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Ning Y, Gao X, Kong Y, Wang Y, Tian T, Chen Y, Yang Y, Lei K, Cui Z. Adoption strategies of fertility-sparing surgery for early-stage cervical cancer patients based on clinicopathological characteristics: a large retrospective cohort study. Front Surg 2024; 11:1456376. [PMID: 39239473 PMCID: PMC11375612 DOI: 10.3389/fsurg.2024.1456376] [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: 07/03/2024] [Accepted: 08/08/2024] [Indexed: 09/07/2024] Open
Abstract
Background The demand for fertility-sparing surgery (FSS) is increasing among patients with early-stage cervical cancer (CC). This study aimed to evaluate the feasibility of local excision as an alternative to hysterectomy in stage I CC patients aged 15-39 years-commonly referred to as adolescents and young adults (AYAs)-with varying clinicopathological characteristics. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients diagnosed between 2000 and 2020. We examined treatment interventions across different age groups, degrees of histological types, tumor differentiation, and tumor stages. The effect of local excision vs. hysterectomy was assessed by comparing overall survival (OS) and disease-specific survival (DSS) rates. Results A total of 10,629 stage I AYA cervical cancer patients were included in this study. Among these patients, 24.5% underwent local excision for fertility preservation, while 67.3% underwent radical hysterectomy. For patients with cervical squamous cell carcinoma (SCC), long-term outcomes favored local excision over hysterectomy, and a similar trend was observed in those with adenosquamous cell carcinoma (ASCC). However, the prognosis was comparable among patients with cervical adenocarcinoma (AC). In patients with well- and moderate- differentiated tumors, local excision demonstrated superior OS compared to hysterectomy. No significant differences in prognosis were found between the two surgical interventions for patients with poorly differentiated and undifferentiated tumors. In stage IA patients, local excision was considered a viable alternative to hysterectomy. In stage IB1-IB2, FSS yielded prognostic outcomes comparable to those of hysterectomy. Conversely, patients with stage IB3 exhibited significantly shorter 5-year OS and DSS following local excision than those who underwent hysterectomy. Conclusion In stage IA-IB2 (diameter ≤4 cm) AYA patients, local excision may serve as a viable option for fertility preservation. The histological type of SCC, AC, and ASCC, along with differentiation, should not serve as restrictive factors in determining fertility preservation strategies for these patients. Patients with early-stage, well- or moderately-differentiated SCC may benefit from local excision surgery, even when fertility preservation is not the primary objective.
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Affiliation(s)
- Ying Ning
- Department of Clinical Medicine, Qingdao University, Qingdao, China
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinyan Gao
- Department of Clinical Medicine, Qingdao University, Qingdao, China
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Kong
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tian Tian
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Chen
- Department of Clinical Medicine, Qingdao University, Qingdao, China
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yufei Yang
- Department of Clinical Medicine, Qingdao University, Qingdao, China
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ke Lei
- Center of Tumor Immunology and Cytotherapy, Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhumei Cui
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Caruso G, Wagar MK, Hsu HC, Hoegl J, Rey Valzacchi GM, Fernandes A, Cucinella G, Sahin Aker S, Jayraj AS, Mauro J, Pareja R, Ramirez PT. Cervical cancer: a new era. Int J Gynecol Cancer 2024:ijgc-2024-005579. [PMID: 39117381 DOI: 10.1136/ijgc-2024-005579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Cervical cancer is a major global health issue, ranking as the fourth most common cancer in women worldwide. Depending on stage, histology, and patient factors, the standard management of cervical cancer is a combination of treatment approaches, including (fertility- or non-fertility-sparing) surgery, radiotherapy, platinum-based chemotherapy, and novel systemic therapies such as bevacizumab, immune checkpoint inhibitors, and antibody-drug conjugates. While ambitious global initiatives seek to eliminate cervical cancer as a public health problem, the management of cervical cancer continues to evolve with major advances in imaging modalities, surgical approaches, identification of histopathological risk factors, radiotherapy techniques, and biomarker-driven personalized therapies. In particular, the introduction of immune checkpoint inhibitors has dramatically altered the treatment of cervical cancer, leading to significant survival benefits in both locally advanced and metastatic/recurrent settings. As the landscape of cervical cancer therapies continues to evolve, the aim of the present review is to provide a comprehensive discussion of the current state and the latest practice-changing updates in cervical cancer.
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Affiliation(s)
- Giuseppe Caruso
- Division of Gynecologic Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew K Wagar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jorge Hoegl
- Obstetrics and Gynecology, Division of Gynecological Oncology, Clínica Maternidad Santa Ana, IVSS, Caracas, Venezuela, Bolivarian Republic of
| | | | - Andreina Fernandes
- Laboratorio de Genética Molecular, Instituto de Oncología y Hematología, Caracas, Venezuela, Bolivarian Republic of
| | - Giuseppe Cucinella
- Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Seda Sahin Aker
- Gynecologic Oncology, Kayseri City Education and Research Hospital, Kayseri, Turkey
- Clinical Anatomy, Ankara University, Ankara, Turkey
| | - Aarthi S Jayraj
- South Tees NHS Foundation Trust, James Cook University, Middlesbrough, UK
| | - Jessica Mauro
- Department of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Rene Pareja
- Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
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Pereira D, Alves N, Sousa Â, Valente JFA. Metal-based approaches to fight cervical cancer. Drug Discov Today 2024; 29:104073. [PMID: 38944184 DOI: 10.1016/j.drudis.2024.104073] [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: 02/10/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
Cervical cancer (CC) is one of the leading causes of death among women worldwide. The current treatments for this cancer consist of invasive methods such as chemotherapeutic drugs, radiation, immunotherapy and surgery, which could lead to severe side effects and hinder the patient's life quality. Although metal-based therapies, including cisplatin and ruthenium-based compounds, offer promising alternatives, they lack specificity and harm healthy cells. Combining metal nanoparticles with standard approaches has demonstrated remarkable efficacy and safety in the fight against CC. Overall, this review is intended to show the latest advancements and insights into metal-based strategies, creating a promising path for more effective and safer treatments in the battle against CC.
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Affiliation(s)
- Diana Pereira
- CICS-UBI-Health Sciences Research Centre, Universidade da Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal
| | - Nuno Alves
- CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal
| | - Ângela Sousa
- CICS-UBI-Health Sciences Research Centre, Universidade da Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal.
| | - Joana F A Valente
- CDRSP-IPL-Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Marinha Grande, 2430-028 Leiria, Portugal.
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D’Amato A, Riemma G, Agrifoglio V, Chiantera V, Laganà AS, Mikuš M, Dellino M, Maglione A, Faioli R, Giannini A, Trojano G, Etrusco A. Reproductive Outcomes in Young Women with Early-Stage Cervical Cancer Greater than 2 cm Undergoing Fertility-Sparing Treatment: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:608. [PMID: 38674254 PMCID: PMC11051883 DOI: 10.3390/medicina60040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Despite advancements in detection and treatment, cervical cancer remains a significant health concern, particularly among young women of reproductive age. Limited data exists in the literature regarding fertility-sparing treatment (FST) of cervical cancers with tumor sizes greater than 2 cm. The objective of this systematic review was to evaluate the reproductive outcomes of women diagnosed with cervical cancer greater than 2 cm who underwent FST. Materials and Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies (retrospective or prospective) that reported reproductive outcomes of patients with cervical cancer >2 cm were considered eligible for inclusion in this systematic review (CRD42024521964). Studies describing only the oncologic outcomes, involving FST for cervical cancers less than 2 cm in size, and case reports were excluded. Results: Seventeen papers that met the abovementioned inclusion criteria were included in the present systematic review. In total, 443 patients with a cervical cancer larger than 2 cm were included in this systematic review. Eighty pregnancies occurred, with 24 miscarriages and 54 live births. Conclusions: FST appears to be a viable option for women of childbearing age diagnosed with cervical cancer larger than 2 cm. However, careful consideration is advised in interpreting these encouraging results, as they are subject to limitations, such as variability in study designs and potential biases. In addition, reproductive outcomes should be further cross-referenced with oncologic outcomes to clarify the potential risk-benefit ratio. It is critical to conduct further research using standardized approaches and larger participant groups to strengthen the validity of the conclusions drawn.
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Affiliation(s)
- Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vittorio Agrifoglio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Gynecologic Oncology, National Cancer Institute—IRCCS—Fondazione “G. Pascale”, 81031 Naples, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia;
| | - Miriam Dellino
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Annamaria Maglione
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Raffaele Faioli
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Andrea Giannini
- Unit of Gynecology, “Sant’Andrea” Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, “Madonna delle Grazie” Hospital, 75100 Matera, Italy;
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
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Siegler K, Plaikner A, Hertel H, Hasenbein K, Petzel A, Schubert M, Blohmer JU, Böhmer G, Marnitz S, Ragosch V, Domröse C, Oppelt P, Jülicher A, Schneider A, Willems A, Favero G, Köhler C. Oncologic and Fertility Outcomes After Simple Trachelectomy in Women With Early Cervical Cancer. J Minim Invasive Gynecol 2024; 31:110-114. [PMID: 37951567 DOI: 10.1016/j.jmig.2023.11.006] [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: 06/28/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE This study aimed to present our case series of patients with early-stage cervical cancer undergoing simple trachelectomy (ST). Currently, radical trachelectomy is considered the most appropriate fertility-preserving procedure for the treatment of early-stage cervical cancer. However, there is increasing debate on the appropriate radicality of the surgery to preserve oncologic safety. DESIGN Descriptive retrospective analysis of patient records and evaluation of questionnaires. SETTING 2 gynecologic oncologic centers, surgeries performed by one surgical team. PATIENTS 36 women with early-stage cervical cancer undergoing ST. INTERVENTIONS Laparoscopic assisted simple vaginal trachelectomy. MEASUREMENTS Demographic, histologic, fertility, and follow-up data of all patients who underwent ST between April 2007 and July 2021 were prospectively recorded and retrospectively analyzed. MAIN RESULTS A total of 36 women (mean age: 28 years) underwent ST of whom 81% were nulliparous. Indications for ST were multifocal International Federation of Gynecology and Obstetrics stage IA1 (n = 30), stage IA1 L1 (n = 1), stage IA2 (n = 2), and stage IB1 (n = 3). Mandatory staging procedure was laparoscopic pelvic lymphadenectomy, including bilateral sentinel biopsy in 92% of the cases and systematic in 8%. Residual tumor was histologically confirmed in 8 specimens (22%); 18 women (50%) were seeking parenthood, and 13 succeeded (72%). There were 16 live births, all on term, with a median fetal weight of 3110 grams (2330-4420). One patient had a medical abortion owing to fetal congenital malformation. One pregnancy is ongoing. After a median follow-up of 91.5 months (9-174), all women are alive with no evidence of disease. CONCLUSION ST represents a de-escalation compared with radical trachelectomy and provides excellent oncologic results with an outstanding fertility rate and obstetric outcome for patients with early cervical cancer. However, clear indications for this tailored fertility-preserving surgery have to be defined in well-designed trials.
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Affiliation(s)
- Kathrin Siegler
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler)
| | - Andrea Plaikner
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler).
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (Dr. Hertel)
| | - Kati Hasenbein
- Specialized Medical Practice for Gynecologic Oncology, Berlin-Spandau, Berlin, Germany (Dr. Hasenbein)
| | - Anja Petzel
- Center for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany (Dr. Petzel)
| | - Melanie Schubert
- Department of Gynecology and Obstetrics, Schleswig-Holstein University Medicine, Campus Kiel, Germany (Dr. Schubert)
| | - Jens Uwe Blohmer
- Department of Gynecology, Charité University Medicine, Campus Mitte, Berlin, Germany (Dr. Blohmer)
| | - Gerd Böhmer
- Center for Dysplasia and Cytology, IZD Hannover, Hannover, Germany (Dr. Böhmer)
| | - Simone Marnitz
- Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany (Dr. Marnitz)
| | - Volker Ragosch
- Department of Obstetrics (Dr. Ragosch), Asklepios Clinic Altona, Hamburg, Germany
| | - Christian Domröse
- Department of Gynecology, University of Cologne, Medical Faculty, Germany (Dr. Domröse)
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Austria (Dr. Oppelt)
| | - Anne Jülicher
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler)
| | - Achim Schneider
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler)
| | - Anne Willems
- Institute for Dysplasia and Cytology, MVZ Köpenick, Germany (Dr. Willems)
| | - Giovanni Favero
- Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Germany (Dr. Favero)
| | - Christhardt Köhler
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler); Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler); Department of Gynecology, German Red Cross Clinic Berlin Westend, Berlin, Germany (Dr. Köhler)
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Crafton SM, Venkat PS, Salani R. A review of the state of cervical cancer: updates from prevention to recurrent disease. Curr Opin Obstet Gynecol 2024; 36:28-33. [PMID: 37873756 DOI: 10.1097/gco.0000000000000918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent updates in cervical cancer from prevention and early detection to the management of early stage and recurrent disease as well as future areas of exploration. RECENT FINDINGS The importance of the human papilloma virus vaccine and screening continue to make an impact in reducing the global burden of cervical cancer. In early-stage, low risk disease, new studies have demonstrated the role of less radical surgery with similar disease related outcomes. Efforts to improve outcomes in locally advanced cervical cancer have been reported. The incorporation of adjuvant chemotherapy, novel agents and checkpoint inhibitors, with the latter impacting disease free survival. In advanced/recurrent disease, the role of immunotherapy continues to make an impact and, in addition to recurrent disease, has now moved to the frontline for patients with programmed cell death ligand 1 expression. Tisotumab vedotin, an antibody drug conjugate, and other novel agents continue to be studied in this setting. SUMMARY In this review, we discuss prevention measures and the outcomes of recent trials in all stages of cervical cancer. As therapies continue to evolve, ongoing trials and new areas of exploration will continue to identify opportunities to improve survival in cervical cancer.
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Affiliation(s)
- Sarah M Crafton
- Division of Gynecologic Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Puja S Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California
| | - Ritu Salani
- Jonsson Comprehensive Cancer Center, University of California
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
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Zheng J, Jiang S, Lin X, Wang H, Liu L, Cai X, Sun Y. Comprehensive analyses of mitophagy-related genes and mitophagy-related lncRNAs for patients with ovarian cancer. BMC Womens Health 2024; 24:37. [PMID: 38218807 PMCID: PMC10788026 DOI: 10.1186/s12905-023-02864-5] [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: 04/03/2023] [Accepted: 12/24/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Both mitophagy and long non-coding RNAs (lncRNAs) play crucial roles in ovarian cancer (OC). We sought to explore the characteristics of mitophagy-related gene (MRG) and mitophagy-related lncRNAs (MRL) to facilitate treatment and prognosis of OC. METHODS The processed data were extracted from public databases (TCGA, GTEx, GEO and GeneCards). The highly synergistic lncRNA modules and MRLs were identified using weighted gene co-expression network analysis. Using LASSO Cox regression analysis, the MRL-model was first established based on TCGA and then validated with four external GEO datasets. The independent prognostic value of the MRL-model was evaluated by Multivariate Cox regression analysis. Characteristics of functional pathways, somatic mutations, immunity features, and anti-tumor therapy related to the MRL-model were evaluated using abundant algorithms, such as GSEA, ssGSEA, GSVA, maftools, CIBERSORT, xCELL, MCPcounter, ESTIMATE, TIDE, pRRophetic and so on. RESULTS We found 52 differentially expressed MRGs and 22 prognostic MRGs in OC. Enrichment analysis revealed that MRGs were involved in mitophagy. Nine prognostic MRLs were identified and eight optimal MRLs combinations were screened to establish the MRL-model. The MRL-model stratified patients into high- and low-risk groups and remained a prognostic factor (P < 0.05) with independent value (P < 0.05) in TCGA and GEO. We observed that OC patients in the high-risk group also had the unfavorable survival in consideration of clinicopathological parameters. The Nomogram was plotted to make the prediction results more intuitive and readable. The two risk groups were enriched in discrepant functional pathways (such as Wnt signaling pathway) and immunity features. Besides, patients in the low-risk group may be more sensitive to immunotherapy (P = 0.01). Several chemotherapeutic drugs (Paclitaxel, Veliparib, Rucaparib, Axitinib, Linsitinib, Saracatinib, Motesanib, Ponatinib, Imatinib and so on) were found with variant sensitivity between the two risk groups. The established ceRNA network indicated the underlying mechanisms of MRLs. CONCLUSIONS Our study revealed the roles of MRLs and MRL-model in expression, prognosis, chemotherapy, immunotherapy, and molecular mechanism of OC. Our findings were able to stratify OC patients with high risk, unfavorable prognosis and variant treatment sensitivity, thus improving clinical outcomes for OC patients.
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Affiliation(s)
- Jianfeng Zheng
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Shan Jiang
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Xuefen Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Huihui Wang
- Department of Anesthesiology, The Central hospital of Wenzhou City, 32 Dajian Lane, Wenzhou, 325000, China
| | - Li Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Xintong Cai
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Yang Sun
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China.
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8
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Furey KB, Anderson ZS, Kuznicki ML, Klar M, Roman LD, Wright JD, Matsuo K. Increasing trends of cervical conization with lymph node evaluation for fertility-sparing surgery in early cervical cancer. Gynecol Oncol 2023; 173:122-129. [PMID: 37137189 DOI: 10.1016/j.ygyno.2023.04.025] [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: 03/15/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To examine uptake, characteristics, and survival outcome of less-radical fertility-sparing surgery with cervical conization and lymph node evaluation (Cone-LN) in reproductive age patients with early cervical cancer. METHODS This retrospective cohort study examined the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The study population included 407 patients aged <50 years with stage IA-IB2 (≤4 cm) cervical cancer who received fertility-sparing surgery from 2004 to 2019. The exposure was fertility-sparing surgery type: Cone-LN (n = 196) or trachelectomy with lymph node evaluation (Trach-LN, n = 211). The main co-outcomes were (i) temporal trends of surgery type, assessed with Cochran-Armitage test, and (ii) clinical and tumor characteristics, assessed with multivariable binary logistic regression model. The secondary outcome was overall survival, assessed with inverse probability of treatment weighting propensity score. RESULTS The number of patients receiving Cone-LN increased from 43.5% in 2004-2007 to 58.4% in 2016-2019 (P-trend = 0.005). Patients receiving conization and sentinel lymph node (SLN) biopsy alone increased from 0% to 14.4% (P-trend < 0.001). In a multivariable analysis, patients in the Cone-LN group were more likely to undergo SLN biopsy (aOR 6.04) compared to those in the Trach-LN group whereas those with adenocarcinoma (aOR 0.49) and T1b tumors (aOR for ≤2 cm 0.21, and aOR for 2.1-4.0 cm 0.10) were less likely to receive Cone-LN. In a propensity score-weighted model, the Cone-LN and Trach-LN groups had comparable overall survival (7-year rates, 98.9% vs 97.8%). Similar associations were observed for patients with squamous, adenocarcinoma / adenosquamous, T1a classification, and T1b(≤2 cm) classification. CONCLUSION The current population-based analysis suggests that the performance of cervical conization with lymph node evaluation, particularly with SLN biopsy, is gradually increasing for early cervical cancer patients desiring future fertility.
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Affiliation(s)
- Katelyn B Furey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Zachary S Anderson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Michelle L Kuznicki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Re GL, Cucinella G, Zaccaria G, Crapanzano A, Salerno S, Pinto A, Casto AL, Chiantera V. Role of MRI in the assessment of cervical cancer. Semin Ultrasound CT MR 2023; 44:228-237. [DOI: 10.1053/j.sult.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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