OBJECTIVE: All patients with stage IB1 cervical cancer do not need to undergo parametrectomy. Some low-risk criteria for parametrial involvement (PI) have been proposed based on pathological findings. The aim of this study was to determine pretreatment risk factors for PI in stage IB1 cervical cancer. METHODS: We retrospectively reviewed 115 patients with stage IB1 cervical cancer who underwent radical hysterectomy or radical trachelectomy. Magnetic resonance imaging (MRI) was performed and serum concentrations of squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 125 (CA-125) were determined in all patients before initial treatment. The following pretreatment factors were investigated: histological variant, maximum tumor diameter, tumor volume (volume index), pelvic lymph node enlargement, and serum tumor markers. Logistic regression analysis was used to select the independent risk factors for PI. RESULTS: Eighteen of the 115 patients (15.7%) were pathologically diagnosed with PI. Multivariate analysis confirmed the following independent risk factors for PI: MRI-based tumor diameter > or =25 mm (odds ratio [OR], 9.9; 95% confidence interval [CI], 2.1 to 48.1), MRI-based volume index > or =5,000 mm3 (OR, 13.3; 95% CI, 1.4 to 125.0), and positive serum tumor markers SCC-Ag > or =1.5 ng/mL or CA-125 > or =35 U/mL (OR, 5.7; 95% CI, 1.3 to 25.1). Of 53 patients with no risk factors for PI, none had PI. CONCLUSION: Less radical surgery may become one of the treatment options for stage IB1 cervical cancer patients with MRI-based tumor diameter <25 mm, MRI-based volume index <5,000 mm3, and negativity for SCC-Ag and CA-125.
Adult ; Aged ; Antigens, Neoplasm/metabolism ; Biomarkers, Tumor/metabolism ; Female ; Humans ; Hysterectomy/methods ; Lymphatic Metastasis ; Magnetic Resonance Imaging/methods ; Middle Aged ; Neoplasm Staging ; Observer Variation ; Retrospective Studies ; Risk Factors ; Serpins/metabolism ; Uterine Cervical Neoplasms/metabolism/*pathology/surgery ; Young Adult

Adenocarcinoma ; metabolism ; pathology ; Adenocarcinoma, Clear Cell ; metabolism ; pathology ; Adult ; Carcinoma, Endometrioid ; metabolism ; pathology ; Cervix Uteri ; metabolism ; pathology ; surgery ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; Diagnosis, Differential ; Electrosurgery ; Endometrial Neoplasms ; metabolism ; pathology ; Female ; Humans ; Hyperplasia ; Keratin-7 ; metabolism ; Mesonephros ; metabolism ; pathology ; surgery ; Neprilysin ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology

Adult ; Breast Neoplasms ; metabolism ; pathology ; secondary ; Carcinoid Tumor ; metabolism ; pathology ; surgery ; Carcinoma, Adenoid Cystic ; pathology ; Carcinoma, Lobular ; metabolism ; pathology ; secondary ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; surgery ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Hysterectomy ; Keratins ; metabolism ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; Ovarian Neoplasms ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; Synaptophysin ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery

Adenocarcinoma ; drug therapy ; immunology ; pathology ; radiotherapy ; surgery ; Adult ; Antigens, Neoplasm ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; administration & dosage ; Carcinoma, Squamous Cell ; drug therapy ; immunology ; pathology ; radiotherapy ; surgery ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Female ; Humans ; Hysterectomy ; Iridium Radioisotopes ; therapeutic use ; Middle Aged ; Neoadjuvant Therapy ; methods ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Preoperative Period ; Radiotherapy, Adjuvant ; Retrospective Studies ; Serpins ; metabolism ; Treatment Outcome ; Uterine Cervical Neoplasms ; drug therapy ; immunology ; pathology ; radiotherapy ; surgery

OBJECTIVETo investigate the association between CTLA-4 +49A/G polymorphisms and the risk of susceptibility to cervical cancer.

METHODSA hospital-based case-control study was conducted. 314 cases with primary cervical cancer and 320 healthy controls were collected and genotyped by PCR-based RFLP for +49A/G polymorphisms in the CTLA-4 gene.

RESULTSThe A allele and AA genotype of CTLA-4 gene were 32.5% and 9.6% in the patients, and 25.8% and 5.6% in the controls, respectively. Subjects with CTLA-4 +49AA genotype conferred a higher risk of cervical cancer (OR = 2.06, 95%CI: 1.10 - 3.85; P = 0.024). However, the correlation between AA genotype in CTLA-4 polymorphisms and clinicopathological characteristics was not significant.

CONCLUSIONThe results of this study suggest that CTLA4 gene is associated with cervical cancer risk and may be a susceptible gene of cervical cancer.

Adenocarcinoma ; genetics ; metabolism ; pathology ; surgery ; Adult ; Aged ; Alleles ; CTLA-4 Antigen ; genetics ; metabolism ; Carcinoma in Situ ; genetics ; metabolism ; pathology ; surgery ; Carcinoma, Squamous Cell ; genetics ; metabolism ; pathology ; surgery ; Case-Control Studies ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Middle Aged ; Neoplasm Staging ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Risk Factors ; Uterine Cervical Neoplasms ; genetics ; metabolism ; pathology ; surgery

OBJECTIVETo investigate the efficacy and toxicity of neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin for patients with locally advanced cervical cancer.

METHODSA total of 70 patients with locally advanced cervical cancer were treated with neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin in our department from July 2007 to May 2010. The stage distribution among the patients included 45 stage IB2, 21 stage IIa, and 4 stage IIb. Of the 70 patients, 6 were G1, 26 were G2, 32 were G3, and the rest 6 patients were not histologically classified. Sixty-five patients had squamous cell carcinoma, 3 had adenocarcinoma, and 2 patients had adenosquamous cell carcinoma. The clinicopathological parameters were analyzed, and their impact on tumor response were investigated.

RESULTSOf the 70 patients, 14 (20.0%) showed a complete response, 37 (52.9%) had a partial response to chemotherapy, making an overall response rate of 72.9%. Sixty-eight (95.7%) patients underwent surgery, and among them 12 (17.1%) pathological CR were identified. Eleven (16.2%) patients were found to have lymph node metastasis after surgery. Response rates of stage Ib2 and IIa patients were 73.7% and 52.3%, respectively, P<0.05. Patients with SCC exhibited a better response rate than patients with adenocarcinoma and adenosquamous cell carcinoma (73.8% vs. 60.0%). Initial tumor volume, histological classification and cycles of neoadjuvant chemotherapy were not significantly correlated with the response rate.

CONCLUSIONPaclitaxel and carboplatin or cisplatin regimen is a promising therapy with definite short-term efficacy, can improve the resection rate with tolerable side effects, and is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvant setting.

Adenocarcinoma ; drug therapy ; immunology ; pathology ; surgery ; Adult ; Antigens, Neoplasm ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; administration & dosage ; Carcinoma, Adenosquamous ; drug therapy ; immunology ; pathology ; surgery ; Carcinoma, Squamous Cell ; drug therapy ; immunology ; pathology ; surgery ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Lymphatic Metastasis ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Remission Induction ; Serpins ; metabolism ; Uterine Cervical Neoplasms ; drug therapy ; immunology ; pathology ; surgery

Adenocarcinoma ; metabolism ; pathology ; surgery ; Adenocarcinoma, Clear Cell ; metabolism ; pathology ; Adult ; CA-125 Antigen ; metabolism ; Carcinoembryonic Antigen ; metabolism ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; surgery ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Ki-67 Antigen ; metabolism ; Lymph Node Excision ; Membrane Proteins ; metabolism ; Neoplasm Invasiveness ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery

Adult ; Carcinoma, Small Cell ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Leukosialin ; metabolism ; Lymphoma ; metabolism ; pathology ; Peroxidase ; metabolism ; Sarcoma, Myeloid ; metabolism ; pathology ; surgery ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery ; Uterine Cervicitis ; metabolism ; pathology

OBJECTIVETo assess the feasibility of nerve sparing radical hysterectomy (NSRH) technique and the impact on the improvement of postoperative bladder function in patients with cervical cancer.

METHODSForty-two patients with FIGO stage Ib1 approximately Ib2 cervical cancer were selected to receive NSRH (study group, 21 cases) or routine hysterectomy (RH) (control group, 21 cases). Duration of surgery, blood loss and mean length of postoperative stay were compared between the two groups. Immunohistochemical analysis of surgical margins using a general nerve marker (S-100) was performed to compare the nerve damages.

RESULTSThe operation time of NSRH group and RH group was (248 +/- 24) min and (227 +/- 27) min, respectively, with a significant difference between the two groups (P < 0.01). No significant difference in blood loss was found between the NSRH and RH group [(459 +/- 143) ml vs. (454 +/- 121) ml, P > 0.05]. However, the median urinary catheterization time was 7 days in NSRH group versus 16 days in the RH group, with a statistically significant difference between the two groups (P < 0.01). The rate of patients who had postoperative residual urine volume in bladder (PVR) < or =100 ml was 66.7% in the NSRH group versus 19.0% in the RH group, with a significant difference between the two groups (P < 0.01). No severe perioperative complications occurred in both groups. After a follow-up of 11 to 16 months (median: 14 months), no recurrence was detected in the two groups. Immunohistochemistry with S-100 staining revealed only small nerve fibers in the surgical margins of the NSRH group, but full with large nerve bundles in that of the RH group. There was a significant difference between two group (P < 0.01).

CONCLUSIONThe results of our preliminary study indicate that nerve sparing radical hysterectomy (NSRH) for the patients with FIGO stage Ib1 approximately Ib2 cervical cancer is safe and feasible, and can well preserve the pelvic autonomic nerves and improve the recovery of bladder voiding function.

Adult ; Blood Loss, Surgical ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hypogastric Plexus ; surgery ; Hysterectomy ; methods ; Middle Aged ; S100 Proteins ; metabolism ; Urinary Bladder ; innervation ; surgery ; Urinary Catheterization ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery

Adult ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antigens, CD20 ; metabolism ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cervical Intraepithelial Neoplasia ; drug therapy ; metabolism ; pathology ; surgery ; virology ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Lymphoma, Follicular ; drug therapy ; metabolism ; pathology ; surgery ; virology ; Neoplasm Staging ; Neprilysin ; metabolism ; Papillomavirus Infections ; Prednisone ; therapeutic use ; Receptors, Complement 3d ; metabolism ; Rituximab ; Uterine Cervical Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; virology ; Vincristine ; therapeutic use