Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.657
Filtrar
2.
Medicine (Baltimore) ; 99(49): e23411, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285731

RESUMO

To evaluate the change of cervical length and the best timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia (CIN).This was a retrospective study including patients under 40 years with fertility desire treated by cervical conization for CIN. To assess the cervical length, the patients were divided into 2 groups according to different surgery procedure: loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC). Patients with cervical length < 2.5 cm in CKC group were divided into 2 groups according to whether receiving cervical cerclage. Trans-vaginal ultrasound examination was used to measure cervical length by fixed professional sonographers.In LEEP group, the cervical length preoperative was significantly longer than 3 months postoperatively (3.03 ±â€Š0.45 cm vs 2.84 ±â€Š0.44 cm, P = .000). In CKC group, the cervical length preoperative was significantly longer than 3 and 6 months postoperatively (2.90 ±â€Š0.41 cm vs 2.43 ±â€Š0.43 cm and 2.68 ±â€Š0.41 cm, respectively, P = .000). Cervical length was significantly longer at 12 and 9 months after cerclage compared to that without cerclage. Eighteen patients got pregnant in LEEP group, among which one was pregnant at 5 months postoperatively and had premature delivery. There was 1 inevitable abortion and 1 preterm birth among 39 pregnant patients from CKC group.Patients who have fertility desire with CIN were recommended for pregnancy at 6 and 9 months after LEEP and CKC, respectively. Cerclage effectively prolonged cervical length in patents with that less than 2.5 cm to prevent cervical incompetence.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Colo do Útero/cirurgia , Conização/métodos , Resultado da Gravidez , Neoplasias do Colo do Útero/cirurgia , Adulto , Colo do Útero/anatomia & histologia , Criocirurgia/métodos , Eletrocirurgia/métodos , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(45): e23124, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157991

RESUMO

OBJECTIVE: To evaluate the effect of combined intravenous-inhalation anesthesia (CIVIA) on postoperative cognitive dysfunction (POCD) after laparoscopic radical resection of cervical cancer. METHODS: By using a predefined standardized study protocol, we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis, searching the following data bases: PubMed, Embase, Web of Science, and Cochrane Library. RESULTS: This systematic review evaluated the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. CONCLUSION: This systematic review provided up-to-date evidence to evaluate the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/82FNA.


Assuntos
Anestesia por Inalação , Anestesia Intravenosa , Laparoscopia , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Neoplasias do Colo do Útero/cirurgia , Feminino , Humanos , Complicações Cognitivas Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
BMC Infect Dis ; 20(1): 846, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198657

RESUMO

BACKGROUND: It is widely acknowledged that HPV prophylactic vaccine could prevent new infections and their associated lesions among women who are predominantly HPV-naive at vaccination. Yet there still remains uncertainty about whether HPV vaccination could benefit to individuals who have undergone surgery for cervical disease. METHODS: This post-hoc analysis intends to focus on intent-to-treat participants who underwent excision treatment at baseline and the follow-up period in a phase II/III, double-blind, randomized trial ( ClinicalTrials.gov , number NCT00779766 ) conducted in Jiangsu province, China. We evaluate the impact of HPV vaccination on preventing women from subsequent infection and cervical lesions (LSIL+ and CIN2+) after excision treatment. RESULTS: One hundred sixty-eight (vaccine, n = 87; placebo, n = 81) performed excisional treatment in this clinical trial. We observed a significant effect of vaccination on acquiring 14 high-risk HPV (HR-HPV) infection after treatment (vaccine efficacy: 27.0%; 95% CI 4.9, 44.0%). The vaccine efficacy against new infections after treatment for 14 HR-HPV infection was estimated as 32.0% (95%CI 1.8, 52.8%), and was 41.2% (95%CI -162.7, 86.8%) for HPV16/18 infection. The accumulative clearance rates of the vaccine group and placebo group were 88.9 and 81.6% for HPV16/18 infection (P = 0.345), 63.4, 48.7% for 14 HR-HPV infection (P = 0.062), respectively. No significant difference was observed on the persistent rate of HPV16/18, 14 HR-HPV infection and occurrence rate of LSIL+ between the two groups. CONCLUSIONS: No significant evidence from this study showed that HPV-16/18 AS04-adjuvanted vaccine could lead to viral faster clearance or have any effect on the rates of persistent infection among women who had excision treatment. However, the vaccine may still benefit post-treatment women with "primary prophylactic" effect. Further research is required in clarifying the effect of using the prophylactic HPV vaccine as therapeutic agents. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00779766 . Date and status of trial registration: October 24, 2008. Completed; Has Results.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Neoplasia Intraepitelial Cervical/prevenção & controle , Neoplasia Intraepitelial Cervical/cirurgia , Papillomavirus Humano 16/imunologia , Papillomavirus Humano 18/imunologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/cirurgia , Vacinação , Adolescente , Adulto , Neoplasia Intraepitelial Cervical/virologia , China , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/imunologia , Neoplasias do Colo do Útero/virologia
5.
Cancer Radiother ; 24(8): 860-865, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33129715

RESUMO

PURPOSE: Adjuvant external beam radiotherapy (EBRT) was shown to decrease pelvic relapses in patients with an early stage cervical cancer and intermediate-risk histopathological prognostic factors, at the cost of increased bowel morbidity. We examined the feasibility and results of adjuvant brachytherapy alone as an alternative to EBRT in this situation. PATIENTS AND METHODS: Medical records of consecutive patients receiving adjuvant brachytherapy between 1991 and 2018 for an early stage cervical cancer were examined. Patients were included if they presented a pT1a2N0 or pT1b1N0 disease following radical colpohysterectomy. Adjuvant vaginal wall brachytherapy (without EBRT) was indicated because of a tumor size≥2cm and/or presence of lymphovascular space invasion (LVSI). Patients received 60Gy to 5mm of the vaginal wall, through low-dose or pulse-dose rate technique. Patients' outcome was examined for disease control, toxicities and prognostic factors. RESULTS: A total of 40 patients were included. Eight patients (20%) had LVSI, 26 patients (65%) had a tumor size≥2cm. With median follow-up time of 42.0 months, 90% of patients were in complete remission and four patients (10%) experienced tumor relapse, all in the peritoneal cavity, and associated with synchronous pelvic lymph node failure in 2/4 patients. No vaginal or isolated pelvic nodal failure was reported. At 5 year, overall survival was 83.6% (CI95%: 67.8-100%) and disease-free survival was 85.1% (CI95%: 72.6-99.9%). In univariate analysis, probability of relapse correlated with tumor size≥3cm (P=0.004). No acute or late toxicity grade more than 2 was reported. CONCLUSION: Brachytherapy alone was a well-tolerated adjuvant treatment for selected patients with intermediate risk factors. The risk of relapse in patients with tumor size≥3cm was however high, suggesting that EBRT is more appropriate in this situation.


Assuntos
Braquiterapia/métodos , Neoplasias do Colo do Útero/radioterapia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Histerectomia/métodos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia , Lesões por Radiação/patologia , Radioterapia Adjuvante/métodos , Resultado do Tratamento , Carga Tumoral , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
6.
Artigo em Inglês | MEDLINE | ID: mdl-32998288

RESUMO

We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received conservative fertility-sparing surgery. Women with early-stage cervical cancer who underwent conservative or fertility-sparing surgery in a tertiary medical center were reviewed from 2004 to 2017. Each patient's clinicopathologic characteristics, adjuvant therapy, subsequent pregnancy, and outcome were recorded. There were 32 women recruited, including 12 stage IA1 patients and 20 stage IB1 patients. Twenty-two patients received conization/LEEP and the other 10 patients received radical trachelectomy. Two patients did not complete the definite treatment after fertility-sparing surgery. There were 11 women who had subsequent pregnancies and nine had at least one live birth. The live birth rate was 73.3% (11/15). We conclude that patients with early-stage cervical cancer who undergo fertility-sparing surgery can have a successful pregnancy and delivery. However, patients must receive a detailed consultation before surgery and undergo definitive treatment, if indicated, and regular postoperative surveillance.


Assuntos
Resultado da Gravidez , Neoplasias do Colo do Útero/cirurgia , Adolescente , Cesárea , Feminino , Humanos , Recém-Nascido , Estadiamento de Neoplasias , Gravidez , Traquelectomia , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
7.
Medicine (Baltimore) ; 99(42): e22285, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080673

RESUMO

The spatial distribution of lymph node (LN) metastasis was analyzed to provide data for an evidence-based approach to radiotherapy field design, particularly for guiding intensity-modulated radiation therapy. A total of 1886 postoperative patients were retrospectively reviewed. Pelvic LNs were classified as common iliac nodes, external iliac nodes, internal iliac nodes/obturator nodes, and deep inguinal nodes. The distribution of LN metastasis in these subgroups was calculated, and the distribution patterns of LN metastasis according to the pathologic types were investigated.We identified 392 eligible patients with LN metastasis. The frequency and number of external iliac node metastasis were higher in the left side in both single subgroup (P < .01) and cosubgroup (P = .04) analyses, whereas few differences were found in other subgroups. Among patients with squamous cell carcinoma, left external iliac node metastasis was observed in 102 (15.13%) patients, whereas right metastasis was observed in 65 (9.64%) patients, and the difference was significant (P < .01).The present results indicated uneven distribution of LN metastasis in the different subgroups, which could help surgeon focus on the dissection of the left subgroups, and help oncologists define margins, refine target volumes for radiation, and improve the accuracy of postoperative radiotherapy especially in patients with squamous cell carcinoma.


Assuntos
Metástase Linfática , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia
8.
Health Qual Life Outcomes ; 18(1): 324, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008423

RESUMO

BACKGROUND: With the widespread clinical application of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L), whether the questionnaire scores are responsive to changes in patients' health and how much changes in questionnaire scores represent patients' real health changes require consideration. Consequently, we assessed responsiveness and estimated the minimal clinically important difference (MCID) of the EQ-5D-5L in surgically treated patients with cervical intraepithelial neoplasia (CIN) to determine the relationship between MCID and minimal detectable change (MDC). METHODS: We conducted a longitudinal, observational study. Participants were patients with CIN from the gynecology inpatient department of a grade-A tertiary hospital in Shihezi, Xinjiang, China. Participants completed the EQ-5D-5L and the Global Rating of Change Questionnaire (GRCQ) at baseline and one month post-surgery. The Wilcoxon signed-rank test was used to compare EQ-5D-5L scores pre- and post-treatment. We calculated the effect size (ES) and the standardized response mean (SRM) to quantitatively assess responsiveness. Distribution-based, anchor-based, and instrument-defined methods were used to estimate MCID. MCID to MDC ratios at individual- and group-levels were also calculated. RESULTS: Fifty patients with CIN completed the follow-up investigation (mean age 44.76 ± 8.72 years; mean follow-up time 32.28 ± 1.43 days). The index value and EQ visual analogue scale (EQ VAS) of the EQ-5D-5L improved by 0.025 and 6.92 (all p < 0.05) at follow-up as compared to baseline respectively. The ES and the SRM of the index value were 0.47 and 0.42 respectively, indicating small responsiveness; while the ES and the SRM of EQ VAS were 0.50 and 0.49 respectively, indicating small to moderate responsiveness. The average (range) of MCIDs for index value and EQ VAS were 0.039 (0.023-0.064) and 5.35 (3.12-6.99) respectively. These values can only be used to determine whether patients have experienced clinically meaningful health improvements at the group level. CONCLUSIONS: The EQ-5D-5L has only small to moderate responsiveness in post-surgical patients with CIN, and the MCIDs developed in this study can be used for group-level health assessment. However, further study is needed concerning health changes at the individual level.


Assuntos
Neoplasia Intraepitelial Cervical/psicologia , Diferença Mínima Clinicamente Importante , Qualidade de Vida , Inquéritos e Questionários/normas , Neoplasias do Colo do Útero/psicologia , Adulto , Neoplasia Intraepitelial Cervical/cirurgia , China , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/cirurgia , Escala Visual Analógica
9.
Rev Med Suisse ; 16(712): 2046-2049, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112518

RESUMO

The treatment of the early-stage cervical cancer is surgical. In the last ten years we have seen a surgical de-escalation and the development of new techniques such as the sentinel node biopsy. In 2018, absolutely against the trend, the study published in the New England Journal of Medicine by Pedro Ramirez upset the world of gynecologic-oncologists by demonstrating that the open approach is superior to the minimally invasive technique in the surgical management of these cancers. A long debate arose after the publication of this article, which remains the only prospective randomized study published to date on the subject. We therefore must take a step back and return to open surgery in the treatment of early-stage cervical cancer.


Assuntos
Estadiamento de Neoplasias , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Detecção Precoce de Câncer , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Biópsia de Linfonodo Sentinela
10.
Minerva Ginecol ; 72(6): 391-398, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32882115

RESUMO

INTRODUCTION: Sentinel lymph node detection is a surgical procedure that allow to avoid systematic lymphadenectomy in those tumors in early stage where lymph node spread is not sure. If the sentinel lymph node is not involved by tumor in 98-99% of case other lymph nodes are clean. The reason why less radical surgery is chosen is linked to the lower postoperative morbidity rate, the risk of lower limb lymphedema decreases. The aim of this review was to summarize what is the state of art of using the sentinel lymph node dissection (SLD) technique and what are the future goals to improve the safety and the reliability. EVIDENCE ACQUISITION: We have conducted a review of the literature of the past 10 years to understand the attitudes of oncologist gynecologists in the world to the conservative treatment of cervical cancer. We only selected articles from 2010 onwards, which meet the inclusion criteria. EVIDENCE SYNTHESIS: The detection rate varies from 83% to 100%. The bilateral detection rate, on the other hand, varies from 42% to 100%. The false negative rate ranges from 4% to 12%. Sensitivity varies from 20.7% (considering the frozen section) to 100%. CONCLUSIONS: Indocyanine green is the most reliable and performing tracer for the search of the sentinel lymph node; that the false intraoperative negative rate is too high to be sure not to subject the patient to an incorrect therapeutic procedure; data concerning the safety and survival of conservative lymphadenectomy (SLND) compared to systematic lymphadenectomy are still lacking in the literature and therefore we are awaiting the results of the two ongoing randomized clinical trials that will allow us to have more significant scientific data.


Assuntos
Tratamento Conservador/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Neoplasias do Colo do Útero/cirurgia , Corantes/administração & dosagem , Reações Falso-Negativas , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/métodos , Excisão de Linfonodo/mortalidade , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/patologia
11.
Br J Radiol ; 93(1116): 20200358, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32960673

RESUMO

OBJECTIVES: To develop and validate a radiomics model for preoperative identification of lymph node metastasis (LNM) in patients with early-stage cervical squamous cell carcinoma (CSCC). METHODS: Total of 190 eligible patients were randomly divided into training (n = 100) and validation (n = 90) cohorts. Handcrafted features and deep-learning features were extracted from T2W fat suppression images. The minimum redundancy maximum relevance algorithm and LASSO regression with 10-fold cross-validation were used for key features selection. A radiomics model that incorporated the handcrafted-signature, deep-signature, and squamous cell carcinoma antigen (SCC-Ag) levels was developed by logistic regression. The model performance was assessed and validated with respect to its calibration, discrimination, and clinical usefulness. RESULTS: Three handcrafted features and three deep-learning features were selected and used to build handcrafted- and deep-signature. The model, which incorporated the handcrafted-signature, deep-signature, and SCC-Ag, showed satisfactory calibration and discrimination in the training cohort (AUC: 0.852, 95% CI: 0.761-0.943) and the validation cohort (AUC: 0.815, 95% CI: 0.711-0.919). Decision curve analysis indicated the clinical usefulness of the radiomics model. The radiomics model yielded greater AUCs than either the radiomics signature (AUC = 0.806 and 0.779, respectively) or the SCC-Ag (AUC = 0.735 and 0.688, respectively) alone in both the training and validation cohorts. CONCLUSION: The presented radiomics model can be used for preoperative identification of LNM in patients with early-stage CSCC. Its performance outperforms that of SCC-Ag level analysis alone. ADVANCES IN KNOWLEDGE: A radiomics model incorporated radiomics signature and SCC-Ag levels demonstrated good performance in identifying LNM in patients with early-stage CSCC.


Assuntos
Algoritmos , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Metástase Linfática/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Adulto , Antígenos de Neoplasias/sangue , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Serpinas/sangue , Neoplasias do Colo do Útero/sangue , Neoplasias do Colo do Útero/cirurgia
12.
Anticancer Res ; 40(10): 5939-5947, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988926

RESUMO

Background/Aim: There is an increasing demand for preserving the fertility of young women impacted with early-stage cervical cancer. The aim of this study is to evaluate the oncological and reproductive outcomes of abdominal radical trachelectomy (ART). Patients and Methods: We retrospectively reviewed patients with FIGO stageIA2-IB1 cervical cancer who underwent ART from 2007 to 2018. We also compared the oncological prognosis between the patients who underwent ART and radical hysterectomy (RH). Results: A total of 42 patients underwent ART. During median follow-up 62.5 months, there were 4 (9.5%) recurrences and 1 (2.4%) death. As for tumors ≤2 cm, the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate for patients who underwent ART was similar to those who underwent RH (89.8% vs. 92.7%, p=0.42 and 97.3% vs. 95.0%, p=0.44, respectively). Nineteen patients attempted to conceive and seven of them were successful. There was one case of a first-trimester miscarriage, two cases of preterm delivery, three cases of full-term delivery and one ongoing pregnancy. Conclusion: ART could be a feasible alternative to RH for patients with tumors ≤2 cm with comparable oncological outcome.


Assuntos
Abdome/cirurgia , Recidiva Local de Neoplasia/cirurgia , Traquelectomia/efeitos adversos , Neoplasias do Colo do Útero/cirurgia , Abdome/fisiopatologia , Adulto , Idoso , Feminino , Fertilidade/fisiologia , Humanos , Histerectomia/efeitos adversos , Recém-Nascido , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/fisiopatologia , Estadiamento de Neoplasias , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/fisiopatologia
13.
Oncology ; 98(11): 807-813, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32892198

RESUMO

INTRODUCTION: Different imaging techniques were introduced to improve preoperative clinical staging of locally advanced cervical cancer (LACC) with transvaginal ultrasound (TV-US) or transrectal ultrasound (TR-US) representing a promising staging technique in the evaluation of the local extension of the disease for invasive tumors. The aim of this study was to evaluate the response to neoadjuvant chemotherapy (NACT) in LACC by 2D/3D ultrasound examination. MATERIALS AND METHODS: We prospectively enrolled patients affected by histologically and clinically confirmed LACC. All patients were scheduled for 3 cycles of platinum-based NACT followed by radical surgery. The ultrasound examination was performed at every cycle and within 10 days before surgery. The parameters evaluated were: the volume (automatically computed by the VOCAL software) and the mass vascularization. RESULTS: From March 2010 to March 2019, 157 women were recruited. Among these patients, 12 of them were excluded: 6 for the presence of distant metastases, 4 for rare histology, and 2 for severe comorbidities not allowing the protocol treatment. Seventeen patients after NACT were excluded because they were not amenable to radical surgery. Thus, 128 were considered for the final analysis of whom 106 (83%) were considered responders to NACT by histology. The sensibility and specificity of ultrasound with regard to the response to chemotherapy compared to histological specimen were 94 and 82%, respectively, with an accuracy of 92%. The positive predictive value and negative predictive value were 96 and 75%, respectively. Finally, we found that nonetheless there was a trend towards a continuous response to chemotherapy among patients who were considered responders to NACT at pathological examination; the major volume and vascularization index (VI) reduction were observed during the first 2 cycles (74, 71% and 47, 63%, respectively). On the contrary, non-responders showed an initial reduction of the VI (4.86 consisting of 33%, 95% CI 0.79-8.92, p = 0.013), but no significant modification in tumour volume along NACT. CONCLUSION: 2D/3D ultrasound is useful in assessing early response to NACT in patients with LACC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/tratamento farmacológico , Adulto , Idoso , Quimioterapia Adjuvante , Feminino , Humanos , Imageamento Tridimensional/métodos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estudos Prospectivos , Ultrassonografia/métodos , Neoplasias do Colo do Útero/cirurgia
15.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 589-599, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957747

RESUMO

Objective: To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 (lymph-vascular space invasion-positive, LVSI+)- Ⅰb1 cervical cancer patients with different tumor sizes. Methods: Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results: (1) A total of 4 891 patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.367, 95%CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups (94.1% vs 95.4%, P=0.151). While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS (HR=1.420, 95%CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.705, 95%CI: 1.088-2.674, P=0.020). Conclusions: For patients with stage Ⅰa1 (LVSI+)-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.


Assuntos
Laparoscopia/métodos , Laparotomia/métodos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
16.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 600-608, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957748

RESUMO

Objective: To investigate the efficacy and safety of laparoscopic radical hysterectomy for early cervical adenocarcinoma. Methods: A retrospective observational study was performed by reviewing medical records of patients with staging Ⅰb1-Ⅱa2 International Federation of Gynecology and Obstetrics (FIGO, 2009) cervical adenocarcinoma who underwent laparoscopic or abdominal radical hysterectomy from 2007 to 2017 in the Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. The difference among clinicopathologic characteristics, surgery-related parameters and complications, and prognosis were analyzed between the laparoscopic group and abdominal group. Results: Two hundreds and ninety-three patients were included with 88 cases in laparoscopic group and 205 cases in abdominal group. (1) There was no significant difference in clinicopathologic characteristics between the two groups (all P>0.05), including age, body mass index, menopause status, history of abdominal surgery, clinical stage, tumor diameter, neoadjuvant chemotherapy, differentiation, lymph-vascular space invasion, positive of surgical margin, parametrial invasion, and lymph node metastasis. But the abdominal group showed a higher proportion of deep stromal invasion (38.5% vs 25.0%, P<0.05). No significant difference was observed between two groups with number of lymph nodes resected, urinary catheter retention, short-term surgical complications (including ureteral injury, ileus, infection, hydronephrosis and poor wound healing), and long-term complications (including voiding dysfunction, defecation dysfunction and lower limb edema; all P>0.05). (2) The laparoscopic group was significantly associated with a longer operation time [(260±51) minutes vs (244±53) minutes, P<0.05], but less bleeding (100 ml vs 300 ml, P<0.01), shorter hospital stay [(13±5) days vs (16±8) days, P<0.01] and lower incidence of lymphedema (12.5% vs 27.8%, P<0.01). (3) The 5-year progression-free survival (PFS; 85.7% vs 86.4%, P=0.971) and 5-year overall survival (OS; 91.4% vs 93.0%, P=0.657) of laparoscopic group were comparable to that of abdominal group. (4) Multivariate analysis demonstrated that lymph node metastasis (HR=2.44, 95%CI: 1.16-5.15, P=0.019) was independent poor prognostic factors related to PFS, while adenosquamous carcinoma (HR=2.54, 95%CI: 1.02-6.35, P=0.046), lymph-vascular space invasion (HR=3.86, 95%CI: 1.60-9.33, P=0.003) and lymph node metastasis (HR=5.92, 95%CI: 2.45-14.34, P<0.01) were independent poor prognostic factors related to OS. The laparoscopy surgery was not an independent poor prognostic factor (P=0.396). Conclusion: The laparoscopic radical hysterectomy for early cervical adenocarcinoma has comparable prognosis to abdominal radical hysterectomy with a higher surgery quality.


Assuntos
Adenocarcinoma/cirurgia , Histerectomia/efeitos adversos , Laparoscopia , Excisão de Linfonodo , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , China/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
17.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 609-616, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957749

RESUMO

Objective: To compare the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy or abdominal radical hysterectomy. Methods: From January 1, 2009 to December 31, 2018, patients with stage Ⅰb2-Ⅱa2 who underwent laparoscopic or abdominal radical hysterectomy (laparoscopic group and abdominal group) in Peking University People's Hospital were collected. The clinicopathological data were retrospectively analyzed. There were 237 cases in this study, including 115 cases in laparoscopic group and 122 cases in abdominal group. The clinicopathological characteristics, surgery-related complications, recurrence and death were analyzed between the two groups. The related factors of recurrence and death were also analyzed.During laparoscopic surgery, the pressure of the carbon dioxide pneumoperitoneum were controlled, to try avoid the tumor tissue in the vagina from being exposed to the abdominal cavity when taking out the uterine specimen through the vagina, and fully flushed the abdominal cavity with sterile water after the specimen was taken out. Results: (1) Clinicopathological characteristics: there was no significant differences between the two groups among age, pathological type, pathological grade, clinical stage, depth of interstitial infiltration, lymph node metastasis,parametrial infiltration, vaginal stump infiltration, lymph-vascular space invasion (LVSI), neoadjuvant chemotherapy, and postoperative adjuvant treatments (all P>0.05). (2) Surgery-related complications: the incidence of surgery-related complications in the laparoscopic group and the abdominal group were 32.2% (37/115) and 25.4% (31/122), respectively. There was no statistically significant difference between the two groups (P>0.05). (3) Recurrence and death: during the follow-up period, the recurrence rates of the laparoscopic group and the abdominal group were respectively 15.7% (18/115) and 12.3% (15/122). There was no statistically significant difference between the two groups (P=0.456). The 5-year overall survival rates of the laparoscopic group and the open group were 86.8% and 87.8%, and the 5-year tumor-free survival rates were 81.7% and 84.6%, respectively. There were no statistically significant differences between the two groups (P=0.405, P=0.429). (4) Analysis of related factors of recurrence and death: univariate analysis showed that neoadjuvant chemotherapy, lymph node metastasis, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative recurrence of cervical cancer patients (all P<0.05); neoadjuvant chemotherapy, lymph node metastasis, parametrial infiltration, vaginal stump infiltration, LVSI and interstitial infiltration depth were risk factors for postoperative death in patients with cervical cancer (all P<0.05). Multivariate analysis showed that neoadjuvant chemotherapy and lymph node metastasis were independent risk factors for postoperative recurrence and death of cervical cancer patients (P<0.05). Conclusion: There is no significant difference in the prognosis of patients with cervical cancer in stage Ⅰb2-Ⅱa2 undergoing laparoscopic radical hysterectomy with non-touch operative technique and abdominal radical hysterectomy.


Assuntos
Histerectomia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade
18.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 617-623, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957750

RESUMO

Objective: To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy. Methods: From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study. Results: There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH (P=0.010). Stratify analysis, including stage of disease (Ⅰb1 and Ⅱa1), histologic subtypes (squamous-cell carcinoma, adenocarcinoma), lymph node metastasis, revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group (98.6% vs 93.6%, P=0.012). In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% (P=0.007). ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference (P=0.046); for adenocarcinoma, the OS at five years were 91.0% and 88.6%, and there was no difference between two groups (P=0.230). ③ Lymph node metastasis: the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively (P=0.156, P=0.093). (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group (88.2% vs 75.8%, P=0.074). Conclusions: The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.


Assuntos
Histerectomia/métodos , Laparoscopia/métodos , Excisão de Linfonodo , Neoplasias do Colo do Útero/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
19.
Anticancer Res ; 40(9): 4819-4828, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878770

RESUMO

Concurrent cisplatin-based chemotherapy and radiotherapy (CCRT) plus brachytherapy is standard treatment for locally advanced cervical cancer. Platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy has been proposed as an alternative approach, especially for patients with stage Ib2-IIb disease. This review analyzes the most commonly used combination regimens in this clinical setting and the randomized trials comparing chemo-surgery versus definitive radiotherapy or CCRT. The combination of paclitaxel plus ifosfamide plus cisplatin (TIP regimen) obtained the highest rates of optimal pathological response, associated with elevated hematological toxicity. In a recent phase II study, a dose-dense regimen consisting of weekly paclitaxel plus carboplatin for 9 cycles has achieved optimal pathological response rates similar to those of TIP with better toxicity profile. Further studies are strongly warranted to better define the optimal regimen for the patients selected to receive NACT followed by radical surgery.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimiorradioterapia , Quimioterapia Adjuvante , Feminino , Humanos , Histerectomia , Terapia Neoadjuvante , Prognóstico , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/radioterapia
20.
Obstet Gynecol ; 136(3): 533-542, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769648

RESUMO

OBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990-2019 with terms "cervical cancer" and "(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy." Grey literature and unpublished data were omitted. METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. TABULATION, INTEGRATION, AND RESULTS: Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2-202 months) across studies, median recurrence rate was 3.3% (range 0-25%); median time to recurrence was 26 months (range 8-44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88-97.3%) and 97.4% (range 95-99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%. CONCLUSION: Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019132443.


Assuntos
Traquelectomia , Neoplasias do Colo do Útero/cirurgia , Feminino , Humanos , Estadiamento de Neoplasias , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Taxa de Gravidez , Traquelectomia/métodos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA