Oncological and Reproductive Outcomes of Fertility-sparing Surgery in Women with Early-stage Epithelial Ovarian Carcinoma:A Multicenter Retrospective Study

Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life.In order to evaluate oncological safety,attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS,this multicenter retrospective study was conducted.Between January 2005 and December 2014,total of 87 young women with FIGO stage I EOC were included,with their clinicopathologic parameters in relation to disease-free survival(DFS)and overall survival(OS)assessed.Attitudes toward childbearing,ovarian function and fertility were studied in women undergoing FSS(n=36).As a result,in contrast to radical sur ery,FSS did not affect prognosis by Kaplan-Meier curves(log-rank test;DFS:P=0.484;OS:P=0.125).However,two of the three recurrence cases and both death cases were in FSS group stage IC.All women undergoing FSS resumed regular menstrual periods after chemotherapy.Only 16(44.44%)had tried to conceive,and 17 pregnancies occurred in 15(93.75%)women.Among 20 women who did not attempt conception,the most common reason was not being married(70%),followed by already having children(15%).In summary,FSS is considered safe in young women with stage IA EOC.Regular menstruation and good obstetric outcomes can be achieved.This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.

Postrecurrence Clinical Outcome of Patients with Stage I Epithelial Ovarian Cancer Who Underwent Fertility-Sparing Surgery Compared to Those with Radical Surgery

Background: To examine the difference in the survival of patients with recurrent ovarian cancer who received fertility-sparing surgery (FSS) and those receiving radical surgery. Methods: Clinicopathologic data on a total of 90 patients with stage I recurrent ovarian cancer collected under the central pathological review system were subjected to survival analyses. Patients were divided into 2 groups: 1) FSS (N = 11), 2) Radical (N = 79). Results: Five-year overall survival rates of patients in the two groups were as follows: 40.8% (FSS)/44.2% (Radical), respectively. There was no significant difference in overall survival among the groups (P = 0.887). Additionally, three-year postrecurrence survival rates of patients in the two groups were 24.8% (FSS) and 25.3% (Radical) (P = 0.730). Furthermore, we accumulated 137 patients {FSS (N = 58), Radical group (N = 79)} with stage I recurrent ovarian cancer from the current study and six representative reports in the literature. Patients who experienced recurrence in the remaining ovary alone (FSS) showed a more favorable prognosis than those who had extra-ovarian site recurrence (overall survival: P = 0.021, postrecurrence survival: P = 0.069). Conclusions: Although our retrospective analysis was very preliminary, we could propose the hypothesis that patients with stage I recurrent ovarian cancer who undergo FSS may not show poorer survival rates than patients who receive radical surgery.

Fertility preservation in patients with gynecologic cancer

In this editorial we comment on the article by Gu et al.We focus and debate the necessity of fertility sparing surgery in young women’s with gynecologic cancers,specifically on those patients with the desire to conceive.This type of individu-alized treatment options is often very difficult,due to the risk of disease evolution and multiple disparities in fertility preservation services among women in di-fferent countries and societies.For this reason national policy interventions are mandatory in order to ensure equitable access this procedures,in women with cancer.

Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma

The standard treatment of endometrial cancer or atypical hyperplasia is surgical removal of the uterus and ovaries. In early stage disease this has an excellent chance of cure but results in infertility. Although the majority of patients are postmenopausal an increasing number of patients with atypical hyperplasia or endometrial cancer are presenting with a desire to retain their fertile potential. In the last 8 years a number of studies have been published involving 403 patients with endometrial cancer and 151 patients with Atypical hyperplasia treated with high dose progestagens. The response rate is 76.2% and 85.6% respectively with endometrial cancer having a recurrence rate of 40.6%. There is a 26% recurrence rate in atypical hyperplasia. Overall 26.3% of those wishing to conceive had a live baby. Although concerns exist about the risks of medical treatment, those that fail this treatment do not appear to have a significantly poorer prognosis although 20 patients(3.6%) had either ovarian cancer or metastatic disease discovered during treatment or follow up.

Role of Ovarian Fertility Sparing Surgery (FSS) in Cases of Early Stage 1 Ovarian Cancer in Patients in Reproductive Age Group

Objective: To assess the role of FSS in women with early stage 1 ovarian cancer. Methods: This was a retrospective analytic study of the results of treatment of 24 patients all under 40 years of age who underwent a full conservative staging laparotomy procedure in oncology center of El Shatby Maternity hospital, Alexandria University in the period of one year from October 2019 to September 2020. All patients were followed up for a six month period following surgery by the pre-operatively elevated tumor marker and by a CT abdomen and pelvis to detect any tumor recurrence. Results: The mean age at diagnosis was 24.29 Years. 6/24 (25%) of surface epithelial tumor were G1, 8/24 (33.3%) were G2, 4/24 (16.7%) were G3. 20/24 (83.3%) of patients were stage FIGO 1a, 4/25 (16.7%) were stage 1b, and none of them was stage 1c. 20/24 (83.3%) of patients were stage FIGO 1a, 4/25 (16.7%) were stage 1b, and none of them was stage 1c. Recurrence was reported in 3/24 of cases (12.5%), such 3 cases underwent unilateral SO plus a FCSLP. No recurrence was reported in cases of bilateral tumors that underwent unilateral SO and a contralateral cystectomy. 100% of recurrence was in epithelial tumors. 1/24 (4.1%) was clear cell, 1/24 (4.1%) was serous and 1/24 (4.1%) was mucinous. None of the endometroid tumors did recur. Also none of the non-epithelial tumors showed any recurrence. Tumors of G1 showed no recurrence, G2 tumors showed 33.3% recurrence and G3 tumors showed the highest recurrence rate (66.6%). Conclusion: ovarian FSS is a safe surgical option for nearly all OC patients with low risk of recurrence, with apparently early stage OC, after being confirmed by a FCSLP to exclude any occult metastasis (occult advanced stage OC), including those cases of early epithelial OC, germ cell and gonadal stromal tumors and it should be considered for patients who have a strong desire to keep their fertility.

子宫内膜不典型增生/早期子宫内膜癌患者保留生育功能治疗后IVF-ET妊娠结局及复发因素分析

目的分析子宫内膜不典型增生/早期子宫内膜癌(AH/EEC)患者保留生育功能治疗后接受体外受精-胚胎移植(IVF-ET)治疗的临床特点和预后,分析影响助孕妊娠结局和疾病复发的主要因素。方法回顾性分析2012年2月至2022年2月在北京协和医院接受AH/EEC生育保留治疗后进行IVF-ET治疗的78例患者的临床资料。总结分析纳入患者的临床特征、IVF-ET相关指标、妊娠结局和复发情况,以单因素和多因素分析临床妊娠率、活产率以及疾病复发的影响因素。结果78例患者中51例(65.38%)为AH患者,27例(34.62%)为EEC患者;开始IVF-ET周期的平均年龄为(34.17±3.70)岁。共有74例患者至少接受了1次移植,每移植周期的临床妊娠率和活产率分别为36.31%(65/179)和18.99%(34/179),累积妊娠率为72.97%(54/74)。多因素分析提示子宫内膜病变初次发病年龄是活产率的独立影响因素[OR=0.8794,95%CI(0.785,0.983),P=0.02]。纳入患者IVF-ET期间子宫内膜病变的总复发率为6.41%(5/78),多因素分析提示子宫内膜病变的病理类型和IVF-ET前复发史是疾病复发的危险因素(P<0.05)。结论AH/EEC患者保留生育功能治疗后的辅助生殖结局相对满意,在肿瘤治疗过程中,进行病变评估时应尽量保护内膜,减少损伤;在肿瘤治疗结束后,应尽快进行助孕治疗,以最大程度降低复发率。

Water and nitrogen transport characteristics of single-line interference infiltration under film hole irrigation with muddy water and fertilizer

Based on the experimental data,this study investigated the effect of sand content of muddy water on water and nitrogen transport characteristics of the single-line interference infiltration under film hole irrigation with muddy water and fertilizer.The relationship between the single-line interference infiltration parameters,the sand content,the wetting front movement distances,and the sand content were all established.The model of the cumulative infiltration volume of per unit film pore area,the vertical and horizontal wetting front movement distance of the free surface,and the wetting front movement distance of the interference center with sand content and infiltration time were proposed.Reveal the law of the change of soil water content and the distribution of NO_(3)^(-)-N content based on different muddy water sand content.The results indicate that at the same infiltration time,as the muddy water sand content increases,the cumulative infiltration volume per unit pore area decreases.The infiltration index of the free infiltration and the single-line interference vary little when the sand content increases,mainly are around 0.64 and 0.58.The relationship between infiltration parameters a,b and the sand content is linear function.At the same location,the more the sand content,the smaller the wetting front movement distance in free surface and the single-line interference surface,the less the NO_(3)^(-)-N content.

根治性宫颈切除术后顺铂及5-氟尿嘧啶联合化疗保留生育功能3例并文献复习

目的初步探讨有复发高危因素的根治性宫颈切除术后宫颈癌患者(IA、IB1期)的辅助化疗的可行性。方法收集2004年7月至2011年4月因宫颈癌行根治性宫颈切除术、术后病理存在复发高危因素接受顺铂及5-氟尿嘧啶(PF)方案化疗患者的病例资料,进行回顾性分析并复习文献。结果行根治性宫颈切除术患者共34例,其中术后病理存在复发高危因素共6例(17.6%),3例充分知情同意后希望继续保留生育功能而接受顺铂及5-氟尿嘧啶(PF)方案辅助化疗。其中2例患者成功分娩。随诊16～65个月,均无瘤生存。结论对于根治性宫颈切除术后病理存在复发高危因素、有强烈保留生育的要求的患者,术后使用PF辅助化疗是可行的,为其完成生育提供可能,但治疗后无瘤生存时间仍需要大样本研究加以证实。

Effect of Cl￣ on Behavior of Fertilizer Nitrogen, Nnmberof Microorganisms and Enzyme Activities in Soils

Pot experiments were conducted to study the effect of Cl￣- on transformation of fertilizer N, number ofmicroorganisms and enzyme activities in soils. It is indicated that Cl￣- did not show significant influenceon total number of bacteria, actinomyces and fungi, but significantly reduced the number of nitrosobacteria,which led to decrease of NO content in the soil. Application of Cl￣- to soil could significantly enhance theactivities of phosphatase and urease in the coastal saline soil and orthic aquisols. In hilly red soil, however,the application of Cl￣- at the rate of 500-1000 mg Cl￣- kg￣(-1) soil significantly decreased the activity of thetwo enzymes mentioned above.

Study on In-vitro Production Technology of Embryos from Young Dorper Sheep

This study was conducted to investigate the in-vitro production technology of embryos from young Dorper sheep, so as to provide technical support for the utilization of ovarian follicles in young Dorper sheep. Tests were conducted from the induction of Dorper sheep of 4 to 8 weeks old using follicle stimulating hormone(FSH) and pregnant horse serum(PMSG), collection of oocytes, in-vitro oocyte maturation-fertilization-zygote cultivation and 2-4-cell-stage fertilized ovum transfer. The results showed that 585 oocytes were collected from eight Dorper sheep at the age of 4 and 8 weeks, with an average of 73.13 oocytes/sheep. 346 of the 2-4-cell-stage fertilized eggs were obtained, whose cleavage rate was 59.15%. 77 in-vitro fertilized eggs at 2-4-cell stage were transplanted into 17 recipient sheep, seven of which were pregnant and gave birth to 13 "test-tube sheep" with a conception rate of 41.18%. It is indicated that the hormone induction technique, in-vitro oocyte maturation-fertilization-zygote cultivation technique and 2-4-cell-stage fertilized ovum transfer technique used in this study can serve as effective techniques for the in-vitro production of embryos from Dorper sheep of 4-8 weeks old.

显微镜下保留睾丸的睾丸良性肿瘤切除术临床疗效分析(附16例报道)

目的:探讨显微外科手术技术应用于保留睾丸的睾丸良性肿瘤切除术的安全性及临床疗效。方法:回顾性分析2020年10月至2023年2月青岛大学附属医院男科收治的16例睾丸肿瘤患者的病例资料。患者中位年龄23岁,睾丸肿瘤均为单侧,左侧7例,右侧9例,睾丸肿瘤最长径1.0~3.5 cm(中位数1.85 cm)。患者均在术前完善阴囊彩超(CDFI)、磁共振(MRI)、精液、血清睾酮、甲胎蛋白(AFP)、人绒毛膜促性腺激素(hCG)、乳酸脱氢酶(LDH)检查。16例患者均行显微镜下保留睾丸的睾丸肿瘤切除术(TSMS),术中运用显微外科技术,精准辨别睾丸内肿瘤与正常睾丸组织的边界,距离肿瘤边界约2 mm完整切除肿瘤及少部分邻近正常睾丸组织,使用显微双极电凝镊给予精确止血,最大限度保留正常睾丸组织。将完整切除的睾丸内肿瘤及邻近正常睾丸组织进行快速冰冻病理检查。术后定期复查CDFI、MRI、精液、血清睾酮等项目。结果:16例患者术前血清睾酮、AFP、hCG、LDH及精液检查指标均在正常参考值范围内。所有16例患者的术中快速冰冻病理依据2022年最新版WHO泌尿及男性生殖系统肿瘤分类标准,均诊断为睾丸良性肿瘤,并顺利完成TSMS治疗。16例患者术后康复顺利,术后1个月复查CDFI提示睾丸剩余组织血供良好,所有患者随访14~40个月,随访期内定期复查CDFI和MRI均未见睾丸内肿瘤残留、复发或转移征象,血清睾酮、AFP、hCG、LDH及精液检查较术前无显著变化,2例育龄期患者的配偶分别于术后16、18个月实现自然受孕。结论:睾丸内良性肿瘤可以通过CDFI、MRI检查进行术前鉴别诊断,最终定性诊断仍需组织病理检查。TSMS运用显微外科手术技术,可以在完整切除睾丸内肿瘤的前提下最大限度保留正常睾丸组织,从而有效保存男性生育力。TSMS疗效良好、安全性高,特别适用于有保留生育力需求的患者。

子宫内膜癌保育治疗后复发的影响因素分析

目的 分析子宫内膜癌(EC)保育治疗后复发的影响因素。方法 选取2019年1月至2021年1月于湖北医药学院附属十堰市太和医院妇科进行治疗的102例EC患者作为研究对象,根据患者复发情况分为复发组(n=30)和未复发组(n=72),采用单因素及多因素logistic回归分析影响EC保育治疗后复发的因素。结果 两组体重指数(BMI)≥24kg/m^(2)、病灶大小≥2cm比较,差异有统计学意义(P<0.05);两组POLE超突变型、CN-H型比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,BMI≥24 kg/m^(2)、病灶大小≥2 cm、CN-H型是EC保育治疗后复发的危险因素(P <0.05)。结论 BMI≥24 kg/m^(2)、病灶大小≥2 cm和CN-H型是EC患者保育治疗后复发的影响因素,临床应根据实际情况,及时调整治疗方案,保障患者预后。

子宫内膜癌保留生育功能患者体质量现状及其影响因素分析

目的调查子宫内膜癌保留生育功能患者的体质量现状,并分析影响其体质量变化的因素。方法便利抽样法选取北京市某三级甲等医院妇科就诊的子宫内膜癌保留生育功能患者85例为研究对象,采用一般人口学与疾病资料调查表、减重调查表对其进行调查。结果子宫内膜癌保育患者超重肥胖发生率为82.4%;进行保留生育功能治疗前体质量指数≥24和减重时长<3个月是影响子宫内膜癌保留生育功能患者体质量变化的高危因素(均P<0.05)。结论子宫内膜癌保留生育功能患者的体质量现状为超重肥胖人数占比较高,保育患者体质量上升受多个因素影响,护理人员应为患者提供专业、个性化、全程的减重指导与随访。

12例子宫外低级别子宫内膜间质肉瘤患者的回顾性分析及文献复习

子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)是一种恶性的子宫间叶源性肿瘤,在宫体恶性肿瘤中占比不到1%,女性生殖道恶性肿瘤中占比0.2%[1]。原发子宫外的子宫内膜间质肉瘤(extrauterine endometrial stromalsarcoma,EESS)是世界卫生组织(WorldHealth Organization,WHO)2014年女性生殖器官肿瘤分类中新收录的间叶性肿瘤,非常罕见,目前未见其发病率的相关报道。

Pregnancy outcomes after fertility preservation in women with endometrial carcinoma and atypical endometrial hyperplasia:A systematic review and meta-analysis

Objective:The objective of the study was to compare the effects of assisted reproductive technology(ART)and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma(EC)and atypical endometrial hyperplasia(AEH)following fertility-sparing treatments.Methods:Relevant studies published through July 2020 were identified from PubMed and Web of Science literature searches.The pregnancy outcomes of ART and spontaneous pregnancy were summarized and compared for women with complete remission of EC/AEH after fertility-sparing treatments.A subgroup analysis was performed based on whether patients had received in vitro fertilization and embryo transfer(IVF-ET)treatment.The complete remission and recurrence rates of EC/AEH following fertility-sparing treatments were estimated.The effect of pregnancy on recurrence rates of EC/AEH was also calculated.Results:Sixteen observational studies reporting pregnancy outcomes or recurrence with ART or spontaneous pregnancy for women with EC/AEH after fertility-sparing treatments were included.The complete remission rate of EC/AEH was 81.5%(95%CI,78%–85%).Compared with spontaneous pregnancy,the pregnancy rate of ART was significantly higher(66.8%vs.43.7%,OR=2.64,95%CI 1.71–4.05,P<0.00001,I^(2)=14%).Subgroup analysis showed that the pregnancy rate of IVF-ET was significantly higher than that of spontaneous pregnancy(62.7%vs.35.1%,OR=2.85,95%CI 1.44-5.63,P=0.003,I^(2)=29%).The live birth rate of ART was significantly higher than that of spontaneous pregnancy(75.3%vs.47.8%,OR=3.96,95%CI1.76-8.77,P=0.0009,I^(2)=45%).The recurrence rate of EC/AEH was 31%(95%CI 24%–39%).Clinical pregnancy could reduce the recurrence rate of EC/AEH,but there was no significant evidence of an association.Conclusions:ART,especially IVF-ET,could significantly improve pregnancy outcomes in women with EC/AEH receiving fertility-sparing treatments.Following complete remission,ART treatment might be a better option for women with EC/AEH than spontaneous pregnancy.

机器人手术系统在早期宫颈癌保留生育功能手术中的应用(附手术视频)

目的:分析达芬奇机器人手术系统在早期宫颈癌保留生育功能手术中的临床应用效果。方法:回顾性分析空军军医大学第一附属医院2013年12月—2021年12月使用达芬奇机器人手术系统完成的11例保留生育功能早期宫颈癌患者的临床资料,统计分析患者术后是否补充切除子宫、月经恢复情况、是否受孕、是否复发等。结果:11例患者至今均存活,未复发,2例切除子宫,其余9例月经均正常,其中2例已成功受孕并足月分娩,7例尚未受孕;目前已求助辅助生殖技术者3例,领养子女者1例。结论:机器人手术系统应用于早期宫颈癌保留生育功能手术安全、有效,为年轻需要保留生育功能的早期宫颈癌患者提供了新的选择,但其应用优势及妊娠结局仍需长期多中心临床试验来验证。

早期年轻子宫内膜癌患者孕激素治疗的疗效及安全性分析

背景与目的:随着近年来子宫内膜癌在年轻人中发病率的上升,孕激素保守治疗受到关注。本研究探讨孕激素保守治疗年轻早期子宫内膜癌患者的效果及对预后的影响。方法:回顾性分析2002—2014年浙江省肿瘤医院及浙江大学附属妇产科医院共19例早期年轻子宫内膜癌患者激素治疗的相关资料。结果:19例患者中首次治疗完全缓解率为68.4%,复发率为15.4%,妊娠生育率为46.2%,平均随访时间为87.9个月。结论:激素治疗是有生育要求的早期子宫内膜癌患者实现妊娠的有效方案,但相比传统治疗方案存在一定的复发风险。

子宫内膜不典型增生及早期子宫内膜癌保守治疗失败患者临床分析

目的探讨年轻子宫内膜不典型增生及早期子宫内膜癌保守治疗失败患者的临床病理特点及预后。方法回顾性分析北京协和医院诊治的19例子宫内膜病变保守治疗失败患者的临床病理资料，并随访其结局。结果患者中位年龄31岁（23~43岁）。除1例未婚患者外均合并原发或继发不孕；15例（78．9％）因不规则阴道出血就诊，4例因不孕就诊；14例（73．7％）初诊为高分化子宫内膜样腺癌，5例为重度不典型增生；从初次确诊子宫内膜病变到子宫切除的中位时间27个月（3～84个月）；18例后期手术的患者中，9例保留了单侧或双侧卵巢；I期患者12例，Ⅲ期3例，Ⅳ期1例，随访的中位时间61个月（2～168个月）；I期患者5年生存率为100％；1例111a期患者无瘤生存66个月，另1例Ⅲa期患者失访，2例患者死于新发肿瘤。结论重度不典型增生及早期子宫内膜癌保守治疗有一定的潜在风险，密切随诊及其重要，有助于预防和早期发现疾病的复发和进展。全面的术前及术中探查评估后，保留卵巢并不影响年轻早期子宫内膜癌患者的预后。

高效孕激素治疗子宫内膜复杂不典型增生及子宫内膜癌的预后分析

目的探讨子宫内膜复杂不典型增生及高分化子宫内膜癌患者经高效孕激素治疗后的肿瘤学预后及生育结局。方法回顾性收集了2000年1月1日-2011年12月31日之间在北京协和医院就诊的子宫内膜复杂不典型增生及高分化子宫内膜癌(无子宫肌层浸润)患者的临床病理资料。所有患者接受口服醋酸甲羟孕酮(250~500 mg/d)或醋酸甲地孕酮(160~480 mg/d),持续至少6个月。结果患者中位年龄32岁(21~41岁)。在55例患者中,41例(75%)获得完全缓解,中位时间为6(3~24)个月。完全缓解率在肥胖患者中较非肥胖患者低(4/12[33%]比37/43[86%];P=0.001)。获得完全缓解的患者中10例(24%)复发。55例患者的5年无复发生存率为71%。在33例有生育愿望的患者中,17例(52%)妊娠。结论采用高效孕激素进行保留生育功能的治疗是有效和安全的。肥胖与预后不良相关。

保留生育功能法治疗年轻早期高分化子宫内膜癌和复杂性不典型增生

目的探讨宫腔镜病灶切除、促性腺激素释放激素类似物(GnRHa)联合左炔诺孕酮宫内节育系统(曼月乐)或来曲唑治疗早期高分化子宫内膜癌和复杂性不典型增生的年轻患者的有效性和安全性。方法对2013年1月~2018年10月34例小于42岁的早期高分化子宫内膜腺癌(局限于黏膜内,无明显肌层侵犯,16例)或复杂性不典型增生(18例),行宫腔镜双极电刀病灶切除术,术后戈舍瑞林3.75 mg皮下注射28天一次共3次。19例手术结束时置入曼月乐,另15例术后口服来曲唑2.5 mg每天一次。所有患者每隔3个月复查阴道超声、宫腔镜诊刮术。结果随访9~68个月,平均34.6月。完全反应率子宫内膜癌为87.5%(14/16),复杂性不典型增生为100%(18/18);疾病稳定2例,均为子宫内膜癌。完全反应的子宫内膜癌和复杂性不典型增生各有1例复发。2例复发和2例疾病稳定者均行子宫切除术。随访期间11例获得12次妊娠。结论宫腔镜病灶切除、GnRHa联合曼月乐或来曲唑的保留生育功能方法治疗早期高分化子宫内膜癌和复杂性不典型增生安全、有效。完成生育后应该行子宫切除,尤其子宫内膜癌患者。