BackgroundOptimal treatment of cervical cancer is based on disease stage; therefore, an understanding of the global epidemiology of specific stages of locally advanced disease is needed.ObjectiveThis systematic literature review was conducted to understand the global and region-specific proportions of patients with cervical cancer with locally advanced disease and to determine the incidence of the locally advanced disease.MethodsSystematic searches identified observational studies published in English between 2010 and June 10, 2020, reporting the proportion of patients with, and/or incidence of, locally advanced stages of cervical cancer (considered International Federation of Gynecology and Obstetrics (FIGO) IB2–IVA). Any staging criteria were considered as long as the proportion with locally advanced disease was distinguishable. For each study, the proportion of locally advanced disease among the cervical cancer population was estimated.ResultsThe 40 included studies represented 28 countries in North or South America, Asia, Europe, and Africa. Thirty-eight studies reported the proportion of locally advanced disease among populations with cervical cancer. The estimated median proportion of locally advanced disease among all cervical cancer was 37.0% (range 5.6–97.5%; IQR 25.8–52.1%); estimates were generally lowest in North America and highest in Asia. Estimated proportions of ≥50% were reported in nine studies from Asia, Europe, Brazil, and Morocco; estimates ≤25% were reported in six studies from Asia, United States, Brazil, and South Africa. Locally advanced disease was reported for 44% and 49% of women aged >70 and ≥60 years, and 5–100% of younger women with cervical cancer. A greater proportion of locally advanced disease was reported for Asian American (19%) versus White women (8%) in one United States study. Two of five studies describing the incidence of locally advanced disease reported rates of 2–4/100 000 women among different time frames.ConclusionThis review highlights global differences in proportions of locally advanced cervical cancer, including regional variance and disparities according to patient race and age.
minute interval) during surgery, were collected. Using the preoperative noninvasive and intraoperative invasive systolic blood pressure values, we calculated the average real variability (ARV), known as a reliable representation of time series blood pressure variability. Associations between the ARV index and survival outcomes were investigated. Results: In total, 441 patients were included. Using the integer close to the median as a cut-off value for the ARV, we found that the high-ARV group (≥8; n=220) showed worse progression-free survival (PFS) than the low-ARV group (<8; n=221) (median=82.8% vs. 89.6%; p=0.020). In multivariate analysis adjusting for confounders, ARV ≥8 was identified as an independent poor prognostic factor for PFS (adjusted hazard ratio [HR]=1.887; 95% confidence interval [CI]=1.158-3.076; p=0.011). In the subgroup of open RH (n=238), ARV ≥8 was associated with significantly worse PFS (adjusted HR=2.402; 95% CI=1.119-5.155; p=0.024). In contrast, in the subgroup of MIS RH (n=238), PFS did not differ by the ARV index. Conclusion:The ARV index, indicating intraoperative hemodynamic instability, might be a novel prognostic biomarker for disease recurrence in early cervical cancer patients who receive primary open RH, not MIS RH. Oral (OC3) Cervical Cancer
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