Stepwise Increase of Carboxypeptidase E and Altered ALDH1A1 Expression During Cervical Carcinogenesis: A Retrospective Immunohistochemical Study.

Cervical carcinogenesis involves progressive molecular changes from preinvasive lesions to invasive carcinoma. Carboxypeptidase E (CPE) and aldehyde dehydrogenase 1A1 (ALDH1A1) have been implicated in cancer-related pathways, yet their stage-specific immunohistochemical expression patterns in cervical disease remain insufficiently characterized. This retrospective, specimen-based study assessed immunohistochemical expression of CPE and ALDH1A1 in cervical samples representing reactive/low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and invasive carcinoma. Staining was semi-quantitatively scored using standardized criteria. Group differences were analyzed with Kruskal-Wallis tests followed by post hoc comparisons, and monotonic trends across ordered disease stages were evaluated using the Jonckheere-Terpstra test. CPE expression differed significantly among disease groups, showing a stepwise increase from reactive/LSIL to HSIL and invasive carcinoma (P<0.001). Post hoc analyses confirmed higher CPE expression in HSIL and invasive carcinoma compared with reactive/LSIL lesions, with a further increase in invasive disease. ALDH1A1 expression did not differ between reactive/LSIL and HSIL groups but was significantly higher in invasive carcinoma. Trend analysis demonstrated significant monotonic increases for both markers across disease stages (P<0.001). This study provides a standardized, stage-specific immunohistochemical evaluation of CPE and ALDH1A1 in cervical lesions, highlighting progressive CPE upregulation and invasion-associated ALDH1A1 expression, and adds methodological clarity to the existing literature.