Manzour, N. (Nabil)
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- Ultrasound for assessing tumor spread in ovarian cancer. A systematic review of the literature and meta-analysis(Elsevier, 2024) Tameish, S. (Sara); Chacón, E. (Enrique); Minguez, J.A. (José Ángel); Alcazar, J.L. (Juan Luis); Pérez-Vidal, J.R. (Juan Ramón); Manzour, N. (Nabil)In this review, we aimed to assess the diagnostic performance of ultrasound for assessing the tumor spread in the abdomen in women with ovarian cancer. A search for studies evaluating the role of ultrasound for assessing intrabdominal tumor spread in women with ovarian cancer compared to surgery from January 2011 to March 2023 was performed in PubMed/MEDLINE, Web of Science, and Scopus databases. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands in STATA 12.0 software. We identified 1552 citations. After exclusions, five studies comprising 822 women were included. Quality of studies were considered as good, except for patient selection as all studies were considered as having high risk of bias. The pooled sensitivity and specificity could be calculated for three anatomical areas (recto-sigma, major omentum and root of mesentery) and the presence of ascites. The pooled sensitivity and specificity for detecting disease in the recto-sigma, major omentum and root of mesentery were 0.83 and 0.95, 0.87 and 0.87, and 0.29 and 0.99, respectively. The pooled sensitivity and specificity for detecting ascites was 0.95 and 0.91, respectively. There is evidence that ultrasound offers good diagnostic performance for evaluating the intra-abdominal extent of disease in women with suspected ovarian cancer.
- Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis.(Elsevier, 2022) Chacón, E. (Enrique); Minguez, J.A. (José Ángel); Alcazar, J.L. (Juan Luis); Boria, F. (Félix); Chiva, L. (Luis); Rodriguez-Velandia, Y.P. (Yessica P.); Vara-García, J. (Julio); Manzour, N. (Nabil); Nuñez-Cordoba, J.M. (Jorge M.)Background. After the LACC trial, the SUCCOR study, and other studies, we know that patients who have un- dergone minimally invasive surgery for cervical cancer have worse outcomes, but today, we do not know if the surgical approach can be a reason to change the pattern of relapses on these patients. We evaluated the relapse pattern in patients with stage IB1 cervical cancer (FIGO, 2009) who underwent radical hysterectomy with differ- ent surgical approaches. Methods. A systematic review of literature was performed in PubMed, Cochrane Library, Clinicaltrials.gov, and Web of science. Inclusion criteria were prospective or retrospective comparative studies of different surgical approaches that described patterns or locations of relapse in patients with stage IB1 cervical cancer. Heterogeneity was assessed by calculating I2. Results. The research resulted in 782 eligible citations from January 2010 to October 2020. After filtering, nine articles that met all inclusion criteria were analyzed, comprising data from 1663 patients who underwent radical hysterectomy for IB1 cervical cancer, and the incidence of relapse was 10.6%. When we compared the pattern of relapse (local, distant, and both) of each group (open surgery and minimally invasive surgery), we did not see statistically significant differences, (OR 0.963; 95% CI, 0.602–1.541; p = 0.898), (OR 0.788; 95% CI, 0.467–1.330; p = 0.542), and (OR 0.683; 95% CI, 0.331–1.407; p = 0.630), respectively. Conclusion. There are no differences in patterns of relapse across surgical approaches in patients with stage IB1 cervical cancer undergoing radical hysterectomy as primary treatment.
- Factores pronósticos y patrones de recaída en pacientes con cáncer de cérvix estadio IB1 tras cirugía radical(2024-11-14) Manzour, N. (Nabil); Chiva, L. (Luis); Mínguez-Milio, J. (José Ángel)Esta tesis doctoral se centró en dos aspectos cruciales del tratamiento del carcinoma de cuello uterino en etapa IB1. En primer lugar, establecer si existe diferencia en el patrón de recidiva de las pacientes con carcinoma de cuello uterino en etapa IB1, tratados quirúrgicamente de manera primaria, dependiendo de si la vía de abordaje es abierta o mínimamente invasiva; para ello, se llevó a cabo un meta-análisis con el objetivo de examinar si la elección de la vía de abordaje quirúrgico (abierta vs. mínimamente invasiva) tiene un impacto en el patrón de recidiva tumoral. Los hallazgos obtenidos indicaron que no existen diferencias estadísticamente significativas en el patrón de recidiva entre ambas modalidades de abordaje quirúrgico. En segundo lugar, mediante un análisis exhaustivo de los datos obtenidos en la base de datos SUCCOR, establecer si existen diferencias en los factores clínicos, quirúrgicos y anatomopatológicos entre las pacientes que recidivan y las que no recidivan por carcinoma de cuello uterino etapa IB1, tratados quirúrgicamente de manera primaria; tras el análisis se encontraron 7 variables que se asocian a la probabilidad de recaída tumoral en estas pacientes: - El tamaño tumoral medido en la prueba de imagen preoperatoria. - La realización de una conización previa a la cirugía. - La vía de abordaje quirúrgica (cirugía abierta vs mínimamente invasiva). - El tamaño tumoral medido en la pieza quirúrgica. - El grado de invasión del estroma cervical. - La afectación del margen quirúrgico. - La etapa oncológica tras el análisis definitivo de la pieza quirúrgica. La conización previa a la histerectomía radical emerge como un factor significativo en la reducción del riesgo de recidiva y de muerte en pacientes con cáncer de cuello uterino en etapa IB1 tratados quirúrgicamente de manera primaria. El subanálisis confirma dicho efecto protector particularmente en el contexto de la cirugía mínimamente invasiva. Además, en este estudio, se desarrolló y validó un índice de riesgo de recidiva que incorporó la conización cervical previa a la cirugía, la vía de abordaje utilizada y el tamaño tumoral en la imagen preoperatoria. Este índice proporciona una herramienta adicional para la evaluación y manejo de las pacientes con carcinoma de cuello uterino en etapa IB1, permitiendo una mejor estratificación del riesgo y una atención más personalizada. Esta tesis doctoral llega a las siguientes conclusiones: 1. La vía de abordaje quirúrgico (abierta vs mínimamente invasiva) no determina el patrón de recaída en las pacientes con cáncer de cérvix en etapa IB1 sometidas a histerectomía radical como tratamiento primario. 2. El tamaño tumoral mayor a 2 cm en las pruebas de imagen preoperatoria se asocia a peores resultados oncológicos, en pacientes con cáncer de cérvix etapa IB1 FIGO 2009, que se someten a histerectomía radical como tratamiento primario. 3. La vía mínimamente invasiva se asocia con resultados oncológicos peores en pacientes con cáncer de cuello uterino en la etapa IB1, que se someten a histerectomía radical como tratamiento primario. 4. La conización cervical previa a la histerectomía radical se asoció a supervivencias libres de enfermedad y a supervivencias globales mejores que las pacientes no conizadas. 5. La conización cervical prequirúrgica protege de la recaída especialmente a las pacientes sometidas a histerectomía radical por vía mínimamente invasiva. 6. El score de riesgo diseñado ha demostrado ser válido y puede ser una herramienta complementaria a los factores de riesgo clásicos para la toma de decisiones terapéuticas y el seguimiento en pacientes con cáncer de cérvix etapa IB1 FIGO 2009, que se someten a histerectomía radical como tratamiento primario.
- SUCCOR risk: design and validation of a recurrence prediction index for early-stage cervical cancer(2022) Chacón, E. (Enrique); Minguez, J.A. (José Ángel); Martin-Calvo, N. (Nerea); Alcazar, J.L. (Juan Luis); Boria, F. (Félix); Chiva, L. (Luis); Manzour, N. (Nabil)Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17-0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33-3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00-2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.
- Factors associated with a post-procedure spontaneous pregnancy after a hysterosapingo-foam-sonography (HyFoSy): results from a multicenter observational study(2023) Rodríguez, R. (Roberto); Engels, V. (Virginia); Medina, M. (Margarita); Alcazar, J.L. (Juan Luis); Ros, C. (Cristina); Brotóns-Almandoz, I. (Isabel); Martínez-Ten, P. (Pilar); de la Cuesta-Benjumea, R. (Reyes); Pelayo, I. (Irene); Antolin, E. (Eugenia); Bermejo, C. (Carmina); Sancho, J. (Javier); Martínez, O. (Óscar); Manzour, N. (Nabil); Sotillo, L. (Laura); de Guirior, C. (Cristian); Amaro, A. (Ainara)Background: Tubal patency testing constitutes an essential part of infertility work-up. Hysterosalpingo-foam-sonography (HyFoSy) is currently one of the best tests for assessing tubal patency. The objective of our study was to evaluate the post-procedure rate of spontaneous pregnancy among infertile women submitted for an HyFoSy exam with ExEm((R)) foam and the factors associated with this. Methods: Multicenter, prospective, observational study performed at six Spanish centers for gynecologic sonography and human reproduction. From December 2015 to June 2021, 799 infertile women underwent HyFoSy registration consecutively. The patients' information was collected from their medical records. Multivariable regression analyses were performed, controlling for age, etiology, and time of sterility. The main outcome was to measure post-procedure spontaneous pregnancy rates and the factors associated with the achievement of pregnancy. Results: 201 (26.5%) women got spontaneous conception (SC group), whereas 557 (73.5%) women did not get pregnant (non-spontaneous conception group, NSC). The median time for reaching SC after HyFoSy was 4 months (CI 95% 3.1-4.9), 18.9% of them occurring the same month of the procedure. Couples with less than 18 months of infertility were 93% more likely to get pregnant after HyFoSy (OR 1.93, 95% CI 1.34-2.81; p < 0.001); SC were two times more frequent in women under 35 years with unexplained infertility (OR 2.22, 95% CI 1.07-4.65; P0.033). Conclusion: After HyFoSy, one in four patients got pregnant within the next twelve months. Couples with shorter infertility time, unexplained infertility, and women under 35 years are more likely to achieve SC after HyFoSy.
- SUCCOR Nodes: May Sentinel Node Biopsy Determine the Need for Adjuvant Treatment?(Springer, 2023) Chacón, E. (Enrique); Martin-Calvo, N. (Nerea); Bizzarri, N. (Nicolò); Boria, F. (Félix); Chiva, L. (Luis); Manzour, N. (Nabil); Berasaluce, A. (Arantxa)Background The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis. Patients and Methods We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders. Results The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98–6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04–11.7, p = 0.042) compared with those who underwent LA. Conclusions Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.