Magnetic resonance imaging-based radiomics model for preoperative assessment of risk stratification in endometrial cancer

BACKGROUND Preoperative risk stratification is significant for the management of endometrial cancer(EC)patients.Radiomics based on magnetic resonance imaging(MRI)in combination with clinical features may be useful to predict the risk grade of EC.AIM To construct machine learning models to predict preoperative risk stratification of patients with EC based on radiomics features extracted from MRI.METHODS The study comprised 112 EC patients.The participants were randomly separated into training and validation groups with a 7:3 ratio.Logistic regression analysis was applied to uncover independent clinical predictors.These predictors were then used to create a clinical nomogram.Extracted radiomics features from the T2-weighted imaging and diffusion weighted imaging sequences of MRI images,the Mann-Whitney U test,Pearson test,and least absolute shrinkage and selection operator analysis were employed to evaluate the relevant radiomic features,which were subsequently utilized to generate a radiomic signature.Seven machine learning strategies were used to construct radiomic models that relied on the screening features.The logistic regression method was used to construct a composite nomogram that incorporated both the radiomic signature and clinical independent risk indicators.RESULTS Having an accuracy of 0.82 along with an area under the curve(AUC)of 0.915[95%confidence interval(CI):0.806-0.986],the random forest method trained on radiomics characteristics performed better than expected.The predictive accuracy of radiomics prediction models surpassed that of both the clinical nomogram(AUC:0.75,95%CI:0.611-0.899)and the combined nomogram(AUC:0.869,95%CI:0.702-0.986)that integrated clinical parameters and radiomic signature.CONCLUSION The MRI-based radiomics model may be an effective tool for preoperative risk grade prediction in EC patients.

Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer.The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery(using traditional laparoscopic or robotic techniques)are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer.Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIM To analyse the perioperative conditions,complications,and short-term and longterm effects in patients undergoing robotic radical hysterectomy(RRH)and laparoscopic radical hysterectomy(LRH)to compare their clinical efficacy,safety,and feasibility.METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTS Of the patients,342 underwent LRH for cervical cancer,and 216 underwent RRH.The total complication rate was 9.65%(20 patients)in the RRH group and 17.59%(60 patients)in the LRH group.The complication rate was significantly lower in the RRH group than in the LRH group.There was no significant difference in the follow-up period(P=0.658).The total recurrence rates were 15.7%and 12%in the RRH and LRH groups,respectively.The progression-free survival time was 28.91±15.68 mo and 28.34±15.13 mo in the RRH and LRH groups,respectively(P=0.669).The overall survival(OS)rates were 92.13%and 94.45%in the RRH and LRH groups,respectively(P=0.292).The OS time was 29.87±15.92 mo and 29.41±15.14 mo in the RRH and LRH groups,respectively(P=0.732).The survival curves and the progression-free survival curves were not statistically significantly different between the two groups(P=0.407 and 0.28,respectively).CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH.The two procedures have similar complication rates,OS,and progression-free survival time.

Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

Objective:To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC).Methods:A retrospective study of young EOC inpatients (≤40 years old) was performed during January 1994 and December 2010 in eight institutions.Results:Data were analyzed from 94 patients treated with fertility-sparing surgery with a median follow-up time of 58.7 months.As histologic grade increased,overall survival (OS) and disease-free survival (DFS) of patients receiving fertility-sparing surgery declined.Neither staging surgery nor laparoscopy of early stage EOC with conservative surgery had a significant effect on OS or DFS.Normal menstruation recommenced after chemotherapy in 89% of the fertility-sparing group.Seventeen pregnancies among twelve patients were achieved by the end of the follow-ups.Conclusions:Fertility-sparing treatment for patients with EOC Stage I Grade 1 could be cautiously considered for young patients.The surgical procedure and surgical route might not significantly influence the prognosis.Standard chemotherapy is not likely to have an evident impact on ovarian function or fertility in young patients.