Risk model in stage IB1-IIB cervical cancer with positive node after radical hysterectomy

Chen, Zhilan; Huang, Kecheng; Lu, Zhongxin; Deng, Song Hua; Xiong, Jiaqiang; Huang, Jia; Xiong, Li; Tang, Fangxu; Wang, Wenwen; Sun, Haiying; Wang, Lin; Zhou, Shasha; Wang, Xiaoli; Jia, Yulin; Hu, Ting; Gui, Juan; Wan, Dongyi; Ma, Ding; Li, Shuang; Wang, Shixuan

doi:10.2147/ott.s94151

Cited by 5 publications

(8 citation statements)

References 39 publications

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“…Although lymph node metastases negatively affect prognosis in cervical cancer, the survival of patients with lymph nodes metastasis is also strongly influenced by parametrial involvement. 8,23,24 Along similar lines, our results showed parametrial involvement was an independent predictor both for recurrence-free survival and overall survival among patients with stages IIIC1p. Accordingly, we rank parametrial involvement as a risk factor for further stratification.…”

Section: Discussionsupporting

confidence: 79%

<p>Risk Stratification Based on Metastatic Pelvic Lymph Node Status in Stage IIIC1p Cervical Cancer</p>

Li¹,

Wang²,

Jiang³

et al. 2020

CMAR

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Purpose: Stage IIIC1 cervical cancer showed heterogeneous in oncologic outcomes with highly variable survival rates. Our objective was to determine the prognostic significance of removed and metastatic pelvic lymph node status and further perform risk stratification in patients with stage IIIC1p cervical cancer. Patients and Methods: Patients with stage IIIC1p cervical cancer and undergoing radical hysterectomy with lymphadenectomy in 2008-2018 were retrospectively analyzed. Patients' stage was classified using the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging schema. Univariate and multivariable models were used to examine the association between removed and metastatic lymph node status and recurrencefree survival/overall survival. Results: During a median follow-up of 34 months, 73 relapses and 44 deaths were observed among 273 patients with stage IIIC1p cervical cancer. Parametrial involvement and metastatic lymph node ratio (mLNR) were identified as independent predictors for recurrence-free survival. Parametrial involvement and mLNR were independent predictors for overall survival. A stratification system was then created based on parametrial involvement and mLNR. A total of 123 (45.1%), 127 (46.5%) and 23 (8.4%) patients were classified into the low-risk, intermediate-risk, and high-risk groups, with as a 5-year recurrence-free survival of 81.7%, 51.1%, 38%, respectively. Compared to the low-risk group, the intermediate-and high-risk groups had a significantly greater risk of recurrence and death. Conclusion: The prognosis of stage IIIC1p patients varied significantly. A risk stratification system based on parametrial involvement and mLNR successfully separated patients into low, intermediate, and high-risk group. Our findings could facilitate the practical use of further stratification in Stage IIIC1p cervical cancer.

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Section: Discussionsupporting

confidence: 79%

<p>Risk Stratification Based on Metastatic Pelvic Lymph Node Status in Stage IIIC1p Cervical Cancer</p>

Li¹,

Wang²,

Jiang³

et al. 2020

CMAR

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“…Clinical and postsurgical tumor stage as well as lymph node status are the most powerful predictors of outcome in cervical cancer 2 , 3 , 4 . The data regarding the prognostic impact of the tumor grade in squamous cell cancers (SCC) of the uterine cervix are controversial, and several approaches using different morphologic variables have been applied 15 .…”

Section: Discussionmentioning

confidence: 99%

“…There are several reports in the literature on survival and disease-free intervals and on their relationship to surgical-pathological factors in cervical carcinoma of the uterus 1 , 2 , 3 , 4 . Among these factors, pelvic lymph node involvement and tumor stage are well-established prognostic parameters.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Impact of Grading in FIGO IB and IIB Squamous Cell Cervical Carcinomas

Brambs

Höhn²,

Hentschel

et al. 2019

Geburtshilfe Frauenheilkd

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Background Tumor grade is one of the more controversial factors, and the data regarding its prognostic impact in squamous cell carcinoma (SCC) of the uterine cervix are controversial. Methods The histological slides of 467 surgically treated FIGO stage IB1 to IIB cervical SCC were re-examined regarding the prognostic impact of the histological tumor grade based on the degree of keratinization (conventional tumor grade) according to the WHO recommendation on recurrence-free and overall survival as well as on the prediction of pelvic lymph node involvement. Results 46.0% presented with well-differentiated tumors (G1, n = 215), 30.6% with moderate (G2, n = 143) and 23.3% with poor differentiation (G3, n = 109). The recurrence-free survival was significantly reduced in patients with poorly differentiated tumors (G1: 81.4%, G2: 70.6%, G3: 64.2%; p = 0.008). There was no impact on overall survival. Because of the lack of survival differences between G1- and G2-tumors, they were merged into low-grade tumors, and their prognostic outcome was compared to the high-grade group (G3-tumors). Based on this binary conventional grading system there was a significantly longer recurrence-free (low-grade: 77.1% vs. high-grade: 64.2%; p = 0.008) and overall survival (low-grade: 76.0% vs. high-grade: 65.1%; p = 0.031) in the low-grade group. However, both the conventional three-tiered and the binary grading systems (separating tumors into a low- and high-grade group) failed to predict pelvic lymph node involvement (p = 0.9 and 0.76, respectively). Conclusion A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may be suitable for the prognostic survival evaluation but failed to predict pelvic lymph node involvement.

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“…In microinvasive cervical cancer lymphogenic spread with invasion of strome to 3 mm in depth almost does not exist (less than 1%), and with stromal invasion from 3 to 5 mm this spread is rare (5–7%). In the stage Ib (FIGO), 15–20% of patients have pelvic (regional) metastases, then in stage IIb about 35%, and in stage III about 60% (Sankaranarayanan, 2006; Zhilan et al, 2016). Paraaortic nodes were attacked in less than 2% of cases in the IIb–III stage of the disease.…”

Section: Introductionmentioning

confidence: 99%

Cervical Cancer, Different Treatments and Importance of Bile Acids as Therapeutic Agents in This Disease

Šarenac

Mikov

2019

Front. Pharmacol.

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Cervical cancer can be cured, because it has a long preinvasive period. Early diagnosis and treatment of cervical cancer at women are crucial for reducing of rate mortality. Today, there are many methods for detecting premalignant lesions and one of them is a conventional Papanicolaou test. Cervical cancer develops through a series of changes in the epithelium called cervical intraepithelial neoplasia (CIN). The biological and genetic characteristics of the cells at cancer in situ are irreversibly altered and abnormal cells have the potential to metastasize to others anatomical regions. Infection with human Papillomavirus, which is transmitted sexually, is considered the main cause and represent the necessary, but not the only factor for the development of cervical cancer. Types of high risk human Papillomavirus are often associated with invasive cervical cancer. The carcinogenic types of HPV 16 and 18 are responsible for 70% of cervical cancer and about 50% of CIN 3. Primary prevention of cervical cancer is aimed at reducing incidence, control of causes and risk factors. In this scientific work, in addition to explaining the various treatments necessary for the treatment of cervical carcinoma, we were discussed about the anticancer effects of the synthetic derivative of ursodeoxycholic acid, such as HS-1183, and synthetic derivatives of chenodeoxycholic acid such as HS-1199 and HS-1200. Also, the effects of bile acid complexes with metals such as platinum, zinc, nickel, and copper were considered in the effective treatment of cervical cancer. KEY POINTS • Lymphogenic spreading of cervical cancer occurs relatively early in the regional lymph nodes, while this sort of progression of cervical cancer is rarer in the juxtaregional (paraaortic), mediastinal and supraclavicular nodes. Clinically proven supraclavicular metastases are not a rarity. In stages IIb and IIIa with metastases in paraaortal nodes occur a 20% metastases at the neck lymph nodes. Hematogenic metastases are relatively rare and occur in the posterior phase. Distant metastases are detected in the lungs and liver. Preinvasive and microinvasive stages of cervical cancer are without symptoms. With deeper invasion of the strome, certain clinical symptoms such as prolonged menstruation, increased vaginal secretions, vaginal bleeding between the two periods, contact bleeding (after coitus), unilateral pelvic pain with spreading in hip joint (infiltration of the pelvic nerve plexus), dysuric disturbance, anemia, islet of the lower extremities. In order to diagnose the level spreading of primary lesion of cervical cancer most commonly are used the supplemental searches such as cytoscopy, rectoscopy, urography, irigography, lung and bone radiography, scintigraphy of the liver, kidney and bone, lymphography, CT (MR) of abdomen and pelvis, as well as laboratory analysis. Surgical treatment consists of transvaginal hysterectomy, transabdominal removal of the...

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Risk model in stage IB1-IIB cervical cancer with positive node after radical hysterectomy

Cited by 5 publications

References 39 publications

<p>Risk Stratification Based on Metastatic Pelvic Lymph Node Status in Stage IIIC1p Cervical Cancer</p>

<p>Risk Stratification Based on Metastatic Pelvic Lymph Node Status in Stage IIIC1p Cervical Cancer</p>

The Prognostic Impact of Grading in FIGO IB and IIB Squamous Cell Cervical Carcinomas

Cervical Cancer, Different Treatments and Importance of Bile Acids as Therapeutic Agents in This Disease

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