Br J Cancer:无肿瘤距离(TFD)可作为早期宫颈癌的新型预后指标

2021-05-05 xiaozeng MedSci原创

尽管目前发达国家进行的筛查和疫苗接种已大大降低了宫颈癌(CC)的发生率,但该恶性肿瘤仍然是一大社会负担。

尽管目前发达国家进行的筛查和疫苗接种已大大降低了宫颈癌(CC)的发生率,但该恶性肿瘤仍然是一大社会负担。早期CC(ECC)的治疗主要为根治性子宫切除术(RH)和盆腔淋巴结清扫术伴随前哨淋巴结活检(SLN)。

根据组织学记录的中间危险因素(淋巴血管间隙浸润LVSI、基质浸润深度DSI和肿瘤直径)或较高风险因素(转移性淋巴结转移、子宫旁膜受累、手术切缘浸润)的组合(也被称为Sedlis标准)可用于ECC的辅助治疗。然而,Sedlis标准中包含的某些参数(例如LVSI或DSI)也有所争议。


无肿瘤距离(TFD)作为定义疾病的另一个参数,其起源可以追溯到1980年代中期。TFD的定义为肿瘤与子宫颈周围基质环之间无累及基质的最小距离;TFD的存在与LVSI、盆腔淋巴结受累以及患者的不良预后相关。

因此,该研究旨在评估在早期宫颈癌中TFD的预后价值。该回顾性研究主要纳入了2000年1月至2019年11月期间接受原发性根治性手术治疗的病理性IA1-IIA2期宫颈癌患者。这些患者根据先前确定的病理危险因素进行相应的辅助治疗。


研究人员通过对子宫切除标本进行组织学测量TFD,回顾患者在MRI扫描中测得的术前TFD并将其与病理学TFD进行比较。

根据危险因素分析的患者分布

该研究共纳入了395名患者的信息。结果显示,其中的93例(23.5%)患者的TFD≤3.0 mm,另外的302例(76.5%)患者的TFD>3.0 mm。多变量分析显示,TFD≤3.0mm且伴有淋巴血管间隙受累是患者淋巴结转移的最强预测因素。


相比于TFD>3.0 mm的患者,TFD≤3.0 mm的患者表现出更差的5年无病生存期(DFS)和总生存期(OS)。在没有接受辅助治疗的低危因素患者亚组中,DFS的差异更为显著。Cohen's Kappa统计系数显示, MRI扫描的术前TFD与组织学TFD之间的一致性为0.654。

根据TFD的患者生存曲线

总而言之,该研究结果揭示,病理TFD≤3.0 mm是与患者淋巴结转移显著相关的一个不良预后因素,其或可作为辅助治疗候选药物的一个新的检测因素。由于该参数可由放射性成像测量,因此其可成为潜在的易于测量的术前标志物,以预测早期宫颈癌中高危病理因素的存在。


原始出处:

Bizzarri, N., Pedone Anchora, L., Zannoni, G.F. et al. Validation of tumour-free distance as novel prognostic marker in early-stage cervical cancer: a retrospective, single-centre, cohort study. Br J Cancer (14 April 2021).

 

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    2021-05-18 ms3000001264084725

    很棒!

    0

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    2021-05-06 一闲
  4. [GetPortalCommentsPageByObjectIdResponse(id=966662, encodeId=d9db966662ef, content=很棒!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3be85451515, createdName=ms3000001264084725, createdTime=Tue May 18 21:28:06 CST 2021, time=2021-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374194, encodeId=f30913e4194e1, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Thu May 06 15:34:40 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1408289, encodeId=9373140828907, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11102737131, createdName=一闲, createdTime=Thu May 06 15:34:40 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962774, encodeId=91f5962e7468, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Wed May 05 11:23:35 CST 2021, time=2021-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962740, encodeId=9f03962e40cb, content=学习中~, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed May 05 07:13:34 CST 2021, time=2021-05-05, status=1, ipAttribution=)]
    2021-05-05 易水河

    学习学习

    0

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    2021-05-05 学医无涯

    学习中~

    0

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