Chemokines and Cancer Progression: A Qualitative Review on the Role of Stromal Cell-derived Factor 1-alpha and CXCR4 in Endometrial Cancer

The goal of this paper was to examine the literature related to stromal cell-derived factor 1-alpha (SDF-1alpha) and its receptor CXCR4 in endometrial cancer, as expression of these biomarkers has been implicated in an aggressive phenotype in other common epithelial cancers. We conducted a qualitative review of all published studies examining the role of SDF-1alpha/CXCR4 in endometrial cancer progression and prognosis. Pubmed and Ovid MEDLINE databases were searched in order to identify relevant studies for this qualitative review. Four studies have examined the role of the SDF-1alpha/CXCR4 pathway on endometrial cancer progression. The findings were contradictory; two studies reported an inverse association between overexpression and mortality while two studies reported overexpression to be associated with hallmarks of aggressive endometrial cancer. Expression of stromal-derived proteins can potentially serve as biomarkers of aggressive disease as well as biomarkers for remission monitoring, however the endometrial cancer literature has lagged behind in this area. Furthermore, the current research suffers from lack of comparability among different studies due to the utilization of different tools and lack of common outcome definitions. Future studies in this area should use clinically meaningful protein expression categories, widely accepted outcome definitions, and larger samples of patients. Finally, although standard immunohistochemistry is a mainstay in tumor marker studies, automated detection methods may be more suitable as they do not rely on subjective interpretation.