Abstract:Ovarian cancer is a common gynecological tumor with the highest mortality rate, which has repeated recurrence and poor efficacy. It is an urgent clinical problem to be solved. Ovarian cancer is expected to improve the survival time and quality of life of patients with whole-course management based on the progress of targeted and immunotherapy, the diagnosis and thinking of recurrent ovarian cancer are initiated, and the standardized management of ovarian cancer throughout its life cycle is further proposed.

Abstract:Ovarian cancer is one of the most challenging gynecologic malignancies. The majority of patients tend to present late with advanced stage of disease given the lack of symptoms and no effective screening tests available. The 5-year overall survival has not obviously been improved nearly two decades. Although many patients display a good initial response to these conventional therapies, most of them experience relapse and ultimately develop platinum resistance, which makes the treatment and the choices more and more difficult. In recent years, a great deal of research has been devoted to targeted therapies. The application of poly-ADP ribose polymerase inhibitors (PARPi) is revolutionizing the treatment of epithelial ovaries. This article summarizes the current situations of PARPi-related genetic testing, maintenance treatment at initial and recurrent ovarian cancer, post-line treatment at recurrent ovarian cancer and related focal issues, in order to provide a reference for better clinical application of PARPi.

Abstract:Neoadjuvant chemotherapy and interval cytoreductive surgery have gradually become one of the mainstream modes for treating advanced epithelial ovarian cancer, but there are still many problems in their clinical application which need to be considered. This article describes the value and controversies of the application of neoadjuvant chemotherapy in patients with advanced ovarian cancer, in order to arouse the attention and in-depth thinking of the majority of gynecological oncologists, and promote the rational application and clinical research of neoadjuvant chemotherapy.

Abstract:Objective:　To discuss the expression of CD147 [extracellular matrix metalloprotein inducer (EMMPRIN)]mediated by specific protein (SP1), the activation of hypoxia inducible factor-1α (HIF-1α), and the effect of vascular endothelial growth factor (VEGF) signaling pathway on angiogenesis in ovarian cancer. Methods:　The angiogenesis is the critical step in tumorigenesis. Most malignant tumors have dense angiogenesis and grow fast, which is due to the tumor cells can secrete many kinds of growth factors themselves to induce angiogenesis. Therefore, angiogenesis plays an important role in the development and metastasis of tumors and inhibition of it will significantly prevent the development and metastasis of tumor tissues.In vitro angiogenesis assay could simulate the procession of tumor angiogenesis well. In this study, the experiment was divided into overexpression group (OE group), silencing group (SI group), CONTROL group (CONTROL group), and negative CONTROL group (NC group). By silencing or over-expressing of SP1 or CD147 in ovarian cancer cell line SKOV3, blocking HIF-1α/VEGF signal pathway with HIF-1α protein translation inhibitor KC7F2, and then using culture supernatants to act on human umbilical vein endothelial cells (HUVEC-12), in vitro angiogenesis assay was carried out to simulate tumor angiogenesis changes. Meanwhile, fluorescence real-time quantitative PCR (RT-qPCR) was used to examine the expressions of CD147 and VEGF in the cells. Results:　The amount of vascular arborizations in NC group (206.33±16.03) was more than that in SI-CD147 group (137.00±15.09). The mRNA level of CD147 in OE-SP1 group (2.38±0.26) was higher than that in SI-SP1 group (0.55±0.12). The amount of vascular arborizations in SI-SP1+OE-CD147 group (200.00±19.52) was more than that in SI-SP1 group (130.00±12.01). The amount of vascular arborizations in OE-CD147 group (373.67±29.02) was more than that in OE-CD147+KC7F2 group (187.00±19.52). The molecular level of VEGF in OE-CD147 group (4.05±0.09) was higher than that in OE-CD147+KC7F2 group (1.02±0.11). Conclusion:　The expression of CD147 increases in ovarian cancer, and the upstream transcription factor SP1 is able to upregulate the expression of CD147, thereby activating HIF-1α/VEGF signaling pathway to promote the angiogenesis of ovarian cancer, and ultimately leading to the pathogenesis of ovarian cancer.

Abstract:Objective:　To clarify the risk factors for venous thromboembolism (VTE) in women with ovarian malignant tumor. Methods:　The data of 345 patients with ovarian malignant tumor admitted to the department of gynecological oncology of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 1, 2015 to June 30, 2018 were analyzed retrospectively, among which 31 cases had VTE and 314 cases didn't. The patients'age, height, weight, surgical-pathological stage, pathological type and level of tumor markers were compared, so as to study the risk factors of VTE in patients with ovarian malignant tumor. Results:　Our analysis showed that there were significant differences in surgical-pathological stage and age among the ovarian malignant tumor patients with VTE and those without (P<0.05), and there was no significant difference between body mass index (BMI) and pathology type (P>0.05). There was also no significant difference among tumor markers (AFP, CEA, CA125, CA199, CA724, HE4) (P>0.05).Logistic analysis suggested that surgical-pathological stage was an independent risk factor of VTE in women with ovarian malignant tumor. Conclusion:　Age and surgical-pathological stage are risk factors of VTE in women with ovarian malignant tumor. The prevention and monitoring of thrombosis should be focused on the elderly and patients with advanced tumor.

Abstract:Objective:　To observe the clinical efficacy and safety of apatinib in the maintenance treatment of platinum-resistant recurrent ovarian cancer after second-line chemotherapy. Methods:　This study collected 36 patients diagnosed with platinum-resistant recurrent ovarian cancer, and who had received at least 4 courses of non-platinum second-line chemotherapy and had achieved clinical remission or stabilization. Then they were given apatinib with initial dose of 500 mg every day for maintenance treatment until disease progressed or toxic side effects were intolerable. In combination with the response evaluation criteria in solid tumors (RECIST) 1.0 and CA125 and HE4 two measures as the synthesis evaluation of curative effect, according to the National Cancer Institute (NCI) of the common toxic standard version 3.0 of BEV, the paclitaxel and platinum drug adverse reaction of chemotherapy were graded. Results:　The objective response rate (ORR) of 36 patients was 52.2%, and the disease control rate (DCR) was 69.4%. Among 19 patients who achieved partial remission, the median duration of remission was 8.1 months (2.5-23.1), of which 12 patients (63.2%) had a remission duration equal to or greater than 6 months. Among the 6 patients with stable disease evaluation, the median stable duration was 5.85 months, and 3 patients had stable disease duration of 6 months or longer. Patients who orally took apatinib 250 mg daily could be well tolerated. Conclusion:　Apatinib in the maintenance treatment of platinum-resistant recurrent ovarian cancer after second-line chemotherapy is safe and effective.

Abstract:Cervical cancer is a tumor with high incidence for female in China. Surgery and radiotherapy are the main treatment methods. Radiotherapy of cervical cancer has made a lot of progress in recent years, but there are still some controversies in the aspects of radiotherapy indication, radiotherapy mode, target volume delineation, and combination of radiotherapy and chemotherapy. In this paper, some uncertain problems and recent research progress in radiotherapy of cervical cancer are reviewed.

Abstract:The prognosis of recurrent and metastatic cervical cancer is very poor. The risk prediction of the recurrence and metastasis after initial treatment is very important for reducing the recurrence rate of cervical cancer and prolonging the survival. MRI is an important imaging method for cervical cancer diagnosis, and it plays an important role in the diagnosis, efficacy evaluation and prognosis prediction. The article focuses on MRI to elaborate the progress of predicting the recurrence and metastasis of cervical cancer after radiotherapy and chemotherapy.

Abstract:Objective:　To compare the accuracy of ¹⁸F-FDG PET/CT in measuring the tumor metabolic volume (MTV) of primary tumor volume of cervical squamous cell carcinoma based on different thresholds of maximum standardized uptake value (SUV_max) (iterative adaptive algorithm and 30%, 40%, 50%). Methods:　All the included patients withⅠB-ⅣA stage cervical squamous cell carcinoma underwent ¹⁸F-FDG PET/CT and MRI. Threshold MTV method was used to calculate the lesion volumes with different fixed thresholds (30%, 40% and 50% SUV_max) and MTV iterative method was used to calculate the lesion volume directly through AW VolumeShare5 system, and MRI was used to measure the tumor volume in transverse and sagittal position on T2WI by Reformat software. Taking MRI measurement results (MRIv) as the "gold standard", the differences between the results of different MTV measurement methods and MRI were compared, and the linear fitting and correlation analysis were conducted between MTVs and MRIv, and finally the ROC curve was drawn to compare the accuracy. Results:　A total of 117 patients met the inclusion criteria. The MTV_30%method and the MTV_iterativemethod were closest to MRIv results, with linear correlation closer to the diagonal; the MTV_iterativemethod had the strongest correlation with MRIv (r=0.98, P=0.000), followed by MTV_30% (r=0.96, P=0.000); the ROC curve showed that the MTV_30%method and the MTV_iterative method were close to the measurement of lesions (z=0.145, P=0.885). Conclusion:　MTV_iterativemethod and MTV_30%methods are more accurate in the calculation of lesion size and target delineation of cervical squamous cell carcinoma, which can be used as a reliable basis for the diagnosis and treatment of cervical squamous cell carcinoma.

Abstract:Objective:　To explore the expression of protein associated with phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway in the pathological tissues of patients with cervical cancer, and to analyze the relationship between its expression level and clinical pathological parameters and prognosis of patients. Methods:　The biopsy and surgical cervical cancer specimens of 61 patients with cervical cancer who were treated in The First People's Hospital of Zunyi from January 2016 to January 2018 were collected. The expression of PI3K, p-Akt, and p-mTOR was detected by immunohistochemistry. The relationship between the expressions of PI3K, Akt, mTOR and clinicopathological characteristics of patients with cervical cancer was analyzed by multivariate logistic regression model, and the relationship between the expressions of PI3K, Akt, mTOR and prognosis of patients with cervical cancer was analyzed by Kaplan-Meier survival curve. Results:　The positive rates of PI3K, p-Akt and p-mTOR in cervical cancer tissues were higher than those in para-cancerous tissues (χ²=64.050, P=0.000; χ²=58.607, P=0.000; χ²=56.637, P=0.000). The expressions of mTOR in cervical cancer patients aged≥45 years were higher than those in patients aged<45 years (χ²=4.163, P=0.041). The expressions of PI3K, Akt, and mTOR in cervical cancer patients with clinical stagesⅢandⅣwere higher than those in patients with clinical stagesⅠandⅡ (χ²=5.610, P=0.018; χ²=5.450, P=0.020; χ²=8.606, P=0.003). The expressions of PI3K, Akt, and mTOR in cervical cancer patients with low-degree of differentiation were higher than those in patients with medium and high-degree of differentiation (χ²=7.062, P=0.029; χ²=10.526, P=0.005; χ²=7.714, P=0.021). The expressions of PI3K, Akt and mTOR in cervical cancer patients with lymph node metastasis were higher than those in patients without lymph node metastasis (χ²=5.643, P=0.018; χ²=6.336, P=0.012; χ²=5.030, P=0.025). There was no statistical difference in the expression levels of PI3K, Akt, and mTOR in cervical cancer patients with different body mass index, menstrual status, tumor diameter, and histological classification (P>0.05). Multivariate logistic analysis showed that the clinical stage, degree of differentiation, and lymph node metastasis of patients with cervical cancer were all independent factors influencing the expression of PI3K, Akt, and mTOR (P<0.05). The median survival time of PI3K, p-Akt, and p-mTOR positive patients were all lower than that of negative patients (P<0.05). Conclusion:　There are high expressions of PI3K, Akt, and mTOR in patients with cervical cancer. Clinical stage, degree of differentiation, and lymph node metastasis are all independent factors influencing the expression of PI3K, Akt, mTOR, and the prognosis of patients with high expression is poor.

Abstract:Objective:　To investigate the therapeutic status and clinical curative effects of patients with locally advanced cervical cancer (LACC) who underwent neoadjuvant chemotherapy (NACT) before radiotherapy. Methods:　Totally 150 cases of LACC (IB2-IVA) admitted to Chongqing University Cancer Hospital from January 2013 to December 2017 were collected in this study. All patients underwent NACT before radiotherapy. The therapeutic status and myelosuppression were evaluated, and the overall survival (OS) and progression-free survival (PFS) of 1 year and 3 years were analyzed. Results:　The concurrent chemotherapy for 36 cases (24%) were not administered during radiotherapy, and 48 cases (42.11%) did not complete the full course of chemotherapy among patients receiving concurrent chemotherapy. The duration of radiotherapy for 55 cases (36.67%) were more than 56 days. The GradeⅢor higher myelosuppression were occurred in 71 patients (47.33%). The recent objective response rate (ORR) was 84.66%, but the complete response (CR) was only 25.33%. A total of 112 cases (74.67%) were given various forms of follow-up adjuvant therapy. The OS and PFS of 1 year and 3 years were 90.0% and 66.7%, and 66.7% and 46.7%, respectively. Conclusion:　The NACT before radiotherapy for LACC patients reduces the tolerance to radiation therapy, prolongs the duration of radiotherapy, affects the implementation of concurrent chemotherapy, and the prognosis of LACC patients is not improved because the OS and PFS are not prolonged.

Abstract:Objective:　To analyze the effect of the clinicopathological features and different surgical approaches on the prognosis of cervical cancer and the choice of appropriate postoperative treatment. Methods:　A total of 217 patients with FIGO 2018 stageⅠA2-ⅡA1 cervical cancer, excluding stageⅠB3, admitted to our hospital from January 2013 to September 2018 were selected in this study. There were two surgical approaches: laparotomy and laparoscopy. The risk factors were assessed after surgery. The patients were divided into radiotherapy group, chemotherapy group and chemoradiotherapy group for postoperative adjuvant therapy. The efficacy and adverse reactions are evaluated. Results:　Of the 217 patients, 122 underwent laparoscopic surgery and 95 underwent laparotomy, and there was no significant difference in the prognosis between the two surgical approaches. Postoperative pathology showed that only deep stromal invasion accounted for 48.85%, only lymphovascular space invasion accounted for 9.22%, two intermediate risk factors accounted for 28.57%, and three intermediate risk factors accounted for 4.61%.Lymphovascular space invasion had an adverse effect on progression-free survival time and overall survival of patients, and was an independent prognostic factor for stageⅠA2-ⅡA1 cervical cancer, which was significantly different from the group without lymphovascular space invasion. There was no significant difference in progression-free survival time and overall survival among the groups in the radiotherapy, chemotherapy, and chemoradiotherapy groups. The main adverse reaction of treatment was myelosuppression, and gradeⅢ/Ⅳmyelosuppression had the highest incidence in the chemoradiotherapy group. The above adverse reactions were relieved after symptomatic treatment, without treatment-related death. Conclusion:　Radiotherapy is recommended as a postoperative adjuvant treatment for stageⅠA2-ⅡA1 cervical cancer.

Abstract:Objective:　To compare the effectiveness and long-term side effects of adjuvant therapy for patients with cervical cancer (IB1-IIA2) with intermediate-risk factors in pathology after chemotherapy alone or concurrent radiotherapy and chemotherapy, and to evaluate the quality of life and explore the feasibility of using chemotherapy alone for cervical cancer patients. Methods:　Cervical cancer patients with intermediate risk factors after surgery in the Department of Gynecological Oncology, The First Affiliated Hospital of USTC West District/Anhui Provincial Cancer Hospital from February 2016 to April 2018 were retrospectively analyzed in this study. All patients underwent standard cervical cancer surgery, and were divided into chemotherapy group and concurrent radiotherapy and chemotherapy group according to the adjuvant treatment methods after surgery. The clinical efficacy and safety of the two adjuvant treatments were discussed through the indicators of treatment effectiveness, long-term toxic side effects and quality of life of the two groups. Results:　There was no significant difference in cervical cancer recurrence (χ²=0.288, P=0.591) and mortality (χ²=0.238, P=0.625) between the two groups. The 3-year progression-free survival (87.70%) and 3-year overall survival (97.60%) of the radiotherapy and chemotherapy group were lower than those of chemotherapy group (81.40% and 89.70%, respectively), without significant differences (χ²=0.787, P=0.375; χ²=1.441, P=0.230). The incidence of lymphedema in the chemotherapy group (16.70%) was lower than that of the radiotherapy and chemotherapy group (37.21%), with significant differences (χ²=4.543, P=0.033). The quality of life scores of the chemotherapy group (88.28±5.84) were higher than those of the radiotherapy and chemotherapy group (78.60±8.32), with significant differences (t=6.020, P<0.001). Conclusion:　Chemotherapy alone for adjuvant treatment of patients with intermediate risk factors after radical resection of IB1-IIA2 cer-vical cancer can also achieve better clinical results, and the side effects are slightly lighter than those in the radiotherapy and chemotherapy group, which can be used as an alternative adjuvant treatment.

Abstract:Objective:　To explore a reasonable treatment for patients with vaginal stump cancer after hysterectomy for cervical intraep ithelial neoplasia (CIN). Methods:　A retrospective analysis was made on the clinical data of 24 patients who were diagnosed with vaginal stump cancer after hysterectomy for CIN from January 2011 to December 2019 in Chongqing University Cancer Hospital. The mean age was (55.83±7.64) years. The duration from the first operation to vaginal stump cancer was (54.83±36.23) months. And 83.33% (20/24) of the patients were high-risk HPV positive. Among them, 2 patients were treated with surgery alone, 7 patients with surgery combined radiation±chemotherapy, 11 patients with radiation and chemotherapy, and 4 patients gave up treatment. Results:　Twenty patients were followed up after treatment. One patient was lost. The mean follow-up time was (44.95±32.98) months, 2 of 19 patients died, and the overall survival rate was 89.47%. Conclusion:　Prevention is more important for patients with vaginal stump cancer after CIN, and treatment should follow the principle of individualization.

Abstract:Objective:　To analyze the prognostic relationship between Human papillomavirus (HPV) -infection and endocervical adenocarcinoma (ECA) of the uterine cervix, so as to provide a reference for clinical work. Methods:　Clinical data of 468 ECA patients screened from SEER Database were divided into HPVA (HPV-associated adenocarcinoma) and NHPVA (non-HPV-associated Adenocarcinoma) group, followed by a retrospective analysis, which were statistically analyzed using Chi-square test, Fisher test, K-M method, log-rank test and Cox regression. Results:　There were significant differences in stage and tumor differentiation grade between the two groups. Compared with HPVA group, the stage of NHPVA group was later (P=0.001), and the tumor differentiation was worse (P<0.05). The NHPVA group had a significantly higher cancer-related mortality (70/205, 34.1%) than HPVA group (53/263, 20.2%). The prognosis was significantly worse in NHPVA group than HPVA group (P=0.001). The cancer-related mortality was significantly different (P=0.002) within the 5 sub-groups of mucinous, gastic type, villoglandular, clear cell, and serous carcinoma, while the serous type had the worst prognosis. Conclusion:　It is important to classify the ECA into HPVA and NHPVA for clinical work in the future.

Abstract:Objective:　To explore the correlation between the apparent diffusion coefficient (ADC) of endometrioid adenocarcinoma based on histogram analysis and the expression of estrogen receptor (ER), progesterone receptor (PR), tumor suppressor gene P53 and proliferating antigen Ki67. Methods:　A total of 68 patients who underwent magnetic resonance imaging before surgery and whose pathology was confirmed to be endometrioid adenocarcinoma were analyzed. Semi-quantitative immunohistochemical scoring was performed. Relevant software was used to delineate the region of interest (ROI) of the whole tumor on the ADC map at each level, excluding cystic degeneration, necrosis, and bleeding areas. Histogram analysis was performed to obtain ADC histogram parameters, including mean, mode, kurtosis, skewness, minimum, maximum, 5th, 25th, 50th, 75th, and 95th percentiles. Spearman correlation analysis was used to statistically analyze the correlation between ADC histogram parameters and immunohistochemical expression. Results:　The mean, mode, 5th, 25th, 50th, 75th and 95th percentiles of the ADC histogram parameters were negatively correlated with Ki67 expression (correlation coefficient and P value were r=-0.394, P=0.001; r=-0.373, P=0.002; r=-0.294, P=0.015; r=-0.359, P=0.003; r=-0.409, P=0.001; r=-0.371, P=0.002; r=-0.396, P=0.001, respectively); the mode, 5th, 25th and 50th percentiles were negatively correlated with P53 expression (correlation coefficient and P value were r=-0.307, P=0.011; r=-0.242, P=0.047; r=-0.252, P=0.038; r=-0.254, P=0.036, respectively), the skewness value was positively correlated with P53 expression (r=0.345, P=0.004). There was no significant correlation between the histogram parameters and the expression of ER and PR (P>0.05). Conclusion:　ADC histogram parameters had a certain correlation with the expression of P53 and Ki67 in endometrioid adenocarcinoma, but had no obvious correlation with the expression of ER and PR in endometrioid adenocarcinoma. ADC values can indirectly reflect clinicopathological characteristics to a certain extent and provide more information for clinical personalized treatment.

Abstract:Objective:　To initially determine the critical values of the immunohistochemical parameters estrogen receptor (ER) and progesterone receptor (PR) in endometrial cancer, and to better evaluate the significance of ER and PR as prognostic and predictive indicators of endometrial cancer. Methods:　A total of 473 patients with stageⅠ-Ⅲendometrial cancer who underwent surgical treatment were included in this study. The receiver operating characteristic curve (ROC curve) and the Jordan index were used to determine the critical values of the immunohistochemical parameters ER and PR for predicting the recurrence of endometrial cancer. Cox regression model was used to analyze the correlation between the factors and the prognosis of endometrial cancer. Results:　The optimal critical values of ER and PR for predicting recurrence of patients with stageⅠ-Ⅲendometrial cancer are 45% and 33%, respectively. Univariate analysis showed that ER (Wald=57.948, P=0.000) and PR (Wald=50.538, P=0.000) were risk factors for endometrial cancer recurrence. Multivariate analysis showed that ER (Wald=9.076, P=0.003) was an independent risk factor for endometrial cancer recurrence. Conclusion:　When the critical value of ER and PR was 45% and 33% respectively, it is most suitable for predicting the recurrence of endometrial cancer.

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