Evaluation of the Factors Associated with Delay in Initiation of Treatment of Advanced Stage Cervical Cancer Patients in Bangladesh

Research Background: Cervical cancer is the second most common cancer in women and the third leading cause of female cancer death in Bangladesh. Delay in initiation of treatment in advanced stage cervical cancer patients is an important modifiable risk factor for cancer-related mortality. Identifying elements associated with delay of diagnosis will help reduce barriers to timely treatment of cervical cancer. Research Objectives: The objective of this study was to analyze the factors leading to delay in diagnosis and treatment of women with advanced stage cervical cancer. Methods: A cross-sectional observational study analyzed the factors associated with delay in initiation of treatment for 138 patients with advanced-stage cervical cancer from November 2019 to October 2020 at the National Institute of Cancer Research and Hospital (NICRH) in Dhaka, Bangladesh. Advanced-stage cervical cancer patients between the ages of 30 to 70 years were included in this study. Face-to-face interviews with the participants used a predesigned data collection sheet. In this study, three components of delay were identified: primary delay due to patient factors, healthcare provider delay, and healthcare-system infrastructure delay. Factors associated with delay were the independent variables and durations of delay were the outcome variables. Descriptive statistics were expressed as mean + standard deviation, median, percentage, and frequency. Results: One hundred and thirty-eight patients with advanced stage cervical cancer were included in the study. The mean age of the patients was 48.74 (±9.57) years. Thirty-four percent of patients were illiterate. More than half (57.25%) of the patients were from lower middle-class families. Delays were categorized as patient-related, healthcare provider delay, and healthcare-system infrastructure related. Patient-related factors included low monthly income, residence in a rural area, embarrassment, fear, lack of knowledge regarding cervical cancer, delay in contacting a spouse, family member or friend prior to the first medical encounter. These elements predicted a primary delay of more than 60 days (P value Conclusion: Three broad categories of delay in diagnosis and treatment of cervical cancer: patient-related factors, healthcare provider-related factors, and healthcare-system infrastructure factors were analyzed. Illiteracy, lack of awareness regarding cervical cancer, lack of health-seeking behavior, and poor income status were associated with patient-related primary delay. Nonperformance of speculum examination in the initial consultation, misdiagnosis, inappropriate management, and delay in referral to the cancer treatment center by primary healthcare providers were the contributing factors for healthcare provider delay. Lack of availability and accessibility of health services and limitation of radiotherapy resources led to healthcare-system infrastructure delays. All three categories of delay must be addressed through the education of communities, the gynecologic training of community healthcare providers, the improvement of medical infrastructure, and the increase of medical resources.

Clinical implication of naive and memory T cells in locally advanced cervical cancer:A proxy for tumor biology and short-term response prediction

Background:This study was designed to investigate the feasibility of tumor-infiltrating immune cells with different phenotypic characteristics for predicting short-term clinical responses in patients with locally advanced cervical cancer(LACC).Methods:Thirty-four patients who received concurrent chemoradiotherapy and twenty-one patients who merely underwent radiotherapy were enrolled in this study.We retrospectively analyzed the T cell markers(i.e.,CD3,CD4,CD8),memory markers(i.e.,CD45,CCR7),and differentiation markers(i.e.,CD27)in the peripheral blood and tumor tissues of patients with LACC before treatment based on flow cytometry.We also analyzed the relationship of T cell subsets between peripheral blood and tumor tissues,and their correlation with complete response or partial response.Results:The percentage of central memory CD8^(+)TCM(CD8^(+)CD45RA^(−)CD27^(+)CCR7^(+))cells in LACC patients was significantly lower than that of the control group.The percentage of CD8^(+)TN in the peripheral blood of LACC patients was significantly higher than that of tumor tissues.CD8^(+)TEM in the peripheral blood was significantly lower than that of tumor tissues.The percentage of CD8^(+)TN and CD8^(+)TCM in human papillomavirus(HPV)positive samples was significantly higher than that of HPV-negative samples.Similarly,the percentage of CD8^(+)TCM in tumor tissues was significantly higher in cancer tissue samples with lymph nodes compared with those without.Conclusion:A higher proportion of CD4^(+)TCM and a lower proportion of CD8^(+)TN in the tumor microenvironment of LACC may contribute to the therapy response prediction.

Specific Immunotherapy in Advanced Cervical-Uterine Cancer Using Humanized Monoclonal Antibody Nimotuzumab and CIMAvax-EGF^®Therapeutic Vaccine

Cervical uterine cancer represents the fourth most common malignant neoplasm worldwide in the female sex in terms of incidence, principally from epithelial origen. The high expression of EGFR in this tumor leads to the search for therapeutic alternatives. An Expanded Access Clinical Program was carried out in parallel groups, randomized, multicenter and prospective study, to evaluate the survival of patients with advanced cervical carcinoma, without therapeutic alternative, who would be treated with the therapeutic vaccine CIMAvax-EGF®, the humanized mAb nimotuzumab or the combination of both products, which targeted EGF and EGFR respectively. The patients were included between 2008 and 2010 with a more than five years follow-up. The results show that the serious adverse events related to the experimental treatments were 0.9%;1.1% and 2.6% and a median ITT survival of 9.1, 23.5, and 16.3 months for CIMAvax-EGF®, nimotuzumab and the combination of both, respectively. Thus fulfilling the hypothesis of safety and efficacy proposed in the investigation was achieved. The three therapeutic regimens achieved overall survival rates greater than 35% at 60 months, encouraging results for advanced uterine cervical cancer. A phase III clinical trial is proposed to consolidate these results in a greater number of patients with nimotuzumab as study drug.

Association between Pretreatment Levels of Serum Vascular Endothelial Growth Factor (VEGF) and Survival Outcomes in Locally Advanced Cervical Cancer Patients

Objective: To evaluate the association between pretreatment levels of serum vascular endothelial growth factor (VEGF) and long-term treatment outcomes in patients with locally advanced cervical cancer (LACC). Methods: Thirty-nine patients diagnosed with LACC (stage IIB-IVA) and obtaining blood for serum VEGF were identified. All patients received complete treatment as radical radiotherapy with or without concurrent chemotherapy. Surveillance for all patients was every 3 months during the first 2 years, and every 6 months later. Results: Mean age of 39 patients was 52.3 ± 10.8 years old. Twenty-three patients (59.0%) had stage IIB, and 16 patients (41.0%) had stage IIIB. Histological cell type was mostly squamous cell carcinoma (89.7%). The median and 75th percentile level of serum VEGF were 610.2 pg/ml (0.0 - 4067.2 pg/ml) and 825.6 pg/ml, respectively. At median follow-up of 37.0 months (range, 26.8 - 46.3 months), the 3-year OS rate was 78.6%. Clinical stage (p = 0.04) and 75th percentile of VEGF level (p = 0.04) were impacted on OS in univariable analysis. The 3-year OS of patients in stage IIB with serum VEGF of ≤825.6 pg/ml and of > 825.6 pg/ml was slightly different, 94.4% and 80.0% respectively (p = 0.34), whereas there were many differences in stage IIIB, 71.4% and 25.0% in patients with serum VEGF of ≤825.6 pg/ml and of >825.6 pg/ml respectively (p = 0.05). Conclusion: High pretreatment serum VEGF level has an influence on OS for LACC. It is potentially used as a predictive factor, especially in patients stage IIIB, in order to provide efficient treatment and improve survival outcomes in the future.

Effect of cisplatin-based concurrent radiochemotherapy on malignant degree of advanced cervical cancer and expression of proto-oncogene and tumor suppressor genes

Objective:To study the effect of cisplatin-based concurrent radiochemotherapy on the malignant degree of advanced cervical cancer and the expression of proto-oncogene and tumor suppressor genes.Methods: A total of 82 patients with advanced cervical cancer who were treated in our hospital between July 2013 and December 2016 were collected and divided into control group and observation group according to random number table, with 41 cases in each group. The control group of patients received radiotherapy alone, while the observation group of patients received cisplatin-based concurrent radiochemotherapy. Tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were compared between two groups of patients before and after treatment.Results:Before treatment, differences in tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were not statistically significant between two groups of patients. After treatment, serum tumor markers SCC, CA50, CA724 and CEA levels of observation group were significantly lower than those of control group;proto-oncogene DEK, c-myc and PIK3CA mRNA expression in tumor tissue were significantly lower than those of control group;tumor suppressor genes p53, SOCS-1, FHIT and PTEN mRNA expression in tumor tissue were significantly higher than those of control group.Conclusions:Cisplatin-based concurrent radiochemotherapy can effectively reduce the tumor malignancy and balance the proto-oncogene / tumor suppressor gene expression in patients with advanced cervical cancer.

Liver cell cancer surveillance practice in Nigeria:Pitfalls and future prospects

Hepatocellular carcinoma(HCC)is a disease of public health concern in Nigeria,with chronic hepatitis B and C infections contributing most to the disease burden.Despite the increasing incidence of HCC,surveillance practices for early diagnosis and possible cure are not deeply rooted in the country.This article aims to review the current status of HCC surveillance in Nigeria,stressing the encounters,breaches,and potential prospects.Several factors,such as limited tools for screening and diagnostics,insufficient infrastructure,and low cognizance among the doctors,and the general public affect the surveillance practices for HCC in Nigeria.Moreover,the lack of standardized guidelines and protocols for HCC surveillance further intensifies the suboptimal diagnosis and treatment.Nevertheless,there are opportunities for refining surveillance practices in the country.This would be achieved through boosted public health sensitization campaigns,integrating HCC screening into routine clinical services,and leveraging technological developments for early detection and monitoring.Furthermore,collaboration between government agencies,healthcare providers,and international organizations can facilitate the development of comprehensive HCC surveillance programs person-alized to the Nigerian setting.Thus,HCC surveillance practice faces substantial challenges.By addressing the drawbacks and leveraging prospects,Nigeria can improve HCC surveillance,with subsequent improved outcomes for individuals at risk of developing the disease.

Neoadjuvant intra-arterial infusion chemotherapy followed by surgery in patients with locally advanced cervical cancer

Objective： The aim of this study was to investigate the role of preoperative neoadjuvant intra-arterial infusion chemotherapy （NAIC） in treating locally advanced cervical caner. Methods： Nineteen locally advanced cervical cancer （LACC） patients from November 2003 to November 2005 were analyzed retrospectively. NAIC was administrated 2 courses every 2 weeks using a combination of 30 mg/m^2 bleomycin and 50 mg/m^2 cisplatin via bilateral femur artedes. The response to NAIC was assessed by pelvic examination and imaging diagnostics and histological analysis. Two weeks after NAIC radical hysterectomy with pelvic lymphadenectomy was performed. Results： Radical hysterectomy with pelvic lymphadenectomy were performed in 18 patients successfully. The mean tumor reduction rate was 73.04%. The overall clinical response rate of NAIC was 84.2% with 2 complete responses and 16 partial responses. Only 1 nonresponder. Six of 7 cases who had parametrial infiltration had a absence after chemotherapy, no significant change was observed in 1 case who followed by radiotherapy. Multivariate logistic regression analysis indicated that tumor volume prior to treatment was determining factor affecting the efficacy of NAIC in LACC. Conclusion： pre-operative NAIC inhibited the growth of LACC, minimized the size, eliminate effectively the pathologic dsk factors in the pelvic cavity, to improve the operability in cervical cancer patients with stage lib or above, considered inoperable.

Effect of Tegafur Gimeracil Oteracil Potassium Capsule + Kangai injection + intensity-modulated radiation therapy on the cellular malignant biological processes in advanced cervical cancer lesion

Objective:To study the effect of Tegafur Gimeracil Oteracil Potassium Capsule + Kangai injection + intensity-modulated radiation therapy on the cellular malignant biological processes in advanced cervical cancer lesion.Methods: Patients who were diagnosed with advanced cervical cancer in the Second People Hospital of Banan District Chongqing between April 2015 and March 2017 were selected and divided into two groups, group A received Tegafur Gimeracil Oteracil Potassium Capsule + Kangai injection + intensity-modulated radiation therapy, and group B received cisplatin + intensity-modulated radiation therapy. Serum contents of tumor markers, tumor invasion molecules and tumor proliferation molecules of two groups of patients were detected before treatment as well as 2 weeks and 4 weeks after treatment.Results: Serum E-cad, STMN1, Fas and p53 levels of both groups of patients 2 weeks and 4 weeks after treatment were significantly higher than those before treatment while TSGF, TK1, SCC-Ag, CA125, OPN, MMP9, NGAL, CyclinE, CyclinD1 and PCNA levels were significantly lower than those before treatment, and serum E-cad, STMN1, Fas and p53 levels of group A 2 weeks and 4 weeks after treatment were significantly higher than those of group B while TSGF, TK1, SCC-Ag, CA125, OPN, MMP9, NGAL, CyclinE, CyclinD1 and PCNA levels were significantly lower than those of group B.Conclusion: Tegafur Gimeracil Oteracil Potassium Capsule + Kangai injection + intensity-modulated radiation therapy for advanced cervical cancer can induce cancer cell apoptosis and inhibit cancer cell proliferation and invasion.

Concurrent chemoradiotherapy for cervical cancer： background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups

Concurrent chemoradiotherapy （CCRT） is regarded as the standard treatment for locally advanced uterine cervical cancer （LACC）, including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics （FIGO） staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage Ⅲ-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin （CDDP）, surgery following CCRT, adjuvant chemotherapy （CT） following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease.

Adjuvant chemotherapy for early-stage cervical cancer

The aim of this review is to address the current status of adjuvant chemotherapy alone in early-stage cervical cancer treatments in the literature. At present, the therapeutic effect of adjuvant chemotherapy alone after radical surgery （RS） has not yet been established, and radiation therapy （RT） or concurrent chemoradiotherapy （CCRT） is recommended as the standard adjuvant therapy after RS for early-stage cervical cancer in various guidelines. The main purpose of adjuvant therapy after RS, however, should be to reduce extrapelvic recurrence rather than local recurrence, although adjuvant RT or CCRT has survival benefits for patients with intermediate- or high-risk factors for recurrence. Moreover, several studies reported that adjuvant therapies including RT were associated with a higher incidence of complications, such as lymphedema, bowel obstruction and urinary disturbance, and a lower grade of long-term quality of life （QOL） or sexual functioning than adjuvant chemotherapy alone. The effect of adjuvant chemotherapy alone for early-stage cervical cancer with intermediate- or high-risk factors for recurrence were not fully investigated in prospective studies, but several retrospective studies suggest that the adjuvant effects of chemotherapy alone are at least similar to that of RT or CCRT in terms of recurrence rate, disease-free survival, or overall survival （OS） with lower incidence of complications. Whereas cisplatin based combination regimens were used in these studies, paclitaxel/cisplatin （TP） regimen, which is currently recognized as a standard chemotherapy regimen for patients with metastatic, recurrent or persistent cervical cancer by Gynecologic Oncology Group （GOG）, had also survival benefit as an adjuvant therapy. Therefore, it may be worth considering a prospective randomized controlled trial （RCT） of adjuvant chemotherapy alone using TP regimen versus adjuvant RT as an alternative adjuvant therapy. Because early-stage cervical cancer is a curable condition, it is necessary that the therapeutic strategies should be improved with considering adverse events and QOL for long-term survivors.

Preliminary evaluation of pelvic vascular bed isolation chemotherapy in the treatment of advanced cervical carcinoma

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Long-term survival outcomes and immune checkpoint inhibitor retreatment in patients with advanced cervical cancer treated with camrelizumab plus apatinib in the phase II CLAP study

Background:Camrelizumab plus apatinib have demonstrated robust antitumor activity and safety in patients with advanced cervical cancer(CLAP study;NCT03816553).We herein present the updated long-term results of the CLAP study and explore potential biomarkers for survival.The outcomes of patients who underwent immune checkpoint inhibitor(ICI)retreatment were also reported.Methods:In this phase II trial,eligible patients received camrelizumab 200 mg intravenously every two weeks and apatinib 250 mg orally once daily in 4-week cycles for up to two years.Treatment was continued until disease progression,unacceptable toxicity,or withdrawal of consent.Results:Between January 21 and August 1,2019,a total of 45 patients were enrolled.Data were analyzed as of July 31,2023,representing>48 months since treatment initiation for all patients.Nine(20.0%)patients completed the 2-year study.The median duration of response(DOR)was 16.6 months,and 45.0%of patients achieved a DOR of≥24 months.The 12-month progression-free survival(PFS)rate was 40.7%(95%confidence interval[CI],25.2-55.6),with an 18-month PFS rate of 37.8%(95%CI,22.7-52.8).The median overall survival(OS)was 20.3 months(95%CI,9.3-36.9),and the 24-month OS rate was 47.8%(95%CI,31.7-62.3).Age>50 years,programmed death-ligand 1(PD-L1)combined positive score(CPS)≥1(versus[vs.]<1),CPS≥10(vs.<1),high tumor mutational burden,and PIK3CA mutations were associated with improved PFS(hazard ratio[HR]<1)and longer OS(HR<1).Eight patients who initially responded in the CLAP trial but later experienced disease progression were retreated with ICIs.Among them,2(25.0%)achieved a partial response,while 5(62.5%)had stable disease.Notably,four patients who received retreatment with ICIs survived for more than 45months.No new safety signals were identified in the present study.Conclusion:Long-term survival follow-up data demonstrated that camrelizumab plus apatinib has robust,sustained,and durable efficacy in patients with advanced cervical cancer who progress after first-line platinum-based chemotherapy.No new safety signals were noted with long-term treatment.

The impact of artificial intelligence-assisted intensity-modulated radiotherapy plan optimization on the radiation doses received by the rectum and bladder as well as radiation-induced injuries in patients with locally advanced cervical cancer

This study aimed to investigate the impact of artificial intelligence-assisted intensity-modulated radiotherapy(IMRT)plan optimization on the radiation doses received by the rectum and bladder as well as radiation-induced injuries in patients with locally advanced cervical cancer.A total of 100 patients with locally advanced cervical cancer were enrolled and divided into a conventional IMRT group and an artificial intelligence-assisted IMRT group.The results showed that in terms of the radiation doses to the rectum and bladder,all dosimetric parameters(such as mean dose,maximum dose,and volume-dose parameters,etc.)in the artificial intelligence-assisted group were significantly lower than those in the conventional group(p<0.05).Regarding radiation-induced injuries,the incidences and severities of both acute and late radiation-induced proctitis and cystitis in the artificial intelligence-assisted group were lower than those in the conventional group(p<0.05).These findings suggest that artificial intelligence-assisted IMRT plan optimization can effectively reduce the radiation doses to the rectum and bladder and decrease radiation-induced injuries in patients with locally advanced cervical cancer,which is expected to provide a more precise and safer treatment strategy for radiotherapy of locally advanced cervical cancer.However,this study has limitations such as a limited sample size and being a single-center study.Future research with multi-center,large-sample,and more in-depth investigations is needed.

DCE-MRI定量参数与局部进展期宫颈癌患者临床病理特征及疗效的关系

目的研究动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)定量参数与局部进展期宫颈癌临床病理特征及同步放化疗疗效的关系。方法选取河南科技大学第一附属医院2017年1月~2022年12月收治的68例局部进展期宫颈癌患者,接受DCE-MRI扫描,分析宫颈癌患者DCE-MRI定量参数[容量转移常数(volume transfer constant,K^(trans))、速率常数(rate constant,K_(ep))、细胞外间隙容积分数(extracellular space volume fraction,V_(e))]与临床病理特征关系;宫颈癌患者均接受同步放化疗,根据放化疗情况,将68例局部进展期宫颈癌患者分为有效组(n=39)与无效组(n=29),对比两组治疗前DCE-MRI定量参数,采用多因素Logistic回归分析探究疗效影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析DEC-MRI定量参数对患者疗效预测价值。结果鳞癌患者K^(trans)值较腺癌高(P<0.05);低分化患者K^(trans)、K_(ep)值较中高分化患者高(P<0.05);临床分期≥Ⅲa期患者K^(trans)、K_(ep)、V_(e)值均较<Ⅲa期高(P<0.05);不同肿瘤直径、是否淋巴结转移、是否脉管浸润患者之间DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值比较无明显差异(P>0.05)。有效组治疗前DCE-MRI定量参数K^(trans)、K_(ep)、V_(e)值均高于无效组(P<0.05)。多因素Logistic回归分析显示,临床分期≥Ⅲa期、K^(trans)、K_(ep)、V_(e)值均是影响局部进展期宫颈癌疗效的危险因素(P<0.05)。K^(trans)、K_(ep)、V_(e)值及三者联合预测疗效的ROC曲线下面积分别为0.962、0.950、0.860、0.997。结论DCE-MRI定量参数与局部进展期宫颈癌患者临床病理特征有一定关系,可作为患者同步放化疗疗效预测指标。

Different strategies of treatment for uterine cervical carcinoma stage ⅠB2-ⅡB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.

治疗前多参数MRI影像组学特征预测晚期宫颈鳞癌患者新辅助化疗后淋巴结转移

目的基于治疗前多参数磁共振成像(multi-parametric magnetic resonance imaging,mpMRI)影像组学特征,结合临床变量构建模型,预测局部晚期宫颈鳞癌(locally advanced cervical squamous cell carcinoma,LACSCC)患者新辅助化疗(neoadjuvant chemotherapy,NACT)后淋巴结转移状况。材料与方法回顾性分析两个中心2013年1月至2022年2月的265例接受NACT并行根治性子宫切除术的LACSCC患者病例及影像,中心1的数据用于模型训练,中心2的数据用于模型验证。所有患者NACT治疗前行盆腔MRI检查。于矢状位T2加权成像(sagittal T2-weighted imaging,Sag_T2WI)、轴位弥散加权成像(axial diffusion-weighted imaging,Ax_DWI)和延迟期矢状位对比增强T1加权成像(sagittal T1-weighted contrast-enhanced imaging,Sag_T1C)勾画肿瘤感兴趣区(region of interest,ROI)并提取影像组学特征。通过K最佳(K-Best)及最小绝对值收缩与选择算法(least absolute shrinkage and selection operator,LASSO)降维并筛选出与淋巴结转移强相关影像组学特征。基于每个序列筛选后的组学特征构建三个单序列模型,在所有特征间作相关性分析,排除高度相关的组学特征,并对临床变量进行多变量回归分析,融合临床变量及筛选后的影像组学特征构建临床-影像组学的组合模型,比较模型间性能差异。利用受试者工作特征(receiver operating characteristic,ROC)曲线及决策曲线(decision curve analysis,DCA)评估模型的诊断性能及临床效能。结果Sag_T2WI、Ax_DWI、Sag_T1C三个序列分别筛选出6、3、7个与淋巴结转移高度相关的组学特征,其中2个形状特征和10个纹理特征被纳入组合模型。多因素logistic回归分析显示MRI评估的淋巴结状态是淋巴结转移的预测因素(P<0.05)。与单序列模型相比,组合模型具有更好的预测能力,在训练集和验证集的诊断能力最高,ROC曲线下面积、敏感度和特异度分别为0.848[95%(confidence interval,CI):0.785~0.912]、78.2%、74.4%和0.827(95%CI:0.737~0.917)、80.8%、69.4%。DCA显示如果风险阈值超过60%,则用组合模型预测LACSCC患者NACT后淋巴结状态可获得较大的临床效益。结论基于治疗前MRI,联合Sag_T2WI、Ax_DWI、Sag_T1C三个序列的组学特征及临床信息对LACSCC患者NACT后淋巴结转移具有较好的预测效能。

同步热放化疗对晚期宫颈癌患者肿瘤标志物及miR-21、miR-130表达的影响

目的探讨同步热放化疗对晚期宫颈癌患者肿瘤标志物及miR-21、miR-130表达的影响。方法选取2020年3月至2022年3月收治的100例晚期宫颈癌患者,按治疗方式差异将其分为对照组和观察组,各50例。对照组采用同步放化疗,观察组采用同步热放化疗。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,观察组的B7同源体4(B7-H4)、缺氧诱导因子-1α(HIF-1α)、增殖细胞核抗原(PCNA)mRNA表达量均低于对照组(P<0.05)。治疗后,观察组的CD3+、CD4+高于对照组,CD8+低于对照组(P<0.05)。治疗后,观察组的miR-21、miR-130表达水平低于对照组(P<0.05)。观察组的恶心呕吐、膀胱炎严重程度低于对照组(P<0.05)。结论同步热放化疗可提高晚期宫颈癌患者的治疗效果,促进肿瘤标志物水平降低,改善免疫功能,也能下调miR-21、miR-130表达水平,降低不良反应程度,值得推广与应用。

Correlations between alterations of T-helper 17 cells and treatment efficacy after concurrent radiochemotherapy in locally advanced cervical cancer (stage IIB-IIIB): a 3-year prospective study

Background::Recently,T-helper 17(Th17)cells have been proved to play an important role in promoting cervical cancer.But,till now,few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments.This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer(LACC)patients before and after concurrent chemoradiotherapy(cCRT)and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.Methods::A prospective study with 49 LACC(International federation of gynecology and obstetrics[FIGO]stage IIB-IIIB)patients and 23 controls was conducted.Patients received the same cCRT schedule and were followed up for 3 years.Circulating Th17 cells(CD3+CD8-interleukin[IL]-17+T cells)and related cytokines IL-17,transforming growth factor-β(TGF-β),IL-10,IL-23,IL-6,and IL-22 were detected before and after cCRT.Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed.Kaplan-Meier analysis was used for overall survival(OS)and progression-free survival(PFS).Results::We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study.The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls,and it significantly decreased after cCRT(P<0.05).After cCRT,patients were divided into two groups based on the average of the Th17 cells declined.The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times.Compared with the control patients,LACC patients had higher IL-6,IL-10,IL-22,TGF-βlevels and a lower IL-23 level(P<0.05).After cCRT,IL-6,IL-10,IL-17,IL-23 level significantly increased and TGF-βlevel significantly decreased compared with the levels before cCRT(P<0.05).Conclusion::Circulating Th17 cells in the LACC patients(FIGO stage IIB-IIIB)were higher than those in the controls,but they generally decreased after cCRT.A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

同步放化疗治疗Ib2和IIa2期宫颈癌疗效及预后相关因素分析

目的:探讨同步放化疗治疗Ib2期和IIa2期宫颈癌的疗效和不良反应,并分析预后影响因素。方法:回顾分析2000年1月至2010年12月首都医科大学附属北京妇产医院妇瘤科收治的73例接受同步放化疗的Ib2和IIa2期宫颈癌患者的临床病理资料。统计有效率和疾病控制率评价近期疗效,统计3年、5年无瘤生存率(DFS)及总生存率(OS)评价远期疗效,记录患者的不良反应,并分析可能影响患者预后的相关因素。结果:同步放化疗治疗Ib2期和IIa2期宫颈癌的有效率(CR+PR)为91.78%,疾病控制率(CR+PR+SD)为97.26%;3年DFS为84.93%,0S为86.30%;5年DFS为79.45%,0S为82.19%。所有不良反应患者均可耐受,对症治疗后均可缓解。单因素分析显示,患者的生存率与肿瘤的病理类型、分化程度、大小、有无淋巴结转移以及治疗前后血鳞状细胞癌抗原(SCC-Ag)值有关(P<0.05)。多因素分析表明,肿瘤病理类型、大小、有无淋巴结转移及治疗后1个月血SCC-Ag值为远期疗效的独立影响因素。结论:同步放化疗治疗Ib2期和IIa2期宫颈癌的近、远期疗效肯定,不良反应可耐受,是一种可供选择的方法。病理类型为腺癌、肿瘤直径﹥5cm、有淋巴结转移、治疗后1个月血SCC-Ag值≥1.5ng/ml者预后较差,需进一步加强研究。

扶正抗癌方联合深部热疗治疗中晚期宫颈癌CT、MRI的应用价值

目的探讨CT、MRI在扶正抗癌方联合深部热疗治疗中晚期宫颈癌的应用价值。方法收集在我院准备和已经接受扶正抗癌方联合深部热疗的中晚期宫颈癌56例患者的临床、影像资料,所有患者治疗前、后随机选择CT或MRI检查,由两位专家独立阅片,统计分析。结果56例宫颈癌中,Ⅱb期13例、Ⅲ期32例、Ⅳ期11例;1例因侵犯宫体并致结肠瘘,及时行外科手术治疗;1例侵犯输尿管,导致双侧肾盂、输尿管积水,先接受双"J"管留置术;23例影像检查后改变了临床分期,其中21例分期升级,2例分期降级;9例进行了治疗前后的检查对照。3例因放疗致放射性直肠炎,影响肿瘤的影像诊断分期。结论中晚期宫颈癌行扶正抗癌方联合深部热疗治疗达到了预期的治疗效果,CT、MRI在肿瘤分期及治疗方式选择上有重要指导意义。