The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer

Lekskul, Navamol,Charakorn, Chuenkamon,Lertkhachonsuk, Arb-Aroon,Rattanasiri, Sasivimol,Ayudhya, Nathpong Israngura Na Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.11

Background: This study aimed to determine the utility and a cut-off level of serum squamous cell carcinoma antigen (SCC-Ag) to predict lymph node metastasis in locally advanced cervical cancer cases. We also investigated the correlation between SCC-Ag level and lymph node status. Materials and Methods: From June 2009 to June 2014, 232 patients with cervical cancer stage IB2-IVA, who were treated at Ramathibodi Hospital, were recruited. Receiver operating characteristic (ROC) curves were used to identify the best cut-off point of SCC-Ag level to predict lymph node metastasis. Quantile regression was performed to evaluate the correlation between SCC-Ag levels and pelvic lymph node metastasis, paraaortic lymph node metastasis, and parametrial involvement as well as tumor size. Results: Pelvic lymph node metastasis and paraaortic lymph node metastasis were diagnosed in 46.6% and 20.1% of the patients, respectively. The median SCC-Ag level was 6 ng/mL (range, 0.5 to 464.6 ng/mL). The areas under ROC curves between SCC-Ag level and pelvic lymph node metastasis, paraaotic lymph node metastasis, parametrial involvements were low. SCC-Ag level was significantly correlated with paraaortic lymph node status (p=0.045) but not with pelvic lymph node status and parametrial involvement. SCC-Ag level was also related to the tumor diameter (p<0.05). Conclusions: SCC-Ag level is not a good predictor for pelvic and paraaortic lymph node metastasis. However, it is still beneficial to assess the tumor burden of squamous cell carcinoma of the cervix.

편평세포암종 임파절 전이에 대한 인공 신경망 시스템의 진단능 평가

허민석,박태원,박상욱,유동수,이삼선,최순철 大韓口腔顎顔面 放射線學會 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: The purpose of this study was to evaluate cervical lymph node metastasis of oral squamous cell carcinoma patients by MRI film and neural network system. Materials and Methods: The oral squamous cell carcinoma patients(21 patients, 59 lymph nodes) who have visited SNU hospital and been taken by MRI, were included in this study. Neck dissection operations were done and all of the cervical lymph nodes were confirmed with biopsy. In MR images, each lymph node were evaluated by using 6 MR imaging criteria(size, roundness, heterogeneity, rim enhancement, central necrosis, grouping) respectively. Positive predictive value, negative predictive value, and accuracy of each MR imaging criteria were calculated. At neural network system, the layers of neural network system consisted of 10 input layer units, 10 hidden layer units and 1 output layer unit. 6 MR imaging criteria previously described and 4 MR imaging criteria (site I-node level II and submandibular area, site II-other node level, shape I-oval, shape II-bean) were included for input layer units. The training files were made of 39 lymph nodes(24 metastatic lymph nodes, 10 non-metastatic lymph nodes) and the testing files were made of other 20 lymph nodes(10 metastatic lymph nodes, 10 non-metastatic lymph nodes). The neural network system was trained with training files and the output level (metastatic index) of testing files were acquired. Diagnosis was decided according to 4 different standard metastatic index-68, 78, 88, 98 respectively and positive predictive values, negative predictive values and accuracy of each standard metastatic index were calculated. Results: In the diagnosis of using single MR imaging criteria, the rim enhancement criteria had highest positive predictive value (0.95) and the size criteria had highest negative predictive value(0.77). In the diagnosis of using single MR imaging criteria, the highest accurate criteria was heterogeneity (accuracy : 0.81) and the lowest one was central necrosis (accuracy : 0.59). In the diagnosis of using neural network systems, the highest accurate standard metastatic index was 78, and that time, the accuracy was 0.90. Neural network system was more accurate than any other single MR imaging criteria in evaluating cervical lymph node metastasis. Conclusion: Neural network system has been shown to be more useful than any other single MR imaging criteria. In future, Neural network system will be powerful aiding tool in evaluating cervical node metastasis.

Muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge is associated with cervical lymph node metastasis

Seung-Ki Min,Hoon Myoung,Jong-Ho Lee,Myung-Jin Kim 대한구강악안면외과학회 2016 대한구강악안면외과학회지 Vol.42 No.3

Objectives: To assess the association between muscle invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis on the basis of preoperative magnetic resonance imaging (MRI). Materials and Methods: Twenty-six patients with oral squamous cell carcinoma of the posterior mandibular alveolar ridge were evaluated by MRI. The associations between cervical lymph node metastasis and independent factors evaluated by MRI were analyzed. Overall survival was also analyzed in this manner. Representative biopsy specimens were stained with anti-podoplanin and anti-CD34 antibodies. Results: Mylohyoid muscle invasion was associated with cervical lymph node metastasis. A combinational factor of mylohyoid and/or buccinator muscle invasion was also associated with cervical lymph node metastasis. Cervical lymph node metastasis and masticator space invasion had a negative effect on overall survival. No lymphatic vessels were identified near the tumor invasion front within the mandible. In contrast, lymphatic vessels were identified near the front of tumor invasion in the muscles. Conclusion: This study demonstrates an association between muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis.

Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes: Early experience

Kim, Jeong Kon,Kim, Kyoung Ah,Park, Bum-Woo,Kim, Namkug,Cho, Kyoung-Sik Wiley Subscription Services, Inc., A Wiley Company 2008 Journal of magnetic resonance imaging Vol.28 No.3

<B>Purpose</B><P>To investigate the feasibility of diffusion-weighted imaging (DWI) in the differentiation of metastatic from nonmetastatic lymph nodes.</P><B>Materials and Methods</B><P>In 125 patients who underwent lymph node dissection for uterine cervical cancer, DWI was performed at b value of 0 and 1000 s/mm<SUP>2</SUP>. By referring to the surgical maps of the pelvic lymph nodes, the apparent diffusion coefficient (ADC) was compared in the metastatic and nonmetastatic lymph nodes, and receiver-operating-characteristics analysis was performed to evaluate the diagnostic performance of the ADC in differentiating metastatic from nonmetastatic lymph nodes.</P><B>Results</B><P>The ADC were significantly lower in the metastatic lymph nodes (0.7651 × 10<SUP>−3</SUP> mm<SUP>2</SUP>/s ± 0.1137) than in the nonmetastatic lymph nodes (1.0021 × 10<SUP>−3</SUP> mm<SUP>2</SUP>/s ± 0.1859; P < 0.001). The area-under-the-curve of ADC for differentiating metastatic from nonmetastatic lymph nodes, was 0.902. The sensitivity and specificity of ADC for differentiating metastatic from nonmetastatic lymph nodes, were 87% for the ADC and 80%, respectively.</P><B>Conclusion</B><P>DWI is feasible for differentiating metastatic from nonmetastatic lymph nodes in patients with uterine cervical cancer. J. Magn. Reson. Imaging 2008;28:714–719. © 2008 Wiley-Liss, Inc.</P>

Significance of histology and nodal status on the survival of women with early-stage cervical cancer: validation of the 2018 FIGO cervical cancer staging system

Hiroko Machida,Koji Matsuo,Yoichi Kobayashi,Mai Momomura,Fumiaki Takahashi,Tsutomu Tabata,Eiji Kondo,Wataru Yamagami,Yasuhiko Ebina,Masanori Kaneuchi,Satoru Nagase,Mikio Mikami 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.3

Objective: To assess the efficacy of the FIGO 2018 classification system for nodal-specific classifications for early-stage cervical cancer; specifically, to examine the impact of nodal metastasis on survival and the effect of postoperative treatments, according to histological subtypes. Methods: This society-based retrospective observational study in Japan examined 16,539 women with the 2009 FIGO stage IB1 cervical cancer who underwent primary surgical treatment from 2004 to 2015. Associations of cause-specific survival (CSS) with nodal metastasis and postoperative adjuvant therapy were examined according to histology type (squamous cell carcinoma [SCC], n=10,315; and non-SCC, n=6,224). Results: The nodal metastasis rate for SCC was higher than that for non-SCC (10.7% vs. 8.3%, p<0.001). In multivariable analysis, the impact of nodal metastasis on CSS was greater for non-SCC tumors (adjusted-hazard ratio [HR], 3.11; 95% confidence interval [CI], 2.40– 4.02) than for SCC tumors (adjusted-HR, 2.20; 95% CI, 1.70–2.84; p<0.001). Propensity score matching analysis showed significantly lower CSS rates for women with pelvic nodal metastasis from non-SCC tumors than from SCC tumors (5-year CSS rate, 75.4% vs. 90.3%, p<0.001).The CSS rates for women with nodal metastasis in SCC histology were similar between the postoperative concurrent chemoradiotherapy/radiotherapy and chemotherapy groups (89.2% vs. 86.1%, p=0.42), whereas those in non-SCC histology who received postoperative chemotherapy improved the CSS (74.1% vs. 67.7%, p=0.043). Conclusion: The node-specific staging system in the 2018 FIGO cervical cancer classification is applicable to both non-SCC tumors and SCC tumors; however, the prognostic significance of nodal metastases and efficacy of postoperative therapies vary according to histology.

Galectin 1 expression is associated with tumor invasion and metastasis in stage IB to IIA cervical cancer

Kim, H.J.,Do, I.G.,Jeon, H.K.,Cho, Y.J.,Park, Y.A.,Choi, J.J.,Sung, C.O.,Lee, Y.Y.,Choi, C.H.,Kim, T.J.,Kim, B.G.,Lee, J.W.,Bae, D.S. W. B. Saunders Co ; Centrum Philadelphia 2013 Human pathology Vol.44 No.1

Galectin 1 is a 14-kd laminin-binding lectin involved in important biologic mechanisms of tumors, including neoplastic transformation, cell survival, angiogenesis, cell proliferation, and metastasis. In this study, we investigated the role of galectin 1 in cell survival and metastasis in cervical cancer. The expression of galectin 1 was determined in 73 formalin-fixed, paraffin-embedded cervical cancer tissues using an immunohistochemical method and compared with clinicopathologic risk factors for recurrence after surgery. To evaluate the role of galectin 1 in cell proliferation and invasion, we performed proliferation and invasion assays with galectin 1 small interfering RNA (siRNA) using cervical cancer cell lines, including HeLa and SiHa cells. Immunohistochemical analysis revealed that galectin 1 expression was found in most peritumoral stroma samples (72/73; 98.6%). Galectin 1 expression was significantly correlated with the depth of invasion in the cervix (P=.015) and lymph node metastasis (P=.045) on univariate analysis. When progression-free survival of all of the patients studied was analyzed based upon galectin 1 expression, galectin 1 expression was not correlated with progression-free survival (P=.32). Down-regulation of galectin 1 using small interfering RNA resulted in the inhibition of cell growth and proliferation of HeLa and SiHa cells. Moreover, the ability of cells to invade was significantly reduced by galectin 1 small interfering RNA. Our results revealed that high galectin 1 expression in peritumoral stroma was significantly correlated with depth of invasion in cervical lesions and lymph node metastasis of cervical cancer and that galectin 1 may be functionally involved in cell proliferation and invasion.

두경부 편평상피암종에서 Matrix Metalloproteinase-2의 발현과 경부림프절 전이에 관한 연구 -임상병리학적 연구-

김승현,임상철,백준,박창수,Chang Soo Park 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.8

림프절 전이가 없는 초기 자궁경부암 환자에서 재발 위험 인자에 대한 scoring system

김호연 ( Ho Yeon Kim ),류미옥 ( Mi Ok Lyu ),윤종혁 ( Jong Hyuck Yoon ),장석준 ( Suk Joon Chang ),장기홍 ( Ki Hong Chang ),유희석 ( Hee Sug Ryu ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.6

Objective: The aim of this study is to apply a prognostic factor scoring system in patients with lymph node-negative stage IB - IIA cervical cancer. Methods: One hundred and ninety-one stage IB - IIA cervical cancer patients were enrolled in this retrospective study from 1994 to 2005 in our gynecologic department. All patients were treated by radical abdominal hysterectomy with lymph node dissection, and there were no patients with involvement of lymph nodes or parametrial invasion. Statistical analysis comprised of clinical characteristics, pathology result, post-operative adjuvant therapy, and recurrence rate. Results: Among the 191 patients, recurrence occurred in 9 patients (4.7%), while no recurrence was observed in the remaining 182 patients (95.3%). No significant difference was found between the two study groups in terms of average age, weight, parity, FIGO stage, and postoperative adjuvant therapy. After univariate analysis, tumor size and deep stromal invasion were factors found to be statistically significant for risk of recurrence. Cell type, close surgical margin, lymphovascular permeation were not significant factors. Multivariate analysis demonstrated deep stromal invasion was the only significant prognostic factor (RR=11.7, p=0.028). The scoring system was applied to tumor size, close surgical margin, and deep stromal invasion, 1, 1, and 2 points given for each factor, respectively. Using the ROC curve, based on 2 points as the cut-off level, the recurrence rate was significantly higher (p<0.0025). Conclusion: Deep stromal invasion was the most important prognostic factor in patients with early stage cervical cancer in the absence of lymph node metastasis. Herein, the scoring system may be applied to predict disease outcome.

선행 화학요법과 광범위 자궁적출술을 시행한 자궁경부암에서 재발 위험 인자에 대한 연구

김승룡,이정한,황정혜,문영진,김경태,조삼현,문형,황윤영 대한부인종양 콜포스코피학회 2001 Journal of Gynecologic Oncology Vol.12 No.1

Objective: This study was done to assess long-term survival and risk factors for recurrence after neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer patients. Methods: Between August 1983 and May 1990, 80 cervical cancer stage IB-IIB patients with tumor diameter 4cm or more received neoadjuvant VBP chemotherapy and radical hysterectomy. After follow-up more than 10 years for these patients, survival rate and risk factors for recurrence were analyzed. Results: Seventy eight of 80 patients were followed for 10 years. During this period, 20,5% patients(16/78) had recurrences and all of them died of recurrence. Five and 10 year survival rates were 82%(64/78) and 79.4%(62/78), respectively. High risk factor for recurrence was pelvic lymph node invasion. However, clinical stage, initial tumor mass size, number of neoadjuvant chemotherapy, clinical response, or residual tumor size were not clinically significant risk factors for recurrence. Initial tumor size was correlated with pelvic lymph node metastasis. In recurrent patients, site of recurrence was not different according to pelvic lymph node status. For node positive patients, combination of chemotherapy and radiation seemed to be more effective in reducing recurrence compared to chemotherapy or radiation only. Conclusion: For locally advanced stage IB-IIB cervical cancer patients who received neoadjuvani chemotherapy and radical hysterectomy, pelvic lymph node metastasis was high risk factor for recurrence and initial tumor size was closely correlated with pelvic lymph node invasion even after neoadjuvant chemotherapy.

The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

Antoni Llueca,Javier Escrig,Antonio Gil-Moreno,Virginia Benito,Alicia Hernández,Berta Díaz-Feijoo 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1

Objective: The prognostic impact of surgical paraaortic staging remains unclear in patientswith locally advanced cervical cancer (LACC). The objective of our study was to evaluate theresults of the surgical technique of preoperative aortic lymphadenectomy in LACC related totumor burden and disease spread to assess its influence on survival. Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanishhospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aorticlymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excisedup to the left renal vein. The extent of the disease was performed evaluating the LNs bycalculating the geometric means and quantifying the log odds between positive LNs andnegative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Coxproportional hazards model was used to account for the influence of multiple variables. Results: A total of 394 patients were included. Pathological analysis revealed positiveaortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognosticindicator. CALS and LODDS <−2 were associated with better disease free survival and overallsurvival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariatemodel analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion: When performing preoperative surgical staging in LACC, it is not advisable totake simple samples from the regional nodes. Radical dissection of the aortic and pelvicregions offers a more reliable staging of the LNs and has a favorable influence on survival.