Bowel resection is necessary during cytoreductive surgery for advanced ovarian cancer to achieve optimal cytoreduction, but is associated with increased life-threatening complications and delays in adjuvant chemotherapy, negatively impacting survival. While studies demonstrate deteriorating survival outcomes with increasing bowel resections during primary cytoreductive surgery, data regarding survival impact during interval cytoreductive surgery (ICS) remains limited and conflicting. Therefore, this study aims to evaluate the survival impact of bowel resection performed during ICS in patients with advanced ovarian cancer. Three hundred thirty patients with advanced ovarian cancer who underwent ICS between 2018 and 2022 were retrospectively reviewed and classified into three groups: no bowel surgery (n = 93), bowel tumor stripping (n = 176), and bowel resection (n = 61). Primary outcome were progression-free survival (PFS) and overall survival (OS). An exploratory analysis was also conducted to examine the effect of bowel resection on post-recurrence progression-free survival 2 (PFS2). Survival analyses were performed using Kaplan-Meier methods and Cox regression models. Propensity score-based inverse probability of treatment weighting (IPTW) was applied to balance between-group differences. Bowel resection during ICS was associated with increased surgical complexity, perioperative morbidity, and postoperative complications. After IPTW adjustment, bowel resection during ICS was an independent risk factor for OS compared to bowel tumor stripping (hazard ratio [HR] 1.83, 95

Complete cytoreduction at interval debulking surgery (IDS) is the most critical prognostic determinant for advanced ovarian cancer patients receiving neoadjuvant chemotherapy (NACT), yet accurate preoperative prediction remains challenging. Pan-immune-inflammation value (PIV) has emerged as a superior predictor in multiple malignancies compared to simple inflammatory ratios, yet its predictive value for surgical outcomes after NACT in ovarian cancer remains uninvestigated. This study aimed to explore the predictive value of PIV at multiple timepoints and its early dynamics during NACT for complete cytoreduction at IDS in patients with advanced ovarian cancer. PIV was calculated at three timepoints in 231 enrolled patients: before NACT (PIV-0), after one cycle of NACT (PIV-1), and before IDS (PIV-2). Early PIV difference was defined as the percentage change between PIV-0 and PIV-1. Receiver operating characteristic analysis and logistic regression were performed to assess the predictive value for cytoreduction status. Associations with chemotherapy response indicators and survival outcomes were also evaluated. Patients with incomplete cytoreduction had significantly higher PIV levels at all timepoints and less favorable early PIV dynamics (all P < 0.001). The area under the curve for PIV-0, PIV-1, PIV-2, and early PIV difference were 0.762, 0.850, 0.754, and 0.787, with optimal cut-off values of 660.6, 404.9, 219.4, and − 19.4

Peritoneal metastasis (PM) after radical surgery is an important cause of treatment failure in colorectal cancer (CRC). Intraoperative intraperitoneal perfusion chemotherapy may be an effective method for preventing postoperative PM in patients with CRC. This study aimed to explore the safety and feasibility of intraoperatively preventive intraperitoneal perfusion chemotherapy using lobaplatin for CRC. Between 12 December 2017 and 17 October 2019, 720 eligible CRC patients with T4 or N + clinical TNM stage were recruited from 25 hospitals in China. Eligible patients were randomised in a 1:1 ratio to undergo resection of CRC only (control group) or resection of CRC with intraperitoneal perfusion chemotherapy with lobaplatin intraoperatively (lobaplatin group). The primary endpoint of this trial was the rate of PM after surgery, while secondary endpoints included safety, overall survival (OS) time, recurrence-free survival (RFS) time, peritoneal recurrence-free survival (PRFS) time, and the rate of liver metastasis. Of 716 patients included in the full analysis set (FAS), 352 were assigned to the lobaplatin group and 364 to the control group. In the FAS population, adding intraoperatively preventive intraperitoneal perfusion chemotherapy with lobaplatin decreased the primary end point rate of 3-year PM (3.56

OBJECTIVE:Platinum-resistant ovarian cancer (PROC) remains a therapeutic challenge. While immune checkpoint inhibitor plus lenvatinib demonstrates potential efficacy in ovarian cancer, the standard 20 mg lenvatinib dosage causes significant adverse events leading to treatment disruption. We present preliminary results of a multicenter, single-arm phase II trial evaluating low-dose lenvatinib plus toripalimab for recurrent PROC. METHODS:Patients with recurrent PROC received low-dose lenvatinib (8 or 12 mg daily) and toripalimab (240 mg, every three weeks). Primary endpoint was progression-free survival (PFS). Second endpoints included objective response rate (ORR), duration of response (DOR), disease control rate (DCR), overall survival (OS), and safety. RESULTS:Thirty-three patients were enrolled at preliminary analysis. 91 % were platinum-resistant, and 9 % were platinum-refractory, with a median of 3 prior therapy lines (range 1-12). Median (95 % CI) PFS and OS were 5.0 months (3.8-6.2) and 13.3 months (12.4-14.2), respectively. Patients with CA125 decrease ≥50 % after the first cycle had longer PFS (7.9 vs 3.7 months). The ORR was 27 % (95 % CI 13 %-46 %) and DCR was 54 % (95 % CI 36 %-72 %). Median DOR was 4.4 months (range 2.1- ≥ 17.4). Treatment-related adverse events occurred in 97 % of patients (39 % grade 3; no grade 4-5). Four (12 %) patients required lenvatinib dose reduction, with treatment interruption and discontinuation rates of 42 % and 12 %, respectively. Patients who underwent platinum rechallenge following progression on trial treatment appeared to regain platinum sensitivity. CONCLUSIONS:Low-dose lenvatinib plus toripalimab demonstrated encouraging efficacy and tolerability in patients with heavily pretreated, recurrent PROC. Completed accrual is needed to confirm these results.

5548 Background: Next-generation sequencing of plasma circulating tumor DNA (ctDNA) shows promise in ovarian cancer management as a minimally invasive alternative to tissue sequencing. However, concordance between genomic alterations detected in tissue and ctDNA remains incompletely characterized, with limited understanding of influencing factors and clinical implications. Methods: We analyzed 29 matched pretreatment tissue and plasma samples from treatment-naïve ovarian cancer patients using a customized 2365-gene panel. Overall and individual concordance rates were calculated as the ratio of total concordant mutations to total tissue mutations, with patients stratified into high concordance (≥50%) and poor concordance (<50%) groups. Clinicopathological and tumor molecular factors influencing concordance were analyzed. Relationship between concordance rates and clinical outcomes, including chemosensitivity (KELIM score) and progression-free survival (PFS), was assessed in advanced-stage patients. Results: The cohort predominantly comprised FIGO III-IV disease (89.7%) and high-grade serous histology (89.7%), with median follow-up of 306 (66-570) days. Overall tissue-plasma concordance rate was 42%, with shared variants exhibiting identical abundance patterns across sample types (r=0.25, p =0.0074) and encompassing 66.1% of tissue driver mutations. Tissue-specific mutations displayed lower variant allele frequencies than shared mutations (median 4.4% vs 28.7%). Single nucleotide variants showed higher plasma detection rate than structural variants (47.3% vs 25.4%). Individual concordance rates varied substantially (0-83.3%). High concordance group exhibited higher tumor Ki-67 index (median 85% vs 70%), tissue tumor mutation burden (TMB, median 5.1 vs 4.1 muts/Mb), and plasma ctDNA fraction (median 8.1% vs 0.9%). No significant differences were observed in largest tumor diameter, CA125 levels, tumor sample locations (from primary site or metastatic site), or BRCA mutation/homologous recombination status between groups. By multivariable analysis, higher TMB (OR 1.931, 95% CI 1.064-3.504) and plasma ctDNA fraction (OR 1.416, 95% CI 1.060-1.893) independently associated with high concordance rates. In advanced-stage patients, poor concordance group showed lower KELIM scores (median 0.7 vs 1.2; 15.4% vs 69.2% of patients with score ≥1), indicating reduced chemosensitivity. Concordance rates strongly correlated with KELIM scores (r=0.71, p <0.0001). Poor concordance group demonstrated shorter PFS (median 436 days vs not reached, p =0.037). Conclusions: Our study revealed moderate concordance between pretreatment tumor tissue and plasma ctDNA mutation profiles in ovarian cancer, influenced by technical and biological factors. Tissue-plasma concordance may serve as a novel chemosensitivity and prognostic indicator.

Purpose:Therapeutic options for patients with platinum-resistant ovarian cancer (PROC) remain a major unmet need. PROC patients with multiple recurrences are unable to continue highly toxic treatment after prior multiple lines of systemic therapy. Chemotherapy-free option lenvatinib plus anti-programmed cell death protein-1 (PD-1) combination therapy has shown promising results in several malignancies including ovarian cancer, but the toxicity of a high starting dose of lenvatinib is also notable and needs to be improved. Our previous pilot study indicated that a reduced starting dose of lenvatinib may maintain comparable anti-tumor activity with favorable safety in heavily pre-treated ovarian cancer. This study is designed to further validate the efficacy and safety of the combination therapy of low-dose lenvatinib and PD-1 inhibitor toripalimab in patients with recurrent PROC. Study Design and Methods:The study is designed as a multicenter, open-label, single-arm, prospective phase II study. Patients with recurrent epithelial ovarian cancer who have disease progression either during or within 6 months after completion of platinum-based therapy will be included. A total of 69 participants will receive low-dose lenvatinib (8 mg or 12 mg, daily, orally, based on patient's body weight) and toripalimab (240 mg, every 21 days, intravenously). Treatment will continue until the development of unacceptable toxicity or disease progression. The primary endpoint is the progression-free survival. The secondary endpoints include objective response rate, duration of response, disease control rate, overall survival, toxicity and patients' quality of life. Exploratory objectives aim to identify biomarkers and molecular signatures for predicting response or prognosis.

Background:Next-generation sequencing (NGS) of plasma circulating tumor DNA (ctDNA) shows promise as a minimally invasive alternative to tissue sequencing. However, concordance between genomic alterations in tumor tissue and plasma ctDNA remains incompletely characterized in ovarian cancer, particularly in the pretreatment setting. Objectives:To identify factors influencing concordance between tissue and ctDNA genomic profiling and explore the potential clinical implications (including treatment and survival outcomes) of this concordance. Design:A prospective, single-center, observational study. Methods:A total of 40 matched pretreatment tumor specimens and blood samples were prospectively collected from patients with ovarian cancer and subsequently sequenced using a customized gene panel. Overall and individual concordance rates were calculated as the ratio of total concordant mutations to total tissue mutations, with patients stratified into highly concordant (⩾50%) and poorly concordant (<50%) groups. Results:The overall tissue-plasma concordance rate was 40.8%, with shared variants exhibiting identical abundance patterns across sample types and capturing the majority of functionally relevant mutations. Single-nucleotide variants in tissue showed a higher detection rate in plasma than structural variants. Individual concordance rates displayed significant inter-patient variability. Higher tissue tumor mutation burden (odds ratio (OR) 2.165, 95% confidence interval (CI) 1.183-3.965) and plasma ctDNA fraction (OR 1.433, 95% CI 1.063-1.933) were independently associated with high concordance rates. In advanced-stage patients, the poorly concordant group showed lower CA125 elimination rate constant K (KELIM) scores (median 0.7 vs 1.3; 15.0% vs 68.8% patients with score ⩾1), indicating reduced chemosensitivity. The poorly concordant group demonstrated a higher disease recurrence rate (40.0% vs 6.2%) and elevated early recurrence risk (12-month progression-free survival rate 82.0% vs 100.0%) compared with the highly concordant group. Conclusion:In the field of ovarian cancer, NGS of ctDNA showed moderate concordance with tissue-based sequencing in the pretreatment setting, influenced by both technical and biological factors. The tissue-plasma concordance may serve as a chemosensitivity and prognostic indicator.

Background The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival. Materials and Methods This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored. Results Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively). Conclusion In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.

OBJECTIVE:Treatment options for heavily pre-treated recurrent ovarian and endometrial cancer are limited. Lenvatinib plus anti-programmed cell death protein-1 (PD-1) combination therapy has been efficacious in advanced endometrial cancer, but at the recommended dose level, high-grade adverse events occur and lead to drug discontinuation. This study evaluated the feasibility of low-dose lenvatinib plus anti-PD-1 therapy in patients with recurrent ovarian and endometrial cancer. METHODS:This is a single-arm, protocol-based pilot study. Patients with recurrent ovarian cancer or endometrial cancer who had at least one line of previous therapy were included and given lenvatinib 8 or 12 mg daily (based on the patient's weight) and anti-PD-1 therapy. The primary endpoint was the objective response rate. RESULTS:Twenty-one patients were enrolled, including 15 with ovarian cancer and six with endometrial cancer. All patients were pre-treated, and the median number of lines of previous treatment of the ovarian and endometrial cancer cohorts was three and two, respectively. After a median follow-up of 11.0 months (range 6.8-23.9), the objective response rate for the ovarian cancer and endometrial cancer cohorts was 46.7% (95% CI 21.3% to 73.4%) and 66.7% (95% CI 22.3% to 95.7%), respectively. The median duration of response for the ovarian cancer and endometrial cancer cohorts was 5.3 (95% CI 0 to 11.7) and 6.1 (95% CI 2.4 to 9.8) months, respectively. The median progression-free survival for the ovarian cancer and endometrial cancer cohorts was 4.1 (95% CI 2.6 to 5.6) and 6.6 (95% CI 1.7 to 11.5) months, respectively. No grade 4 or 5 adverse events occurred. Eight (38.1%) patients had a lenvatinib dose reduction. There was no discontinuation of lenvatinib alone, and only one patient discontinued both drugs due to adverse events. CONCLUSION:Low-dose lenvatinib in combination with anti-PD-1 therapy showed promising efficacy and favorable tolerability in patients with heavily pre-treated ovarian and endometrial cancer.

Objectives: This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods: The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results: All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions: This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

Abstract Background Intravenous leiomyomatosis (IVL), pulmonary benign metastatic leiomyomatosis (PBML), and leiomyomatosis peritonealis disseminata (LPD) are leiomyomas with special growth patterns and high postoperative recurrence rates. We report the safety and efficacy of a pilot study of sirolimus in the treatment of recurrent IVL, PBML, and recurrent LPD. Methods This was a pilot study to evaluate the safety and efficacy of sirolimus in the treatment of leiomyomatosis (ClinicalTrials.gov identifier NCT03500367) conducted in China. Patients received oral sirolimus 2 mg once a day for a maximum of 60 months or until disease progression, intolerable toxicity, withdrawal of consent, or investigator decision to stop. The primary end point of this study was the objective response rate. Secondary end points included safety and tolerability, disease control rate, and progression-free survival. Results A total of 15 patients with leiomyomatosis were included in the study, including five with recurrent IVL, eight with PBML and two with recurrent LPD. The median follow-up time was 15 months (range 6–54 months), nine patients (60%) had treatment-related adverse events (including all levels), and two patients had treatment-related grade 3 or 4 adverse events. The objective response rate was 20.0% (95% CI, 7.1–45.2%), and the disease control rate was 86.7% (95% CI, 62.1–96.3%). Partial response was achieved in three patients. The median response time in the three partial response patients was 33 months (range 29–36 months), and the sustained remission time of these three patients reached 0, 18, and 25 months, respectively. Conclusions Sirolimus was safe and effective in the treatment of recurrent IVL, PBML, and recurrent LPD. Trial registration ClinicalTrials.gov identifier NCT03500367. Registered on 18 April 2018.

Objective We aimed to investigate the differences of transcriptome profile between 2 groups of high-grade serous ovarian cancer (HGSOC) patients with distinct outcomes and identify potential biomarkers for recurrence. Methods RNA sequencing was performed in 2 groups of HGSOC patients with similar demographic characteristics but exhibiting distinct progression-free survival (PFS). Transcriptome data of poor response (PR; PFS ≤6 months) and good response (GR; PFS ≥12 months) group were compared. We employed xCell to evaluate the abundance of 63 cells in tumor microenvironment. The predictive value of recurrence-related tumor infiltration cells was validated in cohort data from Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) dataset. The weighted correlation network analysis was performed to identify the genes related to cell infiltration. Results PR patients exhibited a distinct tumor infiltration immune cells-related transcriptional profile compared to GR patients, such as lower signatures of leukocyte differentiation, activation and chemotaxis. The fraction of T-helper 2 (Th2) cells infiltration was significantly higher in PR group than in GR group. High infiltration of Th2 was significantly associated with unfavorable prognosis in the GEO cohort (area under the curve=0.84 at 6 months recurrence) and TCGA cohort (p=0.008). Genes enriched to extracellular matrix organization and integrin binding were relevant to Th2 infiltration. Conclusion Patients with HGSOC having shorter PFS exhibited a distinct gene signature that related to tumor-infiltrating immune cells. The level of Th2 infiltration could facilitate patient recurrence risk stratification and may be a promising biomarker for prognosis prediction and immune-related treatment.

Background Recently, totally laparoscopic (TLAP) surgery has suggested its potential on ileostomy reversal. This study aimed to compare the short-term outcomes between TLAP and traditional open ileostomy reversal. Patients and methods From September 2016 to September 2021, 107 eligible patients underwent TLAP (n = 48) or open (n = 59) loop ileostomy reversal were retrospectively enrolled. Surgical parameters, postoperative recovery and complications were identified and compared between TLAP technique vs. open surgery. Results The operation time and estimated blood loss showed no obvious difference between TLAP and open group. However, TLAP reversal significantly decreased the incision length (4.5cm vs. 6cm, P < 0.001). Furthermore, patients underwent TLAP surgery showed quicker first ground activities (1 day vs. 2 days, P < 0.001), faster first flatus passage (2 days vs. 3 days, P = 0.004) and shorter postoperative stay (5 days vs. 7 days, P = 0.007). More importantly, postoperative complications were significantly reduced after TLAP reversal (3 cases vs. 10 cases, P = 0.026). Further logistic regression analyses also indicated the TLAP technique was associated with lower incidence of complications (OR=3.316, CI, 1.118–9.835; P = 0.031). Conclusions TLAP surgery is competitive in promoting postoperative recovery as well as reducing complications compared to the traditional open ileostomy reversal.

Background An innovative instrument for laparoscopy using indocyanine green (ICG) allows easy detection of sentinel lymph nodes (SLNs) in lateral pelvic lymph nodes (LPLNs). Here, we investigated the safety and efficacy of lateral pelvic SLN biopsy (SLNB) using ICG fluorescence navigation in advanced lower rectal cancer and evaluated the sensitivity and specificity of this technique to predict the status of LPLN. Methods From April 1, 2017 to December 1, 2020, we conducted lateral pelvic SLNB using ICG fluorescence navigation during laparoscopic total mesorectal excision and lateral pelvic lymph node dissection (LLND) in 23 patients with advanced low rectal cancer who presented with LPLN but without LPLN enlargement. Data regarding clinical characteristics, surgical and pathological outcomes, lymph node findings, and postoperative complications were collected and analyzed. Results We successfully performed the surgery using fluorescence navigation. One patient underwent bilateral LLND and 22 patients underwent unilateral LLND. The lateral pelvic SLN were clearly fluorescent before dissection in 21 patients. Lateral pelvic SLN metastasis was diagnosed in 3 patients and negative in 18 patients by frozen pathological examination. Among the 21 patients in whom lateral pelvic SLN was detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLN. Conclusion This study indicated that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure for advanced lower rectal cancer with good accuracy, and no false-negative cases were found. No metastasis in SLNB seemed to reflect all negative LPLN metastases, and this technique can replace preventive LLND for advanced lower rectal cancer.

In elderly men, prostate cancer is a leading cause of death. Tumor cells require more energy to progress than normal cells, and this energy is mainly dependent on the large amount of ATP support generated by lipid metabolism. Therefore, in this study, we focused on long noncoding RNAs related to lipid metabolism in prostate cancer to discover the biological mechanisms of lipid metabolism regulation. The TCGA-PRAD cohort was used in this study for computational biology analysis. In lipid metabolism biological pathways, 1959 long noncoding RNAs were identified by Pearson correlation coefficient analysis of protein-coding genes, then univariate regression with P values fewer than 0.05. We further identified 784 lncRNAs that were lipid metabolism-related lncRNAs considered to have prognostic value for disease-free survival. Subsequently, we constructed two lncRNA expression patterns of lipid metabolism based on these lncRNAs by nonnegative matrix dimensionality reduction. These two expression patterns showed significant differences in disease-free survival curves for those diagnosed with prostate cancer. We found significant differences in mRNA surveillance pathway and mRNA processing between C1 and C2 groups based on the WGCNA method to explore the biological characteristics of these two expression patterns. Finally, we constructed a disease-free survival (PFS) model based on these lncRNAs. The results identified lncRNAs involved in lipid metabolism and revealed differences in their expression patterns. Additionally, the results offer candidate ideas and approaches concerning the precision treatment of prostate cancer by studying lipid metabolism by candidate long noncoding RNAs.

IntroductionPatients with heavily pretreated gynecological solid tumors have extremely limited treatment options. Lenvatinib combined therapy has efficacy in treating advanced endometrial carcinoma (including non-endometrioid), but nearly half of patients were intolerable toxicity of the recommended doses. Accordingly, we performed this pilot study to evaluate the efficacy and safety of low dose lenvatinib plus toripalimab in patients with heavily pretreated gynecological solid tumors.MethodsLenvatinib was administered with a starting dose of 8 or 12 mg orally once daily based on patient’s body weight and an intravenous infusion of toripalimab was received at a dose of 240 mg every 3 weeks. Patients received therapy for up to 24 months until disease progression or unacceptable toxicity. The primary endpoint was progression free survival (PFS).ResultsTwenty-one patients (ovarian, n=14; endometrial, n=6; vulvar, n=1), who experienced disease progression after prior median 3 lines of systemic therapy, were enrolled and treated from September 2021 to April 2023. In the 21 patients, the median PFS was 5.0 months , the median duration of response (DOR) was 5.2 months, and disease control rate(DCR) was 38.1%. The most common grade 3 treatment-related adverse events(TRAEs) were hypertension (33.3%) and proteinuria (9.5%), respectively. No grade 4 TRAEs occurred.Conclusion/ImplicationsThis study, to our knowledge, is the first to explore the effects of low-dose lenvatinib plus Toripalimab in gynecological solid tumors. The encouraging efficacy and safety of this pilot study strongly support the further investigation of low-dose Lenvatinib plus Toripalimab in patients with heavily pretreated gynecological solid tumors.

BackgroundPulmonary benign metastasizing leiomyoma (PBML) is the most common extrauterine spread of uterine leiomyoma, and its biological behavior is traditionally thought to be hormone dependent. Studies on older PBML patients have been previously reported, but limited literature has been published regarding the clinical features and treatment of PBML in young women.MethodsA total of 65 cases of PBML in women aged 45 years and younger were reviewed, including 56 cases selected from PubMed and 9 cases from our hospital. The clinical characteristics and management of these patients were analyzed.ResultsThe median age of all the patients at diagnosis was 39.0 years. PBML most commonly presented as bilateral solid lesions (60.9%), with other rare imaging manifestations. The median interval time from a pertinent gynecologic procedure to diagnosis was 6.0 years. A total of 16.7% of patients received careful observation, and all achieved stable status in a median follow-up time of 18.0 months. A total of 71.4% of patients were administered anti-estrogen therapies, including surgical castration (33.3%), gonadotropin-releasing hormone analog (23.8%) and anti-estrogen drugs (14.3%). Eight of 42 patients underwent surgical resection of metastatic lesions. Patients who underwent curative surgery for the removal of pulmonary lesions combined with adjuvant anti-estrogen therapies had favorable outcomes compared with those who only underwent surgical resection. The disease control rates of surgical castration, gonadotropin-releasing hormone analog, and anti-estrogen drugs were 85.7%, 90.0%, and 50.0%, respectively. For two patients, sirolimus (rapamycin) achieved successful relief of symptoms and control of pulmonary lesions without lowering hormone levels and causing estrogen deficiency symptoms.ConclusionsIn the absence of standard treatment guidelines for PBML, maintaining a low-estrogen environment using different kinds of antiestrogen therapies has been the mainstream strategy and has satisfying curative effects. A wait-and-see strategy might be an option, but therapeutic approaches must be contemplated when complications or symptoms progress. For PBML in young women, the negative effect on ovarian function of anti-estrogen treatment, especially surgical castration, should be considered. Sirolimus might be a new treatment option for young PBML patients, especially for those who want to preserve ovarian function.

Since the first laparoscopic radical surgery for early gastric cancer 30 years ago, there has been a gradual shift from "open" to "minimally invasive" surgery for gastric cancer. This transition is due to advancements in refined anatomy, enlarged field of view, faster recovery, and comparable oncological outcomes. Several high-quality clinical studies have demonstrated the safety and effectiveness of laparoscopy in the treatment of both early and locally advanced gastric cancer. The role of perioperative chemotherapy in managing locally advanced gastric cancer has been widely recognized, and there have been continuous breakthroughs in the exploration of targeted therapy and immunotherapy for perioperative treatment. Additionally, the application of indocyanine green near-infrared imaging technology, 3D laparoscopic technology, and robotic surgery systems has further improved the accuracy and minimally invasive nature of gastric cancer surgeries. Looking ahead, the field of minimally invasive surgery for gastric cancer is expected to become more standardized, resulting in a significant enhancement in the quality of life for gastric cancer patients.

在结直肠癌手术中,部分患者常需行回肠袢式造口预防术后吻合口漏.尽管造口还纳手术相对简单,但并发症仍难以避免.近年来,腹腔镜技术因其手术创伤小,术后恢复快与并发症少等优点,逐渐应用在造口还纳手术中,并取得了令人满意的疗效.本综述就腹腔镜技术在造口还纳手术中的作用进行分析,并进一步探讨完全腹腔镜技术的应用潜力,以期为腹腔镜造口还纳技术的临床应用提供新思考.