Objective: The interaction between tumor immune microenvironment (TIME) and malignant tumor cells plays a crucial role in the occurrence and development of tumors. This study aimed to establish and validate a prognostic model based on TIME characteristics for prognosis prediction and personalized treatment guidance of patients with endometrial cancer (EC). Methods: 67 EC patients who underwent surgery and TIME detection between January 2018 and December 2022 at Peking University People’s Hospital were included. A prognostic model was established according to the density of CD3+ cell and CD8+ cell. 200 EC patients as the validation set, we used immunohistochemical(IHC) markers CD3+cell and CD8+ cell, verified the accuracy of the prognostic model. Results: (1) Time was detected by multiplex immunofluorescence(mIF) in 67 EC patients from Peking University People’s Hospital, There were statistical difference between the Recurrence group and Non-Recurrence group in density of PD-L1+ cell, CD8+ cell, CD68+CD163+ cell, CD3+ cell and CD56+ cell. Among them, the difference of CD3+ cell was the most significant( P=0.004); (2)In 514 EC patients from TCGA database, There was statistical difference between the Recurrence group and Non-Recurrence group in CD8+ cell, regulatory T cells (Tregs) and Dendritic cells activated(DC activated)，Among them, the difference of CD8+ cell was the most significant( P=0.000); (3) CD3+cell and CD8+cell were selected as modeling factors to establish a prognostic model, the patients were divided into Cluster 1 (n=17), Cluster 2 (n=39) and Cluster 3 (n=11). Survival analysis difference( P=0.006) of the three groups were statistically significant; (4)The three Clusters has differences in other immune cells, molecular typing and clinicopathological characteristics; (5) 200 EC patients from Peking University People’s Hospital as the validation set, using IHC markers CD3+cell and CD8+ cell, the patients were divided into Cluster 1, Cluster 2, and Cluster 3 for survival analysis, which had statistical significance ( P=0.000) and verified the accuracy of the prognostic model. Conclusion: Based on TIME, this study found two immune cells that are significantly related to the prognosis of EC, and established an EC prognostic model based on this, with good prediction efficiency and accuracy.

Objectives: To evaluate the predictive significance of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the prognosis of high-grade endometrial carcinoma and to establish a novel predictive model. Design: A retrospective multicenter study. Setting: Fifteen hospitals of the Chinese Endometrial Carcinoma Consortium. Population: This study included 910 high-grade epithelial endometrial carcinoma patients from the multicenter who underwent initial surgical treatment between January 1, 2005, and December 31, 2019. Methods: Data was retrospectively obtained from the medical records and follow-up information of patients. Cox proportional hazard regression models were developed to predict the risk of recurrence and death at 3, 5, and 10 years, and the models were validated and calibrated. The area under the curve was used to measure the predictive performance of the model. Main outcomes measures: Disease-free survival and overall survival. Result: Platelet-lymphocyte ratio and neutrophil-lymphocyte ratio were risk factors for recurrence, and neutrophil-lymphocyte ratio was a risk factor for death. We established models for predicting death and recurrence. In the validation cohort, the area under receiver operating characteristic curve of disease-free survival model at 3,5 and 10 years was 0.72, 0.77, 0.77, and of overall survival model was 0.72, 0.81, and 0.84. Kaplan–Meier survival analysis showed a significant difference between low-risk and high-risk groups. Conclusions: Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are risk factors affecting the prognosis of high-grade endometrial carcinoma patients. This novel prediction model for high-grade endometrial carcinoma can provide accurate postoperative risk classification and prognosis prediction for patients. Keywords: Endometrial carcinoma, prognostic model, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio

Our minimally invasive Fothergill-Manchester technique aims to decrease blood loss and surgical trauma and to preserve function by1. Vaginal conservation. 2. Cardinal (CL) and uterosacral (USL) ligaments plicated, not severed. 3. Direct suture of vagina to cervix without Sturmdorf sutures after cervical amputation. 4. Use of No2 polyester sutures to create new collagen to reinforce the plicated ligaments.