Radical Hysterectomy for Stage IB1 vs IB2 Carcinoma of the Cervix: Does the New Staging System Predict Morbidity and Survival?

Finan, Michael A.; DeCesare, Stephen; Fiorica, James V.; Chambers, Richard; Hoffman, Mitchel S.; Kline, Richard; Roberts, William S.; Cavanagh, Denis

doi:10.1006/gyno.1996.0206

Cited by 116 publications

(58 citation statements)

References 7 publications

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“…Lymph node metastasis was an independent prognostic factor (11)(12)(13)(14)(15)(16)(17). However, in a univariate analysis of patients with positive lymph nodes, Rutledge et al reported that 2-year DFS decreases from 89% to 63%, whereas a (19).…”

Section: Discussionmentioning

confidence: 99%

Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?

Üreyen¹,

Aksoy²,

Dündar³

et al. 2014

Turk J Med Sci

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IntroductionCarcinoma of the cervix uteri is the second most common cancer and the third most common cause of cancer deaths in women worldwide (1,2). The definitive primary treatment for patients with early-stage disease consists of radiation therapy or radical hysterectomy with pelvic and/ or paraaortic lymph node dissection (3). Knowledge about prognosis and recurrence is critical for the management of early-stage cervical cancer. Lymph node involvement is an important risk factor for recurrence in patients with earlystage cervical cancer. The recurrence rate in lymph nodenegative patients was 10% and the 5-year survival rate ranged from 85%-90%. In contrast, the recurrence rate in lymph node-positive patients was 27% and the 5-year survival rate ranged from 20% to 74% depending on the number of nodes that were involved and the location and size of the metastases (4-6).In this retrospective study, we analyzed the variations in the recurrence patterns of stage IB cervical cancer according to lymph node involvement. These data may improve the management of early-stage cervical cancer to reduce the risk of recurrence and predict the recurrence patterns of early-stage cervical cancer. Materials and methodsThe medical records of patients diagnosed with stage IB cervical cancer and who were treated with type III radical hysterectomy, bilateral salpingo-oophorectomy, or systemic pelvic and paraaortic lymphadenectomy from January 1993 to December 2007 were evaluated retrospectively. The complete pathological data of 170 patients were evaluated. Patients who received neoadjuvant chemotherapy were excluded because chemotherapy is known to improve surgical pathological results (7).All of the patients were evaluated by rectovaginal examination under general anesthesia, computerized tomography of the upper abdomen and pelvic magnetic resonance imaging, or intravenous pyelography. Clinical Background/aim: To investigate the variations in the recurrence patterns of stage IB cervical cancer according to lymph node involvement. Materials and methods:We reviewed the medical records of 170 patients who had undergone type III radical hysterectomy and systematic lymphadenectomy from 1993 to 2007.Results: Among the patients in the study group, 115 did not have lymph node metastases, whereas 55 did. A total of 27 patients developed recurrences. Twelve were in the lymph node-negative group, and 15 were in the lymph node-positive group. The recurrence rate was higher in lymph node-positive group (27.3% versus 10.4%, P = 0.011). The recurrence pattern was not affected by lymph node involvement. However, distant recurrence was more common in the lymph node-positive group (53.3% versus 25%, P = 0.137). Additionally, distant failure was observed only in the patients in the lymph node-negative group who received adjuvant radiotherapy. In this group, 3 patients who did not receive adjuvant radiotherapy developed recurrences only in the pelvic region. Conclusion:The presence of lymph node involvement in stage IB cervical cancer does not affec...

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Section: Discussionmentioning

confidence: 99%

Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?

Üreyen¹,

Aksoy²,

Dündar³

et al. 2014

Turk J Med Sci

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“…All patients referred from 2001 to 2007 because of cervical cancer or an abnormal Pap smear were asked to participate in our study during their initial visit to the outpatient clinic of the University Medical Center Groningen. Gynecologic examination under general anesthesia was done in all cervical cancer patients for staging in accordance with the International Federation of Gynecology and Obstetrics (FIGO) criteria (29). Cervical scrapings were collected during the initial visit to the outpatient department or at gynecologic examination under general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Methylation Markers for CCNA1 and C13ORF18 Are Strongly Associated with High-Grade Cervical Intraepithelial Neoplasia and Cervical Cancer in Cervical Scrapings

Yang

Eijsink

Lendvai

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Purpose: Recently, we reported 13 possible cervical cancer-specific methylated biomarkers identified by pharmacologic unmasking microarray in combination with large-genome computational screening. The aim of the present study was to perform an in-depth analysis of the methylation patterns of these 13 candidate genes in cervical neoplasia and to determine their diagnostic relevance. Experimental Design and Results: Five of the 13 gene promoters (C13ORF18, CCNA1, TFPI2, C1ORF166, and NPTX1) were found to be more frequently methylated in frozen cervical cancer compared with normal cervix specimens. Quantitative methylation analysis for these five markers revealed that both CCNA1 and C13ORF18 were methylated in 68 of 97 cervical scrapings from cervical cancer patients and in only 5 and 3 scrapings, respectively, from 103 healthy controls (P < 0.0005). In cervical scrapings from patients referred with an abnormal Pap smear, CCNA1 and C13ORF18 were methylated in 2 of 43 and 0 of 43 CIN 0 (no cervical intraepithelial neoplasia) and in 1 of 41 and 0 of 41 CIN I, respectively. Furthermore, 8 of 43 CIN II, 22 of 43 CIN III, and 3 of 3 microinvasive cancer patients were positive for both markers. Although sensitivity for CIN II or higher (for both markers 37%) was low, specificity (96% and 100%, respectively) and positive predictive value (92% and 100%, respectively) were high. Conclusion: Methylation of CCNA1 and C13ORF18 in cervical scrapings is strongly associated with CIN II or higher-grade lesions. Therefore, these markers might be used for direct referral to gynecologists for patients with a methylation-positive scraping. (Cancer Epidemiol Biomarkers Prev 2009;18(11):3000-7)

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“…17 Several of the cervical carcinoma patients referred to our clinic already had a previous conization or biopsy in the referring hospital. In general, patients with FIGO stage Ib/ IIa were treated by radical surgery and patients with stage IIb-IV were treated with chemoradiation.…”

Section: Recruitment Of Patientsmentioning

confidence: 99%

“…16,17 Patients with lesions of adenomatous or adenosquamous cell type were excluded from selection. Tissue samples of patients with squamous cell cervical cancer were derived from biopsies taken during gynecological examination under general anesthesia for clinical staging or from radical hysterectomy specimens in patients with FIGO stage IB/IIA.…”

Section: Pathologymentioning

confidence: 99%

Enhancement of human papilloma virus type 16 E7 specific T cell responses by local invasive procedures in patients with (pre)malignant cervical neoplasia

Visser

Baarle

Hoogeboom

et al. 2006

Intl Journal of Cancer

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It has been suggested that local invasive procedures may alter the natural course of (pre)malignant cervical disease. This could be due to partial excision of the lesions, or via induction of cellular immunity against human papillomavirus (HPV) by the local invasive procedures. We studied the influence of local invasive procedures on HPV-16 E7 specific immune responses in patients with different grades of cervical intra-epithelial neoplasia (CIN) and different stages of cervical cancer. Blood was obtained at intake and after invasive procedures from patients with CIN or cervical cancer. Antigen specific T-cell responses were measured by IFN-c ELISPOT analysis, after stimulation with recombinant HPV-16 E7 protein. As expected, HPV-16 E7 specific IFN-c T cell responses were more frequent in HPV-16 DNA positive patients compared with that in HPV-16 DNA negative patients (39/50 vs. 16/36, (p 5 0.006, v 2 test). After invasive procedures, a small number of HPV-16 DNA positive CIN patients, but a considerable proportion of HPV-16 DNA positive cervical cancer patients, showed an enhancement of T cell responses against HPV-16 E7. Induction of T cell reactivity was most pronounced in cervical cancer patients who had undergone previous invasive procedures. Both CD4 1 and CD8 1 T cells showed E7 specific IFN-c production upon in-vitro stimulation. Our study shows that invasive procedures may enhance HPV-specific cell-mediated immunity in a considerable number of patients with cervical cancer, but in only a minority of CIN patients. Our data indicate that invasive procedures should be considered as possible confounding factors when analyzing the effectiveness of therapeutic immunization studies, especially, when induction of HPV-specific immune responses is used as intermediate end-point. ' 2005 Wiley-Liss, Inc.Key words: cervical cancer; IFN-g; HPV; CD4 1 T cell; CD8 1 T cell Infection with oncogenic human papillomavirus (HPV) plays an important role in cervical carcinogenesis, and HPV DNA can be detected in 90-100% of all cervical cancers. 1,2 The majority of women infected with oncogenic HPV types do not develop cervical intraepithelial neoplasia (CIN) or cervical cancer but clear their HPV infection. The immune system plays an important role herein, as demonstrated by the observation that immunocompromised women, such as AIDS-patients, more often fail to clear an HPV infection and have an increased risk to develop cervical cancer. 3 The E6 and E7 transforming oncoproteins of HPV play a crucial role in the transformation and maintenance of the malignant phenotype, and therefore, these proteins are the ideal candidates for tumor-specific cervical cancer immunotherapy. Cytotoxic T cell (CTL) and T helper activity specific for E6 and E7 of HPV-16 and HPV-18 (the 2 most common HPV types) have been demonstrated in the peripheral blood of patients with (pre)malignant cervical neoplasia and healthy controls. [4][5][6][7][8][9][10][11][12] It has been suggested that spontaneous regression of CIN lesions might be associated with...

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Radical Hysterectomy for Stage IB1 vs IB2 Carcinoma of the Cervix: Does the New Staging System Predict Morbidity and Survival?

Cited by 116 publications

References 7 publications

Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?

Does lymph node involvement affect the patterns of recurrence in stage IB cervical cancer?

Methylation Markers for CCNA1 and C13ORF18 Are Strongly Associated with High-Grade Cervical Intraepithelial Neoplasia and Cervical Cancer in Cervical Scrapings

Enhancement of human papilloma virus type 16 E7 specific T cell responses by local invasive procedures in patients with (pre)malignant cervical neoplasia

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