Penglin Liu

Global landscape of cervical cancer incidence and mortality in 2022 and predictions to 2030: The urgent need to address inequalities in cervical cancer

AbstractCervical cancer remains a major public health challenge worldwide, despite being largely preventable through effective interventions. Timely evidence regarding the global landscape of cervical cancer is crucial for measuring the magnitude of inequalities and monitoring progress towards cervical cancer elimination. We aimed to provide an updated overview of the global burden of cervical cancer using the GLOBOCAN 2022 database. Age‐standardized rates of incidence and mortality were presented according to countries, 20 United Nations‐defined world regions, and four‐tier Human Development Index (HDI) levels. The predicted burden of cervical cancer for 2030 was calculated based on global demographic projections. Globally, an estimated 662,301 new cervical cancer cases and 348,874 deaths occurred in 2022. Substantial geographic disparities in cervical cancer burden existed across countries and world regions. Low HDI countries exhibited two times higher incidence rates and five times higher mortality rates, compared to very high HDI countries. For women aged 15–44 years, cervical cancer ranked among the top three most frequent cancers in 149 countries, and among the top three causes of cancer deaths in 154 countries. If 2022 rates remain unchanged, the global burden of cervical cancer was predicted to increase to 760,082 new cases (a 14.8% increase) and 411,035 deaths (a 17.8% increase) by 2030. Our findings highlight the persistent and widening geographic and socioeconomic inequalities in the burden of cervical cancer. There is an urgent need for tailored national strategies to address these inequalities and accelerate progress towards the goal of cervical cancer elimination.

Fertility and prognosis assessment between bleomycin/etoposide/cisplatin and paclitaxel/carboplatin chemotherapy regimens in the conservative treatment of malignant ovarian germ cell tumors: a multicenter and retrospective study

To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (PC) chemotherapy regimens on the fertility and prognostic outcomes in malignant ovarian germ cell tumor (MOGCT) patients who underwent fertility-sparing surgery (FSS). A propensity score matching algorithm was performed between the BEP and PC groups. The χ² test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS) and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factor of DFS. We included 213 patients, 185 (86.9%) underwent BEP chemotherapy, and 28 (13.1%) underwent PC chemotherapy. The median age was 22 years (range, 8-44 years), and the median follow-up period was 63 months (range, 2-191 months). Fifty-one (29.3%) patients had a pregnancy plan, and 35 (85.4%) delivered successfully. In the before and after propensity score matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during-pregnancy status, and live birth between the BEP and PC groups (p>0.05). Fourteen (6.6%) patients experienced recurrence, including 11 (5.9%) in the BEP group and 3 (10.7%) in the PC group. Four (1.9%) patients in the BEP group died. Kaplan-Meier analysis revealed no significant differences in DFS (p=0.328) and OS (p=0.446) between the BEP and PC groups, and the same survival results were observed in the after matching cohort. The PC regimen is as safe as the BEP regimen for MOGCT patients with fertility preservation treatment, and no differences were observed in fertility and clinical prognosis.

Association between tumor laterality and prognosis across different ovarian cancer subtypes: Results from SEER database and a Chinese multicenter cohort

To investigate the association between tumor laterality and prognosis across different histological subtypes of ovarian cancer. In this study, we enrolled patients with ovarian serous cancer (SC), endometrioid cancer (EC), mucinous cancer (MC), clear cell cancer (CCC), sex cord-stromal tumor (SCST) and malignant germ cell tumor (MGCT) from the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2017. Additionally, we enrolled MGCT patients from a Chinese multi-institutional registry between 2003 and 2020 for complementary analyses. The primary outcomes were cancer-specific survival (CSS) and disease-free survival (DFS) in the SEER cohort and Chinese cohort, respectively. Multivariate Cox regression and Kaplan-Meier analyses were used to assess the association of tumor laterality with prognosis. In the SEER cohort with 13597 ovarian cancer patients, the fully-adjusted multivariate Cox regression model showed the right-sided tumor was significantly associated with a better CSS than the left-sided tumor (hazard ratio [HR] 0.51, 95 % confidence interval [CI]: 0.27-0.97; P = 0.041) among MGCT patients, whereas no significant association between tumor laterality and CSS was found among patients with SC, EC, MC, CCC and SCST (all P > 0.05). Furthermore, among the 288 MGCT patients in the Chinese cohort, the significant association of right-sided disease with better DFS (HR: 0.18, 95 % CI: 0.05-0.68; P = 0.011) was also observed. Similar results were found in the Kaplan-Meier analyses. Patients with right-sided tumor had a better prognosis than those with left-sided tumor in MGCT, but not in other ovarian cancer subtypes. Our findings suggested that personalized treatment strategies based on the tumor laterality might be necessary among MGCT patients.

The prognostic significance of primary tumor site in vulvar cancer: a population-based cohort study

To investigate the association of primary tumor site with prognosis in vulvar cancer, stratified by vulvar squamous cell carcinoma (SCC) and non-SCC histological types. This population-based retrospective study enrolled patients with vulvar cancer from the Surveillance, Epidemiology, and End Results database between January 2000 and December 2018. The primary outcome was cancer-specific survival (CSS). The prognostic difference between labium majus, labium minus and clitoris groups was investigated using Kaplan-Meier analyses and Cox proportional hazards regression analyses. A total of 3,465 eligible patients with vulvar cancer were included with a mean age of 54.5 years. Among the 1,076 (31.1%) patients with non-SCC, the multivariate Cox regression analyses showed that labium minus-sited disease (hazard ratio [HR]=1.85; 95% confidence interval [CI]=1.27-2.71; p=0.001) and clitoris-sited disease (HR=2.37; 95% CI=1.47-3.85; p0.05). Kaplan-Meier analyses also showed that the primary tumor site had a significant prognostic effect in vulvar non-SCC (p<0.001) but not in vulvar SCC (p=0.330). Among vulvar non-SCC, patients with labium minus-sited disease had a significantly worse prognosis than those with labium majus-sited disease, and a significantly better prognosis than those with clitoris-sited disease. Gynecologic oncologists should consider the prognostic effect of primary tumor site in vulvar non-SCC, and make optimal, personalized treatment and surveillance strategies based on different primary tumor sites.