1
|
Yin Z, Cui Z, Kang S, Ji M, Li D, Chen B, Zhan X, Li W, Liu P, Chen C. Laparoscopic versus open radical hysterectomy in FIGO 2018 early-stage cervical adenocarcinoma: Long-term survival outcomes after propensity score matching. J Obstet Gynaecol Res 2023; 49:2849-2859. [PMID: 37658744 DOI: 10.1111/jog.15785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare the long-term survival outcomes of laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in International Federation of Gynecology and Obstetrics (FIGO) 2018 early-stage cervical adenocarcinoma. METHODS Based on the clinical diagnosis and treatment for cervical cancer in mainland China (Four C) database, the medical records of 1098 patients with FIGO 2018 early-stage cervical adenocarcinoma were retrospectively reviewed. Long-term and short-term survival outcomes of the two groups were compared using a multivariate Cox regression model and the log-rank method in the whole study population and after propensity score matching. RESULTS There was no difference in disease-free survival (hazard ratio [HR] 0.921, 95% confidence interval [CI]: 0.532-1.595, p = 0.770) and overall survival (HR 1.168, 95% CI: 0.526-2.592, p = 0.702) between LRH (n = 468) and ORH (n = 468) in the risk-adjusted analysis. LRH resulted in significantly lower estimated blood loss (342.7 vs. 157.5 mL, p < 0.001) and shorter postoperative anal exhaust time (2.8 vs. 2.5 days, p < 0.001) in risk-adjusted analysis. The overall rates of intraoperative complications (2.4% vs. 4.3%, p = 0.100) and postoperative complications (7.5% vs. 6.2%, p = 0.437) showed no significant difference between the two groups. However, the LRH group had a significantly higher incidence of ureter injury (0.4% vs. 2.4%, p = 0.012) and great vessel injury (0.0% vs. 0.9%, p = 0.045) compared to the other group. No statistical variation in the site of recurrence was observed between the two groups (p = 0.613). CONCLUSIONS LRH has comparable survival outcomes with ORH and was associated with earlier recovery in FIGO 2018 early-stage adenocarcinoma of the uterine cervix. However, the LRH group had higher risk of ureter injury and great vessel injury.
Collapse
Affiliation(s)
- Zhaohong Yin
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhumei Cui
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shan Kang
- Department of Gynecology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Donglin Li
- Department of Obstetrics and Gynecology, Guizhou People's Hospital, Guiyang, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Xuemei Zhan
- Department of Obstetrics and Gynecology, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
2
|
Virarkar M, Vulasala SS, Calimano-Ramirez L, Singh A, Lall C, Bhosale P. Current Update on PET/MRI in Gynecological Malignancies-A Review of the Literature. Curr Oncol 2023; 30:1077-1105. [PMID: 36661732 PMCID: PMC9858166 DOI: 10.3390/curroncol30010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Early detection of gynecological malignancies is vital for patient management and prolonging the patient's survival. Molecular imaging, such as positron emission tomography (PET)/computed tomography, has been increasingly utilized in gynecological malignancies. PET/magnetic resonance imaging (MRI) enables the assessment of gynecological malignancies by combining the metabolic information of PET with the anatomical and functional information from MRI. This article will review the updated applications of PET/MRI in gynecological malignancies.
Collapse
Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA
| | - Sai Swarupa Vulasala
- Department of Internal Medicine, East Carolina University Health Medical Center, 600 Moye Blvd., Greenville, NC 27834, USA
| | - Luis Calimano-Ramirez
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA
| | - Anmol Singh
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA
| | - Chandana Lall
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| |
Collapse
|
3
|
Tesfaye B, Tilahun T, Dechasa Heyi W, Oljira R. Associated factors of positive visual inspection of cervix with acetic acid test among women screened for cervical cancer at public health facilities in Woliso town, Southwest Shoa, Ethiopia: A case-control study. SAGE Open Med 2022; 10:20503121221108227. [PMID: 35814309 PMCID: PMC9260562 DOI: 10.1177/20503121221108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives: Screening for precancerous cervical lesions and providing access to effective
treatment can significantly improve the likelihood of survival. To identify
associated factors of positive visual inspection of the cervix with acetic
acid test for precancerous cervical lesions among women screened for
cervical cancer at public health facilities in Woliso Town, Southwest Shoa,
Ethiopia. Methods: A facility-based unmatched case–control study was conducted on 86 cases and
172 controls. Cases were women who had a positive result for the visual
inspection of the cervix with acetic acid test, and controls were women with
a negative result. Data were collected using a pretested structured
questionnaire and organized using SPSS version 20. Descriptive analysis and
logistic regressions were performed. The adjusted odds ratio with a 95%
confidence interval was used, and statistical significance was declared at
p-value <0.05. Results: The study found that women aged 40–44 years (adjusted odds ratio = 4.11, 95%
confidence interval (1.20–14.50)), greater or equal to five deliveries
(adjusted odds ratio = 2.78, 95% confidence interval (1.39–5.56)), age at
first birth less than 20 (adjusted odds ratio = 5.45, 95% confidence
interval (1.41–21.04), age at first sexual intercourse less than 18
(adjusted odds ratio = 4.73, 95%, confidence interval (1.79–12.48)), ever
used condom (adjusted odds ratio = 11.06, 95% confidence interval
(3.93–31.14), having a history of sexually transmitted diseases (adjusted
odds ratio = 4.05, 95% confidence interval (2.15–7.76), having a history of
multiple sexual partners (adjusted odds ratio = 4.81, 95% confidence
interval (1.37–16.90)), and being human immunodeficiency virus positive
(adjusted odds ratio = 3.85, 95% confidence interval (1.68–8.83)) were
associated factors of positive visual inspection with acetic acid test for
precancerous cervical lesions. Conclusion: Given the above-associated factors of positive visual inspection with acetic
acid test for precancerous cervical lesions, the health facilities should
target women with these factors and timely screen them with the application
of acetic acid on the cervix.
Collapse
Affiliation(s)
- Bahiru Tesfaye
- Public Health Expert, MEAL Regional Project, Save the Children, Ambo, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Worku Dechasa Heyi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Rut Oljira
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
4
|
Clinical Study of Sentinel Lymph Node Detection to Evaluate Pelvic Lymph Node Metastasis to Determine the Prognosis of Patients with Early Cervical Cancer. Appl Bionics Biomech 2022; 2022:8394049. [PMID: 35369006 PMCID: PMC8967555 DOI: 10.1155/2022/8394049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 01/05/2023] Open
Abstract
Objective Lymph node status is one of the most important prognostic factors for uterine cervical cancer. Sentinel lymph node (SLN) biopsy has emerged as a potential alternative to systematic lymphadenectomy for the lymph node mapping in such patients. However, the SLN metastasis detection via SLN biopsy in early-stage cervical cancer remains controversial. The current study is aimed at investigating the feasibility and accuracy of combined tracer method for localization of SLN in initial stages of cervical cancer and to evaluate the clinical value of SLN biopsy in replacing pelvic lymph node resection. Methods We retrospectively reviewed 348 cases who were admitted to the Department of Gynecologic Oncology, Shandong Provincial Cancer Hospital, China, between February 2003 and June 2018 with FIGO stage IA2 to IIA2 cervical cancer and undergone through SLN biopsy. Methylthioninium chloride was injected in combination with 99mtechnetium-labeled sulfur colloid prior to surgery to these patients. SLNs were identified intraoperatively, excised, and subsequently submitted to fast frozen section. The detection rates, accuracy, sensitivity, coincidence rate, false negative rate, and negative predictive values of these cases were estimated, and the follow-up outcomes were carefully observed. Chi squared test or Fisher's exact test was employed for a comparison of the categorical variables. Univariate and multivariate Cox proportional hazard models were used for estimation of relationships between overall survival (OS) and disease-free survival (DFS) and prognostic factors. Results The total detection rate of SLN was 97.1% (338/348), and identification of bilateral SLN was successful in 237 patients (70.1%). The patient's tumor size, FIGO stage, lymph node metastasis, and depth of invasion had statistically significant differences in SLN detection rates. The detection rate had inverse relation with tumors size (>4 cm), invasive depth > 2/3, lymph node positive, late staging, and preoperative radiotherapy. 117 positive SLNs were detected in 73 patients. The negative predictive value, sensitivity, false negative rate, and coincidence rate and were 97.7%, 92.4%, 7.6%, and 95.4%, respectively. In patients whose tumor size were ≦ 4 cm, the false negative rate was 4.55% (2/44), whereas it was 0 in patients with tumor size≦2 cm. The respective 1, 3, and 5-year OS was 100%, 94.8%, and 91.8%, respectively, whereas DFS rate for 1, 3, and 5 years was 96.7%, 92%, and 89.6%, respectively. The lymph node was positive, tumor size, the depth of invasion, and staging were statistically different from the recurrence rate and survival rate of patients (p < 0.05). When tumor metastasis exceeded SLN, the recurrence rate was significantly increased, and survival rate is significantly reduced (p < 0.05, p < 0.01, p < 0.05, respectively). Conclusions The identification of SLN combined with 99mtechnetium-labeled sulfur colloid and methylthioninium chloride has a good accuracy and is safe for the assessment of the status of pelvic nodes in patients with initial stage cervical cancer. Nuclide as a tracer has low dependence on objective conditions and doctors' technology and has a good detection rate. In our study, we believe that SLN biopsy is feasible when the tumor is ≦ 4 cm. Large scale clinical trials are required in China expand the sample size and validate the results of this study.
Collapse
|
5
|
Nakajo M, Jinguji M, Tani A, Yano E, Hoo CK, Hirahara D, Togami S, Kobayashi H, Yoshiura T. Machine learning based evaluation of clinical and pretreatment 18F-FDG-PET/CT radiomic features to predict prognosis of cervical cancer patients. Abdom Radiol (NY) 2022; 47:838-847. [PMID: 34821963 DOI: 10.1007/s00261-021-03350-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 05/25/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To examine the usefulness of machine learning to predict prognosis in cervical cancer using clinical and radiomic features of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (CT) (18F-FDG-PET/CT). METHODS This retrospective study included 50 cervical cancer patients who underwent 18F-FDG-PET/CT before treatment. Four clinical (age, histology, stage, and treatment) and 41 18F-FDG-PET-based radiomic features were ranked and a subset of useful features for association with disease progression was selected based on decrease of the Gini impurity. Six machine learning algorithms (random forest, neural network, k-nearest neighbors, naive Bayes, logistic regression, and support vector machine) were compared using the areas under the receiver operating characteristic curve (AUC). Progression-free survival (PFS) was assessed using Cox regression analysis. RESULTS The five top predictors of disease progression were: stage, surface area, metabolic tumor volume, gray-level run length non-uniformity (GLRLM_RLNU), and gray-level non-uniformity for run (GLRLM_GLNU). The naive Bayes model was the best-performing classifier for predicting disease progression (AUC = 0.872, accuracy = 0.780, F1 score = 0.781, precision = 0.788, and recall = 0.780). In the naive Bayes model, 5-year PFS was significantly higher in predicted non-progression than predicted progression (80.1% vs. 9.1%, p < 0.001) and was only the independent factor for PFS in multivariate analysis (HR, 6.89; 95% CI, 1.92-24.69; p = 0.003). CONCLUSION A machine learning approach based on clinical and pretreatment 18F-FDG PET-based radiomic features may be useful for predicting tumor progression in cervical cancer patients.
Collapse
Affiliation(s)
- Masatoyo Nakajo
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Megumi Jinguji
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Atsushi Tani
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Erina Yano
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Chin Khang Hoo
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Daisuke Hirahara
- Department of Management Planning Division, Harada Academy, 2-54-4 Higashitaniyama, Kagoshima, 890-0113, Japan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| |
Collapse
|
6
|
Escamilla Galindo EP, Medina Ramos NF, Santana Mateo YL, Armas Roca M, Molero Sala L, León Arencibia L, Arencibia Sánchez O, Martín Martínez AI. Post-Conization FIGO stage IA1 squamous cell cervical carcinoma; is hysterectomy necessary? Eur J Obstet Gynecol Reprod Biol 2021; 264:368-373. [PMID: 34399105 DOI: 10.1016/j.ejogrb.2021.08.002] [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: 05/13/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare and evaluate the results and suitability of two different approaches to the treatment of post-conization International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 cervical carcinoma: a more radical approach, directly scheduling a second surgery versus a more conservative one, which consists of performing a cotest (PAP plus HPV-test) in a follow-up visit and deciding whether to apply a second surgery on the basis of the results. STUDY DESIGN Retrospective descriptive study including 144 cases of stage IA1 cervical carcinoma diagnosed after a loop electrosurgical excisional procedure (conization), between 1987 and 2019 in the Mother-and-Child University Hospital of Gran Canaria (Spain). Selected patients were split into two groups for analysis: patients directly undergoing a second surgical intervention (hysterectomy or re-conization) after diagnosis and patients who were followed-up before making a decision whether to schedule a second surgery or continue to follow-up. RESULTS 75% of women directly receiving a second surgical intervention (no post-conization follow-up) underwent hysterectomy, while 25% underwent re-conization. Histological outcomes from hysterectomized patients showed 65% negative results for intraepithelial lesions, 9% low-grade squamous intraepithelial lesions (LSIL), 16% high-grade squamous intraepithelial lesions (HSIL) and only 10.5% confirmed invasive lesions: hysterectomy complication rate was 7%. Histological studies from women subjected to re-conization showed 32% negative results, 37% LSIL, 5% HSIL and 26% malignancy. In the group of patients who were followed-up after diagnosis, 8.8% needed a second intervention; none of them showed negative histological results, while 100% hysterectomized and 25% patients with re-conization showed HSIL. No unnecessary hysterectomy procedures were conducted in this group. HPV-16 was the most common genotype in both groups. CONCLUSION Conization proved to be a suitable alternative to hysterectomy as a treatment for post-conization stage IA1 cervical cancer. Our results showed that 65% hysterectomy procedures conducted without previously monitoring for residual disease corresponded to negative results and were therefore, unnecessary. We conclude that confirmation of the presence of residual disease by using cotest is essential to make a decision on further treatment and that a conservative management is often possible and, in our opinion, preferable.
Collapse
Affiliation(s)
- Esther Patricia Escamilla Galindo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Norberto Fidel Medina Ramos
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Yaned Lourdes Santana Mateo
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Marta Armas Roca
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laura Molero Sala
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Laureano León Arencibia
- Department of Pathology, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Octavio Arencibia Sánchez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Alicia Inmaculada Martín Martínez
- Gynecology and Obstetrics Department, Women's and Children's University Hospital, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria 35016, Spain.
| |
Collapse
|
7
|
Adam JA, Loft A, Chargari C, Delgado Bolton RC, Kidd E, Schöder H, Veit-Haibach P, Vogel WV. EANM/SNMMI practice guideline for [ 18F]FDG PET/CT external beam radiotherapy treatment planning in uterine cervical cancer v1.0. Eur J Nucl Med Mol Imaging 2021; 48:1188-1199. [PMID: 33275178 PMCID: PMC8041686 DOI: 10.1007/s00259-020-05112-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/08/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this EANM / SNMMI Practice Guideline with ESTRO endorsement is to provide general information and specific considerations about [18F]FDG PET/CT in advanced uterine cervical cancer for external beam radiotherapy planning with emphasis on staging and target definition, mostly in FIGO stages IB3-IVA and IVB, treated with curative intention. METHODS Guidelines from related fields, relevant literature and leading experts have been consulted during the development of this guideline. As this field is rapidly evolving, this guideline cannot be seen as definitive, nor is it a summary of all existing protocols. Local variations should be taken into consideration when applying this guideline. CONCLUSION The background, common clinical indications, qualifications and responsibilities of personnel, procedure / specifications of the examination, documentation / reporting and equipment specifications, quality control and radiation safety in imaging is discussed with an emphasis on the multidisciplinary approach.
Collapse
Affiliation(s)
- Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cyrus Chargari
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
- French Military Health Academy, Ecole du Val-de-Grâce, Paris, France
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro University Hospital and Centre for Biomedical Research of la Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Elisabeth Kidd
- Department of Radiation Oncology, Stanford Cancer Center, Stanford, CA, USA
| | - Heiko Schöder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Wouter V Vogel
- Department of Nuclear Medicine and Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| |
Collapse
|
8
|
Sundaram G, Kothari S, Voleti S, Krishna V, Bose J. Type C1 radical hysterectomy in advanced squamous cell carcinoma of the cervix postdefinitive concurrent chemoradiation: An argument. J Cancer Res Ther 2021; 18:1559-1563. [DOI: 10.4103/jcrt.jcrt_557_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
9
|
Hailemariam G, Gebreyesus H, Wubayehu T, Gebregyorgis T, Gebrecherkos K, Teweldemedhin M, Kifle M. Magnitude and associated factors of VIA positive test results for cervical cancer screening among refugee women aged 25-49 years in North Ethiopia. BMC Cancer 2020; 20:858. [PMID: 32894100 PMCID: PMC7487853 DOI: 10.1186/s12885-020-07344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide cervical cancer is the third most common malignancy in women. It usually arises from the cervical area which is susceptible to Human Papilloma virus induced malignancy changes. In low-resource setting visual inspection with acetic acid (VIA) is an alternative sensitive cervical screening method. Therefore the aim of this study was to assess the magnitude and associated factors of VIA positive test results for Cervical Cancer screening among Eritrean refugee women aged 25-49 years in northern Ethiopia refugee camps. METHODS A community based cross-sectional study was conducted among 412 Eritrean refugee women aged 25-49 years from august 10 to September 25, 2018. Study subjects were selected by simple random sampling method. Data were collected using pretested structured questioner through Face-to-face interview and cervical examination. Data were coded and entered to Epi info software version 7 and then exported to Statistical package for Social Science (SPSS) version 21 for analysis. Bivariable and multivariable logistic regression analysis was made to test the association between the independent variables and the outcome variable. P-value of less than 0.05 with 95% CI was considered to declare statistical significance. RESULT In this study the magnitude of VIA positive precancerous cervical lesions was 9% (95% CI: 6.3-11.8%). Previous history of sexually transmitted infections (STI) [AOR (95%CI) = 2.84(1.07-7.53)] and presence of STI during cervical examination [AOR (95%CI) =3.97(1.75-9.00)] were found significantly associated with VIA positive precancerous cervical lesions. CONCLUSIONS In this study the magnitude of VIA positive precancerous cervical lesions was high. Previous history of sexually transmitted infections (STI) and presence of STI during cervical examination were found associated with VIA positive precancerous cervical lesions. Efforts such as early screening for sexually transmitted disease shall be done to prevent precancerous cervical lesions.
Collapse
Affiliation(s)
- Gebretsadik Hailemariam
- Adminstration for Refugee and Returnee Affairs Adiharsh Eritrean refugee camps Health and Neutrino Coordinator, Adiharsh camp, Shire, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Tewolde Wubayehu
- School of Medicine, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Tsgehana Gebregyorgis
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia.
| | - Kidanemariam Gebrecherkos
- Adminstration for Refugee and Returnee Affairs Adiharsh Eritrean refugee camps Health and Neutrino Coordinator, Adiharsh camp, Shire, Ethiopia
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Manaye Kifle
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
| |
Collapse
|
10
|
Azevedo Martins JM, Rabelo-Santos SH, do Amaral Westin MC, Zeferino LC. Tumoral and stromal expression of MMP-2, MMP-9, MMP-14, TIMP-1, TIMP-2, and VEGF-A in cervical cancer patient survival: a competing risk analysis. BMC Cancer 2020; 20:660. [PMID: 32669083 PMCID: PMC7364527 DOI: 10.1186/s12885-020-07150-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/07/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Expression of matrix metalloproteases 2, 9 and 14 (MMP-2, MMP-9, MMP-14), tissue inhibitors of metalloprotease 1 and 2 (TIMP-1, TIMP-2) and vascular endothelial growth factor A (VEGF-A) is involved in tumor invasion and metastasis via extracellular matrix degradation and angiogenesis. This study aimed to assess whether the expression of MMP-2, MMP-9, MMP-14, TIMP-1, and TIMP-2 in tumors and in the adjacent stroma is associated with cervical cancer prognosis. METHODS This study analyzed a retrospective cohort of 64 patients. Protein expression was previously obtained by immunohistochemistry from biopsies containing both tumor and stroma. The expression and percentage of stained cells were categorized as high or low according to the cutoff points by using ROC curves. The follow-up data was collected from diagnosis to the last clinical visit. Clinical status categorized as alive without disease, alive with disease, death due to other causes, and death from the disease. The relative risk of death from the disease was evaluated according to the proteins expression using a cause-specific Cox regression model with a 95% confidence interval (95%CI). For the significant associations (p < 0.05), survival curves of patients with low and high expression were plotted for the competing risk survival curve analyses. RESULTS High expression levels of stromal MMP-2 (RR; 95%CI: 3.91; 1.17-13.02) and stromal TIMP-2 (RR, 95%CI: 8.67; 1.15-65.27) were associated with a greater relative risk of death from the disease and with lower survival (p = 0.03; p = 0.04) than lower expression levels. Low expression levels of stromal MMP-9 (RR, 95%CI: 0.19; 0.05-0.65) and tumoral MMP-9 (HR, 95%CI: 0.19; 0.04-0.90) were protective factors against death from the disease and were associated with poorer survival. CONCLUSIONS High expression levels of MMP-2 and TIMP-2 in the stroma were significantly associated with poor survival in cervical cancer patients. High expression of MMP-9 was associated with a favorable cervical cancer prognosis.
Collapse
Affiliation(s)
- Jordana Maria Azevedo Martins
- Department of Gynecology and Obstetrics, School of Medical Sciences, State University of Campinas, UNICAMP, Tessalia Vieira de Camargo Street, 126, Campinas, Sao Paulo 13083-887 Brazil
| | - Silvia Helena Rabelo-Santos
- School of Pharmacy, Federal University of Goias, 240 Street, Leste Universitario, Goiania, Goias 74605-170 Brazil
| | - Maria Cristina do Amaral Westin
- Laboratory of Cytopathology, Women’s Health Hospital Professor Jose Aristodemo Pinotti – (CAISM), University of Campinas (UNICAMP), Campinas, Sao Paulo 13083-881 Brazil
| | - Luiz Carlos Zeferino
- Department of Gynecology and Obstetrics, School of Medical Sciences, State University of Campinas, UNICAMP, Tessalia Vieira de Camargo Street, 126, Campinas, Sao Paulo 13083-887 Brazil
| |
Collapse
|
11
|
Yamada I, Oshima N, Miyasaka N, Wakana K, Wakabayashi A, Sakamoto J, Saida Y, Tateishi U, Kobayashi D. Texture Analysis of Apparent Diffusion Coefficient Maps in Cervical Carcinoma: Correlation with Histopathologic Findings and Prognosis. Radiol Imaging Cancer 2020; 2:e190085. [PMID: 33778713 DOI: 10.1148/rycan.2020190085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 12/29/2022]
Abstract
Purpose To determine the feasibility of texture analysis of apparent diffusion coefficient (ADC) maps and to assess the performance of texture analysis and ADC to predict histologic grade, parametrial invasion, lymph node metastasis, International Federation of Gynecology and Obstetrics (FIGO) stage, recurrence, and recurrence-free survival (RFS) in patients with cervical carcinoma. Materials and Methods This retrospective study included 58 patients with cervical carcinoma who were examined with a 1.5-T MRI system and diffusion-weighted imaging with b values of 0 and 1000 sec/mm2. Software with volumes of interest on ADC maps was used to extract 45 texture features, including higher-order texture features. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic performance of ADC map random forest models and of ADC values. Dunnett test, Spearman rank correlation coefficient, Kaplan-Meier analyses, log-rank test, and Cox proportional hazards regression analyses were also used for statistical analyses. Results The ADC map random forest models showed a significantly larger area under the ROC curve (AUC) than the AUC of ADC values for predicting high-grade cervical carcinoma (P = .0036), but not for parametrial invasion, lymph node metastasis, stages III-IV, and recurrence (P = .0602, .3176, .0924, and .5633, respectively). The random forest models predicted that the mean RFS rates were significantly shorter for high-grade cervical carcinomas, parametrial invasion, lymph node metastasis, stages III-IV, and recurrence (P = .0405, < .0001, .0344, .0001, and .0015, respectively); the random forest models for parametrial invasion and stages III-IV were more useful than ADC values (P = .0018) for predicting RFS. Conclusion The ADC map random forest models were more useful for noninvasively evaluating histologic grade, parametrial invasion, lymph node metastasis, FIGO stage, and recurrence and for predicting RFS in patients with cervical carcinoma than were ADC values.Keywords: Comparative Studies, Genital/Reproductive, MR-Diffusion Weighted Imaging, MR-Imaging, Neoplasms-Primary, Pathology, Pelvis, Tissue Characterization, UterusSupplemental material is available for this article.© RSNA, 2020See also the commentary by Reinhold and Nougaret in this issue.
Collapse
Affiliation(s)
- Ichiro Yamada
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Noriko Oshima
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Naoyuki Miyasaka
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kimio Wakana
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akira Wakabayashi
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Junichiro Sakamoto
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yukihisa Saida
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ukihide Tateishi
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Daisuke Kobayashi
- Departments of Diagnostic Radiology and Nuclear Medicine (I.Y., Y.S., U.T.), Comprehensive Reproductive Medicine (N.O., N.M., K.W., A.W.), Oral and Maxillofacial Radiology (J.S.), and Human Pathology (D.K.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| |
Collapse
|
12
|
Lu Y, Xu X, Nong XH, Yao DS. Detection of high-risk human papillomavirus DNA in sentinel lymph nodes of patients with cervical cancer. Oncol Lett 2020; 19:2317-2325. [PMID: 32194731 PMCID: PMC7039119 DOI: 10.3892/ol.2020.11337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the expression of human papillomavirus (HPV) DNA in sentinel lymph nodes (SLN) in patients with early-stage cervical cancer (CC). In addition, the present study compared the positive rate of SLNs metastasis detected by routine pathological examination, and investigated the value of HPV-DNA in the detection of early CC lymph node micrometastasis. Reverse transcription-quantitative PCR (RT-qPCR) was used in order to evaluate the HPV DNA detection in all CC samples [International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA2]. The consistency of HPV-DNA was compared between primary lesions and SLNs. The positive rates of HPV-DNA were compared with pathological diagnosis of SLN metastasis, and the association between the positive expression of HPV-DNA in SLNs and the clinical and pathological parameters of patients with cervical cancer were analyzed. A total of 345 sentinel lymph nodes were detected in 100 patients with IA2-IIA2 CC. The positive rates of RT-qPCR and conventional histopathological detection of SLNs metastasis were 31.6% (109/345) and 12.8% (44/345), respectively (P<0.001). The positive expression of HPV-DNA in SLNs was associated with the clinical stage and tumor diameter (P<0.05), but not with patients' age, depth of cervical invasion, histological grade, lymphatic and vascular space invasion (LVSI), squamous cell carcinoma antigen (SCCAg) (P>0.05). The detection of HPV-DNA expression in pelvic lymph nodes of early CC may be used to improve the detection rate of micrometastasis, guide the postoperative adjuvant therapy more accurately and improve prognosis. Patients with positive HPV-DNA would require closer surveillance than those with negative HPV-DNA.
Collapse
Affiliation(s)
- Yan Lu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xun Xu
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - Xiu-Hong Nong
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| | - De-Sheng Yao
- Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530000, P.R. China
| |
Collapse
|
13
|
Shang H, Pu Y, Wang W, Dai Z, Jin F. Evaluation of plan quality and robustness of IMPT and helical IMRT for cervical cancer. Radiat Oncol 2020; 15:34. [PMID: 32054496 PMCID: PMC7020599 DOI: 10.1186/s13014-020-1483-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Both plan quality and robustness were investigated through comparing some dosimetric metrics between intensity modulated proton therapy (IMPT) and helical tomotherapy based intensity modulated radiotherapy (IMRT) for cervical cancer. Methods Both a spot-scanning robust (SRO) IMPT plan and a helical tomotherapy robust (TRO) IMRT plan were generated for each of 18 patients. In order to evaluate the quality of nominal plans without dose perturbations, planning scores (PS) on clinical target volume (CTV) and five organs at risk (OARs) based on clinical experience, and normal tissue complication probabilities (NTCP) of rectum and sigmoid were calculated based on Lyman-Kutcher-Burman (LKB) model. Dose volume histogram bands width (DVHBW) were calculated in 28 perturbed scenarios to evaluate plan robustness. Results Compared with TRO, the average scores of SRO nominal plans were higher in target metrics [V46.8Gy, V50Gy, Conformity and Homogeneity](16.5 vs. 15.1), and in OARs metrics (60.9 vs. 53.3), including bladder [V35,V45, Dmean,D2cc], rectum [V40,V45,D2cc,Dmax], bowel [V35,V40,V45, Dmax], sigmoid [V40,Dmax] and femoral heads [V30,Dmax]. Meanwhile, NTCP calculation showed that the toxicities of rectum and sigmoid in SRO were lower than those in TRO (rectum: 2.8% vs. 4.8%, p < 0.05; sigmoid: 5.2% vs. 5.7%, p < 0.05). DVHBW in target coverage for the SRO plan was smaller than that for the TRO plan (0.6% vs. 2.1%), which means that the SRO plan generated a more robust plan in target. Conclusion Better CTV coverage and OAR Sparing were obtained in SRO nominal plan. Based on NTCP calculation, SRO was expected to allow a small reduction in rectal toxicity. Furthermore, SRO generated a more robust plan in CTV target coverage.
Collapse
Affiliation(s)
- Haijiao Shang
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, 201800, Shanghai, People's Republic of China.,University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China.,RaySearch China, 200120, Shanghai, People's Republic of China
| | - Yuehu Pu
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, 201800, Shanghai, People's Republic of China.,University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China
| | - Wei Wang
- Department of Radiation Oncology, Xinhua hospital affiliated to shanghai Jiao tong university school of medicine, Shanghai, People's Republic of China
| | - Zhitao Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, People's Republic of China. .,School of Physics and Technology, Wuhan University, Wuhan, 430072, People's Republic of China.
| | - Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, People's Republic of China.
| |
Collapse
|
14
|
Liang SH, Shen YC, Wu JY, Wang LJ, Wu MF, Li J. Impact of Poor Preoperative Glycemic Control on Outcomes among Patients with Cervical Cancer Undergoing a Radical Hysterectomy. Oncol Res Treat 2019; 43:10-18. [PMID: 31747660 DOI: 10.1159/000502911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 08/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of preoperative glycemic control on the survival outcomes of patients undergoing a radical hysterectomy (RH) for cervical cancer has not been investigated. PATIENTS AND METHODS We reviewed patients who underwent a type III RH for cervical cancer between January 2004 and June 2011 in our institution. RESULTS A total of 431 patients were included and 83 (19.3%) were diagnosed with diabetes mellitus (DM). Poorly controlled DM (preoperative hemoglobin A1c [HbA1c] ≥7.0%) was observed in 49 (59.0%) diabetic patients. Compared to patients without DM and diabetic patients with good glycemic control (preoperative HbA1c <7.0%), diabetic patients with poor glycemic control had significantly higher risks of tumor recurrence, cervical cancer-specific death, and overall death. In multivariate analysis, DM with poor glycemic control independently predicted recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We excluded patients without DM and performed a sensitivity analysis. When HbA1c levels were treated as a dichotomous variable, preoperative HbA1c ≥7.0% was independently associated with RFS, CSS, and OS. When HbA1c level was treated as a continuous variable, it remained an independent predictor of RFS, CSS, and OS. CONCLUSION DM with poor glycemic control prior to RH was significantly associated with an increased risk of recurrence and mortality in cervical cancer patients. These results underscore the importance of intensive glycemic control and close follow-up for diabetic patients.
Collapse
Affiliation(s)
- Si-Hua Liang
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Chong Shen
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie-Ying Wu
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Juan Wang
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Miao-Fang Wu
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,
| | - Jing Li
- Operating Room, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
15
|
Yang J, Yang J, Cao D, Shen K, Ma J, Zhang F. Completion hysterectomy after chemoradiotherapy for locally advanced adeno-type cervical carcinoma: updated survival outcomes and experience in post radiation surgery. J Gynecol Oncol 2019; 31:e16. [PMID: 31912674 PMCID: PMC7044008 DOI: 10.3802/jgo.2020.31.e16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT). METHODS Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors. RESULTS A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282-0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189-0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067). CONCLUSION Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.
Collapse
Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jiabin Ma
- Department of Radiation Oncology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
16
|
Sanusi RS. Outcome of Combined Neoadjuvant Chemotherapy and Vitamin A in Advanced Cervical Carcinoma: A Randomized Double-Blind Clinical Trial. Asian Pac J Cancer Prev 2019; 20:2213-2218. [PMID: 31350987 PMCID: PMC6745224 DOI: 10.31557/apjcp.2019.20.7.2213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The latest World Health Organization (WHO) inquiry on the epidemiology of cervical cancers indicate there are approximately 528,000 new cases per year, ranking fourth after breast, colorectal and lung cancer. The validity of neoadjuvant chemotherapy (NAC) alone in advanced cervical cancer is still being debated. NAC induces tumor shrinkage prior to pursuing surgery. NAC also has the benefit of sterilizing the lymph nodes and parametria, thereby lowering the need for adjuvant therapy after surgery. This research aims to determine the impact on the treatment of advanced cervical carcinoma with NAC, with the additional provision of Vitamin A during treatment to assess the factors that could affect the outcome of clinical treatment. Methodology: The research methodology and design of this study is a randomized double-blind clinical trial to compare the effects of treatment with NAC and treatment with NAC + Vitamin A, in advanced cervical carcinoma. Both study groups received treatments consisting of a regime of cisplatin and paclitaxel. The study was conducted at the General Hospital of Dr. Mohammad Hoesin. The total number of patients recruited for the trial was 30 with 15 patients per treatment arm. One group received NAC consisting of cisplatin and paclitaxel and the remaining 15 patients received NAC + Vitamin A. Results: The addition of Vitamin A was found to be much better in influencing the clinical response in the treatment of advanced cervical carcinoma, although this was not statistically significant. However, a larger sample size with the reported proportion of higher positive outcome for NAC + Vitamin A may be statistically significant. Conclusion: Based on the results, Vitamin A supplementation in the treatment of advanced cervical carcinoma with neoadjuvant chemotherapy may play a crucial role in the treatment of cervical carcinoma.
Collapse
Affiliation(s)
- Rizal Sanif Sanusi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, General Hospital of Dr.Mohammad Hoessin, University of Sriwijaya, Palembang, Sumatra, Indonesia.
| |
Collapse
|
17
|
Shi F, Su J, Liu Z, Wang J, Wang T. miR-144 reverses cisplatin resistance in cervical cancer via targeting LHX2. J Cell Biochem 2019; 120:15018-15026. [PMID: 31017720 DOI: 10.1002/jcb.28763] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022]
Abstract
Mounting evidence showed that microRNAs involve in development and chemoresistance of various human cancers. We explored the roles and mechanisms of miR-144 in resistance to cisplatin (CDDP) of cervical cancer cells. miR-144 and LIM homeobox 2 (LHX2) expression in CDDP-resistant and the parental cells was determined by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analysis, respectively. The functions of miR-144 overexpression on cell viability, the incidence of apoptosis, the activity of caspase-3/7, the cleaved-caspase-3 expression, cell migration, and invasion were determined in Hela cells and Hela/CDDP cells. Overexpression of miR-144 reduced cell viability, induced cell apoptosis, and inhibited cell migration and invasion after CDDP treatment. Besides, a luciferase reporter system demonstrated that miR-144 could directly bind to the 3' untranslated region (3'-UTR) of LHX2 messenger RNA (mRNA). Gain expression of miR-144 decreased the expression of LHX2 both in mRNA and protein levels. Furthermore, restoration of LHX2 partly abolished the biological functions of miR-144 in resistance of cervical cancer cells. Taken together, miR-144 overcomes resistance to CDDP via promoting cell apoptosis and inhibiting invasion through targeting LHX2 in cervical cancer cells.
Collapse
Affiliation(s)
- Fan Shi
- Department of Radiation Oncology, First Hospital of Xi'an Jiaotong Univesity, Xi'an, Shaanxi, China
| | - Jin Su
- Department of Radiation Oncology, First Hospital of Xi'an Jiaotong Univesity, Xi'an, Shaanxi, China
| | - Zi Liu
- Department of Radiation Oncology, First Hospital of Xi'an Jiaotong Univesity, Xi'an, Shaanxi, China
| | - Jiquan Wang
- Department of Radiation Oncology, First Hospital of Xi'an Jiaotong Univesity, Xi'an, Shaanxi, China
| | - Tao Wang
- Department of Radiation Oncology, First Hospital of Xi'an Jiaotong Univesity, Xi'an, Shaanxi, China
| |
Collapse
|
18
|
Jonska-Gmyrek J, Gmyrek L, Zolciak-Siwinska A, Kowalska M, Kotowicz B. Adenocarcinoma histology is a poor prognostic factor in locally advanced cervical cancer. Curr Med Res Opin 2019; 35:595-601. [PMID: 30019594 DOI: 10.1080/03007995.2018.1502166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This retrospective study aimed to compare prognostic factors and survival between adenocarcinoma (AC) and squamous cell carcinoma (SCC) in locally advanced cervical cancer treated at a single center. METHODS All medical records of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB or IIIA,B, treated between 2004 and 2012, were reviewed. We treated patients with chemoradiotherapy (CRT) followed by brachytherapy (BT). Multivariate logistic regression and Cox proportional hazard models were used to analyze clinicopathological characteristics, patterns of care and outcomes. RESULTS We included in the analysis 161 patients (52 AC; 109 SCC). Patients with AC were younger (age 50 vs. 55 years), more likely to die from the disease (HR: 1.60; 95% CI: 1.26-2.58; p = .001) and to have disease recurrence (HR: 1.69; 95% C.I: 1.21-2.12; p = .004) than those with SCC. The other significant prognostic factors for overall survival (OS) and recurrence-free survival (RFS) in AC were FIGO stage (p = .001; p = .002), WHO status (0 vs. 1-3; p = .003; p = .04), and hemoglobin level (<12 g/dl>; p = .04; p = .02). The 5 year overall survival for stage II of AC and SCC was 63% and 82% (p = .03), and for IIIA,B it was 33.6% and 73% (p = .0005). The 5 year RFS for AC and SCC stage FIGO IIIA,B was 24% and 57% (p = .001). CONCLUSIONS Adenocarcinoma histology negatively impacts OS and RFS for advanced cervical cancer. Histology-specific therapy may be an opportunity for survival improvement in these women.
Collapse
Affiliation(s)
- Joanna Jonska-Gmyrek
- a Department of Radiotherapy , Maria Sklodowska-Curie Institute - Oncology Center , Warsaw , Poland
- b Department of Urooncology , Maria Sklodowska-Curie Institute - Oncology Center , Warsaw , Poland
| | - Leszek Gmyrek
- c Gynecological Oncology Department , The Holy Family Hospital , Warsaw , Poland
| | | | - Maria Kowalska
- e Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics , Maria Sklodowska-Curie Institute - Oncology Center , Warsaw , Poland
| | - Beata Kotowicz
- e Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics , Maria Sklodowska-Curie Institute - Oncology Center , Warsaw , Poland
| |
Collapse
|
19
|
Chen P, Zhang W, Yang D, Zhang W, Gao S. Human Papillomavirus Status in Primary Lesions and Pelvic Lymph Nodes and Its Prognostic Value in Cervical Cancer Patients with Lymph Node Metastases. Med Sci Monit 2019; 25:1894-1902. [PMID: 30864560 PMCID: PMC6427929 DOI: 10.12659/msm.914564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to assess the presence of HPV DNA in cervical tissues and lymph nodes in patients who have uterine cervical neoplasms with lymphatic metastases and who underwent surgery for invasive cervical cancer and pelvic lymphadenectomy, to establish the utility of HPV type and viral load in predicting disease progression. Material/Methods We retrospectively assessed 88 patients with uterine cervical neoplasms with lymph node metastases. All 88 patients were in FIGO stage IA-IIB. A total of 316 paraffin-embedded archival tissues (88 cervical samples and 228 pelvic lymph node specimens) were acquired. All the samples were analyzed using real-time PCR to determine HPV DNA presence/type and to quantify viral load. Results In total, 17 HPV genotypes were detected in the cervical lesions and pelvic lymph nodes of the patients. The most common HPV type in all samples was HPV16, followed by HPV18. The existence of HPV16 DNA and low HPV16 viral load in cervical lesions were also significantly associated with disease recurrence. Furthermore, lymphovascular space involvement was also correlated with worse disease outcome. Conclusions HPV16 DNA presence and low viral load in primary lesions can be used to predict disease recurrence. HPV DNA is a favorable prognostic indicator in patients with uterine cervical neoplasms who have lymphatic metastases.
Collapse
Affiliation(s)
- Peng Chen
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weiyuan Zhang
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Dong Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weiyang Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Si Gao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin, China (mainland)
| |
Collapse
|
20
|
Basta T, Knapp P, Blecharz P, Bodnar L, Gawron I, Babczyk D, Piróg M, Kluz T, Markowska A, Horbaczewska A, Jach R. Current management of cervical cancer in Poland-Analysis of the questionnaire trial for the years 2002-2014 in relation to ASCO 2016 recommendations. PLoS One 2019; 14:e0209901. [PMID: 30703105 PMCID: PMC6354992 DOI: 10.1371/journal.pone.0209901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/13/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives To assess the survival of patients with cervical cancer (CC). Since the recommendations concerning cervical cancer management adopted by Polish medical societies do not differ significantly from the ESGO or non-European guidelines, and the fact that evaluation of the system for CC treatment in Poland, as well as the mortality rate of Polish women with CC, which is 70% higher than the average for European Union (EU) countries, justifies the hypothesis that treatment of CC in Poland deviates from the Polish and international recommendations. This article puts forward the current management of cervical cancer in Poland and discusses it in the context of ASCO guidelines. Material and methods A survey retrospective multicenter analysis of the medical records of 1247 patients with cervical cancer who underwent treatment for disease and who had completed at least two years of follow-up. Results Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. Conclusion Within the IA to II A cervical cancer patients studied group, the methods of treatment remained in line with ASCO guidelines for countries with the highest standard of care. Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. Our findings, together with the inconsistencies within the cervical cancer screening program, may be one of the explanations of poorer survival rate of women with cervical cancer in Poland.
Collapse
Affiliation(s)
- Tomasz Basta
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Knapp
- Department of Gynecology and Gynecological Oncology, Faculty of Medicine, Medical University in Bialystok, Bialystok, Poland
| | - Paweł Blecharz
- Gynecologic Oncology Department, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Krakow Branch, Krakow, Poland
| | - Lubomir Bodnar
- Department of Clinical Oncology, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Iwona Gawron
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Babczyk
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Piróg
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Fryderyk Chopin University Hospital No 1, Faculty of Medicine, Rzeszow University, Rzeszow, Poland, Poland
| | - Anna Markowska
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Horbaczewska
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
| | - Robert Jach
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
- * E-mail:
| |
Collapse
|
21
|
Prognostic significance of pretreatment lymphocyte percentage and age at diagnosis in patients with locally advanced cervical cancer treated with definite radiotherapy. Obstet Gynecol Sci 2018; 62:35-45. [PMID: 30671392 PMCID: PMC6333767 DOI: 10.5468/ogs.2019.62.1.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/21/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022] Open
Abstract
Objective This study aimed to evaluate the prognostic impact of age at diagnosis, and pretreatment hematologic markers, including lymphocyte percentage and the neutrophil-to-lymphocyte ratio (NLR), in patients with locally advanced cervical cancer (LACC) treated with definitive radiotherapy (RT). Methods A total of 392 patients with LACC (stage IIb to IVa) treated with cisplatin-based concurrent chemoradiotherapy or RT alone between 2001 and 2012 were retrospectively enrolled. Clinical data and pretreatment complete blood counts were extracted from electronic medical records of the patients, and analyzed. Treatment outcomes, progression-free survival (PFS), and overall survival (OS) were evaluated. Results Low lymphocyte percentage and a high NLR were associated with younger age, advanced stage, larger tumor size, lymph nodes metastasis, and treatment failure. The cut-off value for lymphocyte percentage and NLR was determined using a receiver operating characteristic curve. In univariate analysis, low lymphocyte percentage (≤24%) was associated with poor PFS and OS, while high NLR (>2.8) was significantly associated only with PFS. In multivariate analysis, both lymphocyte percentage (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.40–0.85; P=0.005) and NLR (HR, 1.55; 95% CI, 1.07–2.25; P=0.022) had independent prognostic value for PFS. Compared to younger patients (age ≤50 years), older patients (age >60 years) had a lower risk of death. Conclusion Although the lymphocyte percentage did not remain significant in multivariate analysis for OS, it was predictive of PFS and OS. Thus, lymphocyte percentage is a simple hematologic parameter with a significant prognostic value in patients with LACC treated with definitive RT.
Collapse
|
22
|
El-fattah SMA, El-Gohary SH, Hassan NS. 3D Model Construction and Analysis of Female Genital Organs Using Monte Carlo Simulation for Early Detection of Cervical Intraepithelial Neoplasia. 2018 9TH CAIRO INTERNATIONAL BIOMEDICAL ENGINEERING CONFERENCE (CIBEC) 2018. [DOI: 10.1109/cibec.2018.8641808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
23
|
Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One 2018; 13:e0204950. [PMID: 30335786 PMCID: PMC6193633 DOI: 10.1371/journal.pone.0204950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to identify factors predicting parametrial invasion in early-stage cervical cancer patients undergoing radical hysterectomy. We recruited women with invasive cervical cancer who underwent radical hysterectomy at a single medical institute from 2000–2011. The clinical and pathological characteristics and outcomes were retrospectively recorded, and the risk factors for parametrial invasion were analyzed. We enrolled 339 patients, including 7 with stage IA1 carcinomas, 10 with stage IA2, 266 with stage IB1, 39 with stage IB2, 14 with stage IIA1, and 3 with stage IIA2. The majority (237/339, 69.9%) had squamous cell carcinoma, while 32 (12.4%) had parametrial invasion. The 16 patients with stage IB1 tumors and parametrial invasion were older (55.9±9.5vs. 49.0±9.9 years, p = 0.005, Mann-Whitney U test), and had deeper cervical stromal invasion (9.59±4.87 vs. 7.47±5.48 mm, p = 0.048, Mann-Whitney U test), larger tumor size (2.32±1.15 vs. 1.74±1.14cm, p = 0.043, Mann-Whitney U test), higher incidences of lymphovascular space invasion (87.5% vs. 28.8%, p<0.001, chi-square test), and greater lymph node metastasis (68.8% vs. 10.8%, p<0.001, chi-square test) than the 260 patients without parametrial invasion. Among the patients with stage IB1 tumor size >2 cm,10% had parametrial invasion and 24.2% had lymph node metastasis compared with only 4% and 9.4% of stage IB1 patients with a tumor size <2 cm, respectively. Only one (0.9%) of the 109 patients aged less than 50 years had parametrial invasion compared with 6 (9.7%) of the 62 patients aged over 50 years. Patients with stage IA2 and IB1 tumors <2 cm may not need radical hysterectomy owing to the low incidence of parametrial invasion.
Collapse
Affiliation(s)
- Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
24
|
Yuan L, Guo J, Zhang X, Chen M, Xu C, Yao L. Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center. Onco Targets Ther 2018; 11:5527-5533. [PMID: 30275701 PMCID: PMC6157997 DOI: 10.2147/ott.s173208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although definitive chemoradiotherapy is considered as a standard of care for FIGO stage IIB cervical cancer in many countries, the role of surgery remains controversial. We aimed to evaluate the feasibility and outcomes of patients with FIGO stage IIB cervical cancer who received radical surgery in China. Patients and methods A total of 74 women with FIGO stage IIB cervical cancer were treated with radical hysterectomy, with or without adjuvant radio/chemoradiotherapy, at the Obstetrics and Gynecology Hospital of Fudan University between 2004 and 2015. Medical charts and clinical data were retrospectively reviewed. The Kaplan–Meier method and Cox regression models were used for survival analyses. In addition, prognostic nomograms predicting overall survival (OS) and progression-free survival (PFS) were constructed. Results Pathological parametrial involvement (PMI) was only identified in 28.3% (21/74) of all patients and 47.3% (9/19) of patients without neoadjuvant treatment. Major surgical complications, including bladder fistula, intestinal obstruction and ureteral injury, were found in 6.8% (5/74) of patients. Although the use of imaging technologies including magnetic resonance imaging (MRI)/positron emission tomography–computed tomography (PET–CT) has increased after 2010 compared to that prior to 2010, the accuracy of MRI/PET–CT in detecting pathological PMI was lower than that of physical examination under anesthesia (P<0.05). Neoadjuvant treatment was the only risk factor affecting the accuracy of pre- and postoperative accordance of PMI (OR: 3.283 [95% CI: 1.363–7.908], P=0.008). The 2- and 5-year OS rates were 84.1% and 68.9%, respectively, while the 2- and 5-year cumulative recurrence rates were 26.9% and 39.9%, respectively. Cox regression analyses indicated that pre- and postoperative accordance of PMI, common iliac lymph node metastasis and major surgical complications were significant prognostic factors for both OS and PFS. Conclusion Radical hysterectomy might be a feasible alternative for FIGO stage IIB cervical cancer. As pre- and postoperative accordance of PMI is relatively low, strategies to appropriately select patients who will benefit from surgery via pretreatment evaluation need to be further investigated.
Collapse
Affiliation(s)
- Lei Yuan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Jiaqi Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Xiaochun Zhang
- Department of Obstetrics and Gynecology, Fenyi People's Hospital, Jiangxi, People's Republic of China
| | - Mo Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Liangqing Yao
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China,
| |
Collapse
|
25
|
Jolly S, Uppal S, Bhatla N, Johnston C, Maturen K. Improving Global Outcomes in Cervical Cancer: The Time Has Come for International Federation of Gynecology and Obstetrics Staging to Formally Incorporate Advanced Imaging. J Glob Oncol 2018; 4:1-6. [PMID: 30241155 PMCID: PMC6180790 DOI: 10.1200/jgo.2016.007534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shruti Jolly
- Shruti Jolly, Shitanshu Uppal,
Carolyn Johnston, and Katherine Maturen,
University of Michigan, Ann Arbor, MI; and Neerja Bhatla, All India
Institute of Medical Sciences, New Delhi, India
| | - Shitanshu Uppal
- Shruti Jolly, Shitanshu Uppal,
Carolyn Johnston, and Katherine Maturen,
University of Michigan, Ann Arbor, MI; and Neerja Bhatla, All India
Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Shruti Jolly, Shitanshu Uppal,
Carolyn Johnston, and Katherine Maturen,
University of Michigan, Ann Arbor, MI; and Neerja Bhatla, All India
Institute of Medical Sciences, New Delhi, India
| | - Carolyn Johnston
- Shruti Jolly, Shitanshu Uppal,
Carolyn Johnston, and Katherine Maturen,
University of Michigan, Ann Arbor, MI; and Neerja Bhatla, All India
Institute of Medical Sciences, New Delhi, India
| | - Katherine Maturen
- Shruti Jolly, Shitanshu Uppal,
Carolyn Johnston, and Katherine Maturen,
University of Michigan, Ann Arbor, MI; and Neerja Bhatla, All India
Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
26
|
Fuglsang K, Haldorsen IS, Avall-Lundqvist E, Lindahl G, Roed H, Woie K, Pakarinen P, Thoroddsen A, Anttila M, Blaakaer J. Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countries-Survey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology. Acta Obstet Gynecol Scand 2018; 97:1178-1184. [DOI: 10.1111/aogs.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Katrine Fuglsang
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | | | - Elisabeth Avall-Lundqvist
- Department of Oncology; Linköping University; Linköping Sweden
- Department of Clinical and Experimental Medicine; Linköping, University; Linköping Sweden
| | - Gabriel Lindahl
- Department of Oncology; Linköping University; Linköping Sweden
| | - Henrik Roed
- Department of Oncology; Rigshospitalet University Hospital; Copenhagen Denmark
| | - Kathrine Woie
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
| | - Päivi Pakarinen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Asgeir Thoroddsen
- Department of Obstetrics and Gynecology; Reykjavik University Hospital; Reykjavik Iceland
| | - Maarit Anttila
- Department of Gynecology; Kuopio University Hospital; Kuopio Finland
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Odense University Hospital; Odense Denmark
| |
Collapse
|
27
|
Adam JA, Arkies H, Hinnen K, Stalpers LJ, van Waesberghe JH, Stoker J, van Os R, Laan JJ, Mom CH, van Eck-Smit BL. 18F-FDG-PET/CT guided external beam radiotherapy volumes in inoperable uterine cervical cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:420-428. [PMID: 29869485 DOI: 10.23736/s1824-4785.18.03083-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with advanced stage cancer of the uterine cervix who undergo irradiation with curative intent, there is the necessity to treat all suspicious nodes on imaging. Our hypothesis was that adding fluorodeoxyglucose positron emission computer tomography/computer tomography (FDG-PET/CT) to the imaging workup would alter the external beam radiotherapy (EBRT) treatment plan, either resulting in an extended external beam radiotherapy (EBRT) field to the para-aortal region or an additional boost to suspicious nodes. Since extended field radiotherapy or additional boost can cause toxicity, our secondary aim was to assess the incidence of severe late bowel toxicity in patients treated with extended para-aortal EBRT-field and boost compared to elective pelvic radiotherapy. METHODS Eighty-eight patients were enrolled. First, the optimal radiation treatment plan (EBRT and boost) was retrospectively determined based on magnetic resonance imaging (MRI) or FDG-PET/CT. Second, the severe bowel toxicity caused by the extended para-aortal field was assessed, based on the executed radiotherapy. RESULTS Based on MRI 8/88 patients would receive EBRT with para-aortic extension, this was 21/88 for FDG-PET/CT. Based on MRI 47/704 lymph node regions would receive additional boost, while based on PET/CT 91/704. Late severe bowel toxicity was seen in 12/84 patients, 6/65 in the group who received elective pelvic irradiation and 6/19 with para-aortal EBRT and boost at common iliac and/or para-aortal lymph nodes. Significant worse overall survival was seen of patients who needed para-aortal irradiation. CONCLUSIONS Addition of FDG-PET/CT leads to an extension of the elective EBRT volume and more suspicious lymph nodes receive a boost. However, when deciding to intensify radiation therapy, late severe bowel toxicity has to be taken into account.
Collapse
Affiliation(s)
- Judit A Adam
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands -
| | - Hester Arkies
- Department of Nuclear Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Karel Hinnen
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lukas J Stalpers
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan H van Waesberghe
- Department of Radiology and Nuclear Medicine, Free University Medical Center, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob van Os
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Janna J Laan
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Berthe L van Eck-Smit
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
28
|
Lee JW, Lee SM. Radiomics in Oncological PET/CT: Clinical Applications. Nucl Med Mol Imaging 2018; 52:170-189. [PMID: 29942396 PMCID: PMC5995782 DOI: 10.1007/s13139-017-0500-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely used for staging, evaluating treatment response, and predicting prognosis in malignant diseases. FDG uptake and volumetric PET parameters such as metabolic tumor volume have been used and are still used as conventional PET parameters to assess biological characteristics of tumors. However, in recent years, additional features derived from PET images by computational processing have been found to reflect intratumoral heterogeneity, which is related to biological tumor features, and to provide additional predictive and prognostic information, which leads to the concept of radiomics. In this review, we focus on recent clinical studies of malignant diseases that investigated intratumoral heterogeneity on PET/CT, and we discuss its clinical role in various cancers.
Collapse
Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Gil 25, Seo-gu, Incheon, 22711 South Korea
- Institute for Integrative Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Advances in cervical cancer screening and treatment have resulted in high cure rates in developed countries for early-stage disease. Current research focuses on minimizing morbidity and maximizing quality of life. RECENT FINDINGS Imaging has been disappointing in identifying small volume metastases. Sentinel lymph node biopsy represents a significant advantage with high sensitivity, low false negative rates, reduced morbidity, and equivalent survival in recent studies compared to pelvic lymphadenectomy. Non-radical surgical options are currently being investigated for early cervical cancer in a number of large prospective studies in patients at low risk for metastases. Evidence suggests that sentinel lymph node biopsy and non-radical surgery are safe approaches for the staging and management of early cervical cancer in appropriately selected patients with the potential to significantly reduce treatment-related morbidity.
Collapse
|
30
|
Li S, Li X, Zhang Y, Zhou H, Tang F, Jia Y, Hu T, Sun H, Yang R, Chen Y, Cheng X, Lv W, Wu L, Zhou J, Wang S, Huang K, Wang L, Yao Y, Yang Q, Yang X, Zhang Q, Han X, Lin Z, Xing H, Qu P, Cai H, Song X, Tian X, Shen J, Xi L, Li K, Deng D, Wang H, Wang C, Wu M, Zhu T, Chen G, Gao Q, Wang S, Hu J, Kong B, Xie X, Ma D. Development and validation of a surgical-pathologic staging and scoring system for cervical cancer. Oncotarget 2018; 7:21054-63. [PMID: 27014971 PMCID: PMC4991512 DOI: 10.18632/oncotarget.8245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs). Methods Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2). Results In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging. Conclusions Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy.
Collapse
Affiliation(s)
- Shuang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiong Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.,Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, P.R. China
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Hang Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Fangxu Tang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yao Jia
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ting Hu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ru Yang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yile Chen
- Department of Gynecologic Oncology, Hunan Province Tumor Hospital, Changsha, P.R. China
| | - Xiaodong Cheng
- Women's Reproductive Health Laboratory of Zhejiang Province, Zhejiang, P.R. China
| | - Weiguo Lv
- Women's Reproductive Health Laboratory of Zhejiang Province, Zhejiang, P.R. China
| | - Li Wu
- Department of Gynecologic Oncology, Hunan Province Tumor Hospital, Changsha, P.R. China
| | - Jin Zhou
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Kecheng Huang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Lin Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yuan Yao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Qifeng Yang
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Shandong, P.R. China
| | - Xingsheng Yang
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Shandong, P.R. China
| | - Qinghua Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.,Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, P.R. China
| | - Xiaobing Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Zhongqiu Lin
- Department of Gynecologic Oncology, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Hui Xing
- Department of Obstetrics and Gynecology, Xiangfan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Xiangfan, Hubei, P.R. China
| | - Pengpeng Qu
- Tianjin Central Hospital for Gynecology and Obstetrics, Tianjin, P.R. China
| | - Hongbing Cai
- Department of Gynecologic Oncology, Zhong Nan Hospital, Wuhan University, Wuhan, P.R. China
| | - Xiaojie Song
- Commercial Vocational Hospital, Wuhan, P.R. China
| | - Xiaoyu Tian
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan, P.R. China
| | - Jian Shen
- Department of Gynecology and Obstetrics, The Central Hospital of Wuhan, Wuhan, P.R. China
| | - Ling Xi
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Kezhen Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Dongrui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Changyu Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Mingfu Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Tao Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Gang Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Qinglei Gao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Junbo Hu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Beihua Kong
- Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Shandong, P.R. China
| | - Xing Xie
- Women's Reproductive Health Laboratory of Zhejiang Province, Zhejiang, P.R. China
| | - Ding Ma
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| |
Collapse
|
31
|
Prognostic Value of Fluorine-18 Fluorodeoxyglucose Uptake of Bone Marrow on Positron Emission Tomography/Computed Tomography for Prediction of Disease Progression in Cervical Cancer. Int J Gynecol Cancer 2018; 27:776-783. [PMID: 28333846 DOI: 10.1097/igc.0000000000000949] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the prognostic value of fluorine-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography (PET)/computed tomography in patients with uterine cervical cancer. METHODS One hundred forty-five patients with cervical cancer who underwent staging FDG PET/computed tomography and subsequent surgical resection or chemoradiotherapy were retrospectively enrolled in the study. Mean BM FDG uptake (BM standardized uptake value [SUV]) and BM-to-liver uptake ratio of FDG uptake (BLR) were measured. Relationships of BM SUV and BLR with hematologic and inflammatory markers were evaluated. Prognostic values of PET parameters for predicting disease progression-free survival and distant recurrence-free survival (DRFS) were assessed with a Cox proportional hazards regression model. RESULTS Bone marrow SUV and BLR were significantly correlated with white blood cell count and neutrophil-to-lymphocyte ratio. In the multivariate Cox regression analysis, International Federation of Gynecology and Obstetrics stage (P = 0.048), neutrophil-to-lymphocyte ratio (P = 0.028), platelet-to-lymphocyte ratio (PLR; P = 0.004), maximum SUV of cervical cancer (P = 0.030), and BLR (P = 0.031) were significantly associated with progression-free survival, whereas lymph node metastasis (P = 0.041), PLR (P = 0.002), and BLR (P = 0.025) were significantly associated with DRFS. In a patient subgroup with chemoradiotherapy, BLR (P = 0.044) was still an independent prognostic factor for predicting DRFS in multivariate analysis along with PLR (P = 0.004). CONCLUSIONS In patients with cervical cancer, BLR is associated with an increased risk of disease progression and distant recurrence.
Collapse
|
32
|
Smola S, Trimble C, Stern PL. Human papillomavirus-driven immune deviation: challenge and novel opportunity for immunotherapy. THERAPEUTIC ADVANCES IN VACCINES 2017; 5:69-82. [PMID: 28794879 DOI: 10.1177/2051013617717914] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/06/2017] [Indexed: 01/05/2023]
Abstract
It is now recognized that the immune system can be a key component of restraint and control during the neoplastic process. Human papillomavirus (HPV)-associated cancers of the anogenital tract and oropharynx represent a significant clinical problem but there is a clear opportunity for immune targeting of the viral oncogene expression that drives cancer development. However, high-risk HPV infection of the target epithelium and the expression of the E6/E7 oncogenes can lead to early compromise of the innate immune system (loss of antigen-presenting cells) facilitating viral persistence and increased risk of cancer. In these circumstances, a succession of interacting and self-reinforcing events mediated through modulation of different immune receptors, chemokine and cytokine responses (CCL20; CCL2; CCR2; IL-6; CCR7; IL-12) further promote the generation of an immune suppressive microenvironment [increased levels of Tregs, Th17, myeloid-derived suppressor cells (MDSCs) and PD-L1]. The overexpression of E6/E7 expression also compromises the ability to repair cellular DNA, leading to genomic instability, with the acquisition of genetic changes providing for the selection of advantaged cancer cells including additional strategies for immune escape. Therapeutic vaccines targeting the HPV oncogenes have shown some encouraging success in some recent early-phase clinical trials tested in patients with HPV-associated high-grade anogenital lesions. A significant hurdle to success in more advanced disease will be the local and systemic immune suppressive factors. Interventions targeting the different immunosuppressive components can provide opportunity to release existing or generate new and effective antitumour immunity. Treatments that alter the protumour inflammatory environment including toll-like receptor stimulation, inhibition of IL-6-related pathways, immune-checkpoint inhibition, direct modulation of MDSCs, Tregs and macrophages could all be useful in combination with therapeutic HPV vaccination. Future progress in delivering successful immunotherapy will depend on the configuration of treatment protocols in an insightful and timely combination.
Collapse
Affiliation(s)
- Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Germany
| | - Connie Trimble
- Departments of Gynecology/Obstetrics, Oncology, and Pathology, The Johns Hopkins Hospital, USA
| | - Peter L Stern
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Paterson Building, Wilmslow Road, Manchester, M20 4BX, UK
| |
Collapse
|
33
|
Serum MicroRNAs Related with Chemoradiotherapy Resistance in Advanced-Stage Cervical Squamous Cell Carcinoma. Transl Oncol 2017; 10:378-384. [PMID: 28432899 PMCID: PMC5397578 DOI: 10.1016/j.tranon.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE: To investigate the serum microRNAs as biomarkers in predicting chemoradiotherapy resistance in advanced-stage cervical squamous cell carcinoma (ACSCC) patients. METHODS: Serum samples were collected from International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IIIB cervical squamous cell carcinoma patients treated with platinum based Concomitant Chemoradiotherapy (CCRT) in our hospital during September 2013 to November 2015. Twenty well-matched samples (10 resistant and 10 sensitive) were chosen to screen the miRNA expression profile using serum samples pooled with microarrays. miRNAs expressed significantly different between two groups were further verified in 131 patients (29 resistant and 102 sensitive) serum samples with TaqMan Real-time PCR. The AUC was used to evaluate the accuracy of the biomarkers for prediction. RESULTS: MiR-136-5, miR-152-3p and miR-206 were expressed significantly different between sensitive and resistant groups. Results of 131 patients verification showed that the levels of miR-206 in sensitive samples and resistant samples were 2.715 ± 0.2115 and 14.64 ± 1.184, respectively, which was significantly different (P < .0001), while miR-136-5p and miR-152-3p could not be tested without pre-amplification reactions. Univariate analysis revealed that miR-206 expression was significantly associated with patients' DFS. Multivariate analysis demonstrated that miR-206 expression, tumor differentiation and pelvic lymph nodes metastasis were the independent prognostic factors associated with DFS in this cohort (P = .008, 0.000, 0.000, respectively). The probability of the prognostic accuracy of miR-206 expression in predicting chemoradiotherapy sensitivity of ACSCC patients was 91.3% (79.3% sensitivity and 92.2% specificity). CONCLUSION: Serum miR-206 is a powerful tool in predicting chemoradiotherapy sensitivity in ACSCC patients.
Collapse
|
34
|
Kietpeerakool C, Chumworathayi B, Thinkhamrop J, Ussahgij B, Lumbiganon P. Antibiotics for infection prevention after excision of the cervical transformation zone. Cochrane Database Syst Rev 2017; 1:CD009957. [PMID: 28109160 PMCID: PMC6464760 DOI: 10.1002/14651858.cd009957.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Excision of the transformation zone of the cervix is the most commonly used approach to treat cervical precancerous lesions (cervical intraepithelial neoplasia (CIN)) to reduce the risk of developing cervical cancer. As the excision of the transformation zone leaves a raw area on the cervix, there is a risk of infection following the procedure. The incidence of infection after cold knife conization (CKC) is 36%, whereas the incidence for large loop excision of the transformation zone (LLETZ, also known as loop electrical excision procedure (LEEP)) is much lower (0.8% to 14.4%). Prophalytic antibiotics may prevent an infection developing and are often prescribed for CKC. However, there are no formal recommendations regarding the use of prophylactic antibiotics for infection prevention in women undergoing surgical excisional treatment for cervical precancerous lesions. OBJECTIVES To evaluate the effectiveness and safety of antibiotics for infection prevention following excision of the cervical transformation zone. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE, Embase, LILACS to May 2016. We also checked registers of clinical trials, citation lists of included studies, key textbooks and previous systematic reviews for potentially relevant studies SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of prophylactic antibiotics versus a placebo or no treatment in women having excision of the cervical transformation zone, regardless of the type of surgical excisional method used. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias, compared results and resolved disagreements by discussion. We contacted investigators for additional data, where possible. MAIN RESULTS Of the 370 records that we identified as a result of the search (excluding duplicates), we regarded six abstracts and titles as potentially relevant studies. Of these six studies, three met the inclusion criteria involving 708 participants; most trials were at moderate or high risk of bias (risk mainly due to lack of blinding and high rate of incomplete data). We did not identify any ongoing trials. Although all included studies had been published in peer-reviewed journals at the time of the search and data extraction, numerical data regarding the outcome measured in one trial involving 77 participants were insufficient for inclusion in a meta-analyses.The difference in the rates of prolonged vaginal discharge or presumed cervicitis (one study; 348 participants; risk ratio (RR), 1.29; 95% confidence interval (CI) 0.72 to 2.31; low-quality evidence) and severe vaginal bleeding (two studies; 638 participants; RR 1.21; 95% CI 0.52 to 2.82; very low-quality evidence) among the two comparison groups did not reach the level for clinically important effect. In addition, there was no difference in adverse events related to antibiotics i.e. nausea/vomiting, diarrhoea, and headache among the two comparison groups (two studies; 638 participants; RR 1.69; 95% CI 0.85 to 3.34; very low-quality evidence). There were no differences in the incidence of fever (RR, 2.23; 95% CI 0.20 to 24.36), lower abdominal pain (RR, 1.03; 95% CI 0.61 to 1.72), unscheduled medical consultation (RR 2.68, 95% CI 0.97 to 7.41), and additional self-medication (RR 1.22; 95% CI 0.56 to 2.67) between the two comparison groups (one study; 290 participants; low to very low-quality evidence). AUTHORS' CONCLUSIONS As only limited data are available from three trials with overall moderate to high risk of bias, there is insufficient evidence to support use of antibiotics to reduce infectious complications following excision of the cervical transformation zone. In addition, there were minimal data about antibiotic-related adverse events and no information on the risk of developing antibiotic resistance. Antibiotics given for infection prevention after excision of the cervical transformation zone should only be used in the context of clinical research, to avoid unnecessary prescription of antibiotics and to prevent further increases in antibiotic resistance.
Collapse
Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Bandit Chumworathayi
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Jadsada Thinkhamrop
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Butsakorn Ussahgij
- Khon Kaen UniversityMedical Library, Faculty of Medicine123 Mittraparp HighwayKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | | |
Collapse
|
35
|
|
36
|
Lykke R, Blaakær J, Ottesen B, Gimbel H. Incidence of pelvic organ prolapse repair subsequent to hysterectomy: a comparison between radical hysterectomy and total abdominal hysterectomy. Int Urogynecol J 2016; 28:745-749. [PMID: 27752747 DOI: 10.1007/s00192-016-3173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to compare the incidence of subsequent pelvic organ prolapse (POP) repair in women following radical hysterectomy versus total abdominal hysterectomy. METHODS From the Danish National Patient Registry, we collected data on all radical hysterectomies, all total abdominal hysterectomies, and all POP operations performed in Denmark from 1 January 1977 to 31 December 2009. We excluded patients with prior POP repair, POP diagnosis, or concomitant POP repair at hysterectomy. We analyzed the incidence of POP surgery using Kaplan-Meier curves and hazard ratio (HR). RESULTS In all, 5279 women underwent radical hysterectomy, and 63 of these underwent subsequent POP surgery. In the same period, 149,920 women underwent total abdominal hysterectomy, and 6107 of these had POP surgery subsequent to the hysterectomy. The cumulative incidence of POP surgery was significantly lower for radical hysterectomy than for abdominal hysterectomy-3.4 % and 9.5 %, respectively, at the end of the study period, yielding a crude HR of 0.36 and an adjusted HR of 0.40 in favor of the radical hysterectomy. The distribution of POP operations in the defined compartments was the same for the two types of hysterectomy. CONCLUSIONS This study found a significantly lower incidence of subsequent POP operations among women who undergo radical hysterectomy than total abdominal hysterectomy.
Collapse
Affiliation(s)
- Rune Lykke
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Jan Blaakær
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bent Ottesen
- Juliane Marie Centre, Rigshospitalet, København Ø, Denmark
| | - Helga Gimbel
- Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| |
Collapse
|
37
|
Yang Y, Qin T, Zhang W, Wu Q, Yang A, Xu F. Laparoscopic nerve-sparing radical hysterectomy for bulky cervical cancer (≥6 cm) after neoadjuvant chemotherapy: A multicenter prospective cohort study. Int J Surg 2016; 34:35-40. [DOI: 10.1016/j.ijsu.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/19/2016] [Accepted: 08/01/2016] [Indexed: 12/16/2022]
|
38
|
Stamenković M, Knežević A, Knežević I, Kuzmanović I, Karalić D, Milenković S, Jovanović T. High-risk human papilloma virus genotypes in cervical carcinoma of Serbian women: Distribution and association with pathohistological findings. Biologicals 2016; 44:412-6. [PMID: 27461126 DOI: 10.1016/j.biologicals.2016.05.001] [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: 03/28/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/16/2022] Open
Abstract
A significant role of high-risk Human papilloma viruses (HR HPV) in the development of cervical carcinoma is well known. HR HPV 16 and 18 account for approximately 70% of all cases of cervical cancer worldwide. The incidence of cervical cancer in Serbia, is one of the highest in Europe. The aim of our study was to investigate the distribution of HR HPV types in cervical carcinoma of Serbian women, as well as association between the HPV types and pathohistological findings. The study included 80 archival cervical cancer tissues from the same number of patients. The presence of HPV DNA was determined using MY09/MY11 primers for L1 gene and GP1/GP2 primers for E1 gene. HPV was detected in 78.75% tissues. HR HPV genotypes found in the decreasing order of frequency were: HPV16 (80.39%), HPV33 (7.84%), HPV58 (5.88%), HPV18 (1.96%), HPV45 (1.96%) and HPV53 (1.96%). The examined tissues were 91.25% squamous cell carcinomas and 8.75% adenocarcinoma. The high frequency of HPV 16 was observed in both types of carcinoma (80.8% and 75%, respectively) while the prevalence of HPV18 was low. These results may contribute to the implementation of cervical carcinoma prevention program in Serbia, including the selection of the most appropriate vaccine and immunization program.
Collapse
Affiliation(s)
| | - Aleksandra Knežević
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Ivana Knežević
- Department of Essential Medicines and Health Products, Health Systems and Innovation, World Health Organization, 1211, Geneva, Switzerland.
| | - Igor Kuzmanović
- "Narodni Front" University Clinic of Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Danijela Karalić
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Sanja Milenković
- Department for Clinical Pathology, Clinical-Hospital Center "Zemun", Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Tanja Jovanović
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| |
Collapse
|
39
|
Jin YZ, Pei CZ, Wen LY. FLNA is a predictor of chemoresistance and poor survival in cervical cancer. Biomark Med 2016; 10:711-9. [PMID: 27347840 DOI: 10.2217/bmm-2016-0056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim: To investigate the expression of FLNA and its potential prognostic significance in cervical cancer. Patients & methods: Real-time PCR was performed to evaluate the expression levels of FLNA in 44 pairs of cervical cancer and matched normal adjacent tissues. Kaplan–Meier analysis and Cox proportional hazards model were used to examine the correlation between FLNA expression levels and overall survival in cervical cancer patients. Results & conclusion: FLNA was significantly upregulated in cervical cancer tissues. FLNA expression level was associated with lymph node metastasis, parametrial invasion and response to neoadjuvant chemotherapy and predicted poor survival in cervical cancer patients. FLNA may serve as a predictor of chemosensitivity and a prognostic biomarker of survival in cervical cancer.
Collapse
Affiliation(s)
- Yan-Ze Jin
- Department of Obstetrics & Gynecology, Yanbian University Hospital, 1327 Juzi-Road, Yanji 133000, Jilin Province, China
| | - Chang-Zhu Pei
- Department of Obstetrics & Gynecology, Yanbian University Hospital, 1327 Juzi-Road, Yanji 133000, Jilin Province, China
| | - Lan-Ying Wen
- Department of Obstetrics & Gynecology, Yanbian University Hospital, 1327 Juzi-Road, Yanji 133000, Jilin Province, China
| |
Collapse
|
40
|
Ayhan A, Tuncer HA, Reyhan NH, Kuscu E, Dursun P. Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins. Eur J Obstet Gynecol Reprod Biol 2016; 201:1-6. [DOI: 10.1016/j.ejogrb.2016.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 11/24/2022]
|
41
|
Qin T, Zhen J, Zhou M, Wu H, Ren R, Qu B, Wang H. Efficacy of neoadjuvant chemotherapy plus radical surgery in patients with bulky stage II cervical squamous cell carcinoma: A retrospective cohort study. Int J Surg 2016; 30:121-5. [DOI: 10.1016/j.ijsu.2016.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/25/2022]
|
42
|
Tortora M, Annunziata C, Liguori G, Losito S, Botti G, Greggi S, Buonaguro L, Buonaguro FM, Tornesello ML. Detection of human papillomavirus DNA in peri-tumor tissues and pelvic lymph nodes as potential molecular marker of micrometastasis in cervical cancer. Infect Agent Cancer 2016; 11:22. [PMID: 27175213 PMCID: PMC4863320 DOI: 10.1186/s13027-016-0068-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/01/2016] [Indexed: 12/20/2022] Open
Abstract
Background The association between high risk human papillomaviruses (HPV) and cervical cancer has been firmly established. HPV genome is present in nearly all cases of cervical cancer and detection of viral DNA could therefore be used as a surrogate marker of micrometastasis in peri-tumor tissues and lymph nodes. Methods We analyzed primary cervical carcinomas, peri-tumor biopsies and pelvic lymph nodes in 20 women with invasive cancer (FIGO stage I-II) who underwent radical pelvic surgery and lymphadenectomy. HPV DNA was searched by broad spectrum PCR in 142 DNA samples extracted from paraffin embedded tissues. Viral genotypes were identified by direct sequencing analysis. Results HPV DNA sequences were identified in all available primary cervical tumors (n = 15). The most common genotype was HPV16 (60 %), followed by HPV18 (20 %), HPV35 (7 %), HPV45 (7 %) and HPV66 (7 %). Seven out of 20 (35 %) women had metastatic spread in peri-tumor tissues and/or lymph nodes, as determined by histology. HPV DNA was detected in all histological positive samples as well as in 16 and 25 % of histological negative peri-tumor tissues and lymph nodes, respectively. Three out of 20 (15 %) women without histological evidence of metastatic spread had HPV-positive lymph nodes. HPV genotype was found always concordant between primary tumor and metastatic lesions. The remaining 10 women (50 %) were histology and HPV-negative in all peri-tumor biopsies and lymph nodes analyzed. Conclusions Evaluation of HPV DNA in peri-tumor tissues as well as pelvic lymph nodes could be a sensitive marker to identify micrometastasis or isolated tumor cells and to monitor the risk of disease recurrence in women with cervical cancer.
Collapse
Affiliation(s)
- Marianna Tortora
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Clorinda Annunziata
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Giuseppina Liguori
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Simona Losito
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Gerardo Botti
- Department of Pathology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Stefano Greggi
- Division of Gynecology, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, Napoli, 80131 Italy
| | - Luigi Buonaguro
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Franco M Buonaguro
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncology Division, Istituto Nazionale Tumori "Fond. Pascale" - IRCCS, 80131 Napoli, Italy
| |
Collapse
|
43
|
Yang J, Shen K, Wang J, Yang J, Cao D. Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma. J Gynecol Oncol 2016; 27:e40. [PMID: 27102248 PMCID: PMC4864516 DOI: 10.3802/jgo.2016.27.e40] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/02/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC). Methods We reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed. Results PFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery. Conclusion Adjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.
Collapse
Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
| | - Jinhui Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
44
|
Wu MF, Li J, Lu HW, Wang LJ, Zhang BZ, Lin ZQ. Impact of the care provided by gynecologic oncologists on outcomes of cervical cancer patients treated with radical hysterectomy. Onco Targets Ther 2016; 9:1361-70. [PMID: 27022291 PMCID: PMC4792213 DOI: 10.2147/ott.s99874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For many malignant diseases, specialized care has been reported to be associated with better outcomes. The purpose of this study is to investigate the influence of gynecologic oncologists on treatment outcomes for cervical cancer patients treated by radical hysterectomy. Records of patients who received radical hysterectomy between January 2005 and June 2010 were reviewed. Perioperative morbidity, recurrence-free survival, and cancer-specific survival were assessed. Cox regression model was used to evaluate gynecologic oncologists as an independent predictor of survival. A total of 839 patients were included. Of these patients, 553 were treated by gynecologic oncologists, while 286 were treated by other subspecialties. With regard to operative outcomes, significant differences in favor of operation by gynecologic oncologists were found in number of patients receiving para-aortic node sampling and dissection (P=0.038), compliance with surgical guidelines (P=0.003), operative time (P<0.0001), estimated blood loss (P<0.0001), transfusion rate (P=0.046), number of removed nodes (P=0.033), and incidences of ureteric injury (P=0.027), cystotomy (P=0.038), and fistula formation (P=0.002). Patients who were operated on by gynecologic oncologists had longer recurrence-free survival (P=0.001; hazard ratio [HR] =0.64; 95% confidence interval [CI] [0.48, 0.84]) and cancer-specific survival (P=0.005; HR=0.64; 95% CI [0.47, 0.87]), and this association remained significant in patients with locally advanced disease. Care by gynecologic oncologists was an independent predictor for improved recurrence-free survival (P<0.0001; HR=0.57; 95% CI [0.42, 0.76]) and cancer-specific survival (P=0.001; HR=0.58; 95% CI [0.42, 0.81]), which was still significant among patients with locally advanced cancer. Given the results, we believe for cervical cancer patients receiving radical hysterectomy, operation by gynecologic oncologists results in significantly improved surgical and survival outcomes. The importance of the subspecialty of a gynecologist for cervical cancer patients should be addressed in clinical practice, especially for those in developing countries.
Collapse
Affiliation(s)
- Miao-Fang Wu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Li
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Team-based Learning Group of Clinical Study, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Huai-Wu Lu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-Juan Wang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bing-Zhong Zhang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhong-Qiu Lin
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| |
Collapse
|
45
|
Sun HD, Hsiao SM, Chen YJ, Wen KC, Li YT, Wang PHP. Advanced endocervical adenocarcinoma metastatic to the ovary presenting as primary ovarian cancer. Taiwan J Obstet Gynecol 2016; 54:201-3. [PMID: 25951731 DOI: 10.1016/j.tjog.2014.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Chang Wen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan.
| | - Peng-Hui Peter Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang-Ming University School of Nursing, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
46
|
Basu P, Banerjee D, Mittal S, Dutta S, Ghosh I, Chowdhury N, Abraham P, Chandna P, Ratnam S. Sensitivity of APTIMA HPV E6/E7 mRNA test in comparison with hybrid capture 2 HPV DNA test for detection of high risk oncogenic human papillomavirus in 396 biopsy confirmed cervical cancers. J Med Virol 2016; 88:1271-8. [PMID: 26693677 DOI: 10.1002/jmv.24453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 11/06/2022]
Abstract
The sensitivity of E6/E7 mRNA-based Aptima HPV test (AHPV; Hologic, Inc.) for detection of cervical cancer has been reported based on only a small number of cases. We determined the sensitivity of AHPV in comparison with the DNA-based Hybrid Capture 2 HPV test (HC2; Qiagen) for the detection of oncogenic HPV in a large number of cervical cancers at the time of diagnosis using cervical samples obtained in ThinPrep (Hologic). Samples yielding discordant results were genotyped using Linear Array assay (LA; Roche). Of 396 cases tested, AHPV detected 377 (sensitivity, 95.2%; 95%CI: 93.1-97.3), and HC2 376 (sensitivity, 94.9%; 95%CI: 92.7-97.1) with an agreement of 97.2% (kappa 0.7; 95%CI: 0.54-0.87). Among six AHPV+/HC2- cases, LA identified oncogenic HPV types in four including a type 73 and was negative in two. Among five AHPV-/HC2+ cases, LA detected oncogenic HPV types in two including a type 73 and was negative in three. Of 14 AHPV-/HC2- cases, 13 were genotyped. LA detected oncogenic HPV types in six, non-oncogenic types in three, and was negative in four. This is the largest study to demonstrate the sensitivity of AHPV for the detection of invasive cervical cancer and this assay showed equal sensitivity to HC2.
Collapse
Affiliation(s)
- Partha Basu
- Chittaranjan National Cancer Institute, Kolkata, India
| | | | | | | | - Ishita Ghosh
- Chittaranjan National Cancer Institute, Kolkata, India
| | | | - Priya Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Puneet Chandna
- Department of Molecular Oncology, AceProbe Technologies (India) Pvt. Ltd, New Delhi, India
| | - Sam Ratnam
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| |
Collapse
|
47
|
The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review. Gynecol Oncol 2015; 139:559-67. [DOI: 10.1016/j.ygyno.2015.09.076] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 12/31/2022]
|
48
|
Epigenetic Alteration by DNA Methylation of ESR1, MYOD1 and hTERT Gene Promoters is Useful for Prediction of Response in Patients of Locally Advanced Invasive Cervical Carcinoma Treated by Chemoradiation. Clin Oncol (R Coll Radiol) 2015; 27:720-7. [PMID: 26344356 DOI: 10.1016/j.clon.2015.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/16/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
AIMS Locally advanced invasive cervical cancer [International Federation of Gynecology and Obstetrics (FIGO) IIB/III] is treated by chemoradiation. The response to treatment is variable within a given FIGO stage. Therefore, the aim of the present study was to evaluate the gene promoter methylation profile and corresponding transcript expression of a panel of six genes to identify genes which could predict the response of patients treated by chemoradiation. MATERIALS AND METHODS In total, 100 patients with invasive cervical cancer in FIGO stage IIB/III who underwent chemoradiation treatment were evaluated. Ten patients developed systemic metastases during therapy and were excluded. On the basis of patient follow-up, 69 patients were chemoradiation-sensitive, whereas 21 were chemoradiation-resistant. Gene promoter methylation and gene expression was determined by TaqMan assay and quantitative real-time PCR, respectively, in tissue samples. RESULTS The methylation frequency of ESR1, BRCA1, RASSF1A, MLH1, MYOD1 and hTERT genes ranged from 40 to 70%. Univariate and hierarchical cluster analysis revealed that gene promoter methylation of MYOD1, ESR1 and hTERT could predict for chemoradiation response. A pattern of unmethylated MYOD1, unmethylated ESR1 and methylated hTERT promoter as well as lower ESR1 transcript levels predicted for chemoradiation resistance. CONCLUSION Methylation profiling of a panel of three genes that includes MYOD1, ESR1 and hTERT may be useful to predict the response of invasive cervical carcinoma patients treated with standard chemoradiation therapy.
Collapse
|
49
|
Xie Q, Liang J, Rao Q, Xie X, Li R, Liu Y, Zhou H, Han J, Yao T, Lin Z. Aldehyde Dehydrogenase 1 Expression Predicts Chemoresistance and Poor Clinical Outcomes in Patients with Locally Advanced Cervical Cancer Treated with Neoadjuvant Chemotherapy Prior to Radical Hysterectomy. Ann Surg Oncol 2015; 23:163-70. [PMID: 25916979 DOI: 10.1245/s10434-015-4555-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is an important treatment strategy for cervical cancer; however, few predictive markers of the response to NAC exist. Aldehyde dehydrogenase 1 (ALDH1), a cancer stem cell marker, is associated with chemoresistance in a variety of cancers. This study attempted to investigate the value of ALDH1 as a predictive marker of chemosensitivity and its prognostic value in cervical cancer patients treated with NAC. METHODS Immunohistochemistry was used to evaluate ALDH1 expression in matched pre- and post-NAC tumor samples from 52 patients with cervical cancer. Kaplan-Meier analysis and a Cox proportional hazards regression model were applied to determine overall survival (OS) and disease-free survival (DFS). RESULTS Fourteen patients (26.9 %) had ALDH1-positive tumors pre-NAC, and ALDH1 expression pre-NAC was significantly associated with a low clinical chemotherapy response rate and clinical non-response. Twenty-two patients (42.3 %) had ALDH1-positive tumors post-NAC, and ALDH1 expression post-NAC was associated with poor DFS and OS (both p = 0.004). Multivariate analysis revealed that ALDH1 expression post-NAC was an independent prognostic factor for OS (hazard ratio 3.513; p = 0.033). Moreover, we observed that ALDH1 expression was increased after NAC in 18 patients (36.7 %). Increased levels of ALDH1 expression after NAC predicted poor DFS and OS (p = 0.013 and p = 0.08, respectively). CONCLUSIONS Our findings suggest that ALDH1 expression pre-NAC may be a predictive marker for response to NAC, and ALDH1 expression post-NAC could be a prognostic marker for cervical cancer.
Collapse
Affiliation(s)
- Qingsheng Xie
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jinxiao Liang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qunxian Rao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaofei Xie
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruixin Li
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunyun Liu
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hui Zhou
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jingjing Han
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
| |
Collapse
|
50
|
Addressing challenges in future surveillance after surgery for early-stage cervical cancer. Int J Gynecol Cancer 2015; 25:309-14. [PMID: 25594142 DOI: 10.1097/igc.0000000000000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study examines surveillance after early-stage cervical cancer surgery. Since the 1980s, the value of surveillance has been discussed continuously. The main question explored is whether surveillance serves the purpose of ensuring early diagnosis of recurrence. MATERIALS AND METHODS A retrospective cohort study included 389 women with cervical cancer who underwent surgery as the primary treatment modality at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark, from 1996 to 2011. We used data from patient files and the Danish National Pathology Data Bank. The cumulative risk was estimated by the Kaplan-Meier method and tested by the log-rank test. RESULTS Forty-three women (11%) had recurrence. Only 27% of the recurrent cases were diagnosed at a scheduled surveillance appointment, but they were often asymptomatic and seemed to have a better outcome after treatment compared with the recurrent cases diagnosed at self-referral.The 5-year survival was overall 91.3%, recurrence-free survival was 96%, and cancer-specific survival was 54%. The median recurrence-free interval was 23 months (range, 4-144) for the symptomatic patients and 14 months (range, 4-48) for the asymptomatic patients. The median survival after recurrence was 12 months (range, 2-132) for the symptomatic patients and 156 months (range, 40-180) for the asymptomatic patients. CONCLUSIONS At the moment, neither the value of surveillance nor the significance of self-referral related to survival after recurrence is known. In this study, those who are diagnosed with recurrence before symptom onset seem to fare better in terms of 5-year survival than those who are diagnosed after self-referral because of symptoms.
Collapse
|