Ping-Li Sun

Homologous recombination deficiency in high-grade serous ovarian carcinoma: clinical pathological characteristics, impact of neoadjuvant chemotherapy, and prognostic implications

Navigating the future of fertility preservation: advanced predictive strategies for treatment outcomes of endometrial atypical hyperplasia and carcinoma

Due to the decreasing age of onset and the postponement of childbearing, there is a growing number of patients with endometrial carcinoma (EC) and endometrial atypical hyperplasia (EAH) seeking fertility-sparing treatments. Progestogen-based therapy serves as the principal conservative approach for EC. However, the variability in treatment outcomes hampers the potential for delivering more tailored therapies in clinical practice. To better guide the treatment of patients with fertility preservation needs, we conducted a comprehensive review of existing literature to explore factors related to molecular classification, biomarkers and artificial intelligence (AI) technology that may predict fertility-sparing treatment outcomes, we also looked ahead to future research directions in this field. The pathology before and after treatment is the primary basis for assessing the effectiveness of fertility-sparing treatment for EC and EAH. However, it is challenging to predict the therapeutic outcomes based on the pathological morphology of the initial diagnosis. Traditional immunohistochemical markers, such as estrogen and progesterone receptors, are also very limited in predicting therapeutic response. In recent years, the prognosis of fertility-sparing treatment has also been considered to be correlated with the molecular classification and gene mutation markers of EC. However, there are currently few direct clinical studies available, and our focus will be on reviewing these studies and assessing their applicability. In addition, there are some studies utilizing AI to predict the molecular classification, genes and therapeutic response of EC. The integration of these features will aid in the development of advanced predictive strategies for fertility-sparing treatment of EC and EAH.

PD‐L1 expression and immune stromal features in HPV‐independent cervical adenocarcinoma

AimsHuman papilloma virus (HPV)‐independent cervical adenocarcinoma (CA) is usually diagnosed at an advanced stage, while the therapeutic options are limited. Therefore, effective treatment options are required. The programmed cell death 1 (PD‐1) inhibitor pembrolizumab has been approved for the treatment of patients with recurrent or metastatic cervical squamous cell carcinoma expressing PD‐ligand 1 (PD‐L1). However, no data regarding PD‐L1 expression in HPV‐independent CA are available. Thus, we evaluated the association between PD‐L1 expression and the clinicopathological characteristics and survival of patients with HPV‐independent CA.MethodsWe evaluated PD‐L1, mismatch repair (MMR) protein expression and the immune stromal features of 44 patients with HPV‐independent CA. PD‐L1 expression was defined as a combined positive score (CPS) ≥1 and a tumour proportion score (TPS) ≥1%.ResultsPD‐L1 expression was observed in 14 cases (31.8%) with CPS ≥1 and 12 cases (27.3%) with TPS ≥1%. PD‐L1 expression, based on either the CPS or the TPS, was associated with a high tumour‐infiltrating lymphocyte percentage (CPS = P < 0.001; TPS = P < 0.001). Patients with a PD‐L1 CPS ≥1 showed worse progression‐free survival and overall survival than PD‐L1‐negative patients (P = 0.004 and P = 0.023, respectively). Forty‐two cases demonstrated intact MMR expression and two cases demonstrated loss of MSH2/MSH6.ConclusionsOur data demonstrated that PD‐L1 was expressed in HPV‐independent CA, especially in clear cell carcinoma, and that PD‐L1 expression is a negative prognostic marker. Our data support the role of PD‐L1 in HPV‐independent CA and its potential as an immunotherapeutic target.