International Journal of Clinical Practice

Postoperative Adjuvant Treatment in Women with Stage I Endometrial Cancer: A Retrospective Study

Objective. To evaluate whether postoperative adjuvant treatment is beneficial for patient survival after surgery for early stage endometrial cancer (EC). We analyzed the outcomes of patients treated with radiotherapy, chemotherapy, or progestagen combined with other adjuvant treatments. Methods. We analyzed the outcomes of patients treated with radiotherapy alone, chemotherapy alone, or progestagen treatment with other adjuvant treatments. Women without any adjuvant treatment after operation were used as controls. We retrospectively examined disease-free survival (DFS), overall survival (OS), and high-risk factors that affected the survival status of all patients who received different postoperative adjuvant therapies. Results. In all 192 patients, the total relapse and mortality rates were 5.57% and 1.68%, respectively. Fourteen patients (7.29%) developed isolated local recurrence, and 2 patients died (1.04%) of recurrence during the follow-up period. The 5-year DFS and OS rates of all patients were 95.83% and 93.75%, respectively. No significant differences were observed in the 5-year DFS, 5-year OS, OS, or DFS among the four groups of patients with FIGO stage I endometrial cancer ( P = 0.9849 , 0.7430, 0.9754, and 0.4534, respectively). The differences in the log-rank test results of the estimates of the 5-year DFS, 5-year OS, DFS, and OS of patients with different disease stages and different ages were all significant, but no differences were observed in these parameters among patients with varying degrees of differentiation. Histologic grade, CA125 level, ER and PR status, and adjuvant therapy had no significant effect on the DFS and OS of all patients according to univariate and multivariate regression analyses, but a significant effect on DFS and OS was found when the patients were stratified by age. Conclusion. This retrospective study showed that adjuvant therapy after surgery was not significantly associated with improved DFS or OS in patients with early stage endometrial cancer. However, FIGO stage and age affected the survival of patients with stage I endometrial cancer.

Prognostic Factors and a Predictive Nomogram of Cancer-Specific Survival of Epithelial Ovarian Cancer Patients with Pelvic Exenteration Treatment

Objective. The aim of this study was to explore prognostic factors, develop and internally validate a prognostic nomogram model, and predict the cancer-specific survival (CCS) of epithelial ovarian cancer (EOC) patients with pelvic exenteration (PE) treatment. Methods. A total of 454 EOC patients from the Surveillance, Epidemiology, and End Results (SEER) database were collected according to the inclusion criteria and randomly divided into the training (n = 317) and validation (n = 137) cohorts. Prognostic factors of EOC patients with PE treatment were explored by univariate and multivariate stepwise Cox regression analyses. A predictive nomogram was constructed based on selected risk factors. The predictive power of the constructed nomogram was assessed by the time-dependent receiver operating characteristic (ROC) curve. Kaplan–Meier (KM) curve stratified by patients’ nomoscore was also plotted to assess the risk stratification of the established nomogram. In internal validation, the C index, calibration curve, and decision curve analysis (DCA) were employed to assess the discrimination, calibration, and clinical utility of the models, respectively. Results. In the training cohort, age, histological type, Federation of Gynecology and Obstetrics (FIGO) stage, number of examined lymph nodes, and number of positive lymph nodes were found to be independent prognostic factors of postoperative CSS. A practical nomogram model of EOC patients with PE treatment was constructed based on these selected risk factors. Time-dependent ROC curves and KM curves showed the superior predictive capability and excellent clinical stratification of the nomogram in both training and validation cohorts. In the internal validation, the C index, calibration plots, and DCA in the training and validation cohorts confirmed that the nomogram presents a high level of prediction accuracy and clinical applicability. Conclusion. Our nomogram exhibited satisfactory survival prediction and prognostic discrimination. It is a user-friendly tool with high clinical pragmatism for estimating prognosis and guiding the long-term management of EOC patients with PE treatment.

Management options for vaginal intraepithelial neoplasia

Vaginal intraepithelial neoplasia (VaIN) is a rare disease of the lower genital tract, strongly associated with HPV infection, which may progress to vaginal carcinoma. The aim of this review is to summarise current treatment options, evaluate their efficacy and make provide recommendations on the optimal management of the disease. A comprehensive search of the literature was performed using the PubMed database for articles referring to the treatment of VaIN. We restricted our search only in articles written in English with publication dates within the last 10 years. Surgical approach included local excision, CO The choice of treatment depends upon many factors. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Topical agents are useful for persistent, multifocal lesions or for women that cannot undergo surgical treatment. Brachytherapy is associated with high morbidity rates and should be reserved for women who have multifocal disease, are poor surgical candidates and/or have failed other treatments. CO

Metformin Use and Mortality in Women with Ovarian Cancer: An Updated Meta‐Analysis

Background. Previous observational studies and meta‐analysis suggested a possible association between metformin use and reduced mortality in women with ovarian cancer (OC). However, clinical factors that may influence the relationship remain poorly evaluated. We performed an updated meta‐analysis to systematically evaluate the above association and to observe the potential influences of study characteristics on the association. Methods. Relevant studies reporting the association between metformin use and mortality in women with OC in the multivariate adjusted model were identified by search of electronic databases that included PubMed, Embase, and Web of Science. The random‐effects model was adopted to combine the results. Results. Nine studies including 10030 women with OC were included. Overall, metformin use was independently associated with reduced overall mortality (hazard ratio (HR): 0.72, 95% confidence interval (CI): 0.55–0.93, P = 0.01; I2 = 62%). Consistent results were observed for studies comparing metformin users with nondiabetic women and studies comparing metformin users with diabetic women who did not use metformin (P for subgroup analysis = 0.70). Further subgroup analyses showed consistent results in studies with metformin use before or after the diagnosis of OC, with or without adjustment of body mass index (BMI) and with or without adjustment of concurrent medications (P for subgroup analyses all >0.10). Conclusion. Metformin use is associated with reduced mortality in women with OC, which may be independent of the diabetic status of the controls, timing of metformin use, or adjustment of BMI and concurrent medications. Clinical trials are needed to validate the potential benefits of metformin on survival of OC.

A Clinicopathologic Analysis of Decidual Polyps: A Potentially Problematic Diagnosis

Objective. The decidual polyp is a special cervical polyp that is not systemically reported or well known. The aim of this study was to describe the clinicopathologic features of the decidual polyps observed at the West China Second University Hospital of Sichuan University between 2015 and 2020 and to spread awareness of them. Methods. Two hundred and fifty cases of decidual polyps, accounting for 45.45% (250/550) of all cervical polyps identified during pregnancy, were reviewed. The patients were followed up until the end of their pregnancies, which delivered <28 weeks and between 28 and 37 weeks, and full‐term delivery. The t‐test or nonparametric test was used to measure the data, and the chi‐square test was used for counting data. Statistical significance was set at p < 0.05. Results. Most of the decidual polyps occurred during the first trimester, with a median patient age of 33 years. The polyps were both singles and multiples and located at the cervix, with a long stalk, and a median diameter of one centimeter. The gross morphological appearance varied from polypoid to lingulate, and they were fragile and bled easily. Microscopically, the decidual polyps showed diffuse glandular secretion as well as decidual changes in the stromal cells. They could be divided into two subtypes: decidua fragment and decidua with endometrial polyp formation. Seventy‐three patients who went on to have further pregnancies were followed until the end of the study period. Twenty‐one (21/73, 28.77%) of them had adverse pregnancy outcomes (12 cases delivered <28 weeks and 9 cases delivered between 28 and 37 weeks). Conclusions. The data showed that the decidual polyp was the second most common cervical polyp during pregnancy, and its incidence was associated with adverse pregnancy outcomes. Thus, this type of polyp should be considered in cervical polypectomy specimens from pregnant women. A more uniform and accurate pathological diagnosis, including the thrombus status and division subtype, could provide the basis for obstetricians to promote treatment improving pregnancy outcomes.

Epidemiological Trends and Attributable Risk Burden of Cervical Cancer: An Observational Study from 1990 to 2019

Background. Cervical cancer, especially in underdeveloped areas, poses a great threat to human health. In view of this, we stratified the age and social demographic index (SDI) based on the epidemiological development trend and attributable risk of cervical cancer in countries and regions around the world. Methods. According to the data statistics of the global burden of disease database (GBD) in the past 30 years, we adopted the annual percentage change (EAPCs) to evaluate the incidence trend of cervical cancer, that is, incidence rate, mortality, and disability adjusted life expectancy (DALY). Meanwhile, we investigated the potential influence of SDI on cervical cancer’s epidemiological trends and relevant risk factors for cervical cancer‐related mortality. Results. In terms of incidence rate and mortality, the high SDI areas were significantly lower than those of low SDI areas. The incidence and mortality in women aged 20 to 39 were relatively stable, whereas an upward trend existed in patients aged 40 to 59. The global cervical cancer incidence rate increased from 335642 in 1990 to 565541 in 2019 (an increase of 68.50%, with an average annual growth rate of 2.28%), while the age‐standardized incidence rate (ASIR) showed a slight downward trend of 14.91/100000 people (95% uncertainty interval [UI], 13.37‐17.55) in 1990 to 13.35/100,000 persons (95% UI, 11.37‐15.03) in 2019. The number of annual deaths at a global level increased constantly and there were 184,527 (95% UI, 164,836‐218,942) deaths in 1990 and 280,479 (95% UI, 238,864‐313,930) deaths in 2019, with an increase of 52.00%(average annual growth rate: 1.73%). The annual age‐standardized disability adjusted annual life rate showed a downward trend (decline range: 0.95%, 95% confidence interval [CI], from −1.00% to − 0.89%). In addition, smoking and unsafe sex were the main attributable hazard factors in most GBD regions. Conclusions. In the past three decades, the increase in the global burden of cervical cancer is mainly concentrated in underdeveloped regions (concentrated in low SDI). On the contrary, in countries with high sustainable development index, the burden of cervical cancer tends to be reduced. Alarmingly, ASIR in areas with low SDI is on the rise, which suggests that policy makers should pay attention to the allocation of public health resources and focus on the prevention and treatment of cervical cancer in underdeveloped areas, so as to reduce its incidence rate, mortality, and prognosis.