Tianyu Zhang

Role of adjuvant chemotherapy in stage IC ovarian granulosa cell tumors: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the impact of postoperative adjuvant chemotherapy on recurrence and mortality in stage IC granulosa cell tumors (GCTs). We searched the PubMed, Embase, and Cochrane Library for studies published up to December 1, 2024, comparing the oncological outcomes of adjuvant chemotherapy with observation in stage IC GCTs. Seventy studies were identified, with 12 included in the meta-analysis. Among 695 patients, 255 (36.7%) received postoperative adjuvant chemotherapy and 440 (63.3%) received observation. The overall recurrence and mortality rates were 18.7% and 7.6%, respectively. No significant differences were observed in survival outcomes between the adjuvant chemotherapy and observation groups, including recurrence rate (odds ratio [OR]=1.32; 95% confidence interval [CI]=0.67-2.58; p=0.424; I²=33%), mortality rate (OR=0.83; 95% CI=0.44-1.57; p=0.560; I²=0%), 5-year disease free survival (OR=0.88; 95% CI=0.18-4.18; p=0.868; I²=54%) and 5-year overall survival (OR=1.28; 95% CI=0.60-2.74; p=0.519; I²=0%). Subgroup analysis revealed no significant difference in recurrence rate between adjuvant chemotherapy and observation for both adult and juvenile GCTs, or between patients who underwent fertility-sparing surgery and those who did not. Additionally, no difference was found in recurrence rate between 'bleomycin, etoposide, and cisplatin' or 'etoposide and cisplatin' and 'paclitaxel combined with carboplatin or cisplatin' regimens. Postoperative adjuvant chemotherapy did not provide additional benefits in disease recurrence or survival outcomes compared to observation in stage IC GCTs. PROSPERO Identifier: CRD42024559478.

Right diaphragm metastasis of endometrial cancer: a case report

A diaphragmatic tumor is usually caused by metastasis from lung cancer, malignant mesothelioma, and malignant thymoma. Endometrial cancer is rarely involved in metastasis to the diaphragm. A right anterior mediastinal tumor was found in a 60-year-old woman who was initially diagnosed with endometrial carcinoma. There was initially no relationship between the right anterior mediastinal tumor and endometrial carcinoma. Radical curative surgery was performed for endometrial carcinoma. The endometrial carcinoma stage was IA. The patient was admitted to the Department of Thoracic Surgery 6 months after the curative surgery. Intraoperative exploration showed a tumor growing in the right diaphragm. Right diaphragmotomy was performed. Immunohistochemistry showed metastasis of endometrial carcinoma to the diaphragm. Endometrial cancer solitary metastasis to the diaphragm is rare. Clinicians should be aware of this possibility. Surgical treatment followed by a pathological examination is the most useful method for determining the diagnosis of a diaphragmatic tumor due to metastasis of endometrial cancer.

Comparison of carboplatin-based chemotherapy versus cisplatin-based chemotherapy in the treatment of malignant gonadal germ cell tumor: a systematic review and meta-analysis

To evaluate the role of carboplatin-based chemotherapy in patients diagnosed with malignant gonadal germ cell tumors (GCTs), we conducted a systematic review and meta-analysis. We searched PubMed, MEDLINE, Embase, Cochrane library, and Web of Science. Randomized controlled trials or cohort studies on gonadal GCTs between January 1, 1970 and April 26, 2023 were enrolled. The treatment failure rate and mortality rate were the primary outcomes. Subgroup analysis based on the primary tumor site and dose of carboplatin was also conducted. In total, 8 studies with 1,409 patients were included. Compared to cisplatin-based chemotherapy, carboplatin-based chemotherapy had an increased treatment failure rate (odds ratio [OR]=2.23; 95% confidence interval [CI]=1.61-3.08; p<0.001), but similar overall survival outcomes (OR=1.68; 95% CI=0.61-4.61; p=0.315). Subgroup analysis revealed that carboplatin-based chemotherapy did not increase the risk of treatment failure and death in ovarian GCT, while a higher risk of treatment failure and a similar risk of death were observed in testicular GCT. Patients treated with high-dose carboplatin calculated 400 or 600 mg/m² (area under the curve=7.9) obtained similar failure-free survival to the cisplatin group (OR=0.84; 95% CI=0.40-1.73; p=0.629). Compared to the cisplatin group, milder nausea and vomiting, nephrotoxicity, ototoxicity, and more severe myelosuppression were observed in the carboplatin group. In conclusion, carboplatin-based chemotherapy achieves a comparable overall survival outcome to cisplatin-based chemotherapy in gonadal GCT patients, suggesting that carboplatin is a candidate substitute for cisplatin. The efficacy of carboplatin is dose-dependent. High-dose carboplatin can obtain better therapeutic effects with more tolerable toxicities than cisplatin.

Ovarian squamous cell carcinoma: clinicopathological features, prognosis and immunotherapy outcomes

To explore the characteristics and survival outcomes of ovarian squamous cell carcinoma (SCC) and the treatment effectiveness of immune checkpoint inhibitors (ICIs). Patients diagnosed with ovarian SCC at Peking Union Medical College Hospital between January 2000 and September 2023 were included. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate analysis of OS were performed using the Cox proportional hazards model. A total of 42 patients were included, with a median age of 51.5 years (range, 23-74). The majority had SCC arising from teratomas (54.8%), followed by endometriosis (14.3%) and Brenner's tumor (2.4%). Patients undergoing molecular testing exhibited a median tumor mutation burden (TMB) of 10.00 mutations/Mb (range, 7.28-46.86), predominantly featuring The prognosis for ovarian SCC remains unfavorable. The stage and age were prognostic predictors for survival. ICIs may be beneficial for patients with ovarian SCC, particularly those with a high TMB.

Struma ovarii with synchronous ascites and elevated CA125 level: a retrospective cohort study

Benign struma ovarii (SO) with synchronous ascites and elevated CA125 level is extremely rare that the incidence, clinical characteristics, and risk factors remain unclear. We conducted a retrospective study of patients with SO treated in our hospital between 1980 and 2022. Logistic regression was used to identify potential risk factors for SO patients presenting with ascites and elevated CA125 levels. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the identified risk factors. A total of 21 patients with synchronous ascites and elevated CA125 levels were identified in 229 patients with SO, the crude incidence rate was 9.17%, and four patients (1.75%) had pseudo-Meigs' syndrome. Ascites were completely involuted within 1 month postoperatively and the serum CA125 level decreased to normal between 3 d and 6 weeks after surgery. Multivariate logistic regression showed that age ≥49 years (OR 3.71, 95% CI 1.29 - 10.64, Less than one-tenth of patients with SO would present ascites and elevated CA125 levels, while age ≥49 years, tumor sizes ≥10 cm, and the presence of proliferative SO were the risk factors.