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ASO Author Reflections: Conization Before Radical Hysterectomy Improves Disease-Free Survival in Early Stage Cervical Cancer
No full textPast
A well-known randomized study demonstrated that minimally invasive radical hysterectomy was associated with poorer disease-free and overall survival in patients with early stage cervical cancer, when compared with an open approach.1 Despite not yet understanding the technical reasons for this result, different options have been proposed to explain the difference in oncological outcomes. One of these is potential peritoneal ‘contamination’ at time of colpotomy: this possibility is intuitively more likely in cases of bulky tumors.2,3 In this context, conization before radical hysterectomy may reduce the risk of peritoneal exposure to cancer tissue, maintaining the oncological safety of the surgical procedure.
Very few studies have investigated the impact of conization in cervical cancer survival, demonstrating an association between conization and reduced risk of recurrence.3
Present
In this multicenter, retrospective, observational cohort study, we analyzed the survival outcomes of a population of FIGO 2009 stage IB1 cervical cancer, by comparing the group that underwent conization with the group that did not undergo conization before radical hysterectomy. Three hundred and thirty-two patients (166, 50% in each group) were included after balance with a propensity match analysis. On the conization specimens, 14.4% and 85.6% of patients had negative and positive surgical margins, respectively. However, 41.6% of conization patients did not have residual tumor on the hysterectomy specimen, therefore significantly reducing the risk of peritoneal tumor ‘contamination’.
Patients undergoing conization before radical hysterectomy were less likely to receive adjuvant treatment (p < 0.001) and had a better 5-year disease-free survival than patients who did not receive conization (89.8% vs. 80.0%, respectively; p = 0.010). No difference in 5-year overall survival (97.1% vs. 91.4%, respectively; p = 0.114) and in recurrence pattern (p = 0.115) was reported between the two groups. Conization before radical hysterectomy and tumor diameter ≤ 20 mm were independently associated with reduced risk of recurrence.
Future
More and more evidence supports the role of protecting maneuvers performed at the time of radical hysterectomy to avoid peritoneal exposure to tumor cells. Amongst these, the avoidance of using a uterine manipulator, the closure of the vaginal cuff and, now, pre-operative conization, can be listed as actions aimed at reducing or eliminating the risk of peritoneal tumor contamination during minimally invasive surgery.4 Nevertheless, at the moment, most international guidelines and societies’ statements are cautious regarding the use of minimally invasive radical hysterectomy, particularly for tumors > 20 mm, unless within the setting of clinical trials. Prospective randomized trials are ongoing to further confirm or deny the detrimental effect of a minimally invasive approach to radical hysterectomy.5 Importantly, these trials promote or aim to assess the use of protective maneuvers to avoid peritoneal tumor exposure at the time of colpotomy, and conization could be proposed as one of these. Nevertheless, a randomized trial to specifically compare the survival of patients undergoing or not undergoing pre-operative conization, may be necessary in the future to better define and personalize the correct management of early stage cervical cancer.
References
1.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379(20):1895–904.
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2.
Pedone Anchora L, Bizzarri N, Kucukmetin A, et al. Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach. Eur J Surg Oncol. 2020;7983(20):30829–5. https://doi.org/10.1016/j.ejso.2020.09.038.
3.
Casarin J, Buda A, Bogani G, et al. Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: a multi-institutional study. Gynecol Oncol. 2020;159(1):164–70.
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4.
Bizzarri N, Pedone Anchora L, Kucukmetin A, et al. Protective role of conization before radical hysterectomy in early-stage cervical cancer: a propensity-score matching study. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-09695-4.
5.
Basaran D, Leitao MM Jr. The landmark series: minimally invasive surgery for cervical cancer. Ann SurgOncol. 2021;28(1):204–11
Meiofauna densities and gastrotrich community composition in a Mediterranean sea cave
No full textDuring the past 5 decades, the large-sized biota inhabiting dark marine caves has attracted the attention of many marine biologists; in contrast, studies concerning the meiofaunal organisms of these peculiar biotopes remain scanty and mostly with a taxonomic aim. In this study, the nature and abundance of meiofaunal taxa living in a Mediterranean, semi-submerged sea cave was surveyed in relation to distance from the entrance and over two different seasonal periods. Particular attention was paid to the Gastrotricha taxocene. Research was carried out in a cave along the Ionian coast of Apulia (southern Italy), the Grotta Piccola del Ciolo which opens for approximately 120 m on the north-eastern side of a shallow fjord and has a bottom blanketed by fine to very fine sand, occasionally rich in detritus. Quantitative samples in four replicates were collected by SCUBA diving, in November 2000 and June 2001, coring the sediment with a hand-held piston corer in three light-free sites (stations 1-3) located at increasing distances from the entrance. At each site, two additional 500-ml sediment samples were collected for an in vivo study of the Gastrotricha. Faunistic analysis found a fairly high meiobenthic diversity, identifying representatives of more than 12 major groups, with total abundances ranging from 656 ind./10 cm(2) (10 cm(2)) in November to 1,069 ind./10 cm(2) in June. Station 1, the closest to the entrance invariably hosted the most abundant meiofaunal community (851 ind./10 cm2 in November and 1932 ind./10 cm(2) in June), followed by station 2 or 3 depending on the season. While nematodes and harpacticoids appear as the most abundant taxa when the cave is considered as a whole, other taxa may prevail numerically in selected stations, e. g. priapulids, which are the second most abundant taxon at station 1 (30 ind./10 cm(2) in November and 83 ind./10 cm(2) in June). Although the density of total meiofauna and that of the single groups may not be very high, the cave is interesting by virtue of the peculiarity of the hosted fauna, e. g., species and genera new to science or new to the Mediterranean Sea. Regarding the Gastrotricha, we found 16 species, accounting for 1.3-2.6% of the total meiobenthos (density = 8.4 ind./10 cm(2) in November and 27.4 ind./10 cm(2) in June). Analysis of the gastrotrich community found, particularly in June, an assemblage of taxa quite different from those found in open habitats, even at the family level; differences that are probably due to the exploitation of different food resources by animals populating the two environments, i.e. algae in the open sea versus bacteria in the caves. Results indicate that for meiofauna, as happens for macrofauna, the marine caves may represent hotspots of biodiversity and endemism; the driving forces at the base of the trophic depletion hypothesis seem to be responsible for structuring the meiofauna community inside the cave
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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