Cervical Cancer Survival Research Articles

Computed tomography-based radiomics modeling to predict patient overall survival in cervical cancer with intensity-modulated radiotherapy combined with concurrent chemotherapy.

ObjectiveThe objective of this study was to develop a predictive model combining radiomic characteristics and clinical features to forecast overall survival in cervical cancer patients treated with intensity-modulated radiotherapy and concurrent chemotherapy.MethodsIn this retrospective observational study, 159 patients were divided into a training group (n = 95) and a validation group (n = 64). Radiomic characteristics were extracted from contrast-enhanced computed tomography scans. The least absolute shrinkage and selection operator regression analysis was used to filter the extracted radiomic characteristics and reduce the dimensionality of the data. A radiomic score was calculated from the selected features, and multivariate Cox regression models were established to analyze overall survival. A nomogram combining radiomic score and clinical features was developed, and its reliability was assessed using the area under the receiver operating characteristic curve.ResultsFour radiomic characteristics and two clinical features were extracted for overall survival analysis. A nomogram combining these factors was developed and validated, showing good performance with a high C-index. Patients were categorized as low-risk or high-risk for overall survival based on a cut-off value.ConclusionsOur model combining computed tomography-extracted radiomic characteristics and clinical features shows good potential for evaluating overall survival in cervical cancer patients treated with intensity-modulated radiotherapy and concurrent chemotherapy.

Low pretreatment prognostic nutritional index predicts unfavorable survival in stage III-IVA squamous cervical cancer undergoing chemoradiotherapy

BackgroundTo investigate potential predictive factors and assess the utility of systemic inflammatory and nutritional indexes as prognostic indicators for survival in patients with FIGO stage III-IVA squamous cervical cancer (squamous HR-LACC) treated with concurrent chemoradiotherapy.MethodsWe included consecutive patients with PET-CT diagnosed squamous HR-LACC undergoing curative chemoradiotherapy from November 2016 to April 2024. We systematically reviewed data pertaining to pretreatment clinicopathologic characteristics, hematological parameters, and treatment specifics. A range of composite inflammatory and nutritional indices were calculated, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, pan-immune-inflammation value, and prognostic nutritional index (PNI). X-Tile software was utilized to establish optimal cut-off values based on progression-free survival (PFS). Both univariate and multivariate Cox regression analyses were conducted to identify factors associated with PFS and overall survival (OS).ResultsAmong 157 patients (median age 55) included, 136 had lymph node involvement, and 45 had para-aortic metastasis. After a median follow-up of 35 months, 47 patients had disease progression, and 22 died, yielding 3-year PFS and OS rates of 66.2% and 82.0%, respectively. Multivariate analysis revealed that low SCC-Ag (HR: 1.518, 95% CI: 1.067–2.159, p = 0.020), para-aortic lymph node involvement (HR: 1.864, 95% CI: 1.020–3.408, p = 0.043), and low PNI (HR: 1.477, 95% CI: 1.105–1.975, p = 0.009) were independently associated with worse PFS, whereas low PNI emerged as the sole independent risk factor for diminished OS (HR = 1.525, 95% CI: 1.002–2.323, p = 0.049).ConclusionsPNI, a readily obtainable metric based on albumin and lymphocyte count, can serve as a predictor of survival in HR-LACC patients undergoing concurrent chemoradiotherapy. Further research is necessary to ascertain whether optimizing pretreatment nutritional status, a modifiable factor, can enhance outcomes in these high-risk patients.

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.

Prognostic significance of Bcl-2 expression in carcinoma of the uterine cervix: A systematic review and meta-analysis

Apoptosis is the final common pathway in cellular death induced by radiation and chemotherapy. Antiapoptotic protein bcl-2 plays an essential role in the determination of cellular threshold in the process of apoptosis. Immunohistochemical evaluation of bcl-2 has been one of the most widely investigated prognostic markers in cervical cancer. Given the lack of conclusive evidence in the literature, we aimed to systematically review the evidence to use bcl-2 as a prognostic marker for overall (OS) and disease-free survival (DFS) in cervical cancer. We reviewed the studies after a systematic literature search, reporting either OS or DFS. Estimates were extracted from these studies, and a meta-analysis was done. Positive bcl-2 expression was associated with a decreased risk ratio (RR) for OS. The estimated log RR was −0.52 (confidence interval = −0.91–−0.13, RR = 0.60\0.40, 0.88], P &lt; 0.001). No significant association was found with DFS. There was significant heterogeneity among the studies. Bcl-2 can be used as a molecular marker for OS in cervical cancer. It can be helpful to identify a group of patients who might be good responders in locally advanced cervical cancer and help in clinical decision-making to prognosticate the disease.

Hydronephrosis and survival in cervical cancer patients: The role of urinary diversion.

Hydronephrosis and survival in cervical cancer patients: The role of urinary diversion.

Cervical cancer in young women: Does age impact survival in cervical cancer?

Cervical cancer in young women: Does age impact survival in cervical cancer?

Identification of Biomarkers for Cervical Cancer Radiotherapy Sensitivity and Survival Prognosis

Introduction: Radiotherapy resistance leads to treatment failure and disease progression in patients with cervical cancer. This study aims to elucidate the molecular underpinnings of radiotherapy response in cervical cancer by identifying radiotherapy sensitivity genes (RSGs). Methods: We utilized two GEO expression profiling datasets (GSE3578 and GSE6213) comprising cervical cancer biopsy samples taken before and during radiotherapy to identify differentially expressed genes (DEGs) using the RankProd meta-analysis approach. Subsequent analysis was conducted using data from the TCGA-CESE project to further determine the RSGs and investigate their associations with survival prognosis, immune cell infiltration, and drug sensitivities. The differential expressions of the candidate RSGs were validated in an independent set of cervical cancer patients by qPCRs. Results: A total of 518 DEGs were identified, with 305 genes upregulated and 213 genes down-regulated during radiotherapy. Six key RSGs were identified as significantly associated with radiotherapy response. Cox regression analysis revealed that upregulations of IL1RAP and GPR15 were associated with an increased risk of poor survival prognosis. Functional enrichment analysis highlighted the involvement of these genes in critical biological processes such as cytokine signaling and immune regulation. Correlation analyses demonstrated significant associations between RSG expressions and M2 macrophage and γδT cell abundances in tumor microenvironment, as well as drug sensitivities. The expression of IL1RAP was significantly higher in the complete response group, supporting the bioinformatic finding. Conclusion: Our findings on RSGs could potentially serve as potential biomarkers for predicting radiotherapy response and as therapeutic targets to enhance the efficacy of 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.

Global Research Trends in Cervical Cancer Survival in the Last Two Decades: A Bibliometric Analysis.

Cervical cancer poses a significant challenge to global health, particularly in low- and middle-income countries. Tracking the survival rates of cancer patients through data gathered by population-based cancer registries constitutes a crucial aspect of cancer management. In recent years, attention within bibliometric studies has been directed towards examining the correlation between inflammation and radiotherapy in cervical cancer. However, to date, there is no published literature investigating research trends in cervical cancer survival through bibliometric analysis. Thus, this study was undertaken to identify and analyse global research patterns and hotpots in this area. A systematic search was performed within the Web of Science Core Collection (WoSCC) database, employing the following search parameters: TITLE - (((survival) OR (survival rate) OR (survival analysis) OR (survival probability)) AND ((cervical cancer) OR (cervical carcinoma))). A comprehensive analysis of research trends was conducted utilising various tools on the WoSCC website and VOSviewer. A total of 840 papers pertaining to cervical cancer and survival were identified from 45 distinct departments or subjects. Notably, the People's Republic of China and the USA collectively accounted for half of all publications from 2000 to 2023. An extensive cohort comprising 4,759 authors affiliated with 1,454 institutions across 82 countries contributed to the progression of this research domain. Despite a substantial increase in research on cervical cancer survival over the last decade, it is essential to encourage and conduct research, particularly in high-risk regions, especially in countries classified as low- or middle-income.

Bidirectional recurrent neural network approach for predicting cervical cancer recurrence and survival

Cervical cancer is a deadly disease in women globally. There is a greater chance of getting rid of cervical cancer in case of earliest diagnosis. But for some patients, there is a chance of recurrence. The chances of treating the Recurrence of cervical carcinoma arelimited. The main objective of a research is to find the key features that will predict the cervical cancer recurrence and survival rates accurately by utilizing a neural network that is bidirectionally recurrent. The goal is to reduce risk factors of cervical cancer recurrence by identifying genes with positive coefficients and targeting them for preventive interventions. First step is identification of risk factors for cervical carcinoma recurrence by utilising clinical attributes. This research uses following Random forest, Logistic regression, Gradient boosting and support vector machine algorithms are applied for classification. Random forest offers the maximum precision of these four techniques at 91.2%. The second step is identifying long noncoding RNA (lnRNA) gene signatures among people with cervical carcinomaby implementingHSIC model. Intended to discover biomarkers in initial cervical carcinoma clinical data from people who experienced a distant repetition that could be connected to lnRNA gene signatures and utilized for forecasting survival rates using a bidirectional recurrent neural network(Bi-RNN). The results shows that Bi-RNN model effectively forecast the cervical cancer recurrence and survival.

The predictive value of miR-29b-2-5p on the prognosis of cervical cancer and its inhibitory effect on cervical cancer progression.

The poor prognosis of cervical cancer patients leads to an annual increase in mortality, while microRNAs are involved in various cancers, including cervical cancer. This study aimed to investigate the clinical value and possible effect of miR-29b-2-5p on the progression of cervical cancer. The expression level of miR-29b-2-5p in cervical cancer tissues and cells was analyzed by polymerase chain reaction. The Kaplan-Meier curve was used to evaluate the role of miR-29b-2-5p in cervical cancer prognosis. The independent prognostic factors of cervical cancer were explored by the multivariate Cox regression analysis. The effect of miR-29b-2-5p on the proliferation, migration, and invasion of cervical cancer cells was determined by in vitro cell experiments. A significantly downregulated miR-29b-2-5p expression was observed in cervical cancer tumor tissues and cervical cancer cells compared with the adjacent tumor tissues (tissues of the negative surgical margin) and H8 cells, respectively. Higher miR-29b-2-5p expression correlated with a better 5-year progression-free survival of cervical cancer. MiR-29b-2-5p was also associated with the indicators (tumor size, tumor differentiation, FIGO (International Federation of Gynecology and Obstetrics) stage, and invasion depth) of the progression of cervical cancer tumors. And miR-29b-2-5p, along with tumor size, tumor differentiation, FIGO stage, histology type, and invasion depth, were independent prognostic factors for poor cervical cancer prognosis. MiR-29b-2-5p showed a suppressive effect on the proliferation, migration, and invasion of cervical cancer cells. MiR-29b-2-5p was downregulated in cervical cancer tumor tissues and could serve as an independent prognostic factor for cervical cancer. The overexpressed miR-29b-2-5p could be considered a tumor suppressor to inhibit the progression of cervical cancer.

MRI radiomics and nutritional-inflammatory biomarkers: a powerful combination for predicting progression-free survival in cervical cancer patients undergoing concurrent chemoradiotherapy

ObjectiveThis study aims to develop and validate a predictive model that integrates clinical features, MRI radiomics, and nutritional-inflammatory biomarkers to forecast progression-free survival (PFS) in cervical cancer (CC) patients undergoing concurrent chemoradiotherapy (CCRT). The goal is to identify high-risk patients and guide personalized treatment.MethodsWe performed a retrospective analysis of 188 patients from two centers, divided into training (132) and validation (56) sets. Clinical data, systemic inflammatory markers, and immune-nutritional indices were collected. Radiomic features from three MRI sequences were extracted and selected for predictive value. We developed and evaluated five models incorporating clinical features, nutritional-inflammatory indicators, and radiomics using C-index. The best-performing model was used to create a nomogram, which was validated through ROC curves, calibration plots, and decision curve analysis (DCA).ResultsModel 5, which integrates clinical features, Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), and MRI radiomics, showed the highest performance. It achieved a C-index of 0.833 (95% CI: 0.792–0.874) in the training set and 0.789 (95% CI: 0.679–0.899) in the validation set. The nomogram derived from Model 5 effectively stratified patients into risk groups, with AUCs of 0.833, 0.941, and 0.973 for 1-year, 3-year, and 5-year PFS in the training set, and 0.812, 0.940, and 0.944 in the validation set.ConclusionsThe integrated model combining clinical features, nutritional-inflammatory biomarkers, and radiomics offers a robust tool for predicting PFS in CC patients undergoing CCRT. The nomogram provides precise predictions, supporting its application in personalized patient management.

Up-regulation of MSMO1 was associated with poor survival in cervical cancer.

Methylsterol monooxygenase 1 (MSMO1) catalyzes C4-methylsterols demethylation in cholesterol biosynthesis pathway. MSMO1 is increased and up-regulation of MSMO1 is correlated with progression of some tumor. But the correlation of MSMO1 to cervical cancer is unknown. The current study aimed to explore the expression pattern of MSMO1 in cervical cancer and its correlation to clinical characteristics. In this study, 306 cervical cancer cases and 13 non-tumor cases were included. We compared MSMO1 expression level in non-tumor cervical tissues and cervical cancer samples using the Wilcoxon rank sum test. Univariate regression was used to investigate the correlation between MSMO1 expression as well as other clinical characteristics and prognosis. Clinical characteristics associated with prognosis in univariate analysis were used as adjustments for multivariate analysis to further validate the relationship between MSMO1 expression and cervical cancer prognosis. Patients' survival in different subgroups was compared by Kaplan-Meier (KM) method. The potential protein interaction was analyzed. T cell infiltration level in MSMO1 high and low group patients was compared. MSMO1 expression level was up-regulated in cervical cancer (P<0.001). Patients who had stage III-IV diseases (P=0.04) and did not achieve complete response after primary treatment had higher MSMO1 expression (P<0.001). High MSMO1 expression patients showed a lower overall survival (OS) (P=0.004), disease-specific survival (DSS) (P=0.004) and progression-free survival (PFS) (P=0.002). High MSMO1 expression was a risk factor to OS (P=0.01), DSS (P=0.009) and PFS (P=0.009). Multiple variate analysis showed that high MSMO1 expression was an independent risk factor to OS [hazard ratio (HR) =1.902, 95% confidence interval (CI): 1.156-3.129, P=0.01], DSS (HR =2.172, 95% CI: 1.210-3.897, P=0.009) and PFS (HR =1.975, 95% CI: 1.189-3.282, P=0.009) in cervical squamous cell carcinoma (CESC). The prognostic value of high MSMO1 expression was further examined in other databases, including KM-plotter, Gene Expression Profiling Interactive Analysis (GEPIA) and Gene Expression Omnibus (GEO) database. The current research showed that MSMO1 was increased and was associated with poor prognosis in CESC.

The association between ambient PM2.5's constituents exposure and cervical cancer survival

The association between ambient PM2.5's constituents exposure and cervical cancer survival

Therapeutic Strategies in Advanced Cervical Cancer Detection, Prevention and Treatment.

Cervical cancer is ranked the fourth most common cause of cancer related deaths amongst women. The situation is particularly dire in low to lower middle-income countries. It continues to affect these countries due to poor vaccine coverage and screening. Cervical cancer is mostly detected in the advanced stages leading to poor outcomes. This review focuses on the progress made to date to improve early detection and targeted therapy using both circulating RNA. Vaccine has played a major role in cervical cancer control in vaccinated young woman in mainly developed countries yet in low-income countries with challenges of 3 dose vaccination affordability, cervical cancer continues to be the second most deadly amongst women. In this review, we show the progress made in reducing cervical cancer using vaccination that in combination with other treatments that might improve survival in cervical cancer. We further show with both miRNA and siRNA that targeted therapy and specific markers might be ideal for early detection of cervical cancer in low-income countries. These markers are either upregulated or down regulated in cancer providing clue to the stage of the cancer.

Obesity paradox: is a high body mass index positively influencing survival outcomes in gynecological cancers? A systematic review and meta-analysis

ObjectiveObesity represents an exponentially growing preventable disease leading to different health complications, particularly when associated with cancer. In recent years, however, an ‘obesity paradox’ has been hypothesized where obese individuals...

Factors influencing the survival of cervical cancer

More studies on the effect of socioeconomic (SES) factors on the survival of cervical cancer appeared while lacking comprehensive studies on both SES factors and traditional survival-influencing factors. Our study included baseline factors, SES factors, tumor features, and therapy. It thoroughly analyzed their influences and interactions on the survival of the cervical cancer population in the US. A total of 28471 cases from the Surveillance, Epidemiology, and End Results (SEER) database were adapted in our study, using the Kaplan-Meier method and log-rank test as univariate analysis and the Cox proportional hazard model as multivariate analysis. Surgery, marriage, younger age, and higher income were found to have improving effects on survival, and chemotherapy and radiotherapy did the same after adjusting baseline and SES factors. Hispanics have the best survival, while Blacks have the worst. Survival in metropolitan areas decreased as the population increased, while the opposite appeared in nonmetropolitan areas.

E7-mediated repression of miR-203 promotes LASP1-dependent proliferation in HPV-positive cervical cancer

Human papillomaviruses (HPV) are a major cause of malignancy, contributing to ~5% of all human cancers worldwide, including most cervical cancer cases and a growing number of anogenital and oral cancers. The major HPV viral oncogenes, E6 and E7, manipulate many host cellular pathways that promote cell proliferation and survival, predisposing infected cells to malignant transformation. Despite the availability of highly effective vaccines, there are still no specific anti-viral therapies targeting HPV or treatments for HPV-associated cancers. As such, a better understanding of viral-host interactions may allow the identification of novel therapeutic targets. Here, we demonstrate that the actin-binding protein LASP1 is upregulated in cervical cancer and significantly correlates with a poorer overall survival. In HPV positive cervical cancer, LASP1 depletion significantly inhibited the oncogenic phenotype in vitro, whilst having minimal effects in HPV negative cervical cancer cells. Furthermore, we demonstrate that the LASP1 SH3 domain is essential for LASP1-mediated oncogenicity in these cells. Mechanistically, we show that HPV E7 regulates LASP1 at the post-transcriptional level by repressing the expression of miR-203, which negatively regulates LASP1 mRNA levels by binding to its 3’UTR. Finally, we demonstrate that LASP1 expression is required for the growth of HPV positive cervical cancer cells in an in vivo tumourigenicity model. Together, these data demonstrate that HPV induces LASP1 expression to promote proliferation and survival in cervical cancer, thus identifying a potential therapeutic target in these cancers.

Machine learning-based radiomics for predicting outcomes in cervical cancer patients undergoing concurrent chemoradiotherapy

Machine learning-based radiomics for predicting outcomes in cervical cancer patients undergoing concurrent chemoradiotherapy

TPP1 is associated with risk of advanced precursors and cervical cancer survival.

It is unclear how telomere-binding protein TPP1 interacts with human telomerase reverse transcriptase (hTERT) and influences cervical cancer development and progression. This study included all eligible 156 cervical cancers diagnosed during 2003-2008 and followed up through 2014, 102 cervical intraepithelial neoplasia (CIN) patients, and 16 participants with normal cervix identified at the same period. Correlation of expression of TPP1 and hTERT in these lesions was assessed using Kappa statistics. TPP1 was knocked down by siRNA in three cervical cancer cell lines. We assessed mRNA expression using quantitative real-time polymerase chain reaction and protein expression using tissue microarray-based immunohistochemical staining. We further analyzed the impact of TPP1 expression on the overall survival of cervical cancer patients by calculating the hazard ratio (HR) with 95% confidence intervals (CIs) using the multivariable-adjusted Cox regression model. Compared to the normal cervix, high TPP1expression was significantly associated with CIN 3 and cervical cancers (P<0.001 for both). Expressions of TPP1 and hTERT were highly correlated in CIN 3 (Kappa statistics = 0.50, P = 0.005), squamous cell carcinoma (Kappa statistics = 0.22, P = 0.011), and adenocarcinoma/adenosquamous carcinoma (Kappa statistics = 0.77, P = 0.001). Mechanistically, knockdown of TPP1 inhibited the expression of hTERT in both mRNA and protein levels. High expression of TPP1 (HR = 2.61, 95% CI 1.23-5.51) and co-high expression of TPP1 and hTERT (HR = 2.38, 95% CI 1.28-4.43) were independently associated with worse survival in cervical cancer patients. TPP1 and hTERT expression was correlated and high expression of TPP1 was associated with high risk of CIN 3 and cervical cancer and could predict a worse survival in cervical cancer.