Background:Machine learning (ML) has been increasingly applied to cervical cancer (CC) research. However, few studies have combined both clinical parameters and imaging data. At the same time, there remains an urgent need for more robust and accurate preoperative assessment of parametrial invasion and lymph node metastasis, as well as postoperative prognosis prediction. Objective:The objective of this study is to develop an integrated ML model combining clinicopathological variables and magnetic resonance image features for (1) preoperative parametrial invasion and lymph node metastasis detection and (2) postoperative recurrence and survival prediction. Methods:Retrospective data from 250 patients with CC (2014-2022; 2 tertiary hospitals) were analyzed. Variables were assessed for their predictive value regarding parametrial invasion, lymph node metastasis, survival, and recurrence using 7 ML models: K-nearest neighbor (KNN), support vector machine, decision tree, random forest (RF), balanced RF, weighted DT, and weighted KNN. Performance was assessed via 5-fold cross-validation using accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve (AUC). The optimal models were deployed in an artificial intelligence-assisted contouring and prognosis prediction system. Results:Among 250 women, there were 11 deaths and 24 recurrences. (1) For preoperative evaluation, the integrated model using balanced RF achieved optimal performance (sensitivity 0.81, specificity 0.85) for parametrial invasion, while weighted KNN achieved the best performance for lymph node metastasis (sensitivity 0.98, AUC 0.72). (2) For postoperative prognosis, weighted KNN also demonstrated high accuracy for recurrence (accuracy 0.94, AUC 0.86) and mortality (accuracy 0.97, AUC 0.77), with relatively balanced sensitivity of 0.80 and 0.33, respectively. (3) An artificial intelligence-assisted contouring and prognosis prediction system was developed to support preoperative evaluation and postoperative prognosis prediction. Conclusions:The integration of clinical data and magnetic resonance images provides enhanced diagnostic capability to preoperatively detect parametrial invasion and lymph node metastasis detection and prognostic capability to predict recurrence and mortality for CC, facilitating personalized, precise treatment strategies.

Machine learning (ML) has been gradually applied to cervical cancer research, but rarely combines both clinical parameters and image data. Meanwhile, more robust and accurate preoperative assessment of parametrial invasion and lymph node metastasis, as well as postoperative prognosis prediction are also in urgent need. We aimed to develop an integrated ML model that integrates clinicopathological parameters as well as MR images and includes both pre- and post-operation evaluation in cervical cancer (CC) patients. Data of CC patients from 2014 to 2022 in two tertiary hospitals were retrospectively collected and an exempt was granted by the Ethics Committee for this purpose. Variables were analyzed for their predictive value of parametrial invasion, lymph node metastasis, survival and recurrence using 7 ML models. The predictive performance of all 7 ML models was compared and an AI-assisted contouring and prognosis prediction system is developed based on optimal machine learning algorithms. This study included 250 women for analysis (11 deaths, 24 recurrences): (1) In terms of evaluation of both parametrial invasions and lymph node metastasis, integrated ML models with weighted KNN outperformed other ML models, especially in the case of sensitivity. (2) An integrated model using weighted KNN achieved optimal performance in predicting recurrence and survival times for postoperative CC patients, showing high accuracy and balanced sensitivity. (3) an AI-assisted contouring and prognosis prediction system was developed that assists in lesion identification, preoperative evaluation and postoperative prognosis prediction. The integration of clinical data and MR image through ML models offers superior preoperative diagnostic and postoperative prognostic prediction capabilities, potentially reducing clinical errors and enabling tailored, precise treatment strategies.

BACKGROUND:Cervical cancer (CC) is the fourth most common cancer in women worldwide. Although immunotherapy has been applied in clinical practice, its therapeutic efficacy remains far from satisfactory, necessitating further investigation of the mechanism of CC immune remodeling and exploration of novel treatment targets. This study aimed to investigate the mechanism of CC immune remodeling and explore potential therapeutic targets.METHODS:We conducted single-cell RNA sequencing on a total of 17 clinical specimens, including normal cervical tissues, high-grade squamous intraepithelial lesions, and CC tissues. To validate our findings, we conducted multicolor immunohistochemical staining of CC tissues and constructed a subcutaneous tumorigenesis model in C57BL/6 mice using murine CC cell lines (TC1) to evaluate the effectiveness of combination therapy involving indoleamine 2,3-dioxygenase 1 (IDO1) inhibition and immune checkpoint blockade (ICB). We used the unpaired two-tailed Student's t-test, Mann-Whitney test, or Kruskal-Wallis test to compare continuous data between two groups and one-way ANOVA with Tukey's post hoc test to compare data between multiple groups.RESULTS:Malignant cervical epithelial cells did not manifest noticeable signs of tumor escape, whereas lysosomal-associated membrane protein 3-positive (LAMP3+ ) dendritic cells (DCs) in a mature state with immunoregulatory roles were found to express IDO1 and affect tryptophan metabolism. These cells interacted with both tumor-reactive exhausted CD8+ T cells and CD4+ regulatory T cells, synergistically forming a vicious immunosuppressive cycle and mediating CC immune escape. Further validation through multicolor immunohistochemical staining showed co-localization of neoantigen-reactive T cells (CD3+ , CD4+ /CD8+ , and PD-1+ ) and LAMP3+ DCs (CD80+ and PD-L1+ ). Additionally, a combination of the IDO1 inhibitor with an ICB agent significantly reduced tumor volume in the mouse model of CC compared with an ICB agent alone.CONCLUSIONS:Our study suggested that a combination treatment consisting of targeting IDO1 and ICB agent could improve the therapeutic efficacy of current CC immunotherapies. Additionally, our results provided crucial insights for designing drugs and conducting future clinical trials for CC.

Cervical adenocarcinomas (ADCs), including human papillomavirus (HPV)-associated (HPVA) and non-HPVA (NHPVA), though exhibiting a more malignant phenotype and poorer prognosis, are treated identically to squamous cell carcinoma (SCC). This clinical dilemma requires a deeper investigation into their differences. Herein a transcriptomic atlas of SCC, HPVA, and NHPVA-ADC using single-cell RNA (scRNA) and T-cell receptor sequencing (TCR-seq) is presented. Regarding structural cells, the malignancy origin of epithelial cells, angiogenic tip cells and two subtypes of fibroblasts is revealed. The promalignant properties of the structural cells using organoids are further confirmed. Regarding immune cells, myeloid cells with multiple functions other than antigen presentation and exhausted T lymphocytes contribute to immunosuppression. From the perspective of HPV infection, not only is HPV-dependent and independent cervical cancer oncogenesis proposed but also three immune reaction patterns mediated by T cells (coordinated/inactive/imbalanced) are identified. Strikingly, diagnostic biomarkers to distinguish ADC from SCC are discovered and prognostic biomarkers with marker genes for malignant epithelial cells, tip cells, and SPP1/C1QC macrophages are generated. Importantly, the efficacy of anti-CD96 and anti-TIGIT, not inferior to anti-PD1, in animal experiments is confirmed and targeted therapies specifically for HPV-positive SCC, HPVA and NHPVA-ADC, providing essential clues for further clinical trials, are proposed.

Verheij syndrome (VRJS) is a craniofacial spliceosomopathy with a wide phenotypic spectrum. Haploinsufficiency of the poly-uridine binding splicing factor 60 gene (PUF60) and its loss-of-function (LOF) variants are involved in VRJS. We evaluated a human fetus with congenital heart defects and preaxial polydactyly. Clinical data were obtained from the medical record. Whole-exome sequencing (WES) was used to explore the potential genetic etiology, and the detected variant verified using Sanger sequencing. Functional studies were performed to validate the pathogenic effects of the variant. Using trio-WES, we identified a novel PUF60 variant (NM_078480.2; c.1678 T > A, p.*560Argext*204) in the pedigree. Bioinformatic analyses revealed that the variant is potentially pathogenic, and functional studies indicated that it leads to degradation of the elongated protein and subsequently PUF60 LOF, producing some VRJS phenotypes. These findings confirmed the pathogenicity of the variant. This study implicates PUF60 LOF in the etiopathogenesis of VRJS. It not only expands the PUF60 variant spectrum, and also provides a basis for genetic counseling and the diagnosis of VRJS. Although trio-WES is a well-established approach for identifying the genetic etiology of rare multisystemic conditions, functional studies could aid in verifying the pathogenicity of novel variants.

Abstract Background The mechanism underlying cervical carcinogenesis that is mediated by persistent human papillomavirus (HPV) infection remains elusive. Aims Here, for the first time, we deciphered both the temporal transition and spatial distribution of cellular subsets during disease progression from normal cervix tissues to precursor lesions to cervical cancer. Materials & Methods We generated scRNA‐seq profiles and spatial transcriptomics data from nine patient samples, including two HPV‐negative normal, two HPV‐positive normal, two HPV‐positive HSIL and three HPV‐positive cancer samples. Results We not only identified three ‘HPV‐related epithelial clusters’ that are unique to normal, high‐grade squamous intraepithelial lesions (HSIL) and cervical cancer tissues but also discovered node genes that potentially regulate disease progression. Moreover, we observed the gradual transition of multiple immune cells that exhibited positive immune responses, followed by dysregulation and exhaustion, and ultimately established an immune‐suppressive microenvironment during the malignant program. In addition, analysis of cellular interactions further verified that a ‘homeostasis‐balance‐malignancy’ change occurred within the cervical microenvironment during disease progression. Discussion We for the first time presented a spatiotemporal atlas that systematically described the cellular heterogeneity and spatial map along the four developmental steps of HPV‐related cervical oncogenesis, including normal, HPV‐positive normal, HSIL and cancer. We identified three unique HPV‐related clusters, discovered critical node genes that determined the cell fate and uncovered the immune remodeling during disease escalation. Conclusion Together, these findings provided novel possibilities for accurate diagnosis, precise treatment and prognosis evaluation of patients with precancer and cervical cancer.

Various predictive biomarkers are needed to select candidates for optimal and individualized treatments. Tumor‐infiltrating immune cells have gained increasing interest in cancer research for the prediction of therapeutic response and survival. However, the role of dendritic cells (DCs) in PD-1 blockade immunotherapy remains unclear. In this study, we identified a population of PD-1+ DCs in the tumor microenvironment (TME) of cervical cancer (CC). The accumulation of PD-1+ DCs in cervical tumors was correlated with advanced stages, elevated preoperative squamous cell carcinoma antigen levels and lymph-vascular space invasion. PD-1 expression was induced on activated tumor-associated DCs (TADCs) in vitro compared with their resting counterparts. This PD-1+ DC population was characterized by reduced secretion of cytokines (IL-12, TNF-α, and IL-1β) and dysfunctional induction of T cell proliferation and cytotoxic reaction. PD-1 blockade significantly reinvigorated PD-1+ DCs to release IL-12, TNF-α, and IL-1β compared with PD-1- DCs. TILs from samples with higher PD-1+ DC infiltration could be induced to achieve a greater killing effect of PD-1 blockade treatment. Our findings suggested a role for PD-1+ DCs in immune surveillance dysfunction and CC progression. PD-1+ DC density in the TME may serve as a diagnostic factor for predicting the optimal beneficiaries of PD-1/PD-L1 blockade immunotherapy in CC.

目的 探讨多模式教学在胎儿超声心动图住院医师规范化培训教学中的应用效果.方法 多模式教学是采用多媒体现代教学手段讲授传统理论知识、联合CBL和PBL教学模式、将超声模拟系统操作练习与上机操作相结合的教学方法,对2019年9月—2021年9月在南京医科大学第一附属医院参加住院医师规范化培训的2017级及2018级学生分两组,分别采用多模式教学法和传统教学方法,比较分析观察组和对照组间的理论考核、上机操作考核及病例分析回答问题的考核成绩,并对观察组进行问卷调查.结果 观察组基础理论掌握情况、上机操作能力、病例分析能力均明显高于对照组,差异有统计学意义(P<0.05).观察组调查问卷显示,多模式教学法有利于提升学习主观能动性、加深基础理论知识的理解以及上机操作能力等.结论 采用多模式教学法可有助于住培医生提高胎儿超声心动图的学习效果.

Abstract Background Considering the unique biological behavior of cervical adenocarcinoma (AC) compared to squamous cell carcinoma, we now lack a distinct method to assess prognosis for AC patients, especially for intermediate-risk patients. Thus, we sought to establish a Silva-based model to predict recurrence specific for the intermediate-risk AC patients and guide adjuvant therapy. Methods 345 AC patients were classified according to Silva pattern, their clinicopathological data and survival outcomes were assessed. Among them, 254 patients with only intermediate-risk factors were identified. The significant cutoff values of four factors (tumor size, lymphovascular space invasion (LVSI), depth of stromal invasion (DSI) and Silva pattern) were determined by univariate and multivariate Cox analyses. Subsequently, a series of four-, three- and two-factor Silva-based models were developed via various combinations of the above factors. Results (1) We confirmed the prognostic value of Silva pattern using a cohort of 345 AC patients. (2) We established Silva-based models with potential recurrence prediction value in 254 intermediate-risk AC patients, including 12 four-factor models, 30 three-factor models and 16 two-factor models. (3) Notably, the four-factor model, which includes any three of four intermediate-risk factors (Silva C, ≥ 3 cm, DSI > 2/3, and > mild LVSI), exhibited the best recurrence prediction performance and surpassed the Sedlis criteria. Conclusions Our study established a Silva-based four-factor model specific for intermediate-risk AC patients, which has superior recurrence prediction performance than Sedlis criteria and may better guide postoperative adjuvant therapy.

Objective:To evaluate the effects of physician skills on the success rate of the external cephalic version (ECV) and investigate the learning curve for ECV.Methods:A retrospective study of 97 pregnant women who underwent ECV at the First Affiliated Hospital of Nanjing Medical University from March 2019 to August 2021 was performed. Patients were divided into multipara and primipara groups. The success rate of ECV and morbidity were compared between the two groups, and the learning curve for ECV was evaluated using cumulative sum analysis (CUSUM).Results:(1) Patients in the multipara group were older than those in the primipara group [(33.0±3.4) vs (29.2±3.0) years, t=－5.57, P<0.001]. No significant difference was found in other baseline data between the two groups. (2) The overall ECV success rate was 61.9% (60/97), and a higher success rate was observed in the multipara group [93.3% (28/30) vs 47.8% (32/67), χ 2=18.24, P<0.001]. Fetal heart rate deceleration (5.2%, 5/97), vaginal bleeding (1.0%, 1/97), premature rupture of membranes (1.0%, 1/97), and fetal distress (1.0%, 1/97) were the main complications. (3) The CUSUM analysis showed that it needed 53 primiparas for a physician to obtain a 50% consistent success rate ( R2=0.91, H=－3.27, Y=52.16) and seven multiparas to achieve a 70% consistent success rate ( R2=0.99, H=－1.635, Y=6.60). Conclusions:Parity and operator skills have a significant influence on the success of ECV. A physician with standardized training will manage non-anesthesia ECV skillfully in full-term and near-term pregnancies after practice on 50 primiparae or approximately ten multiparae. It is recommended to start with the multiparae for learning ECV to build up confidence and promote the implementation of ECV.

BACKGROUND:Machine learning (ML) has been gradually integrated into oncologic research but seldom applied to predict cervical cancer (CC), and no model has been reported to predict survival and site-specific recurrence simultaneously. Thus, we aimed to develop ML models to predict survival and site-specific recurrence in CC and to guide individual surveillance. METHODS:We retrospectively collected data on CC patients from 2006 to 2017 in four hospitals. The survival or recurrence predictive value of the variables was analyzed using multivariate Cox, principal component, and K-means clustering analyses. The predictive performances of eight ML models were compared with logistic or Cox models. A novel web-based predictive calculator was developed based on the ML algorithms. RESULTS:This study included 5112 women for analysis (268 deaths, 343 recurrences): (1) For site-specific recurrence, larger tumor size was associated with local recurrence, while positive lymph nodes were associated with distant recurrence. (2) The ML models exhibited better prognostic predictive performance than traditional models. (3) The ML models were superior to traditional models when multiple variables were used. (4) A novel predictive web-based calculator was developed and externally validated to predict survival and site-specific recurrence. CONCLUSION:ML models might be a better analytic approach in CC prognostic prediction than traditional models as they can predict survival and site-specific recurrence simultaneously, especially when using multiple variables. Moreover, our novel web-based calculator may provide clinicians with useful information and help them make individual postoperative follow-up plans and further treatment strategies.

Endocervical adenocarcinoma (EAC) is an aggressive type of endocervical cancer. At present, molecular research on EAC mainly focuses on the genome and mRNA transcriptome, the investigation of small RNAs in EAC has not been fully described. Here, we systematically explored small RNAs in 14 EAC patients with different subtypes using small RNA sequencing. MiRNAs and tRNA-derived RNAs (tDRs) accounted for the majority of mapped reads and the total number of miRNAs and tDRs maintained a relative balance. To explore the correlations between small RNAs expression and EAC with different clinical characteristics, we performed the weighted gene co-expression network analysis (WGCNA) and screened for hub small RNAs. From the key modules, we identified 9 small RNAs that were significantly related to clinical characteristics in EAC patients. Gene ontology and pathway analyses revealed that these molecules were involved in the pathogenesis of EAC. Our work provided new insights into EAC pathogenesis and successfully identified several small RNAs as candidate biomarkers for diagnosis and prognosis of EAC.

Objective To evaluate the prognostic performance of the revised 2018 FIGO staging system for cervical cancer. Methods This retrospective multicenter study enrolled cervical cancer patients with 2009 FIGO Stage IA1-IIA2 who underwent surgeries between January 2006 and December 2017 in four tertiary hospitals. Patients were restaged according to the 2018 FIGO staging system by reviewing their medical data. Results Of 3238 cervical cancer patients included, 1841 (56.9%) patients were restaged: 641 (34.9%) due to tumor size, 544 (29.5%) due to lymph node metastasis, 614 (33.4%) due to the inconsistency between pre- and postoperative assessments, and 42 due to the cancellation of invasion width in Stage IA. After restaging, a clear tendency of decreased recurrence-free survival (RFS) and overall survival (OS) with increasing stage was observed. Multivariate Cox analysis showed that 2018 FIGO stage, parametrial involvement, and histology were independent prognostic factors for both OS and RFS (P < 0.05). Based on these factors, we established predictive nomograms with c-indexes of 0.735 and 0.721, showing good predictive ability for cervical cancer. Conclusion The revised 2018 FIGO staging system can better reflect the survival of cervical cancer patients. Based on it, we established a nomogram that can predict the prognosis of cervical cancer patients more precisely.

OBJECTIVE:To compare the characteristics, surgical complications, and overall survival between patients undergoing laparoscopy versus laparotomy for treatment of early-stage cervical stump carcinoma.METHODS:Patients with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA2 to IIA2 cervical stump carcinoma who underwent laparoscopy or laparotomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2000 to June 2018 were retrospectively reviewed. All patients' clinical characteristics, pathological features, complications, and follow-up data were retrieved.RESULTS:Seventy-two patients were included in the analysis; 58 underwent laparoscopy and 14 underwent laparotomy. With respect to surgical complications, laparoscopy was associated with a significantly lower complication rate, less blood loss, a shorter operative time, and a higher hospitalization fee than laparotomy. Survival was not significantly different between the laparoscopy and laparotomy groups.CONCLUSIONS:Although survival was not significantly different between the two surgical approaches, the rate of surgical complications was much lower in the laparoscopy than laparotomy group.

INTRODUCTION:Cervical cancer has high mortality, high recurrence and poor prognosis. Although prognostic biomarkers such as clinicopathological features have been proposed, their accuracy and precision are far from satisfactory. Therefore, novel biomarkers are urgently needed for disease surveillance, prognosis prediction and treatment selection. MATERIALS:Differentially expressed genes (DEGs) between cervical cancer and normal tissues from three microarray datasets extracted from the Gene Expression Omnibus platform were identified and screened. Based on these DEGs, a six-gene prognostic signature was constructed using cervical squamous cell carcinoma and endocervical adenocarcinoma data from The Cancer Genome Atlas. Next, the molecular functions and related pathways of the six genes were investigated through gene set enrichment analysis and co-expression analysis. Additionally, immunophenoscore analysis and the QuartataWeb Server were employed to explore the therapeutic value of the six-gene signature. RESULTS:We discovered 178 overlapping DEGs in three microarray datasets and established a six-gene (APOC1, GLTP, ISG20, SPP1, SLC24A3 and UPP1) prognostic signature with stable and excellent performance in predicting overall survival in different subgroups. Intriguingly, the six-gene signature was closely associated with the immune response and tumour immune microenvironment. The six-gene signature might be used for predicting response to immune checkpoint inhibitors (ICIs) and the six genes may serve as new drug targets for cervical cancer. CONCLUSION:Our study established a novel six-gene (APOC1, GLTP, ISG20, SPP1, SLC24A3 and UPP1) signature that was closely associated with the immune response and tumour immune microenvironment. The six-gene signature was indicative of aggressive features of cervical cancer and therefore might serve as a promising biomarker for predicting not only overall survival but also ICI treatment effectiveness. Moreover, three genes (UPP1, ISG20 and GLTP) within the six-gene signature have the potential to become novel drug targets.

目的 分析胎盘绒毛膜血管瘤产前超声特征及临床结局.方法 回顾性分析20例胎盘绒毛膜血管瘤的临床和超声资料;其中,孕期无并发症12例(无并发症组),有并发症8例(有并发症组).结果 胎盘绒毛膜血管瘤产前超声特征:胎盘实质内或胎盘边缘单发或多发的圆形或类圆形的低回声或中高回声团,边界清晰,部分凸向胎盘胎儿面,肿瘤内血供丰富或不明显.与无并发症组比较,有并发症组肿瘤内部血供更丰富、诊断时和4周后肿瘤最大径更大、临床结局较差(P＜0.05).有并发症组中,羊水过多7例,宫内发育迟缓1例,少量心包积液和轻度三尖瓣返流1例,3例中重度贫血、心胸比增大;5例剖宫产,2例自然分娩,1例经阴道分娩引产.无并发症组中,9例自然分娩,3例剖宫产.两组新生儿预后均较好.结论 产前超声是诊断和监测胎盘绒毛膜血管瘤的重要手段,这类患者出现并发症后临床结局较差.

Xiaoyan Tang* Songping Liu* Yan Ding* Chenyan Guo Jingjing Guo Keqin Hua Junjun Qiu 1Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, People’s Republic of China; 2Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai 200032, People’s Republic of China; 3Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai 200011, People’s Republic of China; 4Department of Obstetrics and Gynecology, Zhenjiang Maternal and Child Health Hospital, Zhenjiang, Jiangsu 212001, People’s Republic of China

Abstract Objective To compare survival outcomes of minimally invasive surgery (MIS) and laparotomy in early‐stage cervical cancer (CC) patients. Methods A multicenter retrospective cohort study was conducted with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA1 (lymphovascular invasion)‐IIA1 CC patients undergoing MIS or laparotomy at four tertiary hospitals from 2006 to 2017. Propensity score matching and weighting and multivariate Cox regression analyses were performed. Survival was compared in various matched cohorts and subgroups. Results Three thousand two hundred and fifty‐two patients (2439 MIS and 813 laparotomy) were included after matching. (1) The 2‐ and 5‐year recurrence‐free survival (RFS) (2‐year, hazard ratio [HR], 1.81;95% confidence interval [CI], 1.09‐3.0; 5‐year, HR, 2.17; 95% CI, 1.21‐3.89) or overall survival (OS) (2‐year, HR, 1.87; 95% CI, 1.03‐3.40; 5‐year, HR, 2.57; 95% CI, 1.29‐5.10) were significantly worse for MIS in patients with stage I B1, but not the cohort overall (2‐year RFS, HR, 1.04; 95% CI, 0.76‐1.42; 2‐year OS, HR, 0.99; 95% CI, 0.70‐1.41; 5‐year RFS, HR, 1.12; 95% CI, 0.76‐1.65; 5‐year OS, HR, 1.20; 95% CI, 0.79‐1.83) or other stages (2) In a subgroup analysis, MIS exhibited poorer survival in many population subsets, even in patients with less risk factors, such as patients with squamous cell carcinoma, negative for parametrial involvement, with negative surgical margins, negative for lymph node metastasis, and deep stromal invasion < 2/3. (3) In the cohort treated with (2172, 54%) or without adjuvant treatment (1814, 46%), MIS showed worse RFS than laparotomy in patients treated without adjuvant treatment, whereas no differences in RFS and OS were observed in adjuvant‐treatment cohort. (4) Inadequate surgeon proficiency strongly correlated with poor RFS and OS in patients receiving MIS compared with laparotomy. Conclusions MIS exhibited poorer survival outcomes than laparotomy group in many population subsets, even in low‐risk subgroups. Therefore, laparotomy should be the recommended approach for CC patients.

Purpose: Circular RNAs (circRNAs) are novel type of noncoding RNAs that play important roles and serve as noninvasive biomarkers in various cancers. In the present study, we focused on circFoxO3a and aimed to investigate its prognostic value as a novel serum biomarker for squamous cervical cancer (SCC). Patients and Methods: Our study included 103 SCC patients from Obstetrics and Gynecology Hospital of Fudan University. Expression levels of circFoxO3a in the serum of patients with SCC were examined by reverse transcription-quantitative PCR (RT-qPCR). The correlation between serum circFoxO3a expression and clinicopathologic factors was analyzed. The Kaplan-Meier method and multivariate Cox regression analysis were applied to evaluate the independent prognostic factors for SCC. A prognostic predictive nomogram was constructed using R software. Results: Levels of serum circFoxO3a were decreased in SCC patients compared with controls. Low expression of circFoxO3a was correlated with deeper stromal invasion and positive lymph node metastasis. Moreover, SCC patients with lower expression of serum circFoxO3a showed poorer prognosis, including both overall survival (OS) and recurrence-free survival (RFS). Multivariate Cox analysis indicated low serum circFoxO3a levels to be an unfavorable prognostic factor for both OS and RFS, independent of positive lymph node metastasis. Notably, the predictive nomogram we established further confirmed that serum circFoxO3a is a useful tool for predicting survival in SCC. Conclusion: Altogether, our findings demonstrated that serum circFoxO3a could serve as a potential novel noninvasive predictive prognostic biomarker and therapeutic target for SCC.

目的:探讨采用二维超声(US)联合磁共振(MRI)诊断胎盘植入的临床价值.方法:选取前置胎盘孕产妇75例作为观察对象,分别对其进行US、MRI、US+MRI检查,并对三者的诊断结果进行对比分析.结果:US对胎盘植入的检出率为78.67％,MRI为76.00％,二者检出率并无明显差异(P>0.05);MRI检查与病理检查分级结果一致性较好(K a p p a=0.685,P<0.01),联合检查对胎盘植入的检出率明显高于单用U S、MRI检查(P<0.05),且与病理检查分级结果一致性强(K a p p a=0.875,P<0.01).结论:通过超声联合磁共振可更为准确地对胎盘植入程度进行评估,更具有临床价值.