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Zhang Q, Liu Z, Wang Y, Zhang J, Li W, Wang T, Wang J, Shi F, Su J. The impacts of minimally invasive surgery on intermediate- or high-risk cervical cancer patients received adjuvant radiotherapy. World J Surg Oncol 2022; 20:372. [PMID: 36443879 PMCID: PMC9703778 DOI: 10.1186/s12957-022-02820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adjuvant chemoradiotherapy (CRT) has been shown to reduce the risk of recurrence for patients with risk factors after radical hysterectomy (RH). Early initiated CRT could result in superior oncological outcomes. Here, we aimed to compare the survival outcome of intermediate- or high-risk cervical cancer (CC) patients who, received adjuvant CRT between minimally invasive surgery (MIS) and open surgery. METHODS Data on stage IB1-IIA2 patients who underwent RH and postoperative CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received sequential chemoradiation (SCRT). According to the surgical approaches, the enrolled patients were divided into MIS and open surgery groups. Then, the disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed. RESULTS Among 129 enrolled CC patients, 68 received open surgery and 61 received MIS. The median time interval from surgery to chemotherapy and to radiotherapy was shorter in the MIS group (7 days vs. 8 days, P=0.014; 28 days vs. 35, P<0.001). Three-year DFS and OS were similar in both groups (85.2% vs. 89.7%, P=0.274; 89.9% vs. 98.5%, P=0.499). Further, sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size >4 cm and time interval from surgery to radiotherapy beyond 7 weeks were adverse independent prognostic factors for DFS. CONCLUSION Based on the population we studied, for early-stage (IB1-IIA2) CC patients with intermediate- or high-risk factors who received postoperative SCRT, although the difference was not significant, the DFS and OS in the MIS group were slightly lower than the ORH group, and tumor size >4 cm and delayed adjuvant radiotherapy beyond 7 weeks were risk factors for recurrence.
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Affiliation(s)
- Qiying Zhang
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Zi Liu
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Yali Wang
- grid.43169.390000 0001 0599 1243Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, 710004 People’s Republic of China
| | - Jing Zhang
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Wen Li
- grid.43169.390000 0001 0599 1243Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, 710004 People’s Republic of China
| | - Tao Wang
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Juan Wang
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Fan Shi
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
| | - Jin Su
- grid.452438.c0000 0004 1760 8119Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No.277, West Yanta Road, Xi’an, Shaanxi 710000 People’s Republic of China
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Diep YN, Kim TJ, Cho H, Lee LP. Nanomedicine for advanced cancer immunotherapy. J Control Release 2022; 351:1017-1037. [DOI: 10.1016/j.jconrel.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/09/2022]
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Lin S, Li X, Zhang Y, Mao X, Liang X, Cheng S, Zhang L. Manifestation of Urinary Tract Injury during Cervical Cancer Surgery Based on CT Urography Secretion Phase Images. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2572681. [PMID: 35821887 PMCID: PMC9217568 DOI: 10.1155/2022/2572681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
Methods We grouped the patients who had undergone cervical cancer surgery in a hospital in this article and compared the nanodrug carrier system under CT imaging with traditional laparoscopy. The postoperative physical parameters of surgical patients are collected from cervical cancer patients of different degrees, and the parameters and prognostic health of patients after different operations are compared. Results The results of the study show that the postoperative patient's body parameters of the nanodrug delivery system under the CT imaging technology used in this article are better than those of the traditional surgery group, and the average intraoperative blood loss is about 20% less than that of the traditional surgery. Postoperative complications occur. The situation is even lower, more than 30% lower than traditional surgery. Conclusion This shows that the operation of the nanodrug delivery system based on CT imaging technology has broken through some of the limitations of the development of laparoscopic technology and has played an important role in the surgical treatment of cervical cancer.
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Affiliation(s)
- Song Lin
- Department of Surgery, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Xiaoshan Li
- Department of Urology, Yangtze River Shipping General Hospital, Wuhan 430014, Hubei, China
| | - Yan Zhang
- Department of Women's Health, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Xiaowen Mao
- Department of Surgery, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Xingchi Liang
- Department of Surgery, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Shigang Cheng
- Department of Surgery, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
| | - Lingli Zhang
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, Hubei, China
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Classifying early stages of cervical cancer with MRI-based radiomics. Magn Reson Imaging 2022; 89:70-76. [PMID: 35337907 DOI: 10.1016/j.mri.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 02/11/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
Abstract
This study aims to establish a MRI-based classifier to distinguish early stages of cervical cancer with improved diagnostic performance to assist clinical diagnosis and treatment. 57 patients with pathological diagnosis of cervical cancer from January 2018 to May 2019 were enrolled in this study. MRI examinations, including T1-weighted image(T1WI), T2-weighted image(T2W), diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE), were performed before surgery. MR images from patients of stage Ib or IIa cervical cancer with tumor segmented were used as input. Feature extraction process extracted first-order statistics and texture and applied filters. The dimensionality of the radiomic features was reduced using the least absolute shrinkage and selection operator (LASSO). Models were trained by three machine-learning (k-nearest neighbor (KNN), support vector machine (SVM), and logistic regression (LR)) and diagnostic performance in differentiating stage Ib and stage IIa cases was evaluated. A total of 27 features were extracted to establish models, including 2 features from T1WI, 5 features from T2WI, 5 features from DWI (b = 50), 4 features from DWI (b = 800), 5 features from DCE, and 6 features from ADC. For each machine learning (ML) classifier, six sequences of training set and testing set are modeled and analyzed. Among all the models, the training set and testing set of T2WI model built by SVM classifier were the best (Area under the curve (AUC) 0.915) / (AUC 0.907). Radiomic analysis of ML-based texture features and first-order statistics features can be used to stage the early cervical cancer pre-operatively.
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Wang Y, Ouyang Y, Su J, Xiao L, Bai Z, Cai Q, Cao X. Is salvage radiotherapy optimal to patients with occult cervical cancer undergoing inadvertent simple hysterectomy? A propensity score-matched analysis of a nationwide clinical oncology database. Jpn J Clin Oncol 2021; 51:630-638. [PMID: 33395486 DOI: 10.1093/jjco/hyaa251] [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: 08/15/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We used National Cancer Institute's Surveillance, Epidemiology and End Result database to assess the role of salvage radiotherapy for women with unanticipated cervical cancer after simple hysterectomy. METHODS Patients with non-metastatic cervical cancer and meeting inclusion criteria were divided into three groups based on treatment strategy: simple hysterectomy, salvage radiotherapy after hysterectomy and radical surgery. Parallel propensity score-matched datasets were established for salvage radiotherapy group vs. simple hysterectomy group (matching ratio 1: 1), and salvage radiotherapy group vs. radical surgery group (matching ratio 1:2). The primary endpoint was the overall survival advantage of salvage radiotherapy over simple hysterectomy or radical surgery within the propensity score-matched datasets. RESULTS In total, 2682 patients were recruited: 647 in the simple hysterectomy group, 564 in the salvage radiotherapy group and 1471 in the radical surgery group. Age, race, histology, grade, FIGO stage, insured and marital status and chemotherapy were comprised in propensity score-matched. Matching resulted in two comparison groups with neglectable differences in most variables, except for black race, FIGO stage III and chemotherapy in first matching. In the matched analysis for salvage radiotherapy vs. simple hysterectomy, the median follow-up time was 39 versus 32 months. In the matched analysis for salvage radiotherapy vs. radical surgery, the median follow-up time was 39 and 41 months, respectively. Salvage radiotherapy (HR 0.53, P = 0.046) significantly improved overall survival compared with simple hysterectomy, while salvage radiotherapy cannot achieve similar overall survival to radical surgery (HR 1.317, P = 0.045). CONCLUSIONS This is the largest study of the effect of salvage radiotherapy on overall survival in patients with unanticipated cervical cancer. Salvage radiotherapy can improve overall survival compared with hysterectomy alone, while cannot achieve comparable survival to radical surgery.
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Affiliation(s)
- Yanhong Wang
- The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China
| | - Yi Ouyang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jingjing Su
- The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China
| | - Lihua Xiao
- The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China
| | - Zhigang Bai
- The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China
| | - Qunrong Cai
- The Second Affiliated Hospital of Fujian Medical University, Department of Radiotherapy, Quanzhou, China
| | - Xinping Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
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Optimal overall treatment time for adjuvant therapy for women with completely resected, node-positive vulvar cancer. Gynecol Oncol 2021; 161:63-69. [PMID: 33500149 DOI: 10.1016/j.ygyno.2021.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/03/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The optimal overall treatment time (OTT) from radical surgery to the end of adjuvant radiation therapy for some squamous cell carcinomas has been found to impact treatment outcomes. This study aims to identify the impact of OTT on overall survival (OS) for women with completely resected, node-positive squamous cell carcinomas of the vulva. MATERIALS AND METHODS The National Cancer Data Base was queried for women with surgically resected, node-positive vulvar squamous cell carcinomas between 2004 and 2016 who were treated with adjuvant radiation therapy. Kaplan-Meier analysis with log-rank test and Cox proportional hazards tests were utilized for OS calculations. RESULTS A total of 1500 women met inclusion criteria. The median OTT was 104 days. Shorter OTT was associated with age, facility volume, private insurance, and duration of post-operative hospitalization. Median OS with OTT ≤ 104 days was 56.1 months vs 45.4 months if ≥105 days (p = 0.015). On multivariable Cox analysis, OTT was independently associated with an increased risk of death of 0.4% per additional day (95%CI 1.001-1.007, p = 0.003), as were age at diagnosis (HR 1.031 [95%CI 1.024-1.037], p < 0.001), number of nodes positive (HR 1.031 [95%CI 1.024-1.037], p = 0.006), the use of concurrent chemotherapy (HR 0.815 [95%CI 0.693-0.960], p = 0.014) and increasing pT/pN stage. After propensity adjustment for factors predicting a shorter OTT, OTT continued to be associated with an increased risk of death per additional day (HR 1.004 [95%CI 1.001-1.007], p = 0.007). CONCLUSION Overall treatment time is an independent risk factor for death in women being treated with adjuvant radiation therapy following complete resection of node-positive squamous cell carcinoma of the vulva.
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