Clinicopathological characterization of cervical squamous cell carcinoma with PIK3CA hotspot mutation: A...

PIK3CA serves a well-established role in carcinogenesis; however, although its prognostic importance in cervical squamous cell carcinoma (SCC) has been extensively studied, the results remain controversial. In the present single-institution study, the clinicopathological features of 207 cases of cervical SCC were characterized based on their PIK3CA hotspot mutational status. The prevalence of PIK3CA hotspot mutations in this cohort was 13% (27/207), with 96.3% (26/27) of mutations clustered in the helical domain (exon 9). Patients harboring PIK3CA mutations tended to be older, and the mutation rate was significantly higher among those aged ≥50 years compared with those aged <50 years (18.4% vs. 8.3%, P=0.031). When stratified by stage, a trend toward a higher frequency of PIK3CA mutations was observed in patients with advanced-stage disease (P=0.0575), although this difference did not reach statistical significance. The mutation rate was 6.8% (5/74) among patients with stage I carcinoma and increased to 18.1% (19/105) among those with stage II or higher disease (P=0.0284). Nearly all patients with PIK3CA-mutant tumors (96%, 23/24) underwent chemotherapy and/or radiation therapy (P=0.0089). No statistically significant difference was observed between patients with PIK3CA-wildtype and PIK3CA-mutant tumors with respect to ethnicity, procedures performed at initial diagnosis or human papillomavirus status. Programmed death-ligand 1 (PD-L1) expression (combined positive score ≥1) was observed in 76.3% of cervical SCC cases. However, immunohistochemical analysis did not reveal a statistically significant association between PD-L1 expression and PIK3CA mutation status. Furthermore, the results showed that PIK3CA mutations were not associated with the prognosis of patients with cervical SCC. The only factor significantly associated with the cause-specific survival and overall survival in this cohort was clinical stage. The present study highlights and expands upon the clinicopathological characteristics of cervical SCC with PIK3CA hotspot mutations in a single-institution cohort. Future studies should focus on evaluating the efficacy of PI3K inhibitors, alone or in combination with immunotherapy and other targeted treatments, in selected patients. This evaluation should be based on molecular alterations that may predict therapeutic benefit.