Uterine Cervical Cancer Research Articles

Percutaneous osteoplasty for painful bony lesions: a technical survey.

Percutaneous osteoplasty (POP) is defined as the injection of bone cement into various painful bony lesions, refractory to conventional therapy, as an extended technique of percutaneous vertebroplasty (PVP). POP can be applied to benign osteochondral lesions and malignant metastatic lesions throughout the whole skeleton, whereas PVP is restricted to the vertebral body. Common spinal metastases occur in the thoracic (70%), lumbosacral (20%), and cervical (10%) vertebrae, in order of frequency. Extraspinal metastases into the ribs, scapulae, sternum, and humeral head commonly originate from lung and breast cancers; extraspinal metastases into the pelvis and femoral head come from prostate, urinary bladder, colon, and uterine cervical cancers. Pain is aggravated in the dependent (or weight bearing) position, or during movement (or respiration). The tenderness and imaging diagnosis should match. The supposed mechanism of pain relief in POP is the augmentation of damaged bones, thermal and chemical ablation of the nociceptive nerves, and local inhibition of tumor invasion. Adjacent (facet) joint injections may be needed prior to POP (PVP). The length and thickness of the applied needle should be chosen according to the targeted bone. Bone cement is also selected by its osteoconduction, osteoinduction, and osteogenesis. Needle route should be chosen as a shortcut to reach the target bony lesions, without damage to the nerves and vessels. POP is a promising minimally invasive procedure for immediate pain relief. This review provides a technical survey for POPs in painful bony lesions.

Analysis of 100 consecutively visiting uterine cervical cancer patients in cancer hospital

Background: Cervical cancer is the most common cancers in female population of Nepal. Though considered a slow growing cancer, majority of patients still present very late. 
 Methodology: One hundred patients of cancer cervix were retrospectively analysed to see their spectrum of clinical presentation and care pathway from January 2012 to April 2012. 
 Results: The clinical spectrum showed they presented to clinic after average of 9 months of symptoms. Squamous cell cancers were the main histology. Majority of cases were in FIGO stage of II and IIIB. Radiation therapy with tele-therapy and brachytherapy was the main modality of treatment (94%) of cases. 
 Conclusion: Late stage of presentation is a very common phenomenon in the patients with cancer of cervix. Need screening programs in systematic manner to detect early stage diseases and for better care.

Genotype Distribution Change After Human Papillomavirus Vaccination in Two Autonomous Communities in Spain.

ContextIt has been more than 10 years since the human papillomavirus (HPV) vaccination program was initiated in most advanced countries. Thus, it seems necessary to change the uterine cervical cancer screening strategy. Molecular-based tests are considered essential in this scenario.ObjectiveWe aimed to review the distribution of the HPV genotypes after the introduction of the vaccination program with Cervarix® and Gardasil 4® in two autonomous communities in Spain, looking for possible changes in distribution and the occurrence of a herd effect.DesignA cross-sectional study was performed in 45,362 samples that were processed in the Cantabria and Aragon communities during the period from 2002 to 2016. We compared the genotype distribution before and after the vaccination program was initiated.ResultsGenotypes HPV6 and HPV11 have decreased significantly after the introduction of the vaccine. HPV16 has had a decrease, but not a significant one in the statistical analysis. However, HPV31, HPV52, and HPV45 have increased in percentage. A replacement phenomenon with other genotypes not included in the vaccine has been observed in our population.ConclusionsContinued surveillance is needed to provide further indication of any changes over time in the genotypes in circulation. This will be facilitated by monitoring the genotyping results from the new model of cervical screening using primary HPV DNA testing.

814P Prevalence of HER2 overexpression and amplification in uterine cervical cancer: A systematic review and a meta-analysis

The reported rates of HER2 positivity in uterine cervical cancer (CC) range from 0% to 87%. The importance of HER2 as an actionable target in CC would depend on HER2 positivity prevalence. We aimed to provide precise estimates of HER2 overexpression and amplification in CC globally and by relevant subgroups. We conducted a PRISMA compliant meta-analytic systematic review.

Ultrasound-guided fine needle aspiration cytology of Para-aortic lymph node metastasis in uterine cervical cancer: diagnostic accuracy and impact on clinical decision making

ObjectiveThe main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making.MethodsWe retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated.ResultsCytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809–0.953), 100% (95% CI: 0.561–1), 100% (95% CI: 0.938–1), 46.7% (95% CI: 0.223–0.726) and 90.9% (95% CI: 0.848–0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354–0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings.ConclusionsUS-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer.

Combination of Radiomics and Machine Learning with Diffusion-Weighted MR Imaging for Clinical Outcome Prognostication in Cervical Cancer.

Objectives: To explore the potential of Radiomics alone and in combination with a diffusion-weighted derived quantitative parameter, namely the apparent diffusion co-efficient (ADC), using supervised classification algorithms in the prediction of outcomes and prognosis. Materials and Methods: Retrospective evaluation of the imaging was conducted for a study cohort of uterine cervical cancer, candidates for radical treatment with chemo radiation. ADC values were calculated from the darkest part of the tumor, both before (labeled preADC) and post treatment (labeled postADC) with chemo radiation. Post extraction of 851 Radiomics features and feature selection analysis—by taking the union of the features that had Pearson correlation >0.35 for recurrence, >0.49 for lymph node and >0.40 for metastasis—was performed to predict clinical outcomes. Results: The study enrolled 52 patients who presented with variable FIGO stages in the age range of 28–79 (Median = 53 years) with a median follow-up of 26.5 months (range: 7–76 months). Disease recurrence occurred in 12 patients (23%). Metastasis occurred in 15 patients (28%). A model generated with 24 radiomics features and preADC using a monotone multi-layer perceptron neural network to predict the recurrence yields an AUC of 0.80 and a Kappa value of 0.55 and shows that the addition of radiomics features to ADC values improves the statistical metrics by approximately 40% for AUC and approximately 223% for Kappa. Similarly, the neural network model for prediction of metastasis returns an AUC value of 0.84 and a Kappa value of 0.65, thus exceeding performance expectations by approximately 25% for AUC and approximately 140% for Kappa. There was a significant input of GLSZM features (SALGLE and LGLZE) and GLDM features (SDLGLE and DE) in correlation with clinical outcomes of recurrence and metastasis. Conclusions: The study is an effort to bridge the unmet need of translational predictive biomarkers in the stratification of uterine cervical cancer patients based on prognosis.

PTEN downregulation induces apoptosis and cell cycle arrest in uterine cervical cancer cells.

The tumor suppressors PTEN and p53 are often downregulated in various human cancer types, which has been associated with a poor prognosis. Recent evidence implies that PTEN downregulation may induce growth arrest of kidney cells and cancer cells. In the present study, the role of PTEN in the proliferation and survival of cervical cancer cells was investigated. It was found that PTEN silencing promoted apoptosis and cell-cycle arrest, accompanied by a significant decrease in the proportion of cells in the S1 phase of the cell cycle. Moreover, PTEN silencing in cervical cancer cells increased levels of p53, p27, p21, phospho-ERK and cleaved caspase-3, and decreased levels of cyclin A2 and cyclin D1. Furthermore, PTEN knockdown significantly impacted the viability of cervical cancer cells. P53 silencing did not affect the ability of PTEN knockdown to induce apoptosis in cervical cancer cells. Taken together, the present study results imply that PTEN silencing induces apoptosis and decreases proliferation in cervical cancer cells; hence, PTEN inhibition may represent a promising strategy for the treatment of cervical cancer.

Predictive value of the 5-factor modified frailty index in oncologic and benign hysterectomies

<h3>Objectives:</h3> The modified frailty index (mFI-5) is a five-factor National Surgical Quality Improvement Program (NSQIP)-based index that has been shown to predict the likelihood of postoperative mortality and morbidity across some surgical specialties. Its validity as a predictive tool has not yet been compared between benign gynecology and gynecologic oncology patients. This study quantifies the predictive value of the mFI-5 in identifying women at increased risk for major postoperative complications, readmission, or death within 30 days of hysterectomy for benign and oncologic indications. <h3>Methods:</h3> Patients who underwent hysterectomy between 2015 and 2017 were identified from the NSQIP database and stratified into benign or malignant indication by postop diagnosis. The oncology group was further stratified by cancer type. Demographic and mFI-5 variables (hypertension requiring medication, partially-dependent or dependent functional status, insulin-dependent diabetes, COPD, and congestive heart failure) were extracted from the database. The mFI-5 was calculated by dividing the sum of all affirmative variables by the total number of input variables in the database, with a higher mFI-5 score indicating a higher degree of frailty. Logistic regression modeling was performed adjusting for ASA class, wound class, patient age, operative time/surgical complexity, and inpatient status. C-statistic with 95% CI was obtained post-regression. <h3>Results:</h3> 80,293 hysterectomies were identified, with 59,078 benign cases and 21, 215 oncologic cases. Benign patients were more likely to have an mFI-5 score of 0 (70% vs 50%, p=0.001) and shorter operative times (p=0.001). They were also younger (p=0.001) and less obese (p=0.001). In the benign group, mFI-5 was a strong predictor of mortality (c=0.795, CI 0.0.684-0.905). Among benign cases, a 1-unit increase in mFI-5 score increased odds of readmission and major complication by 4.9 times and 2.1 times, respectively (Table 1). Within the oncology group, the mFI-5 was similarly a strong predictor of mortality (c=0.770, CI 0.710-0.830), particularly for uterine cancer and cervical cancer (Table 1). It was moderately predictive of readmission (c=0.662, CI 0.646-0.677) and major complication (c=0.679, CI 0.666-0.692), and strongly predictive of major complication among some cancer subgroups (Table 1). Among oncologic cases, a 1-unit increase in mFI-5 score increased odds of readmission and major complication by 2.4 times and 2.2 times, respectively (Table 1). <h3>Conclusions:</h3> The mFI-5, comprised of 5 easily-captured baseline health factors, is a strong predictor of 30-day mortality and good predictor of readmission and major complications following hysterectomy in both benign and oncologic patient populations. Notably, its predictive ability varied by gynecologic cancer type. These findings have the potential to improve identification of high-risk patients in the pre-operative setting.

PO-1305 Radiation Therapy for Stage IVB Uterine Cervical Cancer with Supraclavicular Lymph Nodes Metastases

PO-1305 Radiation Therapy for Stage IVB Uterine Cervical Cancer with Supraclavicular Lymph Nodes Metastases

The delay, symptoms, and survival of Ivorian adolescent girls and young adults with uterine cervical cancer

ObjectiveTo generate data on the nature and duration of cervical cancer symptoms, risk factors for delayed consultation, and diagnosis of adolescent and young adult groups in Côte d'Ivoire. MethodsThis is a hospital-based cross-sectional study, conducted from July 2012 to May 2018, at the Department of Gynecology of the Yopougon teaching hospital in Cote d’Ivoire. The inclusion criteria were those who were under 40 years of age at the time of diagnosis with oral and written consent. Those whose information was more than 10% insufficient for the standards were excluded from the study. The survey files standardized anonymous pre-established data collected using medical records followed by phone calls. ResultsThe average age of the participants was 34±4.95 years with a minimum of 21 years. The mean parity per woman was 3.49 ± 3.54. 34.9% were HIV positive. The median patient delay was 122 days with a long delay in 84.62% of patients. The median time to total diagnosis was 209 days with a longer total delay in diagnosis of 87.18%. 41% of patients honored their treatment, 68.75% of which had received surgery, and 31.25% of which had received chemotherapy. The 5-year survival rate was 65%. ConclusionThe Ivorian health system must focus on primary and secondary prevention, the only guarantee to decrease the morbidity and mortality indicators linked to cervical cancer.

Secondhand smoke exposure, diabetes, and high BMI are risk factors for uterine cervical cancer: a cross-sectional study from the Korea national health and nutrition examination survey (2010\u20132018)

BackgroundHuman papilloma virus infection and tobacco smoking are the major risk factors for cervical cancer. There are limited studies searching other risk factors for cervical cancer and the results are not consistent. This study investigated the relations between cervical cancer and possible risk factors, including secondhand cigarette smoke exposure, diabetes, body mass index (BMI), and work schedule.MethodsIn this cross-sectional study, 29,557 women completed a cervical cancer questionnaire and were selected using 2010–2018 data from the Korea National Health and Nutrition Examination Survey. Details in secondhand smoke exposure, diabetes, BMI, and work schedule were assessed with participants’ health interviews and health-related surveys.ResultsTwo hundred sixty-two women (0.89%) in the sample were diagnosed with cervical cancer. Domestic secondhand smoke exposure, diabetes, and high BMI significantly increased cervical cancer risk. Respective odds ratios and 95% confidence intervals were: 1.547 (1.042–2.297), 2.156 (1.535–3.027), and 1.036 (1.006–1.067). Weekly work hours, and work schedule were not significantly related to cervical cancer incidence.ConclusionAmong Korean women, passive exposure to cigarette smoke at home, diabetes, and high BMI increase risk for cervical cancer.

Small cell neuroendocrine carcinoma of the uterine cervix (SCNEC): a case report and review

Objective: Improving skill and knowledge to diagnose and manage a rare case of small cell neuroendocrine uterine cervical cancer&#x0D; Method: a Case report&#x0D; Result: A 51 years old, para 2, Indonesian woman with chief complaint post-coital vaginal bleeding. Gynecology examination revealed cervical exophytic fragile mass size 3x3x3,5 cm, easily bleeding, with a necrotic part, infiltrated both parametria but not reach the pelvic wall correspond to stage IIB. Initially, the histopathology result from punch biopsy was an adenocarcinoma well-differentiated, with no lymph vascular invasion, DD/ adenosquamous, neuroendocrine tumor. We did the histopathology review continued with immunohistochemistry examination. Immunohistochemistry result showed that although all the sample was not typical, immunohistochemical outward patterns can support morphological features of high-grade neuroendocrine carcinoma, small cell type. We proceed here for chemoradiation therapy.&#x0D; Conclusion: Small cell neuroendocrine carcinoma of the uterine cervix is a rare case. Histopathology and immunohistochemistry examination has an important role to develop the diagnosis. Although the prognosis is poor, adjuvant chemotherapy or chemoradiation was associated with improved survival in patients with advance staged.&#x0D; Keywords: SCNEC, immunohistochemistry, chemoradiation

Quantitative imaging of uterine cancers with diffusion-weighted MRI and 18-fluorodeoxyglucose PET/CT.

Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer.

Why not de-intensification for uterine cervical cancer?

ObjectiveThe majority of uterine cervical cancer is known to be related to human papillomavirus (HPV), and HPV-related tumors are known to be radio-sensitive. In the management of HPV-related oropharyngeal cancer, de-intensification of treatment has been attempted; however, no such attempt is performed in the management of cervical cancer. The aim of this study was to identify a group of patients who can safely be treated by de-escalated treatment intensity. MethodsFrom the Asian international multi-institutional retrospective study involving 13 Japanese, one Thailand, and one Korean institutions based on 469 patients, squamous cell carcinoma (Scc), tumor reduction ratio ≥29%, tumor size before brachytherapy ≤4 cm, and total treatment time (TTT) <9 weeks were identified as factors having an influence on local control. Based on these findings, low-risk patients having these four factors were extracted, and treatment outcomes categorized in 10 Gy increment of CTVHR D90 were compared. ResultsAmong 469 patients, 162 patients (34.5%) met the criteria of low-risk group, and 63, 41, 43, and 15 patients were categorized in CTVHR D90 50–60 Gy, 60–70 Gy, 70–80 Gy, and >80 Gy, respectively. While 4-y progression-free survival ranged from 66 to 80%, 4-y local control was consistently over 90% in every dose group. Rectum and bladder D2cc and incidence of late adverse events decreased as CTVHR D90 decreased. ConclusionsThe low-risk patients achieved favorable local control with CTVHR D90 <80 Gy. A personalized treatment strategy based on tumor response could also be adopted for cervical cancer.

Intratumoral budding: A novel prognostic biomarker for tumor recurrence and a potential predictor of nodal metastasis in uterine cervical cancer

ObjectiveTo evaluate the prognostic and predictive significance of lymphovascular invasion (LVI) and lymph node metastasis of intratumoral budding (ITB) and its correlation with clinicopathological parameters in patients with cervical cancer. MethodsTotal 151 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. We assessed the status of ITB and peritumoral budding (PTB) in all available hematoxylin and eosin-stained specimens. Univariate and multivariate analyses were performed for ITB, PTB, and other clincopathological parameters as predictors of recurrence. ResultsITBhigh (≥3TB/HPF) was significantly associated with large tumor size, deep stromal invasion, LVI, parametrial invasion, and lymph node metastasis. The numbers of ITBs and PTBs were positively correlated (r2 = 0.754, p < 0.0001). ITBhigh was more frequently observed in squamous cell carcinoma compared with adenocarcinoma and adenosquamous cell carcinoma (p = 0.010). ITBhigh was found to be an independent prognostic factor for tumor recurrence by multivariate analysis (hazard ratio, 1.92; 95% confidence interval [CI], 1.37–9.90; p = 0.026). Multiple logistic regression showed association of LVI (odds ratio [OR], 1.85; 95% CI, 1.11–3.06; p = 0.017) and lymph node metastasis (OR, 1.96; 95% CI, 1.26–4.66; p = 0.019). ConclusionITBhigh is an independent prognostic factor for tumor recurrence. ITB is a surrogate marker for predicting LVI in cervical cancers. The evaluation of ITB may be readily applied in the clinical setting for improved prognosis and to guide the clinical management of patients with cervical cancer.

A whole-slide image grading benchmark and tissue classification for cervical cancer precursor lesions with inter-observer variability.

The cervical cancer developing from the precancerous lesions caused by the human papillomavirus (HPV) has been one of the preventable cancers with the help of periodic screening. Cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesion (SIL) are two types of grading conventions widely accepted by pathologists. On the other hand, inter-observer variability is an important issue for final diagnosis. In this paper, a whole-slide image grading benchmark for cervical cancer precursor lesions is created and the "Uterine Cervical Cancer Database" introduced in this article is the first publicly available cervical tissue microscopy image dataset. In addition, a morphological feature representing the angle between the basal membrane (BM) and the major axis of each nucleus in the tissue is proposed. The presence of papillae of the cervical epithelium and overlapping cell problems are also discussed. Besides that, the inter-observer variability is also evaluated by thorough comparisons among decisions of pathologists, as well as the final diagnosis.

Efficacy of local salvage therapy for recurrent uterine cervical cancer after definitive radiotherapy.

The prognosis of patients with recurrence of uterine cervical cancer after definitive radiotherapy and the efficacy of local salvage therapy for recurrence were evaluated. We retrospectively reviewed 110 patients who were treated with definitive radiotherapy/chemoradiotherapy for uterine cervical cancer between 2008 and 2017 at our institution. Local salvage therapy was defined as any surgery or radiotherapy described in the medical record as intended for local control or cure. We identified 25 patients who developed recurrence after definitive radiotherapy/chemoradiotherapy. The median follow-up time post-recurrence was 18.9months. Thirteen patients (52%) reported recurrence in the isolated extra-pelvic lymph node (EPLN). The 2-year overall survival after first recurrence (OSr) for patients with isolated EPLN recurrence was 83.1%, compared to that of 31.2% for patients with other patterns of recurrence (p < 0.001). The 2-year OSr for patients who underwent local salvage therapy was 75.2%, whereas that for patients who did not undergo therapy was 41.6% (p = 0.04). Among patients who had recurrence in the isolated EPLN and received local salvage therapy, 20% of the patients reported recurrence in visceral and/or bone metastases after local salvage therapy, and 50% of the patients experienced another EPLN recurrence, which was salvaged with repeating local therapy. Patients with uterine cervical cancer with isolated EPLN recurrence had favorable prognoses. The indications of local salvage therapy should be considered, especially for patients with isolated EPLN recurrence.

Pregnancy outcomes in children, adolescents, and young adults that survived cancer: A nationwide survey in Japan.

Recent advances in cancer treatment have improved the prognosis of child, adolescent, and young adult (CAYA) cancer survivors. This study aimed to examine the current status of pregnancy outcomes among female cancer survivors in Japan. The first questionnaire was sent to 633 major tertiary institutions certified by the Japan Society of Obstetrics and Gynecology to identify institutions managing cases of pregnant cancer survivors between January 2011 and December 2015. The second questionnaire was sent only to institutions with pregnant cancer survivors during the study period. We analyzed 2242 singleton deliveries of cancer survivors based on the responses received in the second questionnaire (199/255 responses; 78.0%). The three most frequent types of malignant tumors were uterine cervical (23.4%), breast (17.6%), and thyroid cancers (17.5%). Conception was aided by the use of assisted reproductive technology in 17.0% of the patients. The proportions of mothers aged 35-39.9 and ≥ 40 years were 36.5% and 11.8%, respectively. The prevalence of preterm birth (PTB) at <37, <34, and < 32 weeks' gestation were 16.7%, 6.8%, and 4.3%, respectively. The proportion of infants with low birth weight (LBW) was 18.9%. The present study findings suggest that advanced maternal age was common among pregnant cancer survivors and these survivors often gave birth to PTB and LBW infants in Japan. The likelihood of adverse pregnancy outcomes should be considered by healthcare providers when planning counseling and perinatal care for cancer survivors.

Immune Cell Infiltration as Signatures for the Diagnosis and Prognosis of Malignant Gynecological Tumors

Background Malignant gynecological tumors are the main cause of cancer-related deaths in women worldwide and include uterine carcinosarcomas, endometrial cancer, cervical cancer, ovarian cancer, and breast cancer. This study aims to determine the association between immune cell infiltration and malignant gynecological tumors and construct signatures for diagnosis and prognosis.Methods We acquired malignant gynecological tumor RNA-seq transcriptome data from the TCGA database. Next, the “CIBERSORT” algorithm calculated the infiltration of 22 immune cells in malignant gynecological tumors. To construct diagnosis and prognosis signatures, step-wise regression and LASSO analyses were applied, and nomogram and immune subtypes were further identified.Results Notably, Immune cell infiltration plays a significant role in tumorigenesis and development. There are obvious differences in the distribution of immune cells in normal, and tumor tissues. Resting NK cells, M0 Macrophages, and M1 Macrophages participated in the construction of the diagnostic model, with an AUC value of 0.898. LASSO analyses identified a risk signature including T cells CD8, activated NK cells, Monocytes, M2 Macrophages, resting Mast cells, and Neutrophils, proving the prognostic value for the risk signature. We identified two subtypes according to consensus clustering, where immune subtype 3 presented the highest risk.Conclusion We identified diagnostic and prognostic signatures based on immune cell infiltration. Thus, this study provided a strong basis for the early diagnosis and effective treatment of malignant gynecological tumors.

Clinico-pathological characteristics of patients with stage IB1-IB2 (FIGO 2018) uterine cervical cancer: a nationwide study in Japan.

The aim of this retrospective analysis is to reveal clinicopathological findings and clinical outcome of patients with stage IB1/IB2 (FIGO 2018) uterine cervical cancer. Based on the database of the Japanese Gynecologic Oncology Group, 2194 patients with stage IB1/IB2 (FIGO 2018), who underwent radical hysterectomy between 1/1/2004-12/31/2008, were identified as eligible for this retrospective study. Patients with squamous cell carcinoma had significantly frequent lympho-vascular space invasion than those with non-squamous cell carcinoma in both stage IB1 and IB2 (stage IB1; 29.1% vs. 17.1%, p < 0.0001, stage IB2; 50.5% vs. 39.7%, p = 0.0009). Among 1262 patients with stage IB1, 61.2% (772/1262) were low-risk group, 29.4% (371/1262) were intermediate-risk group (single risk: 23.3%, double risks: 6.1%). Of 932 patients with stage IB2, 32.1% (299/932) were low-risk group, 59.1% (551/932) were intermediate-risk group (single intermediate-risk: 31.0%, double intermediate-risk: 28.1%). Disease-free survival rate and overall survival rate of stage IB1 patients were significantly better than those with stage IB2 (5-year DFS; 94.7% vs. 88.6%, p < 0.001, 5-yrs OS; 98.5% vs. 95.1%, p < 0.001). Stage IB1 Patients with double intermediate-risk showed significantly worse survival than those with single intermediate-risk (5-yrs DFS: 96.1% vs. 84.6%, p < 0.001, 5-yrs OS: 98.9% vs. 93.0%, p = 0.029). Multivariate analysis revealed that double intermediate-risk was the independent prognostic factor in stage IB1, but non-squamous cell carcinoma and intermediate-risk in stage IB2. Non-squamous cell carcinoma and intermediate-risk decreased survival in patients with stage IB2, whereas double intermediate-risk was a negative impact on survival in stage IB1.