Objective To evaluate the role of systematic lymphadenectomy (SL) vs. unsystematic lymphadenectomy (USL) for improving overall survival (OS) in epithelial ovarian cancer (EOC). Methods The databases such as PubMed, EMbase, The Cochrane Library, Evidence-Based Medicine Reviews (EBMR), CBM, CNKI and VIP were searched between January 1, 1995 and December 31, 2010, the randomized controlled trials (RCTs) and observational studies on SL vs. USL in treating EOC were included. Based on Cochrane handbook, the data were extracted, the methodological quality was assessed, and then meta-analyses were conducted by using RevMan 5.0 software. Results The total 13 studies involving 22 796 patients were included, including 5 420 patients in the SL group, and the other 17 376 patients in the USL group. Two of the 13 studies were RCTs, and the other 11 were observational studies (including 2 studies retrieved from SEER data). The analyses on 2 RCTs showed that compared with USL, a) SL could not improve 5-PFS (OR=0.70, 95%CI 0.40 to 1.22, P=0.21) in early-stage EOC (FIGO I to II), but it did improve 5-PFS (OR=0.62, 95%CI 0.40 to 0.96, P=0.03) in advanced-stage EOC (FIGO III to IV); b) SL could not improve 5-OS in both early-stage EOC (OR=0.84; 95%CI 0.44 to1.58, P=0.58) and advanced-stage EOC (OR=0.93, 95%CI 0.64 to 1.37, P=0.73); and c) SL could not improve 5-OS in both early-stage (OR=0.84, 95%CI 0.44 to 1.58, P=0.58) and advanced-stage (OR=0.93, 95%CI 0.64 to 1.37, P=0.73) of EOC patients who had optimal tumor dubulking surgery. The analyses on observational studies showed that compared with USL, a) SL could not improve 5-PFS in both early-stage EOC (OR=0.38, 95%CI 0.08 to 1.74, P=0.21) and advanced-stage (OR=2.88, 95%CI 0.95 to 8.72, P=0.06) EOC; b) Whether SEER impacts were excluded or not, SL did improve 5-OS in both early-stage EOC (OR=0.54, 95%CI 0.46 to 0.63, Plt;0.000 01) and advanced-stage (OR=0.47, 95%CI 0.43 to 0.52, Plt;0.000 01) EOC; and c) For EOC patients who had optimal tumor dubulking surgery, SL could not improve 5-OS in early-stage (OR=0.32, 95% CI 0.02 to 6.19, P=0.45), but it did improve 5-OS in advanced-stage (OR=0.53, 95%CI 0.32 to 0.88, P=0.01). Conclusion These findings suggest that maybe SL can improve 5-PFS and 5-OS in EOC. However, the efficacy of SL on 5-PFS and 5-OS is still undetermined, so more relevant studies are required for further investigating the role of SL in EOC.
Objective To assess the efficacy and toxicity of the maintenance radiotherapy for epithelial ovarian cancer. Methods We searched MEDLINE (1950 to 2009), EMbase (1966 to 2009), The Cochrane Library (Issue 1, 2009), CBMdisc (1978 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and relevant internet websites to identify randomized controlled trials (RCTs) of maintenance radiotherapy for epithelial ovarian cancer. The quality of the included trials was assessed by Cochrane Systematic Review Handbook. Meta-analyses were conducted by RevMan 5.0 and SPSS 10.0 software. Results A total of 5 RCTs involving 529 patients were identified. The result of meta-analyses showed that the whole-abdominal radiation increased the 5-year progression-free survival (PFS) at RR1.76 and 95%CI 1.13 to 2.73, while it showed no effect on the 5-year overall survival (OS) at RR1.30 and 95%CI 0.96 to 1.76. The main adverse reactions of maintenance radiotherapy for epithelial ovarian cancer included diarrhea and abdominal pains, whose severity was related to radiation dose. Conclusion The whole-abdominal radiation can increase the 5-year PFS while its effect on the 5-year OS needs to be further studied.
Objective To assess the clinical efficacy, safety and cost-effectiveness of topotecan for recurrent epithelial ovarian cancer. Methods We searched MEDLINE (1966 to 2005), EMbase (1989 to 2004), CancerLit (1996 to 2003), CBMdisc (1978 to 2005), CNKI (1994 to 2005), The Cochrane Library (Issue 3, 2005), The National Research Register, and the Health Technology Assessment Database (HTA). Relevant journals were also handsearched. The search was conducted on December 31, 2005. Randomize controlled trials (RCTs) comparing topotecan versus other agents for recurrent epithelial ovarian cancer were included. The quality of the eligible trials was assessed by two reviewers independently. Meta-analysis was performed. Results Four RCTs met the inclusion criteria, and the methodological quality was either level A or B. When used as second-line chemotherapy for recurrent ovarian cancer, there was no significant difference in remission rate between topotecan and paclitaxel or pegylated liposomal doxorubicin (PLD). The clinical benefit rate of topotecan was higher than that of paclitaxel or PLD. Myelosuppression was more frequent in patients in the topotecan group than those in the PLD or paclitaxel group, but it was not severe. As to cost-effectiveness analysis, topotecan was better than PLD. Conclusions The standard regimen of topotecan (intravenous 1.5 mg/m2/d for 5 consecutive days) is recommended for use in platinum-resistant and refractory ovarian cancer.
ObjectiveTo explore the relationship between p53 mutation in 5-8 exons and type of epithelial ovarian cancer (EOC) pathogenesis of Han nationality women. MethodsFrom August 2011 to December 2012, 45 patients with primary EOC (Han nationality women from Sichuan Province) diagnosed surgically and pathologically were selected. Using direct DNA sequencing, we analyzed the mutations of p53 in 5-8 exons of all cases, and the EOC patients were divided into two types according dualism and the pathogenesis results. The p53 mutation of the different types in EOC patients were analyzed. ResultsThe frequency and efficiency of p53 mutation in type-ⅡEOC patients were significantly higher than that in typeⅠ(P < 0.01). And the codon 175 might be a mutational hotspot of type-ⅡEOC. The malignant degree and oviduct involved frequency of type-ⅡEOC were obviously higher than that of type-I EOC; p53 mutation frequency in high malignant patients increased significantly. Conclusionsp53 mutation plays an important role in the development of type-ⅡEOC. The codon 175 might be a mutational hotspot of type-ⅡEOC.
This study aims to explore the temporal pattern of DNA breaks induced by nanosecond electric pulses (nsEP) in cisplatin-sensitive and cisplatin-resistant human ovarian cancer cells. Human ovarian cancer cells A2780 (cisplatin-sensitive subline) and C30 (cisplatin-resistant subline) were exposed to nsEP. Sham exposed groups were shame exposed to nsEP. Cell viability was determined using CCK-8 assay after 0 h, 4 h, 8 h, 12 h and 24 h, respectively, and the percentage of dead cells was calculated. The DNA break was detected with the alkaline single cell gel electrophoresis (comet assay), and the 75th percentiles of TL (tail length), TM (tail moment) and OTM (Olive tail moment) were measured. Cell viability displayed an early decrease and late increase, with the valley value seen at 8 h. Percentages of cell death and comet-formed in A2780 cells were higher than those in C30 cells (P<0.05) at 8 h, respectively. TL, TM and OTM in C30 cells were less than those in A2780 cells (P<0.05). The percentage of comet-formed correlated with that of cell death in either A2780 (r=0.997, P<0.05) or C30 (r=0.998, P<0.05) cells. DNA breaks induced by nsEP in cisplatin-sensitive cells differred from that in resistant cells, and DNA break resulted in fraction of cell death.
Objective To systematically evaluate the efficiency of fertility-sparing surgery (FSS) compared with radical comprehensive surgery (RCS) in early stage epithelial ovarian cancer (eEOC). Methods We searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect the studies about FSS compared with RCS for eEOC from ineaption to August 10th, 2016. Two reviewers independently evaluated the eligibility of identified studies and extracted the data. Then, meta-analysis was performed using Stata 12.0 software. Results Eight studies involving 2 561 patients were included. The results of meta-analysis showed that: compared with RCS, the aggregated RR of overall survival (OS) of FSS (univariate analysis: RR=1.03, 95%CI 0.98 to 1.07,P=0.815; multivariate analysis: RR=0.81, 95%CI 0.52 to 1.28,P=0.255), the cumulative disease free survival (DFS) of FSS (univariate analysis: RR=1.02, 95%CI 0.96 to 1.09,P=0.968; multivariate analysis: RR=1.24, 95%CI 0.65 to 2.39,P=0.115) and the recurrence of FSS (RR=0.86, 95%CI 0.57 to 1.30,P=0.902), there was no significant difference. This pattern also emerged in the subgroup analysis for FIGO IA and IC patients, and the results showed that there was no significant difference between FSS and RCS in IA patients (OS: RR=0.99, 95%CI 0.98 to 1.02,P=0.186; DFS: RR=1.01, 95%CI 0.95 to 1.06,P=0.541); and IC patients (OS: RR=0.95, 95%CI 0.86 to 1.04,P=0.251; DFS: RR=0.94, 95%CI 0.80 to 1.11,P=0.664). Conclusion In eEOC, FSS does not have a negative effect on oncological outcomes compared with RCS. However, well-designed and large-scale trials are needed to verify this outcome in the future.
Objective To systematically review the diagnostic value of 18F-FDG PET/CT in recurrent epithelial ovarian cancer after treatment. Methods The PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of 18F-FDG PET/CT for epithelial ovarian cancer from inception to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Meta-Disc 1.4 and Stata 15.0 software. Results A total of 15 studies involving 792 patients were included in this study. The results of meta-analysis showed that the sensitivity, specificity, and area under the curve of 18F-FDG PET/CT in the diagnosis of recurrent epithelial ovarian cancer were 0.88 (95%CI 0.85 to 0.90), 0.80 (95%CI 0.75 to 0.85) and 0.91, respectively. The results of the subgroup analysis showed that the sensitivity of the prospective studies was the same as that of the retrospective studies, but the specificity of the prospective studies was higher than that of the retrospective studies. The diagnostic sensitivity and specificity of 18F-FDG PET/CT in recurrent epithelial ovarian cancer were higher in Asian studies than in European/North American studies. Conclusion 18F-FDG PET/CT has high diagnostic value in recurrent epithelial ovarian cancer. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
High-grade serous ovarian cancer has a high degree of malignancy, and at detection, it is prone to infiltration of surrounding soft tissues, as well as metastasis to the peritoneum and lymph nodes, peritoneal seeding, and distant metastasis. Whether recurrence occurs becomes an important reference for surgical planning and treatment methods for this disease. Current recurrence prediction models do not consider the potential pathological relationships between internal tissues of the entire ovary. They use convolutional neural networks to extract local region features for judgment, but the accuracy is low, and the cost is high. To address this issue, this paper proposes a new lightweight deep learning algorithm model for predicting recurrence of high-grade serous ovarian cancer. The model first uses ghost convolution (Ghost Conv) and coordinate attention (CA) to establish ghost counter residual (SCblock) modules to extract local feature information from images. Then, it captures global information and integrates multi-level information through proposed layered fusion Transformer (STblock) modules to enhance interaction between different layers. The Transformer module unfolds the feature map to compute corresponding region blocks, then folds it back to reduce computational cost. Finally, each STblock module fuses deep and shallow layer depth information and incorporates patient's clinical metadata for recurrence prediction. Experimental results show that compared to the mainstream lightweight mobile visual Transformer (MobileViT) network, the proposed slicer visual Transformer (SlicerViT) network improves accuracy, precision, sensitivity, and F1 score, with only 1/6 of the computational cost and half the parameter count. This research confirms that the proposed algorithm model is more accurate and efficient in predicting recurrence of high-grade serous ovarian cancer. In the future, it can serve as an auxiliary diagnostic technique to improve patient survival rates and facilitate the application of the model in embedded devices.