共查询到20条相似文献，搜索用时 31 毫秒
1.
Objectives
The standard treatment for FIGO stage 1B1 cervical cancer is radical hysterectomy (RH) [1]. Indocyanine-green (ICG) is a drug injected within the cervical stroma to detect the sentinel lymph node (SLN) in cervical cancer [2,3]. ICG travels through the lymphatic channels in the lateral parametrium, which results enhanced with green, before reaching the SLNs. This could help identifying the surgical landmarks. The aim of this video is to propose a new approach to perform parametrial dissection as part of RH under the guidance of ICG.Methods
The patient was a 49-years old woman diagnosed with a FIGO 1B1 moderately-differentiated cervical squamous cell carcinoma. No evidence of lymphoadenopathy on pre-operative imaging. 0.25 ml of ICG (1.25 mg/ml) were injected superficially and deep at 3 and 9 o'clock in the cervix as first step of the operation. Bilateral SLN biopsy followed by type C1 RH with bilateral salpingo-oophorectomy and bilateral pelvic node dissection was performed. Near-infrared camera (PINPOINT® - Novadaq Technologies) was used during parametrial dissection.Results
ICG was used as a guide to demarcate the parametrial tissue and assist the dissection of the lateral (paracervix) and anterior (vesico-uterine ligament) parametrium off the surrounding structures (bladder and ureter). Operation time was 150 min and intraoperative estimated blood loss was 50 mls. No intraoperative or postoperative complication was reported.Conclusions
ICG-assisted parametrial dissection during RH after SLN biopsy in early stage cervical cancer can be a useful tool to guide the surgeon to perform the procedure and potentially improve surgical outcomes. 相似文献2.
Gun Oh Chong Yoon Hee Lee Hyung Soo Han Hyun Jung Lee Ji Young Park Dae Gy Hong Yoon Soon Lee Young Lae Cho 《Gynecologic oncology》2018,148(1):97-102
Objective
Although the relationship between human papilloma virus (HPV) and cervical cancer is well established, the prognostic value of HPV status has not been determined, largely because previous studies have yielded conflicting results. This study aimed to investigate the prognostic value of pre-treatment HPV DNA for predicting tumor recurrence in cervical cancer.Methods
The study included 248 eligible patients who provided cervical cell specimens for HPV genotyping before surgery or concurrent chemoradiotherapy (CCRT). Of these 248 patients, 108 were treated with radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage IB1–IIA cervical cancer, and 140 were treated with CCRT for FIGO stage IB2–IV cervical cancer.Results
HPV 16 and 18 were the two most common HPV types detected, with prevalence rates of 52.4% and 12.5%, respectively. The pre-treatment HPV DNA test showed that 18.5% of cervical cancers were HPV negative. Multivariate analysis showed that HPV negativity was associated with poorer disease-free survival (DFS) than HPV-positive status (hazard ratio [HR], 3.97; 95% confidence interval [CI], 1.84–8.58; p = 0.0005), and patients with HPV 16-positive cancers had better DFS (HR, 0.41; 95% CI, 0.23–0.72; p = 0.0019). In the surgery group, only HPV 16 positivity was significantly correlated with DFS (HR, 0.34; 95% CI, 0.12–0.96; p = 0.0416). In the CCRT group, only HPV negativity was significantly correlated with DFS (HR, 3.75; 95% CI, 1.78–7.90; p = 0.0005).Conclusions
Pre-treatment HPV DNA status may be a useful prognostic biomarker in cervical cancer. The presence of HPV 16 DNA was associated with better DFS, and HPV negativity was associated with worse DFS. However, larger sample sizes and more comprehensive studies are required to verify our findings. 相似文献3.
The landscape of somatic mutations in Indonesian cervical cancer is predominated by the PI3K pathway
Vivian M. Spaans I. Nyoman Bayu Mahendra Gatot Purwoto Marjolijn D. Trietsch Michelle Osse Natalja ter Haar Alexander A.W. Peters Gert J. Fleuren Ekaterina S. Jordanova 《Gynecologic oncology》2018,148(1):189-196
Objective
To investigate the prevalence of somatic mutations in Indonesian cervical carcinoma patients in the context of histology and human papillomavirus (HPV) type.Methods
In total 174 somatic hot-spot mutations in 13 genes were analyzed by mass spectrometry in 137 Indonesian cervical carcinomas.Results
In 66/137 tumors (48%) 95 mutations were identified. PIK3CA was most frequently mutated (24%), followed by FBXW7 (7%), CTNNB1 (6%), and PTEN (6%). In squamous cell carcinomas more often multiple mutations per sample (p = 0.040), and more PIK3CA (p = 0.039) and CTNNB1 (p = 0.038) mutations were detected compared to adenocarcinomas. PIK3CA mutations were associated with HPV 16 positivity, CDKN2A mutations with HPV 52 positivity, and, interestingly, PTEN mutations with HPV negativity. Balinese tumor samples more often carried multiple mutations (p = 0.019), and more CTNNB1, CDKN2A, and NRAS mutations compared to Javanese tumor samples.Conclusions
Potentially targetable somatic mutations occurred in 48% of Indonesian cervical carcinomas. The landscape of mutations is predominated by mutations concerning the PI3K pathway, and we prompt for more research on developing therapies targeting this pathway, explicitly for the more advanced stage cervical carcinoma patients. 相似文献4.
Background
There remains uncertainty about the role of human papillomavirus (HPV) infection in causing small-cell neuroendocrine carcinoma (SCNC) and large-cell neuroendocrine carcinoma (LCNC) of the cervix. To clarify the role of HPV in the development of SCNC and LCNC, we conducted a systematic review and meta-analyses.Methods
PubMed and Embase were searched to initially identify 143 articles published on or before June 1, 2017. Studies were limited to methods that tested for HPV in the cancer tissue directly to minimize misattribution. Thirty-two studies with 403 SCNC and 9 studies of 45 LCNC were included in the analysis.Results
For SCNC, 85% (95% confidence interval [95%CI] = 71%–94%) were HPV positive, 78% (95%CI = 64%–90%) were HPV16 and/or HPV18 positive, 51% (95%CI = 39%–64%) were singly HPV18 positive, and 10% (95%CI = 4%–19%) were singly HPV16 positive. In a subset of 5 SCNC studies (75 cases), 93% were positive for p16INK4a by immunohistochemistry and 100% were HPV positive. For LCNC, 88% (95%CI = 72%–99%) were HPV positive, 86% (95%CI = 70%–98%) were positive for HPV16 or HPV18, 30% were singly HPV18 positive (95%CI = 4%–60%), and 29% (95%CI = 2%–64%) were singly HPV16 positive.Conclusions
In conclusion, most SCNC and LCNC are caused by HPV, primarily HPV18 and HPV16. Therefore, most if not all SCNC and LCNC will be prevented by currently available prophylactic HPV vaccines. 相似文献5.
Umesh Mahantshetty Tanuja Teni Pushpa Naga Chandni Hotwani Sumuki Umesh Sadhana Kannan Vinod Hande Sagar Pawar Reena Engineer Supriya Chopra Kedar Deodhar Amita Maheshwari Lavanya Gurram Sudeep Gupta Shyam Kishore Shrivastava 《Gynecologic oncology》2018,148(2):299-304
Objective
With an aim to investigate the impact of Human Papilloma Virus (HPV) 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy, we undertook this prospective study.Methods
Between May 2010 and April 2012, 150 histologically proven cervical cancer patients treated with radio (chemo) therapy were accrued. Cervical biopsies/brushings were collected at pre-treatment, end of treatment and at 3 monthly intervals up to 24 months. Quantitative estimation of HPV 16/18 was done using real-time polymerase chain reaction (RT-PCR) and correlated with various clinical end-points.Results
Out of 150 patients accrued, 135 patients were considered for final analysis. Pre-treatment HPV16/18 DNA was detected in 126 (93%) patients, with HPV-16 present in 91%. The mean log (± SD) HPV-16 and HPV-18 viral load at pre-treatment was 4.76 (± 2.5) and 0.14 (± 2.1) copies/10 ng of DNA, respectively. Though significant decline in viral load was observed on follow-ups (p < 0.0001); by 9-month follow-up, 89 (66%) patients had persistence of HPV infection. Patients with persistent HPV 16/18 infection had a significantly higher overall and loco-regional relapses [44/89 (49%) and 29/89 (32%)] as compared to HPV clearance by 9 months [12/43 (28%) and 5/43 (11%)] with p = 0.024 and p = 0.02, respectively. Also, persistent HPV infection by 24-month showed a significant impact on loco-regional control (LRC) and recurrence-free survival (RFS).Conclusion
In locally advanced cervical cancers treated with radical radio (chemo) therapy, persistent HPV 16/18 infection is significantly high in immediate post-treatment period and correlated with higher loco-regional, overall relapses and was also associated with early relapses. 相似文献6.
Thomas C. Wright Catherine M. Behrens James Ranger-Moore Susanne Rehm Abha Sharma Mark H. Stoler Ruediger Ridder 《Gynecologic oncology》2017,144(1):51-56
Objectives
In addition to genotyping for HPV16/18, dual-immunostaining for p16/Ki-67 has shown promise as a triage of HPV-positive women. We assessed the performance of p16/Ki-67 dual-stained cytology for triaging HPV-positive women undergoing primary HPV screening.Methods
All women ≥ 25 years with valid cervical biopsy and cobas® HPV Test results from the cross-sectional phase of ATHENA who were referred to colposcopy (n = 7727) were eligible for enrolment. p16/Ki-67 dual-stained cytology was retrospectively performed on residual cytologic material collected into a second liquid-based cytology vial during the ATHENA enrolment visit. The diagnostic performance of dual-stained cytology, with or without HPV16/18 genotyping, for the detection of biopsy-confirmed cervical intraepithelial neoplasia grade 3 or worse (CIN3+) was determined and compared to Pap cytology. Furthermore, the number of colposcopies required per CIN3+ detected was determined.Results
Dual-stained cytology was significantly more sensitive than Pap cytology (74.9% vs. 51.9%; p < 0.0001) for triaging HPV-positive women, whereas specificity was comparable (74.1% vs. 75.0%; p = 0.3198). Referral of all HPV16/18 positive women combined with dual-stained cytology triage of women positive for 12 “other” HPV genotypes provided the highest sensitivity for CIN3+ (86.8%; 95% CI: 81.9–90.8). A similar strategy but using Pap cytology for the triage of women positive for 12 “other” HPV genotypes was less sensitive (78.2%; 95% CI: 72.5–83.2; p = 0.0003), but required a similar number of colposcopies per CIN3+ detected.Conclusions
p16/Ki-67 dual-stained cytology, either alone or combined with HPV16/18 genotyping, represents a promising approach as a sensitive and efficient triage for colposcopy of HPV-positive women when primary HPV screening is utilized. 相似文献7.
Ahmed M. Abbas Wael M. Wagdy Mohammed N. Salem Abdelrahman M. Abdelqader 《Middle East Fertility Society Journal》2018,23(1):52-56
Objective
The current study aims to investigate the analgesic effect of combining oral diclofenac potassium and cervical lidocaine cream for alleviating pain during HSG.Study design
A randomized double-blind controlled trial.Setting
Assiut University Hospital, Assiut, Egypt.Materials and methods
Reproductive-aged infertile women scheduled for HSG were recruited and randomized (1:1) to diclofenac plus lidocaine or Placebo group. All women received oral 50 mg diclofenac potassium or placebo tablets one hour before HSG, then 3 ml of lidocaine 5% cream or placebo was applied to the anterior cervical lip, followed by 3 ml placed in the cervical canal using a sterile needless syringe. The study outcomes was the participant’s self-rated pain perception utilizing a 10-cm Visual Analogue Scale (VAS) during speculum placement, cervical tenaculum placement, injection of the dye, 5 min and 30 min post-procedure.Results
One hundred forty women were enrolled (n = 70 in each group). Oral diclofenac plus lidocaine cream significantly reduce the median VAS pain scores during injection of the dye (4 vs. 7), 5 min post-procedure (2 vs. 4) and 30 min post-procedure (1 vs. 2.5) with p = 0.0001 at all steps. No significant differences in VAS score after speculum or tenaculum placement.Conclusions
Utility of oral diclofenac potassium one hour before HSG combined with cervical lidocaine 5% cream significantly alleviate the induced pain during and 30 min after the HSG procedure. 相似文献8.
A.K. Lie A. Tropé G.B. Skare T. Bjørge C.M. Jonassen K. Brusegard S. Lönnberg 《Gynecologic oncology》2018,148(1):111-117
Objective
To explore the HPVgenotype profile in Norwegian women with ASC-US/LSIL cytology and the subsequent risk of high-grade cervical neoplasia (CIN 3 +).Methods
In this observational study delayed triage of ASC-US/LSIL of 6058 women were included from 2005 to 2010. High-risk HPV detection with Hybrid Capture 2 (HC2) was used and the HC2 + cases were genotyped with in-house nmPCR. Women were followed-up for histologically confirmed CIN3 + within three years of index HPV test by linkage to the screening databases at the Cancer Registry of Norway.Results
HC2 was positive in 45% (2756/6058) of the women. Within 3 years CIN3 + was diagnosed in 26% of women < 34 year and in 15% ≥ 34 year. HC2 was positive at index in 94% of CIN3 + cases and negative in 64 cases including three women with cervical carcinomas. Women < 34 years with single infections of HPV 16, 35, 58 or 33 or multiple infections including HPV 16, 52, 33 or 31 were associated with highest proportions of CIN 3 +. Older women with single infection with HPV 16, 33, 31 or 35 or multiple infections including HPV 16, 33, 31 or 18/39 were more likely to develop CIN 3 +.Conclusions
HPV 16 and HPV 33 at baseline both as single or multiple infections, were associated with the highest risk for CIN3 +. Among older women, all 13 high-risk genotypes as single infection were associated with > 20% risk of CIN3 +. Further studies are necessary to risk stratify the individual genotypes to reduce the number of colposcopies in Norway. 相似文献9.
Libing Xiang Wei Jiang Shuang Ye Tiancong He Xuan Pei Jiajia Li David Wai Chan Hextan Yuen Sheung Ngan Fang Li Pingping Tao Xuxia Shen Xiaoyan Zhou Xiaohua Wu Gong Yang Huijuan Yang 《Gynecologic oncology》2018,148(2):311-316
Objective
ERBB2 mutations have been found in a subset of invasive cervical cancer (ICC). Nevertheless, the prevalence, mutation spectrum, clinicopathological relevance, human papillomavirus (HPV)-genotype association and prognostic significance of ERBB2-mutated ICCs have not been well established.Methods
In this study, ICC samples (N = 1015) were assessed for mutations in ERBB2, KRAS, and PIK3CA by cDNA-based Sanger sequencing.Results
Somatic ERBB2 mutations were detected in 3.15% patients. The ERBB2 mutation rate was significantly higher in adenocarcinoma (4.52%, 7/155), adenosquamous carcinoma (7.59%, 6/79) and neuroendocrine carcinoma (10.34%, 3/29) than that in squamous carcinoma (2.14%, 16/749) (P = 0.004, Fisher exact test). In addition, 18.75% of the patients carrying ERBB2 mutations concomitantly harbored PIK3CA or KRAS mutations. Patients with ERBB2-mutated ICCs tended to have a worse prognosis than those with wild-type or PIK3CA-mutated ICCs but a better prognosis than those with KRAS-mutated ICCs.Conclusions
This study provided a promising rationale for the clinical investigation of tyrosine kinase inhibitors for the treatment of cervical cancer with ERBB2 mutations. Patients with non-squamous cell carcinomas have priority as candidates for ERBB2-targeted therapy. Concurrent PIK3CA/RAS mutations should be considered in the design of clinical trials. 相似文献10.
Li Dong Margaret Z. Wang Xue-lian Zhao Rui-mei Feng Shang-ying Hu Qian Zhang Jennifer S. Smith You-lin Qiao Fang-hui Zhao 《Gynecologic oncology》2018,148(1):103-110
Objective
ASCCP cervical cancer screening guidelines recommend triaging high-risk human papillomavirus (hrHPV) positive women with cytology and genotyping, but cytology is often unavailable in resource-limited areas. We compared the long-term risk of cervical cancer and precancers among type-specific hrHPV-positive women triaged by viral load to cytology and visual inspection with acetic acid (VIA).Methods
A cohort of 1742 Chinese women was screened with cytology, VIA, and Hybrid Capture 2 (HC2) test and followed for ten years. All HC2-positive samples were genotyped. Viral load was measured by HC2 relative light units/cutoff (RLU/CO). Ten-year cumulative incidence rate (CIR) of cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) for type-specific hrHPV viral load was estimated using Kaplan-Meier methods.Results
Baseline hrHPV viral load stratified by specific genotypes was positively correlated with prevalent cytological lesions. Ten-year CIR of CIN2 + was associated with cytological lesions and viral load. Among HPV 16/18-positive women, ten-year CIR of CIN2 + was high, even with normal cytology (15.3%), normal VIA (32.4%), viral load with RLU/CO < 10 (23.6%) or RLU/CO < 100 (33.8%). Among non-16/18 hrHPV positive women, ten-year CIR of CIN2 + was significantly stratified by cytology grade of atypical squamous cell of undetermined significance or higher (2.0% VS. 34.6%), viral load cutoffs at 10 RLU/CO (5.1% VS. 27.2%), at 100 RLU/CO (11.0% VS. 35.5%), but not by VIA (19.1% VS. 19.0%).Conclusions
Our findings support the guidelines in referring all HPV16/18 positive women to colposcopy and suggest triaging non-16/18 hrHPV positive women using viral loads in resource-limited areas where cytology screening was inaccessible. 相似文献11.
Waqar Haque Vivek Verma Mohamad Fakhreddine Sandra Hatch E. Brian Butler Bin S. Teh 《Gynecologic oncology》2017,144(1):28-33
Purpose
The standard treatment for stage IB1 and IIA1 cervical carcinoma is surgery. For non-operative cases, the National Comprehensive Cancer Network recommends definitive radiotherapy (RT) with or without chemotherapy. This study sought to determine whether the addition of chemotherapy to RT improved overall survival (OS) for patients with stage IB1 and IIA1 cervical cancer.Methods
We used the National Cancer Data Base to identify patients with stage IB1 or stage IIA1 cervical cancer diagnosed in 2004 to 2012 who received definitive RT with or without chemotherapy. Patient, tumor, and treatment facility characteristics were assessed. Kaplan-Meier analysis was performed to compare overall survival (OS) between groups. Cox regression analysis was performed to identify factors associated with survival. Propensity-score matching was used to compare survival outcomes while accounting for indication bias.Results
825 patients met the specified criteria. 275 (33.3%) of patients received treatment with RT alone, whereas 550 (66.7%) were treated with CRT. The median OS in patients treated with RT alone was 121.1 months, while the median OS for patients treated with CRT was not reached (hazard ratio [HR] = 0.719; 95% confidence interval [CI] 0.549–0.945). Propensity-score matched analysis confirmed that CRT was superior to RT alone (HR = 0.701; 95% CI 0.509 to 0.963).Conclusions
Our study suggests the addition of chemotherapy to definitive RT in patients with stage IB1 or stage IIA1 cervical cancer is associated with an improvement in OS. Prospective studies are recommended to validate these results and to further investigate the quality of life differences associated with chemotherapy use. 相似文献12.
Young-Jae Lee Dae-Yeon Kim Shin-Wha Lee Jeong-Yeol Park Dae-Shik Suh Jong-Hyeok Kim Yong-Man Kim Young-Tak Kim Joo-Hyun Nam 《Gynecologic oncology》2017,144(3):536-540
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).Methods
A total of 299 patients in whom lymph node metastasis was confirmed after radical surgery at Asan Medical Center for stage IA2 to IIB cervical cancer from February 2001 to December 2012 were identified. In all, 72 (24.1%) patients underwent PLND only and 227 (75.9%) underwent PLND with PALNS or PALND. Four patients were excluded due to diagnosed with small cell carcinoma. The clinicopathologic data of 223 patients were retrospectively analyzed. Distant recurrence was defined as recurrence at a site over the pelvic radiation field.Results
Among all 223 study patients, the mean number of positive lymph nodes was 4.46. There were 54 (24.2%) patients with distant metastasis. Multivariate analyses using the Cox proportional hazards model showed that histologic types (HR = 3.031, P ≤ 0.001 for adenocarcinoma, HR = 2.302, P = 0.066 for adenosquamous carcinoma), number of positive lymph nodes (HR = 1.077, P ≤ 0.001), and surgical stage (HR = 1.264, P = 0.022) were independent risk factors for distant recurrence of cervical cancer. A scoring system for the prediction of distant recurrence was generated by incorporating these factors and showed good discrimination and calibration (concordance index of 0.753). In an internal validation set, this scoring system showed good discrimination with a C-statistics of 0.777. According to the Hosmer-Lemeshow test, the chi-square was 0.650 and the P-value was 0.723.Conclusions
We have developed a robust scoring system that can predict the risk of distant recurrence in node-positive cervical cancer patients after radical operation. This scoring system was used to identify a group of patients who required systemic control of distant micrometastasis. This group of patients is an appropriate target for consolidation chemotherapy after concurrent chemoradiation therapy. 相似文献13.
Jie Lee Jhen-Bin Lin Chih-Long Chang Fang-Ju Sun Meng-Hao Wu Ya-Ting Jan Yu-Jen Chen 《Gynecologic oncology》2018,148(2):291-298
Objectives
A previous study has suggested the benefit of sub-renal vein radiotherapy (SRVRT) for pelvic lymph node (PLN)-positive cervical cancer. In order to better select patients for SRVRT, this study aimed to evaluate the value of a risk-based radiation field based on PLN location and number in PLN-positive cervical cancer.Methods
We reviewed 198 patients with FIGO stage IB2–IVA cervical cancer, positive PLNs, and negative para-aortic lymph nodes (PALNs) from 2004 to 2015 at two tertiary centers. All patients underwent pelvic radiotherapy (PRT) or SRVRT with IMRT. The SRVRT extended the PRT field cranially to the level of the left renal vein. The prescribed doses were 45–50.4 Gy in 1.8 Gy per fraction.Results
Overall, 118 and 80 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage, common iliac PLNs, and number of PLNs. The median follow-up was 63 months (range: 7–151 months). PALN failure was experienced by 28 patients (23.7%) in the PRT group and 1 patient (1.3%) in the SRVRT group (p < 0.001). Compared with PRT, SRVRT significantly improved 5-year PALN recurrence-free survival (56.8% vs. 100%, p < 0.001) and cancer-specific survival (56.5% vs. 93.9%, p < 0.001) among patients with common iliac PLNs or ≥ 3 PLNs. No significant differences were observed in these outcomes among patients with PLNs below the common iliac bifurcation and 1–2 PLNs. The SRVRT did not increase severe toxicities.Conclusions
Risk-based radiation field based on PLN location and number could optimize outcomes for PLN-positive cervical cancer. 相似文献14.
Shin-Hyung Park Hyejin Cheon Gun Oh Chong Shin Young Jeong Jeong Eun Lee Min Kyu Kang Mi Young Kim Jeong Won Lee Junhee Park Jae-Chul Kim 《Gynecologic oncology》2018,148(3):449-455
Objective
Lymph node involvement is an important prognostic factor in patients with cervical cancer. However, the prognostic significance of lymph node response to chemoradiotherapy remains unclear. We retrospectively analyzed the relationship between residual lymph node status after definitive chemoradiotherapy and survival.Methods
We enrolled 117 patients with node-positive cervical cancer. All patients were treated with definitive chemoradiotherapy in our institution, from 2006 to 2016. The median follow-up period was 41 months (range, 6–128 months). The criterion for a positive lymph node was defined as a maximum short axis diameter of ≥ 8 mm on pretreatment magnetic resonance imaging (MRI)/computed tomography (CT) scans. Posttreatment pelvic MRI was obtained 3 months after the completion of chemoradiotherapy. Residual primary tumor was defined as any residual lesion identified upon clinical examination and/or MRI. Residual lymph node was defined as any lymph node with a short axis diameter of ≥ 8 mm posttreatment, according to MRI/CT.Results
At follow-up, 3 months after chemoradiotherapy, we observed residual primary tumor in 30 patients (25.6%), and residual lymph node in 31 patients (26.5%). The presence of residual lymph node was associated with worse overall survival according to multivariate analysis (hazard ratio, 3.04; 95% confidence interval, 1.43–6.44; p = 0.004). In the 5-year time-dependent ROC analysis of survival prediction, the presence of residual lymph node showed an AUC value of 0.72.Conclusions
The presence of residual lymph node after chemoradiotherapy was associated with worse survival in patients with node-positive cervical cancer. 相似文献15.
Alshimaa M. Mostafa Yasser Khamis Hanaa K. Helmy Ahmed E. Arafa Ahmed M. Abbas 《Middle East Fertility Society Journal》2018,23(1):68-71
Objective
Obesity is a growing public health concern. Many reports link obesity to female sexuality. The purpose of this study is to assess the prevalence and patterns of female sexual dysfunction (FSD) among overweight and obese premenopausal women in Beni-Suef, Egypt.Study design
A cross sectional study.Setting
Beni-Suef, Egypt.Subjects and methods
150 premenopausal non-pregnant married women were enrolled for the study. Socio-demographic characteristics and obstetric history were collected using a self-administered questionnaire. Sexual dysfunction was assessed using the Arabic version of female sexual function index (ArFSFI).Results
The mean age of the participating women was 31.2 ± 7.3 years and the mean BMI was 27.5 ± 1.9 kg/m2. Circumcision was reported by 59.3% of women. Precisely, 42 (28%) of women had FSD. Pain, lubrication and arousal were the most common reported problems 69.3%, 53.3% and 52%, respectively. Obese women were more likely to have desire, arousal and lubrication problems compared to the overweight. FSFI total score correlated negatively with age of women, marriage duration and parity (p < 0.05), but did not correlate with BMI (p > 0.05).Conclusion
Problems in pain, lubrication and arousal were the most common patterns of sexual dysfunction among overweight Egyptian women. Further research over the effect of certain interventional programs on FSD should be considered. 相似文献16.
W. Ross Green Lara Hathout Atif J Khan Mohamed A Elshaikh Sushil Beriwal William Small Omar Mahmoud 《Gynecologic oncology》2017,144(2):299-304
Background
The primary treatment of early stage cervical carcinoma (IB-IIA) is either surgery or radiation therapy based on the pivotal Milan randomized study published twenty years ago. In the presence of high-risk features, the gold standard treatment is concurrent chemotherapy and radiation therapy (CRT) whether it is the in the postoperative or the definitive setting. Using the National Cancer Data Base (NCDB), the goal of our study is to compare the outcomes of surgery and radiation therapy in the chemotherapy era.Methods
Between 2004 and 2013, 5478 patients diagnosed with early stage cervical cancer were divided into 2 groups based on their primary treatment: non-surgical (n = 1980) and surgical groups (n = 3498). The distribution of patient/tumor characteristics and treatment variables with their relation to overall survival and proportional regression models were assessed to investigate the superiority of one approach over the other. Propensity score analysis adjusted for imbalance of covariates to create a well-matched-patient cohort.Findings
At 46 months median follow-up, the 5-year overall survival was similar between both groups (73·8% vs. 75.7%; p = 0.619) after applying propensity score analysis. On multivariate analysis, high Charlson comorbidity score, stage IIA disease, larger tumor size, positive lymph nodes and high-grade disease were significant predictors of poor outcome while older age and treatment approach were not.Interpretation
Our analysis suggests that surgery (followed by adjuvant RT or CRT) and definitive radiotherapy (with or without chemotherapy) result in equivalent survival. Prospective studies are warranted to establish this paradigm in the chemotherapy era. 相似文献17.
Objective
Evaluate recurrence-free survival (RFS) and short-term morbidity in patients with early cervical cancer who undergo bilateral pelvic lymphadenectomy (BPLND) versus bilateral sentinel lymph node biopsy only (BSLNB) at primary surgery.Methods
All patients with pathologically confirmed node negative stage IA/IB cervical cancer managed with BPLND or BSLNB were identified in the University of Toronto's prospective cervical cancer database from May 1984–June 2015. Groups were compared with Wilcoxon rank-sum, Chi-square, and Fisher's exact tests. Predictors of RFS were identified with Cox proportional hazard models. Kaplan-Meier survival curves were compared. Statistical significance was p < 0.05.Results
1188 node negative patients were identified, BPLND-1078; BSLNB-110. There was no difference between BPLND and BSLNB in 2 and 5 year RFS (95% vs 97% and 92% vs 93% respectively), tumor size, histology, invasion depth, intra-operative complications or short-term morbidity. BPLND was associated with increased surgical time (2.8 vs 2.0 h, p < 0.001), blood loss (500 mL vs 100 mL, p < 0.001), transfusion (23% vs 0%, p < 0.001) and post-operative infection (11% vs 0%, p = 0.001). Age, surgery date, stage, LVSI, and radicality of surgery differed between groups. Controlling for age, stage, LVSI, invasion depth and histology, there was no significant difference in RFS between groups. Only invasion depth, LVSI and histology were predictors of RFS.Conclusion
A negative BSLNB is not associated with a difference in RFS compared to a negative BPLND. Short-term morbidity may be reduced, however due to the long study period, changes in demographics and surgery may contribute to differences noted. 相似文献18.
Mohammed K. Ali Ahmed M. Abbas Osama S. Abdalmageed Tarek A. Farghaly Ali H. Yosef 《Middle East Fertility Society Journal》2018,23(3):211-215
Objective
The current study compares the efficacy of the classic approach and the uterine sounding sparing approach (a new approach) for copper intrauterine device (Cu-IUD) insertion.Study design
A randomized clinical trial.Setting
Woman's Health Hospital, Assiut, Egypt.Materials and methods
The current study was an open parallel randomized clinical study conducted in Assiut Woman’s Health Hospital, Egypt included women requesting Copper IUD insertion. Enrolled women were randomized into 2 groups; group I included women subjected to classic approach for Cu-IUD insertion and group II included women had Cu-IUD insertion using the uterine sound-sparing approach (USSA). This approach utilized transvaginal ultrasound (TV/US) for assessment of the uterine cavity length and position before IUD insertion without using uterine sounding. The primary outcome was the successful Cu-IUD insertion.Results
46 women were analyzed in group I and 46 in group II. The pain during IUD insertion and 5 min post-insertion was significantly lower in group II than group I (p < .001). The Cu-IUD inserted easier in group I than group II (p < .001). Moreover; significant shorter duration of insertion was reported in group II (p = .002). More satisfied women were found in group II (p = .0001). At the 4 weeks follow-up; TV/US showed that all IUDs were in place in all women.Conclusions
Cu-IUD can be inserted successfully without using uterine sound provided using TV/US prior to insertion. This method associated with less pain, greater women satisfaction during insertion with shorter duration. 相似文献19.
Emily N. Prendergast Marie Holzapfel Jennifer J. Mueller Mario M. Leitao Camille C. Gunderson Kathleen N. Moore Britt K. Erickson Charles A. Leath Elena S. Diaz Moore Joshua G. Cohen Christine S. Walsh 《Gynecologic oncology》2017,144(2):274-278
Objectives
To determine if 6 versus 3 cycles of adjuvant platinum-based chemotherapy with or without taxane impacts survival in early stage ovarian clear cell carcinoma (OCCC).Methods
We retrospectively identified all cases of stage I and II OCCC treated at 5 institutions from January 1994 through December 2011. Patients were divided into 2 groups: those who received 3 versus 6 cycles of adjuvant chemotherapy. Our cohort consisted of 210 patients with stage IA-II disease, 116 of whom underwent full surgical staging. Cox proportional hazards regression and Kaplan-Meier analyses were performed to evaluate progression-free (PFS) and overall survival (OS) between groups.Results
Among 210 eligible patients, the median age was 53 years (range 30–88). The majority of patients were Caucasian (83.8%). All patients received adjuvant chemotherapy with 90% receiving carboplatin and paclitaxel. Thirty-eight (18.1%) patients received 3 cycles, and 172 (81.9%) patients received 6 cycles of adjuvant treatment. Recurrence rate was comparable between groups (18.4% vs. 27.3% for 3 vs. 6 cycles, p = 0.4). There was no impact of 3 versus 6 cycles of chemotherapy on PFS (hazard ratio [HR] 1.4; 95% confidence interval [CI] 0.63–3.12, p = 0.4) or OS (HR 1.65; 95% CI 0.59–4.65, p = 0.3) on univariate analysis. There was no benefit to more chemotherapy in stratified analysis by stage nor on multivariate analysis adjusting for the impact of stage. Subgroup analysis of surgically staged patients also showed no difference in survival between 3 versus 6 cycles of chemotherapy.Conclusions
Three cycles of platinum with or without taxane adjuvant chemotherapy were comparable to 6 cycles with respect to recurrence and survival in patients diagnosed with early stage ovarian clear cell carcinoma in this retrospective multi-institutional cohort.Condensation
Three cycles of platinum with or without taxane adjuvant chemotherapy are comparable to 6 cycles with respect to recurrence and survival in patients diagnosed with early stage ovarian clear cell carcinoma in this retrospective multi-institutional cohort. 相似文献20.