Cancer Of Uterine Cervix Research Articles

Incidence and mortality of cervix cancer and their relationship with the human development index in 185 countries in the world: An ecology study in 2018

Introduction: Invasive cervix cancer is one of the most common causes of female genital cancer and accounts for 30% of cancers in developing countries and 5% in developed countries. Economic, social and sexual differences are associated with an increased risk of the cancer in women. Methods: This is a descriptive–analytic study based on incidence and mortality data extracted from the World Cancer Bank. The incidence and mortality rates and cervix uteri cancer distribution maps were drawn for world countries. To analyse data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with Human Development Index (HDI). The statistical analysis was carried out by Stata-14, and the significance level was estimated at the level of 0.05. Results: The results showed a significant negative correlation between cervix cancer incidence rate (r = −0.570,P

PCN371 - HEALTH RELATED QUALITY OF LIFE IN CERVIX-UTERI CANCER WOMEN TREATED IN A MEXICAN THIRD LEVEL PUBLIC FACILITY

Upgrading cervix-uteri cancer (CUCa) detection and treatment, has impacted in patients’ overall survival rates. This situation makes important to evaluate the health-related quality of life (HRQoL) in this women. To determine the HRQoL scores in cervix-uteri cancer women treated in a Mexican third level public facility. The HRQoL scores were evaluated in 70 cervix-uteri cancer patients, using the questionnaires EORTC QLQ-C30 and EORTC QLQ-Cx24. The results were analyzed by clinical stage (CS) and described in median and interquartile interval (IQI). To identify differences between groups, Kruskall-Wallis test was applied. The CS-II was the most frequent (31.4%). The median (Md) and IQI score of Global Health Scale/Quality of Life was 75 (IQI:50-91.67); the physical functioning Md 86.67(IQI:60-93.3); the emotional functioning Md 66.67 (IQI:39.58-93.75); cognitive functioning Md 83.33 (IQI:66.67-100), and social functioning Md 100 (IQI:83.33-100); the most affected symptom scales are: insomnia Md 33.33 (IQI:0.00-66.67) and fatigue Md 33.33 (IQI:0.00-55.56). The most affected score of EORTC QLQ-CX24 questionnaire was the peripheral neuropathy scale with a Md 33.33 (IQI: 0.00-41.66). No differences were observed by clinical stage. The HRQoL scores reported in cervix-uteri cancer Mexican women were lower than reported scores published in other HRQoL studies. The most affected scale was the peripheric neuropathy scale.

PCN358 - SATISFACTION WITH HEALTH CARE ANALYSIS IN CERVIX-UTERI CANCER MEXICAN WOMEN TREATED IN A THIRD LEVEL PUBLIC FACILITY

Quality health care is closely related not only to disease remission or disease cure, also support the patients to handle their disease. Currently, there are different strategies directed to maximazing the values for patients in order to get the best outcomes in a patient-centered point of view based on their own requirements. To evaluate the health care satisfaction in cervix-uteri cancer (CUCa) women treated in a third level public facility. Were studied 70 CUCa patients, treated by surgical oncology and radio-oncology clinical departments. The health care satisfaction was evaluated through EORTC INPATSAT-32 questionnaires. The results were expressed in median (Md) and interquartile interval (IQI). Kruskall-Wallis was used to identify statistical differences between groups. The general satisfaction score shown a Md 100 (IQI:75-100). The analysis by clinical stage (CS), show the lowest scores in CS-I patients group. The score related to doctors-group performance shown a variability between 62 to 75 points in CS-I, 75 to 92 in CS-II, 68 to 87 in CS-III and75 in CS-IV. The lowest scores in nurses-group performance were observed in the information provision scales [CS-I=58.8 (50-100); CS-II=75 (50-100); CS-III=54.17 (43.7-100) and CS-IV=66.67 (50-100)]. The lowest scores were observed for the access scale [CS-I=62.5 (50-81.25); CS-II=75(50-90.63); CS-III=62.25 (25-90.63) and CS-IV=75 (50-87.50)]. The healthcare satisfaction evaluation permitted to identify issues related to the healthcare quality, patient-centered point of view that needs to be enhanced as a part of the third-party payer activities.

Development of Operational Framework for Management of Common Cancers in India

Background and context: Cancers of the breast, uterine cervix, and oral cavity are the 3 most common malignancies in India. Overall, they comprise around one third of >1 million cases diagnosed with cancer in India each year. An effective operational framework (OF) for early detection and screening programs should play a key role in reducing and managing the cancer burden in India. Aim: i. To provide guidelines to the clinicians, and public health practitioners for screening and early detection of breast, uterine cervix, and lip or oral cavity cancers in India. ii. To build guide/roadmap for policymakers involved in developing and implementing strategies for cancer control in India. Strategy/Tactics: In collaboration with the Center for Global Health at the U.S. National Cancer Institute, 25 scientific experts comprising researchers, public health leaders, medical and dental professionals from France, India, United States, and Zambia met at Indian Council of Medical Research (ICMR)-National Institute of Cancer Prevention and Research, to summarize the feasible options and relevant evidence for screening and early detection of common cancers in India. They came out with the operational framework Program/Policy process: Recognizing the key role that effective early detection and screening programs could have in reducing the cancer burden, the ICMR-National Institute of Cancer Prevention and Research, in collaboration with the U.S. National Cancer Institute Center for Global Health, held a workshop to summarize feasible options and relevant evidence for screening and early detection of common cancers in India. Outcomes: a. A publication in Lancet: Rajaraman P, Anderson BO, Basu P, et al: Recommendations for screening and early detection of common cancers in India. Lancet Oncol 16(7):e352-e361, 2015. b. State and PHC level trainings on operational framework started in each state for the primary health care providers. What was learned: The OF acts as a guide for policymakers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control. Common and consistent OF will go a long way to chart out the intensity of the problem and to rectify it.

Comparative Study of External Beam Radiotherapy with Cisplatin Verses Paclitaxel in Locally Advanced Cervical Carcinoma

Objective: The purpose of the study was to identify the value and response of four field radiotherapy, combined with concurrent chemotherapy (cisplatin vs. paclitaxel) as radio a sensitizer.
 Method: Fifty patients with diagnosis of Carcinoma of Cervix were consecutively enrolled in this study 25 assigned in each group. Gr 1 was assigned for Cisplatin as sensitizer and Gr 2 received Paclitaxel. Radiation fields were similar. The response and adverse effects were evaluated in fixed interval or at the time when it occurred.
 Result: Fifty patients were enrolled. FIGO stage of disease were stage IIB (n=33) and stage IIIB (n=14). The most commonly used field size for anterior / posterior field 15 x 15 cm and 15 x 18 cm. The lateral field size from right and left are 15 x 7 cm and 15 x 6 cm. Cisplatin 30 mg /m2 or Paclitaxel 230mg/m2 were used as assigned in each group of 25. During weekly assessment of chemo-irradiation, the reaction was seen from second week to fifth week of the treatment which were mild to moderate in severity. Vesico-Vaginal Fistula were seen in 8.0% of patient. Eighteen patients came for one follow up, 15 patients attended two follow up, and 17 patients attended all three scheduled follow up. Complete response was evaluated in 25 patients (p=0.002), partial response in 14 patients (p=0.03) and poor response in 11 patients (P=0.50).
 Conclusion: There are no significant differences in cisplatin or paclitaxel as a sensitizer in concurrent radiotherapy in response for cancer of uterine cervix. Rate of side effects were also similar. Further large scale studies may evaluate the difference in response of concurrent chemo-radiotherapy of these two drugs to confirm the optimal duration and schedule of concurrent chemotherapy.

CXCL5, the upregulated chemokine in patients with uterine cervix cancer, in vivo and in vitro contributes to oncogenic potential of Hela uterine cervix cancer cells

CXCL5 is showed a surprisingly elevated profile and implicated in tumorigenesis in several tumors. However, the expression and function of CXCL5 in uterine cervix cancer (UCC) remain largely unknown. The current study aimed to elucidate the expression pattern of CXCL5 in human UCC tissues and Hela cervix cancer cell, as well as its functions in Hela cells. Our data showed that CXCL5 and its receptor CXCR2 were expressed by Hela uterine cervix cancer cells. CXCL5 was upregulated in UCC tissues, and its overexpression was positively correlated with age, but did not correlate with clinical stages and tumor infiltration. Exogenous administration of CXCL5 and CXCL5 overexpression contributed to proliferation and migration activities of Hela cells in vitro, consistent with this, CXCL5 overexpression also promoted growth of Hela cells in a nude mouse xenograft model. At the gene level, CXCL5 overexpression regulated the expression of tumor-related genes including ERK, p-ERK, AKT, p-AKT, DIABOL, NUMB, NDRG3 and CXCR2. Taken together, CXCL5 may contribute to a dominant role in UCC progression and sever as a potential molecular therapeutic target for UCC.

Porphyromonas gingivalis Promotes 4-Nitroquinoline-1-Oxide-Induced Oral Carcinogenesis With an Alteration of Fatty Acid Metabolism.

Microbiota has been widely considered to play a critical role in human carcinogenesis. Human papilloma virus, hepatitis B and C virus, and Helicobacter pylori are implicated in the pathogenesis of cancer of uterine cervix, liver, and stomach, respectively. However, whether Porphyromonas gingivalis (P. gingivalis), a common Gram negative oral bacteria, is associated with oral carcinogenesis still remains unclear and its underlying mechanism needs to be addressed. Here, we established a combined experimental system of 4NQO-induced oral carcinoma model and chronic periodontitis model and investigated the effects of P. gingivalis infection on oral carcinogenesis and fatty acid metabolism during oral carcinogenesis. The data showed that in this animal model, P. gingivalis infection induced mice periodontitis, increased the tongue lesion size and multiplicity of each mouse and promoted oral cancer development. P. gingivalis treatment significantly increased the level of free fatty acids and altered the fatty acid profile in tongue tissues and the serum of mice. And P. gingivalis induced the formation of fatty liver of the mice. Besides, immunohistochemical analysis and qRT-PCR showed that the expression of fatty-acid synthase and acetyl-CoA carboxylase 1 were increased in the tongue and liver tissues of 4NQO-treated mice infected with P. gingivalis. These results showed that P. gingivalis promoted oral carcinogenesis and aggravated disturbance of fatty acid metabolism, indicating a close association among P. gingivalis, lipid metabolic and oral carcinogenesis.

Cervical cancer in Iran: integrative insights of epidemiological analysis.

Background: Cervical cancer is a common cancer among women around the world. Due to the geographical differences in incidence, mortality and risk factors of cervical cancer, it is necessary to conduct different studies in different countries. This review study is aimed to investigate the most important aspects of cervical cancer in Iran.Methods: Reviewing papers without time limitation was conducted with the keywords cervical cancer, Cervix uteri cancer and Iran in their title or abstract. The databases of Medline, IranMedex, SID, ScienceDirect, Embase, Google Scholar, Web of Science, and Scopus were searched. The title and abstract of the papers were reviewed, in all, 51 full papers were reviewed.Results: Based on published studies, the incidence of cervical cancer varies between different areas of Iran. The findings of this study demonstrated that there is a relationship between marital status, marriage age, and age of first pregnancy, smoking, and consumption of oral contraceptive pills, multiple sexual partners, family history, multiparty, and cervical cancer.Conclusion: The results of this review showed that the incidence of cervical cancer in Iran is low; however, the risk factors associated with this cancer are not few, which could lead to the increase in the incidence of cervical cancer in the future.

Recurrent pregnancy loss and future risk of female malignancies.

To investigate whether patients with a history of recurrent pregnancy loss (RPL) have an increased risk for future female malignancies. A retrospective population-based study compared the incidence of long-term female malignancies in a cohort of women with and without a history of RPL (2 or more consecutive pregnancy losses). Deliveries occurred between the years 1988 and 2013, with a mean follow-up duration of 12years. Women with known malignancies before the index pregnancy were excluded from the analysis. Female malignancies were divided according to specific type including ovary, breast, uterine and uterine cervix. Kaplan-Meier survival curve was used to estimate the cumulative incidence of malignancies. Cox proportional hazards model was used to determine the adjusted hazard ratios (HR) for female malignancy after controlling for confounders. During the study period, 106,265 patients met the inclusion criteria; 6.6% (n = 7052) of patients had a diagnosis of RPL. During the follow-up period, patients with RPL had a significantly increased risk of being diagnosed with female malignancies as a group, while individually there was an increased risk of breast and uterine cervix cancer. Using a Kaplan-Meier survival curve, patients with a history of RPL had a significantly higher cumulative incidence of female malignancies. Using a Cox proportional hazards model, adjusted for confounders such as smoking, parity, and diabetes mellitus, a history of RPL remained independently associated with female malignancies (adjusted HR 1.4; P = 0.003). RPL is independently associated with long-term female malignancies. Patients with a history of RPL may benefit from counseling and screening for breast and uterine cervix cancer in particular.

Outcome of Treatment and Causes of Failure in Cancer Cervix Treated with Concurrent Chemoradiation

Introduction: Cervix uteri cancer is most known disease found among women worldwide after breast, colorectal and lung cancers. The present study aimed to evaluate prognostic factors (patient, tumor and treatment) in carcinoma of cervix treated with concurrent chemoradiation. Materials and Methods: 40patients included in the study and were planned to deliver by 3- Dimensional Conformal radiotherapy using four field box technique.Radiotherapy dose delivered to pelvic area was 50 Gy in 25 fractions at 200cGy/dayfollowed by intracavitary brachytherapy either 4 applications of 6Gy/fraction or 3 applications of 7Gy/fraction each as per departmental protocol. Chemotherapy dose delivered to patients received cisplatin 35mg/m2 weekly i.v. for a total of 5 cycles or 75mg/m2 triweekly i.v. for a total of 2 cycles. All patients were followed up at least 6 months from day of completion of treatment. Result:Collected data was analyzed using Chi Square test to calculate level of significance it was found that significant prognostic factors are blood haemoglobin level (p = 0.006), stage (p = 0.016), histological grade (p = 0.039), lymph node involvement (p = 0.031), parametrial extension (p = 0.038), hydronephrosis (p = 0.015), tumor size (p = 0.038) and duration of treatment (p = 0.031) whereas age, histological type and subtype, total radiation dose and concurrent use of chemotherapy are found to be insignificant. Conclusion: The outcomes of cancer cervix patent depends upon patient, tumor and treatment related factors. Presence of poor prognostic factors related to tumor may need intensification of the treatment by concurrent use of chemotherapy drugs, counteracting hypoxia by maintaining hemoglobin during treatment.

The dosimetric comparison of ıntensity modulated radiotherapy and volumetric arc therapy in locally advanced uterine cervix cancer

Amaç: Radyokemoterapi lokal ileri evre serviks kanserinin tedavisinde standart yaklaşımdır. Amacımız, serviks kanseri tedavisinde modern tekniklerden yoğunluk ayarlı radyoterapi (YART) ve volumetrik ark terapi (VMAT) tekniklerini dozimetrik olarak karşılaştırmaktır. Gereç ve Yöntem: Kliniğimizde tedavi edilmiş 10 lokal ileri evre serviks kanseri hastasının bilgisayarlı tomografi (BT)’leri kullanılmıştır. Hastalarda gross tümör hacmi (GTV), klinik tümör hacmi (CTVtm) ve lenf nodları (CTV lenf nodu) ve komşu risk altındaki organları konturlanmıştır. CTVtm ve CTV lenf nodlarına 1.5 cm sınır verilerek tedavi hacimleri oluşturulmuştur. Total doz 50.4 Gy olacak şekilde günlük 1.8 Gy fraksiyon dozu ile tedavi planlamaları yapılmıştır. İki teknik, Doz volüm histogramı, homojenite indeks (HI), konformite indeks (KI), monitör ünit (MU), segment sayısı değerlendirmeleri yapılmıştır. Bulgular: İnce bağırsak için, 40 Gy doz alan hacim yüzdeliğinin YART tekniğinde medyan değeri %14.24 iken, VMAT tekniğinde %11.28 olarak hesaplanmıştır (p=0.022). VMAT tekniğinde %12.39 olarak hesaplanan femur başları 30 Gy doz alan hacim değerleri, YART tekniğinde ortanca değeri %7.80 olarak bulunmuştur (p=0.007). VMAT tekniği istatistiksel anlamlı seviye kısa sürede tamamlanırken, fraksiyon başına MU değeri anlamlı olarak fazla bulunmuştur. Her iki tedavi tekniğinin de HI ve KI değerleri açısından aralarında farklılık gösterilememiştir. Sonuç: Hasta konforuna ve cihaz performansına açısından VMAT tekniğinde kısa tedavi süresi avantaj olarak görülmektedir. Kliniğimizin mevcut cihaz durumuna göre her iki tedavi modeli de kullanılabilir

Deregulation of LIMD1-VHL-HIF-1α-VEGF pathway is associated with different stages of cervical cancer.

To understand the mechanism of cellular stress in basal-parabasal layers of normal cervical epithelium and during different stages of cervical carcinoma, we analyzed the alterations (expression/methylation/copy number variation/mutation) of HIF-1α and its associated genes LIMD1, VHL and VEGF in disease-free normal cervix (n = 9), adjacent normal cervix of tumors (n = 70), cervical intraepithelial neoplasia (CIN; n = 32), cancer of uterine cervix (CACX; n = 174) samples and two CACX cell lines. In basal-parabasal layers of normal cervical epithelium, LIMD1 showed high protein expression, while low protein expression of VHL was concordant with high expression of HIF-1α and VEGF irrespective of HPV-16 (human papillomavirus 16) infection. This was in concordance with the low promoter methylation of LIMD1 and high in VHL in the basal-parabasal layers of normal cervix. LIMD1 expression was significantly reduced while VHL expression was unchanged during different stages of cervical carcinoma. This was in concordance with their frequent methylation during different stages of this tumor. In different stages of cervical carcinoma, the expression pattern of HIF-1α and VEGF was high as seen in basal-parabasal layers and inversely correlated with the expression of LIMD1 and VHL. This was validated by demethylation experiments using 5-aza-2'-deoxycytidine in CACX cell lines. Additional deletion of LIMD1 and VHL in CIN/CACX provided an additional growth advantage during cervical carcinogenesis through reduced expression of genes and associated with poor prognosis of patients. Our data showed that overexpression of HIF-1α and its target gene VEGF in the basal-parabasal layers of normal cervix was due to frequent inactivation of VHL by its promoter methylation. This profile was maintained during different stages of cervical carcinoma with additional methylation/deletion of VHL and LIMD1.

A cross sectional study on cervical cancer and its prevention among women of age group 25- 50 years in a rural area of south Tamilnadu, India.

Background:Cancer of uterine cervix is one of the common carcinoma among females. India accounts for about 20% of cervical cancers. Prevention of cervical cancer, whether primary or secondary requires active participation of the community. For this they need knowledge about the disease & its prevention. Hence a study to assess the knowledge, attitude and practice regarding cervical cancer and its prevention was undertaken. Methods:A cross-sectional observational study was conducted in a panchayat area of Kanyakumari district, South Tamilnadu. A sample of 100 women aged 25-50 years was taken by multistage random sampling. Results:Only 68 women were aware of the existence of cervical cancer & Health workers were the most common source of information (41.2%). Those who were employed had more awareness though the differences were not statistically significant. Only 8 women (11.76%) knew that there is a vaccine to prevent cancer cervix. Among those who were aware of cervical cancer, only 47 (69.1%) knew about the existence of a screening test to detect cancer cervix. Only 8 women had undergone PAP smear. Among those willing to reveal the reason for not undergoing PAP smear, lack of time (15.38%), embarrassment (10.26%) and no facility (2.8%) were the reasons. Women who were employed were more likely to be aware about screening for cervical cancer (75%). Conclusions: The existence of cervical cancer has reached the awareness of majority of the women in our area. But specific knowledge about cervical cancer & its prevention is still lacking.

Bivariate spatiotemporal disease mapping of cancer of the breast and cervix uteri among Iranian women.

Cervical cancer in women is one of the most common cancers and breast cancer has grown dramatically in recent years. The purpose of this study was to map the incidence of breast and cervix uteri cancer among Iranian women over a 6-year period (2004-2009) searching for trend changes and risk factors. Cancer incidence data were extracted from the annual reports of the National Cancer Registry in Iran. Hierarchical Bayesian models, including random spatial and temporal effects was utilized together with bivariate, spatio-temporal shared component modelling. The provinces Tehran, Isfahan, Mazandaran and Gilan were found to have the highest relative risk (RR) of breast cancer, while the highest RR of cervix uteri cancer was observed in Tehran, Golestan, Khuzestan and Khorasan Razavi. Shared risk factors (smoking component) between the two cancers were seen to have the highest influence in Tehran, Khorasan Razavi, Yazd, Isfahan, Golestan, Khuzestan, Fars and Mazandaran, while the least were observed in Kohgiluyeh Boyerahmad. Apparent differences and distinctions between high-risk and low-risk provinces reveal a pattern of obvious dispersion for these cancers in Iran that should be considered when allocating healthcare resources and services in different areas.

Impact of cancer diagnosis on different aspects of life of patients of cancer breast and cancer cervix uteri: a cross sectional study at Government Medical College, Amritsar, Punjab

Background: Advancements in understanding about the etiology and pathogenesis of cancer has led to increased awareness regarding the clinical course of disease and its appropriate treatments. This is the major reason behind longer life expectancy in cancer patients. However, this longer life is not necessarily an easy one due to debilitating nature of both the disease and its treatment modalities. This study was done to assess the impact of cancer diagnosis on the psycho-social aspects of patient’s lives.Methods: All patients of cancer breast and cancer of cervix uteri, who reported between January 1, 2013 to December 31, 2015; at Radiotherapy Department, Guru Nanak Dev Hospital, Government Medical College, Amritsar and were residents of Amritsar District, were listed and a total of 127 patients were included in the study. Patients were interviewed using a pre-tested, pre-designed questionnaire at their place of residence.Results: Assessing the demands of the altered lives of cancer patients in different aspects like modifications in daily living, loss of work and pleasure, reformed religious/spiritual opinions, social support received etc. It is seen that social life of patients is affected after diagnosis of cancer. However, social support received by the patients and families is similar as compared to before diagnosis.Conclusions:Maximal impact of cancer, its diagnosis and treatment is on various aspects of the life of patients not only immediate family but relatives, friends and neighbours lend psychological, social and economic support in such situations which helps a cancer survivor cope with the trauma and carry on with their lives.

Leveraging National Cancer Institute Programmatic Collaboration for Uterine Cervix Cancer Patient Accrual in Puerto Rico.

Women in the U.S. Commonwealth of Puerto Rico (PR) have a higher age-adjusted incidence rate for uterine cervix cancer than the U.S. mainland as well as substantial access and economic barriers to cancer care. The National Cancer Institute (NCI) funds a Minority/Underserved NCI Community Oncology Research Program in PR (PRNCORP) as part of a national network of community-based health-care systems to conduct multisite cancer clinical trials in diverse populations. Participation by the PRNCORP in NCI’s uterine cervix cancer clinical trials, however, has remained limited. This study reports on the findings of an NCI site visit in PR to assess barriers impeding site activation and accrual to its sponsored gynecologic cancer clinical trials. Qualitative, semi-structured individual, and group interviews were conducted at six PRNCORP-affiliated locations to ascertain: long-term trial accrual objectives; key stakeholders in PR that address uterine cervix cancer care; key challenges or barriers to activating and to enrolling patients in NCI uterine cervix cancer treatment trials; and resources, policies, or procedures in place or needed on the island to support NCI-sponsored clinical trials. An NCI-sponsored uterine cervix cancer radiation–chemotherapy intervention clinical trial (NCT02466971), already activated on the island, served as a test case to identify relevant patient accrual and site barriers. The site visit identified five key barriers to accrual: (1) lack of central personnel to coordinate referrals for treatment plans, medical tests, and medical imaging across the island’s clinical trial access points; (2) patient insurance coverage; (3) lack of a coordinated brachytherapy schedule at San Juan-centric service providers; (4) limited credentialed radiotherapy machines island-wide; and (5) too few radiology medical physicists tasked to credential trial-specified positron emission tomography scanners island-wide. PR offers a unique opportunity to study overarching and tactical strategies for improving accrual to NCI-sponsored gynecologic cancer clinical trials. Interview findings support adding and re-tasking personnel for coordinated trial-eligible patient referral, accrual, and treatment.

EP-1528: Evolution of acute toxicities in Volumetric Modulated Arc Therapy of uterine cervix cancer

EP-1528: Evolution of acute toxicities in Volumetric Modulated Arc Therapy of uterine cervix cancer

Protein Expression Analysis in Uterine Cervical Cancer for Potential Targets in Treatment.

Specific markers in lesions of the human uterine cervix cancer (UCC) are still needed for prognostic, diagnostic and/or therapeutic purposes. In this study we evaluated key molecules at protein level between normal epithelium, cervical intraepithelial neoplasia (CIN1-3) and invasive cancer of a group of molecules previously reported at mRNA level. For that purpose, human formalin-fixed paraffin embedded tissue microarrays (TMAs) were constructed containing 205 Mexican tissue core specimens. Immunohistochemistry and quantitative analysis of histological staining was performed against twenty-two distinct proteins for each core and the processing platform ImageJ. In the progression of the disease we found key statistical differences for the proteins SEL1, Notch3 and SOCS3. High expressions of SEL1L, Notch3 and SOCS3 have potential value to increase the prognostic of UCC in combination with markers such as p16INK4a. This study identified key drivers in cervical carcinogenesis that should be evaluated for the development of UCC therapies.

Value of introvoxel incoherent motion imaging on evaluating concurrent chemoradiotherapy response in patients with advanced uterine cervix cancer

Objective To investigate the value of introvoxel incoherent motion (IVIM) using 3.0 T MRI to evaluate response to concurrent chemoradiotherapy (CCRT) in patients with advanced uterine cervix cancer. Methods From July 2015 to December 2016, 63 patients with advanced (≥ⅡB) cervical cancer diagnosed by clinical and imaging study, who had completed CCRT plan in Henan Cancer Hospital, were prospectively enrolled. Pelvic MRI protocol including T1WI, T2WI, IVIM and dynamic contrasted enhanced scans were performed in each patient before CCRT and 3 weeks after starting therapy (total dose of 30 Gy), and at the end of therapy (total dose of 90 Gy, 8 weeks after therapy). The mean values of ADC, true molecular diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f) in each tumor at pre-therapy, in the middle of therapy and post-therapy were measured and recorded as ADC-pre, D-pre, D*-pre, f-pre;ADC-mid, D-mid, D*-mid, f-mid and ADC-post, D-post, D*-post, f-post, respectively;the change rates of these parameters during and after therapy (recorded as ΔADC-mid, ΔD-mid, ΔD*-mid, Δf-mid; ΔADC-post, ΔD-post, ΔD*-post, Δf-post) were also calculated. Patients were classified into response group and non-response group, according to response evaluation criteria in solid tumors after CCRT. MRI imaging study was performed in each patient within 1 month after CCRT to follow up, and tumor regression rate was calculated. The Mann-Whitney U test was used to compare differences of parameters and their change rates between response group and non-response group. Spearman correlation analysis was performed to assess relationships between parameters, parameter change rates and tumor regression rate. Logistic regression model was applied to find potential ADC values for predicting therapeutic response. ROC was used to analyze efficacy of ADC values for evaluating therapeutic response in advanced uterine cervix cancer after CCRT. Results The mean value of tumor maximum diameter before and after therapy was (47.5 ± 12.9) and (12.8 ± 10.0) mm, tumor regression rate was (66.7 ± 33.6)%. Forty-eight patients were in the response group and 15 in the non-response group. The mean value of ADC-pre, D-pre, D*-pre and f-pre was 0.74(0.43, 1.14)×10-3, 0.58(0.33, 0.91)×10-3, 12.12(2.30, 21.4)×10-3mm2/s, 9.65%(4.45%, 13.89%), respectively. Tumor regression rate had positive correlation with ADC-pre and D-pre (r=0.773, 0.840;P<0.05). Responders had increased ADC-pre, D-pre values than non-responders, which had statistically significant difference (P<0.05). Responders had increased ADC-mid, D-mid and f-mid values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-mid, D-mid and f-mid (r=0.808, 0.834, 0.563;P<0.05). Responders had increased ADC-post, D-post and f-post values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-post and D-post (r=0.799, 0.829;P<0.05).Tumor regression rate had positive correlation with ΔADC-mid, ΔD-mid, Δf-mid(r=0.526, 0.573, 0.454;P<0.05) and with ΔADC-post, ΔD-post, Δf-post (r=0.541, 0.555, 0.388;P<0.05). Responders had increased ΔADC-mid, ΔD-mid, Δf-mid and ΔADC-post, ΔD-post, Δf-post, which had statistically significant difference (P<0.05). Logistic regression analysis revealed only ADC-pre and D-post could be independent factors to predict therapeutic response in advanced uterine cervix cancer after CCRT, values of B, Wald, odds ratio and P was 22.488, 8.431, 1.429, 0.004 and 16.542, 8.517, 1.779, 0.004. ROC analysis showed the area under the curve (AUC) of ADC-pre, D-pre, ΔADC-mid, ΔD-mid, Δf-mid, ΔADC-post, ΔD-post and Δf-post for predicting therapeutic response in advanced uterine cervix cancer after CCRT were 0.890, 0.926, 0.942, 0.851, 0.803, 0.929, 0.951 and 0.906, respectively. Conclusion The IVIM parameters before and during CCRT process and their changes are valuable for predicting and evaluating therapeutic response in advanced uterine cervix cancer after CCRT, with high clinical practice value. Key words: Uterine cervical neoplasms; Magnetic resonance imaging; Introvoxel incoherent motion; Efficacy evaluation; Concurrent chemoradiotherapy

Abstract P3-01-19: Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management

Abstract Background: The study of sentinel lymph node (SNL) assessed by OSNA provides a new variable, Total Tumoral Load (TTL).This variable is defined as the amount of CK19 mRNA copies number in all positives SLN. TTL has been showed to predict the axillary node status and has been analysed to determine its usefulness in the axillary surgical management. Based on TTL values different cut-off points have been proposed (last 25.000 copies) to establish a new tool to practice axillary lymph node dissection (ALND). We present the follow-up data of at least 5 years of breast cancer patients who underwent ALND according, strictly, to Z0011 trial criteria. We hypothesized that there will be no correlation between TTL and locoregional relapse if Z0011 are followed. Methods: Clinicopathological and follow up data were obtained from patients with invasive breast cancer and SLN assessed by OSNA between 2011 and 2012 at Complejo Asistencial de Ávila, Spain. ALND was decided based on Z0011 study criteria independently of TTL. All patients have been followed for a minimun of 5 years. Results: A total of 106 patients underwent SN assessed by OSNA, age range 27-85 years (mean 58,96). Of them 90% were ductal, 7,5% lobular and 2% others. By inmunophenotype: Luminal A 55%, Luminal B 28%, Triple Negative 9,4%, Her2 positive 3,7% and Luminal B-Her2 positive 2,8%. TTL was equal to zero in 58 cases and greater than zero in 48 cases with a range of 280-2.700.000 copies. Only 5 cases met ALND criteria (average TTL 68.164). Average TTL in cases without ALND was 111.000. For the time being, none of them has had locoregional relapse (median follow up 65 months). 3 patients have died one metastatic desease (Negative SN), one uterine cervix cancer and one neutropenic fever. Baseline and outcomes dataVARIABLE N%Age, years (median, range) 59 (27-85) Tumour TypeDuctal9690,5 Lobular87,5 Others21,8InmunophenotypeLuminal A5955,6 Luminal B3028,3 Luminal B-Her232,8 Her243,7 Triple Negative109,4Total Tumoral Load (TTL)=05854,7 &amp;gt;04845,2Axillary Lymph Node Dissection (ALND) 254,7TTL &amp;gt;25.000 2321,7Locoregional relapse 00Overall Survival 95,2 Conclusions: -Using Z0011 criteria and OSNA no locoregional recurrence has been observed so far. -TTL did not predict risk of recurrence -If we had based axillary management only on TTL values (i.e higher than 25.000 copies) we would have unnecessarily increased the number of lymphadenectomies in a 22%. This is an ongoing study that designed to increased the sample size and obtain longer follow-up data. Citation Format: Tur R, De Grado C, Martin MR, De Castro J, Filipovich E, Segovia B, Ceballos J, Parra J, Revestido R, Alés-Martínez JE. Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-19.