Ting Wan

The impact of lymph node dissection on survival in patients with clinical early-stage ovarian cancer

To estimate the impact of lymph node dissection on survival in patients with apparent early-stage epithelial ovarian cancer (EOC). We conducted a retrospective review of patients with clinical stage I-II EOC. All patients underwent primary surgery at Sun Yat-sen University Cancer Center between January 2003 and December 2015. Demographic features and clinicopathological information as well as perioperative adverse events were investigated, and survival analyses were performed. A total of 400 ovarian cancer patients were enrolled, and patients were divided into 2 groups: 81 patients did not undergo lymph node resection (group A), and 319 patients underwent lymph node dissection (group B). In group B, the median number of removed nodes per patient was 25 (21 pelvic and 4 para-aortic nodes). In groups A and B, respectively, the 5-year progression-free survival (PFS) rates were 83.3% and 82.1% (p=0.305), and the 5-year overall survival (OS) rates were 93.1% and 90.9% (p=0.645). The recurrence rate in the retroperitoneal lymph nodes was not associated with lymph node dissection (p=0.121). The median operating time was markedly longer in group B than in group A (220 minutes vs. 155 minutes, p<0.001), and group B had a significantly higher incidence of lymph cysts at discharge (32.9% vs. 0.0%, p<0.001). In patients with early-stage ovarian cancer, lymph node dissection was not associated with a gain in OS or PFS and was associated with an increased incidence of perioperative adverse events.

Perineural Invasion Should Be Regarded as an Intermediate-Risk Factor for Recurrence in Surgically Treated Cervical Cancer: A Propensity Score Matching Study

Background. Perineural invasion (PNI) is considered as a poor prognostic factor in cervical cancer, but there has been no postoperative adjuvant therapy for it, because whether it belongs to high- or intermediate-risk factors has not been determined, this study intends to provide evidences to solve this problem. Methods. We conducted a retrospective analysis of cervical cancer patients who underwent radical surgery and be reported PNI from January 2012 to June 2017 at the Sun Yat-sen University Cancer Center. After 1 : 1 propensity score matching (PSM), a group of patients without PNI was matched according to the clinical pathological features. Postoperative pathological parameters and prognosis were evaluated between the PNI and the matched groups. Results. 1836 patients were screened, of which 162 (8.8%) diagnosed as stages IB1 to IIB reported PNI. Comparing to the matched group, more PNI (+) patients had deep outer cervix stromal invasion, cervical tunica adventitia invasion, positive lymph nodes, and positive margins. Among patients without high-risk factors, PNI (+) patients had worse 3-year overall survival (90.8% vs. 98.1%, P = 0.02 ), PNI (+) patients with single intermediate-risk factor and PNI (-) patients who meet with SEDLIS criteria had similar progress free survival ( P = 0.63 ) and overall survival ( P = 0.63 ), even similar survival curves. Conclusion. PNI is related to a worse overall survival among cervical cancer patients without high-risk factors and play the role as an intermediate-risk factor.

Simplifying surgical criteria for early-stage cervical cancer: prognostic equivalence of total vs. radical hysterectomy in a retrospective SEER cohort analysis

Background: The prognostic equivalence of total hysterectomy (TH) versus radical hysterectomy (RH) in early-stage cervical cancer (IA2-IB1) with tumor size ≤2 cm remains controversial, particularly regarding the necessity of lymphovascular space invasion (LVSI) assessment. This study evaluates survival outcomes under simplified criteria omitting LVSI and depth of invasion evaluation. Materials and methods: This retrospective cohort study analyzed 3002 FIGO IA2-IB1 cervical cancer patients (tumors ≤2 cm) from the SEER database (2004–2019). Inclusion criteria are histologically confirmed adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma; TH/RH with lymphadenectomy/sentinel node biopsy. Outcomes included overall survival (OS) and disease-specific survival (DSS), analyzed via Kaplan–Meier, Cox regression, and propensity score matching (PSM). Results: Median follow-up was 73 months. No significant differences were observed in OS (92.3% vs. 92.3%, P = 0.74) and DSS (96.4% vs. 96.6%, P = 0.89) outcomes between RH and TH cohorts, consistent across FIGO stages and adjuvant therapy-without patients. Multivariable analysis confirmed age &gt;49 years (HR = 2.50, 95% CI = 1.91–3.28, P &lt; 0.01), marital status of separated/divorced/widowed (HR = 1.66, 95% CI = 1.20–2.28, P &lt; 0.01), and tumor size 11–20 mm (HR = 1.61, 95% CI = 1.18–2.19, P &lt; 0.01) as independent risk factors in OS. While surgical approach still showed no prognostic significance both in OS (HR = 1.04, 95% CI = 0.79–1.37, P = 0.77) and DSS (HR = 1.01, 95% CI = 0.67–1.53, P = 0.96). Post-PSM analysis (n = 2,715) confirmed survival equivalence (P &gt; 0.05). However, in IB1 adenosquamous/adenocarcinoma patients aged &gt;49 years with tumors 11–20 mm, RH achieved superior DSS (P = 0.01), though OS differences were nonsignificant (P = 0.085). Squamous carcinoma outcomes remained equivalent regardless of surgery (P = 0.43). Conclusion: TH achieves survival outcomes comparable to RH in most early-stage cervical cancer patients with tumors ≤2 cm, supporting its application in low-risk populations. However, RH remains preferred for stage IB1 patients with adenocarcinoma or adenosquamous carcinoma aged &gt;49 years and tumors measuring 11–20 mm. Simplified criteria omitting LVSI and stromal depth assessment may enhance accessibility in resource-limited settings without compromising safety.

Comprehensive Multiomics Characterization of Perineural Invasion in Cervical Cancer Reveals Diagnostic Markers, Molecular Drivers, and Therapeutic Strategies

Abstract Perineural invasion (PNI) is an important pathologic feature of cervical cancer that is associated with poor prognosis and provides key information for clinical decisions. A better understanding of the molecular mechanisms underlying PNI could lead to improved patient treatment strategies. Here, we generated whole-exome, whole-genome, and RNA sequencing data from tumors and matched normal clinical samples of 45 patients with cervical cancer and performed a comparative analysis between 23 PNI and 22 non-PNI tumors. A robust machine learning approach identified a three-gene expression signature of MT1G, NPAS1, and SPRY1 that could predict the tumor PNI status with high accuracy, which was validated using an independent cohort (18 PNI and 19 non-PNI). Loss-of-function FBXW7 mutations were identified as driver events for PNI that lead to increased MYC activity and an immunosuppressive tumor microenvironment. Finally, a deep learning model for predicting drug efficacy over patients’ transcriptomic data revealed OTX015, a BET inhibitor, as a promising treatment that targets mutated FBXW7 PNI tumors. This study provides a rich resource for elucidating the molecular mechanisms of PNI tumors, laying a critical foundation for developing effective diagnostic and therapeutic strategies for PNI tumors in cervical cancer. Significance: Generation of a rich resource for characterizing the molecular basis of perineural invasion in tumors lays a critical foundation for developing effective diagnostic and therapeutic strategies in cervical cancer. This article is part of a special series: Driving Cancer Discoveries with Computational Research, Data Science, and Machine Learning/AI .