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 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 systematically review the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features. MethodsWe electronically searched databases including The Cochrane Library (Issue 1, 2014), PubMed, EMbase, Ovid, CNKI, VIP, CBM and WanFang Data from inception to February 2014, to collect the correlation between Beclin1 protein expression and cervical cancer as well as its different clinical pathologic features. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 5 case-control studies involving 637 patients were included, of which, 388 cases in the cervical cancer group, 130 cases in the cervical intraepithelial neoplasia (CIN) group, and 119 cases in the normal cervical tissue group. The results of meta-analysis showed that, a) as for Beclin1 expression, significant differences were found in cervical cancer vs. normal cervical tissues (OR=0.07, 95%CI 0.02 to 0.25, P < 0.000 1), cervical cancer vs. CIN (OR=0.37, 95%CI 0.23 to 0.59, P < 0.000 1), CIN vs. normal cervical tissues (OR=0.23, 95%CI 0.06 to 0.88, P=0.03), and cervical cancer tissues with vs. without lymph node metastasis (OR=0.29, 95%CI 0.17 to 0.49, P < 0.000 01). However, no significant difference was found in medium/low differentiation vs. well differentiation (OR=0.50, 95%CI 0.16 to 1.56, P=0.23), tumour diameter no less than vs. less than 4 cm (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), myometrial invasion depth no less than vs. less than 1/2, and FIGO Ⅰ vs. Ⅱ (OR=0.70, 95%CI 0.44 to 1.10, P=0.12). ConclusionBeclin1 protein expression is notably associated to cervical cancer. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be further verified by performing more high quality studies.
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 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 efficacy and safety of irinotecan as neoadjuvant chemotherapy (INAC) plus radical surgery (RS) for cervical cancer. MethodsWe searched databases including PubMed, EMbase, The Cochrane Library (Issue 10, 2014), CBM, CNKI, VIP and WanFang Data to collect clinical studies on INAC plus RS versus RS alone or other neoadjuvant chemotherapy drugs plus RS in the treatment of cervical cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 6 studies (4 RCTs and 2 CCTs) involving 596 patients were included. The results of meta-analysis showed that, compared with the RS alone group, the INAC group was superior in reducing operation time (MD=-16.17, 95%CI -21.88 to -10.46, P<0.000 01), intraoperative blood loss (MD=-39.56, 95%CI -51.96 to -27.17, P<0.000 01), increasing 3-years OS (OR=0.29, 95%CI 0.15 to 0.57, P<0.000 3), reducing incidence of positive parametrical involvement (OR=0.27, 95%CI 0.12 to 0.60, P=0.001) and incidence of lymphovascular space invasion (OR=0.24, 95%CI 0.09 to 0.61, P=0.003). However, there were no significant differences in the incidence of lymph node metastasis (OR=0.55, 95%CI 0.29 to 1.03, P=0.06) and positive surgical margin (OR=0.33, 95%CI 0.03 to 3.86, P=0.38) between the two groups. Compared with the paclitaxel plus RS group, there were no significant differences for the INAC group in the effective rate (OR=1.58, 95%CI 0.20 to 12.32, P=0.66) and the incidence of more than grade Ⅲ adverse events (OR=2.27, 95%CI 0.62 to 8.27, P=0.21). ConclusionINAC is effective and tolerable in the treatment of cervical cancer. Due to the limitation of quantity and quality of the included studies, more high quality studies are needed 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 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.
ObjectiveTo analyze the relative factors of lymph-nodes metastasis (LM) in patients with cervical cancer. MethodsThe clinico-pathological data of 136 patients with stageⅠ A-Ⅱ A of cervical cancer who underwent surgical therapy from January 2005 to December 2010 were retrospectively analyzed. The correlation between clinico-pathological parameters and LM was analyzed by univariable χ2 analysis and multivariable logistic analysis. ResultsThe total LM rate (LMR) was 14.0% (19/136). The rate of LM in obturator was the highest (63.2%), and then the rate between the external and internal iliac was 42.1%. The rate of deep inguinal lymph nodes and para-aortic lymph node was 0.0%. There was correlation between the clinic staging, depth of stromal invasion, histologic subtype, parametrial invasion, vaginal invasion and LM in univariable analysis (P<0.05). While in multivariable analysis, the correlation with LM was only existed between the clinic staging, histologic subtype, depth of stromal invasion and LM. ConclusionClinic staging, histologic subtype, depth of stromal invasion are high risk factors of LM.