- MeSH
- analýza dat MeSH
- časná detekce nádoru metody statistika a číselné údaje MeSH
- lidé MeSH
- lidské papilomaviry * patogenita MeSH
- nádory děložního čípku * diagnóza prevence a kontrola MeSH
- Papanicolaouův test metody statistika a číselné údaje MeSH
- plošný screening metody statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Avoiding conization may reduce the risk of pre-term labor in future pregnancies, making conservative treatment of high-grade cervical dysplasia an increasingly discussed approach, especially for younger patients. However, data on the integration of individual predictive factors into routine clinical practice remain limited. PRIMARY OBJECTIVE: The primary objective of the Regression of High-Grade Squamous Intraepithelial Cervical Lesions and Associated Risk Factors (RECER) study is to assess the rate of spontaneous regression in high-grade cervical squamous dysplasia (cervical intraepithelial neoplasia [CIN] 2 and 3) and identify associated predictive factors within clinical practice, without necessitating conization. STUDY HYPOTHESIS: We hypothesize that the characterization of cervical lesions, including colposcopic findings and patient-specific factors, along with a sufficient rate of spontaneous regression, will aid in identifying a subgroup of patients who may derive the greatest benefit from conservative management of high-grade cervical lesions. TRIAL DESIGN: The RECER trial is a multi-center prospective cohort study. Patients with histologically confirmed high-grade squamous intraepithelial lesions (CIN 2 or 3) undergo colposcopic assessments every 4 months. Colposcopic images are compared to evaluate lesion dynamics. In case of progression, conization is indicated, whereas in case of regression, documentation of a biopsy with low-grade dysplasia (CIN 1) or no dysplasia is required. Patients with stable disease are further followed up. MAJOR INCLUSION/EXCLUSION CRITERIA: Patients aged 18 to 40 years with bioptically confirmed high-grade lesion (CIN 2 or 3), a fully visible squamo-columnar junction, and a willingness to undergo conservative management can be included. Excluded are patients with unsatisfactory colposcopy, pregnancy, glandular lesions, invasive disease, or a history of treatment for severe cervical dysplasia. PRIMARY ENDPOINT: The primary end point is the regression rate of high-grade cervical dysplasia. SAMPLE SIZE: 300 patients ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: As of October 2024, a total of 127 patients have been recruited from 4 participating sites across 3 countries. Estimated date of last patient enrollment: September 2026; estimated date for results presentation: January 2028. TRIAL REGISTRATION: Clinicaltrials.gov: NCT06147388.
- MeSH
- dlaždicová intraepiteliální léze cervixu * diagnóza patologie MeSH
- dospělí MeSH
- dysplazie děložního hrdla * diagnóza patologie MeSH
- kolposkopie MeSH
- konizace děložního čípku škodlivé účinky MeSH
- lidé MeSH
- mladý dospělý MeSH
- multicentrické studie jako téma MeSH
- nádory děložního čípku * diagnóza patologie prevence a kontrola MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- spontánní remise * MeSH
- stupeň nádoru MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
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OBJECTIVE: The management and surveillance of glandular pre-cancerous lesions of the uterine cervix present distinct challenges compared with squamous lesions, primarily attributed to the lower effectiveness of diagnostic methods such as cytology or colposcopy. This study aimed to investigate the long-term safety of fertility-sparing treatment for adenocarcinoma in situ and microinvasive adenocarcinoma of the cervix, while identifying factors associated with recurrence, with a particular emphasis on the role of human papillomavirus (HPV) testing. METHODS: We retrospectively reviewed data from all patients with histopathologically confirmed adenocarcinoma in situ or microinvasive cervical adenocarcinoma who received treatment at a single center between 2002 and 2023. The study involved the examination of consecutive surgical specimens and the follow-up details. Factors associated with recurrence were assessed in a subgroup of patients with available long-term follow-up data (at least 6 months). RESULTS: In total, 143 patients (112 with adenocarcinoma in situ and 31 with adenocarcinoma) were included in the analysis. Among the 86 patients who underwent fertility-sparing treatment, the recurrence rate was 9% (12% for adenocarcinoma in situ and 4% for adenocarcinoma) during a median follow-up period of 56.6 months (range 7-179). No patients who were HPV negative experienced recurrence during the follow-up period. In contrast, among patients who were HPV positive, the recurrence rate was 38%. Additionally, HPV 16/18 positivity displayed a notable association with a higher risk of recurrence compared with the other high-risk genotypes, although this difference did not reach statistical significance (83% vs 10%; p=0.083, log-rank). CONCLUSION: Our retrospective study demonstrated a significant association between the risk of recurrence and HPV status during the follow-up period. Consequently, long-term follow-up utilizing HPV testing and genotyping appears to be a secure alternative to a hysterectomy.
- MeSH
- adenokarcinom virologie patologie MeSH
- dospělí MeSH
- infekce papilomavirem * diagnóza virologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory děložního čípku * virologie patologie diagnóza terapie MeSH
- následné studie MeSH
- Papillomaviridae izolace a purifikace MeSH
- retrospektivní studie MeSH
- třídění pacientů metody MeSH
- zachování plodnosti metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associated with negative prognosis. METHODS: We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveillance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01-1.0 mm. Disease-free survival (DFS) was compared between N0 and subgroups of N1 patients defined by cut-off ranges. RESULTS: LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 patients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS compared to N0 in all subgroups with metastases ≥0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group. CONCLUSIONS: In cervical cancer patients, the presence of LN metastases ≥0.4 mm was associated with a significant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication.
- MeSH
- biopsie sentinelové lymfatické uzliny MeSH
- lidé MeSH
- lymfatické metastázy patologie MeSH
- lymfatické uzliny patologie MeSH
- mikrometastázy patologie MeSH
- nádory děložního čípku * chirurgie patologie MeSH
- nádory prsu * patologie MeSH
- sentinelová uzlina * patologie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Tato kazuistika popisuje případ pacientky s karcinomem ovaria, u které byla mimo operační léčby a chemoterapie užita i cílená léčba v podobě inhibitoru PARP (poly(ADP-ribóza)polymerázy) niraparibu. Pomocí této léčby bylo dosaženo uspokojivé stabilizace stavu recidivujícího onemocnění. Podmínkou k dosažení uspokojivého výsledku léčby však i nadále zůstává adekvátně provedený operační zákrok.
This case report describes the case of a patient with ovarian cancer who, in addition to surgery and chemotherapy, also received targeted treatment - PARP (poly(ADP-ribose) polymerase) inhibitor niraparib. A satisfactory stabilization of recurrent disease was achieved as a result of such treatment. However, adequately performed surgical procedure remains crucial in the treatment of ovarian cancer.
- Klíčová slova
- niraparib,
- MeSH
- biopsie metody MeSH
- diagnostické zobrazování metody MeSH
- gynekologické chirurgické výkony metody MeSH
- indazoly terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory vaječníků * chirurgie diagnóza farmakoterapie MeSH
- piperidiny terapeutické užití MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
Indikace k provedení HPV testu by měla sledovat jasně dané klinické situace. V těchto případech jeho výsledek zásadním způsobem zpřesňuje stanovení míry rizika aktuální přítomnosti závažné prekancerózy děložního hrdla. Mimoto navíc poskytuje významnou prediktivní hodnotu ohledně pravděpodobnosti výskytu cervikál- ní dysplázie v horizontu příštích let. Tyto informace vedou jak k optimalizaci screeningového programu, tak k individualizaci sledování rizikových žen a redukci počtu prováděných zákroků na děložním hrdle. Naproti tomu chybně indikovaný HPV test nejenže nepřináší další informaci o závažnosti přednádorového stavu, ale vyvolá u pacientky obavy z nejasného výsledku, vede ke kumulaci dalších vyšetření a konzultací a ve výsledku může dospět až k chybně indikované konizaci. Účelem tohoto přehledového článku je sumarizovat indikace k provedení HPV testu a poskytnout průvodce stran stanovení dalšího léčebného managementu v závislosti na jeho výsledku a konkrétní klinické situaci.
HPV test should be performed in clearly defined clinical situations only. HPV status is used along with other prebioptic methods to preciselly define the risk of actual presence of severe cervical dysplasia in these cases. Moreover, the result of HPV test predicts the cummulative risk of cervical precancer in the future. These data are utilized in order to optimize the screening strategy as well as to individualize the follow-up of high-risk patients. On the other hand, the result of inadequately indicated HPV test not only increases the stress of the patient, but leads to cummulation of further tests and surgical overtreatment in some cases. The aim of this review is to summarize the clinical indications for HPV test and to assist with the design of further clinical management.
- MeSH
- doba do početí MeSH
- dysplazie děložního hrdla * chirurgie patologie MeSH
- hodnocení rizik MeSH
- infekce papilomavirem MeSH
- inkompetence hrdla děložního epidemiologie etiologie MeSH
- komplikace těhotenství patologie virologie MeSH
- konizace děložního čípku metody škodlivé účinky MeSH
- lidé MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- MeSH
- dědičné nádorové syndromy diagnóza genetika MeSH
- genetická predispozice k nemoci genetika MeSH
- hormonální substituční terapie metody škodlivé účinky MeSH
- kontraceptiva hormonální farmakologie škodlivé účinky MeSH
- lidé MeSH
- nádory prsu * diagnóza etiologie prevence a kontrola MeSH
- reprodukční anamnéza MeSH
- rizikové faktory * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
