Low serum selenium concentration in patients with cervical or endometrial cancer

Serum concentrations of selenium were determined in 37 patients with cervical and 64 patients with endometrial cancer. The patients had lower (P less than 0.001) serum concentrations of selenium than the age-, weight- and place of residence-matched paired control women. There was no difference in the selenium concentration between various age groups or different clinical stages of cervical or endometrial cancer. A low serum concentration of selenium might be a contributing factor in uterine carcinogenesis.     

Isolated recurrence at the residual uterine cervix after abdominal radical trachelectomy for early cervical cancer

BACKGROUND: We report an isolated recurrence at the residual cervix shortly after abdominal radical trachelectomy for cervical cancer. CASE: A 34-year-old woman underwent radical abdominal trachelectomy and pelvic lymphadenectomy for FIGO stage IB1 squamous cell cervical cancer. The tumor measured 10 mm in maximum diameter with 4 mm of invasion. Histology showed lymph vascular space involvement with no infiltration of adjacent structures and no pelvic lymph node metastases. Tumor-free resection margins exceeded 15 mm. At the 6-month follow-up examination, cervical cytology showed cells suspicious for recurrent cervical cancer. Abdominal hysterectomy was performed and histology showed an isolated 3-mm recurrence in the residual cervix. The patient is free of disease 8 months after hysterectomy. CONCLUSION: Recurrence at the residual cervix is a potential risk of abdominal trachelectomy for early cervical cancer. Patients should be counseled accordingly and followed closely.     

血清胆固醇水平对宫颈癌患者预后的影响

目的:探讨治疗前血清胆固醇水平对宫颈癌患者预后的影响。方法:回顾分析2016年1月1日至2016年12月31日四川省肿瘤医院妇科肿瘤中心收治的277例宫颈癌患者的临床病理资料和随访记录。绘制ROC曲线,评价治疗前血清胆固醇对患者预后的预测效果。分析患者临床病理资料与血清胆固醇水平的关系。应用Kaplan-Meier法绘制生存曲线,建立Cox比例风险模型分析患者预后影响因素。结果:血清胆固醇水平预测DFS、OS的临界值分别为4.875mmol/L、4.605mmol/L。Cox比例风险模型单因素及多因素分析显示,治疗前血清胆固醇水平是影响宫颈癌患者DFS及OS的危险因素。结论:治疗前血清胆固醇水平可作为宫颈癌患者预后风险评价指标。     

Identification of prognostic factors in patients with cervical cancer and supraclavicular lymph node recurrence

Objective

Patients with cervical cancer and supraclavicular lymph nodes (SLN) recurrence have a poor but heterogeneous prognosis. The aim of this study was to identify potential prognostic factors – including FDG-PET results – that may affect survival and treatment outcomes in patients with this group of patients.

Methods

Between January 2001 and December 2008, we identified a total of 31 consecutive patients with cervical cancer who had evidence of SLN recurrence. All participants underwent FDG-PET. Survival was measured from the date of documented SLN recurrence. The latency period was defined as the length of time from the date of first diagnosis to the date of SLN recurrence.

Results

The median follow-up time was 22.8 months (range: 4.7–105.1). The 3- and 5-year survival rates were 41% and 27.3%, respectively. Patients with intermediate SUV values (between 4.3 and 8) had a significantly better prognosis than subjects with both high (> 8) or low (< 4.3) SUV values (p = 0.004). Latency period < 2 years, SCC-Ag levels ≥ 4 ng/mL, recurrence extend beyond SLN, and SUV of < 4.3 > 8 were significant adverse prognostic factors by multivariate analysis. The 3-year overall survival (OS) rate of patients carrying 0–1 adverse prognostic factors was 90% (low-risk group), while 3-year OS rates for intermediate-risk group (2 factors) and high-risk group (3–4 factors) were 30% and 0%, respectively (p = 0.001).

Conclusion

Our results justify the use of PET (accurate extent of relapse and SUV) as a prognostic tool in patients with cervical cancer and SLN recurrence.     

Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence

OBJECTIVES: To assess the value and clinical impact of integrated PET/CT using (18)F-FDG in the diagnosis and management of women with suspected cervical cancer recurrence. METHODS: Fifty-two patients with cervical cancer with suspected recurrence because of clinical, cytological, biochemical and radiological findings were retrospectively evaluated. A final diagnosis of recurrence was confirmed by histologic tissue biopsy or by further clinical or radiological evidence. The clinical impact of information provided by PET/CT on patient management was assessed on the basis of clinical follow-up data concerning further diagnostic or therapeutic approach. RESULTS: Twenty-eight of 32 positive PET/CT scans (87.5%) were proven to have recurrent disease. Seventeen of 20 negative PET/CT scans (85.0%) had no evidence of disease. The sensitivity, specificity, and accuracy of PET/CT for detecting recurrence were 90.3%, 81.0%, and 86.5% respectively. PET/CT changed the management of 12 patients (23.1%) by changing treatment plan (5 patients), by initiating unplanned treatment strategy (4 patients), or by obviating the need for planned diagnostic procedures (3 patients). Median duration after performing PET/CT and last follow-up was 12 (range: 6-27) months, and the 2-year disease-free survival rate of patients with negative PET/CT scan for recurrence was significantly better than that of patients with positive PET/CT (85.0% vs. 10.9%, P=0002). CONCLUSIONS: In patients with a suspected recurrence of cervical cancer, integrated PET/CT using (18)F-FDG provides good anatomic and functional localization of suspicious lesions, and the better diagnostic interpretation has an impact not only on clinical management and treatment planning of patients, but also on disease-free survival.     

A postoperative scoring system for distant recurrence in node-positive cervical cancer patients after radical hysterectomy and pelvic lymph node dissection with para-aortic lymph node sampling or dissection

Objective

To identify risk factors for distant recurrence in node-positive cervical cancer patients who underwent radical hysterectomy and pelvic lymph node dissection (PLND) with para-aortic lymph node sampling (PALNS) or para-aortic lymph node dissection (PALND).

HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Objective

To evaluate the efficacy and toxicity of HDR brachytherapy (BT) for the reirradiation of cervical or vaginal cancer arising within a previously irradiated area with a special focus on dosage delivery to organs at risk.

Methods

Twenty consecutive patients with cervical (N = 19) or vaginal (N = 1) cancer were reirradiated with curative intent using BT with or without external beam irradiation and hyperthermia. The median biologically equivalent dose in 2 Gy fractions (EQD2), assuming α/β = 10, for reirradiation was 48.8 Gy (range: 16.0–91.0 Gy), and the median cumulative EQD2 (for primary treatment and reirradiation) was 133.5 Gy (range: 96.8–164.2 Gy). The median follow-up after retreatment was 31 months (range: 6–86 months).

Results

The 3-year overall survival (OS) rate was 68% (95% confidence interval [CI]: 44%–91%). The 3-year disease-free survival (DFS) rate was 42% (95% CI: 19%–65%). The 3-year local control (LC) rate was 45% (95% CI: 22%–69%). For nine patients who received 3D treatment planning, the median cumulative EQD2 to 2 cm³ of rectum was 94.4 Gy (range: 67.1–118.8 Gy) and to 2 cm³ of bladder was 99.3 Gy (range: 70.4–122.3 Gy). Grade 3 late toxicity was observed in 3 patients (15%). An interval between primary RT and reirradiation of ≤ 12 months and a tumor diameter > 3 cm were significant prognostic factors adversely affecting OS, DFS and LC.

Conclusions

HDR BT is a valuable method for the reirradiation of cervical cancer. A cumulative EQD2 of approximately 100 Gy was safely delivered to 2 cm³ of the bladder and the rectum.     

腹腔镜与开腹手术在宫颈癌腹主动脉旁淋巴结清扫术的安全性和生存结局比较

目的:探讨腹腔镜与开腹手术在宫颈癌腹主动脉旁淋巴结清扫术的安全性和生存结局比较。方法:回顾分析2015年1月至2016年12月于武汉大学人民医院行腹主动脉旁淋巴结清扫的86例宫颈癌患者的临床资料。其中50例行腹腔镜术(腹腔镜组),36例行开腹术(开腹组)。比较两组患者的手术时间、术中出血量、腹主动脉旁淋巴结清扫数、术中及术后并发症、术后肛门排气时间、总住院时间、预后情况。结果:两组患者的手术时间比较,差异无统计学意义(P0.05)。与开腹组比较,腹腔镜组的术中出血量明显减少,术后肛门排气时间早,术后总住院时间短,淋巴结清扫数多,差异均有统计学意义(P0.05)。两组的术中输尿管损伤、血管损伤、术后淋巴囊肿、尿潴留、肠梗阻、深静脉血栓、呼吸系统感染发生率比较,差异均无统计学意义(P0.05)。开腹组切口液化4例,腹腔镜组无切口液化,差异有统计学意义(P0.05)。腔镜组与开腹组患者的远期临床预后并无明显差异。结论:腹腔镜下腹主动脉旁淋巴结清扫手术用于宫颈癌治疗有较好的安全性,值得临床推广。     

血清CA125预测卵巢上皮癌治疗后复发的Meta分析

目的:系统评价血清CA125对卵巢上皮癌综合治疗(手术+化疗)后复发的诊断价值。方法:计算机检索Pub Med、EMBASE、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CJFD)、中国科技期刊数据库(CSJD)、中国知网(CNKI)数据库,检验医学专业数据库:IFCC循证实验医学数据库、Medion、CRDdatabase、Bandlier Knowledge library等;灰色文献检索:中国学术会议论文库(CACP)、ISTP,检索期限自建库至2015年12月31日。收集有关血清CA125诊断卵巢上皮癌综合治疗后复发的前瞻性或回顾性队列研究。使用诊断性试验准确性质量评价工具(QUADAS)评价文献质量并提取数据,采用Meta-Disc1.4版软件进行Meta分析。结果:共纳入33篇文献,共2188例患者。Meta分析结果显示,血清CA125对卵巢上皮癌治疗后复发的诊断优势比DOR为11.77(95%Cl为7.16~19.37),灵敏度为67%(95%Cl为65%~70%),特异度为83%(95%Cl为80%~85%),阳性似然比为3.83(95%Cl为2.70~5.43),阴性似然比为0.41(95%Cl为0.35~0.49)。结论:血清CA125阴性排除"卵巢癌复发"的价值较大,而阳性诊断"卵巢癌复发"的价值有待进一步确证。     

免疫组化法检测ⅠA～ⅡA期宫颈癌盆腔淋巴结微转移的研究

目的 探讨免疫组化法检测ⅠA～ⅡA期宫颈癌根治术后盆腔淋巴结内微转移及其临床意义。方法 回顾性分析2006年1月至12月中国医科大学附属第一医院妇科27例FIGO分期为ⅠA～ⅡA期宫颈癌患者的临床资料,所有患者均行子宫广泛切除术和淋巴结清扫术。术中共取518枚淋巴结,共490枚经组织学证实无转移。对盆腔淋巴结的石蜡包埋组织以抗细胞角蛋白抗体AE1/AE3标记。结果 27例490枚淋巴结中,经免疫组化检测发现,5例患者5枚淋巴结发现微转移病灶,病例总阳性率18.5%（5/27）,淋巴结总阳性率1.02%（5/490）。在有微转移的淋巴结中,髂外淋巴结组、闭孔淋巴结组的检出率分别为2.8%（3/108）和1.5%（2/132）。所切除的淋巴结数目小于20枚与大于20枚两组间微转移的检出率差异有显著性意义（P〈0.05）。结论 宫颈癌患者阴性盆腔淋巴结中存在微转移灶,随着切除淋巴结数目的增多,微转移的检出率逐渐增大,免疫组化法检测微转移淋巴结可能对指导治疗、判断预后有积极的临床意义。     

A scoring system for predicting recurrence of cervical cancer

An evaluation was made of factors that affect the recurrence of cervical cancer after primary surgery, these including age, clinical stage, histology, grade, involvement of uterine body, parametrium or vagina and lymph node metastases. During a period of at least 3 years, 702 of 1508 patients who underwent radical hysterectomy and pelvic lymph node dissection were studied by using a scoring system. A comparison between the group of women scored at or greater than 13 that scored less than 13 revealed that the risk of recurrence was higher in the former group. One hundred and twenty five of 702 patients found to have positive pelvic node involvement scored greater than 13, which rendered them eligible for further mangement as follows: the recurrence rate in 99 patients receiving multi-agent chemotherapy was 34.4%, compared with 65.4% in 26 patients receiving no treatment ( P < 0.01). Applying this score to other patients in planning adjuvant therapy, the recurrence rate may be reduced further. The number of patients needlessly exposed to the toxic effects of multi-agent chemotherapy may be reduced also.     

A comparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for early-stage cervical cancer: a long-term follow-up study

Objective

To determine whether laparoscopic radical hysterectomy (LRH) is a feasible alternative to radical abdominal hysterectomy (RAH) for early-stage cervical cancer.

Study design

A retrospective, matched case-control study of 24 consecutive cases with International Federation of Gynecology and Obstetrics stage I-II cervical cancer who underwent LRH by a single surgeon between January 1994 and December 2001. Cases were matched with controls (ratio 1:2) who underwent RAH by surgeon, age, stage and histology. Patient characteristics, clinical course, intra-operative complications and disease-free survival were compared between the two groups. Median counts were analyzed using the Mann-Whitney U-test. Differences between means were compared using Student's t-test. Dichotomous groupings were analyzed using Chi-squared test and Fisher's exact test as appropriate. Survival data were estimated using Kaplan-Meier estimates and compared with the log-rank test.

Results

The mean estimated blood loss in the RAH group was significantly greater than that in the LRH group (836.0 ml and 414.3 ml, respectively; p < 0.001). Five patients (20.8%) from the LRH group and 23 patients (47.9%) from the RAH group received blood transfusion (p < 0.03). The mean length of hospital stay was significantly shorter in the LRH group compared with the RAH group (10.7 days and 18.8 days, respectively; p < 0.01). No statistically significant difference existed between the two groups with respect to operative time, pelvic lymph node count, frequency of lymph node involvement, extent of parametrial or vaginal resection margins, adjuvant treatment and intra-operative complications. Median follow-up was 78 months for the LRH group and 75 months for the RAH group. There was no significant difference in the 5-year disease-free survival rate between the groups (90.5% and 93.3% for LRH and RAH, respectively; p = 0.918).

Conclusions

LRH is a useful alternative to RAH for the management of early-stage cervical cancer. The benefits of LRH include reduced blood loss, fewer transfusions and shorter hospital stay, with comparable oncologic outcome.     

Control of cervical cancer: Women's options and rights

Cervical cancer takes the lives of more than 250 000 women each year globally, particularly in under-resourced areas of low-, middle-, and high-income countries. Options for cancer control and treatment have reached a point that there are interventions for control that could be adopted for virtually every resource and demographic situation. Women die despite the availability of attractive control options, which means that educating policy makers, women's health professionals, as well as women themselves, must become a major focus for ongoing control of this disease. The human right to life, to prevention of suffering, and to education are all key rights linked to improving the control of cervical cancer and saving the lives of women, particularly in resource-poor parts of the world.     

Prognostic value of metabolic tumor volume measured by FDG-PET/CT in patients with cervical cancer

Objective

To determine if preoperative metabolic tumor volume (MTV) measured by integrated ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) imaging has prognostic value in patients with cervical cancer treated primarily with radical hysterectomy.

Methods

Patients with FIGO stage IB to IIA cervical cancer were imaged with FDG-PET/CT before radical surgery. MTV was measured from attenuation-corrected FDG-PET/CT images using a standard uptake value (SUV)-based automated contouring program. We evaluated the relationship of MTV to disease-free survival (DFS).

Results

A total of 63 patients were included in the study. The cut-off value for predicting recurrence was determined using a receiver operating characteristic (ROC) curve. MTV in this study was found to be correlated with lymph node (LN) metastasis, parametrium (PM) involvement, FIGO stage, and SUV_max. In univariate analysis, MTV ≥ 23.4 mL (HR 1.017, 95% confidence interval (CI) 1.005-1.029, P = 0.004), SUV_max ≥ 9.5 (HR 5.198, 95% CI 1.076-25.118, P = 0.04), LN metastasis (HR 12.338, 95% CI 1.541-98.813, P = 0.018), PM involvement (HR 14.274, 95% CI 1.785-114.149, P = 0.012), and lymphovascular space invasion (HR 8.871, 95% CI 1.104-71.261, P = 0.04), were related to DFS. In multivariate analyses, age (HR 0.748, 95% CI 0.587-0.952, P = 0.018) and MTV ≥ 23.4 mL (HR 49.559, 95% CI 1.257-1953.399, P = 0.037) were determined to be independent prognostic factors of DFS.

Conclusion

Preoperative MTV is an independent prognostic factor for DFS in patients with cervical cancer treated by radical surgery.     

Sentinel lymphatic mapping among women with early-stage cervical cancer: A systematic review

The presence of pelvic lymph node metastases is without doubt the most significant prognostic factor that determines recurrences and survival of women with early-stage cervical cancer. To avoid the underdiagnosis of lymph node metastasis, pelvic lymphadenectomy procedure is routinely performed with radical hysterectomy procedure. However, the pelvic lymphadenectomy procedure may not be necessary in most of these women due to the relatively low incidence of pelvic lymph node metastasis. The removal of large numbers of pelvic lymph nodes could also render non-metastatic irreversible damages for these women, including vessel, nerve, or ureteral injuries; formation of lymphocysts; and lymphedema. Over the past decades, the concept of sentinel lymph node biopsy has emerged as a popular and widespread surgical technique for the evaluation of the pelvic lymph node status in gynecologic malignancies. The histological status of sentinel lymph node should be representative for all other lymph nodes in the regional drainage area. If metastasis is non-existent in the sentinel lymph node, the likelihood of metastatic spread in the remaining regional lymph nodes is very low. Further lymphadenectomy is therefore not necessary for a patient with negative sentinel lymph nodes. Since the uterine cervix has several lymphatic drainage pathways, it is a challenging task to assess the distribution pattern of sentinel lymph nodes in women with early-stage cervical cancer. This review article will adapt the methodology proposed in these studies to systematically review sentinel lymphatic mapping among women with early-stage cervical cancer.     

Acceptability of self-collected human papillomavirus specimens in cervical cancer screening: A review

Cervical cancer morbidity and mortality is an important public health problem around the world. Some of the barriers to cervical cancer screening include the embarrassment, discomfort, lack of privacy and time and cost associated with clinician-collected, clinic-based screening with cytology or human papillomavirus tests. Self-collection of a human papillomavirus (HPV) test has been found to be generally more acceptable, less embarrassing, more comfortable, more private and easy to do and preferred to pelvic examination for cervical cytology by many women worldwide. The most commonly reported limitation to self-collection is a woman’s lack of confidence in her ability to perform it correctly. Self-collected human papillomavirus tests have been shown to be as or more sensitive than cytology or clinician-collected HPV tests. With confidence-building education about self-collection, it is likely a viable method to extend the reach of screening in high and low-resource areas around the world.     

Incidence of subsequent abnormal cytology in cervical cancer patients completing five-years of post treatment surveillance without evidence of recurrence

Objective

To determine the incidence of subsequent abnormal cervical or vaginal cytology and confirmatory histology in women completing five-years of surveillance for cervical cancer without recurrence.

Methods

Following IRB approval, a tumor registry database identified women managed for all stages of cervical cancer from 1990 to 2003 who after completion of 60 months of active surveillance following primary therapy underwent continued vaginal or cervical cytologic surveillance. Retrospective review was performed to determine demographics, clinicopathologic variables, vaginal or cervical cytology and outcomes.

Results

Sixty-one women were identified with a median age at diagnosis of 41 (range 23-81). 72% of women were Caucasian, 16% were African-American with the remainder primarily Asian. Squamous cell carcinoma was the most common histology and present in 47 women (77%) with an equal proportion of women having G1 and G2 tumors. 80% of patients had early stage disease (Stages IA1-IIA). Median follow-up after completing five-years of active surveillance for all patients was 143 months and a total of 303 Pap tests were performed with the mean/median number of five cytologic evaluations per patient. A total of 17 (5.6%) [95% CI, 3.5-8.8%] abnormal Pap tests were reported, which led to the performance of three diagnostic procedures. One case of moderate vaginal dysplasia was diagnosed and treated.

Conclusions

Continued annual cytologic screening is of low yield in women completing five-years of surveillance that have remained free of recurrence. The incorporation of newer testing modalities including HPV testing may allow increases in the screening interval in this group of patients at relatively low risk for recurrence.     

Solitary splenic recurrence of ovarian cancer: case report and review of the literature

We report a rare case of solitary recurrence of ovarian cancer in the spleen which developed 4 years after initial treatment. Only six cases have been reported in the literature and all were serous carcinoma. Our patient had a splenectomy without any complications but developed a liver metastasis 10 months after splenectomy. Received: 12 August 1998 / Accepted: 11 January 1999