• 文章类型: Journal Article
    研究表明,需要新的宫颈癌诊断方法,包括microRNA技术。在这次审查中,我们评估了microRNA在检测宫颈癌和宫颈上皮内瘤变(CIN)中的诊断准确性.我们根据方案的系统评价和Meta分析指南(PRISMA-P)的首选报告项目进行了系统评价。我们搜索了2012年1月1日至2022年8月16日在线数据库和灰色文献中的所有文章。我们使用诊断准确性研究的质量评估工具(QUADAS-2)来评估纳入研究的偏倚风险,然后进行随机效应Meta分析。我们确定了297篇文章,并最终从24项研究中提取了数据。血清/血浆浓度miR-205,miR-21,miR-192和miR-9显示出最高的诊断准确性(AUC分别为0.750,0.689,0.980和0.900),用于检测健康对照的CIN。MicroRNA面板(miR-21,miR-125b和miR-370)和(miR-9,miR-10a,miR-20a和miR-196a和miR-16-2)的AUC值分别为0.897和0.886,用于检测健康对照的CIN。从健康对照中检测宫颈癌,最有前景的微小RNA是miR-21,miR-205,miR-192和miR-9(AUC值分别为0.723,0.960,1.00和0.99).我们报告上调的microRNAs的诊断准确性更高,特别是miR-205、miR-9、miR-192和miR-21。这凸显了它们作为独立筛查或诊断测试的潜力,无论是与他人,在一个新的算法中,或与其他生物标志物一起用于检测宫颈病变。未来的研究可以标准化量化方法,并且还在撒哈拉以南非洲和南亚等高患病率人群中研究microRNA。我们的审查方案在PROSPERO(CRD42022313275)中注册。
    Studies suggest a need for new diagnostic approaches for cervical cancer including microRNA technology. In this review, we assessed the diagnostic accuracy of microRNAs in detecting cervical cancer and Cervical Intraepithelial Neoplasia (CIN). We performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline for protocols (PRISMA-P). We searched for all articles in online databases and grey literature from 01st January 2012 to 16th August 2022. We used the quality assessment of diagnostic accuracy studies tool (QUADAS-2) to assess the risk of bias of included studies and then conducted a Random Effects Meta-analysis. We identified 297 articles and eventually extracted data from 24 studies. Serum/plasma concentration miR-205, miR-21, miR-192, and miR-9 showed highest diagnostic accuracy (AUC of 0.750, 0.689, 0.980, and 0.900, respectively) for detecting CIN from healthy controls. MicroRNA panels (miR-21, miR-125b and miR-370) and (miR-9, miR-10a, miR-20a and miR-196a and miR-16-2) had AUC values of 0.897 and 0.886 respectively for detecting CIN from healthy controls. For detection of cervical cancer from healthy controls, the most promising microRNAs were miR-21, miR-205, miR-192 and miR-9 (AUC values of 0.723, 0.960, 1.00, and 0.99 respectively). We report higher diagnostic accuracy of upregulated microRNAs, especially miR-205, miR-9, miR-192, and miR-21. This highlights their potential as stand-alone screening or diagnostic tests, either with others, in a new algorithm, or together with other biomarkers for purposes of detecting cervical lesions. Future studies could standardize quantification methods, and also study microRNAs in higher prevalence populations like in sub-Saharan Africa and South Asia. Our review protocol was registered in PROSPERO (CRD42022313275).
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  • 文章类型: Journal Article
    宫颈癌是全球主要的健康问题。传统上,宫颈癌的预后标志物集中在肿瘤特征上。然而,人们越来越认识到患者的营养状况作为可能的预后指标的重要性。本荟萃分析旨在评估预后营养指数(PNI)在预测宫颈癌患者总生存期(OS)和无进展生存期(PFS)中的作用。Medline,谷歌学者,对ScienceDirect和CochraneCentral数据库进行了系统搜索,以获得报告宫颈癌患者PNI的研究。纳入标准用于选择相关研究,数据提取由两名独立研究者进行。通过纽卡斯尔-渥太华量表(NOS)评估偏倚风险。本荟萃分析包括10项研究,2,352名参与者。汇总分析表明,在宫颈癌患者中,PNI在预测OS[单变量危险比(HR):1.38;95%置信区间(CI):0.77-2.48)或PFS(单变量HR:1.12;95%CI:0.44-2.68)方面没有显着的预后效用。即使在使用多变量分析校正其他混杂因素后,这些结果也是一致的(合并HR:1.06forOS;95%CI:0.64-1.76;合并HR:1.22forPFS;95%CI:0.65-2.30)。还根据区域进行了亚组分析,PNI截止,样本量,证据等级和治疗方案,未显示PNI的任何重大预后价值。漏斗图显示了对称性,这表明没有发表偏倚。目前的荟萃分析表明,PNI在预测宫颈癌女性的OS或PFS方面没有显著的预后效用。需要进一步的研究来探索替代营养指标并确定该患者人群中可靠的预后标志物。
    Cervical cancer is a major global health concern. Prognostic markers for cervical cancer have traditionally focused on tumor characteristics. However, there is a growing recognition of the importaxnce of the nutritional status of the patient as a possible prognostic indicator. The present meta-analysis aims to estimate the role of the prognostic nutritional index (PNI) in predicting overall survival (OS) and progression-free survival (PFS) in patients with cervical cancer. Medline, Google Scholar, Science Direct and Cochrane Central databases were systematically searched for studies reporting PNI in patients with cervical cancer. Inclusion criteria were applied to select relevant studies and data extraction was performed by two independent investigators. Risk of bias was assessed by the Newcastle-Ottawa Scale (NOS). The present meta-analysis included 10 studies with 2,352 participants. The pooled analysis showed that in patients with cervical cancer PNI did not have a significant prognostic utility in predicting OS [univariate hazard ration (HR): 1.38; 95% confidence interval (CI): 0.77-2.48) or PFS (univariate HR: 1.12; 95% CI: 0.44-2.68). These results were consistent even after adjusting for other confounders using multivariate analysis (pooled HR: 1.06 for OS; 95% CI: 0.64-1.76; pooled HR: 1.22 for PFS; 95% CI: 0.65-2.30). Subgroup analyses were also performed based on region, PNI cut-off, sample size, grade of evidence and treatment protocol and did not demonstrate any significant prognostic value of PNI. The funnel plot demonstrated symmetry, suggesting the absence of publication bias. The present meta-analysis indicated that PNI does not have a significant prognostic utility in predicting OS or PFS in women with cervical cancer. Further research is warranted to explore alternative nutritional indicators and identify reliable prognostic markers in this patient population.
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  • 文章类型: Journal Article
    背景:化疗相关的心脏毒性是一个重要的问题,因为它是发病的主要原因。这项研究旨在通过探索同时报道乳腺癌患者CRCT类型和症状的文献,提供有关化疗相关心脏毒性(CRCT)症状的深入信息。
    方法:使用JoannaBriggsInstitute的指南,根据先验方案进行范围审查。参与者是乳腺癌患者。这个概念是与CRCT和文献直接匹配的专门报道的症状的文献,在英语中,从2010年开始,背景是开放的。搜索策略包括四个关键词:“乳腺癌,化疗,心脏毒性,“和”症状。“所有类型的研究设计都包括在内;然而,涉及其他癌症患者的研究,动物科目,排除与CRCT无直接关系的症状.数据被提取和呈现,包括表格和数字。
    结果:本研究共纳入29篇文献,由23例病例报告组成,4个回顾性研究,和2个前瞻性研究。对参与者的性别没有限制;然而,他们都是女人,除了一个病例报告.最常用的化疗方案是曲妥珠单抗,卡培他滨,和阿霉素或表阿霉素。确定的主要CRCT为心肌功能障碍和心力衰竭,其次是冠状动脉疾病,肺动脉高压,和其他条件。用于诊断CRCT的主要测试包括超声心动图,心电图,血清心肌酶,冠状动脉造影,计算机断层扫描,和磁共振成像。在所有案例报告中,CRCT是通过根据患者的症状表现进行附带检查来诊断的;然而,这些研究中只有10项显示化疗前的基线检查.最常见的5种CRCT症状是呼吸困难,胸痛,外周水肿,疲劳,和心悸,通过患者报告的症状表现而不是使用症状评估工具进行评估。曲妥珠单抗治疗的呼吸困难和卡培他滨治疗的胸痛是特别特征性的。化疗后首发症状的时间为1小时至300天,蒽环类药物治疗需要3-55天,曲妥珠单抗需要60-300天,卡培他滨需要1-7天。
    结论:这项范围审查允许根据研究设计和化疗方案进行数据映射。根据患者的症状进行CRCT诊断的心脏评估。大约有五种典型的CRCT症状,症状发生的时间各不相同。因此,开发和应用CRCT特异性和用户友好的症状评估工具有望帮助医疗保健提供者和患者有效地管理CRCT症状。
    BACKGROUND: Chemotherapy-related cardiotoxicity is a significant concern because it is a major cause of morbidity. This study aimed to provide in-depth information on the symptoms of chemotherapy-related cardiotoxicity (CRCT) by exploring literature that concurrently reports the types and symptoms of CRCT in patients with breast cancer.
    METHODS: A scoping review was performed according to an a priori protocol using the Joanna Briggs Institute\'s guidelines. The participants were patients with breast cancer. The concept was the literature of specifically reported symptoms directly matched with CRCT and the literature, in English, from 2010, and the context was open. The search strategy included four keywords: \"breast cancer,\" \"chemotherapy,\" \"cardiotoxicity,\" and \"symptoms.\" All types of research designs were included; however, studies involving patients with other cancer types, animal subjects, and symptoms not directly related to CRCT were excluded. Data were extracted and presented including tables and figures.
    RESULTS: A total of 29 articles were included in the study, consisting of 23 case reports, 4 retrospective studies, and 2 prospective studies. There were no restrictions on the participants\' sex; however, all of them were women, except for one case report. The most used chemotherapy regimens were trastuzumab, capecitabine, and doxorubicin or epirubicin. The primary CRCT identified were myocardial dysfunction and heart failure, followed by coronary artery disease, pulmonary hypertension, and other conditions. Major tests used to diagnose CRCT include echocardiography, electrocardiography, serum cardiac enzymes, coronary angiography, computed tomography, and magnetic resonance imaging. In all case reports, CRCT was diagnosed through an incidental checkup according to the patient\'s symptom presentation; however, only 10 of these studies showed a baseline checkup before chemotherapy. The five most common CRCT symptoms were dyspnea, chest pain, peripheral edema, fatigue, and palpitations, which were assessed by patient-reported symptom presentation rather than using a symptom assessment tool. Dyspnea with trastuzumab treatment and chest pain with capecitabine treatment were particularly characteristic. The time for first symptom onset after chemotherapy ranged from 1 hour to 300 days, with anthracycline-based regimens requiring 3-55 days, trastuzumab requiring 60-300 days, and capecitabine requiring 1-7 days.
    CONCLUSIONS: This scoping review allowed data mapping according to the study design and chemotherapy regimens. Cardiac assessments for CRCT diagnosis were performed according to the patient\'s symptoms. There were approximately five types of typical CRCT symptoms, and the timing of symptom occurrence varied. Therefore, developing and applying a CRCT-specific and user-friendly symptom assessment tool are expected to help healthcare providers and patients manage CRCT symptoms effectively.
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  • 文章类型: Journal Article
    背景:宫颈癌(CC)是一种潜在的致命疾病,可能对女性健康造成严重后果。因为早期症状通常只出现在疾病的中晚期,临床诊断和治疗具有挑战性。中药(TCM)已被证明在缓解癌症临床症状方面具有独特的益处,降低手术后复发的风险,减少放疗后的毒副作用和药物耐药性。它还被证明可以改善患者的生活质量。由于其提高了抗肿瘤的有效性和生物安全性,它可以被认为是一种替代疗法。本研究探讨了中药如何通过信号转导引起CC细胞凋亡,包括活性成分和药用补品。旨在为CC的中医治疗提供可靠的临床依据和方案选择。
    方法:以下搜索词在PubMed中使用,WebofScience,Embase,CNKI,万方,VIP,SinoMed,和其他科学数据库检索有关“宫颈癌”的相关文献,“\”凋亡,\"\"信号通路,\"\"中药,“\”草药单体,“\”草药成分,“\”草药提取物,\"和\"草药配方。\"
    结果:已经证明,草药可以诱导子宫颈细胞凋亡,一种癌症,通过影响所涉及的信号通路。
    结论:进行了全面的文献检索,2017年1月至2023年12月期间的148篇论文被确定有资格纳入.经过细致的筛选,消除和总结,泛化,和分析,发现中药可以调节多个细胞内信号通路及相关分子靶点,如STAT3、PI3K/AKT、Wnt/β-catenin,MAPK,NF-κB,p53,HIF-1α,Fas/FasL等等。观察到这种调节能力在宫颈癌细胞中诱导凋亡。中药抗宫颈癌作用机制的研究和新药靶点的筛选对今后该领域的研究具有重要意义。本研究结果将为中医药在宫颈癌诊治中的未来发展提供思路和参考。
    BACKGROUND: Cervical cancer (CC) is a potentially lethal disorder that can have serious consequences for a woman\'s health. Because early symptoms are typically only present in the middle to late stages of the disease, clinical diagnosis and treatment can be challenging. Traditional Chinese medicine (TCM) has been shown to have unique benefits in terms of alleviating cancer clinical symptoms, lowering the risk of recurrence after surgery, and reducing toxic side effects and medication resistance after radiation therapy. It has also been shown to improve the quality of life for patients. Because of its improved anti-tumor effectiveness and biosafety, it could be considered an alternative therapy option. This study examines how TCM causes apoptosis in CC cells via signal transduction, including the active components and medicinal tonics. It also intends to provide a reliable clinical basis and protocol selection for the TCM therapy of CC.
    METHODS: The following search terms were employed in PubMed, Web of Science, Embase, CNKI, Wanfang, VIP, SinoMed, and other scientific databases to retrieve pertinent literature on \"cervical cancer,\" \"apoptosis,\" \"signaling pathway,\" \"traditional Chinese medicine,\" \"herbal monomers,\" \"herbal components,\" \"herbal extracts,\" and \"herbal formulas.\"
    RESULTS: It has been demonstrated that herbal medicines can induce apoptosis in cells of the cervix, a type of cancer, by influencing the signaling pathways involved.
    CONCLUSIONS: A comprehensive literature search was conducted, and 148 papers from the period between January 2017 and December 2023 were identified as eligible for inclusion. After a meticulous process of screening, elimination and summary, generalization, and analysis, it was found that TCM can regulate multiple intracellular signaling pathways and related molecular targets, such as STAT3, PI3K/AKT, Wnt/β-catenin, MAPK, NF-κB, p53, HIF-1α, Fas/FasL and so forth. This regulatory capacity was observed to induce apoptosis in cervical cancer cells. The study of the mechanism of TCM against cervical cancer and the screening of new drug targets is of great significance for future research in this field. The results of this study will provide ideas and references for the future development of Chinese medicine in the diagnosis and treatment of cervical cancer.
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  • 文章类型: Journal Article
    化疗引起的恶心和呕吐(CINV)是化疗引起的最常见和最严重的副作用之一。在中国,小班夏汤(XBXT)已被广泛应用于NV的预防和治疗。然而,关于这一目的的有效性和安全性的证词有限,没有相关的系统评价。本综述旨在系统评价XBXT预防和治疗CINV的有效性和安全性。
    在八个数据库中进行了系统搜索,以获得评估XBXT治疗CINV效果的随机对照试验(RCT)。呕吐和恶心的缓解效率,吃效率,生活质量,并对不良反应进行疗效评估。通过操纵Cochrane偏倚风险工具2.0(RoB2)来评估偏倚风险。利用ReviewManager5.4和Stata17.0对检索到的调查进行了分析。采用GRADE工具对证据质量进行评估。
    在CINV治疗中,共有16项XBXT临床随机对照试验被纳入研究,共有1246名参与者。荟萃分析表明,与常规止吐药相比,XBXT和止吐药提高了呕吐缓解效率(RR1.35,95%置信区间:1.25-1.46,p<0.00001),恶心缓解效率(N=367,RR1.23,95%CI:1.09-1.38,p<0.00001),和生活质量(RR=1.37,95%CI:1.14-1.65,p=0.0009),并减少了不良事件(N=370,RR0.53,95%CI:0.29-0.96,p=0.04)。与DARAs相比,XBXT和DARAs提高了进食效率(N=208,RR1.30,95%CI:1.07-1.57,p=0.007)。数据具有统计学意义,从漏斗图和修剪和填充分析中确定出版偏倚相对较低。此外,敏感性分析显示出稳健的结果。每个结果的证据质量从中等到高不等。
    有一些令人鼓舞的证据表明,XBXT和止吐剂在治疗CINV方面比单独止吐药物具有更好的治疗效果和安全性。质量评估和低发表偏倚表明总体标准是科学的。需要更好的研究来验证使用大规模RCT和严格方法设计的证据。
    系统审查注册:https://www。crd.约克。AC.uk/PROSPERO/display_record。php?RecordID=281046。
    UNASSIGNED: Chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent and critical side effects due to chemotherapeutics. In China, Xiao-Ban-Xia-Tang (XBXT) has already been applied extensively to prevent and treat CINV. However, there is limited testimony on the effectiveness and safety of this purpose, and there was no correlative systematic review. The aim of this review was to systematically evaluate the effectiveness and safety of XBXT in preventing and treating CINV.
    UNASSIGNED: The systematic search was conducted in eight databases to acquire randomized controlled trials (RCTs) that appraised the effect of XBXT in treating CINV. The vomiting and nausea relief efficiency, eating efficiency, quality of life, and adverse reactions were explored for efficacy assessment. Bias risk was rated by manipulating the Cochrane risk of bias tool 2.0 (RoB 2). The retrieved investigations were analyzed by utilizing ReviewManager 5.4 and Stata 17.0. The quality of evidence was evaluated adopting the GRADE tool.
    UNASSIGNED: A total of 16 clinical RCTs of XBXT in the treatment of CINV were incorporated into the investigation, with a total of 1246 participants. The meta-analysis showed that compared with conventional antiemetic drugs, XBXT and antiemetics improved the vomiting relief efficiency (RR 1.35, 95% confidence interval: 1.25-1.46, p < 0.00001), nausea relief efficiency (N = 367, RR 1.23, 95% CI: 1.09-1.38, p < 0.00001), and quality of life (RR = 1.37, 95% CI: 1.14-1.65, p = 0.0009) and reduced the adverse events (N = 370, RR 0.53, 95% CI: 0.29-0.96, p = 0.04). XBXT and DARAs raised eating efficiency compared with DARAs (N = 208, RR 1.30, 95% CI: 1.07-1.57, p = 0.007). The data existed as statistically significant, and the publication bias was identified as relatively low from the funnel plot and trim and fill analysis. In addition, sensitivity analysis demonstrated robust outcomes. The quality of evidence for each outcome ranged from moderate to high.
    UNASSIGNED: There is some encouraging evidence that XBXT and antiemetics had better therapeutic effects and safety in treating CINV than antiemetic drugs alone. The quality assessment and low publication bias indicated that the overall criterion was scientific. Better research is required to verify the evidence designed with large-scale RCTs and rigorous methods.
    Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=281046.
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  • 文章类型: Journal Article
    背景:宫颈癌是女性第四常见的癌症,死亡率最高的是低收入和中等收入国家。宫颈癌的腹部顶叶转移是一种非常罕见的实体,发病率为0.1-1.3%,并代表一个不利的预后因素,生存率降至17%。这里,我们回顾了近几十年来腹部顶叶转移的病例,包括在诊断为IIB期宫颈癌(腺鳞癌)28个月后,在前引流管的疤痕部位出现4.5厘米的腹部顶叶转移的新病例,同时进行化疗和腔内近距离放射治疗以及随后的手术(B型根治性子宫切除术)。肿瘤在肿瘤范围内切除,组织病理学结果为腺鳞癌。该案例研究强调了早期发现和适当治疗宫颈癌患者转移的重要性。讨论探讨了壁转移的潜在途径以及不完整的外科手术对转移发展的影响。结论强调了宫颈癌患者与此类转移相关的不良预后,以及手术切除与全身治疗相关的潜在益处。
    BACKGROUND: Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.
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  • 文章类型: Journal Article
    CAR-T细胞疗法为延长癌症缓解提供了一种有希望的方法,特别是在血癌的情况下。然而,其在实体瘤治疗中的应用仍面临诸多局限。这篇综述文章全面概述了与CAR-T细胞治疗实体肿瘤相关的挑战和策略。专注于妇科癌症。这项研究讨论了CAR-T疗法用于实体瘤治疗的局限性,比如T细胞衰竭,基质屏障,和抗原脱落。此外,它提出了增加实体肿瘤中CAR-T功效的可能方法,包括检查点抑制剂和化疗的联合治疗,以及将CAR-T与溶瘤病毒疗法相结合的新方法。鉴于缺乏对CAR-T联合疗法治疗妇科癌症的全面研究,这篇综述旨在为实体瘤联合治疗的现状提供见解,并强调这种方法在妇科中的潜力。
    CAR-T cell therapy offers a promising way for prolonged cancer remission, specifically in the case of blood cancers. However, its application in the treatment of solid tumors still faces many limitations. This review paper provides a comprehensive overview of the challenges and strategies associated with CAR-T cell therapy for solid tumors, with a focus on gynecological cancer. This study discusses the limitations of CAR-T therapy for solid tumor treatment, such as T cell exhaustion, stromal barrier, and antigen shedding. Additionally, it addresses possible approaches to increase CAR-T efficacy in solid tumors, including combination therapies with checkpoint inhibitors and chemotherapy, as well as the novel approach of combining CAR-T with oncolytic virotherapy. Given the lack of comprehensive research on CAR-T combination therapies for treating gynecological cancers, this review aims to provide insights into the current landscape of combination therapies for solid tumors and highlight the potential of such an approach in gynecology.
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  • 文章类型: Journal Article
    背景:该研究的目的是评估尿液样本HPV(人乳头瘤病毒)检测对宫颈癌筛查有效性的影响。
    方法:分析基于系统综述的结果。在以下医学数据库中搜索了次要研究:Medline,Embase,还有Cochrane图书馆.本文中提供的统计测试的结果源于所包含文章的作者进行的研究。
    结果:从总共1869次引用中,本综述包括5项研究。从首次尿液样本中检测任何HPV的敏感性和特异性分别为87%[95%CI:(0.74;0.94)]和89%[95%CI:(0.81;0.93)],分别。此外,分析研究的参与者表示,他们对尿液检测感到满意。
    结论:首次尿液样本中HPV感染检测方法的发展以及这种采样方法在广泛可用的筛查测试中的应用可以显着提高患者参与测试的意愿。
    BACKGROUND: The aim of the study was to evaluate the impact of urine-sample HPV (human papillomavirus) testing on the effectiveness of screening for cervical cancer.
    METHODS: The analysis was based on the results of a systematic review. Secondary studies were searched in the following medical databases: Medline, Embase, and the Cochrane Library. The results of the statistical tests presented in the article originate from research conducted by the authors of the included articles.
    RESULTS: From a total of 1869 citations, 5 studies were included in this review. Sensitivity and specificity for the detection of any HPV from first-void urine samples were 87% [95% CI: (0.74; 0.94)] and 89% [95% CI: (0.81; 0.93)], respectively. Moreover, participants in the analyzed studies had indicated that they felt comfortable with urine testing.
    CONCLUSIONS: The development of methods to detect HPV infection in first-void urine samples and the application of this sampling method in widely available screening tests could significantly increase patients\' willingness to participate in testing.
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  • 文章类型: Journal Article
    目的:PD-L1抑制剂治疗宫颈癌的有效性和安全性是一个正在进行的研究问题。这篇综述旨在建立阿替珠单抗的清晰图谱,检查其对生存结果的影响,反应率,和通过严重不良事件(SAE)衡量的安全性。
    方法:使用PubMed进行了文献检索,Scopus,和WebofScience,重点关注2024年2月之前发表的文章。该审查遵循了PRISMA指南,并综合了四项随机试验研究的结果,这些研究涉及每三周以1200mg静脉给药的阿特珠单抗。单独或与放化疗联合使用。
    结果:共有284例患者接受了阿替珠单抗治疗,大多数是晚期宫颈癌(IVA-IVB)。中位随访时间为9周至32.9个月。研究发现,阿替珠单抗与标准疗法相结合,将中位无进展生存期(PFS)从10.4个月延长至13.7个月,总生存期(OS)从22.8个月延长至32.1个月。根据III期试验。单一疗法和阿替珠单抗的初始治疗设置也显示出有希望的疗效,24个月的无病生存率达到79%,而单独使用标准疗法的生存率为52%。然而,治疗与高SAE发生率相关,在更密集的治疗组合中达到79%。
    结论:Atezolizumab在改善宫颈癌患者的PFS和OS方面显示出显著潜力,支持将其纳入一线治疗方案。尽管有疗效益处,SAEs的高发病率需要谨慎的患者选择和管理策略来降低风险.本系统评价支持阿特珠单抗在更广泛的临床试验中的持续评估,以完善其在宫颈癌治疗背景下的治疗概况和安全措施。
    OBJECTIVE: The efficacy and safety of PD-L1 inhibitors in the treatment of cervical cancer is an ongoing research question. This review aims to establish a clear profile of atezolizumab, examining its impact on survival outcomes, response rates, and safety measured by serious adverse events (SAEs).
    METHODS: A literature search was conducted using PubMed, Scopus, and Web of Science, focusing on articles published up to February 2024. The review followed the PRISMA guidelines and synthesized outcomes from four randomized trial studies involving atezolizumab administered at 1200 mg IV every three weeks, alone or in combination with chemoradiotherapy.
    RESULTS: A total of 284 patients received atezolizumab, the majority being advanced stage cervical cancer (IVA-IVB). Median follow-up times ranged from 9 weeks to 32.9 months. It was found that combining atezolizumab with standard therapies extended median progression-free survival (PFS) from 10.4 to 13.7 months and overall survival (OS) from 22.8 to 32.1 months, according to the phase III trial. Monotherapy and initial treatment settings with atezolizumab also showed promising efficacy, with disease-free survival rates at 24 months reaching 79% compared to 52% with standard therapy alone. However, the treatment was associated with high rates of SAEs, reaching up to 79% in more intensive treatment combinations.
    CONCLUSIONS: Atezolizumab demonstrates significant potential in improving PFS and OS in patients with cervical cancer, supporting its inclusion as a first-line treatment option. Despite the efficacy benefits, the high incidence of SAEs necessitates careful patient selection and management strategies to mitigate risks. This systematic review supports the continued evaluation of atezolizumab in broader clinical trials to refine its therapeutic profile and safety measures in the context of cervical cancer treatment.
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  • 文章类型: Systematic Review
    宫颈癌是全球女性中第四常见的癌症,是由高危型人乳头瘤病毒(HPV)持续感染引起的。HPV病毒载量,样本中HPVDNA的含量,被认为与宫颈疾病的严重程度有关,和宫颈癌的临床结果。在这次系统审查中,我们搜索了三个数据库(EMBASE,PubMed,WebofScience)以检查宫颈样本中HPV病毒载量与疾病严重程度之间关联的当前证据,以及临床结果。排除非HPV的文章后,宫颈癌,或包含临床结果,包括85项原始研究,涉及173,746名妇女。绝大多数(73/85=85.9%)报告说,较高的病毒载量与较高的疾病严重程度或较差的临床结果相关。几项研究报告要么没有相关性(3/85=3.5%),或相反的相关性(9/85=10.6%);可能的原因是HPV病毒载量水平的不同分类,或使用特定的抽样方法。尽管研究设计和人群存在差异,上述结果表明,HPV病毒载量与临床结果相关,并可能成为宫颈癌治疗选择和疗效监测的重要生物标志物。
    Cervical cancer is the fourth most common cancer in women worldwide and is caused by persistent infection with high-risk types of human papillomavirus (HPV). HPV viral load, the amount of HPV DNA in a sample, has been suggested to correlate with cervical disease severity, and with clinical outcome of cervical cancer. In this systematic review, we searched three databases (EMBASE, PubMed, Web of Science) to examine the current evidence on the association between HPV viral load in cervical samples and disease severity, as well as clinical outcome. After exclusion of articles not on HPV, cervical cancer, or containing clinical outcomes, 85 original studies involving 173 746 women were included. The vast majority (73/85 = 85.9%) reported that a higher viral load was correlated with higher disease severity or worse clinical outcome. Several studies reported either no correlation (3/85 = 3.5%), or the opposite correlation (9/85 = 10.6%); possible reasons being different categorization of HPV viral load levels, or the use of specific sampling methods. Despite variations in study design and populations, the above findings suggest that HPV viral load is correlated to clinical outcome, and may become an important biomarker for treatment selection and response monitoring for cervical cancer.
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