Treatment and prognosis analysis of 488 patients with FIGO 2018 stage Ⅲc squamous cervical cancer / 中华妇产科杂志

Objective: To analyze the treatment and prognosis of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage Ⅲc cervical squamous cell carcinoma. Methods: A total of 488 patients at Zhejiang Cancer Hospital between May, 2013 to May, 2015 were enrolled. The clinical characteristics and prognosis were compared according to the treatment mode (surgery combined with postoperative chemoradiotherapy vs radical concurrent chemoradiotherapy). The median follow-up time was (96±12) months ( range time from 84 to 108 months). Results: (1) The data were divided into surgery combined with chemoradiotherapy group (surgery group) and concurrent chemoradiotherapy group (radiotherapy group), including 324 cases in the surgery group and 164 cases in the radiotherapy group. There were significant differences in Eastern Cooperation Oncology Group (ECOG) score, FIGO 2018 stage, large tumors (≥4 cm), total treatment time and total treatment cost between the two groups (all P<0.01). (2) Prognosis: ① for stage Ⅲc1 patients, there were 299 patients in the surgery group with 250 patients survived (83.6%). In the radiotherapy group, 74 patients survived (52.9%). The difference of survival rates between the two groups was statistically significant (P<0.001). For stage Ⅲc2 patients, there were 25 patients in surgery group with 12 patients survived (48.0%). In the radiotherapy group, there were 24 cases, 8 cases survived, the survival rate was 33.3%. There was no significant difference between the two groups (P=0.296). ② For patients with large tumors (≥4 cm) in the surgery group, there were 138 patients in the Ⅲc1 group with 112 patients survived (81.2%); in the radiotherapy group, there were 108 cases with 56 cases survived (51.9%). The difference between the two groups was statistically significant (P<0.001). Large tumors accounted for 46.2% (138/299) vs 77.1% (108/140) in the surgery group and radiotherapy group. The difference between the two groups was statistically significant (P<0.001). Further stratified analysis, a total of 46 patients with large tumors of FIGO 2009 stage Ⅱb in the radiotherapy group were extracted, and the survival rate was 67.4%, there was no significant difference compared with the surgery group (81.2%; P=0.052). ③ Of 126 patients with common iliac lymph node, 83 patients survived, with a survival rate of 65.9% (83/126). In the surgery group, 48 patients survived and 17 died, with a survival rate of 73.8%. In the radiotherapy group, 35 patients survived and 26 died, with a survival rate of 57.4%. There were no significant difference between the two groups (P=0.051). (3) Side effects: the incidence of lymphocysts and intestinal obstruction in the surgery group were higher than those in the radiotherapy group, and the incidence of ureteral obstruction and acute and chronic radiation enteritis were lower than those in the radiotherapy group, and there were statistically significant differences (all P<0.01). Conclusions: For stage Ⅲc1 patients who meet the conditions for surgery, surgery combined with postoperative adjuvant chemoradiotherapy and radical chemoradiotherapy are acceptable treatment methods regardless of pelvic lymph node metastasis (excluding common iliac lymph node metastasis), even if the maximum diameter of the tumor is ≥4 cm. For patients with common iliac lymph node metastasis and stage Ⅲc2, there is no significant difference in the survival rate between the two treatment methods. Based on the duration of treatment and economic considerations, concurrent chemoradiotherapy is recommended for the patients.

Prognostic factors affecting survival of 211 cervical adenocarcinoma patients / 预防医学

Objective This study was conducted to determine the prognostic factors of cervical adenocarcinoma.Methods Between July 2008 and June 2013, 211 consecutive patients were treated because of International Federation of Gynecology and Obstetrics(FIGO) stage IA-IVB cervical adenocarcinoma.Overall survival was analyzed by the Kaplan-Meier method.Results One-year OS rate was 96.2%,and 3-year OS rate was 88.6%,and 5-year OS rate was 74.7%.Patients'age,FIGO stage,postoperative clinicopathological factors such as depth of stromal invasion,number of pelvic lymph node metastasis and para-aortic lymph node metastasis,were analyzed to discriminate their prognostic role.In the univariate analysis, age,FIGO stge,deep stromal invasion, lymph-vascular space invasion, number of pelvic lymph node metastasis,para-aortic lymph node metastasis were associated with poorer survival(P< 0.05).In the cox analysis, age (RR=4.940,95%CI:1.925-12.678),pelvic lymph node metastasis(RR=2.391,95%CI:1.311-4.360),para-aortic lymph node metastasis (RR=6.344,95%CI:1.007-39.990)and FIGO stage(Ⅲ vs I,RR=5.315,95%CI:2.760-12.203;Ⅳ vs I,RR=9.932,95%CI:2.905-18.846)were independent prognostic factors of invasive cervical adenocarcinoma.Conclusion Early detection and early treatment is very important for cervical adenocarcinoma patients.Give the patient suitable and maybe more aggressive adjuvant therapy according to surgical pathology is helpful for imporving adenocarcinoma treatment.

Detection of micrometastases and its clinical significance in sentinel and non-sentinel lymph nodes from early cervical carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of micrometastasis detection in sentinel lymph nodes (SLN) from patients with early cervical carcinoma.</p><p><b>METHODS</b>Thirty patients with early cervical carcinoma were studied to identify SLN intraoperatively using methylene blue. One lymph node was removed randomly from palpable SLN and other pelvic lymph nodes (nSLN) in each patient, so 268 lymph nodes were collected and cut into two halves, one half of the lymph node was used to analyze the expression of cytokeratin 19 (CK19) mRNA by real-time fluorescence quantitative polymerase chain reaction to determine the presence of micrometastasis, the other half was examined by routine histology with HE staining.</p><p><b>RESULTS</b>67 SLNs were detected in 28 cases (93.3%). Pelvic lymph nodes of 6 cases were confirmed pathological metastasis. The sensitivity of SLN detection was 66.7%, the accuracy rate was 96.4%, and the false negative rate was 16.7%. Among 268 lymph nodes (including 9 lymph nodes with pathological metastasis) detected by real-time fluorescence quantitative polymerase chain reaction, 68 lymph nodes were pathological negative but had micrometastasis, accounting for 26.3% (68/259) in pathologically negative lymph nodes. Among 24 patients with pathological negative lymph nodes, 16 cases had micrometastasis, accounting for 66.7% in those patients. Among 16 patients with micrometastasis, SLN of 3 cases were negative, but nSLN were micrometastasis, so the SLN false-negative rate rose to 18.2%. There were no significant relationships between pelvic lymph nodes micrometastasis and perivascular space involvement, deep stromal invasion and tumor grade (all P > 0.05). The micrometastasis rate of nSLN in patients with SLN micrometastasis was 100%, significantly higher than that in the patients with SLN non-micrometastasis (27.3%, P < 0.01).</p><p><b>CONCLUSIONS</b>Real-time fluorescence quantitative polymerase chain reaction is a sensitive method to detect SLN micrometastasis. SLN micrometastasis may be an effective complement to SLN pathology to predict nSLN metastasis. Pelvic lymph nodes micrometastases have no significant relationship with pathological risk factors in cervical cancer and prognosis of patients.</p>

Sentinel lymph node detection in early stage cervical cancer with combined radioisotope and blue dye method / 中华核医学杂志

Objective The aim of this study was to investigate the feasibility and clinical value of detecting sentinel lymph node (SLN) with combined radioisotope and blue dye method in early stage cervical cancer. Methods Between March 2005 and April 2006, 50 patients with cervical cancer, who were staged Ⅰ b and Ⅱ a by International Federation of Gynecology and Obstetrics (FIGO), underwent SLN detection with preoperative lymphoscintigraphy. A dose of 148 MBq (4×10-4L) 99Tcm-sulfur colloid (SC) was injected into the uterine cervix at 3 and 9 o'clock position with lymphoscintigraphy taken at 15-60 min after injection. Intraoperative detection of "hot spot" lymph nodes was performed with a handheld gamma probe (γ-detection). During operation, 2-4 ml metend blue dye (BD-detection) was injected into the uterine cervix at the same positions. All patients underwent hysterectomy and pelvic lymphadenectomy. The spatial and pathological relationships of the SLN samples were compared between the two methods. SPSS 13.0 was used for statistical analysis. Results The detection rate of SLN with combined radioisotope and blue dye was 96.0% (48/50). γ-detection alone was 92.0% (46/50) and BD-detection alone was 70.0% (35/50, x2=4.92, P<0.05). In 37 patients lymphoseintigraphy showed the same SLN as γ-detection did, with a coincidence rate of 74.0% (37/50). The SLN with metastases were confirmed by histopathology in 11/48 (22.9%) patients. In the remaining 37 patients with SLN negative for metastasis, there was 1 case with non-SLN showing metastasis. In the 2 patients negative for SLN, 1 was positive for non-SLN metastasis. The SLN accuracy rate was therefore 97.9% (47/48), and the negative predictive value was 97.3% (36/37) with one patient false negative. About 72.3 % (115/159) of SLN were found in obturator region, 5.0% (8/ 159) in iuteriliac region, 12.0% (19/159) in external iliac chain, 6.9% (11/159) in common iliac region and 3.8% (6/159) in parametrium. The number of left-sided SLN detected was more than that of the right (x2=5.06, P=0.021 ). Conclusion Combined radioisotope and blue dye technique is a feasible and valuable tool to detect pelvic SLN in patients with early uterine cervical malignancy.

Synchronous primary cancer of the endometrium and ovary / 中华肿瘤杂志

<p><b>UNLABELLED</b>To investigate the clinical and pathological characteristics, treatment, and The data of 12 patients prognosis of synchronous primary cancer of the endometrium and ovary. Methods with synchronous primary cancer of the endometrium and ovary were retrospectively reviewed . Results Eight patients had the same histological type of endometrioid carcinoma in both uterus and ovary, 4 patients had different histological types in uterus and ovary. Synchronous primary cancer of the endometrium and ovary was difficult to be dignosed preoperatively. All ovarian tumors were small with an average diameter of 7 cm. Infertility was common among these patients(40.7%). Most of them had early stage I lesion (66.7%). endometrioid carcinomas was the main pathologic type (66.7%). All patients were treated surgically followed by chemotherapy with a 3-year survival rate of 66.7% (8/12).</p><p><b>CONCLUSION</b>Synchronous primary endometrium and ovary cancer is a specific kind of tumor different from either the primary endometrium carcinoma or ovary carcinoma, and usually can be detected in early stage with a good prognosis.</p>