Mingzhu Jia

Clinical analysis of the impact of systematic pelvic and para-aortic lymphadenectomy on the prognosis of patients with early-stage ovarian cancer (stage IA–IIA): a propensity score matching study

The role of systematic pelvic and para-aortic lymphadenectomy (PPAL) in completion staging surgery for early-stage (stage I-IIA) ovarian cancer (EOC) remains controversial. This study evaluates the impact of PPAL on the prognosis of EOC patients. A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results database. Patients with EOC (stage I-IIA) were included. Propensity score matching (PSM) was used at a 1:1 ratio based on age, marital status, race, tumor grade, histological type, FIGO stage, and postoperative adjuvant therapy. Post-matching overall survival (OS) and cancer-specific survival (CSS) were compared between the systematic PPAL group (pathological staging) and the non-lymphadenectomy group (clinical staging). After PSM, no significant differences were observed in OS (p=0.140) and CSS (p=0.066) between the two groups. Subgroup analysis showed that for tumor grade III patients, the pathological staging group had significantly higher OS (p=0.028) and CSS (p=0.010) than the clinical staging group. Multivariate Cox regression indicated that tumor grade III was an independent prognostic factor for OS (p=0.006) and CSS (p=0.020). Systematic PPAL does not significantly improve survival in EOC patients. However, for tumor grade III patients, the pathological staging group demonstrates significantly better prognosis, offering a more personalized alternative to routine staging surgery, which requires further validation through prospective trials.

The Potential Value of Ki-67 in Prognostic Classification in Early Low-Risk Endometrial Cancer

Purpose This study aims to determine the optimal cut-off value of Ki-67 to better predict the recurrence of early low-risk endometrial cancer (EC). Methods Seven hundred and forty-eight patients diagnosed with low-risk EC from West China Second Hospital of Sichuan University and the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The receiver operating characteristic curve (ROC) and Youden index were used to calculate the optimal cut-off value of Ki-67 expression. The clinicopathological indexes between two groups divided by cut-off value of Ki-67 were compared. The univariate and multivariate regression analyses were performed to investigate risk factors connected to the recurrence of early low-risk EC. The survival analysis was shown in Kaplan–Meier curve. Result Thirty-three patients were detected with tumor recurrence after primary surgery (4.4%); 33% was the optimal cut-off value of the Ki-67 index. A high Ki-67 was significantly associated with age ( P = .002), myometrial invasion ( P < .001), and the expression of P53 ( P = .007). The multivariate regression analysis verified that Ki67 ≥ 33% was an independent prognostic factor for predicting recurrence. The recurrence-free survival (RFS) and the overall survival (OS) in high Ki-67 group was significantly lower than that in low Ki-67 group ( P < .001 and P = .029, respectively). The prognostic values of ER, PR, and P53 in combination with Ki-67 were superior to each single predictor. Conclusions The optimal cut-off value of Ki-67 for predicting recurrence is 33%, which quantitatively defines the specific value of Ki-67 that causes high-risk recurrence in early low-risk EC.

The combined ratio of estrogen, progesterone, Ki‐67, and P53 to predict the recurrence of endometrial cancer

AbstractBackground and ObjectivesWe aimed to explore the capacity of the combined ratio of biomarkers to predict the recurrence of Stage I–III endometrial cancer (EC).MethodsA total of 473 patients were enrolled after screening. The cut‐off value of the ratio was calculated by the receiver operating characteristic curve (ROC). The univariate and multivariate Cox regression analysis was used to assess the correlation between the combined ratio and the recurrence of EC. The differences of clinicopathological parameters between the two groups divided based on the threshold were compared.ResultThe ROC curve showed that 0.92 was the optimal cut‐off value of the ratio ([ER + PR]/[P53 + Ki67]). The multivariate analysis demonstrated that only International Federation of Gynecology and Obstetrics stage (p = .031) and the combined ratio (p = .004) were independent risk factors of recurrence. The 3‐year recurrence‐free survival (RFS) and overall survival of patients in the low‐ratio group were 54.1% and 66.8%, respectively; while in the high‐ratio group were 94.9% and 97.9%, respectively (p < .001). The 3‐year RFS of 194 patients, who did not receive the adjuvant therapy, was 54.7% and 97.2% between two groups (p < .001).ConclusionsThe optimal cut‐off value (0.92) of the combined ratio was demonstrated to be better to predict the recurrence of EC than a single immunohistochemical marker.