Title ULOGA TRODIMENZIONALNOGA TRANSVAGINALNOG
ULTRAZVUKA U PROCJENI PROŠIRENOSTI I PROGNOZI
RAKA VRATA MATERNICE Title (english) THE ROLE OF THREE-DIMENSIONAL TRANSVAGINAL
ULTRASOUND IN STAGING AND PROGNOSIS OF
CERVICAL CANCER Author Matija Prka Mentor Alemka Brnčić-Fischer (mentor)Committee member Marko Klarić (predsjednik povjerenstva)Committee member Sanja Dolanski-Babić (član povjerenstva)Committee member Damir Miletić (član povjerenstva)Granter University of Rijeka Defense date and country 2022-11-30, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 61 - Medical sciences Abstract Cilj istraživanja: Značenje trodimenzionalnih (3D) volumetrijskih i doplerskih
istraživanih parametara primarnog raka vrata maternice (RVM) u prognozi tumorskog
odgovora na kemoiradijaciju i brahiterapiju, te uloga trodimenzionalnoga
transvaginalnog ultrazvuka (3D TV UZV) u procjeni proširenosti RVM.
Ispitanice i metode: Sedamdeset pet ispitanica s primarnim RVM FIGO stadija ≥IIB
u istraživanoj skupini (razdoblje praćenja minimalno 24 mjeseca), te 150 ispitanica u
pre- i postmenopauzi s normalnim vratom maternice u kontrolnoj skupini, podvrgnuto
je 3D TV UZV-u.
Rezultati: U univarijatnoj analizi, među volumetrijskim parametrima primarnog RVM,
širina primarnog tumora u 3D multiplanarnom prikazu bila je statistički značajna
nezavisna varijabla s najvećim omjerom izgleda p = 0.0002, OR 3.32 (95% CI 1.77 -
6.23) za parcijalni klinički odgovor na kemoiradijaciju. Diskriminacijske granične
vrijednosti širine primarnog tumora u 3D multiplanarnom prikazu (>4.3 cm) i prodora
u donji uterini segment (>1.86 cm) imale su visoku specifičnost, redom 95.5% i
90.9%, tj. s velikom točnošću su predviđale ispitanice s kompletnim kliničkim
odgovorom. Indeks protoka (FI) je jedina statistički značajna nezavisna varijabla u
univarijatnoj analizi za dva istraživana ishoda: klinički odgovor na kemoiradijaciju p =
0.0192, OR 0.89 (95% CI 0.79 - 0.98) i ukupno preživljenje p = 0.0316, OR 0.89
(95% CI 0.79 - 0.99), omjer izgleda ukazuje na to da niža vrijednost FI povećava
vjerojatnost obaju nepovoljnih ishoda. Uz FI, parcijalni klinički odgovor, recidiv
bolesti, te diskriminacijske granične vrijednosti latero-lateralne (L-L) udaljenosti
(primarnog tumora, nakon kemoiradijacije i na prvom praćenju) u omjeru s
anatomskom (kontrolnom) L-L udaljenosti - pokazatelji infiltracije parametrija,
statistički značajno predviđaju ukupno preživljenje. Klinički najvrjedniji multivarijatni
modeli imali su visoku uspješnost u predviđanju kliničkog odgovora na
kemoiradijaciju (80%) i ukupnog preživljenja (83.6%).
Zaključak: Istraživanje je dokazalo značajnu kliničku važnost 3D TV UZV-a kao nove
i komplementarne slikovne metode u lokoregionalnoj procjeni proširenosti, praćenju i
prognozi primarnog RVM, u sklopu revidirane FIGO 2018 klasifikacije bolesti.
Abstract (english) Objectives: The role of primary cervical cancer (CC) volumetric and Doppler
measurements by three-dimensional transvaginal ultrasound (3D TV US) in
predicting tumor response to chemoradiotherapy and brachytherapy, and the role of
3D TV US in CC staging.
Patients and methods: 3D TV US was performed in 75 patients with primary CC
FIGO stage ≥IIB (study group, minimal follow up for 24 months), and 150 pre- and
postmenopausal women with normal cervix (control group).
Results: Considering volumetric parameters of primary CC, univariate analysis
revealed the primary tumor size on 3D multiplanar image to be a statistically
significant independent variable with the highest odds ratio p = 0.0002, OR 3.32
(95% CI 1.77 - 6.23) for partial clinical response to chemoradiotherapy.
Discriminative borderline values of primary tumor size on 3D multiplanar imaging
(>4.3 cm) and lower uterine segment involvement (>1.86 cm) showed high specificity
of 95.5% and 90.9%, respectively, i.e., predicted patients with complete clinical
response with high accuracy. On univariate analysis, flow index (FI) was the only
statistically significant independent variable for the two study outcomes, i.e., clinical
response to chemoradiotherapy p = 0.0192, OR 0.89 (95% CI 0.79 - 0.98) and
overall survival p = 0.0316, OR 0.89 (95% CI 0.79 - 0.99); odds ratio suggested a
lower FI value to increase the likelihood of both unfavorable outcomes. Besides FI,
overall survival was statistically significantly predicted by partial clinical response,
disease relapse, and discriminative borderline values of the latero-lateral (L-L)
distance (primary tumor, after chemoradiotherapy and on first follow up) relative to
the anatomic (control) L-L distance as indicators of parametrium infiltration. The
clinically most valuable multivariate models were very successful in predicting clinical
response to chemoradiotherapy (80%) and overall survival (83.6%).
Conclusion: The study established the significant clinical role of 3D TV US as a
novel and complementary imaging method in loco-regional staging, follow up and
prognosis of primary CC, according to the revised 2018 FIGO CC staging.
Keywords
Dijagnostički slikovni prikaz
trodimenzionalni prikaz
ultrazvuk
prognoza
procjena proširenosti tumora
tumori
glandularni i epitelni karcinom
vrat maternice
Keywords (english)
Cervix uteri
Diagnostic imaging
imaging
three-dimensional
ultrasonography
Neoplasms
glandular and epithelial
carcinoma
Prognosis
neoplasm staging
Language croatian URN:NBN urn:nbn:hr:184:381971 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2023-01-18 11:41:12
