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.
Objective To evaluate the cost effectiveness of human papillomavirus vaccine (HPV) for treating cervical cancer. Methods We constructed a Markov model to evaluate the cost-effectiveness of HPV versus Chinese healthy women aged 18 to 25 for treating Cervical Cancer. We calculated the clinical benefits and cost-effectiveness and judged the results based on willing to pay. Sensitivity analysis was made for parameters like cost, discounting rate and vaccine efficacy. Results HPV vaccination was a cost-effective option under the local willing to pay value with the incremental cost utility ratio 43 489 per QALY gained. It proved that vaccination was an economic and effective solution. Conclusion Given the results of Markov model, the cost effectiveness of HPV vaccination of Chinese women aged 18 to 25 is positive. Considering the data sources and model hypothesis, this report has some limitations. Further studies are warranted.
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 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.
Objective To evaluate the clinical effect and safety of nerve sparing radical hysterectomy(NSRH) for cervical cancer compared with radical hysterectomy (RH). Methods We searched the Cochrane Library (Issue 2, 2010), MEDLINE (1960 to March, 2010), EMbase (1960 to March, 2010), CBM (1960 to March, 2010), VIP (1960 to March, 2010) and CNKI (1960 to March, 2010), and hand searched related literatures. With a defined search strategy, both randomized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane’s evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration’s RevMan 4.2.2 software. Results Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that: a) There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume (PVR) (WMD= – 5.80, 95%CI – 6.22 to – 5.37), the bladder dysfunction morbidity (RR=0.43, 95%CI (0.26 to 0.75), and the urodynamic study; b) The operation time of NSRH was longer than that of RH with a significant difference (WMD=37.23, 95%CI 12.84 to 61.61); c) There was no significant difference between two groups in bleeding amount (WMD=19.66, 95%CI – 51.57 to 90.90); d) There was no significant difference between two groups in both survival rate and recurrent rate (RR=0.79, 95%CI 0.17 to 3.58); e) There was no significant difference between two groups in resection extension and pathologic outcome, such as, infiltration around uterus and vessels; f) One trail showed a significant difference between two groups that NSRH seldom led to anorectal and sexual dysfunction. Conclusions Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven’t larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postoperative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation.
Objective To investigate the efficacy and safety of neo-adjuvant chemotherapy for stage ⅠB2-ⅡB cervical cancer. Methods From June 2012 to December 2014, 66 patients with stage ⅠB2-ⅡB cervical cancer were selected and treated by PT (cisplatin/ carboplatin and taxol/docetaxel) as neo-adjuvant chemotherapy prior to surgery. Neo-adjuvant chemotherapy response and toxicity were collected and analyzed. Results The extinctive condition of tumor by neo-adjuvant chemotherapy: the complete remission rate was 10.6% (7/66), partial remission rate was 59.1% (39/66), and the total effective rate was 69.7%. The main toxicities were myelosuppression (59.1%, 39/66) and gastrointestinal reactions (33.3%, 22/66). The toxicities could be tolerated or relieved by prevention and treatment. The effective rate of chemotherapy for cervical squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma was 72.6%, 33.3% and 0%, respectively, with significant differences among the three types (P<0.05). The effective rate of chemotherapy for high, medium and low differentiated cervical cancer was 100.0%, 77.3% and 55.9%, respectively, with significant differences among the three degrees (P<0.05). Conclusions Neo-adjuvant chemotherapy is proved to be a safe and effective complementary treatment for most patients with locally advanced cervical cancer. Due to the limitation of sample size, the correlations between therapeutic effect and tumor differentiation degree and between therapeutic effect and pathological type need further study.
ObjectiveTo compare the dosimetric differences among the double-arc volumetric-modulated arc therapy (VMAT), 7 field intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) techniques in treatment planning for cervical cancer as adjuvant radiotherapy. MethodFifteen patients who underwent adjuvant chemotherapy for cervical cancer between March 1st and September 30th, 2013 were chosen to be our study subjects through random sampling. Under Pinnacle 9.2 planning system, the same CT image was designed through three different techniques:VMAT, IMRT and 3D-CRT. We then compared target zone fitness index, evenness index, D98%, D2%, D50% among those different techniques. Monitor unit (MU) and treatment time were also analyzed. ResultsThree techniques showed similar target dose coverage. The IMRT and VMAT plans achieved better target dose conformity, which reduced the V20 of the pelvic, the V50 of the rectum and bladder, as well as the V40/50 of the small intestine (P<0.05). The VMAT technique showed few dosimetric advantages over the IMRT technique. VMAT technique had the advantages of less MU (P>0.05) and shorter overall treatment time (P<0.01) compared with IMRT technique. ConclusionsThe IMRT and VMAT plans achieve similar dose distribution to the target, and are superior to the 3D-CRT plans, in adjuvant radiotherapy for cervical cancer. VMAT technique has the advantages of less MU and shorter overall treatment time.
Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer. Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software. Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (Plt;0.000 01). Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH.
Objective To investigate the expression of COX-2 in human cervical cancer and explore their relationship between the COX-2 expression and the clinicopathologic characteristic of cervical cancer. Methods The published studies were searched in the CBMdisc (1979 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and WANFANG Database (1982 to 2009), and other relevant journals were also hand searched, to identify all the relevant case-control trials. The quality of the included studies was assessed. The Cochrane Collaboration’s software RevMan 4.2.10 was used to test the heterogeneity, overall effect and publication bias of the combined studies. Results A total of 9 studies were recruited. As for the positive rate of COX-2 expression, significant differences was tested between cervical cancer vs. normal cervical tissues, lymph node metastasi vs. non-lymph node metastasi, clinical stages I-II vs. clinical stages III-IV, cell differentiation G1 vs. cell differentiation G2-G3 and cervical squamous cell carcinoma vs. adenocarcinoma with OR (95%CI) at 28.03 (9.53 to 82.50), 5.16 (3.36 to 7.93), 0.53 (0.33 to 0.84), 3.11 (1.86 to 5.22) and 5.00 (2.68 to 9.35) respectively. Conclusions According to the domestic evidence, higher COX-2 expression might be associated with cervical cancer. However, more high quality case-control studies are expected for further study.
Objective To systematically evaluate the diagnostic value of TERC gene on high-grade squamous intraepithelial lesion (HGSIL) of the cervix. Methods Such databases as PubMed, EMbase, and The Cochrane Library were searched by March 31, 2012. According to the inclusion and exclusion criteria, the literature was screened and the data were extracted. The quality was evaluated in accordance with the quality assessment tool for diagnostic accuracy studies (QUADAS) and the meta-analysis was conducted by using Meta-Disc 1.4 software. Result A total of 12 studies involving 7 894 cases were included. The results of meta-analysis showed that the sensitivity, specificity and diagnostic odds ratios of TERC gene on HGSIL of cervix were 0.81 (95%CI 0.80 to 0.82), 0.83 (95%CI 0.82 to 0.84), 17.37 (95%CI 8.77 to 34.41), respectively. Conclusions The diagnostic value of TERC gene were medium in diagnosing HGSIL of the cervix alone, and it can be used as an optional method in clinical diagnosis.