Oncological outcomes of fertility-sparing surgery versus radical surgery in stage - epithelial ovarian cancer: a systematic review and meta-analysis.

BACKGROUND: The oncological outcomes of fertility-sparing surgery (FSS) compared to radical surgery (RS) in patients with stage I epithelial ovarian cancer (EOC) remain a subject of debate. We evaluated the risk ratios (RRs) for outcomes in patients with stage I EOC who underwent FSS versus RS. METHODS: We conducted a systematic search of PubMed, Web of Science, and Embase for articles published up to November 29, 2023. Studies that did not involve surgical procedures or included pregnant patients were excluded. We calculated the RRs for disease-free survival, overall survival, and recurrence rate. The quality of the included studies was assessed using the Cochrane Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. The meta-analysis was registered on PROSPERO (CRD42024546460). RESULTS: From the 5,529 potentially relevant articles, we identified 83 articles for initial screening and included 12 articles in the final meta-analysis, encompassing 2,906 patients with epithelial ovarian cancer. There were no significant differences between the two groups in disease-free survival (RR [95% confidence interval {CI}], 0.90 [0.51, 1.58]; P = 0.71), overall survival (RR [95% CI], 0.74 [0.53, 1.03]; P = 0.07), and recurrence rate (RR [95% CI], 1.10 [0.69, 1.76]; P = 0.68). In sensitivity analyses, the significant difference was observed only for overall survival (before exclusion: RR [95% CI], 0.74 [0.53-1.03], P = 0.07; after exclusion: RR [95% CI], 0.70 [0.50-0.99]; P = 0.04). CONCLUSIONS: This is the first and only individual patient data meta-analysis comparing disease-free survival, overall survival, and recurrence rate of patients with early-stage epithelial ovarian cancer undergoing FSS and RS. FSS was associated with similar disease-free survival and risk of recurrence as RS. We hypothesized that the decreased overall survival in the FSS group could not be attributed to distant metastases from epithelial ovarian cancer.

Clinicopathologic and prognostic significance of tumor-associated macrophages in cervical cancer: a systematic review and meta-analysis.

OBJECTIVES: The role of tumor-associated macrophages (TAMs) in cervical cancer (CC) remains controversial. Here, we report a meta-analysis of the association between TAMs infiltration and clinical outcomes. METHODS: PubMed, Embase, Web of Science, and CNKI were searched systematically from inception until December 20, 2023. Studies involving TAMs and prognosis, clinical, or pathological features were included. Quality assessments of the selected studies were assessed. The fixed-effect or random-effects model, standard mean difference (SMD), odds ratios (OR), or hazard ratios (HR) with 95% confidence intervals (CIs) were used as the effect size estimate. RESULTS: 26 eligible studies with 2,295 patients were identified. Our meta-analysis revealed that TAMs were overexpressed in CC (OR = 12.93, 95% CI = 7.73-21.61 and SMD = 1.58, 95% CI = 0.95-2.21) and that elevated TAM levels were strongly associated with lymph node metastasis (LNM) (SMD = 0.51, 95% CI = 0.90-2.01) and FIGO stages (SMD = 0.46, 95% CI = 0.08-0.85). Subgroup analysis indicated a significant positive correlation between LNM and TAMs density in tumor stroma, but not in cancer nests (SMD = 0.58, 95% CI = 0.31-0.58). Furthermore, in early stage, a stronger correlation exists between LNM and TAM density (SMD = 1.21, 95% CI = 0.75-1.66). In addition, it revealed that patients with high TAMs expression had poorer overall survival (OS) (HR = 2.55 95% CI = 1.59-4.07) and recurrence-free survival (RFS) (HR = 2.17, 95% CI = 1.40-3.35). CONCLUSIONS: Our analyses suggest that a high density of TAMs predicts adverse outcomes in CC.

Direct abdominal vein thrombus imaging (DATI): a contrast-free black-blood MR technique for the diagnosis of abdominal vein thrombosis.

OBJECTIVES: To develop and evaluate a direct abdominal vein thrombus imaging (DATI) technique, based on a respiratory navigating SPACE sequence with DANTE black-blood preparation, for diagnosing abdominal vein thrombosis (AVT) without the use of exogenous contrast agents. METHODS: We prospectively enrolled 10 healthy subjects and 28 suspected AVT patients who underwent DATI scans on 3.0 T MRI. Contrast-enhanced CT venography (CTV) was also conducted on the suspected AVT patients for comparison. All images were analyzed by two blinded radiologists who independently evaluated randomized images and gave image quality and diagnostic confidence scores (1-poor, 4-excellent) for DATI and CTV. The accuracy (ACC), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of CTV were calculated using CTV as a standard reference. The diagnostic agreement between DATI and CTV as well as the interobserver agreement were conducted using Cohen κ test. RESULTS: The patient study demonstrated that DATI can provide adequate thrombus signal intensity and the contrast between the thrombus to dark venous lumen for the diagnosis of AVT. It offers good to excellent image quality (reader1/reader2: 3.50 ± 0.64/3.42 ± 0.63, κ = 0.872) and diagnostic confidence (reader1/reader2: 3.71 ± 0.53/3.78 ± 0.42, κ = 0.804) for the diagnosis of AVT. Taking CTV as a reference, DATI has high accuracy (96.6%), SE (91.5%), SP (98.0%), PPV (92.3%), and NPV (97.8%). DATA CONCLUSION: DATI can provide good to excellent image quality, effective venous blood signal suppression, and definitive thrombus detection for the diagnosis of AVT without the use of exogenous contrast agents.