Ahmad Fuady

Expression of miR-92a and miR-125b and Their Association with Chemoradiotherapy Response in Locally Advanced Cervical Cancer

Cervical cancer remains a major cause of morbidity and mortality, with most cases in Indonesia diagnosed at a locally advanced stage. Although concurrent chemoradiotherapy is the standard treatment, response varies. Dysregulation of microRNAs (miRNAs), particularly oncogenic miR-92a and tumor suppressor miR-125b, may contribute to treatment resistance. This study aimed to evaluate the association between miR-92a and miR-125b expression and chemoradiotherapy response in locally advanced cervical cancer. This single-center retrospective cohort study included patients with stage IB3–IVA cervical cancer treated with chemoradiotherapy between 2019 and 2025. miRNA expression levels were measured from pretreatment tumor biopsy specimens. Poor response was defined as incomplete response or disease progression after treatment. Appropriate comparative, predictive, and survival analyses were performed. Sixty-eight patients were included. Poor response was significantly associated with underweight body mass index, elevated miR-92a, and reduced miR-125b expression (p < 0.05). High miR-92a and low miR-125b expression were also associated with shorter overall survival (p < 0.001). A combined model incorporating BMI, miR-92a, and miR-125b showed good predictive performance. Elevated miR-92a and reduced miR-125b are associated with poor treatment response and worse survival. These miRNAs may support risk stratification and treatment personalization in locally advanced cervical cancer.

Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review

PURPOSE To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment. METHODS We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework. RESULTS Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies—mainly through surveys—reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol. CONCLUSION Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.