Subgroups of peripheral immune effector cells in cervical cancer patients are more sensitive to radiation therapy than chemotherapy

Background:CD8 positive T lymphocytes and natural killer(NK)cells in the peripheral blood of cervical cancer patients exhibit varying sensitivities to radiotherapy and chemotherapy.Methods:A total of 50 healthy peoples and 60 cervical cancer patients were recruited.The patients with cervical cancer were separated into two groups:radiation and chemotherapy,and blood sample were collected before and after treatment.Data on the proportion of CD8 positive T lymphocytes and NK cells were gathered for analytical evaluation.Results:Compared to healthy individuals,patients with cervical cancer exhibit a reduced proportion of CD8 positive T cells within their peripheral blood.And for patients with cervical cancer,radiation therapy has been found to be more effective than chemotherapy in increasing the proportion of CD8 positive T lymphocytes and NK cells.Conclusions:These results suggest that radiation therapy increases the levels of CD8 positive T lymphocytes and NK cells within the peripheral blood of patients with cervical cancer.The study hypothesis that the changes in the percentage of CD8 positive T lymphocytes may serve as a potential indicator for predicting treatment efficacy.

Prognostic evaluation of postoperative adjuvant therapy for operable cervical cancer:10 years'experience of National Cancer Center in China

Objective： The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer. Methods： The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics （FIGO） Ib-[Ia cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months. Results： Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival （DFS） of 92.1% and 5-year overall survival （OS） of 95.0%. In multivariate analysis, differentiation of G3 （P〈0.05）, lymph node metastasis （LNM, P〈0.05） and lymphovascular space invasion （LVSI, P〈0.05） were independent predictors for OS, while LNM （P〈0.05）, deep stroma invasion （DSI, P〈0.05） and LVSI （P〈0.05） were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma （SCC） was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamons carcinoma （AC/ASC）, differentiation was the independent predictor of OS （P〈0.05）; and LVSI of DFS （P〈0.05）. Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy （CCRT, n=195）, radiotherapy （RT, n=24）, and chemotherapy （CT, n=17）. Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT （P=0.118）, with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant. Conclusions： LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival. CCRT＋CT outperformed CCRT in high-risk patients. For patients with single non-high-risk factor, the role of adjuvant therapy needs to be further discussed.

Knockdown of circular RNA (CircRNA)_001896 inhibits cervical cancer proliferation and stemness in vivo and in vitro

Objective:Previous studies indicated that aberrant circular RNA(circRNA)expression affects gene expression regulatory networks,leading to the aberrant activation of tumor pathways and promoting tumor cell growth.However,the expression,clinical significance,and effects on cell propagation,invasion,and dissemination of circRNA_001896 in cervical cancer(CC)tissues remain unclear.Methods:The Gene Expression Omnibus(GEO)datasets(GSE113696 and GSE102686)were used to examine differential circRNA expression in CC and adjacent tissues.The expression of circRNA_001896 was detected in 72 CC patients usingfluorescence quantitative PCR.Correlation analysis with clinical pathological features was performed through COX multivariate and univariate analysis.The effect of circRNA_001896 downregulation on CC cell propagation was examined using the cell counting kit-8(CCK-8)test,clonogenic,3D sphere formation,and in vivo tumorigenesis assays.Results:Intersection of the GSE113696 and GSE102686 datasets revealed an increased expression of four circRNAs,including circRNA_001896,in CC tissues.Fluorescence quantitative PCR confirmed circRNA_001896 as a circular RNA.High expression of circRNA_001896 was considerably associated with lymph node metastasis,International Federation of Gynecologists and Obstetricians(FIGO)stage,tumor diameter,and survival period in CC patients.Proportional hazards model(COX)univariate and multivariate analyses revealed that circRNA_001896 expressions are a distinct risk factor affecting CC patients’prognosis.Cellular functional experiments showed that downregulating circRNA_001896 substantially suppressed CC cell growth,colony formation,and 3D sphere-forming ability.In vivo,tumorigenesis analysis in nude mice demonstrated that downregulating circRNA_001896 remarkably reduced the in vivo proliferation capacity of CC cells.Conclusion:CircRNA_001896 is highly expressed in CC tissues and is substantially related to lymph node metastasis,FIGO stage,tumor size,and survival period in patients.Moreover,downregulating circRNA_001896 significantly inhibits both in vivo and in vitro propagation of CC cells.Therefore,circRNA_001896 might be used as a biomarker for targeted therapy in cervical cancer.

Relationship between Circulating Plasma Galectin-3 Levels and T-Cell Activation during Cervical Cancer Chemotherapy

Objective: Despite the existence of several therapeutic strategies, the management of cervical cancer remains challenging. Our region has very little data on the interaction between the immune system and the clinical response to chemotherapy. This work examines plasma levels of galectin-3 (Gal-3) and percentages of activated T cells in patients with cervical cancer treated with chemotherapy and investigates if there is a relationship between the rates of these two elements. Methods: We compared data from 37 patients with cervical cancer undergoing chemotherapy and 42 controls with normal cervical cytology. Plasma Gal-3 concentrations were assessed by ELISA and expression of activation markers by T cells (CD69 and HLA-DR) was assessed by flow cytometry at three different time points during chemotherapy. Results: Our results showed that patients had a significantly higher concentration of Gal-3 compared to controls (4.025 vs. 1.340, p 0.001), similarly, they had a significantly high percentage of activated lymphocytes (2.610 vs. 0.731;p 0.0001). According to the response to treatment, patients with no response to treatment had a lower concentration of circulating Gal-3 but had approximately the same percentage of activated CD4 and CD8 lymphocytes as patients with a partial or total response. In addition, we found a positive correlation between the Gal-3 level and CD4 T cells expressing the activation marker CD69 (p 0.05;rho = 0.44). Conclusion: In conclusion, our results show that there would be a relationship between circulating galectin-3 and the percentage of peripheral CD4+CD69+ cells in cervical cancer.

<i>FAS</i>-670 Gene Promoter Region Polymorphism in Cervical Intraepithelial Neoplasia Grade 3 (CIN 3) and Invasive Cervical Cancer

The human papillomavirus (HPV) is the etiologic agent of genital cancer, but alone it is incapable of inducing oncogenesis. Rather, progression to invasive lesions is associated with host immunity and interference in the process of cellular apoptosis. Among the several genes involved in cell death, theFAS gene appears to be an important factor. The aim of this study was to evaluate whether there is an association between polymorphisms of the FAS-670 gene promoter region and preinvasive and invasive lesions of the cervix. The FAS gene was evaluated for the presence of polymorphisms using polymerase chain reaction and restriction fragment length polymorphism techniques in 225 blood samples for the control group, as well as cervical tissue from patients with cervical intraepithelial neoplasia grade 3 (CIN 3;75 cases) or invasive carcinoma (214 cases). The AG genotype of the FAS-670 gene promoter region was significantly more frequent in women with CIN 3, with an estimated risk of three times (OR = 3.0). No difference, however, was observed in the control group and women with cervical cancer. In women with cancer, the genotypes were similar in the different histological types and degree of tumor differentiation. Assessing allelic distribution (A or G), we observed no difference in frequency of genotypes in studied groups. These data suggest that polymorphism of the promoter region of the FAS-670 gene is associated with increased risk of CIN 3, but not for invasive cancer of the cervix.

Uterine papillary serous carcinoma: Its clinical and fundamental studyUterine papillary serous carcinoma: Its clinical and fundamental study

Uterine papillary serous carcinoma(UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and ac- counted for 1 % - 10% of endometrial cancers. The occurrencer of papillary patterns of en- dometrial adenocarcinoma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph - vascular space invasion. CA125 is often mentioned a useful tumor marker either for diagnosis before starting treatment or in monitoring recurrence. The optimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery , radiation therapy, and chemotherapy. The molecular basis for the gneeral poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well under- stood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to endometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endometrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.

Quantitative Detection of Screening for Cervical Lesions with ThinPrep Cytology Test

OBJECTIVE To investigate the available parameters in gynecological screening for cervical lesions by liquid-based cytology technology （ThinPrep Cytology Test, TCT） and The Bethesda System （TBS）, also with computer image analysis. METHODS With application of the image analysis system, all grades of cervical lesion cells were detected quantitatively and sorted in atypical squamous cells of undetermined significance （ASCUS）, atypical squamous cells-cannot exclude HSIL （ASC-H）, low-grade squamous intraepithelial lesion （LSIL）, high-grade squamous intraepithelial lesion （HSIL） and cervical squamous cell carcinoma （SCC） with the mean optical density （MOD）, average grey （AG）, positive units （PU）, and nucleus to cytoplasmic ratio （N： C）. Differences between each group of cells were compared and analyzed statistically. RESULTS Apart from four stereologic parameters in LSIL and HSIL groups there were no differences among them, in the other groups, there was statistically significant in differences between MOD, AG and PU values. Differences between them in the ratio of nucleus to cytoplasm were highly statistically significant. CONCLUSION Stereological indexes may serve as a screening tool for cervical lesions. The image analysis system is expected to become a new means of cytological assisted diagnosis.

妇科常见恶性肿瘤全专结合管理专家共识

为提升妇科恶性肿瘤患者的全程健康管理质量,充分发挥基层医疗卫生机构在妇科恶性肿瘤患者筛查、早期识别、干预及康复中的作用,首都医科大学肿瘤学系妇科肿瘤学组联合全科医学、营养学、心理学、康复医学、护理学、卫生统计学等专家,基于基层医疗机构现状,结合循证医学证据、妇科恶性肿瘤管理相关指南等,制定了本共识。妇科常见恶性肿瘤患者全专结合管理应该以妇科医生和全科医生为核心,联合肿瘤、康复等多学科团队,从妇科恶性肿瘤的预防、筛查、随访、转诊、心理疏导、运动康复、营养管理、延续护理、健康教育以及社会功能恢复等方面进行综合管理,致力于延长患者生存期和提高患者生存质量。

1例子宫颈平滑肌肉瘤PET/MRI表现

患者女,53岁,体检发现宫颈占位2年余、出现持续性阴道出血近1个月,无腹痛、腹胀等;停经2年,2年前接受左侧乳腺浸润性导管癌全切术及放射、化学治疗。查体:胸部见左乳术后瘢痕;下腹部触及9 cm×10 cm×9 cm包块,质硬,活动度差,无明显压痛。

合成MRI鉴别宫颈鳞癌与宫颈腺癌

目的观察合成MRI(SyMRI)MAGiC序列参数鉴别宫颈鳞癌与宫颈腺癌的价值。方法回顾性纳入66例宫颈癌患者并分为宫颈鳞癌组(n=56)及宫颈腺癌组(n=10),比较组间MAGiC序列定量参数;联合组间存在统计学差异的参数构建logistic回归模型,采用受试者工作特征(ROC)曲线及其曲线下面积(AUC)评估各参数单独及联合鉴别宫颈鳞癌与宫颈腺癌的效能。结果宫颈腺癌组病变T1、T2均高于而R1、R2均低于宫颈鳞癌组(P均<0.05);组间质子密度差异无统计学意义(P>0.05)。单一T1、T2、R1、R2及其联合鉴别宫颈鳞癌与宫颈腺癌ROC曲线的AUC分别为0.959、0.945、0.961、0.942及0.996,两两之间差异均无统计学意义(Z=0.267~1.396,P均>0.05)。结论SyMRI鉴别诊断宫颈鳞癌与宫颈腺癌具有较高价值。

外周血中性粒细胞与淋巴细胞比值联合癌胚抗原检测对局部晚期宫颈癌同步放化疗效果的预测价值

目的探究外周血中性粒细胞与淋巴细胞比值(NLR)和癌胚抗原(CEA)表达联合检测对局部晚期宫颈癌(LACC)同步放化疗效果的预测价值。方法选取2021年1―12月就诊于保定市第一中心医院的120例LACC病人为研究对象。根据120例LACC病人同步放化疗效果分为A组[完全缓解(CR)/部分缓解(PR),n=94]和B组[病情稳定(SD)/病情进展(PD),n=26],比较两组治疗前外周血NLR、CEA和鳞状细胞癌相关抗原(SCC-Ag)表达水平。多元logistic回归分析影响LACC病人同步放化疗效果的因素;受试者操作特征曲线(ROC曲线)分析外周血NLR和CEA表达水平对LACC病人同步放化疗效果的预测价值。结果与B组比较,A组NLR(2.51±0.24比2.97±0.36)、CEA[(6.84±0.92)μg/L比(8.77±1.03)μg/L]、SCC-Ag[(5.98±1.19)μg/L比(9.06±1.65)μg/L]表达水平明显较低(P<0.05);logistic回归分析结果显示,NLR高表达、CEA高表达、SCC-Ag高表达、淋巴结阳性、非鳞癌、FIGO分期高是影响LACC病人同步放化疗效果的独立危险因素(P<0.05)。ROC结果显示,NLR单独预测LACC病人同步放化疗效果的AUC为0.81,95%CI:(0.73,0.87),灵敏度、特异度分别为69.23%、86.17%,最佳截断值为2.96;CEA水平单独预测LACC病人同步放化疗效果的AUC为0.86,95%CI:(0.79,0.92),灵敏度、特异度分别为73.08%、85.11%,最佳截断值为8.06μg/L;SCC-Ag水平单独预测LACC病人同步放化疗效果的AUC为0.88,95%CI:(0.80,0.95),灵敏度、特异度分别为69.23%、85.11%,最佳截断值为8.28μg/L;三者联合预测LACC病人同步放化疗效果的AUC(0.94)显著大于NLR单独预测的(Z=2.61,P=0.009)、CEA单独预测的AUC(Z=2.57,P=0.010)和SCC-Ag单独预测的AUC(Z=1.99,P=0.046)。结论NLR和CEA在LACC同步放化疗有效病人中水平较低,二者联合检测对LACC同步放化疗效果具有较高的预测价值。

宫颈小细胞神经内分泌癌治疗的研究进展

宫颈小细胞神经内分泌癌(small cell neuroendocrine cervical carcinoma,SCNECC)是一种罕见的妇科恶性肿瘤,早期容易出现侵袭转移,预后比宫颈鳞癌和腺癌差。目前对其临床管理尚处于探索阶段,近年来,随着国内外对SCNECC的关注越来越多,改善其预后的探索也取得一些成果。本文将SCNECC综合治疗的研究进展作一综述,对当前手术、放化疗、靶向与免疫药物等治疗策略中的一些关键问题进行探讨和展望。

Photodynamic Therapy for Gynecological Diseases and Breast Cancer

Photodynamic therapy （PDT） is a minimally invasive and promising new method in cancer treatment. Cytotoxic reactive oxygen species （ROS） are generated by the tissueqocalized non-toxic sensitizer upon illumination and in the presence of oxygen. Thus, selective destruction of a targeted tumor may be achieved. Compared with traditional cancer treatment, PDI has advantages including higher selectivity and lower rate of toxicity. The high degree of selectivity of the proposed method was applied to cancer diagnosis using fluorescence. This article reviews previous studies done on PDT treatment and photodetection of cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, ovarian and breast cancer, and PDT application in treating non-cancer lesions. The article also highlights the clinical responses to PDT, and discusses the possibility of enhancing treatment efficacy by combination with immunotherapy and targeted therapy.

The delay, symptoms, and survival of Ivorian adolescent girls and young adults with uterine cervical cancer

Objective:To generate data on the nature and duration of cervical cancer symptoms,risk factors for delayed consultation,and diagnosis of adolescent and young adult groups in Cote d'Ivoire.Methods:This is a hospital-based cross-sectional study,conducted from July 2012 to May 2018,at the Department of Gynecology of the Yopougon teaching hospital in Cote d’Ivoire.The inclusion criteria were those who were under 40 years of age at the time of diagnosis with oral and written consent.Those whose information was more than 10%insufficient for the standards were excluded from the study.The survey files standardized anonymous pre-established data collected using medical records followed by phone calls.Results:The average age of the participants was 34±4.95 years with a minimum of 21 years.The mean parity per woman was 3.49±3.54.34.9%were HIV positive.The median patient delay was 122 days with a long delay in 84.62%of patients.The median time to total diagnosis was 209 days with a longer total delay in diagnosis of 87.18%.41%of patients honored their treatment,68.75%of which had received surgery,and 31.25%of which had received chemotherapy.The 5-year survival rate was 65%.Conclusion:The Ivorian health system must focus on primary and secondary prevention,the only guarantee to decrease the morbidity and mortality indicators linked to cervical cancer.

妊娠期宫颈癌临床误诊分析

目的探讨妊娠期宫颈癌临床误诊的原因及防范措施。方法回顾性分析2020年1月—2021年12月收治的曾有误诊经过的妊娠期宫颈癌3例临床资料。结果3例均因妊娠期阴道出血、腹痛或阴道分泌物异常就诊。1例考虑为先兆早产,剖宫产术后行MRI检查发现宫颈明显不规则增厚伴异常信号,经增厚组织病理检查确诊为宫颈低分化鳞状细胞癌(鳞癌);1例考虑为先兆流产,妇科检查发现宫颈有一赘生物,经宫颈活检确诊为宫颈中分化鳞癌;1例考虑为前置胎盘,剖宫产术后宫颈内口触及胎盘样组织,腹部超声示宫颈与宫体结合部占位性病变,病理活检示宫颈鳞癌。误诊时间2 d~4个月。3例确诊后予宫颈癌根治术联合术后放疗,随访半年情况良好。结论妊娠期宫颈癌临床少见,临床对以妊娠期出现不规则阴道出血、腹痛及分泌物异常增多就诊者提高警惕,以减少误诊。

宫颈癌保留神经手术后排尿功能评价

目的探讨宫颈癌保留神经的广泛性子宫切除术(nerve sparing radical hysterectomy,NSRH)治疗宫颈癌的效果及对排尿功能的影响。方法纳入2019年5月至2022年5月于首都医科大学附属北京妇产医院就诊并诊断为宫颈癌的患者55例,国际妇产科联盟分期分布在ⅠB至ⅡA2。其中28例患者接受了NSRH(NSRH组),27例患者接受了广泛性全子宫切除术(radical hysterectomy,RH)(RH组)。比较2组患者手术相关指标及术后排尿功能。结果NSRH组平均年龄为(51.0±7.9)岁,RH组平均年龄为(46.3±8.5)岁,年龄分布差异有统计学意义(P<0.05)。2组出血量差异无统计学意义(P>0.05)。2组患者手术切缘均为阴性。术后病理提示阴道长度、淋巴结转移、间质浸润深度、淋巴脉管浸润比较差异均无统计学意义(P>0.05)。在术后膀胱功能方面,NSRH组残余尿较RH组多(P<0.05),但NSRH组拔尿管的时间较RH组明显缩短(P<0.05)。结论NSRH能够在确保手术范围的同时,减轻对术后排尿功能的影响,缩短术后恢复时间。

宫颈癌肉瘤一例并文献复习

宫颈癌肉瘤(cervical carcinosarcoma)是一种由恶性的上皮组织和间质成分组成的恶性肿瘤,患者通常以不规则阴道出血、流液就诊,其病因及发病机制尚不明确,临床上十分罕见,因此容易造成误诊和漏诊。现报告1例42岁宫颈癌肉瘤的病例资料,患者因接触性出血伴下腹痛收入院,盆腔磁共振成像示宫颈部体积明显增大,初步诊断为宫颈恶性肿瘤,遂行根治性全子宫切除+盆腔淋巴结切除+大网膜切除术,术后病理学明确诊断为宫颈癌肉瘤Ⅱb期。截至2024年3月2日,患者已行3次化疗,暂未发现复发及转移。宫颈癌肉瘤恶性程度高,临床表现无特异性,确诊主要依靠病理学检查和免疫组织化学检查,因此早识别、早治疗对改善患者的预后至关重要。

PD⁃1抑制剂联合全身化疗治疗复发转移性宫颈癌的临床效果观察

目的探讨程序性细胞死亡受体-1(PD-1)抑制剂(卡瑞利珠单抗)免疫治疗联合全身化疗治疗复发转移性宫颈癌的临床效果。方法选择2019年2月—2021年6月定州市人民医院收治的复发转移性宫颈癌64例,依据随机数字表法分为研究组和对照组各32例。对照组给予紫杉醇联合顺铂全身化疗方案,研究组给予全身化疗方案+PD-1卡瑞利珠单抗免疫治疗。比较2组临床疗效,分析治疗前及治疗3个周期后鳞状细胞癌抗原(SCC)、外周血淋巴细胞/单核细胞(LMR)及血小板/淋巴细胞(PLR)指标水平及Kamofsky评分变化,并观察治疗期间毒性作用发生情况及随访期间患者总生存期。结果研究组总有效率、疾病控制率分别为93.75%(30/32)、96.88%(31/32),高于对照组的68.75%(22/32)、75.00%(24/32),差异有统计学意义(P<0.05)。治疗3个周期后,2组血清SCC、PLR水平较治疗前降低,LMR较治疗前升高,且研究组改善程度优于对照组(P<0.05)。治疗后,2组Kamofsky评分均较治疗前升高,且研究组高于对照组(P<0.05)。治疗后研究组1、2年生存率及总生存期高于或长于对照组(P<0.05)。2组毒性作用多数为1~2级。研究组血小板下降和转氨酶升高比例分别为37.50%(12/32)和28.12%(9/32),高于对照组的18.75%(6/32)和9.38%(3/32),差异有统计学意义(P<0.05);2组贫血、白细胞下降、恶心、腹泻、乏力等毒性作用发生率比较差异无统计学意义(P>0.05);研究组中发生反应性毛细血管增生症、甲状腺功能减退、皮疹、带状疱疹、过敏等经对症处理后症状消失。结论PD-1抑制剂联合全身化疗治疗复发转移性宫颈癌提高了临床效果、生存质量及生存率,延长生存期,改善了机体的炎症免疫反应状态,毒性作用较少,患者耐受性好。

循环肿瘤细胞上细胞程序性死亡配体1表达对宫颈癌同步放化疗预后的评估价值

目的探讨循环肿瘤细胞(CTC)上细胞程序性死亡配体1(PD-L1)表达对宫颈癌同步放化疗预后的评估价值。方法回顾性选取2021年6月至2023年12月入临汾市人民医院的60例宫颈癌患者,均经病理学确诊,CTC PD-L1经CytoSorter CTC系统测定。对宫颈癌病理特征与PD-L1^(+)CTC之间的相关性予以分析,并比较PD-L1^(+)CTC和PD-L1-CTC宫颈癌患者同步放化疗前后的无进展生存期(PFS),评估宫颈癌放化疗后PD-L1^(+)CTC数量对预后的评估价值。结果同步放化疗前后外周血CTC检出率及数量比较,差异无统计学意义(P>0.05)。较同步放化疗前,宫颈癌患者同步放化疗后PD-L1^(+)CTC检出率更低(38.33%vs.56.67%),PD-L1^(+)CTC检出数量更少[(0.77±1.20)个vs.(1.27±1.51)个],差异均有统计学意义(P<0.05)。同步放化疗前,宫颈癌患者PD-L1^(+)CTC与肿瘤直径、FIGO分期、分化程度及淋巴结转移联系紧密(P<0.05)。同步放化疗后,宫颈癌患者PD-L1^(+)CTC表达水平与肿瘤直径、FIGO分期、分化程度及淋巴结转移密切相关(P<0.05)。PD-L1^(+)CTC患者的PFS短于PD-L1-CTC患者,差异有统计学意义(P<0.05)。Cox回归分析显示,局部晚期宫颈癌患者同步放化疗前后的CTC PD-L1表达水平均可作为PFS预后因素。结论宫颈癌放同步放化疗前后测定的CTC PD-L1表达水平可作为预后评估的辅助指标。

妊娠合并子宫颈癌的管理

子宫颈癌是妊娠期最常见的妇科恶性肿瘤之一,总体发病率较低,临床虽不常见,但流行病学研究显示其发病率不断上升。其症状常与妊娠相关疾病混淆,易误诊或漏诊。妊娠合并子宫颈癌的临床管理极具挑战性,需要兼顾母胎、平衡肿瘤与妊娠的关系,以获得最佳结局。近年妊娠合并子宫颈癌的诊治理念和策略也有很大变化,本文结合国内外权威指南、专家共识及文献报道对其进行阐述。