Publication: Valor pronóstico del antígeno del carcinoma de células escamosas en los pacientes con carcinoma de cérvix localmente avanzado tratadas con radioquimioterapia
Loading...
Files
Official URL
Full text at PDC
Publication Date
2017-02-09
Authors
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
El cáncer de cérvix engloba un grupo complejo de tumores cuyo comportamiento es heterogéneo con respecto a su evolución clínica y respuesta a las diferentes estrategias terapéuticas. Desde hace años se han desarrollado avances en el diagnóstico precoz a partir de la citología cervico-vaginal y en el tratamiento de los estadios avanzados mediante el uso concomitante de radioterapia y quimioterapia. Sin embargo, alrededor del 50% de las enfermas diagnosticadas de un carcinoma invasivo de cérvix fallecerán debido a la aparición de recidivas locales del tumor o por metástasis a distancia. El cáncer de cérvix es un problema de salud pública a nivel mundial, posicionándose como la tercera neoplasia más común en la mujer, la mayor causa de muerte por tumores ginecológicos y la principal causa de muerte por cáncer en mujeres de países con deficientes sistemas sanitarios. En la actualidad, el tratamiento estándar para pacientes con carcinomas de cérvix localmente avanzado o tumores en estadios tempranos pero con factores de mal pronóstico, es la RT-QT concomitante, ésta ha demostrado reducir el riesgo relativo de muerte por cáncer de cérvix en un 30-50%, disminuyendo el fracaso local, pélvico y las metástasis a distancia. Sin embargo, un porcentaje no despreciable de pacientes recaen en el periodo de seguimiento sin una clara correlación con factores pronósticos clínicos como el tamaño tumoral, el estadio y el compromiso ganglionar. Uno de los marcadores biológicos séricos estudiados en el cáncer de cérvix es el antígeno del carcinoma de células escamosas (Ag-SCC), es una subfracción del antígeno tumoral TA-4, glucoproteina de la familia de las serpinas, regulan eventos proteolíticos asociados a la coagulación, fibrinólisis, apoptosis e inflamación. Está presente en el epitelio cervical normal, pero tiene una sobre-expresión en el tejido tumoral. Sus niveles se correlacionan con el tamaño tumoral y la extensión de la enfermedad; en estadios IB-IIA se eleva aproximadamente en el 24-53% de las pacientes y en estadios IIB-IV en el 75-90%. Se ha estudiado la utilidad del Ag-SCC pre-tratamiento en carcinomas de cérvix en estadios precoces (IB-IIA) como predictor de la necesidad de radioterapia adyuvante y como factor pronostico independiente de supervivencia en estadios precoces y avanzados. La elevación de los niveles de Ag-SCC post-tratamiento han demostrado preceder en un promedio de 4 meses la aparición de las recidivas, alcanzando una sensibilidad entre el 56 al 86% y una especificidad entre el 83 al 100%. El establecer factores pronósticos que identifiquen a los subgrupos de pacientes con una escasa respuesta al tratamiento y peor pronóstico es de gran importancia en la clínica diaria de cara a realizar actuaciones terapéuticas precoces que impacten en la supervivencia...
Cancer of the cervix comprises a complex group of tumors with heterogeneous natural histories and response to therapy. Clinical outcome has improved due to early diagnosis with cervical cytology and treatment of advanced stage disease with concomitant chemoradiotherapy (CCRT). Nevertheless, around 50% of patients with invasive cancer of the cervix will die because of local tumor recurrence or distant metastasis. Cancer of the cervix is a worldwide public health issue, being the third commonest cancer, the main cause of death due to gynecological tumors, and the principal cause of cancer death in women in countries with deficient health systems. Currently, CCRT is the standard treatment for patients with locally advanced cancer of the cervix (≥ stage IB2) or tumors in early stages (< IB2) but with poor prognostic factors. This has been shown to reduce the relative risk of death due to cancer of the cervix by 30%-50%, by reducing rates of local pelvic failure and distant metastasis. However, a significant proportion of patients relapse without a clear correlation with known clinical prognostic factors such as tumor size, stage and nodal involvement. One of the biological serological markers studied in cancer of the cervix is the serum squamous cell carcinoma antigen (SCC-Ag). This sub-fraction of the tumor antigen TA-4 is a glycoprotein of the serpin family that regulates proteolytic events associated with coagulation, fibrinolysis, apoptosis and inflammation. It is present in normal cervical epithelium but is overexpressed in cervix cancers. Its levels are correlated with tumor size and the extent of disease. It is elevated in approximately 24-53% of patients with stage IB-IIA disease and in 75-90% of patients with stages IIB-IV disease. High pre-treatment levels of SCC-Ag can indicate adjuvant radiotherapy (RT) in patients with early stage cancer of the cervix (IB-IIA). High SCC-Ag levels are also an independent prognostic factor for survival in both early and advanced stages. An increase in post-treatment SCC-Ag levels can precede clinical diagnosis of a recurrence by an average of 4 months, with sensitivity ranging between 56 to 86% and specificity between 83 to 100%. Establishing prognostic factors that identify patient sub-groups with poor response to treatment is very important in our daily practice to direct early salvage interventions that can impact survival...
Cancer of the cervix comprises a complex group of tumors with heterogeneous natural histories and response to therapy. Clinical outcome has improved due to early diagnosis with cervical cytology and treatment of advanced stage disease with concomitant chemoradiotherapy (CCRT). Nevertheless, around 50% of patients with invasive cancer of the cervix will die because of local tumor recurrence or distant metastasis. Cancer of the cervix is a worldwide public health issue, being the third commonest cancer, the main cause of death due to gynecological tumors, and the principal cause of cancer death in women in countries with deficient health systems. Currently, CCRT is the standard treatment for patients with locally advanced cancer of the cervix (≥ stage IB2) or tumors in early stages (< IB2) but with poor prognostic factors. This has been shown to reduce the relative risk of death due to cancer of the cervix by 30%-50%, by reducing rates of local pelvic failure and distant metastasis. However, a significant proportion of patients relapse without a clear correlation with known clinical prognostic factors such as tumor size, stage and nodal involvement. One of the biological serological markers studied in cancer of the cervix is the serum squamous cell carcinoma antigen (SCC-Ag). This sub-fraction of the tumor antigen TA-4 is a glycoprotein of the serpin family that regulates proteolytic events associated with coagulation, fibrinolysis, apoptosis and inflammation. It is present in normal cervical epithelium but is overexpressed in cervix cancers. Its levels are correlated with tumor size and the extent of disease. It is elevated in approximately 24-53% of patients with stage IB-IIA disease and in 75-90% of patients with stages IIB-IV disease. High pre-treatment levels of SCC-Ag can indicate adjuvant radiotherapy (RT) in patients with early stage cancer of the cervix (IB-IIA). High SCC-Ag levels are also an independent prognostic factor for survival in both early and advanced stages. An increase in post-treatment SCC-Ag levels can precede clinical diagnosis of a recurrence by an average of 4 months, with sensitivity ranging between 56 to 86% and specificity between 83 to 100%. Establishing prognostic factors that identify patient sub-groups with poor response to treatment is very important in our daily practice to direct early salvage interventions that can impact survival...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Radiología y Medicina Física, leída el 24-11-2015