State-of-the-Art Treatment and Novel Agents in Local and Distant Recurrences of Cervical Cancer

The Recurrence of Cervical Precancerous Lesion Among HIV Positive and Negative Ethiopian Women After Cryotherapy: A Retrospective Cohort Study

Background

Early testing and treatment is among the successful strategies for the prevention and control of cervical precancerous and invasive cancer, and a paramount for women with HIV. In Ethiopia, visual inspection with acetic acid for screening and cryotherapy treatment is commonly practiced, though the recurrence of the precancerous lesion after treatment has not been well documented.

Objective

This study was aimed to estimate the association of HIV status and the recurrence of cervical precancerous lesion after cryotherapy among Ethiopian women.

Methods

We conducted a retrospective cohort study from January to April 2021. The time to the incidence of recurrence was compared between HIV positive and HIV negative women. Cox regression models were used to adjust the analyses for potential confounders, and only women treated with cryotherapy after a positive Visual Inspection with Acetic acid (VIA) screening test were included.

Results

A total of 140 eligible patient cards were included in the analysis with the median follow-up of 15.5 months. The overall recurrence rate was 15.7% (22/140), with a greater proportion among HIV negative women, 19.0% (4/21) than HIV positive 15.1% (18/119). Prolonged use of corticosteroid and higher age were the major significant predictors of a higher likelihood of recurrence. The recurrence of screening positive lesion was higher among women aged above 39 years (hazard ratio (HR) of 11.94 (95% CI, 1.07-133.04; P = .04), and women with prolonged use of corticosteroid (HR = 7.82, 95% CI = 1.04-58.75; P = .046) than their counterparts.

Conclusion

The recurrence of cervical precancerous lesion after cryotherapy was higher than the expert panel report by WHO with a higher proportion among women of old age and prolonged corticosteroid use. Cryotherapy showed a satisfying performance against the recurrence of cervical disease diagnosed through VIA. To substantiate, our findings, further prospective cohort study is also recommended.

Analysis of the surgical management of patients with recurrent cervical cancer after radiotherapy and chemotherapy

OBJECTIVE

To analyze the results of morbidity and survival after curative and palliative surgery in recurrent cervical cancer patients who underwent chemoradiation as their primary treatment. Another goal was to assess the factors associated with curative and non-curative procedures.

METHODS

This was a retrospective cohort consisting of patients undergoing surgery curative and palliative from January 2011 to December 2017 at a high complexity oncology center. Outcome of morbidity was reported according to the Clavien-Dindo classification, and survival analysis was carried out using the Kaplan-Meir method. To assess the factors associated with the procedures, a univariate analysis using the Mann-Whitney U test was performed.

RESULTS

Two radical hysterectomies, three pelvic exenterations with curative intent, and five palliatives pelvic exenterations were performed. In the curative group, there were major complications in 40% of the cases, and the median survival time was 16 months. In the palliative group, there were major complications in 60% of the cases, and the median survival time was 5 months. Advanced staging (p-value= 0.02), symptoms (p-value=0.04), tumor size greater than five centimeters (p-value=0.04), and more than three organs involved (p-value=0.003) were factors significantly associated with non-curative surgery.

CONCLUSIONS

The morbidity rates of this study were higher in palliative group, and the median survival time was lower in the palliative group than the curative group, but this difference in survival was not statistically significant. Advanced stage, symptoms, tumor size and number of organs involved are factors that should be taken into consideration when indicating surgical salvage.

Identification of Potential Prognostic Long Non-Coding RNA Biomarkers for Predicting Recurrence in Patients with Cervical Cancer

Background

Cervical cancer (CC) is one of the most common malignant tumors in women, and its treatment is often accompanied by high recurrence. We aimed to identify the long non-coding RNAs (lncRNAs) associated with CC recurrence.

Methods

We downloaded lncRNAs expression data of CC patients from The Cancer Genome Atlas (TCGA) dataset and used Cox regression models to analyze the lncRNAs relationship with CC recurrence. The significantly associated lncRNAs were utilized to construct a recurrence risk score (RRS) model. Bioinformatics analyses were used to assess the potential role of the critical lncRNAs in CC recurrence. The effect of critical lncRNAs on CC phenotype was determined by in vitro experiments.

Results

Using Cox regression analysis, four lncRNAs, ie, HCG11, CASC15, LINC00189, and LINC00905, were markedly associated with worse recurrence-free survival (RFS) of CC, whereas three lncRNAs, including HULC, LINC00173, and MIR22HG, were the opposite. After constructing the RRS model, Kaplan-Meier analysis revealed that patients with high RRS had significantly increased risk of recurrence. Among the 20 types of tumors in the TCGA database which all had adjacent normal tissues, MIR22HG and HCG11were significantly downregulated in 18 and 10 types of tumors including CC, respectively. Increased MIR22HG was significantly relevant to decreased risks of recurrence among the subgroups of age at diagnosis < 45 (Hazard Ratio (HR) = 0.26), stage I/II (HR = 0.33), T stage I/II (HR = 0.30), chemotherapy (HR = 0.18), and molecular therapy (HR = 0.16). Functionally, elevated MIR22HG expression could suppress CC cell proliferation, migration and invasion.

Conclusion

MIR22HG has a fundamental role in CC recurrence and could be served as a potential prognostic biomarker.