Cervical Cancer, Version 2.2015

Koh, Wui Jin; Greer, Benjamin E.; Abu‐Rustum, Nadeem R.; Apte, Sachin M.; Campos, Susana M.; Cho, Kathleen R.; Chu, Christina; Cohn, David E.; Crispens, Marta A.; Dorigo, Oliver; Eifel, Patricia J.; Fisher, Christine M.; Frederick, Peter J.; Gaffney, David K.; Han, Ernest; Huh, Warner K.; Lurain, John R.; Mutch, David G.; Fader, Amanda N.; Remmenga, Steven W.; Reynolds, R. Kevin; Teng, Nelson N.H.; Tillmanns, Todd; Valea, Fidel A.; Yashar, Catheryn M.; McMillian, Nicole R.; Scavone, Jillian L.

doi:10.6004/jnccn.2015.0055

Cited by 262 publications

(240 citation statements)

References 57 publications

(14 reference statements)

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“…Cervical cancer is the leading cause of cancer‐related deaths in women in developing countries 1. In China, there were an estimated 87,982 new cases of cervical cancer and 23,375 related deaths in 2011 2.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, there are several objections because for patients with locally advanced cervical cancer (LACC) who do not response to NACT, the delay in curative treatment, the development of radio‐resistant cellular clones and cross‐resistance with radiotherapy may exert negative impact on patient survival 7. Given these controversies, NACT is not recommended as a routine treatment for LACC patients in current National Comprehensive Cancer Network (NCCN) Clinical Practice guideline 1. The discrepancy raises the possibility that NACT may improve antitumor outcomes in a subset of patients.…”

Section: Introductionmentioning

confidence: 99%

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Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer

et al. 2016

Cancer Medicine

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For locally advanced cervical cancer (LACC), hypoxia is a characteristic property. This study aimed to investigate whether baseline lactic dehydrogenase (LDH) level, which is a marker of hypoxia, had clinical value in determining neoadjuvant chemotherapy (NACT) response and prognosis for LACC patients. The study cohort included 418 patients with a median follow‐up of 37.5 months. Cox proportional hazards models were used to assess the prognostic value of baseline LDH levels. Multivariate logistic regression analysis was performed to identify independent predictors of complete response after NACT. Backward stepwise selection with the Akaike information criterion was used to identify factors that could be entered into the multivariate regression model. Compared with patients with LDH levels <252.0 μ/L, patients with LDH levels ≥252.0 μ/L were more likely to have an elevated level of squamous cell carcinoma antigen, lymphatic vascular space involvement, lymph node metastasis, and positive parametrium and achieved lower complete remission rates. Baseline LDH levels ≥252.0 μ/L was an independent prognosticator for recurrence‐free survival (adjusted hazard ratio [HR], 3.56; 95% confidence interval [CI] 2.22–5.69; P < 0.0001) and cancer‐specific survival (adjusted HR, 3.08; 95% CI, 1.89–5.01; P < 0.0001). The predictive value of baseline LDH value remained significant in the subgroup analysis. LDH level ≥252.0 μ/L was identified as an independent predictor of complete remission after NACT (adjusted odds ratio [OR], 0.29; 95% CI, 0.15–0.58; P < 0.0001). Baseline LDH ≥252.0 μ/L is an independent prognostic predictor for patients receiving neoadjuvant chemotherapy for LACC. It helps distinguish patients with different prognosis and select patients who are more likely to benefit from NACT.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer

et al. 2016

Cancer Medicine

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“…This group of women was named very low‐risk group (VLRG), as no LNM was found among 106 patients meeting inclusion criteria. In the VLRG, 14 women (13.2%) received adjuvant radiotherapy, based on histopathological risk factors 18. With a median follow up of 40 months (16–158), seven (6.6%) recurrences have been registered: five central pelvic (one with LNs) and two distant metastases.…”

Section: Resultsmentioning

confidence: 99%

“…Dedicated pathologists at each center performed histological diagnosis. Adjuvant treatment was suggested according to NCCN guidelines 18. Imaging assessment by FDG‐PET/CT, CT scan, or MRI was done at completion of adjuvant treatment.…”

Section: Methodsmentioning

confidence: 99%

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Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

et al. 2016

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Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1‐IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.

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Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer

et al. 2020

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IMPORTANCE Minimally invasive techniques are increasingly common in cancer surgery. A recent randomized clinical trial has brought into question the safety of minimally invasive radical hysterectomy for cervical cancer.OBJECTIVE To quantify the risk of recurrence and death associated with minimally invasive vs open radical hysterectomy for early-stage cervical cancer reported in observational studies optimized to control for confounding. Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science (inception to March 26, 2020) performed in an academic medical setting. DATA SOURCESSTUDY SELECTION In this systematic review and meta-analysis, observational studies were abstracted that used survival analyses to compare outcomes after minimally invasive (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics 2009 stage IA1-IIA) cervical cancer. Study quality was assessed with the Newcastle-Ottawa Scale and included studies with scores of at least 7 points that controlled for confounding by tumor size or stage. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist was used to abstract data independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between surgical approach and oncologic outcomes.MAIN OUTCOMES AND MEASURES Risk of recurrence or death and risk of all-cause mortality.RESULTS Forty-nine studies were identified, of which 15 were included in the meta-analysis. Of 9499 patients who underwent radical hysterectomy, 49% (n = 4684) received minimally invasive surgery; of these, 57% (n = 2675) received robot-assisted laparoscopy. There were 530 recurrences and 451 deaths reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery (hazard ratio [HR], 1.71; 95% CI, 1.36-2.15; P < .001), and the hazard of death was 56% higher (HR, 1.56; 95% CI, 1.16-2.11; P = .004). Heterogeneity of associations was low to moderate. No association was found between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death (2.0% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −3.4% to 7.7%]) or all-cause mortality (3.7% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −4.5% to 12.6%]).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.

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Cervical Cancer, Version 2.2015

Cited by 262 publications

References 57 publications

Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer

Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer

Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer

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