| Background:Cervical cancer is one of the common malignant tumors,the incidence of gynecological malignancies in the first place,it is a serious threat to the health and life of women around the world.In recent years,with the continuous development of cervical cancer screening and diagnostic techniques,surgical methods continue to improve,more and more precancerous lesions and cervical cancer in patients with timely access to diagnosis and treatment.However,after a standardized treatment,there are still part of patients with cervical cancer recurrence or uncontrolled,which is leading to death of cervical cancer patients main reason.Therefore,how to detect and effectively predict the recurrence of cervical cancer and evaluate its prognosis,to prolong the survival time of cervical cancer patients,has become the concern of many clinicians.Regular clinical follow-up after cervical cancer treatment can help early detection of cervical cancer recurrence,improve the clinical outcome of cervical cancer patients,improve their survival rate.However,the specific follow-up program of cervical cancer after treatment has not yet been conclusive.Human papilloma virus(HPV)detection,liquid-based cytology(TCT)detection,squamous cell carcinoma antigen(SCC-Ag)detection methods are commonly used in the follow-up after cervical cancer treatment,but all have certain limitations,leading to part of the patients with cervical cancer recurrence were missed.Is it possible HPV,TCT and SCC-Ag combined detection of cervical cancer after the follow-up can improve the detection rate of patients with cervical cancer recurrence,has not yet been reported in the literature.In addition,assessing the prognosis of cervical cancer patients and effectively predict its recurrence also has important significance to improve their survival rate,but this is still a clinical problem need to be resolved.In recent years,studies have shown that malignant tumor development,invasion,metastasis and prognosis are closely related with the tumor microenvironment,both interdependence and mutual restraint.As one of the tumor microenvironment,Collagen triple helix repeat containing-1(CTHRC1)is also more and more attention in the role of the tumor.As one of the extracellular secreted proteins,In recent years,CTHRC1 over-expression was also observed in a number of solid tumors,and plays an important role in the invasion and metastasis of lung cancer,colorectal cancer,gastric cancer,ovarian cancer,pancreatic cancer and so on,and is an independent prognostic factor.Studies have shown that,the expression of CTHRC1 shown a upward trend in cervical disease occurrence and development.However,till now no further research has been performed on the details of CTHRC1 expression in cervical cancer tissues and its correlation with clinico-pathological characteristics as well as prognosis of cervical cancer.Chapter 1 TCT,HPV in combination with SCC-Ag detection in the meaning of follow-up after cervical cancer treatmentObjective:To explored the clinical application value of TCT,HPV and SCC-Ag detection in the follow-up after cervical cancer treatment.To find the greatest degree of improvement the monitoring effect of cervical cancer recurrence,and then improve the survival rate of cervical cancer patients after treatment.Methods:This research collected the date from January 2006 to May 2013 in Zhujiang Hospital,Southern Medical University,the 205 patients with cervical cancer confirmed by pathology,to find best follow-up strategy.Results:1.The sensitivity and negative predictive value of TCT,HPV and SCC significantly higher than those of the other four detection schemes(SCC,TCT,HPV,TCT combined HPV test),the difference was statistically significant(P<0.05).2.The sensitivity of TCT and HPV combined with SCC detection was very high for distant metastasis and local recurrence detection(P = 0.643).Conclusion:1.The combined detection of TCT,HPV and SCC has higher sensitivity and negative predictive value,and can be more sensitive to the recurrence of cervical cancer after treatment,has important clinical value in follow-up after cervical cancer treatment.2.The combination of TCT,HPV and SCC has high sensitivity for the detection of distant metastasis and local recurrence after cervical cancer treatment.Chapter 2 Expression of CTHRC1 in cervical cancer and its correlation with prognosisObjective:To detect the expression of collagen triple helix repeat containing-1(CTHRC1)in cervical cancer and explore its relationship with the recurrence and prognosis of cervical cancer.Methods:The expressions of CTHRC1 in cervical tissues were detected by immunohistochemical assay in 96 cervical cancer patients,28 cervical intraepithelial neoplasia(CIN)patients and 30 patients with normal cervical tissues.Meanwhile we analyzed the correlation of CTHRC1 expression with recurrence and prognosis of cervical cancer patients.Results:1.The relative expression of CTHRC1 increased with the severity of cervical lesions(0.259±0.026,0.319±0.043,0.372±0.061,respectively).There was significant difference between normal group and CIN group(P = 0.006).Normal group and CIN group were compared with cervical cancer group,the difference were statistically significant(P = 0.000,P = 0.013).2.The relative expression of CTHRC1 in non-recurrence cervical cancer was significantly lower than that in recurrent cervical cancer(P = 0.000).3.In 22 cases of recurrent cervical cancer,the relative expression of CTHRC1 in the tissue specimens after recurrence significantly higher than that in the tissues before recurrence,the difference was statistically significant(P = 0.046).4.There was no significant difference in positive expression rates of CTHRC1 among various age,histological types and tumor size(P>0.05).However,positive expression rates of CTHRC1 were correlated with clinical staging,tissue differentiation and lymph node metastasis(P<0.05).5.Kaplan-Meier survival analysis showed that DFS,OS of CTHRC1 negative expression group were longer than that of positive expression group,with statistical significance.6.Univariate COX analysis on the correlation of CTHRC1 expression and various clinico-pathological characteristics with DFS and OS of patients is presented in Table 5.Univariate COX analysis demonstrated that CTHRC1 positive expression and lymph node metastasis were risk factors for DFS prognosis.Further multivariate COX analysis found that CTHRC1 positive expression was also an independent prognosis factor for the OS of cervical cancer patients,the same as clinical staging,tissue differentiation and lymph node metastasis(P<0.05).Conclusion:1.The expression of CTHRC1 in cervical cancer was higher than that in normal cervical tissues and cervical intraepithelial neoplasia.2.The expression of CTHRC1 was up-regulated during the development and recurrence of cervical cancer.The expression of CTHRC1 may be associated with the development and recurrence of cervical cancer.3.The expression of CTHRC1 was closely related to the clinical stage,histological differentiation,tumor size and lymph node metastasis of cervical cance.4.The expression of CTHRC1 is closely related to the poor prognosis of cervical cancer and is an independent prognostic factor for the total survival of cervical cancer patients. |
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