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Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emerg Med 2024; 24:26. [PMID: 38355419 PMCID: PMC10865660 DOI: 10.1186/s12873-024-00948-5] [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: 06/28/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The reverse shock index (rSI) combined with the Simplified Motor Score (sMS), that is, the rSI-sMS, is a novel and efficient prehospital triage scoring system for patients with COVID-19. In this study, we evaluated the predictive accuracy of the rSI-sMS for general ward and intensive care unit (ICU) admission among patients with COVID-19 and compared it with that of other measures, including the shock index (SI), modified SI (mSI), rSI combined with the Glasgow Coma Scale (rSI-GCS), and rSI combined with the GCS motor subscale (rSI-GCSM). METHODS All patients who visited the emergency department of Taipei Tzu Chi Hospital between January 2021 and June 2022 were included in this retrospective cohort. A diagnosis of COVID-19 was confirmed through a SARS-CoV-2 reverse-transcription polymerase chain reaction test or SARS-CoV-2 rapid test with oropharyngeal or nasopharyngeal swabs and was double confirmed by checking International Classification of Diseases, Tenth Revision, Clinical Modification codes in electronic medical records. In-hospital mortality was regarded as the primary outcome, and sepsis, general ward or ICU admission, endotracheal intubation, and total hospital length of stay (LOS) were regarded as secondary outcomes. Multivariate logistic regression was used to determine the relationship between the scoring systems and the three major outcomes of patients with COVID-19, including. The discriminant ability of the predictive scoring systems was investigated using the area under the receiver operating characteristic curve, and the most favorable cutoff value of the rSI-sMS for each major outcome was determined using Youden's index. RESULTS After 74,183 patients younger than 20 years (n = 11,572) and without COVID-19 (n = 62,611) were excluded, 9,282 patients with COVID-19 (median age: 45 years, interquartile range: 33-60 years, 46.1% men) were identified as eligible for inclusion in the study. The rate of in-hospital mortality was determined to be 0.75%. The rSI-sMS scores were significantly lower in the patient groups with sepsis, hyperlactatemia, admission to a general ward, admission to the ICU, total length of stay ≥ 14 days, and mortality. Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS exhibited a significantly higher accuracy for predicting general ward admission, ICU admission, and mortality but a similar accuracy to that of the rSI-GCS. The optimal cutoff values of the rSI-sMS for predicting general ward admission, ICU admission, and mortality were calculated to be 3.17, 3.45, and 3.15, respectively, with a predictive accuracy of 86.83%, 81.94%%, and 90.96%, respectively. CONCLUSIONS Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS has a higher predictive accuracy for general ward admission, ICU admission, and mortality among patients with COVID-19.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
| | - Jui-Yuan Chung
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
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Liang C, Jiang H, Sun L, Kang S, Cui Z, Wang L, Zhao W, Bin X, Lang J, Liu P, Chen C. Which factors predict parametrial involvement in stage IB cervical cancer? A Chinese multicentre study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106936. [PMID: 37244844 DOI: 10.1016/j.ejso.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To explore the clinicopathological risk factors influencing parametrial involvement (PI) in stage IB cervical cancer patients and compare the oncological outcomes between Q-M type B radical hysterectomy (RH) group and Q-M type C RH group. METHODS Univariate and multivariate analyses were performed to explore the clinicopathological factors related to PI. Overall survival (OS) and disease-free survival (DFS) in patients with stage IB cervical cancer who underwent Q-M type B or Q-M type C RH under different circumstances of PI were also compared before and after propensity score matching (1:1 matching). RESULTS A total of 6358 patients were enrolled in this study. Depth of stromal invasion>1/2 (HR: 3.139, 95% CI: 1.550-6.360; P = 0.001), vaginal margin (+) (HR: 4.271, 95% CI: 1.368-13.156; P = 0.011), lymphovascular space invasion (LVSI) (+) (HR: 2.238, 95% CI: 1.353-3.701; P = 0.002) and lymph node metastases (HR: 5.173, 95% CI: 3.091-8.658; P < 0.001) were associated with PI. Among the 6273 patients with negative PI, those in the Q-M type B RH group had a higher 5-year OS and DFS than those in the Q-M type C RH group before and after 1:1 matching. Among the 85 patients with positive PI, Q-M type C RH showed no survival benefits before and after 1:1 matching. CONCLUSION Stage IB cervical cancer patients with no lymph node metastasis, LVSI(-) and depth of stromal invasion ≤1/2 may be considered for Q-M type B radical hysterectomy.
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Affiliation(s)
- Cong Liang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haixia Jiang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Gynecology, Chengdu Second People's Hospital, Chengdu, China
| | - Lixin Sun
- Department of Gynecologic Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Shan Kang
- Department of Gynecology, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhumei Cui
- Department of Gynecology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Li Wang
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Weidong Zhao
- Department of Gynecology and Oncology, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xiaonong Bin
- Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 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.
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Wang C, Lester B, Huang L, Sun S, Ko JJ. Patient, disease, and survival outcomes for stage IB to stage IV cervical cancer-A population study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231164551. [PMID: 37052298 PMCID: PMC10102945 DOI: 10.1177/17455057231164551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Factors that impact recurrence in stages IB to IV include larger tumor, high-risk histology, older age, and lymphovascular invasion (LVI); however, local studies on risk factors for recurrence in British Columbia and our local recurrence patterns have not been well studied. Furthermore, the efficacy of treatment modalities including surgery and chemoradiation in the different stages of cervical cancer have not been clarified in this population. OBJECTIVES The purpose of this study is to determine the disease and treatment characteristics of stages IB to IV cervical cancer which are associated with survival differences within British Columbia. METHODS/DESIGN We performed a retrospective population study. A chart review on cervical cancer patients in British Columbia between 1 January 2010 and 31 December 2017 was done. Demographic data and treatment details were collected. Data were analyzed using multivariate Cox regressions, pairwise comparison using the Log-Rank test, and chi-square tests. RESULTS We included 780 patients (stage I: 31.5%, II: 20.0%, III: 34.5%, and IV: 3.3%). LVI and p16 negativity were associated with decreased overall survival (OS), and multivariate analyses show them to be independent risk factors for poorer survival. Surgical resection in stage I was associated with improved survival, but not with stages II-IV. The use of radical radiation therapy (RT), brachytherapy, and concurrent chemotherapy were independently associated with improved survival in stages II-IV. Peri-RT chemotherapy was not associated with survival benefit in adeno/adenosquamous carcinoma. There were 180 recurrences (23.1%), mostly distant metastases (42.8%). There were fewer recurrences after resection of tumors <2 cm compared to tumors 2 cm or larger (6.49% vs 31.3%, p = 0.00011). Only 37.7% of recurrence/metastases were treated with first-line carboplatin/paclitaxel/bevacizumab, but it was associated with better OS compared to other regimens (median OS 40.1 vs 24.8 months, p = 0.03). CONCLUSION A significant portion of patients with localized cervical cancer relapse despite radical therapy, with LVI and p16 negativity associated with poorer survival. Surgical resection may still play a role in stage IB disease, while RT, brachytherapy, and concurrent chemotherapy should be considered first-line therapy in stage II-IV diseases. First-line carboplatin, paclitaxel, and bevacizumab for recurrence shows improved survival.
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Affiliation(s)
- Christine Wang
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Beverly Lester
- Department of Radiation Oncology, BC Cancer-Abbotsford, Abbotsford, BC, Canada
| | - Longlong Huang
- Department of Mathematics and Statistics, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Shaun Sun
- Department of Mathematics and Statistics, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Jenny J Ko
- Department of Medical Oncology, BC Cancer-Abbotsford, Abbotsford, BC, Canada
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Li Y, Chen S, Xu M, Liu J. Effect of crisis intervention nursing on perioperative psychological state and self-efficacy of patients undergoing laparoscopic radical hysterectomy. Am J Transl Res 2021; 13:12988-12995. [PMID: 34956515 PMCID: PMC8661230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the effect of crisis intervention nursing on perioperative psychological state and self-efficacy of patients with laparoscopic radical hysterectomy. METHOD A total of 151 cervical cancer patients that underwent laparoscopic radical surgery during January 2018 to March 2020 in our hospital were selected as the research objects. The patients were divided into control group (n=73) and observation group (n=78) according to treatment regimen. The control group received conventional nursing measures, and the observation group was treated with crisis intervention nursing in addition to the traditional measures. The changes of psychological state, self-efficacy, psychological crisis, hope degree before and after intervention, and the satisfaction of the two groups with nursing care were compared. RESULTS The scores of HAMA, HAMD, self-efficacy, psychological crisis and hope degree in the two groups were remarkably improved after intervention compared with before intervention (all P<0.05), and the improvement of each index in observation group was obviously superior to that in control group (P<0.05). After intervention, the satisfaction to nursing care in observation group was dramatically higher than that in control group (P<0.05). CONCLUSION The application of crisis intervention nursing on patients with laparoscopic radical hysterectomy is conductive to alleviating the adverse emotions such as anxiety and depression, reducing their sense of psychological crisis, improving the self-efficacy and hope degree of curing disease, as well as the satisfaction rate with the nursing care, which is worthy of clinical application.
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Affiliation(s)
- Yan Li
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Sisi Chen
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Mengjie Xu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
| | - Jiao Liu
- Department of Gynecology, Jinan People's Hospital Affiliated to Shandong First Medical University Jinan 271199, Shandong, China
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Yüksel D, Karataş Şahin E, Ünsal M, Çakır C, Kılıç Ç, Kimyon Cömert G, Korkmaz V, Türkmen O, Turan T. The prognostic factors in 384 patients with FIGO 2014 stage IB cervical cancer: What is the role of tumor size on prognosis? Eur J Obstet Gynecol Reprod Biol 2021; 266:126-132. [PMID: 34634671 DOI: 10.1016/j.ejogrb.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/26/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To define the relationship of tumor size with surgico-pathological factors and oncological outcome in FIGO 2014 stage IB cervical cancer. METHODS This study retrospectively evaluated 384 FIGO 2014 Stage IB cervical cancer patients who underwent radical hysterectomy and lymphadenectomy. Tumor size was stratified according to 2 cm (≤ 2cm, 2-≤4 cm, >4 cm) and 4 cm (≤4 cm, >4 cm), and the relationship with poor prognostic factors, and the effects on survival were examined. The distribution of prognostic factors was compared between three subgroups: ≤2 cm vs. 2-≤4 cm; 2-≤4 cm vs. > 4 cm and ≤ 2 cm vs. > 4 cm. Survival rate was evaluated using the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was performed using Cox proportional-hazards regression. RESULTS Stratification of tumor size according to 4 cm was found to better determine pelvic lymph node determination. Parametrial involvement, uterine involvement and deep cervical stromal invasion were correlated with increasing tumor size. Lymph node involvement and uterine involvement were an independent prognostic risk factor for recurrence and cancer-specific survival. Tumor size showed no association with prognosis. CONCLUSION There is no meaningful cut-off value for tumor size determining all surgico-pathological factors. There was also seen to be no association between tumor size and recurrence or disease-related mortality.
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Affiliation(s)
- Dilek Yüksel
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey.
| | - Ediz Karataş Şahin
- Gynecology and Obstetrics Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Mehmet Ünsal
- Gynecology and Obstetrics Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Caner Çakır
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Çiğdem Kılıç
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Günsu Kimyon Cömert
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Vakkas Korkmaz
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Osman Türkmen
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
| | - Taner Turan
- Gynecologic Oncology Department, Health Sciences University Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey
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Ueda K, Yanaihara N, Iida Y, Kobayashi R, Kato S, Matsuda Y, Tomita K, Yamamura N, Saito R, Hirose S, Kuroda T, Seki T, Saito M, Takano H, Yamada K, Okamoto A. Analysis of risk factors for patients with early-stage cervical cancer: A study of 374 patients. J Obstet Gynaecol Res 2020; 47:270-278. [PMID: 33078517 DOI: 10.1111/jog.14510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/05/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022]
Abstract
AIM This study aimed to identify the postoperative histological features affecting the prognosis of patients with early-stage cervical cancer who underwent open radical hysterectomy. METHODS This retrospective study enrolled 374 patients with pT1a, 1b1 and 2a1 early-stage cervical cancer who underwent open radical hysterectomy between 2001 and 2018. Survival outcomes were analyzed by Kaplan-Meier method and compared with log-rank test. Using the Cox proportional hazards regression test, we conducted a multivariate analysis for disease-free survival and overall survival. RESULTS Others histology, including other epithelial tumors and neuroendocrine tumors, had a significantly worse prognosis in both disease-free survival and overall survival than those of squamous cell carcinoma and adenocarcinoma (hazard ratio, 4.37 and 11.76; P = 0.006 and P = 0.002, respectively), along with lymph node metastasis (hazard ratio, 2.99 and 7.03; P = 0.009 and P = 0.001, respectively). CONCLUSION Others histology including adenosquamous carcinoma had a poor prognosis in early-stage cervical cancer as with high-risk factors.
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Affiliation(s)
- Kazu Ueda
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Gynecologic Oncology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Nozomu Yanaihara
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Iida
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ritsuko Kobayashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sayako Kato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuna Matsuda
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keisuke Tomita
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Tokyo, Japan
| | - Nami Yamamura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Saito
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sou Hirose
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Kuroda
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiyuki Seki
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Tokyo, Japan
| | - Motoaki Saito
- Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Tokyo, Japan
| | - Kyosuke Yamada
- Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Zyla RE, Gien LT, Vicus D, Olkhov-Mitsel E, Mirkovic J, Nofech-Mozes S, Djordjevic B, Parra-Herran C. The prognostic role of horizontal and circumferential tumor extent in cervical cancer: Implications for the 2019 FIGO staging system. Gynecol Oncol 2020; 158:266-272. [PMID: 32471646 DOI: 10.1016/j.ygyno.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The FIGO 2019 update on cervical cancer staging removed horizontal tumor extent (HZTE) as a staging variable. Evidence is needed to substantiate this change. The prognostic significance of HZTE and a related variable, circumferential tumor extent (%CTE), is similarly unknown. We aimed to investigate the association of HZTE and %CTE with survival outcomes in cervical cancer patients. METHODS We identified patients treated with primary surgery for stage I cervical cancer in a single institution during a 9-year period. HZTE and, when available, %CTE were obtained from pathology records. Cases were staged using 2019 FIGO staging. Correlations between HZTE, %CTE and FIGO stage with recurrence-free (RFS) and disease-specific survival (DSS) were determined using univariable and multivariable analyses. RESULTS 285 patients were included with a median follow-up of 48 (range 7-123) months. HZTE was statistically associated with RFS and DSS on univariate and multivariate analysis. None of the 168 stage IA patients in our series had tumor recurrence or death during follow-up, including 42 with HZTE ≥7 mm. None of the patients with a tumor horizontal extent <7 mm experienced recurrence or death. %CTE correlated only with RFS on univariate analysis. 2019 FIGO stage did not independently correlate with RFS or DSS in our sample. CONCLUSIONS HZTE is an independent predictor of survival in cervical carcinoma. In stage IA tumors, however, HZTE does not offer superior prognostic value, supporting the 2019 FIGO recommendations to remove this variable from staging in these cases. HZTE may be useful in larger tumors in which staging depends on maximum tumor size. %CTE is not an independent prognostic variable in cervical cancer, and we advise against its use.
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Affiliation(s)
- Roman E Zyla
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Lilian T Gien
- Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Danielle Vicus
- Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Ekaterina Olkhov-Mitsel
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Bojana Djordjevic
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Carlos Parra-Herran
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
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