ABSTRACT Objective: To evaluate the effect of lymphadenectomy on clinical outcome in patients with low-grade serous ovarian cancer (LGSOC). Design: Case-control multicenter retrospective study. Setting: University Hospital-based research center. Population: 147 patients with LGSOC. Methods: Propensity score matching (PSM) algorithm was used to balance the basic characteristics of patients with lymphadenectomy or not, and the Kaplan-Meier analysis was used to evaluate the impact of clinical prognosis. Finally, univariate and multivariate Cox proportional hazards regression analysis were performed to analyze the high-risk factors associated with clinical prognosis. Main outcome measures: Disease-free survival (DFS) and overall survival (OS). Results: A total of 147 women from 4 medical centers were enrolled. In the before matching cohort, 101 (68.7%) patients underwent lymphadenectomy. Fifty-two (35.4%) patients experienced recurrence, and 25 (17%) patients died. Kaplan-Meier analysis showed that there was no significant difference in DFS(P=0.058) and OS(P=0.067) in the after matching cohort. Cox proportional hazard regression analysis showed age (P=0.012), the International Federation of Gynecology and Obstetrics (FIGO) stage (P=0.031) and effective cytoreductive surgery (P=0.044) were 3 high-risk factors associated with recurrence. Age (P=0.031) and effective cytoreductive surgery (P=0.009) were 2 high-risk factors associated with death. Conclusions: Lymphadenectomy seems not to provide a significant benefit neither DFS nor OS in our study. Age, the FIGO stage and effective cytoreductive surgery are high-risk factors associated with clinical prognosis in LGSOC patients.

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

Objective: The therapeutic effect of PARP inhibitors (PARPi) monotherapy compared with platinum-based chemotherapy, and the impact to subsequent platinum-based chemotherapy after PARPi resistance were inconclusive. Design: Retrospective cohort study. Setting: Patients from seven medical centers in China. Population: BRCA1/2-mutated ovarian cancer patients with secondary platinum-sensitive relapse, without any maintenance regimen after first- and second-line platinum therapy, and the secondary platinum-free interval (PFI) was more than 6 months. Methods: Patients in study group (n=31) were treated with PARPi monotherapy until disease progression, and patients in control group (n=33) were treated with platinum-based chemotherapy without restriction. Main Outcome Measures: RECIST and GCIG standard, Kaplan-Meier plotter Results: The objective response rate (ORR: 77.4% vs. 84.0%, p=0.538) and median progression-free survival (mPFS: 8.6 vs. 11.1 months, p=0.679) were comparable. PARPi monotherapy significantly prolonged post-recurrent survival (PRS, HR=0.35, p=0.024), and was the independent factor associated with PRS (HR=0.33, p=0.038). The median time from treatment to first subsequent therapy or death (TFST) of patients with platinum-based chemotherapy after PARPi progression and patients in control group with PFI≥6months after third-line platinum-based chemotherapy was comparable (mTFST: 7.5 vs. 7.1 months, p=0.800). Further survival analysis showed that PRS of patients with PARPi monotherapy were similar to patients with PFI≥6 months after third-line platinum chemotherapy (HR=0.66, p=0.503), and superior to patients with PFI<6 months after third-line platinum chemotherapy (HR=0.15, p=0.009). Conclusions: PARPi monotherapy was equivalent to platinum-based chemotherapy for BRCA1/2-mutated ovarian cancer patients with secondary platinum-sensitive recurrence, and could improve prognosis.

Background: The treatment strategies for ovarian clear cell carcinoma (OCCC) are the same as those for epithelial ovarian cancer. Due to the rarity of OCCC, no prospective studies of its surgery have been reported. Therefore, the therapeutic significance of lymphadenectomy for OCCC needs to be further clarified. Objectives: To assess the effectiveness of lymphadenectomy in patients with ovarian clear cell carcinoma by a meta-analysis. Search Strategy: The Web of Science, Scopus, PubMed, and other sources (e.g. Google Scholar) were searched from each database’s earliest inception to June 2021. Selection Criteria: English-language publications of observational studies that investigated the role of lymphadenectomy in patients with OCCC were included. Data Collection and Analysis: The pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated. Main Results: The analysis demonstrated that lymphadenectomy is associated with significantly improved disease-specific survival (DSS) (HR=0.76; 95%CI=0.60-0.95; P=0.02; I2= 0.0%) and disease-free survival (DFS) (HR=0.58; 95%CI=0.33-1.00; P=0.05; I2=61%), but not for overall survival (OS) (HR=0.80; 95%CI=0.60-1.06; P=0.12; I2= 19%) and progression-free survival (PFS) (HR=0.95; 95%CI=0.64-1.42; P=0.79; I2= 0.0%). But it is worth noting that several single studies indicated a tendency of improved OS, PFS, DFS, DSS with lymphadenectomy. Conclusions: Lymphadenectomy could not significantly improve OS and PFS for OCCC, but is associated with improved DFS and DSS. Gynecologic oncologists should tailor treatment to patients to achieve optimal outcomes. And further studies are necessary to validate the impact of lymphadenectomy on OCCC. Keywords: ovarian clear cell carcinoma, lymphadenectomy, survival, systematic review, meta- analysis