BACKGROUND:Radiation-associated second primary malignancies (SPMs) are a significant risk factor affecting the quality of life in long-term cervical cancer survivors. However, the impact of brachytherapy-boost and advanced radiotherapy techniques on the risk of radiation-related SPMs remains unclear. METHODS:We utilized data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2019) to assess the risk of radiation-associated SPMs among cervical cancer patients. Radiation-associated second solid and hematologic malignancies were defined as those diagnosed in survivors living for ≥5 and ≥2 years, respectively. The fine-gray sub-distribution hazard model was employed to compare the risk of SPMs across different groups. RESULTS:External beam radiation therapy (EBRT) was associated with an increased risk of pelvic SPMs (sub-distribution hazard ratio [sHR] = 2.13; P < .001). However, no increased risk was observed for extra-pelvic or hematologic SPMs. For radiotherapy-treated patients, the 15-year cumulative incidence of overall pelvic SPMs significantly declined from 3.92% in 1975-1994 to 2.85% in 1995-2006 (sHR = 0.87; P = .036), further decreasing to 2.27% after 2001 compared to those treated in 1975-2001 (sHR = 0.59; P = .030). Brachytherapy alone increased the risk of pelvic SPMs (sHR = 3.04; P < .001), but the combination of brachytherapy with EBRT did not further elevate the risk of pelvic SPMs (sHR = 1.35; P = .092). CONCLUSIONS:The risk of radiation-associated pelvic SPMs has diminished over the past 40 years, and the combination of brachytherapy with EBRT did not further increase the risk of SPMs among cervical cancer patients.

Background and objective: The prognostic value of circulating lymphocyte subsets in cervical cancer patients receiving postoperative radiotherapy remains unclear. This study aimed to explore the prognostic significance of these lymphocyte subsets in this patient population. Methods: Peripheral blood samples were collected from 101 cervical cancer patients prior to receiving postoperative radiotherapy. Flow cytometry was utilized to determine the proportions and absolute counts of lymphocyte subsets, including total T cells, CD4+ T cells, CD8+ T cells, natural killer (NK) cells, and B cells. The Kaplan-Meier method and Cox regression analysis were employed to estimate the overall survival (OS) and identify the key prognostic factors. Receiver operating characteristic (ROC) curves were generated to assess the predictive accuracy. Results: The survival analysis indicated that patients with a decreased proportion of NK cells (P = 0.02) or reduced NK cell counts (P = 0.01) exhibited significantly poorer overall survival (OS) compared to those with higher levels of NK cells. In univariate Cox analysis, both the proportion of NK cells (P = 0.025; HR, 0.33; 95% CI, 0.12-0.87) and NK cell counts (P = 0.015; HR = 0.28) significantly influenced OS. In multivariate analysis, the proportion of CD4+ T cells (P = 0.02; HR, 0.08; 95% CI, 0.01-0.72) and NK cell counts (P = 0.08; HR, 0.11; 95% CI, 0.01-1.37) emerged as independent prognostic factors. The areas under the ROC curves (AUCs) for NK cell counts in predicting 1-, 2-, and 3-year survival were 0.66, 0.76, and 0.68, respectively. Patients diagnosed with stage IIIC1 exhibited a significant reduction in both the absolute counts and the proportion of NK cells compared to those diagnosed with earlier stages, specifically IB3 and IIA. Conclusions: Our study found that pre-treatment levels of circulating NK cell counts and proportions serve as promising prognostic biomarkers for cervical cancer patients undergoing postoperative radiotherapy.

The primary aim of this study was to conduct a methodical examination and assessment of the prognostic efficacy exhibited by magnetic resonance imaging (MRI)-derived radiomic models concerning the preoperative prediction of lymph-vascular space infiltration (LVSI) in cervical cancer cases. A comprehensive and thorough exploration of pertinent academic literature was undertaken by two investigators, employing the resources of the Embase, PubMed, Web of Science, and Cochrane Library databases. The scope of this research was bounded by a publication cutoff date of May 15, 2023. The inclusion criteria encompassed studies that utilized radiomic models based on MRI to prognosticate the accuracy of preoperative LVSI estimation in instances of cervical cancer. The Diagnostic Accuracy Studies-2 framework and the Radiomic Quality Score metric were employed. This investigation included nine distinct research studies, enrolling a total of 1,406 patients. The diagnostic performance metrics of MRI-based radiomic models in the prediction of preoperative LVSI among cervical cancer patients were determined as follows: sensitivity of 83% (95% confidence interval [CI]=77%-87%), specificity of 74% (95% CI=69%-79%), and a corresponding AUC of summary receiver operating characteristic measuring 0.86 (95% CI=0.82-0.88). The results of the synthesized meta-analysis did not reveal substantial heterogeneity.This meta-analysis suggests the robust diagnostic proficiency of the MRI-based radiomic model in the prognostication of preoperative LVSI within the cohort of cervical cancer patients. In the future, radiomics holds the potential to emerge as a widely applicable noninvasive modality for the early detection of LVSI in the context of cervical cancer.

Download This Paper Open PDF in Browser Add Paper to My Library Share: Permalink Using these links will ensure access to this page indefinitely Copy URL Copy DOI

Objective: The combined impact of nutritional and inflammatory status on survival of cervical cancer patients remained unclear. This study aimed to construct a survival nomogram involving both nutritional and inflammatory indicators and evaluate their potential correlation. Methods: This retrospective study included 325 cervical cancer patients who received adjuvant radiotherapy between September 2010 and September 2020. Baseline nutritional indicators such as body mass index (BMI), controlling nutritional status (CONUT) and serum albumin were assessed. Inflammatory indicators of platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), systemic immune inflammation index (SII) and system inflammation response index (SIRI) were evaluated respectively. The LASSO regression and Cox regression models were applied for variable selection and nomogram building. The predictive accuracy and superiority of prognostic model were assessed by area under curve (AUC), C-index, decision curve analysis (DCA), integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Results: Patients with high inflammatory indicators (PLR, NLR and SII) and poor nutritional status (CONUT scores > 2) suffered poorer prognosis compared to these with well nutritional status and lower inflammation levels. Our study unveiled a positive correlation between malnutrition and hyperinflammation. Even after accounting for baseline inflammatory level, malnutrition remained a significant risk factor for patients. Notably, the inflammatory level and nutritional status were further modulated by the clinical features of patients. Patients with poorer nutritional status exhibited higher levels of PLR, NLR, SII and SIRI, particularly for those in advanced clinical stages and with non-squamous cell carcinoma. In addition, our study found elevated levels of circulating basophil and serum carbohydrate antigen 125 (CA125) were associated with the poor prognosis. The prognostic nomogram which incorporated the nutritional-inflammatory indicators of PLR and CONUT showed a favorable performance with the AUC value of 0.76 at 5-year survival prediction. The DCA, IDI and NRI consistently demonstrated the favorable superiority of the model. Moreover, the nomogram-based risk stratification system could effectively classify patients into three mortality risks subgroups. Conclusions: Poorer nutritional and high inflammatory status collectively contributed to the poorer prognosis. The prognostic nomogram which incorporated nutritional-inflammatory indicators significantly improved the prediction of long-term outcomes of cervical cancer patients undergoing adjuvant radiotherapy.

This study aimed to evaluate the correlation between the pre-treatment peripheral platelet-to-lymphocyte ratio (PLR) and the prognostic nutritional index (PNI) with the efficacy and prognosis of radiotherapy for cervical cancer. A total of 110 patients with cervical cancer who received radiotherapy at our hospital from November 2017 to November 2020 were retrospectively analysed. The cut-off values of PLR and PNI were obtained using the receive operating characteristic curve (ROC) and the Youden index. The patients were divided into high PLR and low PLR and high PNI and low PNI groups. We compared the clinical characteristics, 3-year overall survival (OS), and progression-free survival (PFS) between the high and low PLR groups, as well as the high and low PNI groups of patients. Cox regression was used to analyse the factors influencing OS and PFS. The median follow-up duration was 26 months. The optimal cut-off value for PLR was 186.88 and that for PNI was 47.35. The 3-year OS values were 81.00% and 97.10% for the high PLR (PLR > 186.88) and low PLR (PLR ≤ 186.88) groups, respectively, and the 3-year PFS values were 59.50% and 88.20% for the high PLR and low PLR groups, respectively, with statistically significant differences (p < 0.05). The 3-year OS values were 97.50% and 74.20% for the high PNI (PNI > 47.35) and the low PNI (PNI ≤ 47.35) groups, respectively, and the 3-year PFS values were 87.30% and 51.60% for the high PNI and low PNI groups, respectively, with statistically significant differences (p < 0.05). Multifactorial Cox regression analyses revealed that high PLR value (PLR > 187.88), low PNI value (PNI ≤ 47.35), histological type, and FIGO stage were independent risk factors for the OS of cervical cancer. Pretreatment PNI values and PLR values can be used as simple and feasible predictors of clinical efficacy and prognosis for patients treated with radiotherapy for cervical cancer.

OBJECTIVE:The objective of this research was to analyze the prognostic significance of the minimum count of lymphocytes (LY) and the corresponding ratio of neutrophil-to-lymphocyte (NLR) in cervical cancer (CC) patients receiving radiotherapy.METHODS:We retrospectively collected data from 202 CC patients who received concurrent chemoradiotherapy or radiotherapy alone at our hospital. Statistical methods including the Kaplan-Meier method, log-rank test and the Cox proportional hazards model were included to examine survival differences and identify independent factors that may affect overall survival (OS) and progression-free survival (PFS).RESULTS:The research enrolled a total of 202 patients. Patients with higher LY levels and lower NLR values during radiotherapy had significantly better survival prognosis than those with lower LY levels and higher NLR values. Multivariate COX regression analysis revealed that FIGO stage I, pathological types of SqCC, absence of lymph node metastasis, concurrent chemoradiotherapy, higher LY levels during radiotherapy, and lower NLR values before radiotherapy were independently associated with poorer PFS. Similarly, FIGO stage I, absence of lymph node metastasis and lower NLR values during and before radiotherapy were independently linked with poorer OS.CONCLUSION:Minimum LY value and its corresponding NLR during radiotherapy serve as prognostic factors for CC.

Lymph node metastasis of cervical cancer is an important factor affecting the survival rate of patients. Para-aortic lymph nodes, as one of the most common sites of cervical cancer metastasis, are regarded as a distant metastasis, which often indicates a poor prognosis for these patients. However, the optimal treatment strategy for para-aortic lymph node metastasis has not been determined. This article reviews the current status of diagnosis and treatment of cervical cancer patients with para-aortic lymph node metastasis, and provides references for clinicians and related researches.

Abstract Background Cervical cancer (CC) still represents an important challenge for female malignant tumors. In recent years, increasing evidence has indicated that EPHB2 plays a significant part in the origin and progression of many types of cancer in humans. Nevertheless, the mechanism of EPHB2 in CC remains inexplicable. The purpose of this study is to determine the prognostic value and related regulatory mechanism of EPHB2 in CC. Methods The basic clinical information and transcriptome data related to CC patients were downloaded from TCGA database and conducted standardization processing. TIMER2.0 was used for analyzing the EPHB2 expression differences of between 38 cancer types and corresponding normal tissues. The expression and prognostic value (including OS and RFS) of EPHB2 in different cancer types were determined by GEPIA2. And the starbase database was used for exploring the upstream miRNAs and lncRNAs of EPHB2. Then, The correlation analysis of EPHB2, miRNA and lncRNA and the exploration of prognostic value and expression of miRNAs in CESC was conducted using the R language packages. We also analyzed the prognostic value and expression difference of 187 lncRNAs based on the UALCAN database. Finally, we performed the correlation analysis between EPHB2 and multiple immune cells using the R language package. Results In our study, the AC073957.3/hsa-miR-150-5p axis was found to be the most potential upstream ncRNA-related regulator of EPHB2 in CC. And the results of immune correlation infiltration analysis suggest that as EPHB2 copy numbers fluctuate in CESC there is an obvious difference in immune cell infiltration levels, and EPHB2 was markedly positively correlated with Th2 cell, NK cell, Eosinophils, Tgd, Mast cell, NK CD56bright cells and Tem while negatively correlated with Tcm and B cell in CC. Conclusion Our study shows that EPHB2 is a potential prognostic marker, and its overexpression is related to poor prognosis of CC, which is expected to be a new therapeutic target for CC.