Fertility-preserving treatment outcome in endometrial cancer or atypical hyperplasia patients with polycystic ovary syndrome

Lulu Wang,Xuezhen Luo,Qian Wang,Qiaoying Lv,Pengfei Wu,Wei Liu,Xiaojun Chen 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.5

Objective: This study aimed to investigate the impact of polycystic ovary syndrome (PCOS) on fertility-sparing treatment in young patients with atypical endometrial hyperplasia (AEH) or endometrioid endometrial cancer (EEC). Methods: A total of 285 patients with EEC (n=76, FIGO stage IA, without myometrium invasion) or AEH (n=209) who received progestin-based fertility-sparing treatment were evaluated retrospectively. Among the 285 patients, 103 (36.1%), including 70 AEH cases and 33 EEC cases, were diagnosed with PCOS. General characteristics, cumulative 16- and 32-week complete response (CR) rate, pregnancy outcome and recurrence were compared between patients with or without PCOS. Results: The cumulative 16-week CR rate was lower in the PCOS group than in the non- PCOS group (18.4% vs. 33.8%, p=0.006). Patients with PCOS took longer treatment duration to achieve CR (7.0 months vs. 5.4 months, p=0.006) and shorter time to relapse after CR (9.6 months vs. 17.6 months, p=0.040) compared with non-PCOS group. After adjusting for patient age, body mass index, PCOS, homeostasis model assessment-insulin resistance index, and serum testosterone levels, we found that body mass index ≥25 kg/m2 (HR=0.583; 95% CI=0.365–0.932; p=0.024) and PCOS (HR=0.545; 95% CI=0.324–0.917; p=0.022) were significantly correlated with lower 16-week CR rate. Conclusion: PCOS was associated with lower 16-week CR rate, longer treatment duration and shorter recurrence interval in patients with AEH or EEC receiving fertility-preserving treatment.

The prognostic significance of estrogen and progesterone receptors in grade I and II endometrioid endometrial adenocarcinoma: hormone receptors in risk stratification

Jun Guan,Liying Xie,Xuezhen Luo,Bingyi Yang,Hongwei Zhang,Qin Zhu,Xiaojun Chen 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objectives: Although patients with grade I and II endometrioid endometrial adenocarcinoma (EEA) are considered with good prognosis, among them 15%–25% died in 5 years. It is still unknown whether integrating estrogen receptor (ER) and progesterone receptor (PR) into clinical risk stratification can help select high-risk patients with grade I–II EEA. This study was to investigate the prognostic value of ER and PR double negativity (ER/ PR loss) in grade I–II EEA, and the association between ER/PR loss and The Cancer Genome Atlas (TCGA) classification. Methods: ER and PR were assessed by immunohistochemistry on hysterectomy specimens of 903 patients with grade I–II EEA. ER and PR negativity were determined when <1% tumor nuclei were stained. Gene expression data were obtained from the TCGA research network. Results: Compared with ER or PR positive patients (n=868), patients with ER/PR loss (n=35) had deeper myometrial infiltration (p=0.012), severer FIGO stage (p=0.004), and higher rate of pelvic lymph node metastasis (p=0.020). In univariate analysis, ER/PR loss correlated with a shorter progression-free survival (PFS; hazard ratio [HR]=5.25; 95% confidence interval [CI]=2.21–12.52) and overall survival (OS; HR=7.59; 95% CI=2.55–22.60). In multivariate analysis, ER/PR loss independently predicted poor PFS (HR=3.77; 95% CI=1.60–10.14) and OS (HR=5.56; 95% CI=1.37–22.55) for all patients, and poor PFS for patients in stage IA (n=695; HR=5.54; 95% CI=1.28–23.89) and stage II–IV (n=129; HR=5.77; 95% CI=1.57–21.27). No association was found between ER/PR loss and TCGA classification. Conclusion: Integrating ER/PR evaluation into clinical risk stratification may improve prognosis for grade I–II EEA patients.

Structure evolution in carbon molecular sieve membranes derived from binaphthol-6FDA polyimide and their gas separation performance

Guoxiong Deng,Yilei Wang,Xueping Zong,Jiangzhou Luo,Xuezhen Wang,Chunxue Zhang,Song Xue 한국공업화학회 2021 Journal of Industrial and Engineering Chemistry Vol.94 No.-

Here we reported a causal relationship between the molecular structure of binaphthol-based polyimideprecursor and the pore-size distribution of the derived carbon membrane. The binaphthol-basedpolyamide acid is synthesized from 2,20-diol-1,10-binaphthyl-6,60-diamine and 4,40-(hexafluoroisopro-pylidene)diphthalic anhydride (6FDA). Then, an azeotropic imidiaztion method was used to synthesizethe polyimide with naphthol groups (XS1). When the imidization is carried out by using acetic anhydride,the polyimide with acetyl groups (XS4) is achieved. The CMS membranes prepared by pyrolyzing XS1 andXS4 at 500, 550, and 600 ℃ are named using the temperature as the suffix, such as XS1-500. Their poreevolution has been investigated using TGA, FTIR, XRD, and Raman measurements. The trimodal pore-sizedistribution is in the carbon molecular sieve (CMS) membranes derived from XS4 and the CMS onesderived from XS1 exhibit a bimodal pore structure. Among them, XS4-500 exhibits the highest gaspermeabilities of 3332 barrer for CO2, 773 barrer for O2, and 119 barrer for N2. XS1-500 only affords theCO2, O2, and N2 permeabilities of 1086, 230, and 30.2 barrer. The esterification of naphthol not justdisturbs the hydrogen bonds between polyimide chains but also affects the pore generation of thederived CMS membranes. Our work provides an effective way to enhance the gas permeability of a CMSmembrane derived from the binaphthol-based polyimide.

Insulin resistance and overweight prolonged fertility-sparing treatment duration in endometrial atypical hyperplasia patients

Bingyi Yang,Liying Xie,Hongwei Zhang,Qin Zhu,Yan Du,Xuezhen Luo,Xiaojun Chen 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3

Objective: Our previous study showed that insulin resistance (IR) was related to endometrial hyperplasia as well as endometrial cancer. But the exact impact of IR on fertility-sparing treatment in endometrial hyperplasic disease is unclear. This study investigated how IR affects fertility-sparing treatment in endometrial atypical hyperplasia (EAH) patients. METHODS: The 151 EAH patients received fertility-sparing treatment were retrospectively investigated. All patients received high-dose progestin combined with hysteroscopy. Therapeutic effects were evaluated by hysteroscopy every 3 months during the treatment. RESULTS: The median age was 33.0 years old (range, 21-54 years old). Sixty-one patients (40.4%) were insulin resistant. Three patients were excluded from the analysis because they chose hysterectomy within 3 months after initiation of progestin treatment. The 141 out of 148 (95.3%) patients achieved complete response (CR). No difference was found in cumulative CR rate between those with or without IR (90.2% vs. 95.6%, p=0.320). IR significantly affected therapeutic duration to achieve CR (8.1±0.5 months with IR vs. 6.1±0.4 months without IR, p=0.004). Overweight (body mass index [BMI]≥25 kg/m²) was associated with higher risk of treatment failure (odds ratio=5.61; 95% confidence interval=1.11-28.35; p=0.040) and longer therapeutic duration to achieve CR (7.6±0.5 months vs. 6.3±0.4 months, p=0.019). EAH patients with both IR and overweight (IR+BMI+) had the longest therapeutic time compared with other patients (8.8±0.6 months vs. 5.6±0.7, 6.3±0.4, and 6.4±0.8 months for IR-BMI+, IR-BMI-, and IR+BMI-, respectively, p=0.006). CONCLUSION: IR and overweight were associated with longer therapeutic duration in EAH patients receiving progestin-based fertility-sparing treatment.

Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia

Weiwei Shan,Chao Wang,Zhenbo Zhang,Chao Gu,Chengcheng Ning,Xuezhen Luo,Qiongjie Zhou,Xiaojun Chen 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.3

Objective: To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH). Methods: This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy. Results: Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed. Conclusion: Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.