Prognostic factors in Asian and white American patients with cervical cancer, considering competing risks

Proportions and incidence of locally advanced cervical cancer: a global systematic literature review

BACKGROUND

Optimal treatment of cervical cancer is based on disease stage; therefore, an understanding of the global epidemiology of specific stages of locally advanced disease is needed.

OBJECTIVE

This systematic literature review was conducted to understand the global and region-specific proportions of patients with cervical cancer with locally advanced disease and to determine the incidence of the locally advanced disease.

METHODS

Systematic searches identified observational studies published in English between 2010 and June 10, 2020, reporting the proportion of patients with, and/or incidence of, locally advanced stages of cervical cancer (considered International Federation of Gynecology and Obstetrics (FIGO) IB2-IVA). Any staging criteria were considered as long as the proportion with locally advanced disease was distinguishable. For each study, the proportion of locally advanced disease among the cervical cancer population was estimated.

RESULTS

The 40 included studies represented 28 countries in North or South America, Asia, Europe, and Africa. Thirty-eight studies reported the proportion of locally advanced disease among populations with cervical cancer. The estimated median proportion of locally advanced disease among all cervical cancer was 37.0% (range 5.6-97.5%; IQR 25.8-52.1%); estimates were generally lowest in North America and highest in Asia. Estimated proportions of ≥50% were reported in nine studies from Asia, Europe, Brazil, and Morocco; estimates ≤25% were reported in six studies from Asia, United States, Brazil, and South Africa. Locally advanced disease was reported for 44% and 49% of women aged >70 and ≥60 years, and 5-100% of younger women with cervical cancer. A greater proportion of locally advanced disease was reported for Asian American (19%) versus White women (8%) in one United States study. Two of five studies describing the incidence of locally advanced disease reported rates of 2-4/100 000 women among different time frames.

CONCLUSION

This review highlights global differences in proportions of locally advanced cervical cancer, including regional variance and disparities according to patient race and age.

Aryl hydrocarbon receptor is a prognostic biomarker and is correlated with immune responses in cervical cancer

Aryl hydrocarbon receptor (AHR) plays an important role in tumor development. However, its function in cervical cancer has not been fully elucidated. We evaluated the ten genes that are predicted to associate with AHR protein interaction. The comprehensive scores were: CYP1A1, ARNT2, HSP90AA1, ARNT, AIP, PTGES3, HSP90AB1, CYP1B1, ESR1, MAF, respectively. In addition, we showed that levels of AHR and its related genes were correlated with the immune infiltration and expression of immuno-regulators (immunoinhibitors, immunostimulators, MHC molecules) levels in cervical cancer. High expression of AHR, CYP1A1, HSP90AA1, and HSP90AB1 and low expression of ESR1 were negatively correlated with the prognoses of cervical cancer patients. The Cox multivariate regression showed that high expression of AHR (HR = 1.874, 95% CI = 1.069–3.285, P= 0.028) and CYP1A1 (HR = 1.822, 95%CI = 1.077–3.080, P= 0.025) were risk factors for prognosis in patients with cervical cancer. IHC results indicated that AHR and CYP1A1 were widely expressed in cervical cancer. These findings suggest that AHR and CYP1A1 may serve as prognostic biomarkers for determining prognosis and immune infiltration in cervical cancer.

Competing risk nomogram predicting cancer-specific mortality for endometrial cancer patients treated with hysterectomy

Background

The incidence of endometrial cancer has tended to increase in recent years. However, competing risk nomogram combining comprehensive factors for endometrial cancer patients treated with hysterectomy is still scarce. Therefore, we aimed to build a competing risk nomogram predicting cancer‐specific mortality for endometrial cancer patients treated with hysterectomy.

Methods

Patients diagnosed with endometrial cancer between 2010 and 2012 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk model was performed to select prognostic variables to build the competing risk nomogram to predict the cumulative 3‐ and 5‐year incidences of endometrial cancer‐specific mortality. Harrell's C‐index, receiver operating characteristic (ROC) curve, and calibration plot were used in the internal validation. And decision curve analysis was applied to evaluate clinical utility.

Results

A total of 10,447 patients were selected for analysis. The competing risk nomogram identified eight prognostic variables, including age at diagnosis, race, marital status at diagnosis, grade, histology, tumor size, FIGO stage, and number of regional nodes positive. The C‐index of the competing risk nomogram was 0.857 (95% confidence interval [CI]: 0.854–0.859), and the calibration plots were adequately fitted. When the threshold probabilities were between 1% and 57% for 3‐year prediction and between 2% and 67% for 5‐year prediction, the competing risk nomogram was of good clinical utility.

Conclusions

A competing risk nomogram for endometrial cancer patients treated with hysterectomy was successfully built and internally validated. It was an accurately predicted and clinical useful tool, which could play an important role in consulting and health care management of endometrial cancer patients.

Morphological Characteristics and Clinical Significance of Different Types of Tumor Vessels in Patients with Stages I-IIA of Squamous Cervical Cancer

The determination of factors associated with progression of cervical cancer is important, both for a recurrence risk assessment and for determining optimal treatment tactics. Previously, we showed the prognostic value of different types of tumor microvessels (MVs) in gastric and breast cancer. The object of this research was to study the morphology and clinical significance of different tumor microvessels in early cervical cancer. A total of 65 archived paraffin blocks of patients with I-IIA stages of squamous cervical cancer were investigated. Samples were stained with Mayer hematoxylin and immunohistochemically using antibodies to CD34, podoplanin, HIF-1a, and Snail. The eight types of tumor MVs differed in morphology were identified. It was established that only the dilated capillaries (DСs) with weak expression of CD34, the contact type DCs, the capillaries in tumor solid component, and the lymphatic vessels in the lymphoid and polymorphic cell infiltrates of tumor stroma are associated with clinical and pathological characteristics of early cervical cancer. Preliminary results also suggest that a combination of fragmentation in tumor solid component and the contact type DCs may predict a recurrence of early cervical cancer. Given the small number of cervical cancer recurrences, the predictive significance of the described markers requires a more thorough examination.

Patterns of metastases in cervical cancer: a population-based study

To investigate the incidence, prognosis, and treatment modality of different metastatic sites in cervical cancer.

METHODS

We used the surveillance epidemiology and end results (SEER) database to collect cervical cancer patients with metastasis from 2010-2016. Kaplan-Meier survival analyses and log-rank tests were used to compare overall survival between groups. Univariate and multivariate Cox proportional hazards regression analyses were used for identifying the prognostic factors in metastatic cervical cancer.

RESULTS

In total, 1347 patients with distant metastatic cervical cancer were selected for the study. The average age of patients with metastatic cervical cancer was 57 years old. Unmarried white patients were the majority. About 7.9%, 53.3%, and 64.6% patients were treated with surgery, radiation, and chemotherapy, respectively. Additionally, lungs were the most common metastatic sites. The survivals of single-site metastases were similar, which were better than multi-organ metastases. Lung metastatic patients were older than other metastatic patients, and with poorer differentiation and higher stage tumors. In terms of treatment, bone metastatic patients were more commonly treated with radiotherapy (68.4%) than other metastatic patterns. Surgery, radiation, and chemotherapy all prolonged survival months of single-site and multi-site metastatic patients. Furthermore, age, ethnicity, tumor stage, surgery, radiotherapy, chemotherapy, and metastatic sites were independent prognostic factors for patients with metastatic cervical cancer.

CONCLUSIONS

This large-population based study showed that the most common metastatic site of cervical cancer is lung. Although lung metastatic patients harbor older ages and poorer differentiation and higher stage tumors than other sites, the prognosis of lung metastasis is similar to other single metastatic sites. However, the single-site metastatic patients survive longer than multi-site metastatic patients. Surgery, radiotherapy, and chemotherapy all bring benefit to patients with metastases, which may guide the treatment in metastatic cervical cancers.

Correlation Between Single Nucleotide Polymorphisms of an miRNA Binding Site in the 3'UTR of PTEN and Risk of Cervical Cancer Among the Han Chinese

Objective: To analyze the association between a single nucleotide polymorphism (SNP) in the 3' untranslated region (UTR) of the phosphatase and tensin homolog (PTEN) gene, that is within a microRNA (miRNA) binding site, and the risk of Chinese Han cervical cancer. Methods: A case-control study was carried out to analyze the genotype of the PTEN rs34140758 locus in 210 surgically treated, Han Chinese, cervical cancer patients and 210 healthy controls. The levels of the miRNAs hsa-miR-586 and hsa-miR-622 and the PTEN mRNA were analyzed by real-time reverse transcription-quantitative polymerase chain reaction in the cancerous and adjacent normal tissues from all cases. HeLa cells were transfected with the miRNAs, hsa-miR-586 and hsa-miR-622, to analyze their effects on PTEN gene expression. Results: After adjusting for age, body-mass index, alcohol consumption, smoking, and familial history of cancer, the PTEN rs34140758 A allele carriers were 1.47 times more likely to suffer from cervical cancer than the C allele carriers (odds ratio [OR] = 1.47, 95% confidence interval [CI]: 1.17-1.72, p = 0.001). Both hsa-miR-586 and hsa-miR-622 were highly expressed in the cancerous tissues of the cervical cancer patients, whereas PTEN expression was low. HeLa cell transfection experiments showed that hsa-miR-586 and hsa-miR-622 inhibited PTEN gene expression. The results of a dual-luciferase reporter assay showed that the PTEN gene is a target for both hsa-miR-586 and hsa-miR-622. Conclusion: The PTEN 3'UTR rs34140758 locus SNP is associated with the risk of cervical cancer in the Han Chinese population. The molecular mechanism may be that the rs34140758 SNP affects the regulation of PTEN gene expression through interaction with the hsa-miR-586 and hsa-miR-622 miRNAs.