Recent studies have suggested potential roles of the microbiome in cervicovaginal diseases. However, there has been no report on the cervical microbiome in cervical intraepithelial neoplasia (CIN). We aimed to identify the cervical microbiota of Korean women and assess the association between the cervical microbiota and CIN, and to determine the combined effect of the microbiota and human papillomavirus (HPV) on the risk of CIN. The cervical microbiota of 70 women with CIN and 50 control women was analysed using pyrosequencing based on the 16S rRNA gene. The associations between specific microbial patterns or abundance of specific microbiota and CIN risk were assessed using multivariate logistic regression, and the relative excess risk due to interaction (RERI) and the synergy index (S) were calculated. The phyla Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, Tenericutes, Fusobacteria and TM7 were predominant in the microbiota and four distinct community types were observed in all women. A high score of the pattern characterized by predominance of Atopobium vaginae, Gardnerella vaginalis and Lactobacillus iners with a minority of Lactobacillus crispatus had a higher CIN risk (OR 5.80, 95% CI 1.73-19.4) and abundance of A. vaginae had a higher CIN risk (OR 6.63, 95% CI 1.61-27.2). The synergistic effect of a high score of this microbial pattern and oncogenic HPV was observed (OR 34.1, 95% CI 4.95-284.5; RERI/S, 15.9/1.93). A predominance of A. vaginae, G. vaginalis and L. iners with a concomitant paucity of L. crispatus in the cervical microbiota was associated with CIN risk, suggesting that bacterial dysbiosis and its combination with oncogenic HPV may be a risk factor for cervical neoplasia.

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Introduction: Numerous studies examined the prognostic factors for pancreatic cancer, but in neoadjuvant setting, the utilities of these markers are fully unknown. We hypothesis that the combination of post-treatment serum albumin, CA19-9 and NLR will be a reliable prognostic score for patients with pancreatic cancer through neoadjuvant chemoradiotherapy. Method: Sixty-one patients who managed in our hospital during 2003 to 2017 were reviewed in this analysis. In our institute, NACRT usually comprises 5-FU (300 mg/body/day) or TS-1 60mg/m2/d, cisplatin (10mg/body), mitomycin C (4mg/body/day,), heparin (6000 IU/body/day, and radiation (total 40 Gy). Cutoff value was set as 3.9g/dL for ALB, 40IU/mL for CA19-9 and 5.0 for NLR, respectively. We examined whether these makers and score are associated with overall survival(OS) in all patients and patients with subsequent surgery. Result: The mean age was 66.7AE8.0, 75.4% were male patients. Forty-three patients underwent subsequent surgery with curative intent and 81.3% of patients had R0 resections. In case that low ALB, high CA19-9 and high NLR were assigned a value of 1, a log-rank test showed statistically significant difference in OS between each score in in both all patients and resected patients (all patients; 3vs2vs1vs0 3year survival rate 0/34.9/58.1/92.3%, 5year survival rate 0/0/50.9/71.8%, p< 0.001, resected patients; 3year survival rate 0/33.3/68.6/92.3% 5year survival rate 0/ 0/68.6/71.8%, p< 0.001). Conclusion: Concise prognostic score in the combination of post-treatment albumin, CA19-9 and NLR is likely to be useful.

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