Effect of the Number of Removed Lymph Nodes on Survival in Patients with FIGO Stage IB-IIA Cervical Squamous Cell Carcinoma following Open Radical Hysterectomy with Pelvic Lymphadenectomy: A Retrospective Cohort Study

Objective. To determine whether the number of removed lymph nodes (RLN) is associated with survival in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIA cervical squamous cell carcinoma (CSCC). Methods. We reviewed the medical records of FIGO stage IB-IIA CSCC patients who underwent standardized radical hysterectomy with pelvic lymphadenectomy (RHPL) in our center between 2006 and 2014. The X-tile software was performed to calculate the optimal grouping of cutoff points for RLN. The impact of RLN on progression-free survival (PFS) and overall survival (OS) was analyzed using Cox regression analysis. Results. Among 3,127 patients, the mean number of RLN was 22, and positive lymph node (LN) was found in 668 (21.4%) patients. X-tile plots identified “21” and “16” as the optimal cutoff value of RLN to divide the patients into two groups in terms of PFS and OS separately. In all patients, the number of RLN was not associated with PFS (P=0.182) or OS (P=0.193). Moreover, in both LN positive and negative patients, the number of RLN was not associated with either PFS (P=0.212 and P=0.540, respectively) or OS (P=0.173 and P=0.497, respectively). Cox regression analysis showed that the number of RLN was not an independent prognostic factor for PFS or OS. Conclusion. If standardized RHPL was performed, the number of RLN was not an independent prognostic factor for survival of patients with FIGO stage IB-IIA CSCC

The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer

Abstract Background The aim of our study was to investigate whether an inflammation-based prognostic score, the prognostic nutritional index (PNI), was associated with clinical characteristics and prognosis in patients with high-grade serous ovarian cancer (HGSC). Methods We retrospectively investigated 875 patients who underwent primary staging or debulking surgery for HGSC between April 2005 and June 2013 at our institution. None of these patients received neoadjuvant chemotherapy. Preoperative PNI was calculated as serum albumin (g/L) + 0.005 × lymphocyte count (per mm3). The optimal PNI cutoff value for overall survival (OS) was identified using the online tool “Cutoff Finder”. Clinical characteristics and PNI were compared with chi-square or Fisher’s exact tests, as appropriate. The impact of PNI on OS was analyzed using the Kaplan–Meier method and Cox proportional hazards model. Results The median (range) PNI was 46.2 (29.2–67.7). The 45.45 cutoff value discriminated patients into the high-PNI and low-PNI groups. A low preoperative PNI was associated with an advanced FIGO stage, increased CA125 level, more extensive ascites, residual disease and platinum resistance. For univariate analyses, a high PNI was associated with increased OS (p < 0.001). In multivariate analyses, the PNI remained an independent predictor of OS as a continuous variable (p = 0.021) but not as dichotomized groups (p = 0.346). Conclusion Our study demonstrated that the PNI could be a predictive and prognostic parameter for HGSC

Developing a nomogram for preoperative prediction of cervical cancer lymph node metastasis by multiplex immunofluorescence

Abstract Background Most traditional procedures can destroy tissue natural structure, and the information on spatial distribution and temporal distribution of immune milieu in situ would be lost. We aimed to explore the potential mechanism of pelvic lymph node (pLN) metastasis of cervical cancer (CC) by multiplex immunofluorescence (mIF) and construct a nomogram for preoperative prediction of pLN metastasis in patients with CC. Methods Patients (180 IB1-IIA2 CC patients of 2009 FIGO (International Federation of Gynecology and Obstetrics)) were divided into two groups based on pLN status. Tissue microarray (TMA) was prepared and tumor-infiltrating immune markers were assessed by mIF. Multivariable logistic regression analysis and nomogram were used to develop the predicting model. Results Multivariable logistic regression analysis constructs a predictive model and the area under the curve (AUC) can reach 0.843. By internal validation with the remaining 40% of cases, a new ROC curve has emerged and the AUC reached 0.888. Conclusions This study presents an immune nomogram, which can be conveniently used to facilitate the preoperative individualized prediction of LN metastasis in patients with CC

Clinical Significance of Programmed Death Ligand‑1 and Intra-Tumoral CD8⁺ T Lymphocytes in Ovarian Carcinosarcoma

<div><p>Ovarian carcinosarcoma (OCS) accounts for high mortality and lacks effective therapeutic methods. So far, we lack reliable biomarkers capable of predicting the risk of aggressive course of the disease. Programmed death ligand-1 (PD-L1) is expressed in various tumors, and antibodies targeting its receptor programmed cell death 1 (PD-1) are emerging cancer therapeutics. This study was designed to evaluate the expression of PD-L1 and intratumoral CD8+ T lymphocytes by immunohistochemistry from 19 OCS patients who underwent primary surgery at Fudan University Shanghai Cancer Center. The correlations between PD-L1 expression and CD8+ T lymphocytes as well as the patients’ clinicopathologic characteristics were integrated and statistically analyzed. PD-L1-positive expression was observed in 52.6% of intraepithelial tissues and 47.4% of mesenchymal tissues (p = 0.370). Meanwhile, intraepithelial and mesenchymal CD8+ T lymphocytes were positive in 36.8% and 84.2% of OCS, respectively (p = 0.628). A significantly negative correlation was found between mesenchymal CD8+ T lymphocytes and PD-L1 expression (r = -0.630, p = 0.011). Intraepithelial PD-L1-positive expression was associated only with positive ascitic fluid (p = 0.008). Mesenchymal PD-L1-positive patients had a poorer survival than those with negative expression (p = 0.036). Meanwhile, intraepithelial PD-L1-positive patients had a better survival trend than PD-L1-negative patients, though no statistical significance was found (p = 0.061). There was a better postoperative survival noted in mesenchymal CD8-positive patients (p = 0.024), and allthough a better trend of OS was observed in intraepithelial CD8-positive patients, no statistical significance was found (p = 0.382). Positive tumoral CD8+ T lymphocytes and mesenchymal PD-L1-negative expression seem to be associated with better survival in OCS. It is possible that immunotherapy targeting PD-L1 pathway could be used in OCS.</p></div

Kaplan-Meier survival curves of patients with ovarian carcinosarcoma (OCS).

<p>Fig 1A and 1B show the post-operative survival classified according to tumor site (unilateral tumor vs. bilateral tumors) and residual disease (no visible disease vs. visible residual disease), respectively. Patients with bilateral tumors and visible residual disease showed significantly worse prognosis (p = 0.019 and p = 0.027, log-rank test). Fig 1C and 1D show the post operation survival curves between mesenchymal PD-L1-positive and PD-L1-negative expression. Intraepithelial PD-L1-positive patients had a trend of better survival than PD-L1-negative patients (p = 0.061). A significant difference in postoperative prognosis between mesenchymal PD-L1-positive and PD-L1-negative patients was observed (p = 0.036).</p

Three-year survival rate of 19 OCS patients according to clinicopathologic characteristics and tumor CD8+ T lymphocytes (Log-rank).

<p>Three-year survival rate of 19 OCS patients according to clinicopathologic characteristics and tumor CD8+ T lymphocytes (Log-rank).</p

Demographic and clinicopathological characteristics of 19 OCS patients.

<p>Demographic and clinicopathological characteristics of 19 OCS patients.</p

Correlations between the expression of PD-Ls or tumor-infiltrating CD8+ lyphocytes and clinicopathological characteristics in ovarian carcinosarcoma (<i>n</i> = 19).

<p>Correlations between the expression of PD-Ls or tumor-infiltrating CD8+ lyphocytes and clinicopathological characteristics in ovarian carcinosarcoma (<i>n</i> = 19).</p

Three-year survival rate of 19 OCS patients according to clinicopathologic characteristics and tumor PD-L1 status (Log-rank).

<p>Three-year survival rate of 19 OCS patients according to clinicopathologic characteristics and tumor PD-L1 status (Log-rank).</p