Long-term outcomes of pelvic exenterations for gynecological malignancies: a single-center retrospective cohort study.

BACKGROUND: Recently, with the advancement of medical technology, the postoperative morbidity of pelvic exenteration (PE) has gradually decreased, and it has become a curative treatment option for some patients with recurrent gynecological malignancies. However, more evidence is still needed to support its efficacy. This study aimed to explore the safety and long-term survival outcome of PE and the feasibility of umbilical single-port laparoscopic PE for gynecologic malignancies in a single medical center in China. PATIENTS AND METHODS: PE for gynecological cancers except for ovarian cancer conducted by a single surgical team in Sun Yat-sen University Cancer Center between July 2014 and December 2019 were included and the data were retrospectively analyzed. RESULTS: Forty-one cases were included and median age at diagnosis was 53 years. Cervical cancer accounted for 87.8% of all cases, and most of them received prior treatment (95.1%). Sixteen procedures were performed in 2016 and before, and 25 after 2016. Three anterior PE were performed by umbilical single-site laparoscopy. The median operation time was 460 min, and the median estimated blood loss was 600 ml. There was no perioperative death. The years of the operations was significantly associated with the length of the operation time (P = 0.0018). The overall morbidity was 52.4%, while the severe complications rate was 19.0%. The most common complication was pelvic and abdominal infection. The years of surgery was also significantly associated with the occurrence of severe complication (P = 0.040). The median follow-up time was 55.8 months. The median disease-free survival (DFS) was 17.9 months, and the median overall survival (OS) was 25.3 months. The 5-year DFS was 28.5%, and the 5-year OS was 30.8%. CONCLUSION: PE is safe for patient who is selected by a multi-disciplinary treatment, and can be a curative treatment for some patients. PE demands a high level of experience from the surgical team. Umbilical single-port laparoscopy was a technically feasible approach for APE, meriting further investigation.

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial.

IMPORTANCE: There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors. OBJECTIVE: To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer. DESIGN, SETTING, AND PARTICIPANTS: After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018. INTERVENTIONS: Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively. MAIN OUTCOMES AND MEASURES: The primary end point was the rate of disease-free survival (DFS) at 3 years. RESULTS: A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00806117.

Combined score of pretreatment platelet count and CA125 level (PLT-CA125) stratified prognosis in patients with FIGO stage IV epithelial ovarian cancer.

BACKGROUND: The majority of death-related ovarian cancer is epithelial ovarian cancer (EOC). Regarding the Federation of Gynecology and Obstetrics (FIGO) stage IV EOC, the 5-year overall survival (OS) has not changed in last decades. Platelet (PLT) count and CA125 level are both prognostic markers that related to inflammation and immune evasion in EOC. This study intended to assess the prognostic value of pretreatment PLT count and CA125 level in FIGO stage IV EOC. METHODS: The study included 108 patients diagnosed with FIGO stage IV EOC and treated with surgery and/or chemotherapy between January 1995 and December 2016. The PLT counts and CA125 levels of the patients before any treatment were analysed with clinical and pathological parameters, OS and progression-free survival (PFS). The survival of different groups was analyzed using the Kaplan-Meier method. The PLT-CA125 scores (0, 1, and 2) were defined basing on the presence of thrombocytosis (PLT count > 400,000/µL), an elevated CA125 level (CA125 > 1200 U/mL), or both. The prognostic value of PLT-CA125 was assessed with a Cox regression model. RESULTS: Median OS, but not median PFS, was significantly decreased in patients with thrombocytosis or elevated CA125 levels when compared with the others (p = 0.011 & p = 0.004). The median OS was significantly decreased in patients with a PLT-CA125 score of 2 [37.8 months; 95% confidence interval (CI) 20.6-54.9] compared with patients with a PLT-CA125 score of 0 (70.0 moths, 95% CI 38.0-101.9, p < 0.001). The median PFS was also significantly decreased in patients with a PLT-CA125 score of 2 (19.6 months; 95% CI 13.0-26.3) compared with patients with a PLT-CA125 score of 0 (32.0 months; 95% CI 23.3-40.7, p = 0.011). Furthermore, multivariate analysis identified both PLT-CA125 scores of 2 and 1 as independent poor prognostic factors for OS (p = 0.004 & p < 0.001) and PFS (p = 0.033 & p = 0.017) compared with a PLT-CA125 score of 0. CONCLUSIONS: The pretreatment PLT-CA125 score can be a reliable marker with high accessibility for stratifying prognosis in patients with FIGO stage IV EOC.

SPOCD1 promotes the proliferation and metastasis of glioma cells by up-regulating PTX3.

Gliomas are the most prevalent type of primary brain tumors in adults, accounting for more than 40% of neoplasms in the central nervous system. The spen paralogue and orthologue C-terminal domain containing 1 (SPOCD1) has been recently identified and found to discriminate progressive from non-progressive bladder cancers. In this study, we detected high-level of SPOCD1 expression in glioma and its high expression significantly associated with advanced tumor grade and poor prognosis. In vitro assays showed that knockdown of SPOCD1 significantly inhibited cell proliferation and colony formation capacities in U373 and U87 cells. In a xenograft model of glioma, SPOCD1 was also found to inhibit tumor growth. In addition, knockdown of SPOCD1 was shown to inhibit cell migration and invasion in glioma U373 and U87 cells. SPOCD1 positively regulated the expression of Pentraxin 3 (PTX3), whereas overexpression of PTX3 attenuated SPOCD1 knockdown-mediated inhibition of cell proliferation, migration and invasion in glioma cells. Our observations suggest that SPOCD1 promotes the proliferation and metastasis of glioma cells through regulating PTX3. Our data might provide novel evidence for the diagnosis and treatment of glioma in clinic.

[Interstitial implantation of ¹²5I seed therapy for recurrent ovarian cancer].

OBJECTIVE: To explore the feasibility, short-term efficacies and complications of computed tomography (CT)-guided ¹²5I interstitial implant therapy for recurrent ovarian cancer. METHODS: From October 2009 to November 2010, a total of 25 lesions for 12 patients were diagnosed as recurrent ovarian cancer by positron emission tomography/computed tomography (PET/CT). Among 25 lesions, 21 underwent ¹²5I seed implantation. And 4 lesions of liver and spleen in one patient were treated with microwave ablation. Nine patients underwent 2 - 6 cycles of chemotherapy after seeding. There were 11 lesions with diameter > 2 cm and 10 ≤ 2 cm. According to the area of physiologic 18FDG uptake in lesions, the treatment plans were formulated by computerized treatment planning system (TPS) and Memorial Sloan-Ketterin nomograph. The matched peripheral dose (MPD) was 145 Gy in target mass. A median of 20.5 seeds per patient (range: 9 - 45) were implanted. The efficacies were evaluated by CT and 18F-FDG PET/CT findings. RESULTS: One patient died of renal failure while the other patients survived during a median follow-up of 15 mouths (range: 9 - 19). Ten lesions showed complete remission, 6 partial remission and 5 progressive disease. The effective rate was 76.2% (16/21). Compared with those > 2 cm, the lesions ≤ 2 cm in diameter had a better local control rate by Fisher's exact test (P = 0.035). The hepatic and renal lesions treated by microwave ablation showed inactivation on PET/CT. Only one patient suffered from sciatic nerve injury caused by punctuation and numbness and pain of right lower extremity were persistent. There was no onset of the complications of radiation injury, such as intestinal fistula and proctitis. CONCLUSION: The CT-guided ¹²5I interstitial implant therapy for recurrent ovarian cancer yields excellent short-term efficacies with fewer complications. The combined modality of ¹²5I interstitial implant and chemotherapy may further improve the patient outcomes.

[Treatment and prognostic analysis of ovarian cancer patients with isolated region of lymph node recurrence].

OBJECTIVE: To evaluate the management and survival of lymph node region recurrence of epithelial ovarian cancer (EOC), and discuss its suitable therapeutic strategy. METHODS: Thirty-eight patients with the recurrence of lymph node region were extracted from 1945 patients who were diagnosed EOC and treated in Sun Yat-sen University Cancer Center from January 1995 to December 2008. The clinical characteristics, therapy methods and survival of them were retrospectively analyzed. Patient age at initial diagnosis was > 50 years old in 24 patients and ≤ 50 years old in 14 patients. There were 15 cases with stage II and 23 cases with stage III in terms of initial International Federation of Gynecology and Obstetrics (FIGO, 1987) staging. Classified with histological grade, 7 cases were in G(1), 14 cases were in G(2), 17 cases were in G(3); according to the histological types, 19 cases were with serous adenocarcinomas, and 19 cases were with non-serous adenocarcinomas (including 9 endometrioid adenocarcinoma, 1 mucinous adenocarcinoma and 9 unclassified adenocarcinoma). The median follow-up time was 59 months (ranged 16 to 124 months). RESULTS: (1) Feature of recurrences: the median interval of last treatment to recurrence was 18 months (range 9 to 96 months). Most of them were absence of symptoms. The serum level of CA(125) was elevated in 15 patients (39%, 15/38). (2) Treatment of recurrences:of the 38 patients, 19 underwent lymphadnectomy for recurrence regions and received adjuvant chemotherapy (surgery + chemotherapy group), 14 received local radiotherapy and adjuvant chemotherapy (radiotherapy + chemotherapy group), 5 received chemoherapy only (chemotherapy group). There were 35 cases achieved complete response (CR), including 19 patients underwent secondary debulking surgery in surgery + chemotherapy group, 14 cases in radiotherapy + chemotherapy group (12 of them treated by radiotherapy, the other 2 cases reached CR after adjuvant chemotherapy) and 2 cases in chemotherapy group. While only 3 patients reached partial response in chemotherapy group. (3) Survival and second recurrences: during follow-up, 14 cases died of tumor, 4 cases survival with tumor while 20 cases survival without evidence of tumor. The 5-year post-recurrence survival rate of 38 cases was 66.5%, with 71.8%, 68.8% and 40.0% in surgery + chemotherapy, radiotherapy + chemotherapy, and chemotherapy group, respectively, and there was no significant difference in survival rate between them (P > 0.05). A total of 15 patients experienced second recurrences, including 7 cases with peritoneal and 8 cases with lymph node region recurrences. (4) Prognosis factors: the univariate analysis shown that survival after recurrence was significantly related to patient age, tumor-free interval and number of recurrence disease (P < 0.05), while not to FIGO stage, histological type, histological grade, and lymphadnectomy during primary surgery (P > 0.05). The multivariate analysis showed that patient age and tumor-free interval were independent prognostic variables for survival after recurrence (P < 0.05). CONCLUSIONS: The lymph node region recurrence of EOC may be have good prognosis and distinctive clinical process. Local treatment strategies including secondary surgery and radiotherapy should be considered, which may significantly improve survival in ovarian cancer patients with lymph node region recurrence.