High Caspase-3 Expression is the Risk Factor of Poor Response to Paclitaxel-Carboplatin Neoadjuvant Chemotherapy in Cervical Cancer Stages IB3, IIA2, AND IIB

Introduction: Neoadjuvant chemotherapy is a therapeutic option for cervical cancer at stages IB3, IIA2, and IIB. Caspase-3, a pro-apoptotic protein, is believed to be involved in the response to chemotherapy and is crucial for determining subsequent treatment. However, the evidence regarding its predictive value in neoadjuvant chemotherapy for cervical cancer remains inconclusive Therefore, this study aimed to evaluate caspase-3 expression as a predictor of a poor response to paclitaxel-carboplatin neoadjuvant chemotherapy in cervical cancer stages IB3, IIA2, and IIB. Methods: This case-control study included cervical cancer patients with stages IB3, IIA2, and IIB who received three cycles of paclitaxel-carboplatin neoadjuvant chemotherapy at Prof. Dr. I.G.N.G. Ngoerah Hospital between June and November 2023. Chemotherapy response was assessed based on changes in tumor diameter via contrast-enhanced CT scans. Caspase-3 expression was analyzed in paraffin-embedded cervical cancer tissues by immunohistochemistry. Operating characteristic (ROC) analysis was performed to determine the optimal cut-off for caspase-3 expression. The chi-square test was used to analyze the association between caspase-3 expression and response to neoadjuvant chemotherapy. Results: A total of 39 patients were included, of whom 18 showed a poor response and 21 showed a good response to chemotherapy. The two groups had similar demographic characteristics, baseline tumor diameter, histological type, and tumor grade (p > 0.05). Caspase-3 expression was higher in the poor response group than in the good response group (9.88 ± 2.31% vs. 7.15 ± 7.63%). High caspase-3 expression (≥ 12.5%) was significantly associated with poor chemotherapy response (OR = 2.61; 95% CI: 1.70–4.01; p