Although the incidence of OM was higher in early-stage ADC than SCC according to ovarian pathology, it might be relatively safe to perform ovarian preservation with early-stage ADC because of low ovarian recurrence rate in short-term follow-ups.
The study population consisted of 105 patients with stage IA to IIB cervical adenocarcinoma (AC) who underwent radical hysterectomy and pelvic lymphadenectomy from three institutions between 1994 and 2015, including 86 patients with bilateral salpingo-oophorectomy (BSO) and 19 patients with ovarian preservation operation. Ovarian metastasis were diagnosed in 3 of 86 patients in BSO group with an incidence rate of 3.5% (3/86). Among the 19 patients with ovarian preservation, none developed an ovarian recurrence in the follow-up (2-71 months). The 5-year overall survival rate of the BSO group and ovarian preservation group were 88.6% and 100%, respectively, with no significant difference (p = .266 > .05). FIGO stage was an independent risk factor of ovarian metastasis for cervical AC (p = .000 < .05). So we concluded that ovarian preservation in young women with early-stage cervical AC may be safe and not associated with an increased risk of overall mortality. Impact statement There has been long-running considerable controversy regarding ovarian preservation in women with cervical AC. The incidence of ovarian metastasis in AC varies significantly from 0% to 12.9%. There were few studies regarding the prognosis and risk factors of cervical AC patients with ovarian preservation. No preoperative selection criteria of ovarian preservation in cervical AC have been officially recommended. In our study of 105 patients with stage IA to IIB cervical AC, the overall ovarian metastasis rate was 3.5% (3/86), and the incidence was 1.5% (1/66) with stage IA to IB. The 5-year overall survival rate of 19 cervical adenocarcinoma patients with ovarian preservation was 100%, and no ovarian recurrence was observed during the follow-up. Our univariate analysis with clinicopathologic variables revealed that only FIGO stage was the risk factor associated with ovarian metastasis of cervical AC. Our data implied that ovarian preservation in young women with early-stage cervical AC might be safe and not associated with an increased risk of overall mortality. Considering the deleterious effects of surgical castration on the long-term quality and quantity of life, we hold that ovarian preservation should be seriously considered in the surgical management of premenopausal women with early-stage cervical AC.
Unilateral cystectomy (19.4%) and serous BOTs (19.2%) are significantly associated with higher recurrence rates, and no negative impact of laparoscopy on recurrence can be demonstrated when compared with laparotomy in the meta-analysis.
Background As we all know, patients with epithelial ovarian carcinoma have poor prognosis and high recurrence rate. It is critical and challenging to screen out the patients with high risk of recurrence. At present, there are some models predicting the overall survival of epithelial ovarian carcinoma, however, there is no widely accepted tool or applicable model predicting the recurrence risk of epithelial ovarian carcinoma patients. The objective of this study was to establish and verify a nomogram to predict the recurrence risk of EOC. Methods We reviewed the clinicopathological and prognostic data of 193 patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy between January 2003 and December 2013 in Peking University First Hospital. The nomogram was established with the risk factors selected by LASSO regression. The medical data of 187 EOC patients with 5-year standard follow-up in Peking University Third Hospital and Beijing Obstetrics and Gynecology Hospital were used for external validation of the nomogram. AUC curve and Hosmer-Lemeshow test were used to evaluate the discrimination and calibration. Results The nomogram for 3-year recurrence risk was established with FIGO stage, histological grade, histological type, lymph node metastasis status and serum CA125 level at diagnosis. The total score can be obtained by adding the grading values of these factors together. The C statistics was 0.828 [95% CI, 0.764–0.884] and the Chi-square value is 3.6 (P = 0.731 > 0.05) with the training group. When the threshold value was set at 198, the sensitivity, specificity, positive predictive value, negative predictive value and concordance index were 88.8, 67.0, 71.8, 86.3% and 0.558 respectively. In the external validation, the C statistics was 0.803 [95%CI, 0.738–0.867] and the Chi-square value is 11.04 (P = 0.135 > 0.05). With the threshold value of 198, the sensitivity, specificity, positive predictive value, negative predictive value and concordance index of the nomogram were 75.7, 77.0, 83.2, 67.9%, and 0.52 respectively. Conclusions We established and validated a nomogram to predict 3-year recurrence risk of patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy. This nomogram with good discrimination and calibration might be useful for screening out the patients with high risk of recurrence.
Background As we all know, patients with epithelial ovarian carcinoma have poor prognosis and high recurrence rate. It is critical and challenging to screen out the patients with high risk of recurrence. At present, there are some models predicting the overall survival of epithelial ovarian carcinoma, however, there is no widely accepted tool or applicable model predicting the recurrence risk of epithelial ovarian carcinoma patients. The objective of this study was to establish and verify a nomogram to predict the recurrence risk of EOC.Methods We reviewed the clinicopathological and prognostic data of 193 patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy between January 2003 and December 2013 in Peking University First Hospital. The nomogram was established with the risk factors selected by LASSO regression. The medical data of 187 EOC patients with 5-year standard follow-up in Peking University Third Hospital and Beijing Obstetrics and Gynecology Hospital were used for external validation of the nomogram. AUC curve and Hosmer-Lemeshow test were used to evaluate the discrimination and calibration.Results The nomogram for 3-year recurrence risk was established with FIGO stage, histological grade, histological type, lymph node metastasis status and serum CA125 level at diagnosis. The total score can be obtained by adding the grading values of these factors together. The C statistics was 0.828 [95% CI, 0.764-0.884] and the Chi-square value is 3.6 (P=0.731>0.05) with the training group. When the threshold value was set at 198, the sensitivity, specificity, positive predictive value, negative predictive value and concordance index were 88.8%, 67.0%, 71.8%, 86.3% and 0.558 respectively. In the external validation, the C statistics was 0.803 [95%CI, 0.738-0.867] and the Chi-square value is 11.04 (P=0.135>0.05). With the threshold value of 198, the sensitivity, specificity, positive predictive value, negative predictive value and concordance index of the nomogram were 75.7%, 77.0%, 83.2%, 67.9%, and 0.52 respectively.Conclusions We established and validated a nomogram to predict 3-year recurrence risk of patients with EOC who achieved clinical complete remission after cytoreductive surgery and chemotherapy. This nomogram with good discrimination and calibration might be useful for screening out the patients with high risk of recurrence.
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