Clinical effects and prognosis of radiotherapy for early cervical cancer patients with postoperative lymph node metastasis / 中华放射医学与防护杂志

Objective:To retrospectively analyze the prognosis and related risk factors of lymph node metastasis in early-stage (Ⅰ B-Ⅱ A) cervical cancer patients with postoperative positive lymph nodes who were treated with intensity modulated radiotherapy (IMRT). Methods:A retrospective analysis was conducted for 292 early-stage cervical cancer patients with postoperative high and/or moderate risk factors who were treated with pelvic-abdominal IMRT with/without concurrent chemotherapy in Ningxia Medical University General Hospital from January 2016 to December 2018. These patients included 239 with negative pelvic lymph nodes and 53 with positive lymph nodes, who were incorporated into the negative group and the positive group, respectively. Multivariate and univariate analyses of the risk factors of lymph node metastasis and prognosis were performed for both groups.Results:The univariate and multivariate analyses showed that the lesion ≥4 cm, deep interstitial invasion, and the number of risk factors were independent factors influencing pelvic lymph node metastasis ( χ2 = 7.11, 9.05, 90.08, P < 0.05). There was no statistically significant difference in the 3- and 5-year OS ( P>0.05) between both groups. The 3-year disease-free survival (DFS) and 5-year DFS of the negative group were 87.6% and 84.5%, respectively, and those of the positive group were 72.5% and 69.3%, respectively ( χ2=8.59, P=0.003). Regarding failure modes, distant metastasis mainly occurred in the positive group, while local recurrence was dominant in the negative group ( χ2=9.40, P<0.05). The univariate analysis of the DFS in 53 patients with postoperative positive lymph nodes showed that deep interstitial invasion affected DFS, with statistically significant differences ( χ2 = 7.25, P < 0.05). The result of the multivariate analysis showed that the lesion size >4 cm, positive residual, and deep interstitial invasion significantly influenced the DFS ( χ2 = 4.37, 4.69, 4.39, P < 0.05). Conclusions:The lesion size, deep interstitial invasion, and risk factor number were independent factors influencing lymph node metastasis, and the DFS after radiotherapy of patients with pelvic lymph node metastasis was significantly lower than the patients with negative lymph nodes. The main recurrence type of patients with lymph node metastasis was distant metastasis. Moreover, the deep interstitial invasion was independent factor affecting the DFS of early-stage cervical cancer patients with postoperative positive lymph nodes.

Tailoring radicality in early cervical cancer: how far can we go? / 부인종양

Today, the patient who is diagnosed with early cervical cancer is offered a variety of treatments apart from standard therapy. Patients can be treated with a less radical hysterectomy (RH) regarding parametrectomy, a trachelectomy either vaginal or abdominal, and this can be performed through a minimal invasive or open procedure. All this in combination with nerve sparing and/or sentinel node technique. Level 1 evidence for the oncological safety of all these modifications is only available from 3 randomized controlled trials (RCTs). Two RCTs on more or less radical parametrectomy both showed that oncological safety was not compromised by doing less radical surgery. Because of the heterogeneity of the patient population and the high frequency of adjuvant radiotherapy, the true impact of surgical radicality cannot be assessed. Regarding the issue of oncological safety of fertility sparing treatments, case-control and retrospective case series suggest that trachelectomy is safe as long as the tumor diameter does not exceed 2 cm. Recently, both a RCT and 2 case-control studies showed a survival benefit for open surgery compared to minimally invasive surgery, whereas many previous case-control and retrospective case series on this subject did not show impaired oncological safety. In a case-control study the survival benefit for open surgery was restricted to the group of patients with a tumor diameter more than 2 cm. Although modifications of the traditional open RH seem safe for tumors with a diameter less than 2 cm, ongoing prospective RCTs and observational studies should give the final answer.

The clinical value of HPV E6/E7 mRNA and HPV DNA in early screening of cervical cancer / 天津医药

Objective To analyze the differences of positive detection rate and copy number of human papillomavirus (HPV) DNA and E6/E7 mRNA between different grades of cervical lesions, and evaluate their clinical values in early screen?ing of cervical cancer. Methods The cervical exfoliated cell samples from 154 women undergoing biopsy examination and 32 objects undergoing hysterectomy (control group) were collected in Tianjin Central Hospital of Gynecology Obstetrics in 2014. According to the pathological results of cervical biopsy, 154 samples were divided into low-grade squamous intraepi?thelial lesion group (LSIL, n=51), high-grade squamous intraepithelial lesion group (HSIL, n=71), and squamous cell carci?noma group (SCC, n=32). HPV DNA was tested with hybrid capture technology, and E6/E7 mRNA was detected with fluores?cence quantitative hybridization. Immunohistochemistry was performed by detecting E6/E7 protein in all patients after sur?gery or cervical biopsy. Results Combined results of HPV DNA and E6/E7 mRNA demonstrated that the positive detection rate was significantly lower in control group than that of all levels of lesion groups (P 10 000 E6/E7 were significantly increased in high-grade squamous intraepithelial lesion group. Immunohistochemical results showed that the positive detection rate of E6/E7 was significantly lower in control group than that of all levels of lesion groups (P<0.05). The positive rate of E6/E7 was significantly higher in the high-grade squa?mous intraepithelial lesion group than that of low-grade group (P<0.05). Conclusion HPV infection is closely related to cervical abnormalities, which is one of effective measures for early screening of cervical cancer. The negative result of HPV DNA is very helpful to exclude the cervical abnormality, whereas the positive detection of mRNA has great value in predict?ing the disease. Combined results of positive detection and copy number make a comprehensive evaluation for the risk of cer?vical lesions.

Ganglio centinela en cáncer de cuello uterino inicial: [revisión] / Sentinel lymph node in early cervical cancer: [review]

La determinación del primer ganglio que drena un tumor, denominado ganglio centinela (GC), permite su estudio selectivo, resultado que puede reducir las linfadenectomías cuando este ganglio resulta ser un adecuado predictor del estado ganglionar regional. Con ésta técnica diagnóstica, el estudio histopatológico de los ganglios se realiza con micro disección e inmunohistoquímica eventual de uno o 2 ganglios centinelas ganglios v/s un promedio de 18 ganglios de una linfadenectomía pelviana sistemática tradicional, estudiada con bisección y tinción clásica con hematoxilina eosina (gold standard).Entre un 16 por ciento a 18 por ciento de las pacientes en estadio IA2-IB1, presentan compromiso ganglionar las cuales se beneficiarían de ésta técnica diagnóstica al evitarse una linfadenectomía pelviana sistemática y eventualmente una histerectomía radical, dado que la presencia de metástasis ganglionares, tiene indicación de radioquimioterapia complementaria con similar control de la enfermedad, menor morbilidad y reducción de costos sanitarios. Por otro lado el 82 por ciento a 84 por ciento de pacientes sin compromiso ganglionar pueden verse favorecidas, si el test demuestra un valor predictivo negativo alto, con una tasa de falsos negativos menor al 5 por ciento, con lo cual el tratamiento podría quedar reducido a una histerectomía radical . Los datos publicados para casos de cáncer de cervix inicial, demuestran que este test ejecutado con técnica mixta, tiene una frecuencia de detección del93-97 por ciento, sensibilidad de 92-96 por ciento, un valor predictivo negativo de 96 por ciento, y tasa de Falsos Negativos cercano al 2 por ciento.

The determination of the first node to drain a tumor, called sentinel lymph node, allows its selective study, result that can reduce the linfadenectomies when this lymph node proves to be a proper predictor of the state regional lymph node. With this one diagnostic technology, the histopathology study is more comprehensive, when looking at fewer nodes (1 or 2) with nodal micro dissection and temporary employee immunohistochemistry v / s an average of 18 nodes in a systematic pelvic lymphadenectomy with traditional bisection and classic staining (goldstandard). Near 16 percent to 18 percent percent of the patients in stadium IA2-IB1, presented node involvement which would benefit from this diagnostic technique to avoid the pelvic lymphadenectomy and eventually a radical hysterectomy, given that the presence of lymph nodal metastasis is an indication of complementary radio chemotherapy with similar control of the disease, child morbidity and reducing health care costs. On the other hand 82 to 84 percent of patients without commitment lymphnode, may be favoured, if the test demonstrate a negative predictive value high, with a rate of false-negative less of 5 percent, with what the treatment could be reduced to a radical hysterectomy only.The data published for the cases of early cervical cancer, show that this test executed with mixed media, has a frequency of detection of 93-97 percent, sensitivity of 92-96 percent, a negative predictive value of 96 per cent, and rate of false-negative near to 2 percent.

A comparison of laparoscopically-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer / 부인종양

OBJECTIVE: The aim of this study was to compare peri-operative morbidity and safety of patients treated by laparoscopically-assisted radical vaginal hysterectomy (LARVH)with laparoscopic pelvic lymphadenectomy (LPL)and radical abdominal hysterectomy (RAH)with pelvic lymph node dissection (PLND) in early stage of cervical cancer. METHODS: Since September 2004,all patients with FIGO stage Ia-IIa cervical cancer undergoing radical surgery by members of our division have been entered into a prospective database. Two surgeons at our center have performed LARVH by Schneider method on all surgically appropriate patients. RESULTS: Between September 2004 and May 2005, 26 patients were performed LARVH with LPL,30 patients were performed RAH with PLND. There were no differences in estimated blood loss, the number of lymph nodes, duration of hospital stay and postoperative complications.But operative time was significantly prolonged in LARVH group. Intraoperative complications in the LARVH with LPL group included: bladder injuries(2), shift to laparotomy due to ureter injury(1). There was one case of vesicovaginal fistula in the RAH group. CONCLUSION: LARVH with LPL in early stage of cervical cancer is a safe and technically effective alternative to RAH. Despite the inherent limitations of LARVH with LPL and its associated learning curve, the procedure conveys many advantages over the open laparotomy technics in terms of postoperative wound pain and recovery. However further study is needed to evaluate long-term recurrence rate and survival rate.

A study of dose distribution in postoperative radiotherapy in uterine cervical cancer / 영남의대학술지

Uterine cervical cancer is the most common malignancy in Korean women. In spite of recent development of early diagnostic and therapeutic modalities, about 40% of treated patient will develop relapse. So more aggressive local treatment such as more extensive surgery and higher radiation dose and administration of systemic chemotherapy will promote the curability but treatment related complications cannot be avoidable. We used 22 cases of early cervical cancer, treated with surgery and post-operative radiotherapy, clinical data of these patients were analyzed to determine relationship between clinical parameters and final outcome. Three out of 22 cases revealed relapse and one patient showed rectovaginal fistula and another patient showed small bowel obstruction and the other patient showed rectal obstruction. Two out of three recurrence were stage IIa and the other one case was stage Ib adenocarcinoma with lymphovascular involvement. Nineteen out of 22 cases were followed without remarkable side effect or treatment related complication or sequelae. We concluded that out treatment policy was safe and effective to eradicate high risk postoperative cervical cancer with acceptable side effects or complication.