Bin Li

Surgical approach and recurrence risk in struma ovarii: A retrospective and systematic analysis

Struma ovarii (SO) represents a rare subset of ovarian germ cell tumors, with approximately 5% transforming into malignant SO (MSO). This study retrospectively analyzed clinical data from 23 SO patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences between January 2013 and December 2023, including 17 benign SO and 6 MSO cases. Additionally, a systematic review of 164 cases of MSO confined to the ovary, reported in the literature from 1946 to 2024, was conducted. Data on pathological type, treatment, and prognosis were extracted, and univariate and multivariate Cox regression analyses were performed to identify risk factors for recurrence in stage I MSO. The median age at diagnosis was higher for benign SO compared to MSO (58 vs. 42.5 years), with 70.6% of patients being postmenopausal. Benign SO commonly presented with abdominal distension or mass, with more than half having ascites, while MSO patients were asymptomatic and lacked ascites. Cox regression analyses revealed that ovarian cystectomy was adversely associated with recurrence risk in stage I MSO, likely due to surgically induced capsular rent and potential tumor spillage. Significantly lower recurrence risks were observed in patients who underwent unilateral or bilateral salpingo-oophorectomy (HR = 0.36, P = 0.019; HR = 0.19, P = 0.004, respectively). This study highlights the importance of the surgical approach in the management of stage I MSO. A thorough preoperative discussion of the benefits and risks of different surgical approaches is recommended for patients desiring fertility preservation. Postoperative adjuvant therapy has not been shown to have a significant impact on prognosis. For the treatment of recurrent MSO, selecting appropriate surgical and adjuvant therapeutic strategies is essential to improve the long-term prognosis of MSO patients.

Targeting of Tumoral NAC1 Mitigates Myeloid-Derived Suppressor Cell–Mediated Immunosuppression and Potentiates Anti–PD-1 Therapy in Ovarian Cancer

Abstract Epithelial ovarian cancer is the most common type of ovarian cancer with a low rate of response to immunotherapy such as immune checkpoint blockade therapy. In this study, we report that nucleus accumbens–associated protein 1 (NAC1), a putative driver of epithelial ovarian cancer, has a critical role in immune evasion. We showed in murine ovarian cancer models that depleting or inhibiting tumoral NAC1 reduced the recruitment and immunosuppressive function of myeloid-derived suppressor cells (MDSC) in the tumor microenvironment, led to significant increases of cytotoxic tumor-infiltrating CD8+ T cells, and promoted antitumor immunity and suppressed tumor progression. We further showed that tumoral NAC1 directly enhanced the transcription of CXCL16 by binding to CXCR6, thereby promoting MDSC recruitment to the tumor. Moreover, lipid C20:1T produced by NAC1-expressing tumor cells fueled oxidative metabolism of MDSCs and promoted their immune-suppressive function. We also showed that NIC3, a small-molecule inhibitor of NAC1, was able to sensitize mice bearing NAC1-expressing ovarian tumors to anti–PD-1 therapy. Our study reveals a critical role for NAC1 in controlling tumor infiltration of MDSCs and in modulating the efficacy of immune checkpoint blockade therapy. Thus, targeting of NAC1 may be exploited to sensitize ovarian cancer to immunotherapy.

Predictive factors of sentinel lymph node mapping failure in cervical cancer: A systematic review and meta-analysis

Sentinel lymph node (SLN) mapping is crucial in cervical cancer, helping to assess lymph node status while reducing unnecessary systemic lymph node dissection. However, bilateral SLN mapping fails in 5 %-20 % of cases, with various contributing factors. This meta-analysis aims to identify predictive factors associated with SLN mapping failure in cervical cancer. A comprehensive literature search was conducted across Cochrane, MEDLINE, Embase, PubMed, Web of Science, CBM, CNKI, WFDB, and VIP from inception to July 2024. Additional data were obtained from SRCTN, Physicians Data Query, ClinicalTrials, and the International Clinical Trials Registry Platform. Two independent researchers screened studies, assessed quality, and extracted data. The associations between predictive factors and SLN mapping failure were evaluated using odds ratios (ORs) with 95 % confidence intervals (CIs). A total of 27 observational studies comprising 4059 patients were included. Significant predictive factors for SLN mapping failure included tumor size ≥2 cm [OR = 1.35, 95 % CI (1.05, 1.74), P = 0.018], age ≥50 years [OR = 2.71, 95 % CI (1.85, 3.97), P ≤ 0.001], FIGO stages II-IV [OR = 2.11, 95 % CI (1.20, 3.72), P = 0.009], pelvic lymph node metastasis [OR = 2.15, 95 % CI (1.10, 4.20), P = 0.025], and neoadjuvant chemotherapy (NACT) [OR = 1.44, 95 % CI (1.09, 1.90), P = 0.010]. Other factors including obesity, surgical approach, cervical conization, tumor differentiation, lymphovascular space invasion (LVSI), and histologic type were not associated with SLN mapping failure. Larger tumor, older age, advanced FIGO stage, pelvic lymph node metastasis, and NACT are predictive factors for SLN mapping failure. These findings highlight the importance of preoperative assessment before SLN mapping.

Characteristics and treatment results of recurrence in adult-type granulosa cell tumor of ovary

Abstract Background The aim of this study was to explore the clinicopathological characteristics of recurrent adult-type granulosa cell tumor of the ovary (AGCOT) and evaluated the treatment results to define the prognostic parameters for survival after recurrence. Results A retrospective review of 40 patients with recurrent AGCOT, who were treated in the Cancer Hospital at the Chinese Academy of Medical Sciences from 2000 to 2015 was conducted. The impact of clinical and pathological characteristics, progression-free survival (PFS), and post-recurrence therapeutic approaches on prognosis were analyzed. Among the 40 recurrent patients, there were 10 cases where the relapse was uncontrolled, 24 cases had second relapses, and 6 cases without further relapses at the time of our follow-up. The median PFS was 61 months (range, 7-408 months), and the median time interval between the first and the second relapses (R-PFS) was 25 months (range, 0–94 months). The median time interval between the first relapse and death (R-OS) was 90 months (range, 2–216 months). PFS ≥ 61 months (P = 0.004) and post-recurrence therapeutic approach (P < 0.001) were independent risk factors for repeated recurrences. The age at recurrence (P = 0.031) and post-recurrence therapeutic approach (P = 0.001) were independent risk factors for death after recurrence. Conclusion Among patients with recurrent AGCOT, those with long PFS had good prognoses. Maximal cytoreductive effort should be made after recurrence. Complete resection and postoperative adjuvant chemotherapy may improve the prognosis of patients with recurrent AGCOT.

Detection of sentinel lymph node in laparoscopic surgery for uterine cervical cancer using carbon nanoparticles

AbstractBackground and ObjectivesCarbon nanoparticles (CNPs) has been widely confirmed the efficiency in sentinel lymph node (SLN) mapping for various solid tumors. This study aims to explore the feasibility and effectiveness of CNPs during laparoscopic surgery for cervical cancer.MethodsWe analyzed 45 women with stage IB1‐IIA1 cervical cancer who underwent SLN mapping using CNPs during laparoscopic surgery. The effectiveness of CNPs was evaluated by the detection rate and accuracy parameters. Factors associated with SLN laterality and SLNs localizations were analyzed.ResultsThe overall and bilateral detection rate was 93.3% (42/45) and 60.0% (27/45), respectively. Elevated body mass index was associated with decreased bilateral detection rate (P = .015). A total of 225 SLNs were harvested, with a mean number of 5.0 ± 3.6. A total of 81.3% of SLNs were in expected localizations including external iliac (39.1%), internal iliac (25.8%), and obturator (16.4%) regions, while 18.7% in unusual localizations including common iliac (10.7%), parametrial (7.6%), and presarcal (0.4%) regions. None positive lymph node was found in non‐SLNs with a false‐negative rate of 0%.ConclusionLaparoscopic SLN mapping with CNPs appears to be simple and efficient for patients with early‐stage cervical cancer.