Journal of Obstetrics and Gynaecology Research最新文献

Aim: To clarify live birth outcomes among women receiving extended or repeated high-dose medroxyprogesterone acetate (MPA) therapy for fertility-sparing management of atypical endometrial hyperplasia or endometrioid carcinoma grade 1.

Methods: We conducted a single-center retrospective case series of 53 patients undergoing MPA therapy between 2005 and 2023. Patients were stratified into three groups: (i) complete response (CR) within 6 months (standard group), (ii) CR after extended treatment beyond 6 months (extended group), and (iii) CR after MPA retreatment for first intrauterine recurrence (retreatment group). Primary outcome was the live birth rate (LBR). Secondary outcomes included the effect of initial reproductive intentions, interval from CR to conception, recurrence rates, and recurrence-free interval (RFI).

Results: LBRs were 33% (10/30) in the standard group, 8% (1/12) in the extended group, and 17% (2/12) in the retreatment group. Among eight patients undergoing MPA retreatment for a second or subsequent recurrence, none achieved live birth. Patients with an initial desire for prompt conception had significantly higher LBRs than those without (38% vs. 5%, p < 0.01). Median time from CR to conception leading to live birth was 12 months. Patients achieving live birth had significantly longer RFIs than those without (p < 0.01).

Conclusions: Live birth is most likely when CR is achieved within 6 months of MPA therapy; nonetheless, extended or repeated MPA treatment may still result in live birth. These findings suggest the importance of appropriate patient selection and careful monitoring during extended or repeated therapy and attempting conception promptly in fertility-sparing management of endometrial neoplasia.

Background: Ovarian cancer (OC) is a growing public health challenge in Asia, with rising incidence and regional disparities. Using the Global Burden of Disease (GBD) 2021 dataset, this study assessed temporal trends, spatial patterns, and determinants of OC burden in Asia from 1990 to 2021, with projections to 2036.

Methods: Data were extracted from GBD 2021 for all Asian regions. Three indicators were analyzed: age-standardized incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years rate (ASDR). Trends were evaluated using estimated annual percentage change (EAPC) and Joinpoint regression. Decomposition analysis examined contributions of population aging, growth, and epidemiological shifts. Age-period-cohort (APC) analysis was performed to disentangle the effects of age, period, and cohort on OC incidence. Future burden (2022-2036) was projected with an autoregressive integrated moving average (ARIMA) model.

Results: From 1990 to 2021, OC burden increased markedly. Southeast, South, and Central Asia had the greatest rises in ASIR, ASMR, and ASDR, while East Asia and high-income Asia Pacific showed stable or declining trends, likely due to healthcare advances and early detection. Higher sociodemographic index (SDI) correlated with greater incidence and mortality. Decomposition revealed aging as the main driver in East Asia and high-income Asia Pacific, while population growth dominated in South Asia. APC analysis highlighted age as the primary risk factor, with a rising period effect and a declining cohort effect. ARIMA projections (2022-2036) show steady ASIR growth and U-shaped trajectories (initial decline then rise) for ASMR and ASDR.

Conclusion: The increasing OC burden in Southeast, South, and Central Asia underscores the urgent need for region-specific strategies. Interventions focusing on early diagnosis, equitable healthcare, and addressing demographic and epidemiological drivers are essential to mitigate the projected rise by 2036.

Aim: To explore the association between D-dimer/fibrinogen ratio (DFR) and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in normocoagulable women.

Methods: This retrospective cohort study included 869 women undergoing their first single blastocyst frozen-thawed embryo transfer (FET) cycles at Beijing Chao-Yang Hospital. Data were collected from the medical records of FET cycles performed at the reproductive medicine center between January 2016 and November 2022. Eligible participants were normocoagulable women aged 22-38 years with a body mass index (BMI) < 30 kg/m², those with metabolic or uterine disorders or incomplete records were excluded. The primary outcomes were live birth and miscarriage. Participants were stratified by live birth status to assess the association between DFR and pregnancy outcomes.

Results: Participants were categorized into live birth group (n = 357) and non-live birth group (n = 512). Compared to the non-live birth group, the live birth group had lower D-dimer (0.19 vs. 0.23 mg/L, p = 0.010) and DFR (0.07 vs. 0.08, p = 0.003). Logistic regression revealed that elevated DFR increased pregnancy failure risk. Receiver operating characteristic (ROC) analysis indicated that DFR predicted live birth with a cut-off value of 0.085. Stratified by this cut-off value, the DFR > 0.085 group had a higher miscarriage rate (26.40% vs. 15.04%), a lower clinical rate (46.98% vs. 54.51%), and a lower live birth rate (34.38% vs. 46.31%).

Conclusions: A higher pre-pregnancy DFR is associated with adverse pregnancy outcomes in normocoagulable women and may serve as a predictor for IVF/ICSI.

Aim: To identify clinical risk factors for endometrial malignancy in postmenopausal women and develop a predictive model for early detection and personalized intervention.

Methods: This study analyzed 1146 postmenopausal women undergoing diagnostic hysteroscopy. Inclusion required: confirmed menopause (age ≥ 40) with recent endometrial thickness measurement, successful hysteroscopy, histopathological verification, and complete records. Exclusions involved incomplete data, type II carcinoma, hormonally active tumors, or prior hysteroscopy indications. Demographics, clinical features, comorbidities, imaging data, and biomarkers were analyzed. Histology was confirmed via standard pathology. Risk factors were identified through univariate and multivariate logistic regression. The resultant predictive nomogram for endometrial malignancy risk stratification underwent rigorous validation using: (1) receiver operating characteristic curve analysis (discriminative power); (2) calibration plotting (prediction accuracy); and (3) decision curve analysis (clinical net benefit).

Results: Among 1146 postmenopausal women undergoing diagnostic hysteroscopy, histopathological analysis identified 69 cases (6.0%) of endometrial carcinoma (EC) and 15 cases (1.3%) of atypical endometrial hyperplasia, with the remaining cases (92.7%) demonstrating benign pathology. Multivariate analysis identified seven independent risk factors for EC: elevated fibrinogen and D-dimer levels, hypertriglyceridemia, decreased high-density lipoprotein, postmenopausal bleeding, ultrasonography blood-flow signals, and increased endometrial thickness. The predictive nomogram incorporating these parameters demonstrated outstanding diagnostic performance, with area under the curve values of 0.955 in the training cohort and 0.960 in the validation cohort, indicating excellent discriminative ability for EC risk stratification.

Conclusion: We developed and validated a novel 7-indicator prediction model for assessing endometrial malignancy risk in postmenopausal women undergoing hysteroscopy biopsy.

Aim: To evaluate the clinical, pathological, and treatment-related factors influencing recurrence and mortality in patients diagnosed with vulvar squamous cell carcinoma (SCC), with a specific focus on the prognostic significance of surgical margin width.

Methods: This retrospective study included 70 patients with histologically confirmed vulvar SCC treated between 2000 and 2020 at a tertiary academic center. Patients were categorized based on tumor-free surgical margin width (< 2 mm, 2-8 mm, > 8 mm). Demographic, clinical, and histopathological parameters were analyzed using Cox regression and Kaplan-Meier methods to assess their impact on disease-free survival (DFS) and overall survival (OS).

Results: The median age at diagnosis was 68 years, and 74.3% of cases were FIGO stage I. Median DFS and OS were 46 and 56 months, respectively. Age and tumor grade emerged as independent predictors of mortality and recurrence. Surgical margins < 2 mm were significantly associated with increased recurrence risk (p = 0.001), while no significant effect on OS was observed. Margins ≥ 2 mm conferred a lower recurrence risk, especially in the 2-8 mm group. Lymphovascular space invasion (LVSI) and depth of invasion were significant in univariate analysis but lost significance after adjustment.

Conclusion: Surgical margin width, particularly margins < 2 mm, is a strong predictor of local recurrence in vulvar SCC. Age and tumor grade are independent predictors of prognosis. These findings highlight the importance of individualized surgical planning and support the development of risk-adapted treatment strategies. Future prospective studies are warranted to refine optimal margin thresholds and improve outcomes, especially in high-risk populations.