Assessment of Hypoxic Tissue Fraction and Prediction of Survival in Cervical Carcinoma by Dynamic Contrast-Enhanced MRI

Study on the Relationship Between Uncertainty Tolerance and Positive Acceptance in Postoperative Patients With Cervical Cancer

OBJECTIVE

The objective of this study is to clarify the correlation between uncertainty tolerance (UT) and positive acceptance (PA) in patients with cervical cancer (CC) after surgical treatment.

METHODS

A total of 233 patients with CC who had undergone surgery were included and were scored on the UT Scale and Positive Acceptance Scale. In addition, patients were classified according to the length of stay ≥1 week and length of stay <1 week, and the UT score and satisfaction and enterprising score of the two groups were compared. This was performed in order to analyze the effect of length of hospital stay on UT and PA.

RESULTS

The mean UT score of 233 patients was 3.74±0.34 and the mean PA score was 1.96±0.20, with a negative correlation and a significant correlation coefficient (r=-0.342, P 0.05). The UT score of post-operative CC patients with length of stay ≥1 week was significantly higher than that of patients with length of stay <1 week, P<0.05. The score of PA in patients with post-operative CC whose hospital stay was ≥1 week was significantly lower than for patients with hospital stays <1 week (P<0.05). UT was negatively correlated with PA in patients with hospital stays < 1 week (r=-0.358, P<0.05). There was a significant negative correlation between UT and PA in patients with hospital stay ≥1 week (r =-0.493, P<0.05). Increased hospitalization time correlated with increased scores of UT, with reductions in scores of PA.

CONCLUSION

Post-operative patients with CC had higher scores of UT and lower scores of PA, which were negatively correlated. Increased hospitalization time was linked to a detriment in patient UT and reduced PA. Targeted interventions to improve the level of UT and PA within postoperative CC cases should be developed.

The Utility of Contrast-Enhanced Magnetic Resonance Imaging in Uterine Cervical Cancer: A Systematic Review

Correct staging of cervical cancer is essential to establish the best therapeutic procedure and prognosis for the patient. MRI is the best imaging modality for local staging and follow-up. According to the latest ESUR guidelines, T2WI and DWI-MR sequences are fundamental in these settings, and CE-MRI remains optional. This systematic review, according to the PRISMA 2020 checklist, aims to give an overview of the literature regarding the use of contrast in MRI in cervical cancer and provide more specific indications of when it may be helpful. Systematic searches on PubMed and Web Of Science (WOS) were performed, and 97 papers were included; 1 paper was added considering the references of included articles. From our literature review, it emerged that many papers about the use of contrast in cervical cancer are dated, especially about staging and detection of tumor recurrence. We did not find strong evidence suggesting that CE-MRI is helpful in any clinical setting for cervical cancer staging and detection of tumor recurrence. There is growing evidence that perfusion parameters and perfusion-derived radiomics models might have a role as prognostic and predictive biomarkers, but the lack of standardization and validation limits their use in a research setting.

Eukaryotic initiation factor 5A2 mediates hypoxia-induced autophagy and cisplatin resistance

Hypoxia-induced cisplatin resistance is a major challenge during non-small cell lung cancer (NSCLC) treatment. Based on previous studies, we further explored the effect of eukaryotic initiation factor 5A2 (eIF5A2) in hypoxia-induced cisplatin resistance. In this study, we found that autophagy and cisplatin resistance were increased under hypoxic conditions in three different NSCLC cell lines. Compared with that under normoxic conditions, dramatic upregulation of eIF5A2 and hypoxia inducible factor 1 subunit alpha (HIF-1α) levels were detected under hypoxia exposure. Small interfering RNA silencing of HIF-1α resulted in decreased expression of eIF5A2, indicating that eIF5A2 acts downstream of HIF-1α. In addition, the expression of eIF5A2 was significantly higher in NSCLC tumors compared with that in normal tissues. RNA silencing-mediated downregulation of eIF5A2 decreased hypoxia-induced autophagy, thereby reducing hypoxia-induced cisplatin resistance in NSCLC cells. The roles of eIF5A2 in cisplatin resistance were further validated in vivo. Combined treatment using eIF5A2-targeted downregulation together with cisplatin significantly inhibited tumor growth compared with cisplatin alone in the subcutaneous mouse model. In conclusions, eIF5A2 overexpression is involved in hypoxia-induced autophagy during cisplatin resistance. We suggest that a combination of eIF5A2 targeted therapy and cisplatin chemotherapy is probably an effective strategy to reverse hypoxia-induced cisplatin resistance and inhibit NSCLC development.

The Role of Imaging Biomarkers to Guide Pharmacological Interventions Targeting Tumor Hypoxia

Hypoxia is a common feature of solid tumors that contributes to angiogenesis, invasiveness, metastasis, altered metabolism and genomic instability. As hypoxia is a major actor in tumor progression and resistance to radiotherapy, chemotherapy and immunotherapy, multiple approaches have emerged to target tumor hypoxia. It includes among others pharmacological interventions designed to alleviate tumor hypoxia at the time of radiation therapy, prodrugs that are selectively activated in hypoxic cells or inhibitors of molecular targets involved in hypoxic cell survival (i.e., hypoxia inducible factors HIFs, PI3K/AKT/mTOR pathway, unfolded protein response). While numerous strategies were successful in pre-clinical models, their translation in the clinical practice has been disappointing so far. This therapeutic failure often results from the absence of appropriate stratification of patients that could benefit from targeted interventions. Companion diagnostics may help at different levels of the research and development, and in matching a patient to a specific intervention targeting hypoxia. In this review, we discuss the relative merits of the existing hypoxia biomarkers, their current status and the challenges for their future validation as companion diagnostics adapted to the nature of the intervention.