Ovarian cancer is one of the common malignant tumors of female genital organs. In gynecological tumors, the incidence rate of ovarian cancer ranks the third after cervical cancer and uterine body cancer, but the death rate of ovarian cancer ranks the first, posing a serious threat to women’s life and health. In recent years, the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for ovarian cancer has become an important basis for diagnosis and treatment of ovarian cancer. In this paper, we interpret the latest version (version 4. 2017) of NCCN clinical practice guidelines for ovarian cancer for its better clinical application.
ObjectiveTo systematically review the prognostic efficacy and safety of patients with ovarian cancer treated with systemic lymphadenectomy (SL). MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the prognostic outcomes of patients with ovarian cancer treated with SL from inception to December 16th, 2020. Six reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 5 RCTs and 23 cohort studies involving 6 166 patients were included. The results of meta-analysis showed that there were no significant differences in the 3-year survival rate, 5-year survival rate, 3-year progression-free survival rate, and 5-year progression-free survival rate between SL group and the no systemic lymphadenectomy (NSL) group. The results of the subgroup analysis showed that pelvic and para-aortic lymph node dissection combined with large omentum resection had a better prognosis for patients. ConclusionsCurrent evidence shows that SL has no significant efficacy on survival and progression-free survival in patients with ovarian cancer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To evaluate the efficacy and the adverse reactions of intensive therapy compared with conventional therapy. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 3, 2008), MEDLINE (January 1980 to June 2008), EMbase (1984 to June 2008), CBM-disc (January 1980 to June 2008) and CNKI (1994 to June 2008) to get all the randomized control trials (RCTs) about paclitaxel intensive versus conventional therapy for ovarian cancer. We used RevMan 5 to perform meta-analysis. Results Six RCTs involving 572 patients were included. Metaanalysis showed the efficacy of intensive therapy and conventional therapy was similar. There were no significant differences in response rate (RR 1.06, 95%CI 0.94 to 1.20), median survival time, survival rate, median progression free survival and median time to progression between the two groups. When taking safety into consideration, intensive therapy significantly reduced the occurrence of grade Ⅲ or higher neutropenia (RR 0.49, 95%CI 0.35 to 0.69, Plt;0.000 1) and Grade Ⅲ or higher neuropathy (RR 0.43, 95%CI 0.24 to 0.78, P=0.006). But there were no significant differences between intensive therapy and conventional therapy in flush, grade Ⅲ or higher vomiting, anemia, leucopenia, grade Ⅲ or higher thrombocytopenia and alopecia. Conclusion Paclitaxel intensive therapy has similar efficacy and adverse reactions compared with conventional therapy in ovarian cancer. Above all, intensive therapy can reduce the incidence of grade Ⅲ or higher neutropenia and neuropathy. It is a good substitution for the conventional therapy.
The mortality rate of ovarian cancer is the highest among female reproductive tract malignancies. Although most patients have undergone recurrent treatments such as surgery, chemotherapy, and targeted therapy, the recurrence rate is still high. The exploration of scholars in this field has never stopped. In recent years, remarkable achievements have been made in the medical treatment of ovarian cancer. The research of poly adenosinediphosphate-ribose polymerase, immunotherapy (immunocheckpoint inhibitor monotherapy, immune checkpoint inhibitor combined with other drugs) and anti-angiogenic drugs have provided new methods for the treatment of this disease, and throughout the whole process of ovarian cancer treatment. This paper summarizes this, and aims to provide a reference for the clinical treatment of ovarian cancer.
ObjectiveTo explore the value of ultrasonic score, blood vessels and vascular resistance index in predicting and diagnosing benign and malignant ovarian tumor. MethodsA total of 157 patients with ovarian tumors (77 benign and 80 malignant) aged from 19 to 68 years old (average 56 years) between January 2008 and June 2012 were enrolled in the research. The ultrasonic score, blood vessels and vascular resistance index were recorded, and the differences between benign and malignant tumor were compared according to the pathological diagnosis; Their sensitivities and specificities were analyzed with the preoperative prediction. ResultsIn benign ovarian tumor, ultrasound scores and blood vessels index were obviously lower than that in the malignant tumor (P<0.05); the vascular resistance index was much higher than that in the malignant tumor (P<0.05). The sensitivities and specificities in diagnosing malignant tumor were high when the ultrasonic score was ≥ 2, vascular index was>0.02/cm3, and blood flow resistance index was ≤ 0.6. The sensitivities were 92.5%, 90.0%, 87.5%, respectively; while the specificities were 90.9%, 89.6%, 84.4%, respectively. ConclusionUltrasonic score, blood vessels and vascular resistance index have significance for identifying benign and malignant ovarian tumors; ultrasonic score is more accurate which has high value of clinical application and popularization.
Objective To investigate the effects and underlying mechanisms of human pituitary tumor-transforming gene 1 (hPTTG1) small interfering RNA (siRNA) on apoptosis of ovarian cancer cell line A2780. Methods hPTTG1 siRNA was transfected into A2780 with lipofectamine (the hPTTG1 siRNA group), and the normal group and the negative control group were set up. Detections were conducted 48 hours after transfection: the interfering efficiency of hPTTG1 mRNA was measured by real-time polymerase chain reaction, the expression of survivin gene and survivin protein was examined by semiquantitative reverse transcriptase-polymerase chain reaction and Western blot, cell apoptosis was detected by DNA fragmentation gel electrophoresis and propidium iodide staining kit, and the activity of caspase-3 was assayed by caspases colorimetric assay kit. Results The expression of hPTTG1 mRNA was expressly inhibited after hPTTG1 siRNA transfection. DNA ladder was observed in the hPTTG1 siRNA group. The apoptotic rate of hPTTG1 siRNA transfection in the hPTTG1 siRNA group was (17.53±2.17)%, higher than those in the normal group and the negative control group [(8.97±1.56)% and (9.64±1.31)%, respectively], with statistically significant differences between them (P<0.05). The expression levels of survivin mRNA and survivin protein were down-regulated. The activity of caspase-3 was raised. Conclusions siRNA targeting hPTTG1 could induce apoptosis of A2780 by inhibition of survivin expression and activation of caspase-3. It may be a potential target for gene therapy of ovarian cancer.
Objective To make an individualized therapeutic regimen for a patient with stage III relapsed ovarian cancer guided by evidence-based medicine.Methods According to the clinical problems this patient showed and the PICO (patient, intervention, comparison and outcome) principle, the best clinical evidence associated with relapsed ovarian cancer was retrieved and evaluated. Results The current evidence showed that the relapsed ovarian cancer with platinum resistance tended to be treated by pharmacotherapy. Consequently, on the basis of combining the recommended guidelines, randomized controlled trials (RCTs), systematic reviews or meta-analyses on RCTs, clinical experience from doctors and willingness of patient, the regimen of Irinotecan plus Pegylated Liposomal Doxorubicin for interventional chemotherapy was recommended for this patient. After three courses of the treatment, the disease got some relieved; the medical team would like to keep conducting the same regimen for another six to eight courses, and the follow-up visit was undergoing. Conclusion For patients with relapsed ovarian cancer with platinum resistance, an individualized therapeutic regimen under the guidance of evidence-based methods can not only improve the therapeutic efficacy but also guide both doctors and patients to take the indeterminate risk of medicine.
ObjectiveTo systematically review the efficacy and safety of intravenous calcium infusion for preventing ovarian hyperstimulation syndrome (OHSS). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), CNKI, Sinomed and WanFang Data were searched from inception to July 2015 to collect randomized controlled trials (RCTs) and non-RCTs about intravenous calcium infusion for OHSS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of six studies involving 1 061 women were included. The results of meta-analysis showed that intravenous calcium infusion could reduce the incidence of moderate OHSS (RR=0.27, 95% CI 0.11 to 0.65, P=0.003), but not the incidence of severe OHSS (RR=0.77, 95% CI 0.23 to 2.63, P=0.68). In addition, intravenous calcium infusion had a tendency to increase the pregnant rate (RR=1.19, 95% CI 0.94 to 1.50, P=0.15). The subgroup analysis showed that, compared with placebo/no treatment, intravenous calcium infusion reduced the incidence of moderate OHSS, but not the incidence of severe OHSS. There were no statistical differences between intravenous calcium infusion and other positive control (cabergoline and hydroxyethyl starch) in the incidence of OHSS and pregnant rate. No side effect was reported in the studies included. ConclusionsCurrent evidence indicates that intravenous calcium infusion can reduce the incidence of OHSS without influence pregnant outcomes. Due to the quantity and quality limitations of included studies, more high quality case-control or cohort studies are needed to verify the above conclusions.
Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors, so as to improve the diagnostic efficiency of existing test indexes. Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected, and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio. Logistic regression was used to construct a diagnostic model in the training set, and the diagnostic efficacy of the model was verified through discrimination, calibration, clinical benefit, and clinical applicability evaluation. Results A total of 929 patients with ovarian tumors were included, including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors. The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases. A diagnostic model was constructed using logistic regression in the training set, containing 5 factors namely age, percentage of neutrophil (NEU%), fibrinogen to albumin ratio (FAR), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4): modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%, with a Hosmer-Lemeshow test P-value of 0.21. The area under the receiver operating characteristic (ROC) curve measured in the training set was 0.927 [95% confidence interval (0.903, 0.951)], the sensitivity was 0.947, and the specificity was 0.780. The area under the ROC curve of the validation set was 0.888 [95% confidence interval (0.840, 0.930)], the sensitivity was 0.744, and the specificity was 0.901. Conclusion A new quantitative tool based on age, NEU%, FAR, CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors, and it is helpful to improve the diagnostic efficiency and is worth popularizing.
ObjectiveTo explore the prevalence rate of gynecologic diseases and its character of age distribution of women in Chengdu, China. MethodsWe retrospectively analyzed gynecologic examination reports of women who underwent physical examination from December 2011 to November 2012. ResultsThis study included 23 389 women; the overall detection rate of cervix erosion was 20.98%. The detection rate of cervix erosion of women aged from 20 (included) to 30 was 44.81%, ranking first. The overall rate of abnormal cervical cytology was 0.93%, and the rate of women aged 41 to 50 was 1.20%, ranking first. The overall detection rate of uterine myoma, uterine adenomyosis, and ovarian tumor was 11.12%, 1.33%, and 3.60%, respectively. Fourty-one to 50 was the peak age of uterine myoma, uterine adenomyosis, and ovarian tumor; the detection rate was 19.95%, 2.46%, and 4.76%, respectively. The difference was significant in different age (P<0.05). ConclusionThe detection rate of gynecological common disease is high in childbearing aged women. Women aged 41-50 is the high-risk population of gynecological common disease.