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Tao S, Zhang Z, Li L, Yuan X, Chen H, Zhang Y, Fu C. Characteristics of systematic lymph node dissection and influencing factors of sentinel lymph node biopsy using carbon nanoparticles in endometrial carcinoma: a single-center study. World J Surg Oncol 2023; 21:39. [PMID: 36750844 PMCID: PMC9903571 DOI: 10.1186/s12957-023-02922-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Carbon nanoparticles (CNPs) are a new tracer for lymph node mapping, which can quickly reach and develop lymph nodes through a lymphatic network. This research investigated the characteristics of systematic lymph node dissection and sentinel lymph node biopsy mapped with CNPs in endometrial carcinoma. METHODS We first applied CNPs to systematic lymph node dissection in 18 endometrial carcinoma patients as the study group and another 18 endometrial carcinoma patients who were not injected with anything served as the control group. Then, we applied CNPs to sentinel lymph nodes biopsy in 54 endometrial carcinoma patients. All 54 patients received systematic lymph node dissection after sentinel lymph node biopsy. The detection rate, sensitivity, specificity, and accuracy of systematic lymph node dissection and sentinel lymph node biopsy by CNPs were respectively analyzed. A nomogram model for predicting the success of sentinel lymph node mapping was established. RESULTS The average number of lymph nodes removed in the CNP-labeled study group was higher than that in the control group (p<0.001). CNPs improved the number of lymph nodes with a diameter ≤ 0.5cm. The detection rate, sensitivity, specificity, and accuracy of sentinel lymph nodes biopsy by CNPs for endometrial carcinoma were 70.4%, 100%, 100%, and 100%, respectively. The nomogram model included factors of long menopause time, cervical cyst, and hard cervical texture, and the area of ROC curve was 0.816. CONCLUSIONS CNPs improve the detection rate of small lymph nodes. CNPs can trace sentinel lymph nodes in evaluating lymph node metastasis in endometrial carcinoma.
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Affiliation(s)
- Siqi Tao
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Zhibang Zhang
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Liling Li
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Xiaorui Yuan
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Hongliang Chen
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Yongjing Zhang
- grid.452708.c0000 0004 1803 0208Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011 Hunan China
| | - Chun Fu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, No. 139 Ren Min Road, Changsha, 410011, Hunan, China.
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Long X, He M, Yang L, Zou D, Wang D, Chen Y, Zhou Q. Validation of the 2018 FIGO Staging System for Predicting the Prognosis of Patients With Stage IIIC Cervical Cancer. Clin Med Insights Oncol 2023; 17:11795549221146652. [PMID: 36726607 PMCID: PMC9884955 DOI: 10.1177/11795549221146652] [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: 06/28/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
Background Risk stratification of patients with cervical cancer accompanied by positive lymph nodes (stage IIIC) (the 2018 International Federation of Gynecology and Obstetrics [FIGO] new staging system) yields a clinically heterogeneous group. In this study, we investigated the prognostic performance of the 2018 FIGO staging system for stage IIIC cervical cancer. Methods The study included patients with stage III cervical cancer based on the 2018 FIGO staging system, who visited Chongqing University Cancer Hospital between January 2011 and December 2014. Kaplan-Meier curves were generated to evaluate overall survival (OS), which was compared using the log-rank test. The Cox proportional hazard regression model was used for multivariable analysis. Results A total of 418 patients were eligible for analysis. The 5-year OS was 54.1% for stage IIIC1, 43.3% for stage IIIA, 40.6% for stage IIIB, and 23.1% for stage IIIC2 (P < .001). Multivariable analysis revealed that compared with stages IIIA (hazard ratio [HR] 1.432, 95% confidence interval [CI] 0.867-2.366, P = .161) and IIIB (HR 1.261, 95% CI 0.871-1.827, P = .219), stage IIIC1 cancer was not significantly associated with an increased mortality risk. Stage IIIC2 was independently associated with an increased mortality risk compared with stages IIIA (HR 2.958, 95% CI 1.757-4.983, P < .001) and IIIB (HR 2.606, 95% CI 1.752-3.877, P < .001). We stratified patients with stage IIIC1 based on the T stage. The 5-year OS was significantly longer in patients with stage IIIC1 (T1) than in those with stage IIIA (P = .004) or IIIB (P < .001). Analysis of multiple factors revealed that the mortality risk was 2.75-fold higher in patients with stage IIIC1pN>2 than in patients with stage IIIC1pN1-2 (HR 2.753, 95% CI 1.527-4.965, P = .001). Conclusions Patients with stage IIIC1 cervical cancer showed heterogeneous clinical characteristics that reflected variable prognoses, depending on the T stage and the extent of pelvic lymph node metastases.
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Affiliation(s)
- Xingtao Long
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China
| | - Misi He
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China
| | - Lingling Yang
- School of Medicine, Chongqing
University, Chongqing, China
| | - Dongling Zou
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China
| | - Dong Wang
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China
| | - Yuemei Chen
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China
| | - Qi Zhou
- Chongqing Cancer Hospital, Chongqing
University, Chongqing, China,Qi Zhou, Chongqing Cancer Hospital,
Chongqing University, 181 Hanyu Road, Shapingba District, Chongqing 400000,
China.
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Borčinová M, Ragosch V, Jarkovský J, Bajsová S, Pilka R, Glickman A, Garrido-Mallach S, Raspagliesi F, Szatkowski W, Pakiz M, Snyman LC, Kocián R, Tamussino K, Kalist V, Michal M, Segovia MG, Poka R, Kipp B, Szewczyk G, Wydra D, Tóth R, Vinnytska A, Fischerová D, Siegler K, Cibula D. Challenges in lower limb lymphoedema assessment based on limb volume change: Lessons learnt from the SENTIX prospective multicentre study. Gynecol Oncol 2021; 164:76-84. [PMID: 34763939 DOI: 10.1016/j.ygyno.2021.10.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. METHODS In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. RESULTS Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. CONCLUSIONS Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. TRIAL REGISTRATION ClinicalTrials.gov: NCT02494063.
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Affiliation(s)
- Martina Borčinová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Volker Ragosch
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sylva Bajsová
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Ostrava Poruba, Czech Republic
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Olomouc, Czech Republic
| | - Ariel Glickman
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | - Maja Pakiz
- University medical Centre Maribor, Slovenia
| | | | - Roman Kocián
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | | | | | | | | | - Robert Poka
- Department of obstetrics and Gynecology, University of Debrecen, Hungary
| | - Barbara Kipp
- Neue Freuenklinik, Luzerner Kantonsspital, Switzerland
| | | | | | - Róbert Tóth
- Oncology Institute of East Slovakia, Košice, Slovakia
| | | | - Daniela Fischerová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - David Cibula
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic.
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