Value of postoperative radiotherapy and analysis of prognostic factors in early-stage neuroendocrine carcinoma of cervix / 中华妇产科杂志

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.

Quality of life in cervical cancer survivors after radical hysterectomy via laparoscopy or laparotomy / 中国实用妇科与产科杂志

OBJECTIVE: To study the difference between laparoscopic and open radical surgery in long-term quality of life(QOL)in cervical cancer survivors.METHODS: The patients with cervical cancer who were followed up in the Outpatient Department of Peking Union Medical College Hospital(PUMCH)from October 2017 to October 2018 were selected for life quality assessment by the EORTC questionnaires,QLQ-C30 and QLQ-Cx24.RESULTS: A total of 319 patients with primary cervical cancer were included in the study.Of all enrolled patients,262 underwent laparoscopic radical hysterectomy while 57 received laparotomy.All patients completed personal information survey,of which 102 patients reported urinary symptoms and 68 reported colorectal symptoms.There were no significant differences in the age of diagnosis,ovarian retention,and postoperative adjuvant radiotherapy between the laparoscopic and open surgery groups.The QLQ-C30 scores showed that the overall quality of life scale items for the laparoscopic and open group were 83.3(0-100)and 95.6(41.7-100)points,respectively,with no statistically significant difference between the two groups(P=0.931).CONCLUSION: Laparoscopic and laparotomic radical hysterectomy are similar in long-term QOL in cervical cancer survivors.

Pelvic Exenteration for Recurrent and Persistent Cervical Cancer / 中华医学杂志(英文版)

<p><b>Background</b>Pelvic exenteration (PE) for primary and recurrent cervical cancer has resulted in favorable survival outcomes, but there are controversies about specific prognosis factors, and up to now, there have been no published reports from China. This study aimed to share our experiences of PE, which were performed in a single institution.</p><p><b>Methods</b>From January 2009 to January 2016, 38 patients with recurrent or persistent cervical cancer were included in the study, and they were followed up until January 2017. Epidemiological and clinicopathological characteristics of patients were compared for survival outcomes in univariate and Cox hazard regression analysis.</p><p><b>Results</b>There were thirty-one and seven patients with recurrent and persistent cervical cancer, respectively. The median age of patients was 45 years (range 29-65 years). Total, anterior, and posterior PE consisted of 52.6%, 28.9%, and 18.4% of cases, respectively. Early and late complications occurred in 21 (55.3%) patients and 15 (39.5%) patients, respectively. Two (5.3%) patients died due to complications related to surgeries within 3 months after PE. The median overall survival (OS) and disease-free survival (DFS) were 28.5 months (range 9-96 months) and 23 months (range 4-96 months), respectively, and 5-year OS and DFS were 48% and 40%, respectively. Cox hazard regression analysis showed that, the margin status of the incision and mesorectal lymph node status were independent risk factors for OS and DFS.</p><p><b>Conclusion</b>In our patients with recurrent and persistent cervical cancer, the practice of PE might achieve favorable survival outcomes.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT03291275; https://clinicaltrials.gov/ct2/show/NCT03291275?term=NCT03291275&rank=1.</p>

Research advance in antitumor activities of artemisinin and its derivatives / 中国医学科学院学报

Artemisinin and its derivatives are highly effective in fighting against malaria. Notably, these drugs have shown potent anti-timor activities by arresting cellular growth, enhancing apoptosis, inhibiting angiogenesis, and regulating the expression of tumor-associated genes, although the underlying mechanisms remain unclear.

Prognostic value of microvessel density and angiogenesis-related molecules in epithelial ovarian cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the correlations of microvessel density (MVD), vascular endothelial growth factor (VEGF), thrombospodin1 (TSP1) and p53 protein with prognosis in epithelial ovarian cancer.</p><p><b>METHODS</b>Samples from 57 patients with primary epithelial ovarian cancer were examined by immunohistochemical staining using anti-VEGF, anti-TSP1, anti-p53 and anti-CD34 antibodies. The correlation of MVD, expression of VEGF, TSP1 and p53 protein with postoperative recurrence and overall survival were analyzed retrospectively.</p><p><b>RESULTS</b>VEGF, TSP1 and p53 protein was positively detected in 40 (70.2%), 27 (47.4%) and 35 (61.4%) of those patients, respectively. The mean MVD in this series was 30.3 +/- 8.5. High MVD, positive VEGF expression and negative TSP1 expression were positively correlated with postoperative recurrence. Univariate analysis showed that patients with high MVD, positive expression of VEGF and p53 had shorter median overall survival time than those with lower MVD, negative expression of VEGF and p53 (P = 0.0187, P = 0.010 and P = 0.005, respectively), while TSP1 expression was revealed as a protective factor for prognosis. Patients with positive expression of TSP1 had longer median overall survival time than those with negative TSP1 expression (P = 0.042). Multivariate analysis showed that MVD and p53 expression were two independent prognostic factors in epithelial ovarian cancer (P = 0.018 and P = 0.009, respectively).</p><p><b>CONCLUSION</b>VEGF, TSP1 and p53 protein may play an important role in the angiogenesis of epithelial ovarian cancer. High MVD level and p53 protein expression are two independent poor prognostic factors.</p>

Effects of medical treatment on apoptosis in eutopic endometrium of patients with endometriosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the apoptosis-related mechanisms of levenorgestrel-releasing intrauterine system (LNG-IUS), oral medroxyprogesterone (MPA), and injective gonadotrophic hormone releasing hormone agonist (GnRHa) on eutopic endometrium of patients with endometriosis. Methods We collected the samples of endometrium from patients with endometriosis before operation and after insertion of LNG-IUS, administration of oral MPA, or injection of GnRHa. The ultrastructure of endometria was observed and compared by electron microscopy. Apoptotic cells were assessed by the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL) assay, and the expressions of Bax, Fas, and Fas-L mRNA were determined by semi-quantitative reverse transcription-polymerase chain raction. Results After have been exposured to LNG-IUS, the apoptotic rate of endometrial epithelial cells and stromal cells increased from (24. 4 +/- 35.0)% to (51.0 +/- 37.8)% (P = 0.027) and (35.3 +/- 30.2)% to (76.4 +/- 11.2)% (P = 0.008), respectively. The degree of apoptosis under transmission electron microscopy was in an order of GnRHa > LNG-IUS > MPA. The expression of Fas-L mRNA in eutopic endometrium of patients with endometriosis was significantly higher than that of the normal control (P < 0.05). The expressions of three apoptosis-related proteins had no significant difference.</p><p><b>CONCLUSION</b>Medical treatments can increase the apoptosis of eutopic endometrial cells, and such effect was strongest in GnRHa and relatively weaker in LNG-IUS and MPA.</p>

Effects of progesterone and progestin on expression of regulated on activation, normal T cell expressed and secreted in eutopic endometrium from patients with endometriosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effects of progesterone and progestin on the expressions of regulated on activation, normal T cell expressed and secreted (RANTES) in eutopic endometrium from patients with endometriosis.</p><p><b>METHODS</b>We collected the samples of endometrium from patients with endometriosis before operation or after insertion of levenorgestrel releasing intrauterine system (LNG-IUS), administration of oral medroxyprogesterone (MPA), or injection of gonadotrophic hormone releasing hormone agonist (GnRHa). Reverse transcription-polymerase chain raction was used to assay the expression of RANTES mRNA. On the other hand, progesterone (Po) and tumor necrosis factor-alpha (TNFalpha) of different concentrations and different manners were used to treat cultured cells in vitro. RANTES secretion was evaluated in the culture medium using ELISA. In order to evaluate the effect of Po on the secretion of RANTES under stimulation of TNFalpha, the cells were cultured in medium containing 100 U/ml TNFalpha and Po of different concentrations for 24 hours. After the pretreatment of Po for 48 hours at different concentrations, TNFalpha (100 U/ml, 16 h) was added to observe whether Po inhibits RANTES or not.</p><p><b>RESULTS</b>The expression of RANTES mRNA in eutopic endometrium of patients with endometriosis was significantly higher than in control group (28.0 +/- 9.0 vs. 22.0 +/- 5.6, P < 0.05). Following the exposures to LNG-IUS (24.0 +/- 4.2 vs. 25.9 +/- 4.2, P > 0.05) or GnRHa (23.0 +/- 12.9 vs. 26.9 +/- 5.2, P > 0.05), the expression of RANTES mRNA had no change. MPA significantly increased the expression of RANTES mRNA (42.6 +/- 3.1 vs. 24.3 +/- 5.7, P < 0.05). Po itself had no significant effect on the secretion of RANTES. Stimulated by Po and TNFalpha at the same time, the secretion of RANTES significantly increased. After pretreatment with Po for 48 hours, the reaction of RANTES to the stimulating effect of TNFalpha was down-regulated.</p><p><b>CONCLUSION</b>The eutopic endometrium of patients with endometriosis has high chemotactic activity. It may be feasible to prevent and treat endometriosis with progestins.</p>

Operative approaches, indications, and medical economics evaluation of 4180 cases of hysterectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.</p><p><b>METHODS</b>Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.</p><p><b>RESULTS</b>Records of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.</p><p><b>CONCLUSIONS</b>The use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.</p>