CD34low and SMAhigh represent stromal signature in uterine cervical cancer and are markers for peritumoral stromal remodeling

Peritumoral desmoplastic stromal reaction (DSR) with myofibroblastic phenotype may be of prognostic impact in uterine cervical carcinoma. The present study evaluates the immunostaining (CD34 and smooth muscle actin; SMA) of 97 squamous cell cancers. Staining was scored as low/negative (< 5% stroma positive), moderate (patchy/focal expression, 5%-50%), or high (diffuse expression throughout peritumoral stroma, > 50%) and DSR as negative/weak and moderate/strong. The staining results were correlated to patient survival. Of the cases, 78.3% showed a decreased of CD34 (< 5% stromal positivity) and 71.9% an increased SMA staining with more than 50% SMA positive stromal cells. Tumors representing moderate/strong DSR showed a significant decreased CD34 (P = .001) and an increased but not statistically significant SMA staining (P = 0.345). Cases with low CD34 and high SMA staining showed reduced 5-year overall survival when compared to cases with high CD34 and low SMA positivity (59.9 vs 81.0%; P = 0.025 and 64.6 vs 81.1%; P = 0.243). Peritumoral stromal response in cervical carcinoma is immunohistochemically characterized by CD34low/SMAhigh and associated reduced overall survival.