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Abrar SS, Azmel Mohd Isa S, Mohd Hairon S, Yaacob NM, Ismail MP. Prognostic Factors for Cervical Cancer in Asian Populations: A Scoping Review of Research From 2013 to 2023. Cureus 2024; 16:e71359. [PMID: 39534844 PMCID: PMC11556266 DOI: 10.7759/cureus.71359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 11/16/2024] Open
Abstract
Cervical cancer is the fourth most common cancer among women worldwide, with particularly high incidence and mortality rates in low- and middle-income countries, with Asia reporting the highest number of cases in 2022. Despite this significant burden, the prognostic factors specific to Asian populations remain underexplored. This scoping review aimed to identify and evaluate prognostic factors associated with cervical cancer outcomes in Asia, focusing on clinical, socio-demographic, and treatment-related variables. The review followed the Arksey and O'Malley framework and included 44 studies published between 2013 and 2023. The majority of research was concentrated in East Asia, particularly in China, Japan, and South Korea. Key prognostic factors affecting overall survival and disease-free survival included tumor size, histology, age, lymphovascular invasion, and lymph node metastasis. Non-squamous cell carcinoma histology, especially adenocarcinoma, was consistently linked to poorer outcomes. Older age and medical comorbidities, such as anemia and diabetes, also negatively impacted survival. Treatment-related factors, though less frequently reported, demonstrated the significance of adjuvant therapy, chemotherapy, and treatment intensity in improving outcomes. This review underscores the complexity of cervical cancer prognosis in Asian populations and highlights the need for targeted research and region-specific interventions to address the rising incidence of cervical cancer. It also highlights the scarcity of research on cervical cancer prognostic factors in West, Central, and South Asian countries. Future research should aim to address the gaps in understanding treatment-related factors and explore the potential for region-specific interventions to improve outcomes in cervical cancer across Asia.
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Affiliation(s)
- Syed S Abrar
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Najib M Yaacob
- Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Mohd Pazudin Ismail
- Department of Gynecology and Obstetrics, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
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Scaglione G, Arciuolo D, Travaglino A, Santoro A, Angelico G, Spadola S, Inzani F, D’Alessandris N, Raffone A, Fulgione C, Padial Urtueta B, Sfregola S, Valente M, Addante F, d’Amati A, Cianfrini F, Piermattei A, Pedone Anchora L, Scambia G, Ferrandina G, Zannoni GF. Prognostic Value of Mandard's Tumor Regression Grade (TRG) in Post Chemo-Radiotherapy Cervical Cancer. Diagnostics (Basel) 2023; 13:3228. [PMID: 37892049 PMCID: PMC10605878 DOI: 10.3390/diagnostics13203228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
In locally advanced cervical cancer (LACC), definitive chemo-radiotherapy is the standard treatment, but chemo-radiotherapy followed by surgery could be an alternative choice in selected patients. We enrolled 244 patients affected by LACC and treated with CT-RT followed by surgery in order to assess the prognostic role of the histological response using the Mandard scoring system. Results: A complete pathological response (TRG 0) was observed in 118 patients (48.4%), rare residual cancer cells (TRG2) were found in 49 cases (20.1%), increased number of cancer cells but fibrosis still predominating (TRG3) in 35 cases (14.3%), and 42 (17.2%) were classified as non-responders (TRG4-5). TRG was significantly associated with both OS (p < 0.001) and PFS (p < 0.001). The survival curves highlighted two main prognostic groups: TRG1-TRG2 and TRG3-TRG4-5. Main responders (TRG1-2) showed a 92% 5-year overall survival (5y-OS) and a 75% 5-year disease free survival (5y-DFS). Minor or no responders showed a 48% 5y-OS and a 39% 5y-DFS. The two-tiered TRG was independently associated with both DFS and OS in Cox regression analysis. Conclusion. We showed that Mandard TRG is an independent prognostic factor in post-CT/RT LACC, with potential benefits in defining post-treatment adjuvant therapy.
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Affiliation(s)
- Giulia Scaglione
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Damiano Arciuolo
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy
| | - Angela Santoro
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Giuseppe Angelico
- Pathology Unit, Cannizzaro Hospital, 95126 Catania, Italy; (G.A.); (S.S.)
| | - Saveria Spadola
- Pathology Unit, Cannizzaro Hospital, 95126 Catania, Italy; (G.A.); (S.S.)
| | - Frediano Inzani
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Nicoletta D’Alessandris
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy;
| | - Caterina Fulgione
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, 80131 Naples, Italy;
| | - Belen Padial Urtueta
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Stefania Sfregola
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Michele Valente
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Francesca Addante
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Antonio d’Amati
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70100 Bari, Italy;
| | - Federica Cianfrini
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Alessia Piermattei
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
| | - Luigi Pedone Anchora
- Gynecologic Oncology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.P.A.); (G.S.); (G.F.)
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.P.A.); (G.S.); (G.F.)
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.P.A.); (G.S.); (G.F.)
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.S.); (D.A.); (A.T.); (A.S.); (N.D.); (B.P.U.); (S.S.); (M.V.); (F.A.); (F.C.); (A.P.)
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Urodynamic outcomes after pelvic nerve-sparing radical hysterectomy with or without neoadjuvant chemotherapy. Oncotarget 2019; 10:5207-5216. [PMID: 31497250 PMCID: PMC6718266 DOI: 10.18632/oncotarget.27147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: Our purposes of this study were to characterize a group of bulky cervical cancer patients who underwent a nerve sparing radical hysterectomy (NSRH) with or without neoadjuvant chemotherapy (NAC), to compare surgical outcomes and the preservation of bladder function, and to compare prognoses.
RESULTS: Fifty-three patients had NSRH without NAC (Group A), and 33 patients had NSRH after NAC (Group B). With regard to prognostic factors, there was only a significant difference between both groups with regard to lymph node metastasis (15% vs 42%, P = 0.01). Moreover, bladder function in Group B patients improved to the same extent as the preoperative rate three months postoperatively. These data were similar to the results in Group A. With regard to overall survival, the 5-year survival rate was 98.1% (95% confidence interval (CI) 87.8–99.7) in Group A and 86.7% (95% CI 71.7–96.7) in Group B (P > 0.1).
METHODS: We retrospectively identified 86 patients with cervical cancer who underwent NSRH at Osaka Medical College from May 2009 to November 2016. NAC was performed via balloon occluded arterial infusion. We extracted data on the patient's stage of progress, tumor volume, histological subtype, bleeding volume, urodynamic study results, and postoperative complications. The data were divided into two groups - those patients who received NAC and those who did not - and then compared.
CONCLUSIONS: According to our analysis, NSRH surgery after NAC via balloon occluded arterial infusion brings beneficial results to patients with bulky IB2 to IIB cervical cancers.
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Optimal pathological response indicated better long-term outcome among patients with stage IB2 to IIB cervical cancer submitted to neoadjuvant chemotherapy. Sci Rep 2016; 6:28278. [PMID: 27325186 PMCID: PMC4915007 DOI: 10.1038/srep28278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
The role of pathological response in long-term outcome is still unclear in cervical cancer patients treated with neoadjuvant chemotherapy (NACT) in China. This study aimed to investigate the effect of optimal pathologic response (OPR) on survival in the patients treated with NACT and radical hysterectomy. First, 853 patients with stage IB2-IIB cervical cancer were included in a retrospective analysis; a Cox proportional hazards model was used to investigate the relationship between pathological response and disease-free survival (DFS). In the retrospective database, 64 (7.5%) patients were found to have achieved an OPR (residual disease <3 mm stromal invasion); in the multivariate Cox model, the risk of death was much greater in the non-OPR group than in the OPR group (HR, 2.61; 95%CI, 1.06 to 6.45; P = 0.037). Next, the role of OPR was also evaluated in a prospective cohort of 603 patients with cervical cancer. In the prospective cohort, 56 (9.3%) patients were found to have achieved an OPR; the log-rank tests showed that the risk of recurrence was higher in the non-OPR patients than in the OPR group (P = 0.05). After combined analysis, OPR in cervical cancer was found to be an independent prognostic factor for DFS.
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The efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer: A randomized multicenter study. Gynecol Oncol 2015; 141:231-239. [PMID: 26115978 DOI: 10.1016/j.ygyno.2015.06.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/11/2015] [Accepted: 06/21/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study sought to evaluate the toxicity and curative effect of irinotecan plus cisplatin neoadjuvant chemotherapy (NACT) for stage Ib2, IIa2, and IIb cervical cancer patients. METHODS A total of 219 patients were randomly assigned to two groups: 109 patients were treated with 1-2 cycles of chemotherapy (NACT group), and 110 patients in the control group were treated directly with surgery (DS group). Patients in the NACT group were randomly assigned to two groups: 50 patients were treated with irinotecan plus cisplatin followed by surgery (IP group), and 59 patients were treated with paclitaxel plus cisplatin followed by surgery (TP group). Patients with pathological recurrence risk factors received post-operative radiotherapy. RESULTS Survival analysis revealed no significant difference in disease-free survival (DFS) or overall survival (OS) between the NACT and DS groups. Analysis of clinicopathologic factors showed that the lymphovascular space invasion (LVSI) and deep stromal invasion rates were significantly lower in the NACT group. Grade 3/4 neutropenia and grade 3/4 diarrhea were both higher in the IP group than in the TP group. DFS and OS were similar in the IP and TP groups. Univariate analysis showed that LVSI was the only factor associated with DFS. CONCLUSION NACT did not improve overall survival but did reduce the number of patients who received post-operative radiotherapy. NACT consisting of irinotecan plus cisplatin for cervical cancer showed similar efficacy and higher toxicity compared with the use of paclitaxel plus cisplatin, although the toxicity was tolerable.
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