Prognostic Value of Lymph Node Characteristics in Patients with Cervical Cancer Treated with Radical Hysterectomy

A Scoring System to Select the Candidates for Adjuvant Chemotherapy Alone in High-Risk Early-Stage Cervical Cancer Patients With Pelvic Lymph Node Metastases After Surgery

BACKGROUND

The aim was to build a risk scoring system to guide the adjuvant treatment for early-stage cervical cancer patients with pelvic lymph node (LN) metastases after surgery.

METHODS

A cohort of 1213 early-stage cervical cancer patients with pelvic LN metastases (T1-2aN1M0) were selected from the NCI SEER database, of which 1040 patients received adjuvant external beam radiotherapy concurrent with chemotherapy (EBRT+Chemo) and 173 patients received adjuvant chemotherapy alone. The Cox regression analysis was applied to identify the risk factors associated with worse survival. The exp (β) of each independent risk factors from multivariate analysis was assigned to develop the risk scoring system. The total cohort was divided into different risk subgroups accordingly and the efficacy of different adjuvant modalities in each risk subgroups was compared.

RESULTS

The patients were divided into 3 risk subgroups (Low-risk: total score <7.20, Middle-risk:7.20≤ total score≤ 8.40, High-risk: total score<8.40) based on the scoring system incorporating 5 independent risk factors. The survival analysis suggested that low-risk (hazard ratio [HR]=1.046, 95% CI: 0.586-1.867; P= 0.879) and middle-risk patients (HR=0.709, 95% CI: 0.459-1.096; P =0.122) could not benefit more from EBRT+Chemo than Chemo alone. However, EBRT+Chemo remained the superiority to Chemo alone in the high-risk subgroup (HR=0.482, 95% CI: 0.294-0.791; P =0.003).

CONCLUSION

A risk scoring system has been built to direct the adjuvant treatment for early-stage cervical cancer patients with pelvic LN metastases after surgery, where Chemo alone was totally enough for low-risk and middle-risk patients stratified by the model while EBRT+Chemo was still recommended for patients in the high-risk subgroup.

Fatty acid metabolism: A new therapeutic target for cervical cancer

Cervical cancer (CC) is one of the most common malignancies in women. Cancer cells can use metabolic reprogramming to produce macromolecules and ATP needed to sustain cell growth, division and survival. Recent evidence suggests that fatty acid metabolism and its related lipid metabolic pathways are closely related to the malignant progression of CC. In particular, it involves the synthesis, uptake, activation, oxidation, and transport of fatty acids. Similarly, more and more attention has been paid to the effects of intracellular lipolysis, transcriptional regulatory factors, other lipid metabolic pathways and diet on CC. This study reviews the latest evidence of the link between fatty acid metabolism and CC; it not only reveals its core mechanism but also discusses promising targeted drugs for fatty acid metabolism. This study on the complex relationship between carcinogenic signals and fatty acid metabolism suggests that fatty acid metabolism will become a new therapeutic target in CC.

Calcium channel blocker and risk of postoperation lymphatic-related complications among gynecologic malignances

Purpose

This study was performed to assess the association of calcium channel blockers (CCB) and other potential factors with postoperative lymphatic-related morbidity in patients with cervical cancer and endometrial carcinoma.

Methods

Patients diagnosed with cervical cancer or endometrial carcinoma with pelvic lymphadenectomy between January 2017 and January 2022 were enrolled. Postoperative lymphatic-related morbidity was evaluated by calculating the lymph cyst occurrence within 3 months after surgery and the duration of pelvic drainage. Univariate analyses evaluating the risk factors for lymphatic-related morbidity were performed.

Results

Of a total of 251 patients, 52 patients were diagnosed with lymphatic cysts by B-ultrasound or computed tomography, and the duration of drainage from 110 patients exceeded the average number of days. Univariable analysis revealed that hypertension, CCB, and lymph node metastasis were independent predictors of postoperative complications.

Conclusions

This study demonstrated that CCB may be a factor associated with the incidence of postoperation lymph cysts, and CCB usage prolongs the duration of pelvic drainage.

Prognostic value of lymph node ratio in cervical cancer: A meta-analysis

BACKGROUND

The role of the lymph node ratio (LNR) in the existing tumor node metastasis classification system should be verified as one of the prognosis prediction factors. This work evaluated LNR's performance in predicting cervical cancer (CC) prognosis through a meta-analysis.

METHOD

Related studies were retrieved from the Cochrane Library, EMBASE, and PubMed databases. The language was restricted to English. The combined hazard ratios (HRs) were utilized to analyze the prognostic value of LNR.

RESULTS

Our study included 8 articles with 3325 subjects published after 2015. Based on our analysis, high LNR was the adverse prognostic factor for overall survival (OS, HR = 1.45; 95% CI = 1.23-1.73; P = .238) and disease-free survival (DFS, HR = 2.69; 95% CI = 1.98-3.66; P = .597) among the CC cases. Furthermore, as revealed by subgroup analysis, in CC patients, median LNR of about 0.0625 and 0.066 served as the prominent risk factor for DFS and OS.

CONCLUSIONS

The current work illustrates that elevated LNR is related to the dismal prognosis of CC. More well-designed clinical studies are warranted for assessing whether LNR is a factor independently predicting the prognosis of CC.