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.
摘要:目的：探讨超声引导下组织间插植内照射治疗中晚期宫颈癌的意义和效果。方法:回顾性分析32例中晚期宫颈癌患者,采用超声引导下肿瘤组织间插植内照射+外照射。结果：有23例肿瘤脱落,宫颈原形出现,其余7例肿瘤缩小50%以上,持续时间均≥1个月,另有2例肿块缩小＜50%,即CR为719%,PR为218%,NC为63%,PD为0%。结论：超声引导下插植内照射是一种治疗中晚期宫颈癌的安全有效的近距离放疗技术。Abstract: Objective: To evaluate the efficacies of interstitial implant brachytherapy by ultrasoundguided for moderately advanced and advanced cervical carcinoma. Methods: Thirytwo patients with cervical cancer ⅡbⅣ who received interstitial implant brachytherapy by ultrasoundguided and routine irradiation. Results: 719% cases achieved complete remission (CR), 219% cases partial remission (PR), 63% cases no change(NC),0% case progressed disease（PD）. Conclusion: Interstitial implant brachytherapy by ultrasoundguided is an effective method for cervical tumor.
目的:探讨妊娠相关性宫颈癌的早期诊断、治疗和预后。方法:结合文献回顾分析我院2000年至2007年收治的13例妊娠相关性宫颈癌的诊治经过和预后。结果:妊娠相关性宫颈癌分化程度低，癌灶体积大，早期盆腔淋巴结转移率高，产褥期宫颈癌预后差。结论:宫颈细胞学检查应列为首次产检常规项目；妊娠期宫颈原位癌在密切随诊前提下可暂不予处理，待分娩后6~8周活检确认病变性质后，再采取相应治疗措施；新辅助化疗同样可为晚期别的妊娠相关性宫颈癌争取手术时机。
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。
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 evaluate the diagnostic accuracy of liquid-based cytology versus conventional cytology for cervical neoplasia. Methods Such databases as PubMed, Embase, The Cochrane Library, Cochrane Central Register of Controlled Trials, CNKI and CBM were searched to collect the random control trials (RCTs) about evaluating the diagnostic accuracy of liquid-based cytology versus conventional cytology for cervical neoplasia published before June, 2010. According to the inclusive and exclusive criteria, two assessors independently screened the studies, extracted the data, assessed the quality and conducted meta-analysis by using RevMan 5.0 and Metadisc 1.4 softwares. Results A total of five RCTS were eligible. With the ASCUS regarded as the abnormal critical value, there were significant differences between liquid-based cytology and conventional cytology in specificity for CIN 3+ (RR=0.97, 95%CI 0.97 to 0.97, Plt;0.000 01) and CIN 2+ of high risk population (RR=1.01, 95%CI 1.01 to 1.01, Plt;0.000 01), but no significant differences were found in other outcomes. Conclusion Based on the current evidence of evidence-based medicine, the liquid-based cytology is of neither more specificity nor more sensitivity for detecting high grade CIN than the convention cytology in the regular screening program, but it seems to be of more specificity in high risk group.
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 evaluate the diagnostic accuracy of human papillomavirus test for cervical neoplasia. Methods The Cochrane Library (Issue 2, 2010), Cochrane Central Register of Controlled Trials (Issue 2, 2010), and the following databases as CBMdisc, CNKI, MEDLINE, PubMed, and EMbase were all searched from their establishment to June 2010 to get all the randomized control trials (RCTs), and the relevant magazines and the references of the included studies were also searched. The screening, data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently. The software Metadisc 1.4 was used to perform meta-analyses, and the forest plots and SROC curves were drewn with the RevMan 5.0 software. Results A total of 7 RCTs involving 171 604 subjects were included. The meta-analyses showed, the sensitivity of the HPV test for detecting cervical neoplasia (CIN) was higher than that of the conventional cytology test; the difference in sensitivity for detecting CIN in or above second grade was only found between the test of HPV combined with cervical cytology and the test of conventional cytology (Plt;0.00001), but the HPV test obviously lowered its diagnostic specificity. Among the following three tests for diagnosing CIN, such as, the single test of HPV, the combined test of HPV and cervical cytology, and the test of HPV followed by cytology shunting, the statistic differences compared with the conventional cytology test were found (Plt;0.01) except the last test (P=0.41) which had no difference in diagnosing CIN in or above the first grade. Conclusion The current evidence indicates that, compared with the conventional cytology test, the HPV combined with the cytology test can improve the sensitivity for diagnosing CIN in or above the second grade, but the HPV test cannot improve the specificity for cervical neoplasia. The application of human papillomavirus test for detecting cervical neoplasia needs to be further studied.