Recommendations on management of gynecological malignancies during the COVID-19 pandemic: perspectives from Chinese gynecological oncologists

Yingmei Wang,Shiqian Zhang,Lihui Wei,Zhongqiu Lin,Xinyu Wang,Jianliu Wang,Keqin Hua,Manhua Cu,Jiandong Wang,Shixuan Wang,Wen Di,Yudong Wang,Ruifang An,Mingrong Xi,Ruixia Guo,Qi Zhou,Xing Xie,Fengxia X 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratorysyndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk ofbeing infected with the coronavirus and are more likely to develop severe complications, ascompared to the general population. The increasing spread of COVID-19 presents challengesfor the clinical care of patients with gynecological malignancies. Concerted efforts should beput into managing gynecological malignancies in an orderly manner by strictly implementingthe measures that are specifically developed for controlling the spread of COVID-19. We havedrafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemicbased on our experience on controlling COVID-19 pandemic in China. We recommendthat patients with gynecological malignancies should be managed in hierarchical andindividualized manners in combination with local conditions related to COVID-19. Medicalcare decision should be balanced between controlling COVID-19 pandemic spread and timelydiagnosis and treatment for gynecologic oncology patients.

Prognostic significance of lymphovascular space invasion in patients with endometrioid endometrial cancer: a retrospective study from a single center

Yibo Dai,Yangyang Dong,Yuan Cheng,Hongyi Hou,Jingyuan Wang,Zhiqi Wang,Jianliu Wang 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.3

Objective: This study aims to analyze factors associated with lymphovascular space invasion (LVSI) and evaluate the prognostic significance of LVSI in Chinese endometrioid endometrial cancer (EEC) patients. Methods: Five-hundred eighty-four EEC patients undergoing surgery in our center from 2006 to 2016 were selected for analysis. Univariate analysis and multivariate logistic regression were used to examine relevant factors of LVSI. To evaluate the prognostic role of LVSI, survival analyses were conducted. In survival analyses, both multivariate Cox regression and propensity score matching were used to control the confounders. Results: The incidence of LVSI was 12.16% (71/584). Diabetes history (p=0.021), lymph node metastasis (p=0.005), deep myometrial invasion (p<0.001) and negative PR expression (p=0.007) were independently associated with LVSI. Both Kaplan-Meier method and univariate Cox regressions showed LVSI negative and positive cases had similar tumor-specific survival (TSS) and disease-free survival (DFS). After adjusting for the influence of adjuvant therapy and other clinicopathological factors with multivariate Cox regressions, LVSI still could not bring additional survival risk to the patients (p=0.280 and p=0.650 for TSS and DFS, respectively). This result was verified by Kaplan-Meier survival analyses after propensity score matching (p=0.234 and p=0.765 for TSS and DFS, respectively). Conclusion: LVSI does not significantly compromise the survival outcome of Chinese EEC patients.

The 2018 Beijing-Seoul-Tokyo Obstetrics and Gynecology Summit Forum

( Xiuli Sun ),( Yang Zhao ),( Yiqin Wang ),( Seung-cheol Kim ),( Aikou Okamoto ),( Jianliu Wang ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.5

Serum calcium is a novel parameter to assess metabolic syndrome in endometrial carcinoma

Yanying Lin,Jingyi Zhou,Linlin Cao,Juan Hao,Lijun Zhao,Jianliu Wang,Qi Xu 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objectives: To investigate the distribution of serum calcium and the relationship between serum calcium and serum metabolic parameters in endometrial carcinoma (EC) patients. Methods: Retrospective assessment of patients diagnosed with endometrial cancer from Peking University People's Hospital from 2004 to 2009. Clinical characteristics as well as pretreatment serum calcium, albumin, fasting plasma glucose (FPG), serum triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC) value were extracted from patient records. Serum calcium was corrected for albumin. Unpaired t test and analysis of covariance were used to compare serum calcium among categorical variables. Simple correlation analyses and partial correlation analyses were used to assess the associations between serum calcium and continuous variables. Results: Two-hundred twenty patients were included in this study. After adjusting for confounders, postmenopausal patients had higher total serum calcium (p=0.002) and albumin-corrected serum calcium (p=0.012) than premenopausal patients, endometrioid endometrial carcinoma (EEC) patients had higher total serum calcium than nonendometrioid endometrial carcinoma (NEEC) patients (p=0.037). Significant positive correlations were found between total serum calcium and FPG (p=0.017), TG (p=0.043), HDL (p=0.042), LDL (p<0.001), and TC (p<0.001) after adjusting for multiple variables, and the corrected serum calcium showed no significant correlation with metabolic parameters. Conclusion: Total serum calcium might be a more sensitive parameter for metabolic syndrome in endometrioid endometrial cancer patients than lipids.

Development and validation of a prognostic model based on metabolic risk score to predict overall survival of endometrial cancer in Chinese patients

Xingchen Li,Xiao Yang,Yuan Cheng,Yangyang Dong,Jingyuan Wang,Jianliu Wang 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.6

Objective: Metabolic syndrome (MetS) is closely related to the increased risk and poor prognosis of endometrial cancer (EC). The purpose of this study was to analyze the relationship between metabolic risk score (MRS) and EC, and establish a predictive model to predict the prognosis of EC. Methods: A retrospective study was designed of 834 patients admitted between January 2004 to December 2019. Univariate and multivariate Cox analysis were performed to screen independent prognostic factors for overall survival (OS). A predictive nomogram is built based on independent risk factors for OS. Consistency index (C-index), calibration plots and receiver operating characteristic curve were used to evaluate the predictive accuracy of the nomogram. Results: The patients were randomly divided into training cohort (n=556) and validation cohort (n=278). The MRS of EC patients, ranging from −8 to 15, was calculated. Univariate and multivariate Cox analysis indicated that age, MRS, FIGO stage, and tumor grade were independent risk factors for OS (p<0.05). The Kaplan–Meier analysis demonstrated that EC patients with low score showed a better prognosis in OS. Then, a nomogram was established and validated based on the above four variables. The C-index of nomogram were 0.819 and 0.829 in the training and validation cohorts, respectively. Patients with high-risk score had a worse OS according to the nomogram. Conclusion: We constructed and validated a prognostic model based on MRS and clinical prognostic factors to predict the OS of EC patients accurately, which may help clinicians personalize prognostic assessments and effective clinical decisions.

Identification of an immune-related risk signature and nomogram predicting the overall survival in patients with endometrial cancer

Yuan Cheng,Xingchen Li,Yibo Dai,Yangyang Dong,Xiao Yang,Jianliu Wang 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.3

Objective: Aimed to construct an immune-related risk signature and nomogram predictingendometrial cancer (EC) prognosis. Methods: An immune-related risk signature in EC was constructed using the least absoluteshrinkage and selection operator regression analysis based on The Cancer Genome Atlas(TCGA) and Gene Expression Omnibus (GEO) databases. A nomogram integrating theimmune-related genes and the clinicopathological characteristics was established andvalidated using the Kaplan-Meier survival curve and receiver operating characteristic (ROC)curve to predict the overall survival (OS) of EC patients. The Estimation of STromal andImmune cells in MAlignant Tumor tissues using Expression data (ESTIMATE) R tool wasused to explore the immune and stromal scores. Results: CCL17, CTLA4, GPI, HDGF, HFE2, ICOS, IFNG, IL21R, KAL1, NR3C1, S100A2, andS100A9 were used in developing an immune-related risk signature evaluation model. TheKaplan-Meier curve indicated that patients in the low-risk group had better OS (p<0.001). The area under the ROC curve (AUC) values of this model were 0.737, 0.764, and 0.782 for the3-, 5-, and 7-year OS, respectively. A nomogram integrating the immune-related risk modeland clinical features could accurately predict the OS (AUC=0.772, 0.786, and 0.817 at 3-, 5-,and 7-year OS, respectively). The 4 immune cell scores were lower in the high-risk group. Forkhead box P3 (FOXP3) and basic leucine zipper ATF-like transcription factor (BATF)showed a potential significant role in the immune-related risk signature. Conclusion: Twelve immune-related genes signature and nomogram for assessing the OS ofpatients with EC had a good practical value.

Fertility and prognosis assessment between bleomycin/etoposide/cisplatin and paclitaxel/carboplatin chemotherapy regimens in the conservative treatment of malignant ovarian germ cell tumors: a multicenter and retrospective study

Ran Chu,Penglin Liu,Jingying Chen,Xiaodong Cheng,Kezhen Li,Yanci Che,Jianliu Wang,Li Li,Xi Zhang,Shu Yao,Li Song,Ying Zhao,Changzhen Huang,Ying Xue,Xiyu Pan,Junting Li,Zhongshao Chen,Jie Jiang,Beihua 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.2

Objective: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (PC) chemotherapy regimens on the fertility and prognostic outcomes in malignant ovarian germ cell tumor (MOGCT) patients who underwent fertility-sparing surgery (FSS). Methods: A propensity score matching algorithm was performed between the BEP and PC groups. The χ2 test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS) and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factor of DFS. Results: We included 213 patients, 185 (86.9%) underwent BEP chemotherapy, and 28 (13.1%) underwent PC chemotherapy. The median age was 22 years (range, 8–44 years), and the median follow-up period was 63 months (range, 2–191 months). Fifty-one (29.3%) patients had a pregnancy plan, and 35 (85.4%) delivered successfully. In the before and after propensity score matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during-pregnancy status, and live birth between the BEP and PC groups (p>0.05). Fourteen (6.6%) patients experienced recurrence, including 11 (5.9%) in the BEP group and 3 (10.7%) in the PC group. Four (1.9%) patients in the BEP group died. Kaplan-Meier analysis revealed no significant differences in DFS (p=0.328) and OS (p=0.446) between the BEP and PC groups, and the same survival results were observed in the after matching cohort. Conclusion: The PC regimen is as safe as the BEP regimen for MOGCT patients with fertility preservation treatment, and no differences were observed in fertility and clinical prognosis.

Genomic and Transcriptomic Characterization Revealed the High Sensitivity of Targeted Therapy and Immunotherapy in a Subset of Endometrial Stromal Sarcoma

Nan Kang,Yinli Zhang,Shichao Guo,Ran Chen,Fangzhou Kong,Shuchun Wang,Mingming Yuan,Rongrong Chen,Danhua Shen,Jianliu Wang 대한암학회 2023 Cancer Research and Treatment Vol.55 No.3

Purpose The unique chromosomal rearrangements of endometrial stromal sarcoma (ESS) make it possible to distinguish high-grade ESS (HGESS) and low-grade ESS (LGESS) from the molecular perspective. Analysis of ESS at the genomic and transcriptomic levels can help us achieve accurate diagnosis of ESS and provide potential therapy options for ESS patients.Materials and Methods A total of 36 ESS patients who conducted DNA- and/or RNA-based next-generation sequencing were retrospectively enrolled in this study. The molecular characteristics of ESS at genomic and transcriptomic levels, including mutational spectrum, fusion profiles, gene expression and pathway enrichment analysis and features about immune microenvironment were comprehensively explored.Results <i>TP53</i> and <i>DNMT3A</i> mutations were the most frequent mutations. The classical fusions frequently found in <i>HGESS</i> (<i>ZC3H7B-BCOR</i> and <i>NUTM2B-YWHAE</i>) and LGESS (<i>JAZF1-SUZ12</i>) were detected in our cohort. <i>CCND1</i> was significantly up-regulated in HGESS, while the expression of <i>GPER1</i> and <i>PGR</i> encoding estrogen receptor (ER) and progesterone receptor (PR) did not differ significantly between HGESS and LGESS. Actionable mutations enriched in homologous recombination repair, cell cycle, and phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathways were detected in 60% of HGESS patients. Genes with up-regulated expression in HGESS were significantly enriched in five immune-related pathways. Most HGESS patients (85.7%) had positive predictors of immunotherapy efficacy. Moreover, immune microenvironment analysis showed that HGESS had relatively high immune infiltration. The degree of immune infiltration in HGESS patients with <i>ZC3H7B-BCOR</i> fusion was relatively higher than that of those with <i>NUTM2B-YWHAE</i> fusion.Conclusion This study investigated the molecular characteristics of ESS patients at the genomic and transcriptomic levels and revealed the potentially high sensitivity of targeted therapy and immunotherapy in a subset of HGESS with specific molecular features, providing a basis for guiding decision-making of treatment and the design of future clinical trials on precision therapy.

Asian Society of Gynecologic Oncology International Workshop 2018

공태욱,유희석,김승철,Takayuki Enomoto,Jin Li,Kenneth H. Kim,심승혁,Peng-Hui Wang,Suwanit Therasakvichya,Yusuke Kobayashi,이마리아,Ting-Yan Shi,이신화,Mikio Mikami,Satoru Nagase,임명철,Jianliu Wang,Sarikapan Wilailak,김상운,홍숙 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2

The Asian Society of Gynecologic Oncology International Workshop 2018 on gynecologic oncology was held in the Ajou University Hospital, Suwon, Korea on the 24th to 25th August 2018. The workshop was an opportunity for Asian doctors to discuss the latest findings of gynecologic cancer, including cervical, ovarian, and endometrial cancers, as well as the future of fertility-sparing treatments, minimally invasive/radical/debulking surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. Clinical guidelines and position statement of Asian countries were presented by experts. Asian clinical trials for gynecologic cancers were reviewed and experts emphasized the point that original Asian study is beneficial for Asian patients. In Junior session, young gynecologic oncologists presented their latest research on gynecologic cancers.