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Ma GF, Lin GL, Wang ST, Huang YY, Xiao CL, Sun J, Shi TY, Xiang LB. Prediction of recurrence-related factors for patients with early-stage cervical cancer following radical hysterectomy and adjuvant radiotherapy. BMC Womens Health 2024; 24:81. [PMID: 38297248 PMCID: PMC10829327 DOI: 10.1186/s12905-023-02853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To analyze recurrent factors in patients with clinical early-stage cervical cancer (ESCC) following hysterectomy and adjuvant radiotherapy. METHODS We collected data from patients with ESCC, staged according to the 2009 Federation International of Gynecology and Obstetrics (FIGO) staging criteria, who underwent hysterectomy followed by adjuvant radiotherapy between 2012 and 2019. These patients were subsequently restaged using the 2018 FIGO criteria. Univariable and multivariable analyses, along with nomogram analyses, were conducted to explore factors associated with recurrence-free survival (RFS). RESULTS A total of 310 patients met the inclusion criteria, with a median follow-up time of 46 months. Among them, 126 patients with ESCC were restaged to stage III C1 or III C2 after surgery due to lymph node metastasis (LNM) based on the 2018 FIGO staging criteria. Of these, 60 (19.3%) experienced relapse. The 1-, 3-, and 5-year RFS rates were 93.9%, 82.7%, and 79.3%, respectively. Multivariate analysis revealed that the number of positive lymph nodes (LNs), tumor diameter (TD) > 4 cm, and parametrial invasion (PI) were associated with recurrence. The nomogram indicated their predictive value for 3-year and 5-year RFS. Notably, the 5-year recurrence rate (RR) increased by 30.2% in patients with LNM, particularly those with ≥ 3 positive LNs (45.5%). Patients with stage III C2 exhibited a significantly higher RR than those with IIIC1 (56.5% vs. 24.3%, p < 0.001). The 5-year RFS for patients with TD > 4 cm was 65.8%, significantly lower than for those with TD ≤ 4 cm (88.2%). Subgroup analysis revealed higher 5-year RRs in patients with stage III C2 than that in patients with III-C1 (56.5% vs. 24.3%, p < 0.001), demonstrating a significant difference in the RFS survival curve. CONCLUSION RR in patients with clinical ESCC after hysterectomy followed by adjuvant radiotherapy is correlated with the number of positive LNs, TD > 4 cm, and PI. Emphasis should be placed on the common high-risk factor of LNM association with recurrence after radical hysterectomy in ESCC.
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Affiliation(s)
- Gui-Fen Ma
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Gen-Lai Lin
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Si-Tong Wang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ya-Yu Huang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Xiamen Branch, Fujian, 361000, China
| | - Chun-Li Xiao
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jing Sun
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ting-Yan Shi
- Department of Gynecological Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li-Bing Xiang
- Department of Gynecological Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Deng YR, Chen XJ, Xu CQ, Wu QZ, Zhang W, Guo SQ, Li LX. A preoperative nomogram predicting risk of lymph node metastasis for early-stage cervical cancer. BMC Womens Health 2023; 23:568. [PMID: 37924031 PMCID: PMC10623856 DOI: 10.1186/s12905-023-02726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE This study aimed to develop a preoperative nomogram based on clinical and pathological characteristics to provide a more individualized and accurate estimation of lymph node metastasis (LNM) in patients with early-stage cervical cancer. METHODS A total of 7,349 early-stage cervical cancer patients with pathologically confirmed between 1988 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. All the patients were divided into training (n = 5,500) and validation (n = 1,849) cohorts randomly. A cohort of 455 patients from multicenter was used for the external validation. We established a multivariate logistic regression model based on preoperative clinicopathological data, from which a nomogram was developed and validated. A predicted probability of LNM < 5% was defined as low risk. RESULTS From multivariate logistic regression analysis, age at diagnosis, histologic subtype, tumor grade, tumor size and FIGO stage were identified as preoperative independent risk factors of LNM. The nomogram incorporating these factors demonstrated good discrimination and calibration (concordance index = 0.723; 95% confidence interval (CI), 0.707-0.738). In the validation cohort, the discrimination accuracy was 0.745 (95% CI, 0.720-0.770) and 0.747 (95% CI, 0.690-0.804), respectively. The nomogram was well calibrated with a high concordance probability. We also established an R-enabled Internet browser for LNM risk assessment, which tool may be convenient for physicians. CONCLUSIONS We developed an effective preoperative nomogram based on clinical and pathological characteristics to predict LNM for early-stage cervical cancer. This model could improve clinical trial design and help physicians to decide whether to perform lymphadenectomy or not.
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Affiliation(s)
- Yuan-Run Deng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Tianhe District, 183 Zhongshan Avenue West, Guangzhou, 510630, P. R. China
| | - Xiao-Jing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Cai-Qiu Xu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Tianhe District, 183 Zhongshan Avenue West, Guangzhou, 510630, P. R. China
| | - Qiao-Zhi Wu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Tianhe District, 183 Zhongshan Avenue West, Guangzhou, 510630, P. R. China
| | - Wan Zhang
- Department of Radiation Oncology, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, 523059, China
| | - Sui-Qun Guo
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Southern Medical University, Tianhe District, 183 Zhongshan Avenue West, Guangzhou, 510630, P. R. China.
| | - Li-Xian Li
- Department of Medical Matters, Puning People's Hospital, 30 Liusha Dadao, Puning, 515300, P. R. China.
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Liu Q, Jiang N, Hao Y, Hao C, Wang W, Bian T, Wang X, Li H, zhang Y, Kang Y, Xie F, Li Y, Jiang X, Feng Y, Mao Z, Wang Q, Gao Q, Zhang W, Cui B, Dong T. Identification of lymph node metastasis in pre-operation cervical cancer patients by weakly supervised deep learning from histopathological whole-slide biopsy images. Cancer Med 2023; 12:17952-17966. [PMID: 37559500 PMCID: PMC10523985 DOI: 10.1002/cam4.6437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) significantly impacts the prognosis of individuals diagnosed with cervical cancer, as it is closely linked to disease recurrence and mortality, thereby impacting therapeutic schedule choices for patients. However, accurately predicting LNM prior to treatment remains challenging. Consequently, this study seeks to utilize digital pathological features extracted from histopathological slides of primary cervical cancer patients to preoperatively predict the presence of LNM. METHODS A deep learning (DL) model was trained using the Vision transformer (ViT) and recurrent neural network (RNN) frameworks to predict LNM. This prediction was based on the analysis of 554 histopathological whole-slide images (WSIs) obtained from Qilu Hospital of Shandong University. To validate the model's performance, an external test was conducted using 336 WSIs from four other hospitals. Additionally, the efficiency of the DL model was evaluated using 190 cervical biopsies WSIs in a prospective set. RESULTS In the internal test set, our DL model achieved an area under the curve (AUC) of 0.919, with sensitivity and specificity values of 0.923 and 0.905, respectively, and an accuracy (ACC) of 0.909. The performance of the DL model remained strong in the external test set. In the prospective cohort, the AUC was 0.91, and the ACC was 0.895. Additionally, the DL model exhibited higher accuracy compared to imaging examination in the evaluation of LNM. By utilizing the transformer visualization method, we generated a heatmap that illustrates the local pathological features in primary lesions relevant to LNM. CONCLUSION DL-based image analysis has demonstrated efficiency in predicting LNM in early operable cervical cancer through the utilization of biopsies WSI. This approach has the potential to enhance therapeutic decision-making for patients diagnosed with cervical cancer.
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Affiliation(s)
- Qingqing Liu
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Nan Jiang
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Yiping Hao
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Chunyan Hao
- Department of Pathology, School of Basic Medical Science, Cheeloo College of MedicineShandong UniversityJinan CityChina
- Department of PathologyQilu Hospital of Shandong UniversityJinan CityChina
| | - Wei Wang
- Department of PathologyAffiliated Hospital of Jining Medical UniversityJining CityChina
| | - Tingting Bian
- Department of Medical ImagingAffiliated Hospital of Jining Medical UniversityJining CityChina
| | - Xiaohong Wang
- Department of Obstetrics and GynecologyJinan People's HospitalJinan CityChina
| | - Hua Li
- Department of Obstetrics and GynecologyTai'an City Central HospitalTai'an CityChina
| | - Yan zhang
- Department of Obstetrics and GynecologyWeifang People's HospitalWeifang CityChina
| | - Yanjun Kang
- Department of Obstetrics and GynecologyWomen and Children's Hospital, Qingdao UniversityQingdao CityChina
| | - Fengxiang Xie
- Department of PathologyKingMed DiagnosticsJinan CityChina
| | - Yawen Li
- Department of PathologyQilu Hospital of Shandong UniversityJinan CityChina
| | - XuJi Jiang
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Yuan Feng
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Zhonghao Mao
- Cheeloo College of MedicineShandong UniversityJinan CityChina
| | - Qi Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan HospitalShandong UniversityJinan CityChina
| | - Qun Gao
- Department of Obstetrics and GynecologyThe Affiliated Hospital of Qingdao UniversityQingdao CityChina
| | - Wenjing Zhang
- Department of Obstetrics and GynecologyQilu Hospital of Shandong UniversityJinan CityChina
| | - Baoxia Cui
- Department of Obstetrics and GynecologyQilu Hospital of Shandong UniversityJinan CityChina
| | - Taotao Dong
- Department of Obstetrics and GynecologyQilu Hospital of Shandong UniversityJinan CityChina
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Fan X, Wang Y, Yang N, Zhu P. Prognostic analysis of patients with stage IIIC1p cervical cancer treated by surgery. World J Surg Oncol 2023; 21:186. [PMID: 37344912 DOI: 10.1186/s12957-023-03076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is one of the most common gynaecologic malignancies. The prognosis of stage IIIC1p cervical cancer patients treated by surgery is heterogeneous. Therefore, the aim of this study was to analyse the factors influencing the prognosis in such patients. METHODS From January 2012 to December 2017, 102 patients with cervical cancer who underwent surgical treatment in the Department of Gynaecology and Tumours, Changzhou Maternal and Child Health Hospital, and had pelvic lymph node metastasis confirmed by pathology were analysed retrospectively. All patients underwent radical hysterectomy with/without oophorectomy with pelvic lymphadenectomy with/without para-aortic lymphadenectomy. Clinical data was collected including age, surgical method, ovarian status, intraoperative blood loss, perioperative complications, tumour size, pathological type, depth of stromal invasion (DSI), whether the lymphatic vascular space was infiltrated, number of pelvic lymph node metastases, location of pelvic lymph node metastases, total number of lymph nodes resected, lymph node ratio (LNR), nature of vaginal margin, whether parametrium was involved, postoperative adjuvant therapy, preoperative neutrophil-lymphocyte ratio (NLR) and prognostic information of patients. Survival curves for overall survival (OS) and disease-free survival (DFS) were plotted using the Kaplan-Meier method, and the difference between the survival curves was tested using the log-rank test. Univariate and multivariate COX regression models were used to assess the factors associated with overall survival and disease-free survival in patients with stage IIIC1p cervical cancer. Nomogram plots were constructed to predict OS and DFS, and the predictive accuracy of the nomograms was measured by Harrell's C-index and calibration curves. RESULTS A total of 102 patients with stage IIIC1p cervical cancer were included in the study, and the median follow-up time was 63 months (range from 6 to 130 months). The 5-year OS was 64.7%, and the 5-year DFS was 62.7%. Multivariate analysis showed that no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8 were independent risk factors for OS and DFS in patients with stage IIIC1p cervical cancer. CONCLUSIONS Patients with stage IIIC1p cervical cancer have a poor prognosis. Lower OS and DFS were associated with no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8.
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Affiliation(s)
- Xiang Fan
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yifei Wang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Ni Yang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Pengfeng Zhu
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
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Li Y, Gao X, Huang Y, Zhu X, Chen Y, Xue L, Zhu Q, Wang B, Wu M. Tumor microenvironment promotes lymphatic metastasis of cervical cancer: its mechanisms and clinical implications. Front Oncol 2023; 13:1114042. [PMID: 37234990 PMCID: PMC10206119 DOI: 10.3389/fonc.2023.1114042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Although previous studies have shed light on the etiology of cervical cancer, metastasis of advanced cervical cancer remains the main reason for the poor outcome and high cancer-related mortality rate. Cervical cancer cells closely communicate with immune cells recruited to the tumor microenvironment (TME), such as lymphocytes, tumor-associated macrophages, and myeloid-derived suppressor cells. The crosstalk between tumors and immune cells has been clearly shown to foster metastatic dissemination. Therefore, unraveling the mechanisms of tumor metastasis is crucial to develop more effective therapies. In this review, we interpret several characteristics of the TME that promote the lymphatic metastasis of cervical cancer, such as immune suppression and premetastatic niche formation. Furthermore, we summarize the complex interactions between tumor cells and immune cells within the TME, as well as potential therapeutic strategies to target the TME.
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Affiliation(s)
- Yuting Li
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Xiaofan Gao
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Yibao Huang
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Xiaoran Zhu
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Yingying Chen
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Liru Xue
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Qingqing Zhu
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Bo Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
| | - Mingfu Wu
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Department of Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education, Wuhan, Hubei, China
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Fan W, Lu Q, Liu G. A Clinical Prediction Model of Overall Survival for Patients with Cervical Cancer Aged 25-69 Years. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030600. [PMID: 36984601 PMCID: PMC10052094 DOI: 10.3390/medicina59030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Aims: This study aims to develop a prediction tool for the overall survival of cervical cancer patients. Methods: We obtained 4116 female patients diagnosed with cervical cancer aged 25-69 during 2008-2019 from the Surveillance, Epidemiology, and End Results Program. The overall survival between groups was illustrated by the Kaplan-Meier method and compared by a log-rank test adjusted by the Bonferroni-Holm method. We first performed the multivariate Cox regression analysis to evaluate the predictive values of the variables. A prediction model was created using cox regression based on the training set, and the model was presented as a nomogram. The proposed nomogram was designed to predict the 1-year, 3-year, and 5-year overall survival of patients with cervical cancer. Besides the c-index, time-dependent receiver operating curves, and calibration curves were created to evaluate the accuracy of the nomogram at the timepoint of one year, three years, and five years. Results: With a median follow-up of 54 (28, 92) months, 1045 (25.39%) patients were deceased. Compared with alive individuals, the deceased were significantly older and the primary site was more likely to be the cervix uteri site, large tumor size, higher grade, and higher combined summary stage (all p values < 0.001). In the multivariate Cox regression, age at diagnosis, race, tumor size, grade, combined summary stage, pathology, and surgery treatment were significantly associated with the all-cause mortality for patients with cervical cancer. The proposed nomogram showed good performance with a C-index of 0.82 in the training set. The 1-year, 3-year, and 5-year areas under the curves (with 95% confidence interval) of the receiver operating curves were 0.88 (0.84, 0.91), 0.84 (0.81, 0.87), and 0.83 (0.80, 0.86), respectively. Conclusions: This study develops a prediction nomogram model for the overall survival of cervical cancer patients with a good performance. Further studies are required to validate the prediction model further.
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Affiliation(s)
- Wenli Fan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Qin Lu
- Ultrasound Room, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, China
| | - Guokun Liu
- Comprehensive Ward, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, China
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Chang H, Wang M, Liu Y, Wu Y. Parametrial involvement and decreased survival of women with FIGO stage IIIC1 cervical cancer. J Gynecol Oncol 2023:34.e46. [PMID: 36929577 DOI: 10.3802/jgo.2023.34.e46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To evaluate the effect of parametrial status on FIGO stage IIIC1 cervical cancer. METHODS A retrospective study was conducted from June 1, 2009, to December 31, 2018.Patients with stage IIIC1 cervical cancer were included and stratified into two groups based on the status of parametrial involvement. Patients with IIIA or IIIB were selected as control. The primary outcomes are overall survival (OS) and progression-free survival (PFS). RESULTS Of 586 patients included, 377 patients were stage IIIC1 (group A) and 209 patients were stage IIIA/IIIB (group B). Compared control, stage IIIC1 was not associated with worse 5-year OS or PFS. Of the stage IIIC1 patients, 58.1% without parametrial involvement (group A1) and 41.9% with parametrial involvement (group A2). Patients of group A1 showed a better prognosis than group A2 both in 5-year rates of OS (79.09% vs. 59.43%, p<0.001) and PFS (73.27% vs. 56.95%, p=0.0002). However, patients of group A1 showed a better prognosis than group B both in OS and PFS. Also, patients of group A2 showed a comparable prognosis to group B both in OS and PFS. CONCLUSION Reclassification of stage IIIC1 cervical cancer without parametrial into a new stage is more appropriate and improves discriminatory ability.
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Affiliation(s)
- Hong Chang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ming Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yang Liu
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yumei Wu
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing, China.
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8
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Zeng J, Zuo J, Li N, Yao H, Zhang Y, Zhao Y, Wang T, Xiu L, Li J, Yu J, Liang L, Wu L. Clinical analysis of 312 patients with stage IB1-IIA2 cervical squamous cell carcinoma and research on the influencing factors of postoperative recurrence. BMC Womens Health 2023; 23:82. [PMID: 36823536 PMCID: PMC9951481 DOI: 10.1186/s12905-023-02159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/03/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To investigate the influencing factors of the recurrence of IB1-IIA2 cervical squamous cell carcinoma after surgical treatment, and to explore the relationship between high-risk human papillomavirus (HR-HPV) infection and postoperative cervical squamous cell carcinoma recurrence. METHODS Patients (n = 312) diagnosed with stage IB1-IIA2 cervical cancer and treated by radical hysterectomy and lymphadenectomy at this hospital were accrued between January 2014 and December 2016. The clinical data of these patients were analysed, and the association among clinicopathological factors, the association among clinicopathological factors, HPV infection and recurrences was investigated through Cox regression. RESULTS The median follow-up time was 59.2 months (with a range of 14-77.9 months). The pre-operative HPV infection rate was 85.3% (266/312), and 74 patients had a high level of HPV-DNA (> 5 × 106 copy number / 104 cells). Twenty-nine patients had a postoperative persistent high level of HPV-DNA (9.3%). On multivariate analysis, deep 1/3 stromal invasion (hazard ratio [HR] 114.79, 95% confidence interval [CI] 2.821-4670.111, p = 0.012*) and postoperative persistence of high HPV-DNA levels within 12 months (HR 269.044, 95% CI 14.437-5013.754, p < 0.001*) and 24 months (HR 31.299, 95% CI 1.191-822.215, p = 0.039*) were associated with a higher local recurrence rate. CONCLUSION Continuous high HPV-DNA levels within 24 months of an operation and deep 1/3 interstitial infiltration were independent risk factors for local recurrences of cervical cancer.
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Affiliation(s)
- Jia Zeng
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - Jing Zuo
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - Ning Li
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - HongWen Yao
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - YuanYuan Zhang
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - YuXi Zhao
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - TianTian Wang
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - Lin Xiu
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - Jian Li
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - Jing Yu
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - LeiLei Liang
- grid.506261.60000 0001 0706 7839Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021 China
| | - LingYing Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 of Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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9
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Guo J, Lv W, Wang Z, Shang Y, Yang F, Zhang X, Xiao K, Zhang S, Pan X, Han Y, Zong L, Hu W. Prognostic Value of Inflammatory and Nutritional Markers for Patients With Early-Stage Poorly-to Moderately-Differentiated Cervical Squamous Cell Carcinoma. Cancer Control 2023; 30:10732748221148913. [PMID: 36599103 PMCID: PMC9982384 DOI: 10.1177/10732748221148913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), systemic inflammation response index (SIRI), and Onodera's prognostic nutritional index (OPNI) have been reported as prognostic markers for various cancers. We evaluated the prognostic value of the NLR, PLR, MLR, SII, SIRI, and OPNI for poorly-to moderately-differentiated cervical squamous cell carcinoma (CSCC). PATIENTS AND METHODS We retrospectively analyzed the cases of 109 patients with early-stage poorly-to moderately-differentiated CSCC who underwent radical surgery at our institution in 2014-2017. The optimal cutoff points for the NLR, PLR, MLR, SII, SIRI, and OPNI were determined by receiver operating characteristic curves. Overall survival was analyzed by the Kaplan-Meier method. We performed a multivariate analysis using the Cox proportional hazard regression model to determine the independent prognostic indicators for early-stage poorly-to moderately-differentiated CSCC. RESULTS The appropriate cutoff points were: NLR, 1.72; PLR, 111.96; MLR, .24; SII, 566.23; SIRI, 1.38; and OPNI, 52.68. The OS of the patients with a high OPNI (P = .04), low SII (P = .03), or low SIRI (P = .01) was significantly better. The uni- and multivariate analyses identified only the OPNI as an independent prognostic marker for early-stage poorly-to moderately-differentiated CSCC (P = .04 and P = .02). CONCLUSION The OPNI is an independent prognostic marker for early-stage poorly-to moderately-differentiated CSCC; the NLR, PLR, MLR, SII, and SIRI are not.
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Affiliation(s)
- Jianfei Guo
- Graduate School of Medicine, Changzhi Medical
College, Changzhi, PR China
| | - Weiqing Lv
- Department of Gynecology, Yuncheng Central
Hospital, The Affiliated Hospital of Shanxi Medical University,
Shanxi, PR China
| | - Zehua Wang
- Department of Anesthesiology, Heji Hospital Affiliated to Changzhi
Medical College, Changzhi, PR China
| | - Yun Shang
- Department of Gynecology, Yuncheng Central
Hospital, The Affiliated Hospital of Shanxi Medical University,
Shanxi, PR China
| | - Fan Yang
- Department of Central Laboratory,
Changzhi People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China
| | - Xiaomin Zhang
- Department of Central Laboratory,
Changzhi People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China
| | - Keyuan Xiao
- Department of Central Laboratory,
Changzhi People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China
| | - Shangyunduo Zhang
- Graduate School of Medicine, Changzhi Medical
College, Changzhi, PR China
| | - Xiaoqi Pan
- Graduate School of Medicine, Changzhi Medical
College, Changzhi, PR China
| | - Yan Han
- Department of Gynecology, Changzhi
People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China,Yan Han, PhD, Department of Gynecology,
Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical
University, No. 502 Changxing Middle Road, Changzhi, Shanxi Province 1046000, PR
China.
| | - Liang Zong
- Department of Gastrointestinal
Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China,Liang Zong, PhD, Department of
Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of
Shanxi Medical University, No. 502 Changxing Middle Road, Changzhi, Shanxi
Province 1046000, PR China.
| | - Wenqing Hu
- Department of Gastrointestinal
Surgery, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi
Medical University, Changzhi, PR China,Wenqing Hu, PhD, Department of
Gastrointestinal Surgery, Changzhi People’s Hospital, The Affiliated Hospital of
Shanxi Medical University, No. 502 Changxing Middle Road, Changzhi, Shanxi
Province 1046000, PR China.
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10
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Tian J, Wang J, Chi Y, Han Z, Zhang D, Zhang H. Expression of GMFB in High-Grade Cervical Intraepithelial Neoplasia and Its Role in Cervical Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7784921. [PMID: 36238479 PMCID: PMC9553332 DOI: 10.1155/2022/7784921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022]
Abstract
Cervical intraepithelial neoplasia (CIN) is a collective term for specific precancerous lesions associated with cervical cancer (CC). Although it has been affirmed with slow development of several levels of cellular changes, the existing poor prognosis calls for an urgent need to diagnose CIN at early stage and be aware of markers related to its pathogenesis and prognosis. We explored the expression level of a newly marker GMFB and its regulatory effect on CIN and CC. Patient samples and cell models were included. Bioinformatic studies were taken to predict its binding to miR-143-3p, miR-26b-5p, miR-191-5p, and miR-223-3p. Luciferase reporter and RNA pull-down assays were used to validate the prediction. Edu assay and flow cytometry were used to measure the regulation of GMFB on proliferation and apoptosis of CC cells. qRT-PCR was used for mRNA expression level detection. The results showed that GMFB was targeted by miR-143-3p, miR-26b-5p, miR-191-5p, and miR-223-3p. It had elevated expression in both CIN and CC samples. GMFB had highly prognostic value for CIN, and lymph node metastasis of CC was much associated with high GMFB expression level. Besides, silencing of GMFB inhibited CC cell proliferation and elevated cell apoptosis. In conclusion, we determined that GMFB has regulatory effect on high grade CIN and CC, which could lighten a novel way in exploring their pathogenesis and improving accuracy of prognosis.
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Affiliation(s)
- Jun Tian
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu 222005, China
| | - Jianqing Wang
- Department of Gynecology, Yancheng First People's Hospital, Yancheng, Jiangsu 222005, China
| | - Yinxiu Chi
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu 222005, China
| | - Zhongbao Han
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu 222005, China
| | - Dongliang Zhang
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu 222005, China
| | - Hu Zhang
- Jiangsu Vocational College of Medicine, Yancheng, Jiangsu 222005, China
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11
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Wang M, Ma M, Yang L, Liang C. Development and validation of a nomogram for predicting pelvic lymph node metastasis and prognosis in patients with cervical cancer. Front Oncol 2022; 12:952347. [PMID: 36119526 PMCID: PMC9479219 DOI: 10.3389/fonc.2022.952347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Cervical cancer (CC) is one of the main causes of death among gynecological malignancies. Patients with CC with lymph node metastasis (LNM) have poor prognoses. We investigated the risk factors and prognosis of LNM in patients with CC patients using data from the SEER database. Methods We collected the information of cervical cancer patients registered in SEER database from 2010 to 2015. The dataset was divided into a training set and a validation set at a 7:3 ratio. LASSO regression analysis was used to evaluate risk factors for LNM in patients with CC. Using the results, we established a nomogram prediction model. C-index, ROC curves, calibration curves, decision curve analysis, and clinical impact curves were used to evaluate the prediction performance of the model. Results We included 14,356 patients with CC in the analysis. Among these, 3997 patients were diagnosed with LNM. A training set (10,050 cases) and a validation set (4306 cases) were used for the following analysis. We established nomogram LNM prediction models for the patients with T1-2-stage CC. The C-indices for the internal and external validations of the prediction models were 0.758 and 0.744, respectively. In addition, we established a prognostic nomogram for all CC patients with LNM, and the internal and external validation C-indices were 0.763 and 0.737. Conclusion We constructed a quantitative and visual predictive nomogram that predicted prognosis of patients with LNM in CC to provide clinicians with a reference for diagnosis and treatment.
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Affiliation(s)
- Mengting Wang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Min Ma
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Liju Yang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Chengtong Liang
- Department of Laboratory Medicine, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
- *Correspondence: Chengtong Liang,
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12
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Xu M, Xie X, Cai L, Xie Y, Gao Q, Sun P. Risk Factor Assessment of Lymph Node Metastasis in Patients With FIGO Stage IB1 Cervical Cancer. Front Oncol 2022; 12:809159. [PMID: 35433446 PMCID: PMC9007329 DOI: 10.3389/fonc.2022.809159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the risk factors of lymph node metastasis (LNM) in patients with FIGO stage (2009) IB1 cervical cancer (CC). Methods Patients with FIGO stage IB1 CC who underwent radical resection between 2012 and 2018 were recruited. The risk factors for LNM were analysed. A recursive partitioning analysis (RPA) was used to divide the patients into risk groups and assess their risk of LNM. Results The 5-year overall survival rate was 91.72%, while 80.0% and 93.5% for patients with or without LNM (P<0.05). Multivariable logistic regression analysis showed that lymphovascular invasion (LVI), depth of invasion (DI), tumour size (TS), squamous cell carcinoma (SCC) antigen level were independent risk factors (all P<0.05). Patients were divided into low-risk (no LVI, DI <1/2, TS <2 cm), intermediate-risk (no LVI, DI <1/2, TS ≥2 cm; no LVI, DI ≥1/2, normal SCC level; LVI, DI <1/2, TS <2 cm), and high-risk (no LVI, DI ≥1/2, SCC level ≥1.5 ng/ml; LVI, TS <2 cm, DI ≥1/2; LVI, TS ≥2 cm) groups by RPA according to these four factors. The incidence of LNM among the three groups was 0.00%, 4.40%, and 24.10%, respectively (all P<0.001). The 5-year overall survival rates differed among the groups (98.2%, 92.7%, 83.0%, respectively, P=0.001). Conclusions LNM affects the prognosis of patients with FIGO stage IB1 CC. Lymphadenectomy may be avoided for patients in the low-risk group and recommended for those in the high-risk group. Whether dissection is performed in the intermediate-risk group depends on the lymph node biopsy results.
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Affiliation(s)
- Mu Xu
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaoyan Xie
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liangzhi Cai
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yongjin Xie
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiao Gao
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Pengming Sun
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Laboratory of Gynecologic Oncology, Fujian Maternal and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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13
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Zhang Y, Ding J, Hua K. Data from small cell neuroendocrine carcinoma of the cervix: FIGO 2018 staging is more accurate than FIGO 2009. J Int Med Res 2022; 50:3000605211067397. [PMID: 34986672 PMCID: PMC8753085 DOI: 10.1177/03000605211067397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the prognostic value of International Federation of Gynecology and Obstetrics (FIGO) 2009 and 2018 staging systems in surgical patients with small cell neuroendocrine carcinoma of the cervix (SCNEC). METHODS We re-staged 64 surgical IB-IIA (FIGO 2009) SCNEC patients according to the FIGO 2018 system and refined stage IIIC of FIGO 2018 based on tumor local invasion. The prognostic factors were analyzed, and the advantages of FIGO 2018 were compared with 2009. RESULTS The 5-year overall survival rate (OS) was 78.5% for stage I and 22.2% for stage II (FIGO 2009). In FIGO 2018, there was no difference between stage I and II, and the 5-year OS was 74.1%, 60.2%, and 0% for stage I/II, IIIC1, and IIIC2. After combining stage IIIC with the local invasion stage (T1 was limited to the cervix and vagina; T2 involved the parametrium; T3 involved the pelvic or abdominal cavity), the 5-year OS for stage IIICT1, IIICT2, and IIICT3 was 83.3%, 30.0%, and 0%, respectively. CONCLUSIONS For stage II SCNEC patients, FIGO 2009 underestimated the prognosis, while FIGO 2018 was more accurate. For stage IIIC, FIGO 2018 might be more individualized and accurate after combining stage IIIC with tumor local invasion.
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Affiliation(s)
- Yunqiang Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
- Keqin Hua, Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai 200090, P.R. China.
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14
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He T, Sun J, Wu J, Wang H, Liang C, Wang H, Li S, Su S. PET-CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta-analysis. Microsc Res Tech 2022; 85:1791-1798. [PMID: 34981608 DOI: 10.1002/jemt.24039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/28/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
To compare the clinical application value of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) in the diagnosis of cervical cancer lymph node metastasis. We searched PubMed and other databases for the studies comparing the use of PET-CT and MRI for the diagnosis of cervical cancer lymph node metastasis up to January 20, 2021. We strictly followed the inclusion and exclusion criteria to screen the literature and extract the data. Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool was used for quality evaluation of included studies, and Revman 5.3 and Stata 15.0 software were used for evaluating heterogeneity, synthesize sensitivity (SEN), specificity (SPE), positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the curve (AUC) and comparing the pretest and posttest probabilities. Finally, 11 studies were included for meta-analysis. The synthesized results indicated that the SEN value of PET-CT was 0.65 (0.60 ~ 0.69) and SPE was 0.93 (0.91 ~ 0.94), and the SEN value of MRI was 0.58 (0.54 ~ 0.63) and SPE was 0.91 (0.90 ~ 0.92). AUC of PET-CT was 0.824, which was significantly higher than that of MRI (AUC = 0.702; p < .05). The subgroup analysis showed that the AUC value of the study based on study design and use of blinding methods was not statistically significant (all p > .05). There was no obvious publication bias in the synthesized analysis of the diagnostic value of PET-CT and MRI (all p > .05). HIGHLIGHTS: To compare positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) in diagnosis of cervical cancer lymph node metastasis. Synthesize sensitivity value of PET-CT was comparable with that of MRI. Area under the curve of PET-CT was significantly higher than that of MRI. There was no obvious publication bias in synthesized analysis.
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Affiliation(s)
- Tao He
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Jiangming Sun
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Jie Wu
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Hui Wang
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Changping Liang
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Huan Wang
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Shujun Li
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Shunbing Su
- Department of Nuclear Medicine, Panzhihua Central Hospital, Panzhihua, China
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15
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Qin F, Pang H, Yu T, Luo Y, Dong Y. Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review. Technol Cancer Res Treat 2022; 21:15330338221086403. [PMID: 35341413 PMCID: PMC8966198 DOI: 10.1177/15330338221086403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the fourth most common malignant tumor globally in terms of morbidity and mortality. The presence of lymph node metastasis (LNM) is an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in cervical cancer patients. The International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2018. An important revision designates patients with regional LNM as stage IIIC, pelvic LNM only as stage IIIC1, and para-aortic LNM as stage IIIC2. However, the current staging system is only based on the anatomical location of metastatic lymph nodes (LNs). It does not consider other LN status parameters, which may limit its prognostic significance to a certain extent and needs further exploration and confirmation in the future. The purpose of this review is to summarize the choice of treatment for stage IIIC cervical cancer and the effect of different LN status parameters on prognosis.
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Affiliation(s)
- Fengying Qin
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Huiting Pang
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Yu
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yahong Luo
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yue Dong
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
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16
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Zhu M, Wang B, Wang T, Chen Y, He D. Risk Assessment of Pulmonary Metastasis for Cervical Cancer Patients by Ensemble Learning Models: A Large Population Based Real-World Study. Int J Gen Med 2021; 14:8713-8723. [PMID: 34853529 PMCID: PMC8628546 DOI: 10.2147/ijgm.s338389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/10/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Pulmonary metastasis (PM) is an independent risk factor affecting the prognosis of cervical patients, but it still lacks a prediction. This study aimed to develop machine learning-based predictive models for PM. Methods A total of 22,766 patients diagnosed with or without PM from the Surveillance, Epidemiology, and End Results (SEER) database were enrolled in this study. The cohort was randomly split into a train set (70%) and a validation set (30%). In addition, 884 Chinese patients from two tertiary medical centers were included as an external validation set. Duplicated and useless candidate variables were excluded, and sixteen variables were included for the machine learning algorithm. We developed five predictive models, including the generalized linear model (GLM), random forest model (RFM), naive Bayesian model (NBM), artificial neural networks model (ANNM), and decision tree model (DTM). The predictive performance of these models was evaluated by the receiver operating characteristic (ROC) curve and calibration curve. The Cox proportional hazard model (CPHM) and competing risk model (CRM) were also included for survival outcome prediction. Results Of the patients included in the analysis, 2456 (4.38%) patients were diagnosed with PM. Age, organ-site metastasis (liver, bone, brain), distant lymph metastasis, tumor size, and pathology were the important predictors of PM. The RFM with 9 variables introduced was identified as the best predictive model for PM (AUC = 0.972, 95% CI: 0.958-0.986). The C-index for the CPHM and CRM was 0.626 (95% CI: 0.604-0.648) and 0.611 (95% CI: 0.586-0.636), respectively. Conclusion The prediction algorithm derived by machine-learning-based methods shows a robust ability to predict PM. This result suggests that machine learning techniques have the potential to improve the development and validation of predictive modeling in cervical patients with PM.
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Affiliation(s)
- Menglin Zhu
- Department of Anesthesiology, Hubei Minzu University Affiliated Enshi Clinical Medical School, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, People's Republic of China
| | - Bo Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases; Key Laboratory of Cancer Invasion and Metastasis, Ministry of Education; Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tiejun Wang
- Department of Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yilin Chen
- Department of Anesthesiology, Hubei Minzu University Affiliated Enshi Clinical Medical School, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, People's Republic of China.,Department of Pulmonary and Critical Care Medicine, Hubei Minzu University Affiliated Enshi Clinical Medical School, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, People's Republic of China
| | - Du He
- Department of Anesthesiology, Hubei Minzu University Affiliated Enshi Clinical Medical School, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, People's Republic of China.,Department of Oncology, Hubei Minzu University Affiliated Enshi Clinical Medical School, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, People's Republic of China
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17
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Lee YH, Chong GO, Kim SJ, Hwang JH, Kim JM, Park NJY, Hong DG. Prognostic Value of Lymph Node Characteristics in Patients with Cervical Cancer Treated with Radical Hysterectomy. Cancer Manag Res 2021; 13:8137-8145. [PMID: 34737642 PMCID: PMC8560076 DOI: 10.2147/cmar.s332612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/17/2021] [Indexed: 01/09/2023] Open
Abstract
Objective This study evaluated the prognostic value of various lymph node (LN) characteristics, including the lymph node ratio (LNR), in patients with cervical cancer treated with radical hysterectomy. Methods In this retrospective study, 260 patients with cervical cancer who had undergone radical hysterectomy with pelvic or paraaortic lymphadenectomies were included. LN characteristics related to several LN statuses included total LN counts, LN metastasis, total positive LN counts, LNR, and levels of lymphadenectomy. LNR was defined as the number of metastatic LNs divided by the total number of LNs harvested. Univariate and multivariate analyses for disease-free survival (DFS) and overall survival (OS) were performed using the clinicopathological and LN characteristics. Results Based on receiver-operating characteristics curve analysis, the cut-off value of LNR was 0.0625. Multivariate analysis revealed that high LNR was significantly related to tumor recurrence (hazard ratio [HR], 5.182; 95% confidence interval [CI], 2.424–11.075; p < 0.0001). After adjusting for clinicopathological factors, LNR was also independent prognostic factor for predicting tumor recurrence (HR, 5.930; 95% CI, 2.114–16.634; p = 0.0007). However, total retrieved LN counts and level of lymphadenectomy were not associated with survival outcomes. Conclusion LNR may be a prognostic biomarker for predicting disease recurrence in cervical cancer treated with radical hysterectomy.
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Affiliation(s)
- Yoon Hee Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.,Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.,Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Su Jeong Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ja Hyun Hwang
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jong Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Nora Jee-Young Park
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Phung HT, Truong MC, Nguyen LT, Dang ATV, Vu TH, Nguyen HT. Treatment Outcome and Prognosis Factors of FIGO 2018 Stage III Cervical Cancer Patients Treated with Definitive Concurrent Chemoradiation in Vietnam. Asian Pac J Cancer Prev 2021; 22:853-859. [PMID: 33773550 PMCID: PMC8286661 DOI: 10.31557/apjcp.2021.22.3.853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: This study aimed to analyze the treatment outcome and toxicities, along with prognosis factors of patients with FIGO 2018 stage III cervical cancer treated with definitive concurrent chemoradiation. Methods: A total of 83 stage III cervical cancer patients with good performance status (ECOG PS 0, 1) were treated with three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy (weekly cisplatin), followed by high-dose-rate (HDR) brachytherapy between January 2017 and March 2019 at Vietnam National Cancer hospital. Treatment outcomes and prognosis factors were assessed along with acute and late toxicities. Results: The 3-year DFS was 67.8% and 3-year OS was 80.3%. On multivariate analyses, short axis of pelvic lymph node diameter of ≥ 15mm, invasion of the lower third of vagina and para-aortic lymph node metastasis were identified as adverse prognostic factors for DFS. The cumulative incidence rate of gastrointestinal and genitourinary toxicity (≥ grade 2) at the 3-year follow-up were 29.6% and 11.6%, respectively. Conclusions: 3D CRT and HDR brachytherapy with concurrent chemotherapy is an effective treatment, with acceptable toxicity for FIGO 2018 stage III cervical cancer in Vietnam.
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Affiliation(s)
- Huyen Thi Phung
- Department of Medical Oncology 6, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Department of Oncology, Vietnam University of Traditional Medicine, Hanoi, Vietnam
| | - Minh Cong Truong
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Anh Thi Van Dang
- Department of Breast and Gynecologic Radiotherapy, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Thanh Ha Vu
- Department of Medical Oncology 2, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Hoa Thi Nguyen
- Department of Medical Oncology 6, Vietnam National Cancer Hospital, Hanoi, Vietnam
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Clinical features that affect the number of pelvic lymph nodes harvested in patients with cervical cancer stage IB1 to IIA2. Obstet Gynecol Sci 2020; 64:73-79. [PMID: 33137864 PMCID: PMC7834762 DOI: 10.5468/ogs.20016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate clinical features that affect the number of pelvic lymph nodes (PLNs) harvested and prognostic significance of the number of PLNs removed in patients with stage IB1 to IIA2 cervical cancer. Methods Data from patients with cervical cancer whom underwent hysterectomy with PLN dissection between June 2004 and July 2015 were reviewed retrospectively. Data on clinicopathologic factors including age, height, and weight were collected. Data on the presence of PLN metastasis on imaging studies prior to surgery, number of PLNs harvested, and presence of metastasis in the harvested PLNs were retrieved from medical records. Clinical features associated with the number of PLNs harvested were analyzed. Disease-free survival (DFS) and overall survival (OS) according to the number of PLNs harvested were analyzed. Results During the study period, 210 patients were included. The height and weight of patients and preoperative positive positron emission tomography findings were significantly associated with a higher number of PLNs harvested. As a pathologic factor, larger tumor size was associated with a higher number of PLNs harvested. Furthermore, a higher number of PLNs harvested was associated with a higher number of metastatic PLNs and patients undergoing postoperative concurrent chemoradiation therapy. Patient height and tumor size were independent factors affecting the number of PLNs harvested in multivariate analysis. However, the number of PLNs harvested was not associated with DFS or OS. Conclusion The number of PLNs harvested during surgery was associated with patient height; however, this was not related to the prognosis of the disease.
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Llueca A, Escrig J, Gil-Moreno A, Benito V, Hernández A, Díaz-Feijoo B. The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival. J Gynecol Oncol 2020; 32:e4. [PMID: 33185045 PMCID: PMC7767657 DOI: 10.3802/jgo.2021.32.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/11/2020] [Accepted: 09/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. METHODS Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. RESULTS A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of -2 was established as a prognostic indicator. CALS and LODDS <-2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥-2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. CONCLUSION When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Department of Medicine, Universitat Jaume I (UJI), Castellón, Spain.
| | - Javier Escrig
- Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Department of Medicine, Universitat Jaume I (UJI), Castellón, Spain
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Virginia Benito
- Department of Gynecologic Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Alicia Hernández
- Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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21
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Pedone Anchora L, Carbone V, Gallotta V, Fanfani F, Cosentino F, Turco LC, Fedele C, Bizzarri N, Scambia G, Ferrandina G. Should the Number of Metastatic Pelvic Lymph Nodes be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer? Cancers (Basel) 2020; 12:cancers12061552. [PMID: 32545508 PMCID: PMC7352475 DOI: 10.3390/cancers12061552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023] Open
Abstract
Introduction: Lymph node status has become part of the new staging system for cervical cancer (CC). It has been shown that patients staged as IIIC1 had heterogeneous prognoses and, in some cases, experienced better outcomes than patients with lower stages. We evaluated the impact of the number of metastatic pelvic lymph nodes (MPLNs) among patients with stage IIIC1 cervical cancer. Methods: Survival analyses were conducted in order to identify the best cut-off prognostic value relative to the number of MPLNs. Disease free survival (DFS) was considered the main outcome. Results: 541 patients were included in the study. Eighty-nine patients were of stage IIIC1. The best prognostic cut-off value of the number of MPLNs was 2. Patients with >2 MPLNs (n > 2 group) had worse DFS compared with those having <2 (N1-2 group) (5 yr DFS: 54.7% vs. 78.1%, p value = 0.006). Multivariate analyses demonstrated that the extent of MPLNs had little impact on DFS and that replacement of IIIC1 staging with N1-2 and n > 2 grouping provided a better, statistically significant model (p value = 0.006). Discussion: Using a cut-off value of 2, the number of MPLNs could better predict prognostic outcomes within stage IIIC1 cervical cancer and have potential implications for therapeutic decision-making in the treatment of patients with stage IIIC1 CC.
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Affiliation(s)
- Luigi Pedone Anchora
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
| | - Vittoria Carbone
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
- Correspondence: ; Tel.: +39-333-6496669
| | - Valerio Gallotta
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
| | - Francesco Fanfani
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00167 Roma, Italy
| | - Francesco Cosentino
- Dipartimento di Oncologia, UOC Ginecologia Oncologica, Gemelli Molise, 86100 Campobasso, Italy; (F.C.); (L.C.T.)
| | - Luigi Carlo Turco
- Dipartimento di Oncologia, UOC Ginecologia Oncologica, Gemelli Molise, 86100 Campobasso, Italy; (F.C.); (L.C.T.)
- Brest Care Unit, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Camilla Fedele
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
| | - Nicolò Bizzarri
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00167 Roma, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, 00167 Roma, Italy; (L.P.A.); (V.G.); (F.F.); (C.F.); (N.B.); (G.S.); (G.F.)
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00167 Roma, Italy
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Qin S, Liao Y, Du Q, Wang W, Huang J, Liu P, Shang C, Liu T, Xia M, Yao S. DSG2 expression is correlated with poor prognosis and promotes early-stage cervical cancer. Cancer Cell Int 2020; 20:206. [PMID: 32514251 PMCID: PMC7268232 DOI: 10.1186/s12935-020-01292-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background The pathogenesis and developmental mechanism of early-stage (FIGO 2009 IA2-IIA2) cervical cancer (CC) remain unclear. Seeking novel molecular biomarkers based on The Cancer Genome Atlas (TCGA) will facilitate the understanding of CC pathogenesis and help evaluate early-stage CC prognosis. Methods To identify prognosis-related genes in early-stage CC, we analyzed TCGA mRNA-seq data and clinical data by univariate Cox and Kaplan-Meier plotter analyses. Differential expression analysis identified upregulated genes in early-stage CC. Combined with the genes correlated with unfavorable prognosis, we selected desmoglein-2 (DSG2) for further investigation. To detect DSG2 expression in early-stage CC, we used immunohistochemistry (IHC), quantitative real-time PCR (qRT-PCR) and western blotting. The relationship between the expression of DSG2 and clinical features was analyzed by the Chi square test. Cox analysis was applied to assess the relationship between CC overall survival (OS) and risk factors. The correlations between DSG2 expression and CC cell line proliferation and migration were investigated with Cell Counting Kit-8 (CCK-8) and migration assays. Results There were 416 prognosis-related genes in early-stage CC. DSG2, matrix metallopeptidase 1 (MMP1), carbonic anhydrase IX (CA9), homeobox A1 (HOXA1), and serine protease inhibitor B3 (SERPINB3) were upregulated in early-stage CC compared with adjacent noncancerous tissue (ANT) and correlated with unfavorable prognosis. Among them, DSG2 was most significantly correlated with patient survival. Coexpression analysis indicated that DSG2 was probably involved in cell division, positive regulation of transferase activity, positive regulation of cell migration, EGFR upregulation pathway and regulation of lymphangiogenesis. IHC, qRT-PCR and western blotting showed that DSG2 expression was higher in CC than in normal tissue. Significant correlations were identified between DSG2 expression and several aggressive clinical features, including pelvic lymph node metastasis (PLNM). Multivariate Cox analysis showed that DSG2 and PLNM were independent prognostic factors for OS. DSG2 knockdown inhibited CC cell proliferation and migration. Conclusions DSG2 is a biomarker that promotes tumor proliferation and metastasis and is correlated with poor prognosis in early-stage CC.
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Affiliation(s)
- Shuhang Qin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Yuandong Liao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Qiqiao Du
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Wei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Jiaming Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Pan Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Chunliang Shang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191 People's Republic of China
| | - Tianyu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Meng Xia
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Zhongshan Second Road 58, Guangzhou, 510080 People's Republic of China
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23
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Kim H, Park W, Cho WK. Who can benefit from a lymph node boost in definitive chemoradiotherapy for node-positive cervical cancer: an evaluation of nodal failure in patients without nodal boost. JOURNAL OF RADIATION RESEARCH 2020; 61:479-486. [PMID: 32211854 PMCID: PMC7299268 DOI: 10.1093/jrr/rraa012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/13/2020] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
This study was performed to identify risk factors for pelvic nodal failure (PNF) after definitive concurrent chemo-radiotherapy (CCRT) in patients with metastatic pelvic lymph nodes (mPLNs) from squamous cell carcinoma (SCC) of the cervix. We retrospectively reviewed data on 80 patients who received definitive CCRT between 2005 and 2014 at our hospital. All patients underwent brachytherapy and whole-pelvic radiotherapy (WPRT) without nodal boost. mPLNs was diagnosed by magnetic resonance imaging and positron emission tomography. The rate of PNF and factors affecting PNF were analysed. A total of 156 mPLNs were found. The median number of mPLNs was 2 per patient (range 1-6); the median short diameter was 1.7 cm (range 1.0-4.2 cm). After a median follow-up of 64 months, 10 (6.4%) mPLNs failed in 13 (16.3%) patients. The 5-year PNF-free survival (PNFFS), disease-free survival and overall survival rates were 83.4, 62.7 and 74.7%, respectively. The mPLN size was not associated with the risk of PNF. However, pre-radiotherapy SCC antigen (SCC-Ag) >6.8 ng/mL and number of mPLNs >2 were significant risk factors for PNF. Using the two risk factors, we categorized the patients into three risk groups. The 5-year PNFFS rates in patients with 0, 1 and 2 risk factors were 100.0, 78.3 and 44.4%, respectively (P < 0.01). SCC-Ag level and number of mPLNs were significant factors for PNF. Patients with both risk factors developed frequent PNF after WPRT without nodal boost. The two risk factors can be a guide in deciding whether to administer nodal boost radiotherapy.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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24
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Ryu JM, Choi YS, Bae JY. Prognostic factors in women with cervical cancer stage IIIC1r treated with concurrent chemoradiotherapy. J Obstet Gynaecol Res 2020; 46:1165-1172. [PMID: 32428977 DOI: 10.1111/jog.14305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/17/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022]
Abstract
AIM The purpose of this study was to evaluate the prognostic factors of patients with stage IIIC1r cervical cancer who underwent concurrent chemoradiotherapy. METHODS A total of 134 patients treated with chemoradiotherapy for cervical cancer with pelvic and/or paraaortic lymph node metastasis (PALNM) were enrolled in this study. Clinical variables were investigated through review of the patients' medical records. RESULTS The 5-year overall survival (OS) rate in patients with stage IIICr cervical cancer was 70.5%. Age, PALNM, parametrial invasion, T stage, pelvic side wall invasion, differentiation, lymphovascular space involvement and high squamous cell carcinoma antigen level (>8 ng/mL) were prognostic factors for survival. The 5-year OS rate of patients with stage IIIC1r was 74.5%, and that of stage IIIC2r was 38.1% (P-value = 0.012). The 5-year OS rate of patients with stage IIIC1r with the presence of pelvic side wall invasion was 48.3% and that in its absence was 83.0% (P-value < 0.001). The 5-year OS rate of patients with stage IIIC1r with the presence of parametrial invasion was 68.9% and that in its absence was 82.4% (P-value = 0.031). In multivariable analysis via backward conditional modeling, age, PALNM and pelvic side wall invasion were independent prognostic factors for survival of stage IIICr. Age and pelvic side wall invasion were independent prognostic factors for survival of stage IIIC1r cervical cancer. CONCLUSION In stage IIICr cervical cancer, patients with PALNM, and/or pelvic side wall invasion can expect to have a poor prognosis. Particularly, pelvic side wall invasion in stage IIIC1r is an independent prognosis factor.
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Affiliation(s)
- Jung Min Ryu
- Department of Obstetrics and Gynecology, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea
| | - Yoon Seok Choi
- Department of Obstetrics and Gynecology, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea
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Chen S, Gao C, Wu Y, Huang Z. Identification of Prognostic miRNA Signature and Lymph Node Metastasis-Related Key Genes in Cervical Cancer. Front Pharmacol 2020; 11:544. [PMID: 32457603 PMCID: PMC7226536 DOI: 10.3389/fphar.2020.00544] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background miRNAs and genes can serve as biomarkers for the prognosis and therapy of cervical tumors whose metastasis into lymph nodes is closely associated with disease progression and poor prognosis. Methods R software and Bioconductor packages were employed to identify differentially expressed miRNAs (DEMs) from The Cancer Genome Atlas (TCGA) database. GEO2R detected differentially expressed genes (DEGs) in the GSE7410 dataset originating from the Gene Expression Omnibus (GEO). A Cox proportional hazard regression model was established to select prognostic miRNA biomarkers. Online tools such as TargetScan and miRDB predicted target genes, and overlapping DEGs and target genes were defined as consensus genes. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and Gene Ontology (GO) function annotations were performed to discern the potential functions of consensus genes. STRING and Cytoscape screened key genes and constructed a regulatory network. Results A combination of four miRNAs (down-regulated miR-502 and miR-145, up-regulated miR-142 and miR-33b) was identified as an independent prognostic signature of cervical cancer. A total of 94 consensus genes were significantly enriched in 7 KEGG pathways and 19 GO function annotations including the cAMP signaling pathway, the plasma membrane, integral components of the plasma membrane, cell adhesion, etc. The module analysis suggested that CXCL12, IGF1, PTPRC CDH5, RAD51B, REV3L, and WDHD1 are key genes that significantly correlate with cervical cancer lymph node metastasis. Conclusions This study demonstrates that a four-miRNA signature can be a prognostic biomarker, and seven key genes are significantly associated with lymph node metastasis in cervical cancer patients. These miRNAs and key genes have the potential to be therapeutic targets for cervical cancer. Among them, two miRNAs (miR-502 and miR-33b) and two key genes (PTPRC and CDH5) were first reported to be potential novel biomarkers for cervical cancer. The current study further characterizes the progression of lymph node metastasis and mechanism of cervical tumors; therefore, it provides a novel diagnostic indicator and therapeutic targets for future clinical treatments.
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Affiliation(s)
- Shuoling Chen
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Research Platform Service Management Center, Guangdong Medical University, Dongguan, China.,The Second School of Clinical Medicine, Guangdong Medical University, Dongguan, China
| | - Chang Gao
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Research Platform Service Management Center, Guangdong Medical University, Dongguan, China.,Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Guangdong Medical University, Dongguan, China
| | - Yangyuan Wu
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Research Platform Service Management Center, Guangdong Medical University, Dongguan, China.,The Second School of Clinical Medicine, Guangdong Medical University, Dongguan, China
| | - Zunnan Huang
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Research Platform Service Management Center, Guangdong Medical University, Dongguan, China.,Institute of Marine Biomedical Research, Guangdong Medical University, Zhanjiang, China
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26
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Lu Y, Xu X, Nong XH, Yao DS. Detection of high-risk human papillomavirus DNA in sentinel lymph nodes of patients with cervical cancer. Oncol Lett 2020; 19:2317-2325. [PMID: 32194731 PMCID: PMC7039119 DOI: 10.3892/ol.2020.11337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the expression of human papillomavirus (HPV) DNA in sentinel lymph nodes (SLN) in patients with early-stage cervical cancer (CC). In addition, the present study compared the positive rate of SLNs metastasis detected by routine pathological examination, and investigated the value of HPV-DNA in the detection of early CC lymph node micrometastasis. Reverse transcription-quantitative PCR (RT-qPCR) was used in order to evaluate the HPV DNA detection in all CC samples [International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA2]. The consistency of HPV-DNA was compared between primary lesions and SLNs. The positive rates of HPV-DNA were compared with pathological diagnosis of SLN metastasis, and the association between the positive expression of HPV-DNA in SLNs and the clinical and pathological parameters of patients with cervical cancer were analyzed. A total of 345 sentinel lymph nodes were detected in 100 patients with IA2-IIA2 CC. The positive rates of RT-qPCR and conventional histopathological detection of SLNs metastasis were 31.6% (109/345) and 12.8% (44/345), respectively (P<0.001). The positive expression of HPV-DNA in SLNs was associated with the clinical stage and tumor diameter (P<0.05), but not with patients' age, depth of cervical invasion, histological grade, lymphatic and vascular space invasion (LVSI), squamous cell carcinoma antigen (SCCAg) (P>0.05). The detection of HPV-DNA expression in pelvic lymph nodes of early CC may be used to improve the detection rate of micrometastasis, guide the postoperative adjuvant therapy more accurately and improve prognosis. Patients with positive HPV-DNA would require closer surveillance than those with negative HPV-DNA.
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Affiliation(s)
- Yan Lu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xun Xu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xiu-Hong Nong
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - De-Sheng Yao
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
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Zhao D, Li B, Zheng S, Ou Z, Zhang Y, Wang Y, Liu S, Zhang G, Yuan G. Separate lateral parametrial lymph node dissection improves detection rate of parametrial lymph node metastasis in early-stage cervical cancer: 10-year clinical evaluation in a single center in China. Chin J Cancer Res 2020; 32:804-814. [PMID: 33447002 PMCID: PMC7797234 DOI: 10.21147/j.issn.1000-9604.2020.06.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the clinical significance of separate lateral parametrial lymph node dissection (LPLND) in improving parametrial lymph node (PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer. Methods From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1−IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy (CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups. Results Compared with CRH group, the rate of laparoscopic surgery was higher (60.3% vs. 15.9%, P<0.001), and the blood transfusion rate was lower (19.0%vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases (96.7%) in the LPLND group, and 270 cases (11.6%) in the CRH group (P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group (median 3vs. 1, P<0.001). The PLN metastases were detected in 25 cases (6.8%) in the LPLND group, and 18 cases (0.8%) in the CRH group (P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio (OR)=228.999, 95% confidence interval (95% CI): 124.661−420.664; P<0.001], but also for PLN metastasis identification (OR=10.867, 95% CI: 5.381−21.946; P<0.001).
Conclusions LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.
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Affiliation(s)
- Dan Zhao
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bin Li
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shan Zheng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhengjie Ou
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yanan Zhang
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yating Wang
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuanghuan Liu
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Gongyi Zhang
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guangwen Yuan
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Wu H, Song S, Yan A, Guo X, Chang L, Xu L, Hu L, Kuang M, Liu B, He D, Zhao R, Wang L, Wu X, Gu J, Ruan Y. RACK1 promotes the invasive activities and lymph node metastasis of cervical cancer via galectin-1. Cancer Lett 2020; 469:287-300. [DOI: 10.1016/j.canlet.2019.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
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Aslan K, Meydanli MM, Oz M, Tohma YA, Haberal A, Ayhan A. The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. J Gynecol Oncol 2019; 31:e1. [PMID: 31788991 PMCID: PMC6918892 DOI: 10.3802/jgo.2020.31.e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/30/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to determine the prognostic value of lymph node ratio (LNR) in women with 2018 International Federation of Gynecology and Obstetrics stage IIIC cervical cancer. Methods In this retrospective dual-institutional study, a total of 185 node-positive cervical cancer patients who had undergone radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy were included. All of the patients received adjuvant chemoradiation after surgery. LNR was defined as the ratio of positive lymph nodes (LNs) to the total number of LNs removed. The patients were categorized into 2 groups according to LNR; LNR <0.05 and LNR ≥0.05. The prognostic value of LNR was evaluated with univariate log-rank tests and multivariate Cox regression models. Results A total of 138 patients (74.6%) had stage IIIC1 disease and 47 (25.4%) patients had stage IIIC2 disease. With a median follow-up period of 45.5 months (range 3–135 months), the 5-year disease-free survival (DFS) rate was 62.5% whereas the 5-year overall survival (OS) rate was 70.4% for the entire study population. The 5-year DFS rates for LNR <0.05 and LNR ≥0.05 were 78.2%, and 48.4%, respectively (p<0.001). Additionally, the 5-year OS rates for LNR <0.05 and LNR ≥0.05 were 80.6%, and 61.2%, respectively (p=0.007). On multivariate analysis, LNR ≥0.05 was associated with a worse DFS (hazard ratio [HR]=2.12; 95% confidence interval [CI]=1.15–3.90; p=0.015) and OS (HR=1.95; 95% CI=1.01–3.77; p=0.046) in women with stage IIIC cervical cancer. Conclusions LNR ≥0.05 seems to be an independent prognostic factor for decreased DFS and OS in stage IIIC cervical carcinoma.
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Affiliation(s)
- Koray Aslan
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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30
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Shih CC, Chou HC, Chen YJ, Kuo WH, Chan CH, Lin YC, Liao EC, Chang SJ, Chan HL. Role of PGRMC1 in cell physiology of cervical cancer. Life Sci 2019; 231:116541. [PMID: 31216441 DOI: 10.1016/j.lfs.2019.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
AIMS The most frequent cancers among women worldwide. The mortality of cervical cancer has declined significantly primarily due to the widespread use of Pap smear tests as a screening test and therapeutic vaccination. However, cervical cancer still remains a severe disease among the female population, as the prognosis of metastatic cervical cancer is very poor. KEY METHODS In this study, we performed 2D-DIGE and MALDI-TOF/TOF MS to analyze differentially expressed proteins between HeLa and invasive HeLa-I5 cells.. KEY FINDINGS According to our proteomics data, 68 differentially expressed proteins between the HeLa and HeLa-I5 cells were identified. One of these differentially expressed proteins, Progesterone receptor membrane component 1 (PGRMC1), was selected as a candidate for further studies. To correlate the role of PGRMC1 with cellular migration and cancer progression, small interfering RNA (siRNA) was used to knockdown the expression of PGRMC1. Similar function of PGRMC1 was also observed in two other cervical cancer lines, CaSki and ME-180. SIGNIFICANCE PGRMC1 plays an essential role in regulating cancer progression and metastasis of cervical cancer cells, thus serving as a potential therapeutic target for cervical cancer.
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Affiliation(s)
- Chuan-Chi Shih
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hsiu-Chuan Chou
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Taiwan
| | - Ying-Jen Chen
- Dept. of Medical Sciences & Inst. of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, Taiwan
| | - Wen-Hung Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hao Chan
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Yi-Chieh Lin
- Dept. of Medical Sciences & Inst. of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, Taiwan
| | - En-Chi Liao
- Dept. of Medical Sciences & Inst. of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, Taiwan
| | - Shing-Jyh Chang
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Hong-Lin Chan
- Dept. of Medical Sciences & Inst. of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, Taiwan.
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