Ultrasound Features Improve Diagnostic Performance of Ovarian Cancer Predictors in Distinguishing Benign and Malignant Ovarian Tumors

To determine whether ultrasound features can improve the diagnostic performance of tumor markers in distinguishing ovarian tumors,we enrolled 719 patients diagnosed as having ovarian tumors at Nanfang Hospital from September 2014 to November 2016.Age,menopausal status,histopathology,the International Federation of Gynecology and Obstetrics(FIGO)stages,tumor biomarker levels,and detailed ultrasound reports of patients were collected.The area under the curve(AUC),sensitivity,and specificity of the bellow-mentioned predictors were analyzed using the receiver operating characteristic curve.Of the 719 patients,531 had benign lesions,119 had epithelial ovarian cancers(EOC),44 had borderline ovarian tumors(BOT),and 25 had non-EOC.AUCs and the sensitivity of cancer antigen 125(CAI25),human epididymis-specific protein 4(HE4),Risk of Ovarian Malignancy Algorithm(ROMA),Risk of Malignancy Index(RMI1),HE4 model,and Rajavithi-Ovarian Cancer Predictive Score(R-OPS)in the overall population were 0.792,0.854,0.856,0.872,0.893,0.852,and 70.2%,56.9%,69.1%,60.6%,77.1%,71.3%,respectively.For distinguishing EOC from benign tumors,the AUCs and sensitivity of the above mentioned predictors were 0.888,0.946,0.947,0.949,0.967,0.966,and 84.0%,79.8%,87.4%,84.9%,90.8%,89.1%,respectively.Their specificity in predicting benign diseases was 72.9%,94.4%,87.6%,95.9%,86.3%,90.8%,respectively.Therefore,we consider biomarkers in combination with ultrasound features may improve the diagnostic performance in distinguishing malignant from benign ovarian tumors.

Expression of Wnt-1,beta-catenin and c-myc in Ovarian Epithelial Tumor and Its Implication

Objective： To investigate the expression of Wnt-1, beta-catenin and c-myc in normal ovarian epithelial cell and malignant ovarian epithelial tumor. Methods： Immunohistochemical staining with SP method was conducted to identify the expression of Wnt-1, beta-catenin and c-myc in 18 samples of normal epithelial tissue and 34 cases of malignant epithelial tumor of ovary. Results： The expression rate of Wnt-1 and c-myc in malignant epithelial tumors was higher than those in normal epithelial cell （P〈0.05）. The abnormal expression rate of beta-catenin in malignant ovarian epithelial tumors was higher than that in normal epithelial cell （P〈0.05）. A significant positive correlation was found between Wnt-1, beta-catenin and c-myc in malignant ovarian epithelial tumor （P〈0.05）. A significant difference of expressions of Beta-catenin and C-myc was found between serous and mucinous tumors （P〈0.05）. Conclusion： The abnormal expression of Wnt-1, beta-catenin and c-myc might indicate the malignant transformation in ovarian epithelial tumors.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Evaluation the effect of fertility-preserving surgery on young patients with malignant ovarian tumors

Objection： To evaluate the impact of fertility-preserving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors. Methods： Retrospective analysis of 39 patients with ovarian malignant germ cell tumors, 23 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conservative treatments. Results： Two patients lost follow-up （we do not statistics them）. Fifty-nine among 64 patients were alive up to now （92.19%）. The overall survival rate for ovarian epithelial malignancies, malignant germ cell tumors and sexual cord mesenchymal tumors were 95.45%, 89.47% and 100% respectively. Fifteen patients received second operation and recurrence was found in 6 patients. Among the 59 surviving patients, 53 patients have normal menstruation. Thirteen patients among 20 patients who want to pregnant have 15 pregnancies and 9 successful deliveries. Conclusion： The management of fertility-preserving surgery on patients with ovarian malignant germ cell tumors, whatever the FIGO staging is, is a safe option. For patients with ovarian epithelial carcinomas, fertility-preserving surgery only confined to low-stage （stage Ⅰ）, low-grade （G1）, and patients who want keep fertility function seriously. Cisplatinum-based combination chemotherapy is necessary. Standardized chemotherapy has no affection on fertility function.

Prognostic Significance of Hormonal Receptor Status of Malignant Ovarian Tumors

The objective of this study is to investigate hormonal receptor status of MOT （malignant ovarian tumor） and to evaluate its clinical and prognostic significance. Retrospective analysis of the case reports of 284 patients with MOT of different histogenesis, stages I-IV, and immunohistochemical study of paraffin-embedded tissues were performed. Hormonal receptor status of tumors with different morphology genesis was studied and hormonal receptor phenotype of serous OC （ovarian cancer） was determined. The analysis of correlation between the expression of steroid hormone receptors （receptors to estrogens （ER）, progesterone （PR） and testosterone （TR）） in ovarian tumors, histological type of tumors and clinical morphological parameters were performed. Overall and relapse-free survival rates of the patients with serous OC depending on the hormonal receptor phenotype of the tumor were assessed. Presence of positive expression of steroid hormone receptors in serous OC （ER-66.4%, PR^53.4%, TR-53.0%）, mucinous OC （ER-88.0%, PR-84.0%, TR-60.0%） and in sex cord stromal tumors （ER-74.1%, PR and TR-77.8%） is proved by correlation of all steroid receptors expression with morphology type of ovarian tumors （ER - r = 0.4; PR - r = 0.4; TR - r = 0.3; p 〈 0.05）. Direct correlation between hormonal receptor phenotype of serous OC and the age period of the patients was established （r = 0.5; p = 0.002）： postmenopausal women patients reported the most increased frequency of serous OC with positive hormonal receptor tumor phenotypes （52.4%）, in particular during their late post-menopausal period （39.0%）. Significantly low overall survival among the patients with positive hormonal receptor phenotype of serous OC was recorded （29.5±3.4%） in comparison with the same score in the patients with negative phenotype of tumors （44.5±3.7%） （p 〈 0.05）. Multifactor analysis of Cox-regression model has defined that positive hormonal receptor phenotype of serous OC increases the risk of disease relapse （HR 1.4; 95.0% CI 1.1-1.7）, significantly decreases overall survival rates in the patients （HR 1.4; 95.0% CI 1.1-1.8）. Positive hormonal receptor status of MOT is an independent factor of unfavorable clinical progress of tumor process which can be regarded as the criterion for development of the methods of hormonal therapy application in complex treatment of the patients, and demands further large-scale multi-center studies in that direction.

Expression levels of matrix metalloproteinases in ascites of patients with ovarian cancer and the relationship with pathological characteristics of ovarian cancer

Objective:To explore the expression levels of matrix metalloproteinase-2(MMP-2)and matrix metalloproteinase-9(MMP-9)in ascites in ovarian tumor and provide a theoretical basis for the diagnosis and prognosis evaluation of ovarian cancer ascites.Methods:ELISA was used to detect the levels of MMP-2 and MMP-9 in ascites samples from 73 cases of patients with malignant ovarian tumor,and RIA was used to detect the expression level of CA125 in the serum in these patients.Results:The expression levels of MMP-2 and MMP-9 in ascites in malignant ovarian tumor were higher than those in ascites in benign ovarian tumor(t=8.08,10.39,p<.01),and the difference was of statistical significance.The expression levels of MMP-2 and MMP-9 in patients with stage III and IV malignant ovarian tumors were higher than those in patients with stage I and II malignant ovarian tumors,and the difference was statistically significant(t=2.75,2.75,p<.05).There was no statistically significant difference in the expression levels of MMP-2 and MMP-9 among the patients with different pathological types,different histological grades,lymph node metastasis or not,different ascites volumes and different residual lesions(p>.05).The sensitivities of detecting MMP-2 and MMP-9 in ascites were 76.0%and 88.0%,respectively,which were significantly higher than those of ascites cytological examinations(χ^(2)=4.61,12.74,p<.05),but in comparison with serum CA125,there was no statistically significant difference(p>.05).The specificities of detecting MMP-2 and MMP-9 in ascites were 78.3%and 82.6%,respectively,which were significantly lower than those of ascites cytological examinations(χ^(2)=5.61,4.38,p<.05),but in comparison with serum CA125,there was no statistically significant difference(χ^(2)=1.64,2.68,p<.05).Conclusions:The levels of MMP-2 and MMP-9 in ascites may be markers for the differential diagnosis of benign and malignant ovarian lesions,and they are related to the prognosis in patients with malignant ovarian tumors.

Study on the Correlation between the Detection of Tumor Markers in Abdominal Effusion and Chemotherapy Sensitivity

Since most patients with ovarian cancer are in the advanced stage when they are prone to recurrence,it is difficult to detect and treat ovarian cancer.There are tumor serum markers in the ascites.Therefore,the study explored the correlation between the serum marker levels of the ascites and chemotherapy sensitivity in patients with ovarian malignant tumors.First,50 patients with nested cancer were selected as research subjects and received treatment,and then immediately 200 mg carboplatin+100 mL normal saline was placed in the abdominal cavity of all patients,which was equivalent to an intraperitoneal chemotherapy.Carboplatin+docetaxel combined with intravenous chemotherapy was started 3 weeks after surgery,and chemotherapy was given every 3 weeks for a total of 5 to 6 courses.The serum levels of CA125,CA199,CEA and AFP in peripheral blood and peripheral blood were determined by ELISA.The results showed that the levels of CA125,CA199,CEA and AFP in serum and ascites after chemotherapy were lower than before chemotherapy(P<0.05).The short-term effective rate of 50 ovarian cancer patients(8 CR,28 PR,12 SD,2 PD)was 72.00%.Therefore,patients with ovarian malignant tumors had a good short-term curative effect after chemotherapy,which can reduce the ascites and serum levels of CA125,CA199,CEA,AFP for clinical reference value dual-mode MRI nanoparticle-mediated photothermal therapy showed good application potential in tumor treatment and diagnosis.

Analysis of 20 mature ovarian cystic teratoma cases in postmenopausal women

Objective To study the incidence of malignant change, diagnosis and management of mature cystic teratomas in postmenopausal women.Methods Twenty cases of mature cystic teratoma in postmenopausal women admitted to our hospital between January 1977 and January 1997 was retrospectively reviewed and evaluated.Results The number of postmenopausal patients with mature cystic teratoma (20) accounted for 7.6% of the total number of patients with benign ovarian teratomas (263). There were 3 cases of malignant change, which were squamous carcinoma, carcinosarcoma, and digestive gland epithelial carcinoma. The incidence of malignant change was 15%.Conclusion In postmenopausal women, mature ovarian cystic teratoma should be treated as lowly malignant and should be paid much attention.