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Schepens EJA, Al-Mamgani A, Karssemakers LHE, van den Broek D, van den Brekel MWM, Lopez-Yurda M. Squamous Cell Carcinoma Antigen in the Follow-up of Patients With Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 170:422-430. [PMID: 37694613 DOI: 10.1002/ohn.510] [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: 04/20/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE to determine if the tumor marker squamous cell carcinoma antigen (SCC-Ag) observed over time may contribute to the early detection of recurrence, metastasis, and second primary tumors in the follow-up of patients with head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN A retrospective analysis of patients with HNSCC and at least one SCC-Ag measurement was conducted. Hazard ratios (HRs) were used to determine the correlation between SCC-Ag and an event. SETTING patients with HNSCC, treated in the Antoni van Leeuwenhoek Hospital in The Netherlands between 2010 and 2020 were used for the analysis. METHODS Data from 789 patients were used on event-free survival (EFS) with time-dependent Cox models. In addition to current (most recent) SCC-Ag (also dichotomized into high and low as done for clinical practice), average SCC-Ag and change between SCC-Ag measurements (delta SCC-Ag) were considered, using restricted cubic splines to explore nonlinear relationships. RESULTS Dichotomized SCC-Ag values (HR = 3.01, 95% confidence interval [CI]: 2.17-4.18) and the delta SCC-Ag (HR = 1.15, 95% CI: 1.07-1.22) predicted EFS better than models using the cumulative average or current value of SCC-Ag, also after adjusting for tumor site, stage, age, and gender. A strong association was observed when using delta SCC-Ag as a linear predictor in the subgroup of oropharynx patients (HR = 4.88, 95% CI: 2.71-8.79). CONCLUSION Dichotomized and delta SCC-Ag values can be important markers for EFS, during the follow-up of patients treated for HNSCC. These results were more evident in patients with oropharyngeal cancer.
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Affiliation(s)
- Emma J A Schepens
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc H E Karssemakers
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marta Lopez-Yurda
- Biometrics Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Zhang Y, Liu L, Zhang K, Su R, Jia H, Qian L, Dong J. Nomograms Combining Clinical and Imaging Parameters to Predict Recurrence and Disease-free Survival After Concurrent Chemoradiotherapy in Patients With Locally Advanced Cervical Cancer. Acad Radiol 2023; 30:499-508. [PMID: 36050264 DOI: 10.1016/j.acra.2022.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/27/2023]
Abstract
PURPOSES To investigate the value of nomograms based on clinical prognostic factors (CPF), intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and MRI-derived radiomics in predicting recurrence and disease-free survival (DFS) after concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). METHODS Retrospective analysis of data from 115 patients with ⅠB-ⅣA cervical cancer who underwent CCRT and had been followed up consistently. All patients were randomized 2:1 into training and validation groups. Pre-treatment IVIM-DWI parameters (ADC-value, D-value, D*-value and f-value) and pre- and post-treatment three-dimensional radiomics parameters (from axial T2WI) of primary lesions were measured. The LASSO algorithm and Logistic regression analysis were used to filter texture features and calculate radiomics score (Rad-score). Multivariate Logistic and Cox regression analysis was used to construct nomograms to predict recurrence and DFS for patients with LACC after CCRT respectively, with internal and external validation. RESULTS External beam radiotherapy dose, f-value, pre-treatment and post-treatment Rad-score were independent prognostic factors for recurrence and DFS in patients with cervical cancer, forming Model1 and Model2, with OR values of 0.480, 1.318, 3.071, 3.200 and HR values of 0.322, 3.372, 5.138, 7.204. The area under the curve (AUC) of Model1 for predicting recurrence of cervical cancer was 0.977, with internal and external validation C-indexes of 0.977 and 0.962. The AUC for Model2 predicting disease-free survival (DFS) at 1, 3, and 5 years was 0.895, 0.888 and 0.916 respectively, with internal and external C-indexes of 0.860 and 0.892. The decision curves analysis and clinical impact curves further indicate the high predictive efficiency and stability of nomograms. CONCLUSION The nomograms based on clinical, IVIM-DWI and radiomics parameters have high clinical value in predicting recurrence and DFS of patients with LACC after CCRT and can provide a reference for prognostic assessment and individualized treatment of cervical cancer patients.
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Affiliation(s)
- Yu Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Long Liu
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang University, Taizhou, Zhejiang, China
| | - Kaiyue Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Rixin Su
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Haodong Jia
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China; Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Liting Qian
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
| | - Jiangning Dong
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China; Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
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Qi L, Zhou H, Wang Y, Jablonska E, Wang M, Su S, Jia Y, Wang R, Jiang M, Wang Y, Zhang Y, Li Q, Wang T. The role of selenoprotein P in the determining the sensitivity of cervical cancer patients to concurrent chemoradiotherapy: A metabonomics-based analysis. J Trace Elem Med Biol 2022; 73:127041. [PMID: 35905604 DOI: 10.1016/j.jtemb.2022.127041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of selenoprotein P (SELENOP) levels on the sensitivity of cervical cancer patients to concurrent chemoradiotherapy (CCRT) has not been reported. In this study, the effects of the variations in plasma SELENOP levels on the sensitivity of cervical cancer patients to CCRT were investigated using metabonomics. METHODS Two patient groups were evaluated, i.e., the case group: 11 patients with intermediate to advanced primary squamous cervical cancer, who developed resistance against CCRT, and the sensitivity group: 11 patients who did not develop resistance were matched in a 1:1 ratio (controls). Blood samples were collected before and after CCRT, and the plasma SELENOP levels were measured by ELISA. The different metabolites present in the plasma were analyzed by UPLC-MS-MS. RESULTS SELENOP levels exhibited a significant reduction in both the resistant and sensitive groups after CCRT (F = 50.705, P < 0.001), and interaction effects between sensitivity and pre-and post-treatment on SELENOP levels were observed (F = 7.414, P = 0.013). Further, a more significant reduction in the SELENOP levels was observed in the CCRT-resistant group (mean reduction, 0.028 µg/mL; P < 0.001) than in the sensitive group (mean reduction, 0.013 µg/mL; P = 0.006). Four metabolic biomarkers, i.e., C18, C19, C20 sphingomyelin, and phosphatidylcholine 20:2/22:6, were shown to be differentially expressed between the resistant and sensitive groups pre-and post-treatment. C20 sphingomyelin levels exhibited a significant correlation with SELENOP levels (r = -0.326, P = 0.031). CONCLUSION The levels of plasma SELENOP in the CCRT-resistant group decreased significantly, suggesting that SELENOP might affect the sensitivity by modulating lipid synthesis and metabolism.
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Affiliation(s)
- Lei Qi
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China
| | - Huihui Zhou
- Department of Public Health, Jining Medical University, Jining 272029, China
| | - Yuanyuan Wang
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China
| | - Ewa Jablonska
- Department of Translational Research, Nofer Institute of Occupational Medicine, Sw. Teresy 8 Street, Lodz 91-348, Poland
| | - Mingxing Wang
- Department of Gynecological Radiotherapy, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Shengqi Su
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China
| | - Yuehui Jia
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China
| | - Ruixiang Wang
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China
| | - Meijing Jiang
- Department of Gynecological Radiotherapy, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Yanan Wang
- School of Public Health and Management, Binzhou Medical University, No.346 Guanhai Road, Laishan District, Yantai 264003, China
| | - Yiyi Zhang
- Yantai Center for Disease Control and Prevention, No.17 Fuhou Road, Laishan District, Yantai 264003, China
| | - Qi Li
- Department of Gynecological Radiotherapy, Harbin Medical University Cancer Hospital, Harbin 150081, China.
| | - Tong Wang
- Institute of Keshan Disease, Chinese Center for Endemic Disease Control, Harbin Medical University, Harbin 150081, China.
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Serum conversion pattern of SCC-Ag levels between pre- and post-chemoradiotherapy predicts recurrence and metastasis in cervical cancer: a multi-institutional analysis. Clin Exp Metastasis 2021; 38:467-474. [PMID: 34392458 DOI: 10.1007/s10585-021-10115-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
The value of squamous-cell carcinoma antigen (SCC-Ag) as a tumor marker for cervical cancer is controversial because it is not elevated (> 2 ng/mL) in a quarter of patients at diagnosis. Two hundred ninety one IB-IVA cervical squamous cell-carcinoma patients who underwent definitive chemoradiotherapy (CRT) were included in four tertiary institutions. Serum conversion pattern between pre- and post-treatment SCC-Ag levels was categorized into the following three arms: (1) Consistent Seronegative arm (both ≤ 2 ng/mL); (2) Negative Conversion arm (from > 2 ng/mL to ≤ 2 ng/mL); and (3) Consistent Seropositive arm (both > 2 ng/mL). Median follow-up time was 40.3 months. For Consistent Seronegative (N = 67), Negative Conversion (N = 165), and Consistent Seropositive (N = 59) arms, the 3-year recurrence-free survival (RFS) rates were 79.4%, 62.0%, and 48.4% (P < 0.001) and the 3-year overall survival (OS) rates were 86.3%, 80.6%, and 58.7% (P = 0.001), respectively. The serum conversion pattern of SCC-Ag between pre- and post-treatment was the most significant and potent prognostic factor of RFS (P = 0.001) and OS (P = 0.007) on the multivariate analysis. Simply checking whether SCC-Ag level is above or below 2 ng/mL before and after definitive CRT can provide clinicians with a simple rule-of-thumb for prediction of disease outcome in cervical cancer patients.
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Arakaki Y, Ariga T, Heianna J, Shimoji Y, Nakasone T, Taira Y, Nakamoto T, Ooyama T, Kudaka W, Kaneshima I, Nishihira K, Mekaru K, Aoki Y. Long-term Outcomes of Cervical Adenocarcinoma Treated With Concurrent Chemoradiotherapy Using Paclitaxel and Cisplatin. In Vivo 2021; 34:2739-2743. [PMID: 32871808 DOI: 10.21873/invivo.12096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We retrospectively analyzed the locally advanced adenocarcinoma (AC)/adenosquamous carcinoma (ASC) of the uterine cervix treated with concurrent chemoradiotherapy using cisplatin plus paclitaxel (TP-CCRT). PATIENTS AND METHODS Thirty patients with stage IB-IVA AC/ASC were treated with whole pelvis external beam radiotherapy. A high-dose-rate intracavitary brachytherapy was delivered once per week at a fractional dose of 6 Gy. For TP-CCRT, the patients received cisplatin and paclitaxel. RESULTS A complete response was achieved in 17 patients (77.3%) in the TP-CCRT group and 4 patients (50.0%) in the P-CCRT group. The 5-year OS rate in the TP-CCRT and P-CCRT groups was 74.2% and 25.0% (p=0.0094), the central DFS rate was 58.0% and 12.5% (p=0.0267), and the distant DFS rate was 63.6% and 12.5% (p=0.0042), respectively. CONCLUSION TP-CCRT achieves a considerably better disease control for AC of the cervix, leading to a better OS.
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Affiliation(s)
- Yoshihisa Arakaki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuro Ariga
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuko Shimoji
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tadaharu Nakasone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Taira
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Nakamoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuma Ooyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Itomi Kaneshima
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kumiko Nishihira
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Keiko Mekaru
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Guo Q, Zhu J, Wu Y, Wen H, Xia L, Wu X, Ju X. Predictive value of preoperative serum squamous cell carcinoma antigen (SCC–Ag) level on tumor recurrence in cervical squamous cell carcinoma patients treated with radical surgery: A single-institution study. Eur J Surg Oncol 2020; 46:131-138. [DOI: 10.1016/j.ejso.2019.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022] Open
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Prognostic Role of Squamous Cell Carcinoma Antigen in Cervical Cancer: A Meta-analysis. DISEASE MARKERS 2019; 2019:6710352. [PMID: 31275450 PMCID: PMC6589214 DOI: 10.1155/2019/6710352] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/18/2019] [Indexed: 01/03/2023]
Abstract
Objective To systematically evaluate the significance of squamous cell carcinoma antigen (SCC-Ag) in the prognosis of cervical cancer. Methods Literature from Pubmed, Embase, and Cochrane Library was retrieved to collect all English literature on the correlation between SCC-Ag and cervical cancer prognosis, and the quality of literature collected was assessed based on evaluation criteria. The heterogeneity, sensitivity, and specificity were detected using the StataSE12.0 software, and the correlation between SCC-Ag and cervical cancer prognosis as the effect variables was assessed using the hazard ratio (HR) and 95% confidence interval (CI). Moreover, the forest map and funnel plot were drawn. Results A total of 17 articles meeting the inclusion criteria were selected. The high expression of SCC-Ag was significantly correlated with the poor prognosis of cervical cancer (HR = 2.22, 95% CI = 1.38 − 3.57, P = 0.002). The disease-free survival (DFS) was higher in low SCC-Ag expression patients than in high SCC-Ag expression patients (HR = 2.17, 95% CI = 1.84 − 2.57, P < 0.001). The progression-free survival (PFS) was inferior in patients with a high SCC-Ag expression (HR = 2.70, 95% CI = 1.11 − 6.53, P = 0.028). Conclusion SCC-Ag is an important prognostic factor for cervical cancer, and its high expression is significantly correlated with a poor prognosis of the disease.
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Lee J, Kim CK, Gu KW, Park W. Value of blood oxygenation level-dependent MRI for predicting clinical outcomes in uterine cervical cancer treated with concurrent chemoradiotherapy. Eur Radiol 2019; 29:6256-6265. [PMID: 31016443 DOI: 10.1007/s00330-019-06198-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/15/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the value of blood oxygenation level-dependent (BOLD) MRI as a predictor of clinical outcomes in cervical cancer patients treated with concurrent chemoradiotherapy (CCRT). METHOD Enrolled 92 patients with stage IB2-IVB cervical cancer who received CCRT underwent 3-T BOLD MRI before treatment. The R2* value (rate of spin dephasing, s-1) was measured in the tumor. Cox regression analysis was used to evaluate the associations of imaging and clinical parameters with progression-free survival (PFS) and cancer-specific survival (CSS). Inter-reader reliability for the R2* measurements was evaluated using an intraclass correlation coefficient (ICC). RESULTS Tumor R2* values were significantly different between patients with and without disease progression (p < 0.001). Multivariate analysis demonstrated that tumor R2* value was significantly independent factor for PFS (hazard ratio [HR] = 5.746, p < 0.001) and CSS (HR = 12.878, p = 0.001). Additionally, squamous cell carcinoma antigen (HR = 1.027, p = 0.001) was significantly independent factor for PFS. Inter-reader reliability for the R2* measurements was good (ICC = 0.702). CONCLUSION Pretreatment 3-T BOLD MRI may be useful for predicting clinical outcomes in uterine cervical cancer patients treated with CCRT, with good inter-reader reliability. KEY POINTS • Tumor R2* values are different between patients with and without disease progression. • The R2* value is an independent factor for treatment outcomes in cervical cancer. • Inter-reader reliability for R2* measurements using BOLD MRI is good.
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Affiliation(s)
- Jiyeong Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Kyo-Won Gu
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Du S, Sun H, Gao S, Xin J, Lu Z. Metabolic parameters with different thresholds for evaluating tumor recurrence and their correlations with hematological parameters in locally advanced squamous cell cervical carcinoma: an observational 18F-FDG PET/CT study. Quant Imaging Med Surg 2019; 9:440-452. [PMID: 31032191 DOI: 10.21037/qims.2019.02.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Positron emission tomography (PET) parameters for a combination of the primary tumor and suspicious metastatic lymph nodes (SMLNs) appear to be more potential than those for the primary tumor alone for evaluating tumor recurrence in locally advanced cervical carcinoma (LACC), while the optimal threshold has not been determined. This study investigated the optimal PET parameters and percentage of SUVmax (%SUVmax) thresholds for tumor recurrence evaluation, and the relationship with hematological parameters in patients with LACC treated with concurrent chemoradiotherapy (CCRT). Methods Eighty-nine patients with advanced squamous cell cervical carcinoma (SCCC) scheduled for CCRT underwent pretreatment whole body PET/CT scans. We analyzed PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor (SUVmax-P, MTV-P, TLG-P) and the combination of the primary tumor and SMLNs (SUVmax-C, MTV-C, TLG-C). The association between PET parameters with different %SUVmax threshold and recurrence-free survival (RFS), and the correlations between PET parameters and hematological parameters including squamous cell carcinoma antigen (SCC-ag), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (Hb) were evaluated. Results The optimal threshold for evaluating tumor recurrence was 50%SUVmax, and the optimal PET parameter was MTV-C with the 50%SUVmax threshold (MTV-C50%) (c-index =0.752). Multivariate analysis indicated that MTV-C50% [hazard ratio (HR), 1.065; P<0.001], NLR (HR, 1.195; P=0.045) and SMLNs (HR, 2.225; P=0.003) were independent risk factors for RFS. MTV and TLG with most of %SUVmax thresholds had slight-to-moderate correlations with SCC-ag, NLR and PLR. For SCC-ag, MTV-C55% (r=0.500; P<0.001) had the highest correlation coefficient among all parameters. For NLR and PLR, MTV-C50% (r=0.637 and r=0.515, respectively; P<0.001 for both correlations) received the highest correlation coefficient. Conclusions The MTV-C estimated by using a 50%SUVmax threshold, which is related to systemic inflammatory response biomarker (NLR and PLR), can be used as an optimal PET parameter associated with tumor recurrence of LACC.
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Affiliation(s)
- Siyao Du
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Hongzan Sun
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Si Gao
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jun Xin
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zaiming Lu
- 1Department of Radiology, 2Liaoning Provincial Key Laboratory of Medical Imaging, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Chen Y, Hou Y, Yang Y, Pan M, Wang J, Wang W, Zuo Y, Cong J, Wang X, Mu N, Zhang C, Gong B, Hou J, Wang S, Xu L. Gene expression changes in cervical squamous cancers following neoadjuvant interventional chemoembolization. Clin Chim Acta 2019; 493:79-86. [PMID: 30772336 DOI: 10.1016/j.cca.2019.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The efficacy of therapy for cervical cancer is related to the alteration of multiple molecular events and signaling networks during treatment. The aim of this study was to evaluate gene expression alterations in advanced cervical cancers before- and after-trans-uterine arterial chemoembolization- (TUACE). METHODS Gene expression patterns in three squamous cell cervical cancers before- and after-TUACE were determined using microarray technique. Changes in AKAP12 and CA9 genes following TUACE were validated by quantitative real-time PCR. RESULTS Unsupervised cluster analysis revealed that the after-TUACE samples clustered together, which were separated from the before-TUACE samples. Using a 2-fold threshold, we identified 1131 differentially expressed genes that clearly discriminate after-TUACE tumors from before-TUACE tumors, including 209 up-regulated genes and 922 down-regulated genes. Pathway analysis suggests these genes represent diverse functional categories. Results from real-time PCR confirmed the expression changes detected by microarray. CONCLUSIONS Gene expression signature significantly changes during TUACE therapy of cervical cancer. Theses alterations provide useful information for the development of novel treatment strategies for cervical cancers on the molecular level.
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Affiliation(s)
- Yonghua Chen
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Yuanyuan Hou
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Ying Yang
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Meixia Pan
- Yantai Yuhuangding Hospital LaiShan Division of Medical College, Qingdao University, China
| | - Jing Wang
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Wenshuang Wang
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Ying Zuo
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Jianglin Cong
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Xiaojie Wang
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Nan Mu
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Chenglin Zhang
- Central Laboratory, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Benjiao Gong
- Central Laboratory, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China
| | - Jianqing Hou
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China.
| | - Shaoguang Wang
- Department of Obstetrics and Gynecology, the Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai 264000, Shandong, China.
| | - Liping Xu
- Medical College, Qingdao University, Qingdao 266021, Shandong, China
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Queiroz ACM, Fabri V, Mantoan H, Sanches SM, Guimarães APG, Ribeiro ARG, da Nogueira Silveira Lima JP, Chen MJ, Baiocchi G, da Costa AABA. Risk factors for pelvic and distant recurrence in locally advanced cervical cancer. Eur J Obstet Gynecol Reprod Biol 2019; 235:6-12. [PMID: 30771718 DOI: 10.1016/j.ejogrb.2019.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/08/2019] [Accepted: 01/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the benefits of concomitant radiotherapy and cisplatin for locally advanced cervical cancer, recurrence rates remain high. New treatment strategies such as consolidation chemotherapy and different concomitant chemotherapy combinations have been tested in recent years. Identification of the best candidates for each treatment strategy could optimize results. STUDY DESIGN A retrospective review of data from 127 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics Stages IIB-IVA), treated at a single institution from 2005 to 2014. Risk factors for loco-regional and systemic recurrence, and prognostic factors for overall survival (OS) were analysed using Cox regression. Survival of patients treated with consolidation chemotherapy was compared with survival of patients not treated with consolidation chemotherapy in the role cohort and in a propensity-score-matched cohort. RESULTS With a median follow-up time of 48.7 months, loco-regional-recurrence-free survival (LRFS), distant-metastasis-free survival (DMFS) and OS at 5 years were 76.6%, 54.0% and 63.0%, respectively. On multivariate analysis, tumour size ≥6 cm was associated with shorter LRFS [hazard ratio (HR) 5.18; 95% confidence interval (CI) 1.45-18.45; p = 0.011], and adenocarcinoma (HR 2.48; 95% CI 1.10-5.57; p = 0.028) and positive lymph nodes (HR 2.21; 95% CI 1.303-4.72; p = 0.041) were associated with shorter DMFS. Tumour size ≥6 cm was associated with shorter OS (HR 2.64; 95% CI 1.09-6.35; p = 0.031). Twenty-two patients were treated with consolidation chemotherapy; on univariate analysis, these patients had longer OS compared with patients who were not treated with consolidation chemotherapy (p = 0.043). In a propensity-score-matched cohort, patients treated with consolidation chemotherapy had longer DMFS and OS compared with patients who were not treated with consolidation chemotherapy, although the difference was not significant. CONCLUSIONS Different risk factors are associated with loco-regional and distant metastases in patients with locally advanced cervical cancer, and could potentially lead to particular therapeutic strategies. Although the number of patients treated with consolidation chemotherapy in the study cohort was small, they seemed to live longer and to have better control of distant relapse then patients who were not treated with consolidation chemotherapy.
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Affiliation(s)
| | - Vanessa Fabri
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Henrique Mantoan
- Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | | | - Glauco Baiocchi
- Gynaecology Oncology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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HOLDENRIEDER S, MOLINA R, QIU L, ZHI X, RUTZ S, ENGEL C, KSPER-SAUER P, DAYYANI F, Mkorse C. 鳞状上皮细胞癌抗原水平新检测方法在宫颈癌、肺癌和头颈部癌鉴别诊断中的性能及临床表现. CHINESE JOURNAL OF LUNG CANCER 2018. [PMCID: PMC6136062 DOI: 10.3779/j.issn.1009-3419.2018.07.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
鳞状上皮细胞癌抗原水平在鳞状上皮细胞癌中通常升高。这项多中心研究评估了一种新的Elecsys®鳞状上皮细胞癌检测的检测性能,该检测方法是以等摩尔方式测量血清鳞状上皮细胞癌抗原1和2的水平,并研究了鳞状上皮细胞癌抗原用于宫颈癌、肺癌和头颈部鳞状上皮细胞癌鉴别诊断的潜能。在欧洲三个研究中心进行了精确度和方法学比较实验。健康人群的参考区间使用来自欧洲和中国人群的样本确定的。鉴别诊断试验确定了鳞状上皮细胞癌抗原水平能否将宫颈癌、肺癌或头颈癌与表观健康的、良性的或其他恶性群组区分开来。根据95%特异性下的鳞状上皮细胞癌抗原水平计算出鳞状上皮细胞癌抗原医学截断值。9个分析浓度的重复性变异系数 < 5.3%,中间精密变异系数 < 0.3%。方法学比较显示,与Architect和Kryptor系统具有很好的相关性(斜率分别为1.1和1.5)。表观健康人群的第95百分位数的参考区间为2.3 ng/mL(95%置信区间:1.9-3.8;欧洲队列,n=153)和2.7 ng/mL(95%置信区间:2.2-3.3;中国队列,n=146)。最佳的鉴别诊断结果见于宫颈鳞状上皮细胞癌:受试者工作特征曲线分析显示鳞状上皮细胞癌抗原水平(2.9 ng/mL的医学截断值)鉴别宫颈鳞状上皮细胞癌(n=127)与表观健康女性(n=286;曲线下面积:86.2%;95%置信区间:81.8-90.6;灵敏度:61.4%;特异性:95.6%),良性疾病(n=187;曲线下面积:86.3%;95%置信区间:81.2-91.3;灵敏度:61.4%;特异性:95.0%)和其他宫颈癌(n=157;曲线下面积:78.9%;95%置信区间:70.8-87.1;灵敏度:61.4%;特异性:86.7%)。鳞状上皮细胞癌还可帮助鉴别诊断肺癌。Elecsys鳞状上皮细胞癌检测技术在宫颈鳞状上皮细胞癌的临床实践中表现出了良好的性能,适合用于鉴别诊断。
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Affiliation(s)
| | - Rafael MOLINA
- 巴塞罗那医院和巴塞罗那大学,巴塞罗那,西班牙Hospital Clinic de Barcelona and University of Barcelona, Barcelona, Spain
| | - Ling QIU
- 北京协和医院,北京,中国Peking Union Medical College Hospital, Beijing, China
| | - Xiuyi ZHI
- 首都医科大学宣武医院,北京,中国Xuanwu Hospital, Capital Medical University, Beijing Shi, China
| | - Sandra RUTZ
- 罗氏诊断公司,Penzberg,德国Roche Diagnostics GmbH, Penzberg, Germany
| | | | | | - Farshid DAYYANI
- 罗氏诊断国际有限公司,Rotkreuz,瑞士Roche Diagnostics International Ltd, Rotkreuz, Switzerland,加利福尼亚大学,Irvine,CA,美国University of California, Irvine, Irvine, CA, USA
| | - Catharina Mkorse
- 荷兰癌症研究院,阿姆斯特丹,荷兰The Netherlands Cancer Institute, Amsterdam, The Netherlands,Catharina M KORSE, The Netherlands Cancer Institute, PO Box 90203, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. E-mail:
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13
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Choi KH, Lee SW, Yu M, Jeong S, Lee JW, Lee JH. Significance of elevated SCC-Ag level on tumor recurrence and patient survival in patients with squamous-cell carcinoma of uterine cervix following definitive chemoradiotherapy: a multi-institutional analysis. J Gynecol Oncol 2018; 30:e1. [PMID: 30479085 PMCID: PMC6304399 DOI: 10.3802/jgo.2019.30.e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/20/2018] [Accepted: 08/28/2018] [Indexed: 01/18/2023] Open
Abstract
Objective There is no definitive guideline for the significance and cut-off value of squamous-cell carcinoma antigen (SCC-Ag) in cervical cancer. Thus, we analyzed the significance and optimal cut-off value of SCC-Ag for predicting tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix. Methods From January 2010 to October 2016, we enrolled 304 cervical cancer patients with squamous-cell carcinoma staging International Federation of Gynecology and Obstetrics (FIGO) Ib–IVa and treated with definitive chemoradiotherapy (CRT) followed by intra-cavitary radiotherapy (ICR). The cut-off value of SCC-Ag level for tumor recurrence was calculated using the receiver operating characteristic (ROC) curve. The recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier method to estimate the significance of SCC-Ag level. Results The optimal cut-off value of SCC-Ag level for predicting tumor recurrence was calculated and set at 4.0 ng/mL in the ROC curve. After a median follow-up period of 36.5 months, the 3-year RFS (56.6% vs. 80.2%, p<0.001) and OS (72.1% vs. 86.8%, p=0.005) were significantly lower in SCC-Ag ≥4 ng/mL arm than in <4 ng/mL arm. The 3-year locoregional recurrence (17.6% vs. 7.0%, p=0.012), distant metastasis (20.4% vs. 6.9%, p=0.002), and para-aortic recurrence (9.4% vs. 2.1%, p=0.012) rates were significantly higher in SCC-Ag ≥4 ng/mL arm than in SCC-Ag <4 ng/mL arm. Conclusion Pre-treatment SCC-Ag level higher than 4 ng/mL may be a useful predictor of tumor recurrence in patients with squamous-cell carcinoma of uterine cervix treated with definitive CRT and ICR.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sea Won Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mina Yu
- Department of Radiation Oncology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Songmi Jeong
- Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Radiation Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
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Holdenrieder S, Molina R, Qiu L, Zhi X, Rutz S, Engel C, Kasper-Sauer P, Dayyani F, Korse CM. Technical and clinical performance of a new assay to detect squamous cell carcinoma antigen levels for the differential diagnosis of cervical, lung, and head and neck cancer. Tumour Biol 2018; 40:1010428318772202. [PMID: 29701125 DOI: 10.1177/1010428318772202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In squamous cell carcinoma, squamous cell carcinoma antigen levels are often elevated. This multi-center study evaluated the technical performance of a new Elecsys® squamous cell carcinoma assay, which measures serum squamous cell carcinoma antigen 1 and 2 levels in an equimolar manner, and investigated the potential of squamous cell carcinoma antigen for differential diagnosis of cervical, lung, and head and neck squamous cell carcinoma.Assay precision and method comparison experiments were performed across three European sites. Reference ranges for reportedly healthy individuals were determined using samples from banked European and Chinese populations. Differential diagnosis experiments determined whether cervical, lung, or head and neck cancer could be differentiated from apparently healthy, benign, or other malignant cohorts using squamous cell carcinoma antigen levels alone. Squamous cell carcinoma antigen cut-off levels were calculated based on squamous cell carcinoma antigen levels at 95% specificity. Repeatability coefficients of variation across nine analyte concentrations were ≤5.3%, and intermediate precision coefficients of variation were ≤10.3%. Method comparisons showed good correlations with Architect and Kryptor systems (slopes of 1.1 and 1.5, respectively). Reference ranges for 95th percentiles for apparently healthy individuals were 2.3 ng/mL (95% confidence interval: 1.9–3.8; European cohort, n = 153) and 2.7 ng/mL (95% confidence interval: 2.2–3.3; Chinese cohort, n = 146). Strongest differential diagnosis results were observed for cervical squamous cell carcinoma: receiver operating characteristic analysis showed that squamous cell carcinoma antigen levels (2.9 ng/mL cut-off) differentiate cervical squamous cell carcinoma (n = 127) from apparently healthy females (n = 286; area under the curve: 86.2%; 95% confidence interval: 81.8–90.6; sensitivity: 61.4%; specificity: 95.6%), benign diseases (n = 187; area under the curve: 86.3%; 95% confidence interval: 81.2–91.3; sensitivity: 61.4%; specificity: 95.0%), and other cervical cancers (n = 157; area under the curve: 78.9%; 95% confidence interval: 70.8–87.1; sensitivity: 61.4%; specificity: 86.7%). Squamous cell carcinoma may also aid in the differential diagnosis of lung cancer. The Elecsys squamous cell carcinoma assay exhibited good technical performance and is suitable for differential diagnosis of cervical squamous cell carcinoma in clinical practice.
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Affiliation(s)
| | - Rafael Molina
- Hospital Clinic de Barcelona and University of Barcelona, Barcelona, Spain
| | - Ling Qiu
- Peking Union Medical College Hospital, Beijing, China
| | - Xiuyi Zhi
- Xuanwu Hospital, Capital Medical University, Beijing Shi, China
| | | | | | | | - Farshid Dayyani
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
- University of California, Irvine, Irvine, CA, USA
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Cho O, Chun M, Oh YT, Noh OK, Chang SJ, Ryu HS, Lee EJ. Prognostic implication of simultaneous anemia and lymphopenia during concurrent chemoradiotherapy in cervical squamous cell carcinoma. Tumour Biol 2017; 39:1010428317733144. [PMID: 29022484 DOI: 10.1177/1010428317734303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Radioresistance often leads to poor survival in concurrent chemoradiotherapy-treated cervical squamous cell carcinoma, and reliable biomarkers can improve prognosis. We compared the prognostic potential of hemoglobin, absolute neutrophil count, and absolute lymphocyte count with that of squamous cell carcinoma antigen in concurrent chemoradiotherapy-treated squamous cell carcinoma. We analyzed 152 patients with concurrent chemoradiotherapy and high-dose-rate intracavitary brachytherapy-treated cervical squamous cell carcinoma. Hemoglobin, absolute neutrophil count, absolute lymphocyte count, and squamous cell carcinoma antigen were quantitated and correlated with survival, using Cox regression, receiver operating characteristic curve analysis, and Kaplan-Meier plots. Both hemoglobin and absolute lymphocyte count in the second week of concurrent chemoradiotherapy (Hb2 and ALC2) and squamous cell carcinoma antigen in the third week of concurrent chemoradiotherapy (mid-squamous cell carcinoma antigen) correlated significantly with disease-specific survival and progression-free survival. The ratio of high-dose-rate intracavitary brachytherapy dose to total dose (high-dose-rate intracavitary brachytherapy ratio) correlated significantly with progression-free survival. Patients with both low Hb2 (≤11 g/dL) and ALC2 (≤639 cells/µL) showed a lower 5-year disease-specific survival rate than those with high Hb2 and/or ALC2, regardless of mid-squamous cell carcinoma antigen (mid-squamous cell carcinoma antigen: ≤4.7 ng/mL; 5-year disease-specific survival rate: 85.5% vs 94.6%, p = 0.0096, and mid-squamous cell carcinoma antigen: >4.7 ng/mL; 5-year disease-specific survival rate: 43.8% vs 66.7%, p = 0.192). When both Hb2 and ALC2 were low, the low high-dose-rate intracavitary brachytherapy ratio (≤0.43) subgroup displayed significantly lower 5-year disease-specific survival rate compared to the subgroup high high-dose-rate intracavitary brachytherapy ratio (>0.43) (62.5% vs 88.2%, p = 0.0067). Patients with both anemia and lymphopenia during concurrent chemoradiotherapy showed poor survival, independent of mid-squamous cell carcinoma antigen, and escalating high-dose-rate intracavitary brachytherapy ratio might improve survival.
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Affiliation(s)
- Oyeon Cho
- 1 Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Mison Chun
- 1 Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Young-Taek Oh
- 1 Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - O Kyu Noh
- 1 Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Suk-Joon Chang
- 2 Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Hee-Sug Ryu
- 2 Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Eun Ju Lee
- 3 Department of Radiology, School of Medicine, Ajou University, Suwon, Republic of Korea
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Kinjyo Y, Nagai Y, Toita T, Kudaka W, Ariga T, Shimoji Y, Nakasone T, Taira Y, Arakaki Y, Nakamoto T, Wakayama A, Ooyama T, Maemoto H, Heianna J, Aoki Y. Concurrent weekly cisplatin versus triweekly cisplatin with radiotherapy for locally advanced squamous-cell carcinoma of the cervix: a retrospective analysis from a single institution. Br J Radiol 2017; 90:20170241. [PMID: 28707541 PMCID: PMC5603956 DOI: 10.1259/bjr.20170241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare patients with cervical cancer who were primarily treated with concurrent chemoradiotherapy (CCRT) using 20 mg m-2 CDDP for 5 days every 3 weeks with weekly regimens of 40 mg m-2. METHODS We retrospectively analyzed 185 patients with Stage IB-IVA squamous-cell carcinoma of the cervix who were treated with CCRT between 2005 and 2013 at our hospital. The CCRT regimen consisted of cisplatin (CDDP) at 20 mg m-2 for 5 days every 3 weeks or 40 mg m-2 weekly, administered concomitantly with RT. RESULTS The median age was 50 years (range: 22-70 years) in the triweekly group and was 50.5 years (range: 28-70 years) in the weekly group. The 5-year overall survival rate in the triweekly and weekly groups were 82.0% and 83.3%, respectively (p = 0.851); their disease-free survival rate was 79.6% and 78.1%, respectively (p = 0.672). In the triweekly group, 56 patients (50.9%) had grade 3/4 leukopenia, which was significantly higher than that of 11 patients (15%) in the weekly group (p < 0.0001). CONCLUSION The weekly CDDP regimen for CCRT seems better in patients with International Federation of Gynecology and Obstetrics Stages IB-IVA squamous-cell carcinoma of the cervix. Advances in knowledge: The weekly CDDP regimen for CCRT seems better in patients with International Federation of Gynecology and Obstetrics Stages IB-IVA squamous-cell carcinoma of the cervix.
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Affiliation(s)
- Yoshino Kinjyo
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yutaka Nagai
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Takafumi Toita
- 2 Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Wataru Kudaka
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Takuro Ariga
- 2 Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yuko Shimoji
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tadaharu Nakasone
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Taira
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yoshihisa Arakaki
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Nakamoto
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Akihiko Wakayama
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Takuma Ooyama
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Maemoto
- 2 Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Joichi Heianna
- 2 Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Yoichi Aoki
- 1 Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Prognostic Significance of Cytokeratin 19 and Squamous Cell Cancer Antigen in Histologically Negative Sentinel Lymph Nodes of Cervical Squamous Cell Carcinoma. Int J Gynecol Cancer 2016; 26:1679-1685. [DOI: 10.1097/igc.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of the study was to evaluate the prognostic value of positive cytokeratin 19 (CK19) and squamous cell cancer antigen (SCCAg) expression in histologically negative sentinel lymph nodes after surgery for cervical squamous cell carcinoma.MethodsImmunohistochemistry was performed to detect the expression of CK19 and SCCAg using polyclonal antibody on 149 pair of formalin-fixed, paraffin-embedded cervical squamous cell carcinoma and histologically negative sentinel lymph node tissue samples, and results were compared with data from the prospectively registry of cervical squamous cell carcinoma by univariate and multivariate logistic regression model focusing specifically on recurrence. The survival was assessed by the Kaplan-Meier method and proportional hazards model.ResultsCytokeratin 19 and SCCAg expression in histologically negative sentinel lymph nodes were documented in 15.4% (n = 23) and 20.8% (n = 31) patients and were associated with a higher incidence of tumor progression and poorer disease-free survival (DFS, P < 0.05). Multivariate logistic regression analysis demonstrated that CK19 (P = 0.001) and SCCAg (P = 0.001) expression in histologically negative sentinel lymph nodes, International Federation of Gynecology and Obstetrics staging (P = 0.000), and cervical stroma infiltration depth (P = 0.005) were independent predictive factors for recurrence. The proportional hazards model identified CK19 (P = 0.001) and SCCAg (P = 0.005) expression in histologically negative sentinel lymph nodes, International Federation of Gynecology and Obstetrics staging (P = 0.003), and cervical stroma infiltration depth (P = 0.005), as independently related to DFS. Using subgroup analysis, we found that the CK19+/SCCAg + subgroup has the poorest prognosis, whereas the CK19−/SCCAg − subgroup has the best prognosis (P = 0.000).ConclusionsImmunohistochemical assessment of both CK19 and SCCAg status in histologically negative sentinel lymph nodes may be a valuable approach for predicting recurrence and survival after curative surgery for cervical squamous cell carcinoma.
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Wang Y, Cui T, Du L, Xu X, Tian B, Sun T, Han C, Zhao X, Jing J. The Correlation Between the Serum Squamous Carcinoma Antigen and the Prognosis of Recurrent Cervical Squamous Carcinoma. J Clin Lab Anal 2016; 31. [PMID: 27435426 DOI: 10.1002/jcla.22020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/02/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To explore the relationship of the serum squamous cell carcinoma antigen (SCC-Ag) with the pathologic characteristics, occurrence, and prognosis of cervical squamous carcinoma. METHODS The enzyme-linked immunosorbent assay (ELISA) method was used to determine the serum SCC-Ag levels for the patients, which included 424 pretreatment patients and 500 cases after treatment. RESULTS (a) Pretreatment SCC-Ag levels of patients were related to clinical stages, lymphatic metastasis, and myometrial invasion, (b) within a median follow-up of 54 months, 180 recurrences (36%) and 102 disease-associated deaths (20.4%) were recorded, 161 recurrent patients showed elevated SCC-Ag levels (161/180, 89.4%), and 60 of them (37.3%) had a significant increase in SCC-Ag serum levels before clinical manifestation of relapse. The lead time ranged between 1 and 5 months (median: 2.3 months). The total survival rates were 23.4% and 17.8% for 3-year and 5-year period, respectively, and (c) clinical stages, the site of recurrence, and SCC-Ag levels after treatment were closely related with recurrent patients' survival time (P < 0.01~<0.005). Multivariate analysis indicated that the clinical stages and SCC-Ag levels of recurrent patients were independent prognostic factors (P < 0.05˜0.01). CONCLUSION Serum SCC-Ag level was an important predictor for the cervical squamous carcinoma recurrence and prognosis.
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Affiliation(s)
- Yan Wang
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Tong Cui
- Department of Radiation Therapy, Shanxi Cancer Hospital, Taiyuan, China
| | - Lili Du
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Xiaoqin Xu
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Baoguo Tian
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Ting Sun
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Cunzhi Han
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Xianwen Zhao
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
| | - Jiexian Jing
- Department of Tumor Markers and Etiology Detection, Shanxi Cancer Hospital, Taiyuan, China
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Salvatici M, Achilarre MT, Sandri MT, Boveri S, Vanna Z, Landoni F. Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: Role in the early diagnosis of recurrence. Gynecol Oncol 2016; 142:115-119. [PMID: 27117922 DOI: 10.1016/j.ygyno.2016.04.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/13/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess the potential benefit of routine squamous cell carcinoma antigen (SCC-Ag) assessment during follow-up of patients after treatment for early cervical cancer with regard to early diagnosis of cancer recurrence before clinical signs and symptoms occur. METHODS All clinical, pathological, and serological data of patients referred to the Department of Gynecologic Oncology between July 1999 and June 2014, were retrospectively collected and analyzed. The SCC-Ag levels of 197 patients with diagnosis of stage I or II cervical squamous carcinoma, were performed. RESULTS In the univariate analysis, serum SCC-Ag was not significantly associated with grading (p=0.85), LVSI (p=0.95) and FIGO stage (p=0.83) but it was significantly associated with recurrence of disease (p<0.001). The Cox multivariate analyses showed that serum SCC-Ag level was an independent and statistically significant prognostic factor for OS and PFS. The median time interval between SCC-Ag test and diagnosis of recurrence were 0.3 and 1.8months for positive and negative SCC-Ag groups respectively (p=0.01). Considering patients with recurrence, no significant difference in terms of DFS and OS was found between women with high or low SCC-Ag levels. CONCLUSIONS Serum SCC-Ag reflects the response to treatment, and rising antigen levels often precede the clinical detection of recurrent disease, and may lead to early diagnosis. However such an advantage does not seem to improve the cure rate of patients with elevated SCC-Ag levels, most likely due to the lack of curative salvage treatments.
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Affiliation(s)
- Michela Salvatici
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy.
| | - Maria T Achilarre
- Division of Gynaecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy
| | - Maria T Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Sara Boveri
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - Zanagnolo Vanna
- Division of Gynaecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy
| | - Fabio Landoni
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
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The Treatment of Pelvic Locoregional Recurrence of Cervical Cancer After Radical Surgery With Intensity-Modulated Radiation Therapy Compared With Conventional Radiotherapy: A Retrospective Study. Int J Gynecol Cancer 2015; 25:1058-65. [DOI: 10.1097/igc.0000000000000360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of this study was to investigate the therapeutic response and toxicity of intensity-modulated radiation therapy (IMRT) or conventional radiotherapy (c-RT) as adjuvant therapy in patients with pelvic locoregional recurrence of cervical cancer after radical surgery.MethodsThis retrospective study included 161 patients with unresectable pelvic locoregional recurrence of cervical cancer after radical surgery between March 2003 and May 2012. All patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer and received radical hysterectomy and pelvic lymphadenectomy. A total of 82 patients were treated with c-RT, whereas the remaining 79 patients underwent IMRT. Intracavitary brachytherapy and concurrent chemotherapy were performed during external irradiation.ResultsThe mean dose delivered to the planning target volume was significantly higher in the IMRT group than in the c-RT group (61.8 vs 50.3 Gy,P= 0.029). Intensity-modulated radiation therapy plans yielded better dose sparing of small bowel, bladder, and rectum than did c-RT (P< 0.05). Moreover, the IMRT patients experienced less acute and chronic toxicities (P< 0.05) and better short-term effects (complete response + partial response) than did those treated with c-RT (89.9% vs 63.4%,P= 0.03). Three- and 5-year overall survival rates were significantly higher in the IMRT group than in the c-RT group (3-year: 58.4% vs 39.1%,P= 0.012; 5-year: 35.4% vs 21.4%,P= 0.007). Furthermore, 5-year progression-free survival rates were significantly higher in the IMRT group than in the c-RT group (26.1% vs 15.1%,P= 0.031).ConclusionsIntensity-modulated radiation therapy achieved outcomes superior to c-RT in patients with pelvic locoregional recurrence of cervical cancer after radical surgery. The acute and chronic toxicities were acceptable, and the adjacent organs at risk were well protected.
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Five years' experience treating locally advanced cervical cancer with concurrent chemoradiotherapy: results from a single institution. Arch Gynecol Obstet 2015; 292:1091-9. [PMID: 25914074 DOI: 10.1007/s00404-015-3712-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/01/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical cancer is the second most common cause of female cancer death. In Morocco it is the second most common cancer, our department recruits more than 500 patients each year and proximally half of the cases are diagnosed at an advanced stage. PATIENTS AND METHODS Between January 2008 and December 2008, all patients with diagnosis of locally advanced cervical cancer referred to our department and treated with concurrent chemoradiotherapy were retrieved. We analyzed outcomes for this particular population; overall survival, local control, and toxicities, we also retrieved prognostic factors influencing outcomes for this population. RESULTS The overall survival rate for the cohort was 68 % at 2 years, and reached 47 % at 5 years. The overall LC rate was 71 % at 2 years and 58 % at 5 years. The most important prognostic factors for OS and LC were the pretreatment hemoglobin, the tumor size, total duration of treatment, and the use of brachytherapy. For OS, the presence of enlarged lymph nodes was also important. For LC, the number of chemotherapy's courses was important. Of the included patients, 20 % experienced late grade 3 or 4 toxicity. CONCLUSION The results of our study have shown that despite all the treatment strategies available, locally advanced cervical cancer is associated with bad outcomes. In this cohort, the most important prognostic factors were the pretreatment hemoglobin level and the tumor size.
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Hu YY, Fan W, Zhang X, Liang PY, Lin XP, Zhang YR, Li YH. Complementary Roles of Squamous Cell Carcinoma Antigen and (18)F-FDG PET/CT in Suspected Recurrence of Cervical Squamous Cell Cancer. J Cancer 2015; 6:287-91. [PMID: 25663947 PMCID: PMC4317765 DOI: 10.7150/jca.10819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/08/2014] [Indexed: 11/07/2022] Open
Abstract
Purpose: To assess the clinical value of FDG PET/CT and evaluate the complementary roles of serum squamous cell carcinoma antigen (SCCAg) and FDG PET/CT in the diagnosis of suspected recurrent of cervical squamous cell cancer. Methods: Serum SCCAg levels were retrospectively reviewed in patients previously treated for cervical squamous cell carcinoma, who had suspected recurrence of cervical cancer and who had undergone FDG PET/CT scans. The clinical impact of elevated SCCAg (>1.5 ng/ml) and negative SCCAg (≤1.5 ng/ml) levels were analyzed based on the results of PET/CT and final diagnosis. Results: The overall patient-based sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT for the detection of tumor recurrence or malignancy were 100% (86/86), 80.8% (21/26), 95.5% (107/112), 94.5% (86/91) and 100% (21/21), respectively. Of the 112 patients included in this study, recurrence or malignancy was detected by PET/CT in 62 of the 64 patients with elevated SCCAg, compared to 24 of the 48 patients with negative SCCAg levels. The overall patient-based PPV, NPV, sensitivity and accuracy of SCCAg for the detection of tumor recurrence or malignancy were 96.9% (62/64), 50% (24/48), 72.1% (62/86) and 76.8% (86/112), respectively. The five false-positive PET/CT results were all associated with patients with negative SCCAg levels. The PPV of positive PET/CT-associated elevated SCCAg for the detection of tumor recurrence or malignancy was 100% (62/62). The NPV of negative SCCAg-associated negative PET/CT was 100% (19/19). Conclusions: Serum SCCAg evaluation and FDG PET/CT imaging can be complementary techniques in cases of suspected recurrent cervical squamous cancer. Positive PET/CT with elevated SCCAg can predict recurrence. Although PET/CT cannot confidently be deferred due to a negative SCCAg test, the possibility of a false-positive PET/CT in those cases may have diagnostic importance.
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Affiliation(s)
- Ying-Ying Hu
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Wei Fan
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xu Zhang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Pei-Yan Liang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xiao-Ping Lin
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Ya-Rui Zhang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yuan-Hua Li
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
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Errachdi A, Asabbane A, Nkoua Epala B, Hemmich M, Kabbali N, Kebdani T, Benjaafar N. [Advanced cervical cancer: Evolutionary and prognostic. Moroccan experience]. Presse Med 2014; 43:e257-64. [PMID: 25001047 DOI: 10.1016/j.lpm.2014.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 09/26/2013] [Accepted: 02/13/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Standard treatment of locally advanced cervical carcinoma is actually represented by concomitant chemoradiotherapy followed by brachytherapy. However, in spite of good local control rates after treatment, local and regional relapses still a major cause of failure treatment. The occurrence of progressions and relapses depends on prognostic factors of disease evolution. Their treatment is often palliative. METHODS The aim of this study is to report the evolution of our retrospective series after radiotherapy with or without concomitant chemotherapy, and to discuss progressions and relapses factors for the stages IIIB and IVA of cervical carcinoma. RESULTS Progressions occurred in 15 patients (13.7%) with an average of three months. Recurrences occurred in 15 patients (13.7%) with an average of 19.6 months. The overall treatment failure rate was 27.5%. Seventy-six of treated patients were in good locoregional control with a median follow of 64 months (61-76). The overall survival at five years was 41.3%. CONCLUSION Relapses of cervical cancer have a poor prognosis and long-term survival remains very poor. The suitable treatment of the primary disease, respecting essentially therapeutic times, is the only guarantee of a good prognosis, as well as screening at early stages, involving less poor prognostic factors.
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Affiliation(s)
- Amal Errachdi
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc.
| | - Amal Asabbane
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
| | - Brice Nkoua Epala
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
| | - Mariem Hemmich
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
| | - Naoual Kabbali
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
| | - Tayeb Kebdani
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
| | - Noureddine Benjaafar
- CHU Ibn Sina, Université Mohamed 5, Institut national d'oncologie Sidi-Mohamed-Benabdellah, service de radiothérapie, 10100 Rabat, Maroc
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Meads C, Davenport C, Małysiak S, Kowalska M, Zapalska A, Guest P, Martin-Hirsch P, Borowiack E, Auguste P, Barton P, Roberts T, Khan K, Sundar S. Evaluating PET-CT in the detection and management of recurrent cervical cancer: systematic reviews of diagnostic accuracy and subjective elicitation. BJOG 2013; 121:398-407. [PMID: 24299154 DOI: 10.1111/1471-0528.12488] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET-CT) is recommended to triage women for exenterative surgery and surveillance after treatment for advanced cervical cancer. OBJECTIVE To evaluate diagnostic accuracy of additional whole body PET-CT compared with CT/magnetic resonance imaging (MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance. DESIGN Systematic reviews. Subjective elicitation to supplement diagnostic information. SEARCH STRATEGY/SELECTION CRITERIA/DATA COLLECTION AND ANALYSIS Searches of electronic databases were performed to June 2013. Studies in women with suspected recurrent/persistent cervical cancer and in asymptomatic women undergoing follow up with sufficient numeric data were included. We calculated sensitivity, specificity and corresponding 95% confidence intervals. Meta-analyses employed a bivariate model that included a random-effects term for between-study variations (CT studies) and univariate random effects meta-analyses (PET-CT studies) for sensitivity and specificity separately. SUBJECTIVE ELICITATION Prevalence of recurrence and the accuracy of imaging elicited using the allocation of points technique. Coherence of elicited subjective probabilities with estimates in the literature examined. RESULTS We identified 15 relevant studies; none directly compared additional PET-CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET-CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET-CT were less than elicited increases required to justify the use in PET-CT for surveillance. CONCLUSION Evidence to support additional PET-CT is scarce, of average quality and does not distinguish between application for surveillance and diagnosis. Guidelines recommending PET-CT in recurrent cervical cancer need to be reconsidered in the light of the existing evidence base.
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Affiliation(s)
- C Meads
- Health Economics Research Group, Brunel University, Middlesex, UK
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Liu SP, Yang JX, Cao DY, Shen K. Analysis of 30 patients with persistent or recurrent squamous cell carcinoma of the cervix within one year after concurrent chemoradiotherapy. Cancer Biol Med 2013; 10:227-31. [PMID: 24349833 PMCID: PMC3860346 DOI: 10.7497/j.issn.2095-3941.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/08/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the recurrence sites, risk factors, and prognosis of patients with persistent or recurrent squamous cell carcinoma (SCC) of the cervix within one year after undergoing concurrent chemoradiotherapy (CCRT). METHODS Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year after CCRT between July 2006 and July 2011 were analyzed retrospectively. These data were compared with those of 35 SCC cases with no signs of recurrence after complete remission. These 35 patients were treated during the same period (between 2006 and 2011) and selected randomly. RESULTS Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months after CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag >10 ng/mL in the group with persistent or recurrent disease before treatment (P<0.01). Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag >10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. The 2-year survival rate was 21.7%, and the median survival time was 17 months. CONCLUSION Patients with persistent or recurrent SCC of the cervix after CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag >10 ng/mL were identified as the independent risk factors for persistent or recurrent SCC within 1 year after CCRT.
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Affiliation(s)
- Shi-Ping Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jia-Xin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Dong-Yan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union College, Chinese Academy of Medical Science, Beijing 100730, China
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Kawaguchi R, Furukawa N, Kobayashi H, Asakawa I. Posttreatment cut-off levels of squamous cell carcinoma antigen as a prognostic factor in patients with locally advanced cervical cancer treated with radiotherapy. J Gynecol Oncol 2013; 24:313-20. [PMID: 24167666 PMCID: PMC3805911 DOI: 10.3802/jgo.2013.24.4.313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the present study was to assess prognostic factors for patients with locally advanced cervical cancer treated with radiotherapy as the primary treatment and to assess the posttreatment cut-off levels of squamous cell carcinoma antigen (SCC-Ag) to predict three-year overall survival (OS) rates. METHODS One hundred and twenty-eight patients with cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IIB-IVA) treated using radiotherapy or concurrent chemoradiotherapy were identified. Of these patients, 116 who had SCC-Ag levels >1.5 ng/mL prior to treatment were analyzed retrospectively. RESULTS Median age was 68 years (range, 27 to 79 years). The complete response rate was 70.7% and the three-year OS rate was 61.1%. The median levels of pretreatment and posttreatment SCC-Ag were 11.5 ng/mL (range, 1.6 to 310.0 ng/mL) and 0.9 ng/mL (range, 0.4 to 41.0 ng/mL), respectively. Multivariate analysis showed that pretreatment anemia (p=0.041), pelvic lymph node metastasis (p=0.016) and posttreatment SCC-Ag levels (p=0.001) were independent prognostic factors for three-year OS. The SCC-Ag level cut-off point for three-year OS rates, calculated using a receiver operating characteristic curve, was 1.15 ng/mL (sensitivity, 80.0%; specificity, 74.0%). CONCLUSION Pretreatment anemia and pelvic lymph node metastasis are poor prognostic factors in locally advanced cervical cancer. Furthermore, posttreatment SCC-Ag levels <1.15 ng/mL predicted better three-year OS rates.
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Affiliation(s)
- Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
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Kudaka W, Nagai Y, Toita T, Inamine M, Asato K, Nakamoto T, Wakayama A, Ooyama T, Tokura A, Murayama S, Aoki Y. Long-term results and prognostic factors in patients with stage III-IVA squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy from a single institution study. Int J Clin Oncol 2012; 18:916-21. [PMID: 22898910 DOI: 10.1007/s10147-012-0457-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We evaluated the longer-term efficacy and safety of concurrent chemoradiotherapy (CCRT) incorporating high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a lower cumulative radiotherapy (RT) protocol and analyzed prognostic risk factors for survival among patients with FIGO stage III-IVA squamous cell carcinoma (SCC) of the cervix. PATIENTS AND METHODS Ninety-nine patients with FIGO stage III-IVA SCC of the cervix between 1997 and 2008 were treated with CCRT using cisplatin 20 mg/m(2) for 5 days every 3 weeks or 40 mg/m(2) weekly. Acute and late toxicities were evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. RESULTS Median age was 53.5 years. Median follow-up period was 58 months (range 6-170 months). Pathologically complete response was achieved in 93 patients (96.9%). The 5-year OS and DFS were 72.0 and 69.3%, respectively. The 5-year local and distant DFS were 83.0 and 75.1%, respectively. Thirty-one patients (31.3%) experienced recurrence. Multivariate analysis showed that tumor size and pretreatment hemoglobin level remained an independent risk factor for OS and DFS. Acute toxicity was moderate. In terms of late adverse effects, 2 patients (2.0%) suffered from grade 4 late intestinal toxicity because of radiation enterocolitis, with both requiring intestinal surgery. CONCLUSIONS Our study demonstrates that the CCRT schedule in patients with FIGO stage III-IVA SCC is efficacious and safe. In addition, the assessment of tumor size and pretreatment anemia can provide valuable prognostic information.
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Affiliation(s)
- Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Kang S, Nam BH, Park JY, Seo SS, Ryu SY, Kim JW, Kim SC, Park SY, Nam JH. Risk Assessment Tool for Distant Recurrence After Platinum-Based Concurrent Chemoradiation in Patients With Locally Advanced Cervical Cancer: A Korean Gynecologic Oncology Group Study. J Clin Oncol 2012; 30:2369-74. [PMID: 22614984 DOI: 10.1200/jco.2011.37.5923] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Our study aimed to develop a model to predict distant recurrence in locally advanced cervical cancer, which can be used to select high-risk patients in enriched clinical trials. Patients and Methods Our study was a retrospective analysis of a multi-institutional cohort of patients treated between 2001 and 2009. According to the order of data submission, data from three institutions were allocated to a model development cohort (n = 434), and data from the remaining two institutions were allocated to an external validation cohort (n = 115). Patient information including [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) data and clinical outcome was modeled using competing risk regression analysis to predict 5-year cumulative incidence of distant recurrence. Results The competing risk analysis revealed that the following four parameters were significantly associated with distant recurrence: pelvic and para-aortic nodal positivity on FDG-PET, nonsquamous cell histology, and pretreatment serum squamous cell carcinoma antigen levels. This four-parameter model showed good discrimination and calibration, with a bootstrap-adjusted concordance index of 0.70. Also, the validation set showed good discrimination with a bootstrap-adjusted concordance index of 0.73. A user-friendly Web-based nomogram predicting 5-year probability of distant recurrence was developed. Conclusion We have developed a robust model to predict the risk of distant recurrence in patients with locally advanced cervical cancer. Further, we discussed how the selective enrichment of the patient population could facilitate clinical trials of systemic chemotherapy in locally advanced cervical cancer.
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Affiliation(s)
- Sokbom Kang
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Byung-Ho Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jeong-Yeol Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Young Ryu
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jae Weon Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Seung-Cheol Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Yoon Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
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Jeong BK, Choi DH, Huh SJ, Park W, Bae DS, Kim BG. The role of squamous cell carcinoma antigen as a prognostic and predictive factor in carcinoma of uterine cervix. Radiat Oncol J 2011; 29:191-8. [PMID: 22984670 PMCID: PMC3429902 DOI: 10.3857/roj.2011.29.3.191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 12/02/2022] Open
Abstract
Purpose Although the role of squamous cell carcinoma antigen (SCC-Ag) as a predictive and prognostic factor for uterine cervical cancer has been identified in previous studies, 1) the effective patient group of screening for recurrence with SCC-Ag, 2) the relationship between SCC-Ag and recurrence site, and 3) the relationship between the change of SCC-Ag and treatment outcome or recurrence have not been described. Materials and Methods The study included 506 patients with histologically proven uterine cervical cancer between January 1994 and December 2010. We determining the serum SCC-Ag level before treatment and after treatment, and conducted a retrospective review of the patients' records. We evaluated the sensitivity and specificity of SCC-Ag for the detection of tumor recurrence by comparing biochemical recurrence with clinical recurrence. Results The pretreatment SCC-Ag level and the proportion of patients over 1.5 ng/mL were higher in poor prognostic patient group. In the univariate and multivariate analysis, pretreatment SCC-Ag showed a statistically significant correlation with tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology. In patients with biochemical recurrence vs. those without, 5-year DFS and OS were 27.6 vs. 92.7% (p ≤ 0.001) and 53.7 vs. 92.5% (p ≤ 0.001), respectively. Conclusion Our study reconfirmed the known function of pretreatment SCC-Ag, but could not confirm the function of biochemical response as a predictive factor for treatment and as a prognostic factor. There was no statistically significant relationship between SCC-Ag level and recurrence site. We confirmed the role of SCC-Ag as a follow-up tool for recurrence of disease and which patient groups SCC-Ag was more useful for.
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Affiliation(s)
- Bae Kwon Jeong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Atuhairwe S, Busingye RB, Sekikubo M, Nakimuli A, Mutyaba T. Urologic complications among women with advanced cervical cancer at a tertiary referral hospital in Uganda. Int J Gynaecol Obstet 2011; 115:282-4. [DOI: 10.1016/j.ijgo.2011.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 07/16/2011] [Accepted: 08/29/2011] [Indexed: 01/20/2023]
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Zhang H, Qi S. A rapid and sensitive chemiluminescence immunoassay based on magnetic particles for squamous cell carcinoma antigen in human serum. Clin Chim Acta 2011; 412:1572-7. [DOI: 10.1016/j.cca.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 05/01/2011] [Accepted: 05/03/2011] [Indexed: 11/30/2022]
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Long-term results and prognostic factors of patients with cervical carcinoma treated with concurrent chemoradiotherapy. Clin Transl Oncol 2011; 13:504-8. [DOI: 10.1007/s12094-011-0688-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huang EY, Hsu HC, Sun LM, Chanchien CC, Lin H, Chen HC, Tseng CW, Ou YC, Chang HY, Fang FM, Huang YJ, Wang CY, Lu HM, Tsai CC, Ma YY, Fu HC, Wang YM, Wang CJ. Prognostic value of pretreatment carcinoembryonic antigen after definitive radiotherapy with or without concurrent chemotherapy for squamous cell carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 2010; 81:1105-13. [PMID: 20932670 DOI: 10.1016/j.ijrobp.2010.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/15/2010] [Accepted: 07/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate whether pretreatment carcinoembryonic antigen (CEA) levels have a prognostic role in patients after definitive radiotherapy for squamous cell carcinoma (SCC) of the uterine cervix. METHODS AND MATERIALS A retrospective study of 550 patients was performed. The SCC antigen (SCC-Ag) and CEA levels were regarded as elevated when they were ≥2 and ≥5 ng/mL, respectively. A total of 208 patients underwent concurrent chemoradiotherapy (CCRT). The Kaplan-Meier method was used to calculate the distant metastasis (DM), local failure (LF), disease-free survival (DFS), and overall survival (OS) rates. Multivariate analysis was performed using the Cox proportional hazards model. The hazard ratio (HR) with 95% confidence interval (CI) was evaluated for the risk of a poor prognosis. RESULTS Compared with the patients with normal CEA/SCC-Ag levels, CEA levels ≥10 ng/mL but without elevated SCC-Ag levels was an independent factor for LF (HR, 51.81; 95% CI, 11.51-233.23; p < .001), DM (HR, 6.04; 95% CI, 1.58-23.01; p = .008), DFS (HR, 10.17; 95% CI, 3.18-32.56; p < .001), and OS (HR, 5.75; 95% CI, 1.82-18.18; p = .003) after RT alone. However, no significant role for CEA was noted in patients with SCC-Ag levels ≥2 ng/mL. In patients undergoing CCRT, a CEA level ≥10 ng/mL was an independent factor for LF (HR, 2.50; 95% CI, 1.01-6.21; p = .047), DM (HR, 3.41; 95% CI, 1.56-7.46; p = .002), DFS (HR, 2.73; 95% CI, 1.39-5.36; p = .003), and OS (HR, 3.93; 95% CI 1.99-7.75; p < .001). A SCC-Ag level of ≥40 ng/mL was another prognostic factor for DM, DFS, and OS in patients undergoing not only CCRT, but also RT alone. The 5-year OS rate for CCRT patients with CEA <10 ng/mL and ≥10 ng/mL was 75.3% and 35.8%, respectively (p < .001). CCRT was an independent factor for better OS (HR, 0.69; 95% CI, 0.50-0.97; p = .034). CONCLUSION Pretreatment CEA levels in patients with SCC of the uterine cervix provide complementary information for predicting LF, DM, DFS, and OS, except for in patients with abnormal SCC-Ag levels before RT alone. More aggressive therapy might be advisable for patients with CEA levels of ≥10 ng/mL.
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Affiliation(s)
- Eng-Yen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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Kang S, Park JY, Lim MC, Song YJ, Park SH, Kim SK, Chung DC, Seo SS, Kim JY, Park SY. Pelvic lymph node status assessed by 18F-fluorodeoxyglucose positron emission tomography predicts low-risk group for distant recurrence in locally advanced cervical cancer: a prospective study. Int J Radiat Oncol Biol Phys 2010; 79:788-93. [PMID: 20452133 DOI: 10.1016/j.ijrobp.2009.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/04/2009] [Accepted: 11/19/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop a prediction model to identify a low-risk group for distant recurrence in patients with locally advanced cervical cancer treated by concurrent chemoradiation. METHODS AND MATERIALS Prospectively, 62 patients with locally advanced cervical cancer were recruited as a training cohort. Clinical variables and parameters obtained from positron emission tomography (PET) and magnetic resonance imaging were analyzed by logistic regression. For the test set, 54 patients were recruited independently. To identify the low-risk group, negative likelihood ratio (LR) less than 0.2 was set to be a cutoff. RESULTS Among the training cohort, multivariate logistic analysis revealed that advanced International Federation of Gynecology and Obstetrics (FIGO) stage and a high serum squamous cancer cell (SCC) antigen level were significant risk factors (p=0.015 and 0.025, respectively). Using the two parameters, criteria to determine a low-risk subset for distant recurrence were postulated: (1) FIGO Stage IIB or less and (2) pretreatment SCC<2.4 (Model A). Positive pelvic node on PET completely predicted all cases with distant recurrence and thus was considered as another prediction model (Model B). In the test cohort, although Model A did not showed diagnostic performance, Model B completely predicted all cases with distant recurrence and showed a sensitivity of 100% with negative LR of 0. Across the training and test cohort (n=116), the false negative rate was 0 (95% confidence interval 0%-7.6%). CONCLUSIONS Positive pelvic node on PET is a useful marker in prediction of distant recurrence in patients with locally advanced cervical cancer who are treated with concurrent chemoradiation.
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Affiliation(s)
- Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
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Ferdousi J, Nagai Y, Asato T, Hirakawa M, Inamine M, Kudaka W, Kariya KI, Aoki Y. Impact of human papillomavirus genotype on response to treatment and survival in patients receiving radiotherapy for squamous cell carcinoma of the cervix. Exp Ther Med 2010; 1:525-530. [PMID: 22993571 DOI: 10.3892/etm_00000083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 03/15/2010] [Indexed: 11/06/2022] Open
Abstract
To determine the clinical implications and prognostic value of the human papillomavirus (HPV) genotype, we evaluated the various HPV types in patients receiving radiotherapy for squamous cell carcinoma of the cervix. The study population included 113 invasive squamous cell carcinoma patients treated with radiation or chemoradiation between 1993 and 2002. The median age of the patients was 61 years. Tumors were classified by the International Federation of Gynecology and Obstetrics staging as stage IB in 11 patients, stage II in 39, stage III in 57 and stage IVA in 6 patients. To investigate HPV infection and its genotypes in the tumor specimens, L1 consensus PCR was performed followed by the direct nucleotide sequencing of the PCR products. Ninety-five samples (84.1%) were positive for HPV DNA. The most prevalent type was HPV-16 (34.7%). Poorer response to radiotherapy was observed in the patients with the HPV-16 genotype, in which 7 of the 33 patients had persistent disease. Only 1 of the 10 patients with HPV-58, 1 of the 5 with HPV-31 and 5 of the 10 patients with HPV-33 had a recurrence. The 5-year survival rate was 90, 80, 69.4 and 39% in the HPV-58, HPV-31, HPV-16 and HPV-33 type groups, respectively. Patients with HPV-31 and HPV-58 types were found to have better survival, whereas patients with the HPV-33 type experienced a higher risk of death. HPV genotyping may serve as a potential biomarker of response to radiation and prognosis in cervical carcinoma patients undergoing radio- or chemoradiotherapy.
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