-4929

Comparative immunohistochemical analysis of survivin, p53, and Ki-67 expression in cervical squamous intraepithelial lesions and squamous cell carcinoma

Satyadev Rana, Anirban Kundu, Debanjan Ghosh, Pratyush Datta, Jayati Chakraborty
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ABSTRACT

Background:

Cervical squamous cell carcinoma (SCC) develops through precursor squamous intraepithelial lesions (SILs); however, morphology alone may not reliably predict biological behavior. Immunohistochemical markers related to apoptosis and proliferation may provide additional insights into cervical carcinogenesis and histopathological evaluation.

Aim:

To evaluate the immunohistochemical expression of survivin, p53, and Ki-67 across cervical squamous intraepithelial lesions and SCC, and to assess their association with lesion category and tumor grade.

Materials and Methods:

This prospective observational study included 135 cervical specimens: normal cervix (n = 9), low-grade SIL (LSIL; n = 5), high-grade SIL (HSIL; n = 50), and SCC (n = 71). Immunohistochemistry was performed using survivin (EP119), p53 (DO7), and Ki-67 (MIB1). Survivin and p53 were evaluated using semi-quantitative scoring, while the Ki-67 labeling index was expressed as percentage positivity. Statistical analysis included the Chi-square test and one-way ANOVA, with P < 0.05 considered statistically significant.

Results:

Survivin expression differed significantly among lesion categories ( P = 0.0015), with higher expression in HSIL and SCC than in LSIL. Moderate-to-strong survivin staining was observed in 80% of HSIL and 56.3% of SCC cases, with strongest expression in well-differentiated SCC. p53 expression showed no significant association with lesion category ( P = 0.095). The Ki-67 labeling index increased significantly with lesion severity and SCC grade ( P = 0.0015). Significant correlations among survivin, p53, and Ki-67 were found mainly in HSIL and SCC ( P < 0.00001), whereas conclusions for LSIL were limited by the small sample size.

Conclusions:

Survivin and Ki-67 were significantly associated with cervical lesion severity, supporting their role as adjunctive biomarkers in cervical carcinogenesis, while findings in LSIL remain preliminary because of the limited sample size. However, larger prospective studies with molecular and clinical outcome correlation are needed before routine clinical application.

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