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Alzibdeh A, Mohamad I, Wahbeh L, Abuhijlih R, Abuhijla F. Can we triumph over locally advanced cervical cancer with colossal para-aortic lymph nodes? A case report. World J Clin Cases 2024; 12:1851-1856. [PMID: 38660077 PMCID: PMC11036483 DOI: 10.12998/wjcc.v12.i10.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/04/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Para-aortic lymph nodes (PALNs) are common sites for the regional spread of cervical squamous cell carcinoma (SCC). CASE SUMMARY We report the case of a 36-year-old woman who presented with cervical SCC with multiple bulky PALNs, largest measured 4.5 cm × 5 cm × 10 cm. The patient was treated with radical intent with definitive chemoradiation using sequential dose-escalated adaptive radiotherapy, followed by maintenance chemotherapy. The patient achieved a complete response; she has been doing well since the completion of treatment with no evidence of the disease for 2 years. CONCLUSION Regardless of the size of PALN metastases of cervical carcinoma origin, it is still treatable (with radical intent) via concurrent chemoradiation. Adaptive radiotherapy allows dose escalation with minimal toxicity.
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Affiliation(s)
- Abdulla Alzibdeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
| | - Lina Wahbeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
| | - Ramiz Abuhijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
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Olthof EP, Wenzel H, van der Velden J, Spijkerboer AM, Bekkers R, Beltman JJ, Nijman HW, Slangen B, Smolders R, van Trommel N, Zusterzeel PLM, Zweemer R, Stalpers LJA, van der Aa M, Mom C. Treatment of bulky lymph nodes in locally advanced cervical cancer: boosting versus debulking. Int J Gynecol Cancer 2022; 32:861-868. [PMID: 35483738 PMCID: PMC9279830 DOI: 10.1136/ijgc-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Treatment strategies for bulky lymph nodes in patients with locally advanced cervical cancer scheduled for definitive chemoradiation include nodal boosting with radiotherapy, surgical debulking, or both. The aim of this retrospective cohort study was to compare survival and toxicity in patients receiving these treatments and to compare them with a group that received neither form of treatment. Methods Women diagnosed between January 2009 and January 2017 with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2, IIA2–IVA cervical cancer with lymph nodes ≥1.5 cm without upper limit on pretreatment imaging and treated with definitive chemoradiation were selected from the Netherlands Cancer Registry. Patients were categorized by intention-to-treat strategy: boosting, debulking, or neither treatment, with subgroup analysis for patients receiving both treatments, that is, debulking with boosting. Overall and relapse-free survival outcomes were compared by Kaplan-Meier and Cox regression analyses and toxicity by logistic regression analysis. Results Of 190 patients, 101 (53%) received only nodal boosting, 31 (16%) debulking alone, 29 (15%) debulking combined with boosting, and 29 (15%) received neither treatment. The 5 year overall and relapse-free survival for the treatment groups were 58%, 45% and 45% (p=0.19), and 47%, 44% and 46% (p=0.87), respectively. Multivariable Cox regression analyses demonstrated no differences in overall and relapse-free survival. Combination of debulking with boosting was associated with decreased overall and relapse-free survival compared with debulking alone (HR 2.47, 95% CI 1.22 to 5.00; and HR 2.37, 95% CI 1.14 to 4.93). Nodal boosting was independently associated with a decreased toxicity risk compared with debulking strategy (OR 0.37, 95% CI 0.16 to 0.83). Conclusions This study showed no survival benefit from either nodal boosting or debulking strategy in patients with suspicious bulky nodes. Nodal boosting might, however, be associated with less toxicity. Dual treatment with debulking and boosting showed a worse survival outcome because this group probably represents patients with poor prognostic factors.
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Affiliation(s)
- Ester Paulien Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands .,Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Hans Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacobus van der Velden
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Anje M Spijkerboer
- Department of Radiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ruud Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jogchum J Beltman
- Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Brigitte Slangen
- Department of Gynecologic Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ramon Smolders
- Department of Gynecological Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nienke van Trommel
- Department of Gynecological Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Centre for Gynecologic Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald Zweemer
- Department of Gynecological Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maaike van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Constantijne Mom
- Department of Gynecological Oncology, Amsterdam University Medical Centres, Centre for Gynecological Oncology Amsterdam (CGOA), Amsterdam, The Netherlands
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Qin F, Pang H, Yu T, Luo Y, Dong Y. Treatment Strategies and Prognostic Factors of 2018 FIGO Stage IIIC Cervical Cancer: A Review. Technol Cancer Res Treat 2022; 21:15330338221086403. [PMID: 35341413 PMCID: PMC8966198 DOI: 10.1177/15330338221086403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is the fourth most common malignant tumor globally in terms of morbidity and mortality. The presence of lymph node metastasis (LNM) is an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in cervical cancer patients. The International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2018. An important revision designates patients with regional LNM as stage IIIC, pelvic LNM only as stage IIIC1, and para-aortic LNM as stage IIIC2. However, the current staging system is only based on the anatomical location of metastatic lymph nodes (LNs). It does not consider other LN status parameters, which may limit its prognostic significance to a certain extent and needs further exploration and confirmation in the future. The purpose of this review is to summarize the choice of treatment for stage IIIC cervical cancer and the effect of different LN status parameters on prognosis.
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Affiliation(s)
- Fengying Qin
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Huiting Pang
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Yu
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yahong Luo
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Yue Dong
- 74665Liaoning Cancer Hospital, Shenyang, Liaoning, China
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Obrzut B, Kusy M, Semczuk A, Obrzut M, Kluska J. Prediction of 10-year Overall Survival in Patients with Operable Cervical Cancer using a Probabilistic Neural Network. J Cancer 2019; 10:4189-4195. [PMID: 31413737 PMCID: PMC6691714 DOI: 10.7150/jca.33945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Toward the goal of predicting individual long-term cancer survival to guide treatment decisions, this study evaluated the ability of a probabilistic neural network (PNN), an established model used for decision-making in research and clinical settings, to predict the 10-year overall survival in patients with cervical cancer who underwent primary surgical treatment. Patients and Method: The input dataset was derived from 102 patients with cervical cancer FIGO stage IA2-IIB treated by radical hysterectomy. We identified 4 demographic parameters, 13 tumor-related parameters, and 6 selected perioperative variables for each patient and performed computer simulations with DTREG software. The predictive ability of the model was determined on the basis of its error, sensitivity, and specificity, as well as area under the receiver operating characteristic curve. The results of the PNN predictive model were compared with those of logistic regression analysis and a single decision tree as reference models. Results: The PNN model had very high predictive ability, with a sensitivity of 0.949, a specificity of 0.679, and an error rate of 12.5%. The PNN's area under the receiver operating characteristic curve was high, 0.809, a value greater than those for both logistic regression analysis and the single decision tree. Conclusion: The PNN model effectively and reliably predicted 10-year overall survival in women with operable cervical cancer, and may therefore serve as a tool for decision-making process in cancer treatment.
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Affiliation(s)
- Bogdan Obrzut
- Medical Faculty, University of Rzeszow, Rejtana str. 16C, 35-959 Rzeszow, Poland
- Department of Obstetrics and Gynecology, Provincial Clinical Hospital No. 2, Lwowska str. 60, 35-301 Rzeszow, Poland
| | - Maciej Kusy
- Faculty of Electrical and Computer Engineering, Rzeszow University of Technology, Powstanców Warszawy avenue 12, 35-959 Rzeszow, Poland
| | - Andrzej Semczuk
- II ND Department of Gynecology, Lublin Medical University, Jaczewski str. 8, 20-954, Lublin, Poland
| | - Marzanna Obrzut
- Medical Faculty, University of Rzeszow, Rejtana str. 16C, 35-959 Rzeszow, Poland
| | - Jacek Kluska
- Faculty of Electrical and Computer Engineering, Rzeszow University of Technology, Powstanców Warszawy avenue 12, 35-959 Rzeszow, Poland
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Oh J, Seol KH, Choi YS, Lee JW, Bae JY. Clinical significance of lymph node size in locally advanced cervical cancer treated with concurrent chemoradiotherapy. Yeungnam Univ J Med 2019; 36:115-123. [PMID: 31620623 PMCID: PMC6784628 DOI: 10.12701/yujm.2019.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background This study aimed to assess the in-field lymph node (LN) failure rate according to LN size and to investigate effect of LN size on the survival outcome of patients with locally advanced cervical carcinoma treated with concurrent chemoradiotherapy (CCRT). Methods A total of 310 patients with locally advanced cervical carcinoma treated with CCRT were enrolled in retrospective study. LN status was evaluated by magnetic resonance imaging. All patients received conventional external beam irradiation and high-dose rate brachytherapy, and concurrent cisplatin-based chemotherapy. In-field LN failure rate according to LN size was analyzed. Results The median follow-up period was 83 months (range, 3-201 months). In-field LN failure rate in patients with pelvic LN size more than 10 mm was significantly higher than that in patients with pelvic LN size less than 10 mm (p<0.001). A similar finding was observed in the in-field para-aortic LN (PALN) failure rate (p=0.024). The pelvic and PALN size (≥10 mm) was a significant prognostic factor of overall-survival (OS) and disease-free survival rate in univariate and multivariate analyses. The OS rate was significantly different between groups according to LN size (<10 mm vs. ≥10 mm). Conclusion A LN of less than 10 mm in size in an imaging study is controlled by CCRT. On the other hand, in LN of more than 10 mm in size, the in-field LN failure rate increase and the prognosis deteriorate. Therefore, a more aggressive treatment strategy is needed.
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Affiliation(s)
- Jinju Oh
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Youn Seok Choi
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jeong Won Lee
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
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Zhou J, Wu SG, Sun JY, Liao XL, Li FY, Lin HX, Yang LC, He ZY. Incorporation of the number of positive lymph nodes leads to better prognostic discrimination of node-positive early stage cervical cancer. Oncotarget 2018; 8:26057-26065. [PMID: 28199962 PMCID: PMC5432237 DOI: 10.18632/oncotarget.15220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/27/2017] [Indexed: 12/02/2022] Open
Abstract
To determine the prognostic value of the number of positive lymph nodes (LNs) in cervical cancer and further stratify patients with positive LNs into multiple risk groups based on analysis of Surveillance Epidemiology and End Results (SEER) program. Patients with cervical cancer who undergo hysterectomy and had pathologically-confirmed positive LNs after lymphadenectomy were identified using the SEER database (1988-2012). Kaplan–Meier survival methods and Cox proportional hazards regression were performed. We included 2,222 patients with the median number of removed LNs and positive LNs was 22 and 2, respectively. Multivariable Cox analysis showed patients with > 2 positive LNs had poorer cause-specific survival (CSS) (hazard ratio [HR] 1.631, 95% confidence interval [CI] 1.382–1.926, P < 0.001) and overall survival (OS) (HR 1.570, 95% CI 1.346–1.832, P < 0.001) than patients with 1–2 positive LNs. Five-year CSS and OS were 78.9% vs. 65.5% (P < 0.001) and 76.7% vs. 62.7% (P < 0.001) for 1–2 positive LNs and > 2 positive LNs, respectively. The number of positive LNs had prognostic value in cervical squamous cell carcinoma or adenosquamous carcinoma, but not in cervical adenocarcinoma. The number of positive LNs is an independent risk factor for CSS and OS in cervical cancer. This new category might be helpful in better prognostic discrimination of node-positive early stage cervical cancer after hysterectomy.
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Affiliation(s)
- Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Jia-Yuan Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Xu-Lin Liao
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen 361005, People's Republic of China
| | - Feng-Yan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Huan-Xin Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Li-Chao Yang
- Faculty of Basic Medicine, Medical College, Xiamen University, Xiamen 361005, People's Republic of China
| | - Zhen-Yu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
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Obrzut B, Kusy M, Semczuk A, Obrzut M, Kluska J. Prediction of 5-year overall survival in cervical cancer patients treated with radical hysterectomy using computational intelligence methods. BMC Cancer 2017; 17:840. [PMID: 29233120 PMCID: PMC5727988 DOI: 10.1186/s12885-017-3806-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/21/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Computational intelligence methods, including non-linear classification algorithms, can be used in medical research and practice as a decision making tool. This study aimed to evaluate the usefulness of artificial intelligence models for 5-year overall survival prediction in patients with cervical cancer treated by radical hysterectomy. METHODS The data set was collected from 102 patients with cervical cancer FIGO stage IA2-IIB, that underwent primary surgical treatment. Twenty-three demographic, tumor-related parameters and selected perioperative data of each patient were collected. The simulations involved six computational intelligence methods: the probabilistic neural network (PNN), multilayer perceptron network, gene expression programming classifier, support vector machines algorithm, radial basis function neural network and k-Means algorithm. The prediction ability of the models was determined based on the accuracy, sensitivity, specificity, as well as the area under the receiver operating characteristic curve. The results of the computational intelligence methods were compared with the results of linear regression analysis as a reference model. RESULTS The best results were obtained by the PNN model. This neural network provided very high prediction ability with an accuracy of 0.892 and sensitivity of 0.975. The area under the receiver operating characteristics curve of PNN was also high, 0.818. The outcomes obtained by other classifiers were markedly worse. CONCLUSIONS The PNN model is an effective tool for predicting 5-year overall survival in cervical cancer patients treated with radical hysterectomy.
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Affiliation(s)
- Bogdan Obrzut
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Rzeszow, Lwowska 60, Rzeszow, 35-301 Poland
| | - Maciej Kusy
- Faculty of Electrical and Computer Engineering, Rzeszow University of Technology, al. Powstancow Warszawy 12, Rzeszow, 35-959 Poland
| | - Andrzej Semczuk
- IIND Department of Gynecology, Lublin Medical University, al. Raclawickie 1, Lublin, 20-059 Poland
| | - Marzanna Obrzut
- Faculty of Medicine, University of Rzeszow, al. Kopisto 2a, Rzeszow, 35-959 Poland
| | - Jacek Kluska
- Faculty of Electrical and Computer Engineering, Rzeszow University of Technology, al. Powstancow Warszawy 12, Rzeszow, 35-959 Poland
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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. Gynecol Oncol 2017; 144:536-540. [PMID: 28108027 DOI: 10.1016/j.ygyno.2017.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/31/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022]
Abstract
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.
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Analysis of Prognostic Factors Affecting the Outcome of Stage IB-IIB Cervical Cancer Treated by Radical Hysterectomy and Pelvic Lymphadenectomy. Am J Clin Oncol 2016; 39:604-608. [DOI: 10.1097/coc.0000000000000100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang Y, Yao T, Yu J, Li J, Chen Q, Lin Z. Can pelvic lymphadenectomy be omitted in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer? SPRINGERPLUS 2016; 5:1262. [PMID: 27536545 PMCID: PMC4974207 DOI: 10.1186/s40064-016-2927-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
Purpose This study aimed to identify the surgical-pathologic risk factors of lymph node metastasis (LNM) in patients with early stage squamous cell cervical cancer and to evaluate the potential efficacy of omitting pelvic lymphadenectomy. Methods A total of 276 patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer receiving primary radical hysterectomy with pelvic lymphadenectomy were included in this study. Results The incidences of LNM in patients with stage IA2, IB1, and IIA1 squamous cell cervical cancer were 0 % (0/8), 17.4 % (36/207), and 29.5 % (18/61), respectively. The most common location of LNM was the obturator lymph node. Human papilloma virus 16 subtype was the most common infection in early stage squamous cell cervical cancer. Univariate analysis revealed that squamous cell carcinoma antigen (SCCAg) greater than 1.5 μg/L (p < 0.001), tumor size greater than 2 cm (p < 0.001), tumor size greater than 3 cm (p < 0.001), depth of stromal invasion (p < 0.001) and lymphovascular invasion (p < 0.001) were associated with LNM. Logistic regression analysis revealed that depth of stromal invasion {model 1 [p = 0.006; odds ratio (OR) 2.161; 95 % confidence interval (CI) 1.251–3.734], model 2 [p = 0.002; OR 2.344; 95 % CI 1.337–3.989]}, lymphovascular invasion [model 1 (p = 0.004; OR 2.967; 95 % CI 1.411–6.237), model 2 (p = 0.004; OR 2.978; 95 % CI 1.421–6.243)], and SCCAg greater than 1.5 μg/L [model 1 (p = 0.023; OR 2.431; 95 % CI 1.129–5.235), model 2 (p = 0.024; OR 2.418; 95 % CI 1.125–5.194)] were independently associated with LNM. Conclusions Pelvic lymphadenectomy may be omitted in patients with SCCAg lower than 1.5 μg/L, superficial stromal invasion and without lymphovascular invasion in stage IA2, IB1, IIA1 squamous cell cervical cancer.
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Affiliation(s)
- Yaxian Wang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China.,Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Jin Yu
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Jing Li
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
| | - Qionghua Chen
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003 People's Republic of China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120 People's Republic of China
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The influence of number of high risk factors on clinical outcomes in patients with early-stage cervical cancer after radical hysterectomy and adjuvant chemoradiation. Obstet Gynecol Sci 2016; 59:184-91. [PMID: 27200308 PMCID: PMC4871934 DOI: 10.5468/ogs.2016.59.3.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/09/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate the prognosis according to the number of high risk factors in patients with high risk factors after radical hysterectomy and adjuvant chemoradiation therapy for early stage cervical cancer. Methods Clinicopathological variables and clinical outcomes of patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IIA cervical cancer who had one or more high risk factors after radical hysterectomy and adjuvant chemoradiation therapy were retrospectively analyzed. Patients were divided into two groups according to the number of high risk factors (group 1, single high risk factor; group 2, two or more high risk factors). Results A total of 93 patients were enrolled in the present study. Forty nine out of 93 (52.7%) patients had a single high risk factor, and 44 (47.3%) had two or more high risk factors. Statistically significant differences in stage and stromal invasion were observed between group 1 and group 2. However, age, histology, tumor size, and lymphovascular space invasion did not differ significantly between the groups. Distant recurrence occurred more frequently in group 2, and the probability of recurrence and death was higher in group 2. Conclusion Patients with two or more high risk factors had worse prognosis in early stage cervical cancer. For these patients, consideration of new strategies to improve survival may be worthwhile. Conduct of further clinical trials is warranted for development of adjuvant treatment strategies individualized to each risk group.
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The size of the metastatic lymph node is an independent prognostic factor for the patients with cervical cancer treated by definitive radiotherapy. Radiother Oncol 2013; 108:168-73. [DOI: 10.1016/j.radonc.2013.04.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/18/2013] [Accepted: 04/20/2013] [Indexed: 11/22/2022]
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Biedka M, Makarewicz R, Kopczyńska E, Marszałek A, Goralewska A, Kardymowicz H. Angiogenesis and lymphangiogenesis as prognostic factors after therapy in patients with cervical cancer. Contemp Oncol (Pozn) 2012; 16:6-11. [PMID: 23788848 PMCID: PMC3687378 DOI: 10.5114/wo.2012.27330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 04/02/2011] [Accepted: 07/25/2011] [Indexed: 01/16/2023] Open
Abstract
AIM OF THE STUDY This retrospective study attempts to evaluate the influence of serum vascular endothelial growth factor C (VEGF-C), microvessel density (MVD) and lymphatic vessel density (LMVD) on the result of tumour treatment in women with cervical cancer. MATERIAL AND METHODS The research was carried out in a group of 58 patients scheduled for brachytherapy for cervical cancer. All women were patients of the Department and University Hospital of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University in Toruń. VEGF-C was determined by means of a quantitative sandwich enzyme immunoassay using a human antibody VEGF-C ELISA produced by Bender MedSystem, enzyme-linked immunosorbent detecting the activity of human VEGF-C in body fluids. The measure for the intensity of angiogenesis and lymphangiogenesis in immunohistochemical reactions is the number of blood vessels within the tumour. Statistical analysis was done using Statistica 6.0 software (StatSoft, Inc. 2001). The Cox proportional hazards model was used for univariate and multivariate analyses. Univariate analysis of overall survival was performed as outlined by Kaplan and Meier. In all statistical analyses p < 0.05 (marked red) was taken as significant. RESULTS In 51 patients who showed up for follow-up examination, the influence of the factors of angiogenesis, lymphangiogenesis, patients' age and the level of haemoglobin at the end of treatment were assessed. Selected variables, such as patients' age, lymph vessel density (LMVD), microvessel density (MVD) and the level of haemoglobin (Hb) before treatment were analysed by means of Cox logical regression as potential prognostic factors for lymph node invasion. The observed differences were statistically significant for haemoglobin level before treatment and the platelet number after treatment. The study revealed the following prognostic factors: lymph node status, FIGO stage, and kind of treatment. No statistically significant influence of angiogenic and lymphangiogenic factors on the prognosis was found. CONCLUSION Angiogenic and lymphangiogenic factors have no value in predicting response to radiotherapy in cervical cancer patients.
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Affiliation(s)
- Marta Biedka
- Chair and Clinic of Oncology and Brachytherapy, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Radiotherapy Department I, Oncology Centre, Bydgoszcz, Poland
| | - Roman Makarewicz
- Chair and Clinic of Oncology and Brachytherapy, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Ewa Kopczyńska
- Chair and Department of Pathobiochemistry and Chemistry, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Andrzej Marszałek
- Chair and Department of Clinical Pathomorphology, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Chair and Department of Clinical Pathomorphology, Poznan University of Medical Sciences, Poland
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Zheng M, Huang L, Liu JH, Xiong Y, Li JD, Huang X, He L, Ren YF, Wang HY. Type II radical hysterectomy and adjuvant therapy for pelvic lymph node metastasis with stage IB-IIB cervical carcinoma: a retrospective study of 288 patients. J Surg Oncol 2011; 104:480-5. [PMID: 21538358 DOI: 10.1002/jso.21956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 03/31/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate type II radical hysterectomy with or without adjuvant therapy as a treatment for patients with pelvic lymph node metastasis (PLNM) and stage IB-IIB cervical carcinoma. METHODS A total of 288 patients with stage IB-IIB cervical carcinoma and confirmed PLNM who underwent a type II radical hysterectomy between 1995 and 2005 were retrospectively evaluated. RESULTS The 5-year overall survival (OS) rate for this cohort was 65.6%, and independent prognostic factors identified for PLNM patients included a non-squamous cell histological subtype and parametrial involvement. Survival differences between patients that received or did not receive adjuvant treatment were also evaluated, and the 5-year OS and DFS rates for patients who did not receive adjuvant therapy (47 and 41.4%, respectively) were much lower than the rates for patients who did receive adjuvant therapies (67.7 and 59.4%, respectively). However, these differences were not statistically significant (OS, P = 0.057; DFS, P = 0.080). CONCLUSIONS Type II radical hysterectomy, in combination with adjuvant therapies, is an efficient treatment for PLNM patients with stage IB-IIB cervical cancer.
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Affiliation(s)
- Min Zheng
- State Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong PR China.
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15
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Hosaka M, Watari H, Mitamura T, Konno Y, Odagiri T, Kato T, Takeda M, Sakuragi N. Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Int J Clin Oncol 2010; 16:33-8. [PMID: 20842404 DOI: 10.1007/s10147-010-0123-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Lymph node metastasis (LNM) is known to be the most important prognostic factor in cervical cancer. We analyzed the number of positive lymph nodes and other clinicopathological factors as prognostic factors for survival in node-positive patients with cervical cancer. METHODS Node-positive cervical cancer patients (n = 108) who underwent radical hysterectomy and systematic lymphadenectomy in Hokkaido University Hospital from 1982 to 2002 were enrolled. Clinicopathological data including age, stage, histologic subtype, and the number of LNM sites were collected. The main outcome was the overall survival (OS) rate for Stage Ib-IIb patients treated with surgery and postoperative radiotherapy. RESULTS The 5-year OS rate of patients with 1 positive node was 93.3%, that for 2 nodes was 77.3%, for 3 nodes it was 33.3%, and for 4 or more it was 13.8%. The OS rate of patients with 1 or 2 LNM sites was significantly better than that for patients with more than 2 LNM sites. The OS rate of patients with adenocarcinoma (Ad) (28.6%) was significantly lower than that for patients with other histologic subtypes (squamous cell carcinoma; 66.7%, adenosquamous carcinoma; 75.0%, p = 0.0003). Multivariate analysis revealed that >2 LNM sites and Ad were independent prognostic factors for survival. The 5-year OS rate of patients with 1 or 2 LNM sites was 86.8%, a more favorable prognosis than the OS rates in other reports. CONCLUSION More than two LNM sites and adenocarcinoma were independent prognostic factors for node-positive patients with cervical cancer.
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Affiliation(s)
- Masayoshi Hosaka
- Department of Gynecology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
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Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Further stratification of risk groups in patients with lymph node metastasis after radical hysterectomy for early-stage cervical cancer. Gynecol Oncol 2010; 117:53-8. [PMID: 20061005 DOI: 10.1016/j.ygyno.2009.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/28/2009] [Accepted: 12/02/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prognostic factors in node-positive patients with early-stage cervical cancer who underwent radical hysterectomy (RH) and to use these factors to stratify patients into risk groups for individualized adjuvant therapy. METHODS Patients with early-stage cervical cancer who had lymph node metastasis after RH were retrospectively analyzed. RESULTS Multivariate analysis showed that non-squamous histology, tumor size and parametrial involvement were significantly associated with recurrence-free survival (RFS) and overall survival (OS). Prognostic scores were generated for these factors, and patients were categorized into low- (score 0; n=74), intermediate- (score 1-2; n=100) and high- (score 3-4; n=14) risk groups. Relative to the low-risk group, the probability of cancer recurrence was significantly higher in the high- (OR=10.87, 95% CI=4.22-28.0, P<.001) and intermediate- (OR=3.01, 95% CI=1.37-6.58, P=.006) risk groups. Moreover, the probability of cancer death was significantly higher in the high- (OR=9.88, 95% CI=3.76-25.94, P<.001) and intermediate- (OR=2.49, 95% CI=1.12-5.55, P=.026) risk groups compared with the low-risk group. The rates of pelvic failure and distant recurrence increased with increasing risk. CONCLUSION(S) Node-positive patients were heterogeneous, with different prognoses and recurrence patterns according to clinicopathologic risk factors. Further clinical trials are warranted to develop adjuvant treatment strategies individualized to each risk group.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Tavares MBAC, Sousa RB, Silva TOE, Moreira LA, Silva LTTL, Tavares CBAC, Vieira SC. Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy. SAO PAULO MED J 2009; 127:145-9. [PMID: 19820876 PMCID: PMC10956892 DOI: 10.1590/s1516-31802009000300007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 07/14/2009] [Accepted: 06/08/2009] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5% was used. RESULTS The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036), presence of lymph node metastasis (P < 0.0004), necrosis (P < 0.05) and surgical margin involvement (P < 0.0015) presented impacts on survival. The overall survival with 98 months of follow-up was 88.35%. CONCLUSION The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.
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Affiliation(s)
| | - Rodrigo Beserra Sousa
- Medical student, School of Medicine, Universidade Federal do Piauí (UFPI), Teresina, Piauí, Brazil.
| | - Thiago Oliveira e Silva
- Medical student, School of Medicine, Universidade Federal do Piauí (UFPI), Teresina, Piauí, Brazil.
| | | | | | - Carolina Buenos Aires Cabral Tavares
- MD. Gynecologist and Obstetrician, Maternidade-Escola Assis Chateaubriand (MEAC), Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil.
| | - Sabas Carlos Vieira
- MD, PhD. Oncological Surgeon and Professor, Universidade Federal do Piauí (UFPI), Teresina, Piauí, Brazil.
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Chen Y, Xu H, Li Y, Wang D, Li J, Yuan J, Liang Z. The outcome of laparoscopic radical hysterectomy and lymphadenectomy for cervical cancer: a prospective analysis of 295 patients. Ann Surg Oncol 2008; 15:2847-55. [PMID: 18649105 DOI: 10.1245/s10434-008-0063-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Cervical carcinoma is likely to become one of the most important indications for laparoscopic radical surgery. The laparoscopic technique combines the benefits of a minimally invasive approach with established surgical principles. In our institution, the laparoscopic radical hysterectomy and transperitoneal approach for lymphadenectomy have become the standard techniques for invasive cervical cancer. We report the indications, techniques, results, and oncological outcome in a single center experience. METHODS Between February 2001 and June 2007 we performed laparoscopic radical hysterectomies for cervical cancer in 295 patients. Their initial techniques, operation data, complications, postoperative course, oncological outcome, and survival were evaluated. RESULTS Out of 295 procedures, 290 were successful. Para-aortic lymphadenectomy was performed in 156 patients (52.9%), and pelvic lymphadenectomy was performed in all 295 patients. The median blood loss was 230 mL (range, 50-1200 mL). The mean operation time was 162 min (range, 110-350), which included the learning curves of 3 surgeons. In 5 cases (1.7%), conversion to open surgery was necessary due to bleeding (3 cases), bowel injury (1 case), and hypercapnia (1 case). Other major intraoperative injuries occurred in 12 patients (4.1%). Positive lymph nodes were detected in 80 cases (27.1%), lymphovascular space invasion in 54 cases (18.3%), and surgical margins were negative for tumor in all patients. The mean hospital stay was 10.3 days. Postoperative complications occurred in 10.8% patients, ureterovaginal fistula in 5 cases, vesicovaginal fistula in 4, ureterostenosis in 3 cases, deep venous thrombosis in 9 cases, lymphocyst in 4 cases, lymphedema in 5 cases, and 1 case with trocar insertion site metastasis. Other medical problems included 47 cases (15.9%) of bladder dysfunction and 62 cases (21.0%) of rectum dysfunction or constipation. The median follow-up was 36.45 months (range, 8-76 months). Recurrences or metastasis occurred in 48 patients (16.3%). Of these patients, 43 (14.6%) have died of their disease, and 5 (1.7%) are alive with disease. The overall disease-free survival was 95.2% for Ia, 96.2% for Ib, 84.5% for IIa, 79.4% for IIb, 66.7% for IIIa, and 60.0% for IIIb. CONCLUSION Laparoscopic radical hysterectomy is a routine, effective treatment for patients with Ia2-IIb cervical carcinoma. With more experience it is envisaged that IIb stage patients can be managed safely offering all the benefits of minimal surgery to the patients. Although no long-term follow-up is available, our follow-up data for up to 76 months confirm the effectiveness of laparoscopic radical hysterectomy in terms of surgical principles and oncological outcome.
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Affiliation(s)
- Yong Chen
- Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P.R. China
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Benedetti Panici P, Palaia I, Basile S, Perniola G, Sansone M, Gradinaru N, Zullo MA, Angioli R. Conservative approaches in early stages of cervical cancer. Gynecol Oncol 2007; 107:S13-5. [PMID: 17727934 DOI: 10.1016/j.ygyno.2007.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/19/2022]
Abstract
Several authors have proposed the use of a less aggressive surgery (i.e. conization, trachelectomy plus laparoscopic lymphadenectomy, modified or type 2 radical hysterectomy) for patients affected by early stages invasive cervical carcinoma. Tumor size and pelvic nodal status are parameters that must be evaluated to better select a patient's population suitable of a less aggressive surgery, with the aim of sparing morbidity without jeopardizing cancer cure.
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Affiliation(s)
- Pierluigi Benedetti Panici
- Institute of Gynecology, Perinatology and Child Health, La Sapienza University, Viale del Policlinico, 155, 00100 Rome, Italy.
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Kodama J, Seki N, Nakamura K, Hongo A, Hiramatsu Y. Prognostic factors in pathologic parametrium-positive patients with stage IB-IIB cervical cancer treated by radical surgery and adjuvant therapy. Gynecol Oncol 2007; 105:757-61. [PMID: 17433424 DOI: 10.1016/j.ygyno.2007.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 02/18/2007] [Accepted: 02/22/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the present study was to identify prognostic factors and recurrent patterns in pathologic parametrium-positive patients with stage IB-IIB cervical cancers treated by radical surgery and adjuvant therapy. METHODS The patient population consisted of 84 individuals presenting with stage IB-IIB cervical cancers and histologically proven parametrial invasion. All these patients were treated postoperatively with adjuvant external whole pelvic irradiation, combination chemotherapy, or chemoradiotherapy. RESULTS The 5-year disease-free survival rate was found to be 67.2% and 5-year overall survival rate, 75.4%. Multivariate analysis revealed that vaginal invasion (p=0.0008), lymph node metastasis (p=0.002), and non-squamous histology (p=0.010) were independent indicators of the disease-free survival rates and that the vaginal invasion (p=0.009) and lymph node metastasis (p=0.011) were independent prognostic factors for the overall survival rates. The 5-year overall survival rate was approximately 90% for patients without these risk factors. Disease recurrence was observed in 26 patients (31.0%) with a median time of 16.5 months (range, 5-59 months) from the surgery. Hematogenous recurrences, including those in the lung, liver, and bone, were significantly higher in patients with non-squamous cell carcinomas (p=0.008). Distant lymph node recurrences were significantly higher in patients with positive pelvic lymph node and vaginal invasion (p=0.004 and p=0.023, respectively). Pelvic recurrences were significantly higher in patients with vaginal invasion (p=0.026). CONCLUSIONS Vaginal invasion and lymph node metastasis are independent indicators for disease-free and overall survival rates in pathologic parametrium-positive patients with stage IB-IIB cervical cancer treated by radical surgery and adjuvant therapy. The survival rate is excellent in the patients without these risk factors. Hematogenous recurrence may be evident in patients with non-squamous cell carcinomas.
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Affiliation(s)
- Junichi Kodama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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