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Chouchane-Mlik O, Oniga A, Latouche A, Halladjian M, Kleine-Borgmann FB, Gérardy JJ, Mittelbronn M, Kamal M, Scholl SM. Systematic assessment of tumor necrosis at baseline in cervical cancer - An independent factor associated with poor outcome. Hum Pathol 2024; 143:62-70. [PMID: 38135059 DOI: 10.1016/j.humpath.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
Cervical cancer (CC) is a leading challenge in oncology worldwide, with high prevalence and mortality rates in young adults, most prominent in low to middle-income countries with marginal screening facilities. From the prospectively collected BioRAIDS (NCT02428842) cohort of primary squamous CC conducted in 7 European countries, a central pathology review was carried out on 294 patients' tumors. The focus was on identification of tumor-stromal characteristics such as CD8+, CD45+, CD68+ staining cells, PD-L1 expression, tumor infiltrating lymphocytes (TILs) together with the degree of tumor necrosis. Both (FIGO-2018) stage (I-II/III-IV) as well as tumor necrosis were highly significantly associated with Progression-free Survival (PFS); with tumor necrosis scoring as most potent independent factor in a multivariable analysis (p < 0.001). Tumor necrosis can be assessed in the very first diagnostic biopsyand our data suggest that this rapid, simple and cost-effective biomarker, should be routinely assessed prior to treatment decisions.
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Affiliation(s)
- Olfa Chouchane-Mlik
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg.
| | - Alexandra Oniga
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg
| | - Aurélien Latouche
- Statistical Methods for Precision Medicine, PSL Research University, Mines Paris Tech, INSERM U900, Paris, France; Conservatoire National des Arts et Métiers, Paris, France
| | - Maral Halladjian
- Department of Drug Development and Innovation, Institut Curie, PSL Research University, Paris & Saint-Cloud, France
| | - Felix B Kleine-Borgmann
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg; Luxembourg Centre of Neuropathology (LCNP), Luxembourg
| | - Jean-Jacques Gérardy
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg; Luxembourg Centre of Neuropathology (LCNP), Luxembourg
| | - Michel Mittelbronn
- National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Dudelange, Luxembourg; Luxembourg Centre of Neuropathology (LCNP), Luxembourg; Department of Oncology (DONC), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg; Department of Life Sciences and Medicine, University of Luxembourg, Esch sur Alzette, Luxembourg; Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg; Faculty of Science, Technology and Medicine (FSTM), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Maud Kamal
- Department of Drug Development and Innovation, Institut Curie, PSL Research University, Paris & Saint-Cloud, France.
| | - Suzy M Scholl
- Department of Drug Development and Innovation, Institut Curie, PSL Research University, Paris & Saint-Cloud, France.
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Zheng Z, Hu K, Hou X, Yu L, Yan J, Zhang F. Radiotherapy for postoperative vaginal recurrences of cervical squamous cell carcinoma: analysis of dosing and prognosis. J OBSTET GYNAECOL 2023; 43:2213328. [PMID: 37462369 DOI: 10.1080/01443615.2023.2213328] [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: 07/25/2022] [Accepted: 04/16/2023] [Indexed: 07/21/2023]
Abstract
Squamous cell carcinoma (SCC) is the most common type of vaginal recurrence in cervical cancer patients, and the role of salvage radiotherapy on these patients remains unclear. This study aimed to investigate the efficacy of salvage radiotherapy for vaginal recurrence of SCC in patients who previously underwent surgery and to explore prognostic factors associated with survival. Ninety-seven patients with histologically proven SCC who were treated for vaginal recurrence at Peking Union Medical College Hospital were identified. All patients had previously undergone surgery and received salvage radiotherapy. Factors predictive of overall survival (OS), progression-free survival (PFS), and local control (LC) were investigated. The median follow-up time was 42.5 months. The estimated 5-year OS, PFS, and LC rates were 84%, 79%, and 91%. On multivariate analysis, inguinal lymph node metastasis was significantly associated with poor OS; a tumour size ≤4 cm was associated with longer PFS (p < 0.05); the recurrence pattern was an independent predictor of LC (p < 0.05). In the 45 patients with recurrences that were paravaginal or invasive of surrounding organs, biologically equivalent doses in 2 Gy fractions of ≥72.6 Gy were independently predictive of longer LC (p < 0.05). RT is an effective treatment for postoperative vaginal recurrence in patients with cervical SCC. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.Impact statementWhat is already known on this subject? Radiotherapy plays a critical role in treating recurrent cervical cancer, but the effectiveness of RT for vaginal recurrence in patients who previously underwent surgery remains limited. Few studies have focussed on the effect of RT dose on patient survival.What do the results of this study add? This study investigated the efficacy of RT in patients with cervical squamous cell carcinoma who experienced postoperative recurrence. Lymph node metastasis, tumour size and recurrence pattern were significantly associated with survival. Moreover, an EQD2 ≥ 72.6 Gy was independently predictive of longer LC.What are the implications of these findings for clinical practice and/or further research? RT is an effective treatment for postoperative vaginal recurrence in patients with cervical squamous cell carcinoma. For patients with extravaginal recurrence, a salvage dose of ≥72.6 Gy appears to be optimal.
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Affiliation(s)
- Ziye Zheng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lihua Yu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
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Khan S, Sheikh T, Castro G, Barengo NC. Effect Modification of Race on the Associated Tumor Size at Diagnosis and 10-Year Cancer Survival Rates in Women with Cervical Squamous Cell Carcinoma in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6742. [PMID: 37754602 PMCID: PMC10530672 DOI: 10.3390/ijerph20186742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND While there may be an association between race, tumor size, and survival in patients with cervical squamous cell carcinoma (SCC), evidence on the effect of race on the association between tumor size at diagnosis and survival is limited. Our study evaluated whether race modifies the association between tumor size and 10-year survival in cervical SCC. METHODS This non-concurrent cohort study with the Surveillance, Epidemiology, and End Results (SEER) database included women diagnosed with cervical SCC between 2004-2018. The independent variable was diagnosis tumor size, where 2-4 cm was classified as high risk, and <2 cm was considered low risk. The dependent variable was 10-year cancer-specific survival rates, and race was our effect modifier. Unadjusted and adjusted Cox regression analysis were conducted to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS While a higher proportion of Black/Asian/Pacific Islander patients presented with tumor sizes of 2-4 cm compared to <2 cm (32.8% vs. 22.3%; p = 0.007) and having a tumor size of 2-4 cm had a significantly decreased 10-year survival (HR: 2.7; 95% CI: 1.3-5.8), the interaction between race and 10-year cancer-specific survival was not significant. CONCLUSION Although race did not modify the interaction between tumor size and 10-year survival, emphasis needs to be placed on screening and proper data collection, especially for minority races, and studies with larger sample sizes should be conducted in order to better implement future recommendations to improve health and survival.
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Affiliation(s)
- Samara Khan
- Division of Medical and Population Health Sciences Education and Research, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (T.S.); (G.C.); (N.C.B.)
| | - Tooba Sheikh
- Division of Medical and Population Health Sciences Education and Research, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (T.S.); (G.C.); (N.C.B.)
| | - Grettel Castro
- Division of Medical and Population Health Sciences Education and Research, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (T.S.); (G.C.); (N.C.B.)
| | - Noël C. Barengo
- Division of Medical and Population Health Sciences Education and Research, Department of Medical Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (T.S.); (G.C.); (N.C.B.)
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata 7600, Argentina
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Fan X, Wang Y, Yang N, Zhu P. Prognostic analysis of patients with stage IIIC1p cervical cancer treated by surgery. World J Surg Oncol 2023; 21:186. [PMID: 37344912 DOI: 10.1186/s12957-023-03076-9] [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: 03/24/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is one of the most common gynaecologic malignancies. The prognosis of stage IIIC1p cervical cancer patients treated by surgery is heterogeneous. Therefore, the aim of this study was to analyse the factors influencing the prognosis in such patients. METHODS From January 2012 to December 2017, 102 patients with cervical cancer who underwent surgical treatment in the Department of Gynaecology and Tumours, Changzhou Maternal and Child Health Hospital, and had pelvic lymph node metastasis confirmed by pathology were analysed retrospectively. All patients underwent radical hysterectomy with/without oophorectomy with pelvic lymphadenectomy with/without para-aortic lymphadenectomy. Clinical data was collected including age, surgical method, ovarian status, intraoperative blood loss, perioperative complications, tumour size, pathological type, depth of stromal invasion (DSI), whether the lymphatic vascular space was infiltrated, number of pelvic lymph node metastases, location of pelvic lymph node metastases, total number of lymph nodes resected, lymph node ratio (LNR), nature of vaginal margin, whether parametrium was involved, postoperative adjuvant therapy, preoperative neutrophil-lymphocyte ratio (NLR) and prognostic information of patients. Survival curves for overall survival (OS) and disease-free survival (DFS) were plotted using the Kaplan-Meier method, and the difference between the survival curves was tested using the log-rank test. Univariate and multivariate COX regression models were used to assess the factors associated with overall survival and disease-free survival in patients with stage IIIC1p cervical cancer. Nomogram plots were constructed to predict OS and DFS, and the predictive accuracy of the nomograms was measured by Harrell's C-index and calibration curves. RESULTS A total of 102 patients with stage IIIC1p cervical cancer were included in the study, and the median follow-up time was 63 months (range from 6 to 130 months). The 5-year OS was 64.7%, and the 5-year DFS was 62.7%. Multivariate analysis showed that no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8 were independent risk factors for OS and DFS in patients with stage IIIC1p cervical cancer. CONCLUSIONS Patients with stage IIIC1p cervical cancer have a poor prognosis. Lower OS and DFS were associated with no postoperative adjuvant therapy, LNR > 0.3 and NLR > 3.8.
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Affiliation(s)
- Xiang Fan
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Yifei Wang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Ni Yang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Pengfeng Zhu
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
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Liu J, Li S, Cao Q, Zhang Y, Nickel MD, Wu Y, Zhu J, Cheng J. Risk factors for the recurrence of cervical cancer using MR-based T1 mapping: A pilot study. Front Oncol 2023; 13:1133709. [PMID: 37007135 PMCID: PMC10061013 DOI: 10.3389/fonc.2023.1133709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesThis study aimed to identify risk factors for recurrence in patients with cervical cancer (CC) through quantitative T1 mapping.MethodsA cohort of 107 patients histopathologically diagnosed with CC at our institution between May 2018 and April 2021 was categorized into surgical and non-surgical groups. Patients in each group were further divided into recurrence and non-recurrence subgroups depending on whether they showed recurrence or metastasis within 3 years of treatment. The longitudinal relaxation time (native T1) and apparent diffusion coefficient (ADC) value of the tumor were calculated. The differences between native T1 and ADC values of the recurrence and non-recurrence subgroups were analyzed, and receiver operating characteristic (ROC) curves were drawn for parameters with statistical differences. Logistic regression was performed for analysis of significant factors affecting CC recurrence. Recurrence-free survival rates were estimated by Kaplan–Meier analysis and compared using the log-rank test.ResultsThirteen and 10 patients in the surgical and non-surgical groups, respectively, showed recurrence after treatment. There were significant differences in native T1 values between the recurrence and non-recurrence subgroups in the surgical and non-surgical groups (P<0.05); however, there was no difference in ADC values (P>0.05). The areas under the ROC curve of native T1 values for discriminating recurrence of CC after surgical and non-surgical treatment were 0.742 and 0.780, respectively. Logistic regression analysis indicated that native T1 values were risk factors for tumor recurrence in the surgical and non-surgical groups (P=0.004 and 0.040, respectively). Compared with cut-offs, recurrence-free survival curves of patients with higher native T1 values of the two groups were significantly different from those with lower ones (P=0.000 and 0.016, respectively).ConclusionQuantitative T1 mapping could help identify CC patients with a high risk of recurrence, supplementing information on tumor prognosis other than clinicopathological features and providing the basis for individualized treatment and follow-up schemes.
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Affiliation(s)
- Jie Liu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jie Liu,
| | - Shujian Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qinchen Cao
- Department of Radiotreatment, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marcel Dominik Nickel
- Magnetic Resonance (MR) Application Predevelopment, Siemens Healthcare Gesellschaft mit beschrankter Haftung (GmbH), Erlangen, Germany
| | - Yanglei Wu
- Magnetic Resonance (MR) Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Jinxia Zhu
- Magnetic Resonance (MR) Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Zhang Y, Ding J, Hua K. Data from small cell neuroendocrine carcinoma of the cervix: FIGO 2018 staging is more accurate than FIGO 2009. J Int Med Res 2022; 50:3000605211067397. [PMID: 34986672 PMCID: PMC8753085 DOI: 10.1177/03000605211067397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the prognostic value of International Federation of Gynecology and Obstetrics (FIGO) 2009 and 2018 staging systems in surgical patients with small cell neuroendocrine carcinoma of the cervix (SCNEC). METHODS We re-staged 64 surgical IB-IIA (FIGO 2009) SCNEC patients according to the FIGO 2018 system and refined stage IIIC of FIGO 2018 based on tumor local invasion. The prognostic factors were analyzed, and the advantages of FIGO 2018 were compared with 2009. RESULTS The 5-year overall survival rate (OS) was 78.5% for stage I and 22.2% for stage II (FIGO 2009). In FIGO 2018, there was no difference between stage I and II, and the 5-year OS was 74.1%, 60.2%, and 0% for stage I/II, IIIC1, and IIIC2. After combining stage IIIC with the local invasion stage (T1 was limited to the cervix and vagina; T2 involved the parametrium; T3 involved the pelvic or abdominal cavity), the 5-year OS for stage IIICT1, IIICT2, and IIICT3 was 83.3%, 30.0%, and 0%, respectively. CONCLUSIONS For stage II SCNEC patients, FIGO 2009 underestimated the prognosis, while FIGO 2018 was more accurate. For stage IIIC, FIGO 2018 might be more individualized and accurate after combining stage IIIC with tumor local invasion.
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Affiliation(s)
- Yunqiang Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital, Shanghai, P.R. China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P.R. China
- Keqin Hua, Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai 200090, P.R. China.
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