To the Editor: Endometrial cancer (EC) is the sixth most common cancer diagnosed in women, and its prevalence is reportedly increasing worldwide. Endometrial clear cell carcinoma (ECCC) accounts for 2–5% of all EC, and is a rare but ominous subtype of high-risk EC that has a poorer prognosis and exhibits greater chemoresistance. Owing to the rarity of ECCC, few clinical trials have included patients with this disease exclusively, and limited data are available regarding its pathogenesis and clinical progression compared with other more common subtypes of EC. Venous thromboembolism (VTE) has been known to be associated with underlying visceral malignancy since the 19th century, and has been observed at greater incidence rates in patients with cancer. Meanwhile, deep vein thrombosis (DVT) is a significant complication during gynecologic cancer surgery given that the embolus can cause life-threatening conditions, such as pulmonary embolism (PE) and acute cerebral infarction. The potential impact of VTE on survival remains largely unknown with respect to people with ECCC. Therefore, we conducted this retrospective study to investigate the characteristics of patients with ECCC and determine whether VTE has an impact on survival outcomes. Patients with ECCC who underwent primary surgical staging at Peking Union Medical College Hospital (PUMCH) were retrieved, and the study was approved by the Institutional Ethics Review Committee of PUMCH (No. K23C0468), with waived consent as retrospective study. The inclusion criteria were patients with a pathological confirmation of ECCC who underwent primary staging surgery. Electronic medical records of all patients were collected and reviewed. Patients who received post-recurrence treatment without centralized pathology review were excluded. Perioperative VTE was defined as the development of VTE within 30 days pre- or post-surgery. All pathology slides were centralized and assessed by the Pathology Department of PUMCH using the World Health Organization criteria, and miscellaneous carcinoma was defined as one or more pathological entities accompanying the clear cell carcinoma (CCC). The progression-free survival (PFS) was calculated as the interval in months between the date of the primary surgery and that of the detection of any progression or recurrence, including via biopsy pathology or imaging with or without elevated serum CA-125. Overall survival (OS) was calculated as the interval in months between the date of primary surgery and the date of death. Patients lost to follow-up were right-censored. Mann–Whitney, Pearson, and Fisher's exact χ2 (two-tailed) tests were performed for intergroup comparisons. Kaplan–Meier survival curves were analyzed according to VTE status and stage, and the log-rank test was applied to quantify survival differences. Univariate and multivariate Cox regression analyses were conducted on the variates including VTE status, age, comorbidities, stage, surgical completeness, adjuvant therapies, lymphovascular space invasion (LVSI), deep myometrial invasion (DMI), parametrial involvement (PI), and histology; the hazard ratios (HRs) were calculated with 95% confidence intervals (CIs). All statistical analyses were performed using SPSS version 20 (IBM Corp, Armonk, NY, USA); the threshold of statistical significance was set at P <0.05. The records of 137 patients who underwent primary surgery between November 2009 and April 2022 following a histological diagnosis of ECCC were retrieved. The median age at diagnosis and primary surgery was 61 years (range, 31–82 years). Majority had stage I (56.2%, 77/137) or stage III (25.5%, 35/137) ECCC. Among patients with advanced stages, suboptimal cytoreductive surgery was performed in 4 who had a residual mass >1 cm. During the surveillance, the majority of patients received monotherapy or combined adjuvant therapies after primary surgery: 65 patients received mono-adjuvant therapy (either chemotherapy [41.6%, 57/137] or radiotherapy [5.8%, 8/137]); 51 patients (37.2%) were managed by combination chemoradiotherapy; No adjuvant therapy was administered for 15.3% (21/137) of the patients. Patients were screened for VTE under the physician's guidance with or without indications, including elevated d-dimer level, swelling or pain in the lower extremities, or hypoxemia. A total of 22 patients (16.1%) were diagnosed with perioperative VTE during primary treatment. In patients screened positively with VTE, 9 patients were positive for DVT preoperatively; 2 of them were simultaneously diagnosed with PE; 13 patients (including 8 with DVT) had newly diagnosed VTE after surgery; 1 had an isolated PE; and 4 had concomitant DVT and PE [Supplementary Table 1, https://links.lww.com/CM9/B827]. The basic characteristics and prognoses of patients in these two groups were compared [Supplementary Table 2, https://links.lww.com/CM9/B827]. A significantly higher percentage of LVSI was observed in patients with VTE (P = 0.033); however, no significant differences were detected in other parameters. There were no fatalities caused directly by VTE-related complications in our study. Not counting one patient who was lost to follow-up during the first month, the median follow-up time was 49.9 months and ranged from 6.8 months to 146.5 months. The median PFS for the entire cohort was 42.3 months (95% CI, 44.9–58.7). Patients with perioperative VTE had a shorter median PFS than those without (13.3 months vs. 47.3 months, P = 0.001) [Figure 1A]. The median OS in the overall population was 49.2 months (95% CI, 50.6–63.6), and consistent with PFS, the median OS of patients with VTE was significantly shorter than that in patients without (19.8 months vs. 57.0 months, P = 0.008) [Figure 1B]. When stratified according to disease stage, significant differences in survival were only observed in the early stages. The median PFS of patients with stage I/II disease was 63.2 months (95% CI, 59.9–76.9) in the non-VTE population vs. 17.1 months (95% CI, 13.0–48.0) in those with perioperative VTE (P = 0.047) [Figure 1C]. Furthermore, the median OS was 65.3 months (95% CI, 62.3–78.7) vs. 23.1 months (95% CI, 17.9–50.5), respectively, in this subgroup (P = 0.001) [Figure 1D]. As shown in Figure 1, a more marked difference in OS was observed when the analysis was limited to patients with stage I/II ECCC (Figure 1Bvs.Figure 1D).Figure 1: Kaplan–Meier survival curves comparing patients with ECCC who experienced perioperative VTE to those who did not. (A) PFS in patients with all disease stages, (B) OS in patients with all disease stages, (C) PFS among patients with stage I/II ECCC, (D) OS among patients with stage I/II ECCC, ECCC: Endometrial clear cell carcinoma; OS: Overall survival; PFS: Progression-free survival; VTE: Venous thromboembolism.On univariate analysis, patients with perioperative VTE had a 3.3-fold increase in the risk of tumor progression (HR, 3.3; 95% CI, 1.6–7.0; P = 0.002) and a 3.3-fold increase in the risk of death (HR, 3.3; 95% CI, 1.3–8.5; P = 0.012) overall. After controlling for known survival-related factors, we used multivariate Cox regression analysis and found that VTE status, age at diagnosis, comorbidities, tumor stage, and gross residual disease were independently associated with tumor progression and death, whereas adjuvant therapy, LVSI, DMI, or tumor histology did not significantly influence survival. Compared with the non-VTE group (all stages), increases of 7.1-fold (95% CI, 2.1–23.7; P = 0.001) and 4.0-fold (95% CI, 1.7–9.3; P = 0.002) were found in the risk of death and disease progression in the perioperative VTE group, respectively. Additionally, a more marked increase in the risk of death was observed when the analysis was limited to patients with early-stage disease (HR, 24.9; 95% CI, 1.6–382.0) (Supplementary Table 3, https://links.lww.com/CM9/B827 for all stages and Supplementary Table 4, https://links.lww.com/CM9/B827 for stage I/II). In the present study, 16.1% of the patients received perioperative VTE during primary treatment. LVSI and other well-known survival risk factors were included in our regression analyses, and perioperative VTE, age ≥60 years, advanced-stage disease, and suboptimal cytoreductive surgery were independently associated with worse survival outcomes in the overall cohort. Perioperative VTE during primary treatment was linked to shorter PFS and OS without being a direct cause of death. When stratified according to tumor stage, VTE diagnosis at primary surgery remained an independent risk factor for survival in patients with stage I/II disease. A remarkably lower incidence rate of VTE was reported in a retrospective study of 422 patients with EC of all types (6.16% overall and 0.7% within 60 days post-surgery),[1] suggesting that the ECCC tumor biology may specifically play a role in thrombogenesis. In the present study. Perioperative VTE and other factors without LVSI were independently associated with worse survival outcomes in the cohort overall. Patients without VTE experienced longer PFS and OS than those with the condition, whether overall or in the early-stage population alone. A similar phenomenon was observed in patients with OCCC, wherein Diaz et al[2] observed a difference in survival rates among patients with early-stages disease. A potential explanation could be that the increased tumor burden and compromised health status of individuals with advanced-stage CCC may supersede the negative impact of VTE on survival. The relationship between VTE and survival outcomes in patients with EC was first described by Matsuo et al[3], who concluded that VTE could be regarded as a surrogate for EC aggressiveness; however, only 25 of 516 patients with clear cell histology (4.9%) were included in their analyses. Several cancer-specific mechanisms that may contribute to thrombogenesis have been proposed, including leucocytosis, thrombocytosis, increased levels of tissue factor (TF)-positive microvesicles and hypofibrinolysis.[4] The expression of TF (a transmembrane receptor with potent pro-coagulant function) by activating the extrinsic coagulation cascade pathway has been detected in certain cancerous tissues.[5] There is only limited evidence regarding the potential mechanism of cancer-related thrombosis in the field of endometrial carcinoma; hence, further studies are required to understand the etiology of thrombogenesis in this population. It was previously proposed that VTE itself might contribute to tumor invasion and metastasis, as elevated levels of preoperative serum TF have been positively correlated with death from ovarian cancer. Nevertheless, the tumor-type specific mechanism underlying the association between VTE and poor survival in ECCC remains to be elucidated. We found no significant association between adjuvant therapy and survival in our study, which was in contrast to data from Cetinkaya et al's study.[6] Adjuvant therapies for ECCC were highly individualized in our research, which could potentially lead to compromised anti-tumor efficiency. Studies involving larger cohorts ought to elucidate the value of adjuvant therapies in patients with ECCC. Given the limited information on ECCC, a rare disease, ours is one of the few studies to investigate the influence of perioperative VTE status on survival using a relatively large cohort from a single institution. Patients with no VTE were found to have significantly longer PFS and OS, and VTE at the time of primary surgery was found to be an independent predictor of disease progression and death. These results further emphasize the importance of preoperative screening and postoperative surveillance for DVT in patients with cancer, as well as better awareness of its potentially negative impact on survival, especially in patients with CCC. Given that our study was limited by its retrospective nature and by the fact that the analysis was correlative, we were unable to extract certain details regarding molecular subtypes or anticoagulant management, which would have strengthened the data derived from our multivariate models. Prospective studies and in vitro assays may further validate our findings and improve our understanding of the relevant mechanisms. In summary, we found that 16.1% of patients with ECCC developed VTE perioperatively regardless of tumor stage. Perioperative VTE at primary surgery was independently associated with a significantly higher risk of cancer recurrence and death, although the greater risk of death was not directly caused by the VTE itself. Funding This study was supported by the National High Level Hospital Clinical Research Funding (No. 2022-PUMCH-B-083), the Capital's Funds for Health Improvement and Research (No. 2022-1-4011), and the National Natural Science Foundation of China (NSFC) (No. 82271886). Conflicts of interest None.

e17573 Background: Homologous recombination deficiency (HRD) testing has been approved by FDA for selecting epithelial ovarian cancer (EOC) patients who may benefit from the first-line poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance therapy. However, the effects of HRD on the clinical outcomes of first-line chemotherapy and first-line PARPi maintenance therapy have not been rigorously evaluated in Chinese EOC patients. Methods: We developed a customized sequencing panel named “Precision Human HRD Assay”.This HRD assay contains two sets of probes, HRD-score probes (~50K) and DDR-gene probes, which were used to evaluate HRD score and genotype 36 DDR genes. Then we applied it to two large Chinese EOC patient cohorts and performed a retrospective analysis of progression-free survival (PFS) and overall survival (OS) estimated using the Kaplan-Meier method. Results: In the first-line adjuvant chemotherapy cohort (FACT, N = 380), HRD status significantly improved PFS (median, 15.6 months vs. 9.4 months; HR, 0.688; 95% CI, 0.526 to 0.899; P = 0.003) and OS (median, 89.5 months vs. 60.9 months; HR, 0.636; 95% CI, 0.423 to 0.955; P = 0.008). In the first-line PARPi maintenance therapy cohort (FPMT, N = 83), HRD status significantly improved PFS (median, NA vs 12 months; HR, 0.438; 95% CI, 0.201 to 0.957; P = 0.033) and OS (median, NA vs NA months; HR, 0.12; 95% CI, 0.029 to 0.505; P = 0.001). Conclusions: Our results demonstrate that HRD status is a significant predictor for PFS and OS in both first-line chemotherapy and first-line PARPi maintenance therapy, providing strong real-world evidence for conducting genetic testing and improving clinical recommendations for Chinese EOC patients.

A 24-year-old patient accepted laparoscopic radical trachelectomy for stage IB1 cervical squamous cell carcinoma. During the surgery([Figure 1][1]), after resection of the deep uterine vein (V) and its branches by the right parametrium, the parasympathetic pelvic visceral nerves originating from

Abstract Background: Target sequencing of epithelial ovarian cancer (EOC) has been widely used in clinical to detect the status of BRCA1/2 and genes in homologous recombination repair (HRR) pathway. But there still lacks of systematic evaluation of HRR related gene mutation effect on clinical outcome. Methods: Totally 230 EOC patient is recruited and received OseqT panel sequencing including 12 HRR related genes, 5 mismatch repair related genes and 8 ovarian cancer related genes. All the patients received platinum-based chemotherapy. 25 of them received PARP inhibitor therapy. Their responses to the therapy, OS and PFS were collected for analysis. Results: We found that BRCA2 and BRCA1/2 mutation carriers (somatic and germline) had longer OS (p value: 0.016 and 0.028) and PFS (p value: 0.002, 0.006) than non-carriers, PTEN and MSH2 germline mutation carriers had longer PFS (p value: 0.038, 0.049) than non-carries. When we compared germline pathogenic carriers and non-pathogenic carriers on OS and PFS, there is significant difference in PALB2 (p value: 0.036, 0.015) and STK11 (0.001, 0.018), BRCA1 mutation did not affect survival time in both OS and PFS. Then we observed the response to platinum-based chemotherapy. We found that the carriers of germline pathogenic variants in BRCA1, BRCA1/2 and HRR related genes were significant related with better response (p value: 0.16, 0.042 and 0.048), If we combined germline and somatic pathogenic variants together, the p value of BRCA1, BRCA1/2 and HRR related genes were changed to 0.001, 0.009 and 0.001. Somatic status of those gene alone had no relationship with chemotherapy response.In the patients received treatment of PARP inhibitor Niraparib, carriers of germline and somatic pathogenic variant in BRCA1 and BRCA1/2 were more sensitive to Niraparib (p value: 0.18, 0.008), There was only 1 BRCA2 pathogenic carrier and no other HRR related gene pathogenic carrier in 25 patients. So, the sensitivity of BRCA2 and HRR-related gene mutation carriers were not calculated. Conclusions: In our cohort, BRCA2 and BRCA1/2 mutation carriers had longer OS and PFS than non-carriers. PTEN, MSH2, PALB2 and STK11 mutation status also had relationship with survival in some circumstances, BRCA1, BRCA1/2 and HRR-related genes could all be used to predict drug sensitivity, germline and somatic variant should be combined used to reach better performance. Citation Format: Lei Li, Kang Shao, Jianwei Zhang, Meng Liu, Kui Wu, Ming Wu. Evaluation of homologous recombination repair related gene mutation on survival and drug response in Chinese epithelial ovarian cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 659.

Study designRetrospective cohort study.IntroductionDebates remain regarding the role of lymphadenectomy in patients with apparent stage IA endometrial cancer, especially subtypes with a favorable prognosis. This study aimed to explore the prognostic value of staging surgeries in apparent stage IA endometrial endometrioid cancer patients in a retrospective cohort study.MethodsCases from June 1, 2010 to June 1, 2017 were reviewed in patients with pathologically confirmed endometrial endometrioid carcinoma limited to <1/2 of the myometrium, without extrauterine metastasis on preoperative evaluation and during surgical inspection. Survival outcomes were compared between patients with and without lymphadenectomy and between patients with and without metastasis to lymph nodes.ResultsIn total, 1,312 eligible patients were included, among which 836 underwent staging surgeries and 476 underwent simple hysterectomy. Twenty-eight patients were found with metastasis to retroperitoneal lymph nodes. After a median follow-up of 57.4 months, lost to follow-up, recurrence, death, and cancer-specific death occurred in 28, 39, 24, and 16 patients, respectively. In a univariate analysis, lymphadenectomy of the pelvis with or without para-aortic lymph nodes had no significant impact on disease-free survival, overall survival or cancer-specific overall survival (p values >0.05). However, after adjusting for important baseline risk factors [menopausal status, tumor differentiation, maximum diameter and location, lymph-vascular space invasion (LVSI) status, and postoperative adjuvant therapy), lymphadenectomy resulted in significantly improved survival outcomes (p values <0.05). Menopause (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.3–16.4, p=0.015), tumor diameter larger than 2 cm (OR 4.6, 95% CI 1.3–16.0, p=0.016), grade 3 tumors (OR 3.0, 95% CI 1.0–8.5, p=0.042), positive LVSI (OR 8.7, 95% CI 3.7–20.4, p<0.001) and lower uterine segment involvement (OR 3.1, 95% CI 1.4–7.2, p=0.007) had more extrauterine metastases.ConclusionIn cases of apparent stage IA endometrioid endometrial carcinoma, staging surgeries should be considered in patients with larger, higher grade tumors, positive LVSI, or lower uterine segment involvement.

e18088 Background: Insight on the germline and somatic mutation in BRCA1/2 was predictable on the sensitivity on platinum-based therapy. The therapeutic impact of mutations in other hereditary breast and ovarian cancer related genes is uncertain. Methods: We sought to investigate the germline and somatic deleterious mutations through all exons in 25 hereditary breast and ovarian cancer related genes in paired blood and frozen tumor samples from 235 Chinese women diagnosed with epithelial ovarian carcinomas. Results: Forty-seven subjects (24.6%) had a germline deleterious mutation, and 126 subjects (66%) had a somatic deleterious mutation. Thirty-four (17.8%) had both a germline and somatic mutation. Of the 203 germline and somatic deleterious mutations, 114 (56.2%) occurred in TP53, 41 (20.2%) in BRCA1, 11 (5.4%) in BRCA2 and 37 (23.6%) in 13 other genes: ATM, BARD1, BRIP1, CDH1, CHEK2, MLH1, MRE11A, MSH2, NF1, PALB2, PTEN, RAD51C and, STK11. In 235 patients, 215 (91.5%) and 20 (8.5%) cases were sensitive and resistant to the platinum-based chemotherapy. In the whole population, homologous recombination repair (HRR) mutations, non- homologous recombination repair(non-HRR) mutations, mismatch repair (MMR) mutations had no impact on the platinum-based chemotherapy response. No significant difference in platinum response were found in HRR, non-HRR and MRR mutation(P = 0.788). In 235 patients, ones with ATM (10), CHEK2(9), NF1(5), PALB2(8), PTEN (8) mutations were available for platinum response information; Among them, there were three patients with either ATM, CHEK2 or PALB2 mutation presented platinum resistance. Conclusions: Multi-gene panel testing of germline and somatic HBOC related gene mutations was feasible to characterize a comprehensive molecular profile of ovarian cancer and showed non-BRCA gene stratification potential value in predicting patient’s response for platinum-based chemotherapy.

OBJECTIVE:To explore the clinicopathologic features, managements and outcomes of villoglandular adenocarcinoma (VA) of uterine cervix.METHODS:From June 2009 to January 2014, a total of 16 cases of VA were reviewed retrospectively.RESULTS:Their mean age was 41.4 (30-56) years. The major symptoms were post-coital hemorrhage or abnormal vaginal hemorrhage (10/16). And the International Federation of Gynecology and Obstetrics (FIGO) stages were Ia1 (n = 1),Ib1 (n = 12),Ib2 (n = 2) and IIa1 (n = 1).One patient of Ia1 stage underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy (BSO) after conization; one patient of Ib1 stage total abdominal hysterectomy and BSO after radiotherapy and concurrent chemotherapy while another one of Ib1 stage radical vaginal trachelectomy; one pregnancy-associated patient of Ib1 stage was diagnosed at 12 weeks' gestation and underwent cesarean radical hysterectomy plus pelvic lymphadenectomy after four courses of chemotherapy. Aand the remainder underwent radical hysterectomy plus pelvic lymphadenectomy.None of 14 cases with a known status of lymph node status had positive nodes. And 1/13 cases undergoing ovariectomy had pathologically confirmed cervical cancer metastasis of ovarian surface and the remainder and another patient of ovarian biopsy had negative results for lymph nodes. The median follow-up period was 23.3 (5-60) months. All patients survived and there was one recurrent case of vaginal stump mass at 8 months after initial surgery. The overall and disease-free 5-year survival was 100% and 94% (15/16) respectively.CONCLUSION:VA mainly affects younger women and prognosis is generally fair with a lower rate of ovarian metastasis compared to common forms of cervical cancer. Due to a limited sample size and clinical data are studied retrospectively, multi-center prospective studies are warranted for a better understand of this disease.

Objective The aim of the study reported here was to investigate the protective effect of gonadotropin-releasing hormone analog (GnRHa) against cyclophosphamide (CTX)-induced gonadotoxicity. Methods Eighty Fischer 344 rats were divided randomly into four groups (20 per group). One group received normal saline, one GnRHa, one CTX, and one GnRHa+CTX. Several parameters were used to observe the ovarian reserve, including ovary weight, follicle number and diameter, concentrations of estradiol (E2) and follicle-stimulating hormone (FSH), and expressions of sex hormone receptors. Results When treatment was finished, the number of small follicles in the GnRHa+CTX group was significantly higher than in the CTX-alone group. Thirty days after treatment, the ovary weight, percentage of small follicles, mean follicular diameter, and serum concentrations of E2 and FSH in the GnRHa+CTX group all recovered, approaching normal levels. Sex hormone receptors did not show significant differences between the four groups. Conclusion Combination treatment with GnRHa could prevent CTX-induced damage to ovarian reserve.

OBJECTIVE:To explorer the diagnostic rationales for primary pelvic retroperitoneal tumors and summarize their clinical characteristics and treatments.METHODS:The clinicopathological data of total of 36 patients with primary pelvic retroperitoneal tumor, who visited Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences because of pelvic mass from January 1986 and September 2013 were analysed retrospectively. And their clinical manifestations, accessory examination, surgical findings, postoperative pathological results and prognosis were summarized.RESULTS:Among the 36 patients, twenty-nine cases were treated by gynecology department firstly, 7 cases were treated by surgical department firstly. Only 7 cases complained abdominal expanding while others had no uncomfortable complains before the discovery of the tumor. Among 27 cases who took color Doppler ultrasonography examination, only 3 cases reminded that the tumors might come from the pelvic retroperitoneal space. CT and MRI results were respectively 6/16 and 3/6, that the tumor might come from the pelvic retroperitoneal space. The level of CA125 of 18 cases were tested before the surgery: 17 out of 18 cases were normal or elevated lightly. The tumors of 8 cases were excised incompletely because of the blood vessels around the tumors and the close relationship between the tumors and the pelvic wall, while other's were excised completely. Among the 25 cases that had operation at the gynecological department, ten cases underwent operations collaboratively with surgical department; two cases had complications of urinary system injures. Postoperative pathological examinations revealed there were 28 cases (78%, 28/36)with benign lesions including 11 schwannoma, 6 leiomyoma, 3 teratoma, 1 lymphangioleiomyoma, 1 neurofibroma, 1 paraganglioma, 2 fibromatosis, 1 aggressive angiomyxoma, 1 mucinous cystadenoma and 1 solitary fibrous tumor; and 8 cases(22% , 8/36)with malignant lesions including 3 leiomyosarcoma, 2 liposarcoma, 2 adenocarcinoma and 1 squamous carcinoma. During the follow-up period, 28 cases whose tumors were excised completely had no recurrence. While, 3 out of 8 cases excised incompletely recurred.CONCLUSIONS:Primary pelvic retroperitoneal tumors have no typical manifestations, CT and MRI are more accurate. Surgery is a key for retroperitoneal tumors. Considering the complexity of the anatomy of the pelvic retroperitoneal space and the resulted difficulties of the surgeries, multidisiciplinary cooperation is needed and important.

To explore clinicopathologic/prognostic aspects of pseudomyxoma peritonei (PMP).

OBJECTIVE:To determine the clinicopathological characteristics of borderline ovarian tumors and to evaluate their prognostic factors and pregnancy rates/fertility outcomes after conservative surgery.METHODS:A total of 186 patients with borderline ovarian tumors receiving treatment at our hospital from 1990 to 2007 were retrospectively studied and followed-up post-operatively for at least six months. The effects of clinicopathological characteristics upon recurrence and mortality were analyzed by independent sample t test, Chi-square test, Kaplan-Meier and Cox proportional hazard model.RESULTS:The median follow-up time was 44 months. One hundred and nine patients underwent conservative surgery and 77 patients underwent radical surgery. Thirty-one relapses were reported. Only 3 died of disease. As demonstrated by multivariate analysis, surgical procedure, stage and pseudomyxoma peritonei were the independent prognostic factors for recurrence.CONCLUSION:The recurrence rate of conservative surgery is higher than that of radical surgery. However, conservative surgery is safe as it does not result in a higher mortality rate.

OBJECTIVE:To analyze the clinical characters, treatment and prognosis of primary malignant tumor in vagina.METHODS:A retrospective analysis of 42 patients diagnosed with primary malignant tumor in vagina in Peking Union Medical College Hospital (PUMCH) between Jan 1984 and Aug 2006 was performed.RESULTS:Primary malignant tumor accounted for 0.98% (42/4286) in the total gynecological malignant tumors during that period in PUMCH. According to the International Federation of Gynecology and Obstetrics (FIGO) staging system, 19 cases were at stage I, 12 cases at stage II, 5 cases at stage III, and 6 cases at stage IV. Thirteen cases were squamous carcinoma, 13 cases were malignant melanoma, 8 cases were adenocarcinoma, 3 cases were yolk sac tumor and 5 cases were other types. The majority of patients were treated with surgery combined with radiotherapy and chemotherapy. Up to August 2007, 19 cases survived, 18 cases were dead and 5 cases were lost. The longest follow up was 10 years, with the median time of 2 years. The overall 2-year survival rate was 60.6%. For stage I, stage II and stage III - IV, the 2-year survival rates were 71.3%, 58.3% and 29.6% respectively. The 2-year survival rate of patients with squamous carcinoma was 46.8%, malignant melanoma 72.9%, adenocarcinoma 20.0% and patients with yolk sac tumor were all alive tumor-free after 6 - 10 years' follow up.CONCLUSIONS:The prognosis of primary malignant tumor in vagina is affected by clinical stage and histological type. As to malignant melanoma, radical surgery combined with chemotherapy and immunotherapy produce good effects. Patients with yolk sac tumor can be cured only with chemotherapy. As to other types, more treatment experiences are needed.

OBJECTIVE To analyze the correlation of preoperative serum vascular endothelial growth factor (VEGF) level with serum CA125 level in patients with epithelial ovarian cancer (EOC), and to evaluate the prognostic value of preoperative serum VEGF in these patients. METHODS Forty-one patients with EOC were included as study group, while 20 healthy women were selected as control group. Enzyme-linked immunosorbent assay (ELISA) and chemiluminescence assay were used to measure serum VEGF and CA125 level respectively. The correlations of serum VEGF with CA125 level, postoperative recurrence rate and survival time were analyzed retrospectively. RESULTS Serum VEGF levels in patients with EOC were higher than those in healthy women, with the median of 415 and 165 ng/L, range 110-2120 and 100-735 ng/L respectively (P<0.01). No correlation was found between preoperative serum VEGF and CA125 level (Spearman test, P=0.989). High preoperative serum VEGF was positively correlated with postoperative recurrence. Serum VEGF level in patients with postoperative recurrence was higher than that in patients without recurrence, with the median of 490 and 315 ng/L respectively (P=0.035). Univariate analysis showed that higher serum level was reversely correlated with shorter survival. Median overall survival time in patients with higher serum VEGF level and lower serum VEGF level was 18 months and >35 months respectively (P=0.010). Multivariate Cox model analysis showed that high VEGF level was an independent factor for the prognosis of EOC (P=0.042). CONCLUSION Preoperative serum VEGF level is not correlated with CA125 concentration in patients with EOC, and it is an independent risk factor for prognosis.

BACKGROUND & OBJECTIVE:Recurrent ovarian cancer is associated with a poor prognosis, and optimal management for this problem is not well defined. The purpose of the study was to evaluate treatment opportunity for patients with recurrent ovarian cancer. METHODS:Fifty-four cases of recurrent ovarian cancer during 1990 to 2000 were randomly selected to compare the effect of treatment opportunity on the outcome. All the clinical data related to the recurrent ovarian cancer were collected. The difference in survival was calculated by the Cox model. RESULTS:The multivariate analysis showed that the platinum-free-interval >6 months and the surgery followed salvage chemotherapy were associated with a significant prolongation of survival for the patients with recurrent ovarian cancer(P< 0.05). The odds ratio was 0.389 for the patients whose platinum-free-interval was more than 6 months as compared to that of the platinum-free-interval < 6 months. The OR was 4.194 for the patients who were only with salvage chemotherapy as compared to that with surgery followed salvage chemotherapy. The numbers of chemotherapy cycles may offer some effect on the survival (P=0.07). The odds ratio(OR) was 0.346 for the patients whose chemotherapy cycles were more than 10 as compared to that of chemotherapy cycles < 6. The timing of the beginning of the retreatment and chemotherapy regiments were failed to demonstrate an improvement in survival(P >0.05). CONCLUSION:The treatment opportunity for patients with recurrent ovarian cancer is depend on the platinum-free-interval of the patients. A strategy of secondary surgical cytoreduction followed salvage chemotherapy is suggested for the patients whose platinum-free-interval >6 months. The goal of the treatment for platinum-resistant patients is to improve the quality of life.

OBJECTIVE:To determine the influence of different surgical procedure on post-operative survival rate and recurrence of stage I endometrial carcinoma.METHODS:From 1986 to 1996, 110 patients with stage I endometrial carcinoma surgically treated in our hospital were studied retrospectively. They were divided into three groups, including total hysterectomy plus bilateral salpingo-oophorectomy (group A), radical or modified radical hysterectomy (group B) and total hysterectomy plus bilateral salpingo-oophorectomy or radical hysterectomy or modified radical hysterectomy + pelvic lymphadenectomy (group C). Survival and recurrent rates were analysed according to the follow-up data.RESULTS:Five-year survival rate of the three groups are 89.5%, 90.5% and 95.1% respectively (P > 0.05). Of the 71 cases followed up for more than two years, 9 relapsed. The recurrent rates were 12.7%. Seven relapsed within three years after operation. Eight patients had local recurrence and 5 had distant metastasis. Recurrent rates of three groups are 13.9%, 9.1% and 12.5% (P > 0.05), local recurrent rates are 13.9%, 9.1% and 8.3% (P > 0.05), distant metastasis rates are 2.8%, 9.1% and 12.5% respectively (P > 0.05) with no statistical significance.CONCLUSIONS:Surgical method is not the main factor influenced the survive of stage I endometrial carcinoma. Radical operation or lymphadenectomy will not increase the survival rate of stage I endometrial carcinoma significantly. The purpose of such operation is to find out the exact stage and the possible prognosis. Distant metastasis is remarkable, and should be considered in the adjuvant therapy.

OBJECTIVE:To investigate the efficiency of positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose ((18)FDG) for detecting recurrent epithelial ovarian carcinoma.METHODS:Fifteen (18)FDG-PET scanning were performed on 13 patients, who was clinically free of disease after optimal cytoreductive surgery and sufficient chemotherapy, with suspicion of recurrence. Ten second-look or re-debulking operation were given after PET scanning.RESULTS:In all 8 cases with and 1 without elevated serum CA(125), PET demonstrated sites of increased (18)FDG uptake, which correlated well with surgical-pathologic findings (100%). Computed tomography scan and B ultrasonography each detected 1 recurrence. One of the 6 patients with negative PET scan results underwent a second-look operation, which found no malignancy. The other 5 were closely followed up for 11 to 13 months. No sign of recurrence was noticed within 8 months. One patient received her second PET scanning after the serum CA(125) began to elevate in the 9th month. Recurrent tumor was found by the second PET scan and confirmed by the operation after that.CONCLUSIONS:PET is accurate in detecting the recurrent epithelial ovarian carcinoma. As a non-invasive method, PET might be a fairly effective tool for monitoring and locating the recurrence of ovarian carcinoma.

AIM:To evaluate the potential of RA-538 gene therapy for gastric carcinoma.METHODS:Human gastric carcinoma cell line SGC7901 treated with Ad-RA538 or Ad-LacZ were analysed by X-gal stain, MTT, DNA ladder, Tunel, flow cytometric analysis, PCR, and Western Blot in vitro. The tumorigenicity and experimental therapy in nude mice model were assessed in vivo.RESULTS:Ad-LacZ could efficiently transfer the LacZ gene into SGC7901 cells. X-gal-positive cells at MOI 25, 50, 100, and 200 were 90%, 100%, 100%, and 100% respectively. Ad-RA538 could strongly inhibit cell growth and induced apoptosis in SGC7901 cells.The proliferation of the Ad-RA538-infected SGC7901 cells was reduced by 76.3%.The mechanism of killing of gastric carcinoma cells by Ad-RA538 was found to be apoptosis by DNA ladder,Tunel and flow cytometric analysis.The tumorigenicity in nude mice using Ad-RA538 showed that all three mice failed to form tumor from 7 to 30 days compared with Ad-LacZ and parent SGC7901 cells. Experimental therapy on the nude mice model bearing subcutaneous tumor of SGC7901 cells showed that intratumor instillation of Ad-RA538 inhibited the growth of the tumors. Ad-RA538-treated tumors were inhibited by 60.66%, compared with that of the tumor injected with Ad-LacZ and mock.CONCLUSION: The expression of Ad RA538 can inhibit growth and induce apoptosis of gastric cancer cell in vitro and in vivo. Ad RA538 can be used potentially in gene therapy for gastric carcinoma.