scholarly journals Integrated Analysis of Immune Infiltration Features for Cervical Carcinoma and Their Associated Immunotherapeutic Responses

2021 ◽  
Vol 9 ◽  
Author(s):  
Yanan Kang ◽  
Jin Huang ◽  
Yang Liu ◽  
Nan Zhang ◽  
Quan Cheng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Tumor Recurrence ◽  
Preliminary Evidence ◽  
Integrated Analysis ◽  
Survival Outcomes ◽  
Cervical Cancers ◽  
Tcga Dataset ◽  
The Relationship

Cervical cancer is the fourth most prevalent cancer in women, which decreases quality of life of the patients. Traditional interventions have failed to improve the overall survival period of patients due to high tumor recurrence after treatment or late diagnosis. Fortunately, preliminary evidence suggests that anti-angiogenic and immunotherapy can efficiently treat against cervical cancer. However, there is no clear evidence on the efficacy of immunotherapy in cervical cancer. Therefore, in this study, we classified cervical cancers in the TCGA dataset using various algorithms and explored the relationship between the immune profile and corresponding sensitivity of the tumors to immunotherapy. Results showed that patients with tumors had higher expression of immunocytes and longer overall survival time. In addition, we build a scoring system based on the immune landscape of the tumor microenvironment of cervical cancer. Tumors with higher scores exhibited better survival outcomes and were more sensitive to immunotherapy. In this study, the immune landscape of cervical cancer was analyzed, and the subtype of cervical cancer based on that difference was proposed. Besides, the subtype of cervical cancer showed different sensitivity to immunotherapeutic response which further confirmed its relationship with tumor immune landscape.

Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

2019 ◽  
Vol 29 (9) ◽  
pp. 1355-1360 ◽  
Author(s):  
Giorgio Bogani ◽  
Daniele Vinti ◽  
Ferdinando Murgia ◽  
Valentina Chiappa ◽  
Umberto Leone Roberti Maggiore ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Rank Test ◽  
Survival Outcomes ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Log Rank Test ◽  
Disease Free ◽  
Positive Lymph Nodes

ObjectiveNodal involvement is one of the most important prognostic factors in cervical cancer patients. We aimed to assess the prognostic role in relation to the burden of nodal disease in stage IIICp cervical cancer.MethodsData on all consecutive patients diagnosed with cervical cancer undergoing primary surgery (radical hysterectomy plus lymphadenectomy) or neoadjuvant chemotherapy followed by radical hysterectomy plus lymphadenectomy, between January 1980 and December 2017, were collected in a dedicated database. Exclusion criteria were: (1) consent withdrawal; (2) synchronous malignancies (within 5 years). Survival outcomes were assessed using Kaplan-Meier and Cox models.ResultsOverall, 177 (14.1%) of 1257 patients with cervical cancer were diagnosed with positive lymph nodes. After a median follow-up of 58 (range 4–175) months, 66 (37.3%) and 37 (20.9%) patients developed recurrent disease and died of disease, respectively. Via multivariate analysis, positive para-aortic nodes (HR 2.62, 95% CI 1.12 to 6.11; p=0.025) and the number of positive nodes (HR 1.06, 95% CI 1.02 to 1.11; p=0.002) correlated with worse disease-free survival. Furthermore, the number of positive nodes (HR 1.06, 95% CI 1.01 to 1.12; p=0.021) correlated with worse overall survival. Number of positive nodes (1, 2 or ≥3) strongly correlated with both disease-free survival (p<0.001, log-rank test) and overall survival (p=0.001, log-rank test). Focusing on patients receiving adjuvant radiation and chemotherapy, the number of positive lymph nodes was associated with response to treatment (p<0.001). Median disease-free survival was 100, 42, and 12 months for patients with one, two, or three or more positive lymph node(s), respectively (p<0.001, log-rank test).ConclusionsIn stage IIICp cervical cancer, adjuvant radiation and chemotherapy provides adequate overall survival in patients diagnosed with only one metastatic node, while survival outcomes are poor in patients with two or more metastatic nodes. This highlights the need for innovative treatments in patients with a high burden of lymphatic disease.

scholarly journals Five-year overall survival following chemoradiation therapy for locally advanced cervical carcinoma in women living with and without HIV infection in Botswana

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Emily MacDuffie ◽  
Memory Bvochora-Nsingo ◽  
Sebathu Chiyapo ◽  
Dawn Balang ◽  
Allison Chambers ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Hiv Infection ◽  
Locally Advanced ◽  
Chemoradiation Therapy ◽  
Survival Outcomes ◽  
Stage At Diagnosis ◽  
Hiv Status ◽  
Women Living With Hiv ◽  
Lower Stage

Abstract Purpose To compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting. Methods & Materials Women in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up. Results This cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001). Conclusions Five-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.

scholarly journals High tumor mutational burden predicts worse prognosis for cervical cancer treated with radiotherapy

2021 ◽  
Author(s):  
Norichika Ota ◽  
Yuya Yoshimoto ◽  
Narisa Dewi Maulany Darwis ◽  
Hiro Sato ◽  
Ken Ando ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Prognostic Factor ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Definitive Radiotherapy ◽  
Cervical Cancers ◽  
Mutational Burden ◽  
Tumor Mutational Burden ◽  
High Cervical

Abstract Purpose Tumor mutational burden (TMB) is a surrogate biomarker of neo-antigens and high TMB status is associated with favorable response to immune-checkpoint inhibitors (ICIs). This study aimed to elucidate the association between TMB and the outcome of definitive radiotherapy in patients with cervical cancer. Materials and methods TMB and treatment outcome were retrospectively analyzed in patients with newly diagnosed cervical cancer treated with definitive radiotherapy available with somatic mutation data of pre-treatment tumors obtained using a commercially available gene panel. Results The study enrolled 98 patients (median follow-up period, 61 months). The median TMB was 9.5 mutations per megabase (range, 3.0–35.5 mutations per megabase). After dichotomization based on this median value, the 5-year overall survival (OS) for TMB-high patients was significantly worse than that of TMB-low patients (61.1% vs. 82.2%). Multivariate analysis identified high TMB status as a significant prognostic factor for worse OS, along with advanced stage, para-aortic lymph node involvement, and absence of concurrent chemotherapy. Conclusion These data indicate that TMB is a potential prognostic factor for worse survival in patients with cervical cancer treated with definitive radiotherapy, thereby providing a rationale for treatment of TMB-high cervical cancers with a combination of ICIs plus radiotherapy. Secondary abstract This retrospective study of 98 patients demonstrates for the first time that tumor mutational burden (TMB) is an independent prognostic factor for worse overall survival of patients treated with definitive radiotherapy, providing a rationale for treatment of TMB-high cervical cancers with a combination of immune-checkpoint inhibitors plus radiotherapy.

Treating Tongue-Tie: Assessing the Relationship Between Frenotomy and Breastfeeding Symptoms

2014 ◽  
Vol 5 (1) ◽  
pp. 20-27 ◽  
Author(s):  
James W. Ochi
Keyword(s):  
Support Group ◽  
Preliminary Evidence ◽  
Control Group ◽  
Breastfeeding Support ◽  
The One ◽  
Post Hoc ◽  
And Control ◽  
The Relationship ◽  
Question Survey

Objective: Ankyloglossia (or “tongue-tie”) may increase the risk for newborn breastfeeding symptoms. Lingual frenotomy is the standard treatment for ankyloglossia, but its efficacy at improving the quality of infant breastfeeding has received little formal study. We developed an original 10-question survey of mother and newborn breastfeeding symptoms that are typically observed with ankyloglossia. Possible survey scores ranged from 10 (minimal breastfeeding symptoms) to a maximum of 50 (extreme symptoms). We predicted that survey scores should decrease after lingual frenotomy.Method: The survey was administered to mothers of 20 newborns with ankyloglossia, before lingual frenotomy, and about 2 weeks after. The control group consisted of 15 breastfeeding dyads recruited from a breastfeeding support group who filled out the survey twice at 2-week intervals. A 2 × 2 mixed-methods ANOVA was conducted to test for an interaction between group and time.Results: Post hoc analysis of simple effects provided evidence that (a) the frenotomy group had higher survey scores than the control group before intervention and (b) the frenotomy-group survey scores decreased after the intervention. No significant score differences were observed between the frenotomy and control groups after the intervention, and the control group scores did not show a statistically significant decrease over time.Conclusions: The study provides preliminary evidence for the effectiveness of lingual frenotomy for reducing breastfeeding symptoms associated with ankyloglossia. Furthermore, the study suggests that the use of surveys, such as the one in this study, may help with assessment for ankyloglossia.

Establishing the prognostic value of platelet-to-lymphocyte ratio in cervical cancer: a systematic review and meta-analysis

2019 ◽  
Vol 29 (4) ◽  
pp. 683-690 ◽  
Author(s):  
Lixiao Yang ◽  
Huixiao Chen
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Survival Outcomes ◽  
Platelet To Lymphocyte Ratio ◽  
Free Survival ◽  
Lymphocyte Ratio ◽  
Meta Regression

ObjectiveThe aim of this study was to conduct a meta-analysis to establish the prognostic value of platelet-to-lymphocyte ratio in cervical cancer.MethodsWe conducted a search in Medline and Embase datasets for articles published until May 1, 2018 to perform a meta-analysis to establish the prognostic value of platelet-to-lymphocyte ratio in cervical cancer. The primary survival outcomes were overall survival and progression-free survival. The pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) were combined to calculate overall effects. Cochran’s Q test and Higgins’ I2statistics were employed to estimate the heterogeneity. In addition, the subgroup analysis, sensitivity analysis, and meta-regression were performed to identify the source of heterogeneity. Egger’s linear regression test and Begg’s funnel plot and the trim and fill methods were employed to evaluate the publication bias.ResultsA total of 2616 patients from eight studies were enrolled in the meta-analysis. Significant association was observed between elevated platelet-to-lymphocyte ratio and a worse overall survival, with a combined HR of 1.49 (95% CI 1.24 to 1.79, I2=32.8%). Elevated platelet-to-lymphocyte ratio was significantly associated with a worse progression-free survival, with a combined HR of 1.65 (95% CI 1.17 to 2.33, I2= 49.4%). Subsequently, sensitivity analysis, subgroup analysis, and meta-regression model containing six predominant factors were applied to trace the origin of heterogeneity. However, no significant factors or studies were explored as the potential source of heterogeneity.ConclusionElevated pre-treatment platelet-to-lymphocyte ratio may be an adverse prognostic factor for overall survival and progression-free survival in patients with cervical cancer. Further investigations are warranted to determine the exact mechanism by which platelet-to-lymphocyte ratio impacts survival outcomes in cervical cancer.

scholarly journals Pretreatment Neutrophil-to-Lymphocyte Ratio Combined with Platelet-to-Lymphocyte Ratio as a Predictor of Survival Outcomes after Definitive Concurrent Chemoradiotherapy for Cervical Cancer

2021 ◽  
Vol 10 (10) ◽  
pp. 2199
Author(s):  
Jeong Won Lee ◽  
Ki Ho Seol
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Clinical Outcomes ◽  
Concurrent Chemoradiotherapy ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Neutrophil To Lymphocyte Ratio ◽  
Survival Outcomes ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio

The aim of the study was to evaluate pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for predicting clinical outcomes after definitive concurrent chemoradiotherapy (CCRT) for cervical cancer. The cases were divided into two groups based on the values of NLR and PLR: High NLR-PLR (high value in both NLR and PLR) and Low NLR-PLR (low value in either NLR or PLR). The relationships between survival outcomes and the pretreatment NLR-PLR were investigated. Of the 148 patients enrolled in the study, 30 patients died during the median follow-up of 75 months. Based on receiver operating curves, NLR and PLR cut-off values for survival analysis were 2.34 and 148.89. The 10-year overall survival and disease-free survival rates for high NLR-PLR vs. low NLR-PLR were 63.6% vs. 86.2% (p = 0.001) and 63.3% vs. 77.5% (p = 0.026), respectively. Based on a multivariate analysis, independent predictors of overall survival were high NLR-PLR (hazard ratio [HR], 2.435; 95% confidence interval [CI], 1.106–5.361; p = 0.027) and stage (HR 2.659; 95% CI, 1.146–6.613; p = 0.024). Increases in both NLR and PLR are associated with poor survival. Elevation in both NLR and PLR before initiation of CCRT may be a useful biomarker for predicting clinical outcomes.

scholarly journals Percutaneous parametrial dose escalation in women with advanced cervical cancer: feasibility and efficacy in relation to long-term quality of life

2018 ◽  
Vol 52 (3) ◽  
pp. 320-328
Author(s):  
Sati Akbaba ◽  
Jan Tobias Oelmann-Avendano ◽  
Tilman Bostel ◽  
Harald Rief ◽  
Nils Henrik Nicolay ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Dose Escalation ◽  
Advanced Cervical Cancer ◽  
Sequential Boost

Abstract Background We analyzed long-term quality of life (QoL) and prognostic factors for QoL as well as clinical outcome in patients with advanced cervical cancer (ACC) treated with primary radiochemotherapy (RChT) consisting of external beam radiotherapy (EBRT) with or without sequential or simultaneous integrated boost (SIB) to the parametria, intracavitary brachytherapy and concomitant chemotherapy (ChT). Patients and methods Eighty-three women were treated with primary RChT between 2008 and 2014. Survival of all patients was calculated and prognostic factors for survival were assessed in univariate and multivariate analysis. In 31 patients QoL was assessed in median 3 years (range 2–8 years) after treatment. QoL was compared to published normative data and the influence of age, tumour stage, treatment and observed acute toxicities was analyzed. Results Thirty-six patients (43.4%) died, 18 (21.7%) had a local recurrence and 24 (28.9%) had a distant progression. Parametrial boost (p = 0.027) and ChT (p = 0.041) were independent prognostic factors for overall survival in multivariate analysis. Specifically, a parametrial equivalent doses in 2-Gy fractions (EQD2) > 50 Gy was associated with an improved overall survival (OS) (p = 0.020), but an EQD2 > 53 Gy did not further improve OS (p = 0.194). Tumour size was the only independent prognostic factor for local control (p = 0.034). Lymph node status (p = 0.038) and distant metastases other than in paraaortic lymph nodes (p = 0.002) were independent prognostic factors for distant progressionfree survival. QoL was generally inferior to the reference population. Age only correlated with menopausal symptoms (p = 0.003). The degree of acute gastrointestinal (p = 0.038) and genitourinary (p = 0.041) toxicities correlated with the extent of chronic symptom experience. Sexual/vaginal functioning was reduced in patients with larger tumours (p = 0.012). Parametrial EQD2 > 53 Gy correlated with reduced sexual/vaginal functioning (p = 0.009) and increased sexual worry (p = 0.009). Whether parametrial dose escalation was achieved by sequential boost or SIB, did not affect survival or QoL. Conclusions Primary RChT is an effective treatment, but long-term QoL is reduced. The degree of acute side effects of RChT correlates with the extent of chronic symptoms. Patients benefit from parametrial SIB or sequential boost, but an EQD2 > 53 Gy does not further improve survival and negatively affects QoL.

scholarly journals Integrated Analysis of Virus and Host Transcriptomes in Cervical Cancer in Asian and Western Populations

2020 ◽  
Author(s):  
Qiongzi Qiu ◽  
Qing Zhou ◽  
Aoran Luo ◽  
Xufan Li ◽  
Kezhen Li ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Racial Disparities ◽  
Cancer Survival ◽  
Integrated Analysis ◽  
Rna Seq ◽  
Cervical Cancers ◽  
Tumor Subtypes ◽  
Normal Tissues ◽  
Different Populations

Abstract Background: Race may influence vulnerability to HPV and have an effect on cervical cancer survival independent of socioeconomic status. Integration of the virus and host transcriptomes from different populations provides an unprecedented opportunity to understand these racial disparities in the prevalence of HPV and its associated cervical cancers in addition to fundamentally advancing the knowledge of HPV-induced cervical carcinogenesis and progression. Methods: We performed RNA-Seq analysis of 90 tumors and 39 adjacent normal tissues from cervical cancer patients at Zhejiang University (ZJU) in China, and conducted a comparative analysis with RNA-Seq data of 286 cervical cancers from TCGA. Results: We found a significantly higher rate of HPV positives and HPV integrations in TCGA than in ZJU. In addition to LINC00393 and HSPB3 as new common integration hotspots in both populations, we found new hotspots such as SH2D3C and CASC8 in TCGA, and SCGB1A1 and ABCA1 in ZJU. We described the first, to our knowledge, virus-transcriptome-based classification of cervical cancer that is highly predictive of clinical outcome. Particularly, patients with expressed E5 performed better than those without E5 expression. However, the constituents of these virus-transcriptome-based tumor subtypes differ dramatically between the two populations. We further characterized the immune infiltration landscapes between different HPV statuses and revealed significantly elevated levels of regulatory T cells and M0 macrophages in HPV positive tumors, which were associated with poor prognosis. Conclusions: These findings increase our understanding of the racial disparities in the prevalence of HPV and its associated cervical cancers between Asian and Western populations, and also have important implications in the classification of tumor subtypes, prognosis, and anti-canc

The relationship between patient experience with service quality and survival in pancreatic cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14697-e14697
Author(s):  
Christopher G. Lis ◽  
Maurie Markman ◽  
Mark Rodeghier ◽  
Digant Gupta
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Quality Of Care ◽  
Service Quality ◽  
Patient Experience ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Patient Reported ◽  
The Relationship

e14697 Background: Despite the recognized relevance of symptom burden in pancreatic cancer, there has been limited exploration of whether an individual patient’s assessment of the overall quality-of-care received might influence outcome. To assess this issue we evaluated the relationship between patient-reported experience with service quality and overall survival. Methods: We evaluated 496 returning pancreatic cancer patients treated at Cancer Treatment Centers of America between July 2007 and December 2010. Overall patient experience “considering everything, how satisfied are you with your overall experience with CTCA?” was measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied.” It was dichotomized into 2 categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between patient experience and survival. Results: 317 patients were newly diagnosed while 179 were previously treated. 16, 93, 81 and 306 patients had stage I, II, III and IV disease respectively. 292 were males and 204 females. Mean age was 57.3 years. 387 (78%) patients had expired at the time of this analysis. 345 patients were “completely satisfied” while 151 were not. Median overall survival was 7.9 months (95% CI: 7.3-8.6 months). On univariate analysis, “completely satisfied” patients had a significantly lower risk of mortality compared to those not “completely satisfied” (HR=0.62; 95% CI: 0.50-0.78; p<0.001). On multivariate analysis controlling for stage at diagnosis, treatment history, age and gender, “completely satisfied” patients demonstrated significantly lower mortality (HR=0.61; 95% CI: 0.49-0.76; p<0.001) compared to those not “completely satisfied”. Conclusions: Patient experience with service quality was an independent predictor of survival in pancreatic cancer. This finding underscores the importance of psychosocial factors in patient prognosis. Patients who evaluate their quality of care more favorably may in turn have more positive attitudes toward their treatment outcomes, and may engage in other health behaviors that could potentially increase survival.

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