A Robust Gene Expression Prognostic Signature for Overall Survival in High-Grade Serous Ovarian Cancer.

The objective of this research was to develop a robust gene expression-based prognostic signature and scoring system for predicting overall survival (OS) of patients with high-grade serous ovarian cancer (HGSOC). Transcriptomic data of HGSOC patients were obtained from six independent studies in the NCBI GEO database. Genes significantly deregulated and associated with OS in HGSOCs were selected using GEO2R and Kaplan-Meier analysis with log-rank testing, respectively. Enrichment analysis for biological processes and pathways was performed using Gene Ontology analysis. A resampling/cross-validation method with Cox regression analysis was used to identify a novel gene expression-based signature associated with OS, and a prognostic scoring system was developed and further validated in nine independent HGSOC datasets. We first identified 488 significantly deregulated genes in HGSOC patients, of which 232 were found to be significantly associated with their OS. These genes were significantly enriched for cell cycle division, epithelial cell differentiation, p53 signaling pathway, vasculature development, and other processes. A novel 11-gene prognostic signature was identified and a prognostic scoring system was developed, which robustly predicted OS in HGSOC patients in 100 sampling test sets. The scoring system was further validated successfully in nine additional HGSOC public datasets. In conclusion, our integrative bioinformatics study combining transcriptomic and clinical data established an 11-gene prognostic signature for robust and reproducible prediction of OS in HGSOC patients. This signature could be of clinical value for guiding therapeutic selection and individualized treatment.

Is Ki-67 of Diagnostic Value in Distinguishing Between Partial and Complete Hydatidiform Moles? A Systematic Review and Meta-analysis.

BACKGROUND/AIM: To demonstrate the value of Ki-67 in distinguishing between partial and complete hydatidiform moles. MATERIALS AND METHODS: We searched electronic databases included Medline, WOK, Cochrane Library and CNKI, through January 24, 2015. Experts were consulted, and references from related articles were examined. The meta-analysis was conducted with RevMan5.3, according to the PRISMA guidelines. Mantel-Haenszel estimates were calculated and pooled under a random effect model, with data expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS: We analyzed eight trials with a total of 337 participants who underwent uterine curettage and met the inclusion criteria. A significantly higher expression of Ki-67 was observed in complete than in partial hydatidiform moles (OR=3.28; 95%CI=1.80-5.96; p<0.0001). CONCLUSION: The Ki-67 expression was higher in complete than in partial hydatidiform moles. Therefore, Ki-67 may be of diagnostic value in distinguishing between partial and complete hydatidiform moles. However, the present study had only a limited number of samples, so investigation of a greater number of cases is needed to confirm this conclusion.

Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer: A Systematic Review and Meta-Analysis.

PURPOSE: To investigate the value of laparoscopic radical hysterectomy (LRH) in the treatment of early stage cervical cancer by comparing intraoperative and postoperative outcomes with abdominal radical hysterectomy (ARH). MATERIALS AND METHODS: We searched the Medline, Web of Knowledge, Cochrane Library, and Chinese National Knowledge Infrastructure, through February 2, 2016 with keywords of "laparoscopic OR laparoscopy" AND "radical hysterectomy OR early cervical cancer OR stage IB, stage IB1, stage IB2, stage IIA, stage IIA1, stage IIA2, stage IIA cervical cancer" to identify all relevant studies that compared LRH with ARH in treating early cervical cancer. Two reviewers evaluated the quality of literature independently. Standardized tables were used to extract data (study or participant details and results) from the texts, tables, figures, or any other attachments of eligible publications. Weighted mean differences (MDs) and odds ratios (ORs) were pooled with the random effects model. Then we conducted meta-analysis using the RevMan5.3 software. RESULTS: A total of 615 studies were initially identified. After screening, 23 studies, including 4205 patients were recruited. LRH was associated with lower estimated blood loss (mL) (MD = -178.41, 95% confidence interval [CI] = -214.89 to -141.94, P < .00001), longer operation time (minutes) (MD = 43.68, 95% CI = 29.42-57.95, P < .00001), fewer retrieved lymph nodes (MD = -3.44, 95% CI = -5.96 to -0.92, P = .007), shorter hospital stay (day) (MD = -3.17, 95% CI = -4.06 to -2.29, P < .00001), quicker return to normal bowel activity (day) (MD = -0.7, 95% CI = -0.96 to -0.45, P < .00001), and shorter duration of bladder catheterization (day) (MD = -1.69, 95% CI = -2.83 to -0.55, P < .004) than ARH. LRH also demonstrated lower odds of transfusion (OR = 0.47, 95% CI = 0.30-0.73, P = .0007), and ileus (OR = 0.34, 95% CI = 0.12-0.91, P = .03) than ARH. CONCLUSION: LRH outweighs ARH in treating early stage cervical cancer in most essential aspects, which should arouse sufficient attention.

[Umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations].

OBJECTIVE: To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations. METHODS: From January 2009 to December 2012, clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected. Among the patients, 6 were selective intrauterine growth restriction (1 with type I, 4 with type II, 1 with type III); 4 were acrania or hydropic twins; 4 were acardiac twins, 2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history. The procedure was performed under both endoscopic and sonographic guidance. The gestational age at the time of the procedure were 17-27(+6) weeks. The procedure and perinatal outcome were analyzed. RESULTS: (1) The procedure was performed successfully in all the 18 cases. The average duration of the procedure was 63 min (24-156 min). The blood loss was 7.6 ml (5-20 ml). The mean gestational age at the time of the procedure was 20 weeks (17-27(+) weeks). The average birth weight of the neonates was 2441 g (1000-3400 g) .(2) There were 206 fetuses survived. Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicen-cephalopathy (HIE) .Fourteen neonates were in healthy and normal development by 3-51 months' follow-up.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks, averagely 33(+1) weeks). The gestational weeks were prolonged by 5-21 weeks (averagely 13(+4) weeks). Among them, 3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks). CONCLUSION: Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations, especially for monochronic monoamniotic pregnancies.

Endoscopic treatment of ectopic pregnancy in a cesarean scar.

STUDY OBJECTIVE: To describe our experience with endoscopic removal of cesarean scar pregnancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary-care university hospital. PATIENTS: Twenty-one patients with cesarean scar pregnancy. INTERVENTIONS: All the patients underwent removal of pregnancy mass at hysteroscopy or combined with laparoscopy. Nine patients received a methotrexate injection before the operation, and 13 underwent uterine artery embolization before surgery. MEASUREMENTS AND MAIN RESULTS: Clinical data, serum ß-human chorionic gonadotropin concentration, findings of ultrasound or magnetic resonance imaging examinations, therapeutic options, operative time, operative blood loss, and duration of hospitalization time were recorded. The mean serum ß-human chorionic gonadotropin concentration at diagnosis was 53,350.4 IU/ L. Seventeen patients underwent hysteroscopy, which failed in 2, and the other 4 patients underwent hysteroscopy combined with laparoscopy. Mean operative time was 51.4 minutes, and mean blood loss was estimated at 48.1 mL. A gestational mass can be removed at hysteroscopy, with rapid recovery and a high success rate. If a cesarean scar pregnancy mass grows toward the bladder and abdominal cavity, hysteroscopy combined with laparoscopy is more appropriate. Preoperative uterine artery embolization can decrease blood loss substantially during the operation. No patients underwent hysterectomy. CONCLUSIONS: Endoscopy seems to be the optimal surgical management in patients with a cesarean scar pregnancy and who desire to preserve the uterus and fertility. However, further study is warranted.

[Human papillomavirus type 16 variant analysis of upstream regulatory region and E6, E7 oncogene from cervical cancer patients in Beijing].

To investigate distributional characteristics of mutations of HPV16 upstream regulatory region (URR) and E6 and E7 oncogene in the patients with cervical cancer in Beijing and to explore the potential association between oncogenesis of cervical cancer and HPV variants in this region, cervical cancer tissue from 31 cases with positive HPV16 were subjected to regular DNA extraction procedure. The corresponding primers were then designed to amplify the target sequence of URR, E6 and E7. The PCR products were sequenced and blast analysis against GenBank was carried out to evaluate the gene mutation and identify the phylogenetic branches. Among all the cases studied, URR was found to be the most frequent mutation fragments, followed by E7, and E6 was the most conservative sequence. A total of 8 hot mutation spot was identi-fied, which were URR G7521A (100%), C7435G (96.77%), C24T (45.16%), A7729C (45.16%), G7839A (45.16%), E6 T178G (41.94%), E7 A647G (45.16%), and T846C (45.16%). The most frequent HPV 16 branch was type As (54.84%), followed by type E (45.16%). Our results suggested that the mutations of G7521A, A7729C, G7839A, T178G, T350G, A647G, and G658A were likely to be associated with the enhanced oncogenic potential of HPV16 and oncogenesis of cer-vical cancer. In Beijing area, two major branches of HPV16 were type As and E. This finding provides valuable information for HPV vaccine development and infection treatment. Type As and E variants had different distributions among various ages and clinic stage groups. It might lead to a new explanation for the getting younger trend of cervical cancer.

[Complication of laparoscopic radical hysterectomy and lymphadenectomy: an analysis of 23 cases].

OBJECTIVE: To explore complications of laparoscopic radical hysterectomy and lymphadenectomy in patients with cervical and endometrial carcinoma, and its prevention. METHODS: From July 2000 to December 2004 at our institution, a total of 278 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed in 242 patients with cervical carcinoma and 36 patients with endometrial carcinoma. We reviewed the clinical data of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to check their complications and other factors related to this open surgical procedure. RESULTS: All but 4 surgical procedures were completed laparoscopically. Paraaortic lymphadenectomy was performed in 108 patients and pelvic lymphadenectomy was performed in all of 278 patients. Major and minor intraoperative complications occurred in 4.7% (13/278) of patients. The overall conversion rate was 1.4% (4/278), consisting of 3 emergency and 1 elective conversions. Vascular injuries occurred in 7 patients, five of them were repaired or treated laparoscopically and one left external iliac vein injury required laparotomy, another patient underwent laparotomy to control bleeding. Operative cystotomies occurred in 4 patients and all were repaired laparoscopically. One patient underwent laparotomy because of hypercapnia. Another patient underwent laparotomy because of ascending colon injury. Postoperative surgery complications occurred in 3.6% (10/278) of patients. Three patients had a ureterovaginal fistula and three patients had a vesicovaginal fistula after the operation that required reoperation. There was one patient with ureterostenosis while three patients with urinary retention. CONCLUSIONS: Laparoscopic radical hysterectomy in combination with lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications that are unique to laparoscopy exist but they decrease with more practice and experience.

[Role of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating early cervical carcinoma].

OBJECTIVE: To investigate the possibility and effect of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating women with early cervical cancers who desired to maintain fertility. METHODS: From August 2001 through May 2003, we performed vaginal radical trachelectomy with laparoscopic lymphadenectomy on 12 patients with biopsy-proven early stage cervical carcinomas. Subjects were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. Pelvic lymphadenectomies were performed in all patients. Vaginal radical trachelectomy was performed immediately if lymph nodes were negative. RESULTS: Twelve women underwent this procedure. The median age was 27.6 years (range 24 - 31 years); 10 were nulligravid and 2 were multipara. Mean operative time was 142 min (115 - 178 min), with a mean blood loss of 180 ml (120 - 230 ml), and an average hospital stay of 6.7 days. There was no intra- or post-operative complication. With an average follow-up of 21.5 months, there have been no recurrences. One woman has become pregnant. CONCLUSIONS: Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy permits preservation of fertility in selected patients. It is mini-invasive, and needs shorter recovery time.

[Laparoscopic suture uterosacral ligament hysteropexy for uterine prolapse].

OBJECTIVE: To investigate possibility and effect of laparoscopic suture uterosacral ligament hysteropexy or colpopexy for women with uterine prolapse. METHODS: Thirty-two women with symptomatic uterine prolapse underwent laparoscopic suture uterosacral ligament hysteropexy. At the laparoscopic suture hysteropexy or colpopexy, the pouch of Douglas was closed and the uterosacral ligaments were plicated and reattached to the cervix. All patients were multipara and menopausal with prolapse of anterior wall of vagina. Additionally, 4 patients were with prolapse of posterior wall of vagina, 15 with stress urinary incontinence, and 4 with myomas. RESULTS: All procedures were successfully completed laparoscopically. The mean operating time for the laparoscopic suture hysteropexy or colpopexy alone was (32 +/- 11) min (range 20 approximately 80 min), and the mean blood loss was less than 50 ml. After a mean follow-up of (12 +/- 6) months (range 4 approximately 28 months), 23 women had no symptoms of uterine prolapse and seven had no objective evidence of uterine prolapse. Two women presented recurrence of uterine prolapse 3 months after operation. CONCLUSIONS: The laparoscopy suture hysteropexy or colpopexy is effective and safe in the management of symptomatic uterine prolapse. It may be an appropriate procedure for women with uterine prolapse hoping for uterine preservation.

[Clinical evaluation of laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy in patients with cervical cancer].

OBJECTIVE: To evaluate the effective, results and complications in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy and retroperitoneal lymphadenectomy. METHODS: In 57 consecutive patients with stage Ia to IIb cervical cancer, laparoscopic radical hysterectomy and lymphadenectomy were performed. Forty-eight patients had squamous cell carcinomas, 7 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. RESULTS: All but 2 surgical procedures were completed laparoscopically. The average operative time was 186 min (150 - 320 min). The average blood loss was 168 ml (120 - 700 ml). Average numbers of pelvic and paraaortic lymph nodes removed were 18.6 (12 - 23) and 8.2 (6 - 12), respectively. Eight patients (14.0%) had positive lymph nodes. All surgical margins were macroscopically negative. Operative cystotomies occurred in 2 patients and one patient with venous injuries were repaired laparoscopically. Two other patients underwent laparotomy to control bleeding or repair ascending colon. After surgery, patients passed gas in 2.3 days and self-voided in 10.2 days on average. Follow-up has been provided every 3 months. There have been 3 cases of recurrences, one patient uncontrolled, and one patient ureteral constriction. Three patients have retention of urine. CONCLUSIONS: Laparoscopic radical hysterectomy and lymphadenectomy can be successfully completed in patients with cervical cancer with acceptable operation complications, a less injury and recovery time, and may become preferred for treating early cervical cancer.