Stage Cervical Cancer Research Articles

Exploring and detecting predictors associated with survival and mortality of cervical cancer patients: a 10-year retrospective study

Abstract Background Cervical cancer is the 4th most prevalent cancer among females globally. In India, approximately 123,907 women are diagnosed with cervical cancer every year, leading to 77,348 deaths annually. However, Indian healthcare system lacks the sufficient information regarding the factors influencing survival and mortality among cervical cancer patients at regional levels. Thus, we aimed to identify the predictors associated with survival outcomes and mortality rates among cervical cancer. Methods A retrospective cohort study was conducted over 8 months at a tertiary care hospital where 10-year (January 2013–December 2022) data of cervical cancer patients were analyzed from medical record department (MRD). Telephonic interviews were carried out with patients or patient parties to know the survival status of patients. The data was analyzed using descriptive statistics, Kaplan–Meier curve, log-rank test and Cox regression. Results Out of 330 cervical cancer patients, majority (64.24%) were > 50 years of age followed by 35.76% were < 50 years. Most of the patients had abnormal body mass index (BMI) (46.96%), postmenopausal stage (75.76%), stage II cancer (43.03%), histologically poorly differentiated grade (47.88%) and squamous cell carcinoma (87.88%), with radiation plus chemotherapy being popular treatment choice (48.79%) and with the overall mean age of 56 years. Age, BMI, menopause, stage of cancer, histological grades and types of treatment were found to be significant predictors (p < 0.05) of survival among cervical cancer patients. Using cox regression analysis, advanced age (age > 50 years: hazard ratio (HR): 1.82), underweight (BMI < 18.5: HR:1), postmenopause (HR:1), advanced stage of cervical cancer (Stage I, Stage II, Stage III, Stage IV: HR:1, HR:2.78, HR:10.08, HR:20.81), poorly differentiated cervical cancer (HR:1.70), radiation therapy (HR:4.86), chemotherapy (HR:6.55) or chemoradiation therapy (HR:3.31) and surgery plus chemotherapy (HR: 4.55) were identified to be significant predictors of mortality among cervical cancer patients. Conclusion We conclude that the 5- and 10-year survival rates for cervical cancer patients were found to be 51.2% and 42.9%, respectively. Advanced age, underweight, postmenopausal status, advanced cancer stage, poor cancer cell differentiation and chemotherapy-based treatment were significant predictor of mortality and vice-versa for survival which might guide clinicians and policymakers in making informed clinical decisions to combat cervical cancer.

Examined lymph node counts affected the staging and survival in cervical cancer: a retrospective study using the SEER and Chinese cohort

Background The impact of examined lymph node (LN) count on survival in cervical cancer remains understudied, with no consensus on the optimal number required. Objectives We aimed to investigate the role of LN count in postoperative pathological evaluation for cervical cancer patients undergoing surgery. Methods Data from the US SEER database and a retrospective Chinese cohort were analyzed. Multivariable logistic and Cox regression models assessed LN positivity detection and overall survival (OS), respectively. Smoothing spline curves and Chow tests identified structural change points in hazard ratios and LN-positive ratios. Results Among 14,133 SEER and 2,811 Chinese cases, higher LN counts correlated with increased detection of positive LNs (OR: 1.040, 95% CI: 1.019–1.062) and improved OS (HR: 0.990, 95% CI: 0.984–0.996). Structural change points occurred at 20 LNs for LN-negative patients and 13 LNs for LN-positive patients (both P < 0.001). An elevated LN-positive ratio (positive/examined LNs) strongly predicted worse OS (HR: 4.208; 95% CI: 1.454–12.181). Conclusions An increased number of examined LNs significantly contributes to the detection of positive LNs and improved patient survival. For patients with claimed LN-negative and LN-positive disease, a minimum examination of 20 and 13 LNs, respectively, is recommended to ensure adequate LN evaluation. The LN positive ratio is a strong prognostic indicator in patients with LN-positive disease.

Surgical Advancements, Immunotherapy, Targeted and Conventional Therapies, Biopsy, Colposcopy, and Pap Smear Integration in the Management of Cervical Cancer.

Cervical cancer remains a significant global health concern, making it essential to investigate new treatment options continuously. This page provides an overview of the latest advancements and best practices in detection and intervention, including Pap smears, colposcopy, biopsy, immunotherapy, targeted therapies, chemotherapy, radiation therapy, and surgery. Surgical techniques such as radical hysterectomy and minimally invasive procedures have advanced to enhance patient outcomes and quality of life. Simultaneously, radiation therapy methods have been refined to maximize tumour control while reducing adverse effects. Chemotherapy remains vital, with new drugs and combination regimens demonstrating improved tolerance and efficacy. Immunotherapy, notably immune checkpoint inhibitors, has shown promise in advanced stages of cervical cancer. Additionally, targeted therapies that focus on specific biochemical pathways offer the potential for personalized treatment approaches. This review critically assesses ongoing research, evaluates existing data, and emphasizes the opportunities and challenges of each therapeutic approach. Ultimately, integrating these diverse treatment strategies is the key to enhancing patient outcomes.

Re-evaluating prognostic factors for cervical cancer with lymph node metastasis: a Japanese multicenter cohort study based on FIGO 2018.

In 2018, the International Federation of Gynecology and Obstetrics (FIGO) revised its cervical cancer staging system to enhance clinical relevance, notably by categorizing lymph node metastases (LNM) as an independent stage IIIC. This multicenter study evaluates the prognostic implications of the FIGO 2018 classification within a Japanese cohort. This study included 1468 patients with cervical cancer. Initial FIGO 2009 stages were restaged under FIGO 2018. Stage IIIC was further compared based on the location of LNM (pelvic or para-aortic, i.e., IIIC1 and IIIC2, respectively), local tumor stage, and histology. A total of 345 cases (27.4%) were upstaged to stage IIIC, which exhibited a poorer prognosis compared to stage II (HR, 2.12; 95% CI 1.29 - 3.48; p = 0.004) and better than stage IIIAB (HR, 0.46; 95% CI 0.27 - 0.78; p = 0.004). Notably, stage IIIC2 showed a significantly worse prognosis than IIIC1 (HR, 2.32; 95% CI 1.37 - 3.93; p = 0.003). Subdivisions of stage IIIC1 (T1, T2, and T3AB) displayed significantly varied prognoses, with the prognosis for IIIC1-T3AB similar to that of stage IIIAB. In contrast, all subdivisions of IIIC2 showed uniformly poor outcomes. Multivariate analysis of stage IIIC patients revealed that para-aortic LNM, adenocarcinoma and adenosquamous carcinoma histology, and local T3AB tumor remained significant. The classification of para-aortic LNM as stage IIIC2 has proven to be of critical relevance in the Japanese cohort. However, the prognostic impact of stage IIIC1 remains influenced by local tumor factors and histological subtypes.

Fiber, lactose and fat-modified diet for the prevention of gastrointestinal chemo-radiotherapy-induced toxicity in patients with cervical cancer: Randomized clinical trial.

The most frequent early gastrointestinal (GI) toxicity symptoms are nausea (58%), diarrhea (46.7%), and vomiting (45.5%) in patients with cervical cancer (CC). Approximately 90% of patients undergoing abdominopelvic radiotherapy present with changes in the GI tract, such as degenerative alterations in mucosal epithelial cells and nutrient malabsorption. To evaluate the effect of a diet modified in fiber, lactose, and fat on the prevention of chemoradiotherapy (QTRT)-induced GI toxicity compared to the usual prescription in women with locally advanced CC. A total of 134 women with a confirmed diagnosis of CC in locally advanced stages (IB2-IVA) were included in a randomized clinical trial conducted between February 2017 and March 2020. The intervention group (IG) received a modified diet of fiber, lactose, and fat, while the usual prescription group (UP) followed habitual nutritional recommendations. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) v4. A total of 134 women were included in the IG (65) and UP (69) groups. The mean age in the IG and UP groups were 47.2±13.4 and 49.7±14.2 years, respectively. Radiotherapy doses received by the IG and UP groups were 50.1±6.7 and 49.9±4.6 Gy, respectively. IG had a lower risk of presenting with mild constipation compared to the UP (hazard ratio: 0.46, 95% confidence interval: 0.28-0.76, P<0.01). Patients with locally advanced stages of CC undergoing QTRT who received fiber, lactose, and fat-modified diet may have a lower risk of mild constipation during abdominal radiotherapy.

Cervical cancer stage distribution and survival outcomes in Africa: a systematic review and meta-analysis.

Cervical cancer is a leading cause of cancer-related deaths among women, with a disproportionate burden in sub-Saharan Africa. Understanding the cervical cancer stage and outcomes is crucial for developing effective interventions and reducing its burden. We aimed to undertake a systematic review and meta-analysis of cervical cancer stage distribution and survival outcomes in Africa. We searched MEDLINE, Embase, PubMed, Cochrane Library, Clarivate Analytics Web of Science, and the World Health Organization African Index Medicus database for publications in all languages from the inception of databases to July 2021. A total of 144 studies published between 1978 and 2021 from 33 African countries were included, encompassing 55,747 patients. We revealed that 53.3% (95% CI 50.9 to 55.6) of cervical cancer cases in Africa were diagnosed at late stages (stage III-IV). This proportion varied significantly across countries and regions, ranging from 7.7% to 86.3%. The study also highlighted disparities by Human Development Index (HDI) grouping, with low HDI countries exhibiting higher proportions of late-stage diagnoses (56.0%, 95% CI 51.6 to 60.4) compared with medium (51.2%, 95% CI 47.5 to 54.9) and high (50.7%, 95% CI 47.0 to 54.5) HDI countries. Notably, there was no stage migration observed over time (p = .53). The median overall survival was 24.0 months (interquartile range, 19.2-39.4). These stage and outcomes data highlight the need for expanding cervical cancer screening and treatment and are crucial for policymakers to develop evidence-based strategies aimed at accelerating the elimination of cervical cancer in Africa. Additionally, standardized data collection and reporting are needed to facilitate better monitoring of cervical cancer outcomes across countries.

Whole-Genome Methylation Sequencing Analysis and Functional Verification of LIM-Homeobox Family Genes in Cervical Cancer.

Gene methylation in cells is an important factor in tumorigenesis, and radiotherapy can change DNA methylation in cells. In this study, complete genome methylation sequencing (BS-Seq) technology was used to analyze the genome-wide methylation of patients with cervical cancer before and after radiotherapy. Three pairs of cervical squamous cell carcinoma samples were collected from patients before and after radiotherapy in July 2020. Genome-wide DNA methylation profiles were generated using WGBS. Bioinformatics analysis was conducted to identify differential methylation regions (DMRs) and their associated genes and pathways. The study focused on the methylation changes of LHX2, LHX5, and LHX9 genes, assessing their expression levels using qRT-PCR and correlating these changes with cervical cancer stages. MCG was the main way of genomic DNA methylation in the three patients. The DNA methylation level and methylation density on each chromosome varied greatly. As revealed by comparison of methylation before and after radiation in the three patients, 1287, 1261 and 789 differential methylation genes were identified, respectively.3) Combined with clinical treatment, methylation level difference and correlation enrichment analysis, it was found that LHX2, LHX5 and LHX9 were closely related to the occurrence and development of cervical cancer. After 5-Aza-DC and radiotherapy, the methylation of the CpG islands in LHX2, LHX5 and LHX9 genes in these patients was decreased (p < 0.01), and the mRNA and protein expression levels were relatively increased (p < 0.01). In our present work, genome-wide DNA methylation maps of cervical cancer tissues before and after radiotherapy were successfully constructed. We found that LHX5 and LHX9 genes are closely related to cervical cancer. LHX5 and LHX9have a negative effect on cervical cancer. The migration ability of LHX9 silenced cells was significantly enhanced after irradiation.

ANALYSIS OF REGIONALLY METASTATIC CERVICAL CANCER ACCORDING TO DATA FROM THE SAMARKAND REGION OF THE REPUBLIC OF UZBEKISTAN

Today, cervical cancer is the most important global medical and social problem. Purpose of the study. To study the incidence of cervical cancer and analyze the results of treatment of stage III-IV disease in the Samarkand region. Material and methods. The study was conducted on the basis of the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology of the Republic of Uzbekistan. The collection of research data included analysis of outpatient cards and anamnesis of patients admitted with the diagnosis of regionally metastasized forms of cervical cancer, data of patients with malignant neoplasms and advanced cases of malignant neoplasms - an accounting and reporting form. Interpretation work was carried out by age categories. At the same time, data from histologic and cytologic reports in the control group of cervical cancer stages III - IV, treated between 2020 and 2022, were used and processed. Results of the study. The reason for the first visit to the gynecologist at the time of diagnosis is mainly pain in the lower abdomen and lower back, bloody discharge from the genital tract on non-menstrual days and after contact, which are signs of advanced disease. The obstetric history revealed that 56 (53.3%) women did not consult a gynecologist at all after their last childbirth, and all patients had one to five medical abortions. Thirty-eight (36.2%) patients of early reproductive age were registered with an endocrinologist with a diagnosis of diffuse goiter. In 46% of the patients the menarche occurred at the age of 12-13 years, in 50% of the patients at the age of 14-16 years, and in 4% at the age of 18-19 years. Conclusion. The main goal of modern radiotherapy for cervical cancer today is radiation therapy without complications, elimination of relapse, and prolongation of survival. Our research continues in this direction.

Mortality Predictors and Survival Analysis in Cervical Cancer Patients Treated with Brachytherapy: A Retrospective Study at RMCH

Cervical cancer remains a significant health burden, particularly in low- and middle-income countries, where over 85% of cases occur. Bangladesh exhibits crude incidence and mortality rates of 10.2 and 6.1 per 100,000, respectively, highlighting the impact of cervical cancer. This retrospective study, conducted at Rajshahi Medical College Hospital, assessed 141 cervical cancer patients treated with brachytherapy between December 2016 and December 2020. The primary objective was to examine survival outcomes and associated mortality factors in relation to the stage of cervical cancer at diagnosis. The study revealed that 59 patients (42%) were alive at the time of analysis, of which 88% had achieved disease-free survival. Conversely, 35 patients (25%) were deceased, with advanced-stage disease being predominant among them. Renal failure was identified as the leading cause of death (37%). Results suggest that early-stage cervical cancer correlates with improved survival outcomes, underscoring the necessity of early detection and prompt treatment. Despite the curative potential of brachytherapy when combined with external beam radiotherapy and cisplatin-based chemotherapy, global disparities in access to brachytherapy hinder effective cervical cancer management, particularly in low-resource settings. Enhanced screening programs, vaccination efforts, and broader access to advanced treatment modalities, including brachytherapy, are critical in reducing cervical cancer-related mortality in low- and middle-income countries.

Assessing the Efficacy of 18F FDG PET-CT in Preoperative Staging of Early-Stage Cervical Cancer in Novi Sad, Serbia-A Pilot Study.

Background and Objectives: This study primarily aims to evaluate the preoperative staging effectiveness of PET-CT in early-stage cervical cancer, particularly, its ability to detect primary tumors and micrometastases. Materials and Methods: In this retrospective study, cervical cancer patients who had undergone preoperative 18F FDG PET-CT scans and were treated at the Department of Gynecology, Institute of Oncology, Vojvodina, in Sremska Kamenica, during the period from 2016 to 2020 were analyzed. Results: The study included 62 patients (mean age, 49.3 ± 9.6 years). Squamous cell carcinoma was the predominant histological type (95.2%), with G2 differentiation (82.3%) and FIGO stage Ib1 (80.6%) being the most common. Assessed by 18F FDG PET-CT, the mean tumor size was 26.4 ± 10.8 mm, which is slightly lower than the 26.9 mm measured during clinical examination (p = 0.784), with a significant (r = 0.678, p < 0.001) correlation between these methods. 18F FDG PET-CT demonstrated an overall accuracy of 88.7% for identifying primary tumors, with a sensitivity of 86.8%, specificity of 100.0%, PPV of 100.0%, and NPV of 56.2%. An intraoperative examination showed identical overall accuracy but higher sensitivity (98.1%) and lower specificity (33.3%). For 18F FDG PET-CT, the level of agreement with the histopathological examination was good (Kappa 0.656), while for the intraoperative examination, it was moderate (Kappa 0.409). Regarding the lymph node assessment, 18F FDG PET-CT's accuracy was 82.2%, with a sensitivity of 53.8% and a specificity of 89.8%. The intraoperative examination showed lower accuracy (66.1%) but higher sensitivity (76.9%). The 18F FDG PET-CT Kappa value indicated moderate agreement (0.449), while the intraoperative examination showed poor agreement (0.282). Conclusions: In conclusion, significant effectiveness is shown by 18F FDG PET-CT for preoperative staging of early-stage cervical cancer, offering superior accuracy in detecting primary tumors and micrometastases, particularly in predicting lymph node metastases, thereby enhancing diagnostic accuracy and informing treatment decisions.

Age, parity and stage of cervical cancer among cervical cancer patients attending oncology department- An observational cross sectional study

Cervical cancer is one of the common cancers in women worldwide. This study was conducted to determine age, parity and stage of cervical cancer patients in Pakistani population. This was a prospective cross-sectional study, conducted in the Oncology Department of Jinnah Postgraduate Medical Center, Karachi during October 2023 to January 2024. A total of 92 women of age 18 years or above, presenting with biopsy proven cervical cancer were recruited. The mean age of study participants was 53.4 years SD± 10.9 years. The highest proportion of cases were recorded between 47 to 57 years of age with a proportion of 37.0% (n=34). Among the study participants 62% (n=57) had a history of multiparty with at least five or more children and 65% (n=60) were postmenopausal women, while 59.8% (n=55) were found to have Stage-II and Stage-III disease at the time of diagnosis. Histopathologically Squamous Cell Carcinoma was the most frequent histopathological type reported. In conclusion the highest burden of cervical cancer was found to be present among the women of age group 47 to 57 years. Cervical cancer was most prevalent among women with higher parity or having five or more children. Squamous cell carcinoma was the most frequently occurring histopathological type, while most patients were diagnosed at the stage-II disease.

Predicting Tumor Progression in Patients with Cervical Cancer Using Computer Tomography Radiomic Features

The objective of this study was to evaluate the effectiveness of utilizing radiomic features from radiation planning computed tomography (CT) scans in predicting tumor progression among patients with cervical cancers. A retrospective analysis was conducted on individuals who underwent radiotherapy for cervical cancer between 2015 and 2020, utilizing an institutional database. Radiomic features, encompassing first-order statistical, morphological, Gray-Level Co-Occurrence Matrix (GLCM), Gray-Level Run Length Matrix (GLRLM), and Gray-Level Dependence Matrix (GLDM) features, were extracted from the primary cervical tumor on the CT scans. The study encompassed 112 CT scans from patients with varying stages of cervical cancer ((FIGO Staging of Cervical Cancer 2018): 24% at stage I, 47% at stage II, 21% at stage III, and 10% at stage IV). Of these, 31% (n = 35/112) exhibited tumor progression. Univariate feature analysis identified three morphological features that displayed statistically significant differences (p &lt; 0.05) between patients with and without progression. Combining these features enabled a classification model to be developed with a mean sensitivity, specificity, accuracy, and AUC of 76.1% (CI 1.5%), 70.4% (CI 4.1%), 73.6% (CI 2.1%), and 0.794 (CI 0.029), respectively, employing nested ten-fold cross-validation. This research highlights the potential of CT radiomic models in predicting post-radiotherapy tumor progression, offering a promising approach for tailoring personalized treatment decisions in cervical cancer.

Cervical intraepithelial neoplasia and cervical cancer in Hunan Province, China, 2020-2023.

To describe the incidence and distribution of cervical intraepithelial neoplasia (CIN) and cervical cancer (CC) for rural women aged 35-64 in Hunan Province, China, 2020-2023. Data were from the Hunan Provincial Cervical Cancer Screening Program in Rural Areas. Most rural women aged 35-64 in Hunan Province attend the program. All women diagnosed with CINs and CCs will be asked to register detailed information, including pelvic examination, diagnosis, age, education level, etc. CINs included low-grade squamous intraepithelial lesions (LSIL) (CIN1), high-grade squamous intraepithelial lesions (HSIL) (CIN2 and 3); CCs included adenocarcinoma in situ (AIS), early invasive cervical cancer (EICC) (stage Ia1 and Ia2) and invasive cervical cancer (ICC) (stage Ib and above). The incidence of CIN and CC is the number of cases per 1000 women. Chi-square tests (χ2 ) were used to examine if there were significant differences in proportions among different groups. A total of 4150700 women were included, and 67071 CINs and CCs were identified. The incidence of LSIL, HSIL, AIS, EICC and ICC were 10.63‰(95%CI: 10.53-10.73), 4.98‰(95%CI: 4.91-5.05), 0.06‰(95%CI: 0.06-0.07), 0.23‰(95%CI: 0.22-0.25), and 0.26‰(95%CI: 0.24-0.27), respectively. The proportion of previous pelvic examinations was relatively low in EICC (17.24%) and ICC (17.45%) (χ2 = 236.57, P <0.01), present abnormal examination was relatively high in AIS (51.33%), EICC (49.74%) and ICC (62.45%) (χ2 = 331.15, P <0.01). HPV16 was the most common high-risk type for LSIL (22.01%), HSIL (36.92%), AIS (46.01%), EICC (58.88%), and ICC (64.34%). The proportion of HSIL was relatively high in women aged 35-44 (27.03%), AIS was relatively high in women aged 45-54 (46.39%), EICC (44.24%), and ICC (48.58%) was relatively high in women aged 55-64. The proportion of ICC was relatively high in women with elementary school (38.68%), HSIL (15.10%) and AIS (17.49%) was relatively high in women with senior high school, AIS (1.52%), EICC (0.62%) and ICC (0.75%) was relatively low in women with university and above. (P <0.01). We have described the incidence and distribution of CIN and CC among rural women aged 35-64. These findings were clinically relevant and were useful for clinical counseling and early diagnosis of CC.

The Added Role of Diffusion-Weighted Magnetic Resonance Imaging in Staging Uterine Cervical Cancer.

Cervical cancer is considered one of the most common gynecological malignancies with an increased incidence in developing countries. Magnetic resonance imaging (MRI) plays a valuable role in staging cervical cancer and providing valuable information necessary for selecting the appropriate treatment plan, while closely correlating with the prognosis of the patient. The aim of this study is to assess the diagnostic value of diffusion-weighted imaging (DWI) in the preoperative loco-regional staging of cervical carcinoma. Our purpose is to establish apparent diffusion coefficient (ADC) values of cervical carcinoma compared with normal cervical tissue and their variability based on different pathological characteristics of the lesions. It is a retrospective analysis of 57 patients diagnosed with cervical cancer, who underwent MRI examinations. The study evaluated the aspect of the lesions on T2-weighted imaging, DWI, ADC maps, and pre- and post-contrast T1-weighted imaging with fat saturation. The ADC mean values ranged between 0.63 × 10-3 mm2/second and 0.99 × 10-3 mm2/second (mean 0.79) for tumoral tissue and 1.33 × 10-3 mm2/second and 1.74 × 10-3 mm2/second (mean 1.59) for surrounding non-affected cervical tissue. The ADC mapping showed a decreasing trend with the increased sizes of the tumors (p<0.001). The ADC mean showed lower values with increased International Federation of Gynecology and Obstetrics (FIGO) stage of the tumors. The ADC mean value for cases that had spread to other organs (IVA+IVB) was significantly lower than that of the early stages (IB1 + IB2 + IIA2), stage IIB, and stages IIIA+IIIC1+IIIC2 (p<0.001). The ADC mean value of stage III disease was significantly lower than that of stage IIB, respectively early stages (p<0.001). The ADC mean value of the stage IIB tumor was significantly lower than that of the early stages (p<0.001). The differences in ADC mean values based on the histopathological type and differentiation grade were not statistically significant. The ADC mean value of the cases with positive pelvic lymph nodes was significantly lower than in those with negative lymph nodes (p<0.001). ADC mean values of cervical carcinoma are significantly lower than those from unaffected uterine tissue and they also correlate with the severity of the disease. The advancements and additional capabilities DWI can bring are the elements of interest in this article. Using DWI means a more accurate capability in diagnosing cervical cancer, providing a compelling argument for its integration into standard clinical practice. This study discusses the quantitative imaging parameters of DWI such as ADC values, which can provide objective measurements for tumor evaluation. These parameters can be standardized and used across different institutions, enhancing the reproducibility and reliability of imaging findings.

Addition of Bevacizumab to Chemotherapy and Its Impact on Clinical Efficacy in Cervical Cancer: A Systematic Review and Meta-Analysis.

Background and Objectives: Cervical cancer is the third leading cause of cancer-related mortality in females. One of the most successful therapeutic modalities to date is suppressing vascular endothelial growth factor (VEGF)-mediated angiogenesis. Bevacizumab is a monoclonal antibody that targets VEGF-A. The outcomes for cervical cancer patients treated with bevacizumab in combination with platinum-based chemotherapy have been explored in several studies. This study aimed to assess the impact of bevacizumab on progression-free survival (PFS) and overall survival (OS) in patients with metastatic cervical cancer. Materials and Methods: This systematic review was registered in PROSPERO (CRD42023456755). Following PRISMA guidelines, a comprehensive literature search on PubMed and Google Scholar identified 28 studies meeting the inclusion criteria. The outcomes of interest were PFS and OS. The statistical analysis computed hazard ratios (HRs) with 95% confidence intervals (CIs). The study also included a subgroup analysis by cervical cancer stage. Results: The pooled analysis revealed that bevacizumab-based therapy significantly improved both PFS with HR 0.77 (95% CI: 0.58-0.96; p < 0.01; I2 = 58%) and OS with HR 0.63 (95% CI: 0.45-0.89; p < 0.01; I2 = 41%) in cervical cancer patients. Subgroup analysis by stage of cervical cancer demonstrated better efficacy of bevacizumab in metastatic stage IVB cervical cancer patients indicated by HR for PFS (0.69, 95% CI: 0.54-0.79; p < 0.01) and HR for OS (0.57, 95% CI: 0.46-0.73; p < 0.01). Conclusions: Bevacizumab exhibits a significant increase in PFS and OS, underscoring the efficacy of anti-angiogenesis therapy in cervical cancer, particularly in stage IVB metastatic cervical cancer patients.

Development of a radiomic model for cervical cancer staging based on pathologically verified, retrospective metastatic lymph node data.

Cervical cancer is a major cause of morbidity and mortality among gynecological malignancies. Diagnostic imaging of lymph node (LN) metastasis for prognosis and staging is used; however, the accuracy in classifying the stage needs to improve. To examine the accuracy of AI-based radiomics in diagnosis, prognosis assessment and predicting the diagnostic value of radiomics for pelvic LN metastasis in cervical cancer patients. The study included 118 female patients with 660 LNs and 118 merged LNs. Four imaging histology models-decision tree, random forest, logistic regression, and support vector machine (SVM)-were created in this study. The imaging histology features were extracted from both the independent and merged LN groups. The AUC values for the test sets and the training sets of the four imaging histology models were compared for the independent LN group and the merged LN group. The DeLong test was used to compare the models. The imaging histology prediction model developed in the merged LN group outperformed the independent LN group in terms of test set AUC (0.668 vs. 0.535 for decision tree, 0.841 vs. 0.627 for logistic regression, 0.785 vs. 0.637 for random forest, 0.85 vs. 0.648 for SVM) and accuracy (0.754 vs. 0.676 for decision tree, 0.780 vs. 0.671 for random forest, 0.848 vs. 0.685 for logistic regression, 0.822 vs. 0.657 for SVM). The constructed SVM imaging histology model for the merged LN group might be advantageous in predicting pelvic LN metastasis in cervical cancer.

High Expression of KIF4A Predicts Poor Prognosis Hallmark and Is Correlated with Immune Infiltrates in Cervical Cancer

Cervical cancer (CC) has become the fourth most common cancer among women and cause a larger number of deaths in worldwide. Screening at the early stage of CC is an effective precaution. Discovery of the new hallmark of CC will provide a guidance for CC screening. Kinesin family member 4A (KIF4A) expressed in a variety of tissues and also contributed to development of several cancers, however its function in CC remains unclear. In this study, high-expression of KIF4A was observed in the CC patients according to the bioinformatics analysis and clinical test. Additionally, loss-function of KIF4A with shRNA abrogated cervical cell proliferation, migration and invasion. We also found that the difference expression genes were identified between KIF4A-high and KIF4A-low CC patients among with abundant mutation of several genes occurred in the CC progression. Finally, we also proved that KIF4A was involved in the immune cell infiltration in the CC patients by clinical information analysis. These demonstrated that the dys-expression of KIF4A may be used for the CC screening and clinical therapy.

Circulating tumor HPV DNA as a specific biomarker for cervical cancer.

The aim of this study was to determine whether circulating tumor human papillomavirus (HPV) DNA is a potential specific biomarker for cervical cancer (CC). This retrospective matched study included 87 patients with cervical intraepithelial neoplasia (CIN), 29 CC patients (FIGO IA1-IVA) and 29 HPV-negative controls at Yuhuangding Hospital of Qingdao University (from July 2022 to September 2023). The digital droplet PCR (ddPCR) was used to detect and quantify ctHPV DNA in the plasma of patients with HPV16, 18, 33, 52, or 58-associated CC. The ctHPV DNA was exclusively detectable in HPV-positive samples, with no detection in patients across various CIN stages (n = 87) or HPV-negative controls (n = 29). Additionally, ctHPV DNA was identified in nine out of 10 late-stage patients (90%) and six out of 19 early-stage patients (31.6%). The ctHPV DNA serves as a specific biomarker for the diagnosis CC. Additionally, this discovery addresses the knowledge gap in ctHPV DNA research in the early stages of CC and promotes clinical diagnosis and treatment strategies.

Comparative Diagnostic Value of 18F-FDG-PET-CT and Intraoperative Examination in Cervical Cancer Staging.

Background and Objectives: The primary objective of this study is to assess the effectiveness of 18F-FDG-PET-CT in preoperative staging of cervical cancer, focusing on determining surgical operability and exploring the correlation between its quantitative parameters and clinicopathological characteristics. Materials and Methods: This retrospective study included 62 cervical cancer patients treated at the Department of Gynecology, Clinic for Operative Oncology at the Institute of Oncology Vojvodina between January 2016 and January 2020, where preoperative clinical examinations and 18F-FDG-PET-CT were performed to assess the extent of cancer, followed by intraoperative and pathohistological examinations of surgically removed specimens to provide a comprehensive evaluation. Results: The mean tumor size measured by 18F-FDG-PET-CT was slightly greater than that obtained through clinical examination (26.4 mm vs. 26.0 mm), with a strong linear correlation (r = 0.678, p < 0.001) observed between the two measurement methods. The overall prediction accuracy of 18F-FDG-PET-CT for primary tumors is 88.7% (55/62) [sensitivity 86.8%, specificity 100.0%, PPV 100.0%, NPV 56.2%] and for intraoperative examination is 88.7% (55/62) [sensitivity 98.1%, specificity 33.3%, PPV 89.7%, NPV 75.0%]. The agreement with histopathological examination was good for 18F-FDG-PET-CT and moderate for intraoperative examination for primary tumors. Regarding lymph nodes, the overall prediction accuracy of 18F-FDG-PET-CT is 82.2% (51/62) [sensitivity 53.8%, specificity 89.8%, PPV 58.3%, NPV 88.8%] and for intraoperative examination 66.1% (41/62) [sensitivity 76.9%, specificity 63.3%, PPV 35.7%, NPV 91.2%]. The agreement with histopathological examination was moderate for 18F-FDG-PET-CT and poor for intraoperative examination for lymph node metastasis, highlighting that the overall accuracy of 18F-FDG-PET-CT (82.1%) was significantly higher than that of intraoperative examination (66.1%) (p = 0.002). Conclusions: In conclusion, 18F-FDG-PET-CT provides high accuracy in detecting primary tumors and superior predictive value for lymph node metastases compared to intraoperative examination, highlighting the importance of incorporating this imaging modality into the preoperative evaluation process to enhance diagnostic precision and inform treatment decisions.

The importance of MRI in determining the stage of cervical cancer

Cervical cancer is one of the most common malignant tumours in women. The treatment of early and locally advanced stages of this cancer typically involves surgery, chemotherapy, and radiotherapy. However, there is no standardised therapy for metastatic cervical cancer due to the diverse manifestations of the disease. Therefore, timely diagnosis and staging of the carcinoma are crucial for maintaining the quality of life of patients. Imaging during the initial diagnostic evaluation is essential for accurately assessing the extent of the tumour and metastases, and for selecting the optimal therapy, with the FIGO system further emphasising this role. Compared to other imaging techniques, MRI provides detailed information on the location and size of the tumour, invasion into surrounding tissues, and the presence of distant metastases. This allows MRI to facilitate a tailored approach in therapy selection, taking into account the specific characteristics of the tumour. The integration of MRI into the diagnostic and therapeutic process improves clinical outcomes for patients with cervical cancer, enabling effective care. MRI is used alongside other imaging modalities in the diagnosis and treatment planning, and without it, precise staging of the disease and establishing a final diagnosis would not be possible.