Background This study aimed to analyze the clinical and pathological features of extrauterine endometrial stromal sarcoma (EESS) and explore an effective therapeutic regimen to reduce the recurrence rate in low-grade EESS patients. Methods Ten LG-EESS patients who were treated at the Chinese Academy of Medical Sciences Cancer Institute and Hospital from June 1999 to June 2019 were collected and analyzed. Results (1) Patient demographics are summarized in manuscript. Preoperative CA125 examination showed that 8 patients had a median level of 49.5 U/L (15.4–168.0 U/L). (2) All ten patients underwent tumor cytoreductive surgery. Five patients underwent optimal tumor resection and achieved an R0 resection. After the initial surgery, 7 patients who had multiple metastasis were treated with adjuvant chemotherapy, 2 patients with vaginal ESS were treated with chemotherapy and radiation therapy, and 6 patients with ER/PR positive received hormone therapy with or without chemotherapy. (2) Most EESS patients had multiple tumors. The omentum was the most commonly affected site, followed by the ovaries. (3) The median follow-up was 94 (range: 27–228) months, and recurrence was observed in 3 patients ( n = 10, 30%) who underwent non-optimal surgery and no hormone therapy. The 5-year and 10-year DFS rates were both 70%, as shown in Fig. 2. OS was both 100% at 5 and 10 years. Conclusion As a conclusion, EESS is a rare disease and LG-EESS has a good prognosis. Surgery remains the available treatment for patients. LG-EESS has a risk of late recurrence which requires a long-term follow-up. With a limited sample size, our study shows optimal tumor reductive surgery and adjuvant hormone therapy may significantly reduce the risk of recurrence.

BACKGROUND:Plasma cell-free DNA (cfDNA) methylation has shown the potential in the detection and prognostic testing in multiple cancers. Herein, we thoroughly investigate the performance of cfDNA methylation in the detection and prognosis of ovarian cancer (OC).METHODS:The OC-specific differentially methylated regions (DMRs) were identified by sequencing ovarian tissue samples from OC (n = 61), benign ovarian disease (BOD, n = 49) and healthy controls (HC, n = 37). Based on 1,272 DMRs, a cfDNA OC detection model (OC-D model) was trained and validated in plasma samples from patients of OC (n = 104), BOD (n = 56) and HC (n = 56) and a prognostic testing model (OC-P model) was developed in plasma samples in patients with high-grade serous OC (HG-SOC) in the training cohort and then tested the rationality of this model with International Cancer Genome Consortium (ICGC) tissue methylation data. Mechanisms were investigated in the TCGA-OC cohort.FINDINGS:In the validation cohort, the cfDNA OC-D model consisting of 18 DMRs achieved a sensitivity of 94.7% (95% CI: 85.4%‒98.9%) at a specificity of 88.7% (95% CI: 78.7%‒94.9%), which outperformed CA 125 (AUC: 0.967 vs 0.905, P = 0.03). Then the cfDNA OC-P model consisting of 15 DMRs was constructed and associated with a better prognosis of HG-SOC in multivariable Cox regression analysis (HR: 0.29, 95% CI, 0.11‒0.78, P = 0.01) in the training cohort, which was also observed in the ICGC cohort using tissue methylation (HR: 0.56, 95% CI, 0.32‒0.98, P = 0.04). Investigation into mechanisms revealed that the low-risk group had higher homologous recombination deficiency and immune cell infiltration (P < 0.05).INTERPRETATION:Our study demonstrated the potential utility of cfDNA methylation in the detection and prognostic testing in OC. Future studies with a larger population are warranted.FUNDING:This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage IIIB-IVA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseII study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. To determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. Patients were enrolled if they had biopsy proven stage IIIA-IVA squamous cervical cancer or stage IIB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 50.0 Gy at 1.8 Gy 2.0 Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0–65 Gy at 2.0- 2.6 Gy/fraction in 25 fractions. A total dose of 28 35 Gy high-dose- rate brachytherapy was prescribed to point A in 4 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30 mg/m2 was initiated on the first day of radiotherapy for over 1-h during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m2 was given as a 3-h infusion on day1, followed by cisplatin 35 mg/m2 with 1-h infusion on day1-2 (70 mg/m2 in total). Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5

Background: Lymph node metastasis (LNM) accounts for the most important route of metastasis for cervical cancer. Yet, the status of LNM is different in patients with similar clinico-pathological variables. It has been revealed that microRNAs are widely involved in the occurrence and development of various malignancies, and the tumor-suppressive or promoting effects of microRM-99 (miR-99) family have been previously reported. This study sought to investigate the predictive value of miR-99a for lymphogenous spread and its effect on the survival of patients with early-stage cervical squamous cell cancer (CSCC). Methods: Patients with stage IB squamous cervical cancer who were treated surgically between October 2015 and November 2018 were enrolled. A total of 21 formalin-fixed paraffin-embedded tissues of pathologically confirmed positive lymph nodes were retrieved, and an additional 21 tissues of negative lymph nodes from patients well-matched on baseline characteristics were collected as the control group. TaqMan real-time quantitative polymerase chain reaction was used to examine the expression levels of miR-99a in the samples. Differential expression levels of miR-99a were compared between the 2 groups using independent sample t-test. Furthermore, the associations between miR-99a expression level and clinico-pathological parameters of these 42 patients was evaluated by Chi-square test or Fisher's exact-probability method, and their effects on survival were assessed using Kaplan-Meier product-limit method. Results: There were no significant differences in baseline clinico-pathological parameters between the 2 groups (P>0.05). The expression levels of miR-99a in the node-positive group and control group were 1.61 +/- 3.09 and 16.77 +/- 30.40, respectively (P=0.029). Downregulated expression of miR-99a was dosely related to depth of invasion (DOI) and lymph-vascular space invasion (P<0.05). Univariate analysis revealed that downregulated miR-99a and deeper DOI were associated with worse 5-year disease-free survival, while multivariate analysis showed that only the expression level of miR-99a was an independent factor for disease-free survival (HR =0.120; 95% CI: 0.015-0.979; P=0.048). Patients with downregulated miR-99a tended to have more unfavorable overall survival, but the difference did not reach statistical significance. Conclusions: MiR-99a plays an inhibitory role in the pathogenesis of lymph node metastasis and may serve as a novel prognostic biomarker for patients with CSCC.

Background This study aimed to analyze the clinical and pathological features of extrauterine endometrial stromal sarcoma (EESS) and explore an effective therapeutic regimen to reduce the recurrence rate in low-grade EESS patients. Methods Ten LG-EESS patients who were treated at the Chinese Academy of Medical Sciences Cancer Institute and Hospital from June 1999 to June 2019 were collected and analyzed. Results (1) Patient demographics is summarized in Table 1. Preoperative CA125 examination showed that 8 patients had a median level of 49.5 U/L (15.4–168.0 U/L). (2)All ten patients underwent tumor cytoreductive surgery. Five patients underwent optimal tumor resection, achieved a R0 resection. After the initial surgery ,two patients were treated with adjuvant chemotherapy only, two patients were treated with chemotherapy and radiation therapy, and three patients were treated with chemotherapy plus hormonal treatment.(2) Most EESS patients had multiple tumors. the omentum was the most commonly affected site, followed by ovaries.(3) The median follow-up was 94 (range: 27–228) months, and recurrence was observed in 3 patients (n = 10, 30%). The 5-year and 10-year DFS rates were both 70%, as shown in Fig. 1. OS was both 100% at 5 and 10 years. Conclusion As a conclusion, EESS is a rare disease and LG-EESS has a good prognosis. Surgery remains the available treatment for patients. LG-EESS has a risk of late recurrence which requires a long-term follow-up. With a limited sample size, our study shows optimal tumor reductive surgery and adjuvant hormone therapy can significantly reduce the risk of recurrence.

Abstract Background The aim of this study was to explore the clinicopathological characteristics of recurrent adult-type granulosa cell tumor of the ovary (AGCOT) and evaluated the treatment results to define the prognostic parameters for survival after recurrence. Results A retrospective review of 40 patients with recurrent AGCOT, who were treated in the Cancer Hospital at the Chinese Academy of Medical Sciences from 2000 to 2015 was conducted. The impact of clinical and pathological characteristics, progression-free survival (PFS), and post-recurrence therapeutic approaches on prognosis were analyzed. Among the 40 recurrent patients, there were 10 cases where the relapse was uncontrolled, 24 cases had second relapses, and 6 cases without further relapses at the time of our follow-up. The median PFS was 61 months (range, 7-408 months), and the median time interval between the first and the second relapses (R-PFS) was 25 months (range, 0–94 months). The median time interval between the first relapse and death (R-OS) was 90 months (range, 2–216 months). PFS ≥ 61 months (P = 0.004) and post-recurrence therapeutic approach (P < 0.001) were independent risk factors for repeated recurrences. The age at recurrence (P = 0.031) and post-recurrence therapeutic approach (P = 0.001) were independent risk factors for death after recurrence. Conclusion Among patients with recurrent AGCOT, those with long PFS had good prognoses. Maximal cytoreductive effort should be made after recurrence. Complete resection and postoperative adjuvant chemotherapy may improve the prognosis of patients with recurrent AGCOT.

PURPOSE:To avoid misdiagnosis, clinicopathological features were analyzed in cases of cervical mucinous adenocarcinoma with solitary ovarian metastatic masses.PATIENTS AND METHODS:Three cases misdiagnosed as primary ovarian adenocarcinoma before surgery were filtered from the database of the Cancer Hospital/Chinese Academy of Medical Sciences from January 1998 to December 2016. The clinical data were thoroughly collected and compared, and both frozen and paraffin-embedded pathological sections were reviewed by two expert pathologists.RESULTS:None of the patients experienced cervical contact bleeding, and no typical cervical neoplasms were found. The cervical canals were slightly thickened in two patients, as detected by either palpation or imaging. The high-risk human papillomavirus (HPV) test results were all negative, and the thin-prep cytologic test (TCT) screened only one case of atypical glandular epithelial cells. All cases were indicative of higher serum CA19-9 levels (79.49-6124 U/mL). The ovarian masses showed no regular laterality, while they were all cystic or solid-cystic. Their pathological sections indicated a benign appearance of the capsule tissue with well-differentiated mucinous glands infiltrating the ovarian cortex with focal necrosis.CONCLUSION:Attention should be paid to cervical examinations before and during surgery for cervical mucinous adenocarcinoma with a metastatic ovarian mass as the first manifestation. Such patients may gain a better prognosis after active treatment.

Objective: To investigate the diagnosis, treatment and prognosis of uterine serous carcinoma (USC), and further analyze the prognostic factors. Methods: USC patients who underwent surgery with complete follow-up at Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: (1) Diagnosis and treatment: the study included 71 USC patients. Only 32 patients (45%, 32/71) were diagnosed preoperatively with USC, and 25 cases of them (35%, 25/71) underwent USC standard comprehensive staging surgery. Of the 25 patients, 10 cases (40%, 10/25) had up-staged after operation. (2) Prognosis: the 5-year disease free survival (DFS) rate and overall survival (OS) rate for all patients were 76.5% and 80.6%, respectively. (3) The results of prognostic factors analysis: univariate analysis on age, range of lymphadenectomy, peritoneal cytology, the depth of myometrial invasion, adnexal and (or) serosa involvement and omentum metastasis were significantly associated with 5-year DFS rate (all P<0.05); range of lymphadenectomy, range of surgical staging, peritoneal cytology, adnexal and (or) serosa involvement and postoperative adjuvant treatment were significantly associated with 5-year OS rate (all P<0.05). Multivariate analysis on range of surgical staging (HR=5.18, 95%CI: 1.04-25.70, P=0.044) and adnexal and (or) serosa involvement (HR=8.41, 95%CI: 2.28-31.05, P=0.001) were independent prognostic factors for 5-year DFS rate; range of lymphadenectomy [no lymphadenectomy vs pelvic lymphadenectomy (PLN)+para-aortic lymphadenectomy (PALN), HR=27.76, 95%CI: 1.76-437.78, P=0.018;PLN vs PLN+PALN, HR=5.98, 95%CI: 1.11-32.27, P=0.038] and peritoneal cytology (HR=5.47, 95%CI: 1.18-25.39, P=0.030) were independent prognostic factors for 5-year OS rate. Conclusions: The preoperative pathological diagnosis of USC is difficult, resulting in incomplete surgical staging and inaccurate staging. Range of surgical staging, adnexal and (or) serosa involvement, peritoneal cytology and range of lymphadenectomy are independent prognostic factors, which deserve much attention in clinical practice.

This retrospective cohort study was designed to explore the prognostic impact of adjuvant chemotherapy and tumor substage on stage I ovarian clear cell carcinoma (OCCC). Data of 102 patients with stage I OCCC who underwent surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from February 1999 to December 2018 was retrospectively analyzed. Prognostic factors were evaluated using the Cox Regression Model. The disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method and compared between different groups with the log-rank test. P < 0.05 was considered statistically significant. The median follow-up duration was 40.5 months. Thirty-one (30.4%) patients were at stage IA, and 17 (16.7%), 5 (24.5%) and 17 (16.7%) patients were at stage IC1, IC2 and IC3 respectively. The 5-year and 10-year DFS rates of the entire cohort were 82.8% and 78.8% respectively, and the 5-year OS was 97.9%. Patients at stages ICI (intraoperatively ruptured tumor) and IA had similar DFS (P=0.538, OR=0.024), and that of patients at stages IC2 (tumor ruptured preoperatively or tumor on ovarian surface) or IC3 (ascites or peritoneal washings with positive cytology) was significantly lower (72.6% vs. 95.1%, P=0.039, OR=5.051). The 5-year DFS of patients receiving four (83.9%) and more than four (81.7%) cycles adjuvant chemotherapy were similar. Furthermore, univariate analysis showed that age, tumor size and CA199 levels were significantly correlated with DFS, although none of these variables were identified as independent prognostic factors in the multivariate analysis. In summary, our results suggest that patients with stage I OCCC have overall good prognosis. However, tumor surface involvement or positive cytology can worsen prognosis, and the prognosis may not be improved by more than four cycles chemotherapy following surgery. The remarkable increased CA199 may be a potential indicator of poor prognosis in stage I OCCC.

目的 分析宫颈腺鳞癌患者的生存情况以及预后的影响因素.方法 收集119例宫颈腺鳞癌患者的临床资料,分析其临床特点、治疗方式及生存情况.结果 119例患者的中位年龄为44岁,中位随访时间为88个月.83例ⅠB1期~ⅡA2期患者中,3例ⅡA1期患者接受了单纯放疗,1例ⅠB2期患者接受了同步放化疗;另79例患者接受了手术治疗,其中44例患者直接行手术治疗,其余35例患者接受了术前新辅助治疗.26例患者术后接受了辅助放疗,31例患者术后接受了同步放化疗,8例患者术后接受了辅助化疗,其余14例患者术后未接受辅助治疗.30例ⅡB~ⅢB期患者中,12例患者接受了单纯放疗,18例患者接受了同步放化疗.6例Ⅳ期患者中,4例患者接受了化疗+姑息性放疗,2例患者仅接受了化疗.119例患者中,36例患者肿瘤复发,复发率为30.3%,中位复发时间为9.5个月(0~72个月);中位生存时间为88个月,5年生存率为74.8%.ⅠB1期、ⅠB2期、ⅡA1期、ⅡA2期、ⅡB期、ⅢB和Ⅳ期患者的5年生存率分别为100%、80.0%、77.8%、75.0%、65.0%、40.0%和0%,6例Ⅳ期患者的生存时间分别为2、3、10、15、21、26个月.不同年龄、临床分期和早期(ⅠB1~ⅡA2期)治疗方式的宫颈腺鳞癌患者的5年生存率比较,差异均有统计学意义(P﹤0.05);Cox多因素分析结果显示,临床分期是宫颈腺鳞癌患者预后的独立影响因素(P﹤0.01).结论 宫颈腺鳞癌早期患者可选择手术治疗或同步放化疗,预后较好;晚期患者应选择同步放化疗,预后相对较差,特别是Ⅳ期患者,预后极差.

Objective:To investigate the risk factors and prognosis of lymph node metastasis in patients with stage Ⅰ B cervical cancer. Methods:From April 2014 to December 2016, the clinical data of 305 patients with stage Ⅰ B1-Ⅰ B2 who were admitted to Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College for radical surgery±postoperative treatment were retrospectively analyzed. Among them, 31 cases with lymph node metastasis. Logistic regression model was used to analyze the influencing factors of metastasis. Results:The median follow-up time of patients with lymph node metastasis was 36 months, 2 cases with recurrence and metastasis, the 3-year disease-free survival rate was 94% (29/31); 1 case died, the 3-year survival rate was 97% (30/31). Logistic regression analysis showed that the lymph node metastasis rates of stage I B1 (tumor size≤4 cm) or stage I B2 (tumor size>4 cm) were 8.2% (22/267) or 24% (9/38), respectively, with statistical difference ( P<0.01). LVSI positive ( P<0.01) and cervical stromal infiltration depth>1/2 ( P<0.01) were associated with lymph node metastasis in stage I B. Multivariate results showed that LVSI positive ( P=0.016) was an independent risk factor for lymph node metastasis in stage I B cervical cancer. Conclusions:In patients with stage I B cervical cancer, tumor size>4 cm, with LVSI and cervical interstitial invasion depth>1/2 are prone to lymph node metastasis, and LVSI positive is an independent risk factor. For patients with lymph node metastasis in stage I B cervical cancer, radical surgery and postoperative adjuvant concurrent chemo-radiotherapy can achieve good results.

To evaluate the efficacy and safety of apatinib, an oral antiangiogenic drug, in patients with recurrent or refractory cervical cancer as salvage treatment, we retrospectively analyzed the medical records of recurrent or refractory cervical cancer patients admitted to the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Hunan Cancer Hospital, from October 1, 2016, to December 31, 2017. Patients who progressed within 6 months after the last treatment were given apatinib orally at a dose of 250 mg daily until disease progression or unacceptable toxicity. Twenty-nine patients were enrolled in our retrospective study. Up to February 1, 2019, the median follow-up time was 18 months. The median progression-free survival was 128 days (95% confidence interval (CI): 20–540 days), and the median overall survival was 9 months (95% CI: 4–23 months). The longest period of apatinib administration was 540 days. No complete response was observed, 5 (17.2%) patients achieved partial response, and 11 (37.9%) achieved stable disease. The objective response rate and disease control rate were 17.2% and 55.1%, respectively. The most common adverse events were hypertension (G1, 65.5%, 19/29), mucositis (G1, 55.2%, 16/29), hand-foot syndrome (G1-2, 44.8%, 13/29), and proteinuria (G1-2, 20.7%, 6/29). Grade 3 proteinuria occurred in only one patient (3.4%, 1/29). Apatinib single-agent use might be an effective and tolerable choice as salvage therapy for patients with recurrent or refractory cervical cancer.

BACKGROUND To analyze the relationship between HPV infection and early cervical cancer and postoperative survival outcomes. METHODS A total of 556 women were recruited to receive TCT and HPV tests from October 2017 to October 2018. The type of disease was pathologically diagnosed. The HPV positive rate, HPV-DNA, and E6/E7 mRNA quantitative level were detected, and the diagnostic accuracy of the subjects was analyzed by the receiver operating characteristic (ROC). The cervical intraepithelial neoplasia (CIN) and early cervical cancer patients were radically cured and followed up for 12.0 months to analyze the recurrence rate. RESULTS Seventy-two cases of chronic cervicitis, 54 cases of CIN, and 51 cases of cervical cancer patients were pathologically diagnosed (32 cases in early stage and 19 cases in middle and late stage). HPV positive rate increased gradually in chronic cervicitis, CIN, and cervical cancer group (p < 0.001) and HPV 16 + 18 subtype. The positive rate was significantly different (p = 0.009). HPV-DNA and E6/E7 mRNA quantification also showed significant differences (p < 0.001). ROC analysis indicated that the accuracy of HPV-DNA and E6/E7 mRNA quantitative diagnosis of malignant lesions (CIN+ cervical cancer) were 0.865 and 0.879, respectively. There were 4 cases (7.41%) of recurrence in CIN group and 5 cases (15.63%) in early cervical cancer group. There was no difference (p = 0.401) among all of the patients. All patients with recurrence were HPV positive. CONCLUSIONS HPV detection is an indispensable screening method for early cervical cancer and precancerous lesions, and comprehensive HPV 16 and 18 subtypes. DNA and E6/E7 mRNA quantification assay would further improve the accuracy of screening.

Objective: To investigate the efficacy and side effect of paclitaxel liposome for neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer. Methods: This study were included 265 cervical cancer patients staging Ⅰb2 and Ⅱa2 who underwent paclitaxel-platinum NACT followed by radical surgery from June 2008 to December 2016 in the Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. All patients were classified into two groups with 106 patients in paclitaxel liposome group and 159 patients in traditional paclitaxel group. The difference in clinicopathologic characteristics, efficacy and side effect were analyzed retrospectively between the two groups. Results: (1) Clinicopathologic characteristics: there were no significant difference in clinicopathologic characteristics between the two groups, including age, body mass index, clinical stage, pathological histology, cycles of NACT, combined platinum regimen, lymph-vascular space invasion, lymph node metastasis, deep stromal invasion, and postoperative adjuvant therapy (all P>0.05). (2) Efficacy: after NACT, the overall response occurred in 90 (15 complete response plus 75 partial response) of 106 cases in the paclitaxel liposome group versus 131 (21 complete response plus 110 partial response) of 159 cases in the traditional paclitaxel group without statistical significance (84.9% vs 82.4%; χ(2)=0.291, P=0.590). A total of 248 patients received surgery after NACT and were evaluable in survival. The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of these patients was 85.1% and 88.2%. The 5-year RFS rate in the paclitaxel liposome group was 85.9% compared with 85.2% in the traditional paclitaxel group, while the corresponding 5-year OS rate was 88.5% and 88.7%, respectively. There was no statistically significant difference in efficacy between the two groups (P=0.968, P=0.797). (3) Side effect: the incidence of allergic reaction between the paclitaxel liposome group and the traditional paclitaxel group was 0 versus 1.9% (3/159) without statistical significance (P=0.277). But the incidence of neurotoxicity in the paclitaxel liposome group significantly decreased compared with the traditional paclitaxel group (6.6% vs 15.7%, P<0.05), as well as the incidence of alopecia (67.9% vs 79.2%, P<0.05) and myalgia (17.9% vs 28.9%, P<0.05). However, significant differences were not found in terms of hematological toxicity, gastrointestinal reaction, and hepatic function damage (P>0.05). Conclusion: In paclitaxel-platinum NACT of local advanced cervical cancer, paclitaxel liposome can achieve similar efficacy compared with traditional paclitaxel, but paclitaxel liposome is helpful in decreasing the toxicity of neurotoxicity, alopecia and myalgia.

Neoadjuvant chemotherapy (NACT) followed by radical surgical hysterectomy and pelvic lymph node dissection is considered an effective method to treat patients with bulky stage IB-IIA cervical cancer, but not all patients benefit from NACT. Apoptotic proteins play important roles in the progression of chemotherapy, and second mitochondria-derived activator of caspase (Smac) may have a cooperative relationship with Omi/HtrA2, leading to carcinogenesis and chemotherapy resistance. Chemosensitivity is an important prognostic factor for cervical cancer patients. The aim of this study was to evaluate the significance of Smac, survivin, X-linked inhibitor-of-apoptosis protein (XIAP), and Omi/HtrA2 expression in predicting the response to neoadjuvant chemotherapy and the prognostic significance of te expression of these proteins in cervical cancer patients. Our findings showed that low expression levels of survivin and high expression levels of Omi/HtrA2 in chemotherapy-responsive cervical carcinoma patients significantly increased chemosensitivity.

Objective: To evaluate the significance of different clinicopathologic features on prognosis of patients with squamous cell carcinoma of vulva. Methods: We retrospectively analyzed the prognostic relevance of different clinicopathological variables of 201 patients with squamous cell carcinoma of vulva treated in Cancer Hospital, Chinese Academy of Medical Sciences. The data including age, initial symptoms, stage, location, tumor size, histological grade, number and size of metastatic lymph nodes, treatment mode, and presence of leukoplakia vulva was used to evaluate the prognosis of vulvar squamous cell carcinoma. Results: The median age of onset was 62.0 years old, with 74 patients in stage Ⅰ, 27 in stage Ⅱ, 55 in stage Ⅲ and 9 in stage Ⅳ. The median progression-free survival was 90.0 months. The 5-year progression-free survival rate of the total patients was 55.5%, while the 10-year progression-free survival rate was 48.5%. Univariate analysis showed statistically significant prognostic parameters included clinical stage, number of metastatic lymph nodes, tumor size and treatment mode (all P<0.001). Multivariate analysis showed that number of metastatic lymph nodes (P<0.05) was an independent prognostic factor for progression-free survival. Conclusion: The study illustrates that number of metastatic lymph nodes represents important independent factor for progression-free survival of patients with vulvar squamous cell carcinoma.

目的 分析ⅠA1期宫颈癌患者的临床特征及宫颈冷刀锥切治疗的有效性及安全性.方法 选取采用宫颈冷刀锥切初次治疗的74例ⅠA1期宫颈癌患者的病历资料进行回顾性分析,分析其临床特征、预后及生育情况.结果 74例采用宫颈冷刀锥切治疗患者中,35例(47.3％)患者术前阴道镜下活检病理提示宫颈微小浸润癌,而13例患者锥切术后病理未发现浸润性病变;活检病理为CIN而锥切术后病理诊断为ⅠA1期宫颈癌的患者有39例(52.7％).冷刀锥切术后病理诊断显示,35例(47.3％)为多灶性浸润,39例(52.7％)为单灶性浸润;62例(83.8％)患者病变浸润深度≤2 mm;2例(2.7％)有淋巴脉管间隙受侵.本组患者的中位随访时间为70.3个月,5年无复发生存率为95.1％,总生存率为100％,2例(2.7％)患者出现复发(1例于冷刀锥切术后5年半出现全身多发淋巴结转移行化疗,另1例为术后4年盆腔局部复发给予放化疗).74例患者中,发病年龄≤45岁有64例(86.5％),其中6例患者术后自然妊娠,但仅3例完成生育(1例足月顺产,1例足月剖宫产,1例早产),另2例行人工流产术,1例因胚胎停育行清宫术.结论 宫颈冷刀锥切术可安全有效地治疗要求保留生育功能(或保留子宫)的ⅠA1期宫颈癌患者,病灶浸润深度与术后复发、转移可能有关,而病灶状态(多灶性浸润与单灶性浸润)、淋巴脉管间隙是否受侵与患者术后的复发、转移无关,术后应长期严密随诊.

亲爱的女性朋友们,你们知道女性与男性除了相貌不一样外,内在的不同是什么吗?大家都知道,上天赋予我们女性具有生育的能力,这个能力源于女性具有特殊的器官:乳房、子宫、卵巢、输卵管、阴道、外阴.随着年龄由小女孩发育到十来岁的少女,卵巢逐渐发育成熟开始排卵、分泌激素,女性不断发育成熟,完成结婚、生育.随着年龄渐老,卵巢功能衰退,女性逐渐丧失生育能力,进入更年期.女性的一生在不断代谢、转变中,每个器官都可能会发生变异、发生癌变.

Objective: To study the efficacy of surgery for recurrent cervical cancer and the influencing factors on prognosis. Methods: To retrospectively analyze the clinical data of 45 patients with recurrent cervical cancer undergoing surgical treatment in our hospital from January 1980 to October 2015, and study their clinical features and prognosis. Results: The Recurrence Free Interval (RFI) of these 45 patients was 3~120 months, and their median RFI was 15 months. Of the 45 cases, 21 recurred inside the radiotherapy field, including 18 with central recurrence and 3 with non-central recurrence; and 24 recurred outside the radiotherapy field, including 16 with pelvic recurrence who did not receive radiotherapy and 8 with distant recurrence. The overall survival time after recurrence of these 45 cases was (39.1±1.0) months, and their 2-year and 5-year survival rates were 55.6% and 22.2%, respectively. The univariate analysis showed that clinical stage, RFI, recurrent site, and initial treatment method affected the survival rate of the patients with recurrent cervical cancer (P<0.05), while the multivariate analysis revealed that recurrent site was an independent prognostic factor for recurrent cervical cancer (P=0.047). Conclusions: Appropriate surgery should be chosen for recurrent cervical cancer according to initial treatment and recurrent site. For patients with central recurrence inside their radiotherapy field, surgery is an effective treatment. Surgery is also suitable for patients without previous radiotherapy and with isolated recurrence, and adjuvant radiotherapy and chemotherapy can improve their survival.

Dendritic cell (DC) vaccine-based immunotherapy for glioblastoma multiforme (GBM) has shown apparent benefit in animal experiments and early-phase clinical trials, but the survival benefit is variable. In this work, we analyzed the mechanism of the potent antitumor immune response induced in vivo by tumor-associated antigen (TAA)-specific DCs with an invariant natural killer T (iNKT) cell adjuvant in orthotopic glioblastoma-bearing rats vaccinated with tumor-derived exosomes and alpha-galactosylceramide (alpha-GalCer)-pulsed DCs. Compared with traditional tumor lysate, exosomes were utilized as a more potent antigen to load DCs. iNKT cells, as an effective cellular adjuvant activated by alpha-GalCer, strengthened TAA presentation through their interaction with DCs. Co-delivery of tumor-derived exosomes with alpha-GalCer on a DC-based vaccine showed powerful effects in glioblastoma immunotherapy. This vaccine induced strong activation and proliferation of tumor-specific cytotoxic T lymphocytes, synergistically breaking the immune tolerance and improving the immunosuppressive environment. (c) 2017 Elsevier B.V. All rights reserved.