OCT4 and SOX2 as Predictive Biomarkers for Radiotherapy Efficacy among Cervical Cancer Patients of North Indian Population

Introduction: Cervical cancer is a leading cause of mortality among women, largely influenced by clinical and histopathological tumor characteristics at diagnosis. While tumor size is an effective predictor of chemoradiotherapy (CRT) response, variability in treatment outcomes highlights the need for reliable biomarkers. OCT4 and SOX2, key stem cell markers, have been linked to cancer progression, poor prognosis, and chemoresistance. This study aims to evaluate the expression of OCT4 and SOX2 in cervical cancer tissues and assess their potential as predictive biomarkers for radiotherapy efficacy. Materials and Methods: The study included 56 cervical cancer patients, with detailed data on cancer stage, tumor characteristics, and treatment modalities collected from medical records. Tissue microarrays were constructed from paraffin-embedded samples, and immunohistochemical staining was performed to assess OCT4 and SOX2 expression, with staining intensity analyzed using specialized software. Histoscores were compared across subgroups, and ROC analysis determined cut-off values for biomarker expression. Kaplan-Meier survival analysis, Cox regression, and chi-square tests were used to evaluate associations between biomarker expression, survival, and disease characteristics, with statistical significance set at p < 0.05. Results: The study found that 66.1% of cervical cancer patients achieved a complete response to radiotherapy, while 33.9% had a partial response. Higher SOX2 and OCT4 expression levels were significantly associated with partial response and some toxicities like diarrhea. SOX2 showed stronger predictive value for radiotherapy response compared to OCT4, with significant differences in expression between complete and partial response groups. ROC analysis highlighted SOX2 as a more reliable biomarker for predicting treatment outcomes. Conclusion: Higher expression of SOX2 and OCT4 was significantly associated with partial response to radiotherapy in cervical cancer patients, with SOX2 showing a stronger predictive value. These biomarkers may serve as useful tools for predicting radiotherapy efficacy and guiding personalized treatment strategies.