Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration.

Introduction: In early-stage epithelial ovarian cancer (EOC), how to perform lymphadenectomy to avoid stage migration and achieve reliable targeted excision has not been explored in depth. This study comprehensively considered the stage migration and survival to determine appropriate numbers of examined lymph node (ELN) for early-stage EOC and high-grade serous ovarian cancer (HGSOC). Methods: From the Surveillance, Epidemiology, and End Results database, we obtained 10372 EOC cases with stage T1M0 and ELN ≥ 2, including 2849 HGSOC cases. Generalized linear models with multivariable adjustment were used to analyze associations between ELN numbers and lymph node stage migration, survival and positive lymph node (PLN). LOESS regression characterized dynamic trends of above associations followed by Chow test to determine structural breakpoints of ELN numbers. Survival curves were plotted using Kaplan-Meier method. Results: More ELNs were associated with more node-positive diseases, more PLNs and better prognosis. ELN structural breakpoints were different in subgroups of early-stage EOC, which for node stage migration or PLN were more than those for improving outcomes. The meaning of ELN structural breakpoint varied with its location and the morphology of LOESS curve. To avoid stage migration, the optimal ELN for early-stage EOC was 29 and the minimal ELN for HGSOC was 24. For better survival, appropriate ELN number were 13 and 8 respectively. More ELNs explained better prognosis only at a certain range. Discussion: Neither too many nor too few numbers of ELN were ideal for early-stage EOC and HGSOC. Excision with appropriate numbers of lymph node draining the affected ovary may be more reasonable than traditional sentinel lymph node resection and systematic lymphadenectomy.

Changes in inflammatory factors, oxidative stress, glucose and lipid metabolism, and insulin resistance in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a common disease in women, affecting women's menstruation and significantly impacting women's physical and mental health. Studies have shown that insulin resistance has an important relationship with polycystic ovary. It is of great significance to explore the changes of inflammatory factors, oxidative stress, glucose and lipid metabolism, and insulin resistance in patients with PCOS. In the study process, 642 polycystic ovary patients in the first half of 2019 were divided into insulin resistance (n=357) and non-insulin resistance (n=285) groups. Oxidative stress index, glucose, and lipid metabolism index, and inflammatory factors were detected during the study process. The results showed that the levels of hs-CRP, TNF- α, and IL-6 in the IR group were 5.9mg/L, 9.2µg/L, and 87.2ng /ml, while those in the non-IR group were 4.6mg/L, 6.3µg/L and 51.5ng/ml, respectively. Thus, IL-6 and insulin levels maintain a dynamic balance. Low levels of IL-6 can promote insulin secretion, while high levels can inhibit its secretion. The results of this study will provide a specific clinical reference value for the prevention and treatment of polycystic ovary syndrome.

Development and identification of a prognostic nomogram model for patients with mixed cell adenocarcinoma of the ovary.

BACKGROUND: Mixed cell ovarian adenocarcinoma (MCOA) is a malignant gynecologic tumor consisting of serous, mucous, and papillary tumor cells. However, the clinical features and prognosis of MCOA patients are unclear. METHODS: In this study, univariate and multivariate Cox proportional risk models were performed to identify independent prognostic factors. The Kaplan-Meier method was used to assess the relationship between clinical characteristics and patient survival. Finally, a nomogram was constructed and validated to predict patient survival time, and the C-index was used to evaluate the efficacy of the nomogram. RESULTS: A total of 2,818 patients diagnosed with MCOA were identified, and the 5-year survival rate was 62%. Univariate and multivariate Cox models suggested that age (HR=1.28, 95% CI[1.15,1.44]), grade (HR=1.26, 95% CI[1.12,1.41]), SEER stage (HR=1.63, 95% CI[1.25,2.13]) and AJCC (American Joint Committee on Cancer) stage (HR=1.59, 95% CI[1.36,1.86]) were independent prognostic factors for MCOA patients. After propensity score matching for age, grade, SEER stage, and AJCC stage, the 5-year survival rate was 69.7% for ovarian serous cystadenocarcinoma and 62.9% for ovarian papillary serous cystadenocarcinoma. These results mean that serous adenocarcinoma had the best prognosis of the three pathologic types of ovarian carcinoma (p<0.0001), with no significant difference between papillary serous cystadenocarcinoma and MCOA (p=0.712). Finally, a nomogram consisting of age, grade, SEER stage, and AJCC stage was established and validated to predict the survival time, with C-indices of 0.743 and 0.731, respectively. CONCLUSIONS: In summary, MCOA is uncommon, and age, grade, SEER stage, and AJCC stage are independent prognostic factors. Compared with other common malignant ovarian tumors, MCOA has a poor prognosis.