ObjectivesTo assess the methodological quality of clinical practice guidelines of cervical cancer in China published from 2014 to 2018.MethodsCNKI, WanFang Data, CBM, VIP, Medlive.cn, the National Guideline Clearinghouse, PubMed, The Cochrane Library and EMbase were searched for cervical cancer clinical practice guidelines published in China from January 1st, 2014 to December 31st, 2018. Four reviewers searched and selected the literature independently according to the inclusion and exclusion criteria and assessed the methodological quality of the included guidelines by using AGREE Ⅱ.ResultsA total of 9 guidelines were included. The average score for each area was: scope and purpose 75.47%, stakeholders’ involvement 35.09%, the rigor of development 43.70%, clarity of presentation 87.74%, applicability 80.76%, and editorial independence 0%.ConclusionsThe quality of cervical cancer clinical practice guidelines in China requires further improvement.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic radical hysterectomy (LRH) for cervical cancer. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), CBM, CNKI, VIP, WanFang Data (from inception to October, 2013) through computer, and manually searched related journals. Randomized controlled trials (RCTs) on LRH versus abdominal radical hysterectomy (ARH) in the treatment of cervical cancer were identified according to the inclusion and exclusion criteria, data were extracted, and methodological quality of the included studies was accessed by two reviewer independently. Meta-analysis was then performed using RevMan 5.2 software. ResultsSeven RCTs involving 462 patients were finally included. The results of meta-analysis showed that: there were significant differences between LRH and ARH in the operation time, intraoperative bleeding, recovery time of gastrointestinal function, postoperative pain, postoperative hospital stay, and surgical site infection (MD=20.25, 95%CI 0.26 to 40.24, P=0.05; MD=-56.18, 95%CI-74.84 to-37.52, P < 0.000 01; SMD=-1.54, 95%CI-2.92 to-0.16, P=0.03; MD=-1.37, 95%CI-1.85 to-0.89, P < 0.000 01; MD=-2.32, 95%CI-3.57 to-1.06, P=0.000 3; RR=0.42, 95%CI 0.18 to 0.97, P=0.04). But there was no significant difference in the number of lymph node biopsy (MD=1.34, 95%CI-4.26 to 6.94, P=0.64) and some operative complications (lymphocyte: RR=1.19, 95%CI 0.54 to 2.63, P=0.66; DVT: RR=1.23, 95%CI 0.48 to 3.20, P=0.67; urinary retention: RR=0.85, 95%CI 0.41 to 1.75, P=0.66; cystotomy: RR=1.91, 95%CI 0.49 to 7.51, P=0.35). ConclusionCurrent evidence shows that although applying LRH costs longer time, and with high-level technology, its safety and short-term efficacy are superior to ARH. Due to the limited quantity and quality of the included studies, its long-term efficacy still needs to be further confirmed by conducting more high-quality, multi-centre RCTs with large sample size.
ObjectiveTo systematically review the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer. MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2015), PubMed, EMbase, CNKI, CBM, VIP and WanFang Data from inception to April 2015 to collect case-control studies investigating the correlation between mTOR protein expression and different clinical pathological features as well as the response to radiotherapy and chemotherapy of cervical cancer. Two reviewers independently screened literature, extracted data and assessed the risk bias of the included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 8 case-control studies involving 591 patients were included. Among these cases, 365 cases were in the cervical cancer group, 135 cases were in the cervical intraepithelial neoplasia (CIN) group, and 91 cases were in the normal cervix tissue group. The results of meta-analysis showed that:(1) Compared with the normal cervix tissue group, mTOR protein was overexpressed in the cervical cancer group (OR=24.14, 95%CI 4.47 to 130.35, P=0.000 2) and the CIN group (OR=4.71, 95%CI 2.15 to 10.33, P=0.000 1); Compared with the CIN group, mTOR protein was overexpressed in the cervical cancer group (OR=5.12, 95%CI 2.96 to 8.86, P<0.000 01). (2) Compared with the non-lymphnode-metastasis group, mTOR protein was overexpressed in the lymph node metastasis group (OR=3.29, 95%CI 1.61 to 6.69, P=0.001); Compared with the FIGO I group, mTOR protein was overexpressed in the FIGO Ⅱ group (OR=3.00, 95%CI 1.49 to 6.04, P=0.002); Compared with the radiotherapy and chemotherapy responsive group, mTOR protein was overexpressed in the non-response group (OR=15.64, 95%CI 3.17 to 77.15, P=0.000 7). In addition, there was no significant difference between the medium/high differentiation group and low differentiation group (OR=1.70, 95%CI 0.75 to 3.81, P=0.20). ConclusionmTOR protein expression is associated with cervical cancer, and mTOR protein overexpression was associated with lymph node metastasis, higher FIGO and non-response to radiotherapy and chemotherapy. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
探讨宫颈癌中EphA2的表达及其临床意义。方法:应用免疫组织化学方法检测10例慢性宫颈炎、25例宫颈上皮内瘤样变（CIN）、50例宫颈癌（鳞癌41例、腺癌9例）中EphA2的蛋白表达。并对50例宫颈癌患者进行8～46月随访，分析EphA2在宫颈癌中的表达与患者预后的关系。结果:慢性宫颈炎、CIN、宫颈癌组织中EphA2蛋白阳性表达的差异有统计学意义（P＜0.05）。EphA2蛋白在宫颈癌中的表达与患者年龄、FIGO分期、病理类型无关，与病理分级、有无淋巴结转移有密切相关性，且EphA2蛋白表达越强，患者生存率越低。结论：EphA2与宫颈癌的侵袭、转移密切相关，可望作为判断宫颈癌患者预后的参考指标。
ObjectivesTo explore the efficacy of simultaneous chemoradiotherapy combined with surgery for locally advanced cervical patients and perform multivariable analysis.MethodsA total of 130 cases of patients with locally advanced cervical cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from June 2012 to December 2016 were randomly divided into case group and control group. The patients in the control group were treated with platinum-based radical concurrent chemoradiation. In the case group, patients received both treatment in the control group with the addition of extensive hysterectomy and pelvic lymph node dissection. The short-term efficacy and survival outcomes of the two groups were compared.ResultsThe present study was the final report of this randomized controlled trial. 68 patients were randomly enrolled into the case group and 50 patients into control group. The non-microscopic residual tumor (non-MRT) rates were 83.8% (57/68) and microscopic residual tumor (MRT) rates were 2.9% (2/68) in the experimental group. There was no significant difference between two groups (χ2=0.008, P=0.928) in 3-year progression-free survival rate (65.6%vs. 59.6%) and 4-year progression-free survival rate (52.5% vs. 56.3%). And there was no significant difference between two groups (χ2=0.361, P=0.548) in 3-year overall survival rate (80.3%vs. 74.6%) and 4-year overall survival rate (77.6% vs. 64.9%). Multivariable analysis showed that only tumor size and parametrial invasion were significant prognostic factors of PFS (P<0.05). And only parametrial invasion was a potential prognostic indicator affecting OS (P=0.078).ConclusionParametrial invasion is an important prognostic factor. Radical concurrent chemoradiotherapy combined with surgical treatment of locally advanced cervical cancer has not significantly improved progression-free survival and overall survival. The treatment regimen should be applied with caution and selectivity.
Objective To systematically review the prognostic value of perineural invasion (PNI) for patients with early-stage cervical cancer. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 10, 2016), CNKI, WanFang Data, CBM and VIP databases to collect case-control studies about prognostic value of PNI in cervical cancer from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results Seven case-control studies from eight articles involving 1 218 patients were included. The results of meta-analysis showed that: (1) On Cox's model multivariate analysis, PNI was not identified as an independent risk factor for disease free survival (DFS) (HR=0.73, 95%CI 0.33 to 1.58,P=0.42) or overall survival (OS) (HR=0.89, 95%CI 0.41 to 1.94,P=0.77) with no significant difference; (2) On Kaplan-Meier-curves, DFS (HR=1.86, 95%CI 1.20 to 2.88,P=0.006) and OS (HR=2.43, 95%CI 1.63 to 3.62,P<0.000 1) were both significantly decreased in patients with PNI positive group. Conclusion PNI represents a decreasing disease-free survival and overall survival in patients with early-stage cervical cancer, and is one of the poor prognosis factors which be informed management decisions regarding adjuvant therapy. However, there is no evidence that PNI is an independent factor affecting the prognosis. In view of the limitation of the studies, a large sample prospective controlled trial is warranted to verify the above conclusion.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic operation versus laparotomy for stage I-IIa cervical cancer. MethodDatabases including PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI were searched to collect controlled trials and cohort studies about laparoscopic operation versus laparotomy for stage I-IIa cervical cancer from inception to July 2014. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 3 RCTs, 4 non-randomized controlled trials and 11 cohort studies involving 2 020 patients were included. The results of meta-analysis showed that, compared with laparotomy, laparoscopy operation could reduce intraoperative blood loss (MD=-247.99, 95%CI -408.90 to -87.07, P=0.003) , the incidence of perioperative blood transfusion (OR=0.33, 95%CI 0.21 to 0.52, P<0.000 01) , haemoglobin level before and after surgery (MD=-0.98, 95%CI -0.13 to -0.93, P<0.000 01) , postoperative complication (OR=0.61, 95%CI 0.40 to 0.93, P=0.02) , and shorten postoperative exhaust time (MD=-17.41, 95%CI -32.79 to -2.03, P=0.03) and postoperative hospitalization days (MD=-2.51, 95%CI -3.25 to -1.78, P<0.000 01) . There were no significant differences between two groups in the number of pelvic lymph nodes removed, operative complications, as well as the recurrence rate, mortality and non-recurrence survivals after 2 to 5 years of follow-up. But the operation time of the laparoscopy operation group was longer than that of the laparotomy group. ConclusionsCurrent evidence shows that compared with laparotomy, laparoscopic operation for early stage cervical cancer has less trauma, less blood loss, shorter hospitalization days and less postoperative complications. Due to the limited quantity of the included studies, more studies are needed to verify the above conclusion.
The study was performed to construct a human cervical cancer cell line C33A which can stably express HPV58E6E7 fusion gene. Firstly, C33A cells were transfected with the recombinant lentivirus LV-HPV58E6E7 which contained HPV58E6E7 fusion gene, and the stably transfected cells (LV-HPV58E6E7/C33A) were screened out by flow cytometry. MTT was used to observe the growth of LV-HPV58E6E7/C33A cells and flow cytometry was carried out to detect the cell cycle. LV-HPV58E6E7/C33A cells were inoculated into the left armpits of nude mice. Then, the transcription and expression of HPV58E6E7 fusion gene was detected by qRT-PCR and Western blot, respectively. The results showed that HPV58E6E7 fusion gene can promote the proliferation of C33A cells. HPV58E6E7 fusion gene can be stably transcripted and expressed in vaccinated nude mice. The conclusion indicated that we successfully established a cervical cancer cell line LV-HPV58E6E7/C33A which can stably express HPV58E6E7 fusion gene. This cell line will provide an antigen cell line for the immune effect detection of HPV58 therapeutic vaccine.