Volume 102 ·  Issue 26 ·  2022

To further improve the survival rate of patients with gynecological malignancies, our paper currently propose to focus on the quality of diagnosis and treatment of gynecological malignancies. We suggest to promote the standardization of the diagnosis and treatment, to perform innovative clinical trial, and to construct a multidisciplinary model of diagnosis and treatment for patients with gynecological malignancies.

Chronic active antibody-mediated rejection (caAMR) caused by de novo donor-specific antibodies (dnDSA) is the main risk factor of late allograft loss in kidney transplantation. The treatment remains difficult due to the lack of effective methods. Through comprehensive management pre and post kidney transplantation, which starts from the prevention of dnDSA generation, periodical monitoring of dnDSA, to timely implement of pathological diagnosis and early initiation of synthetical treatment, it will be beneficial to the prevention and treatment of caAMR and ultimately improve the long-term survival of the renal graft.

The current diagnosis and treatment concept of prostate cancer is that if prostate cancer is suspected through one or more examination methods, prostate biopsy should be performed to confirm the diagnosis of prostate cancer and then subsequent treatment should be given. Nowadays, the application of multi-parameter magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) PET/CT has further improved the imaging diagnosis of prostate cancer, and the diagnostic accuracy of clinically significant prostate cancer has reached almost 100%. In addition, minimally invasive techniques represented by robot-assisted laparoscopic surgery have developed rapidly, and the safety and postoperative recovery of radical prostatectomy have been significantly improved. Therefore, we proposed the concept of radical prostatectomy avoiding biopsy (RPAB), that is, the patients with high suspicion of prostate cancer by multi-parameter MRI and PSMA PET/CT can be directly treated by radical surgery. Preliminary clinical practice confirmed that this concept is feasible. However, RPAB is not suitable for all prostate cancer patients, and any new concept needs to be supported by long-term and high-quality clinical studies. We predict that RPAB will become a new clinical option and produce good economic and social benefits.

In recent years, the diagnosis and treatment of gynecologic cancer have entered a new era with the development of precision medicine. The diagnosis and treatment modes for ovarian cancer, cervical cancer, and endometrial cancer are constantly adjusted. The application of molecular targeted drugs and the progress of surgical concepts and technology have greatly improved the survival of patients with ovarian cancer. Immunotherapy and targeted therapy have become a new hot spot in the treatment of cervical cancer. More clinical research data have been accumulated on the comparison of laparoscopic and open radical hysterectomy in cervical cancer. The surgical management of endometrial cancer has been improved, and molecular diagnostics are increasingly used to guide the diagnosis and treatment of endometrial cancer. Meanwhile, it′s necessary to realize the limitations and challenges of precision medicine in gynecologic cancer.

Surgery is the primary treatment for early cervical cancer. Radical hysterectomy by laparotomy and minimally invasive surgery have been widely used for years. The results of the LACC study has overturned the clinical practice of the cervical cancer, and the radical hysterectomy by laparotomy is the only standard operation. Based on the studies of laparoscopy or robot-assisted laparoscopy comparing laparotomy for the risk factors of survival outcomes, as well as a series of methods for improving oncology outcomes, it suggests that the minimally invasive surgical approach in early cervical cancer should be reconsidered. Focusing on this topic, this paper discussed the risk factors that might affect the oncology outcome of minimally invasive surgery, and analyzed the surgical indications and recurrence patterns. Hence, to promote the standardized operation of "tumor-free" in the procedure of the minimally invasive surgery might be improve the patient survival outcomes.

Antibody-mediated rejection (AMR) in late renal transplantation seriously affects the long-term survival rate of transplanted kidneys, and neonatal donor-specific antibody (dnDSA) is the main pathogenic factor of late AMR. In order to cope with this important clinical bottleneck and improve the long-term survival rate of kidney transplantation in China, the Transplantation Technology Branch of China Medical Biotechnology Association and the Expert Committee of Shanghai Kidney Transplantation Quality Control Center organized relevant experts to refer to the latest foreign progress and combine the clinical practice of kidney transplantation in China. The first draft was written, and the revised opinions of domestic experts in this field were widely solicited to complete this consensus. The consensus discusses the reduction of the risk of dnDSA to prevent late AMR, regular detection of dnDSA and timely detection of late AMR through pathological diagnosis, and the treatment methods of late AMR, and gives recommendations from relevant experts.

Hemodialysis patients are susceptible to novel coronavirus pneumonia (COVID-19), have a high incidence and have a high mortality rate. In view of the problems existing in the prevention and control of COVID-19 and dialysis treatment of hemodialysis patients in China, the National Center for Medical Quality Management and Control of Nephrology organized experts to propose the opening of hemodialysis rooms during the current COVID-19 epidemic, the hierarchical management of hemodialysis patients with different COVID-19 spread risks, the management of medical staff and patients in hemodialysis rooms in areas with high epidemic of COVID-19, normalized prevention and control measures, and expert suggestions on quality control of COVID-19 vaccination related research for dialysis patients, so as to guide the scientific and standardized prevention and control of COVID-19 in hemodialysis rooms.

To estimate endometrial cancer (EC) incidence and mortality in China in 2015.

Qualified cancer registry data collected in 2011-2015 were pooled for analysis, from which EC cases and deaths were extracted. EC cases were classified into endometrioid, nonendometrioid and other & unspecified according to their histologic types. Incidence and mortality rates stratified by region and age group were calculated. Population data of 2015 was used to estimate cancer cases and deaths in China. Segi′s population was used for the calculation of age-standardized rates by world standard population (ASW).

Data from 158, 176, 239, 235, 231 qualified cancer registries of 2011 to 2015 were pooled together. These registries covered about 488 million population, including about 255 million population in urban area and 233 million population in rural area. In 2015, a total of 53 600 EC cases were estimated, with a crude incidence rate of 7.74/100 000 and an ASW of 5.13/100 000. Incidence rates were higher in urban areas (9.15/100 000) than in rural areas (6.20/100 000). A total of 10 700 deaths were estimated, with a crude mortality rate of 1.60/100 000 and an ASW of 0.98/100 000. Mortality rate was higher in urban areas (1.78/100 000) than in rural areas (1.40/100 000). Among reported EC cases during 2011-2015, 70.92% (23 641 cases) were endometrioid, 5.13% (1 709 cases) were nonendometrioid and 23.95% (7 982 cases) were other & unspecified. The mean age at onset of all EC cases was 55.9±10.6. The mean age at onset of endometrioid cases (55.7±10.0) was younger than that of nonendometrioid cases (57.7±10.8) (P<0.001). The mean age at onset of all histologic types in urban areas was higher than that in rural areas (P<0.001). The mean age at death for EC deaths was 63.9±12.5. The mean age at death in urban areas (65.3±12.5) was higher than that in rural areas (61.4±12.2) (P<0.001).

EC disease burden differs between urban and rural areas. Targeted cancer prevention and control strategies should be made for each region.

To investigate the effect of preoperative serum creatinine (Scr) level on the prognosis of patients with early cervical adenocarcinoma (ADC) and its predictive value.

A retrospective review was performed on 199 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage ⅠA1-ⅡA1 and pathology-proven invasive ADC from January 2005 to December 2015. Patients were followed up by phone and outpatient, with a median follow-up time 77.5 (57.0, 114.0) months, 11 cases (5.5%) were missing, 19 cases (10.1%) recurred, and 17 cases (9.0%) died. Multivariate analysis was performed by Cox regression model to analyze the related factors of the prognosis of ADC patients. The optimal cut-off point was determined by the analysis of receiver operating characteristics (ROC), and the predictive value of related factors for prognosis was evaluated by the area under the curve (AUC).

The median age of 199 patients was 44.0 (39.0-50.0) years. Overall, 16 patients (8.0%) were stage ⅠA1; 4 patients (2.0%) were stage ⅠA2; 147 patients (74.0%) were stage ⅠB1; 13 patients (6.5%) were stage ⅠB2; 19 patients (9.5%) were stage ⅡA1. The multivariate analysis showed that FIGO stage [4.570 (1.625-12.854)] and elevated Scr [1.065 (1.006-1.128)] were correlated with DFS in patients with early ADC, as well as correlated with OS [4.412 (1.458-13.350) and 1.076 (1.012-1.144), respectively (all P<0.05)]. The optimal cut-off point of Scr level was 75.2 μmoI/L. The AUC showed that the Scr level was a predictor of DFS (AUC=0.677, 95%CI: 0.608-0.742, P=0.006) and OS (AUC=0.677, 95%CI: 0.607-0.741, P=0.012).

The preoperative Scr level independently predicts the prognosis of early-stage ADC; patients with Scr levels>75.2 μmoL/L might require more follow-up and adjuvant treatment, as they might have a poorer prognosis.

To explore the clinical prognosis and fertility outcomes in patients with borderline ovarian tumors (BOT) who underwent fertility-sparing surgery, and evaluate the related risk factors.

The study examined the clinicopathological characteristics of 280 patients diagnosed with BOT from Qilu Hospital of Shandong University between January 2009 and December 2019. According to the surgery plan, the patients were divided into the fertility-sparing group (167 cases) and the radical surgery group (113 cases). The information of the patients′ age, preoperative serum CA-125 level, surgery method, pathological type, FIGO stage (2014), tumor location, and whether focal canceration combined were collected. The Kaplan-Meier method was used to compare disease-free survival (DFS) between the fertility-sparing surgery group and the radical surgery group. The univariate and multivariate Cox proportional hazard regression analysis was used to explore high-risk factors associated with DFS.

A total of 280 BOT patients were identified in the study, with a median age of 35.0 (26.0, 51.0) years old. The median follow-up time was 55.2 (34.7, 79.3)months. 25 patients (15.0%) developed recurrence in the fertility-sparing surgery group, 11 patients (8.7%) developed recurrence in the radical surgery group. There was no significant difference in 5-year DFS rate between the two groups (84.4% vs 90.1%, P=0.223). Only FIGO stage was found to be related to DFS through the univariable and multivariable Cox proportional hazard regression analysis, and patients with FIGO Ⅱ/Ⅲ had higher risk of recurrence [HR (95%CI) 2.872(1.283-6.431)] (P=0.010); Fertility-sparing surgery does not increase the recurrence risk of BOT patients (P=0.116). Pregnancies were reported in 39 patients (54.2%), among whom 37 patients gave birth successfully, and 2 patients selected to terminate pregnancy.

The fertility-sparing surgery does not increase the risk of recurrence in BOT patients, and patients who underwent the fertility-sparing surgery have a favorable outcome. FIGO stage is the independent risk factor of DFS in BOT patients.

This study aims to analyze the clinicopathological characteristics of patients with intravenous leiomyoma (IVL), and to explore the expression characteristics and diagnostic value of angiogenesis related molecules in IVL.

The clinicopathological data of 40 patients with IVL at Women′s Hospital, School of Medicine, Zhejiang University from January 2013 to April 2021 were reviewed. Log-rank test was performed to compare the difference in recurrence-free survival (RFS) rates among patients with different clinicopathological characteristics. Immunohistochemistry (IHC) staining was performed on 10 angiogenesis related molecules to analyze their expression characteristics in IVL. The sensitivity and specificity of molecules with high expression rates in the diagnosis of IVL were calculated, the receiver operating characteristic curve (ROC) was plotted and the area under ROC (AUC) was calculated to evaluate the diagnostic value.

Median age of the 40 patients was 47 (43, 50) years. The clinical manifestations of IVL were atypical with the diagnostic accuracy of preoperative ultrasound was 12.5% (5/40), CT and/or MRI was 26.7% (8/30), and intraoperative frozen section was 30.0% (12/40). The overall recurrence rate of IVL was 10.0% (4/40). The Log-rank test showed that the cumulative recurrence-free survival rate of IVL patients with previous cesarean section (40.9%) was lower than that of those without cesarean section (96.4%) (P<0.05); and their median RFS time was shorter than those without cesarean section (16.4 months vs 22.2 months). The overall positive rates of adrenomedullin (ADM), fibroblast growth factor receptor 1 (FGFR1), vascular endothelial growth factor receptor 3 (VEGFR3) and angiogenin receptor tyrosine kinase receptor 1 (TIE1) were 65.0% (26/40), 75.0% (30/40), 57.5% (23/40) and 50.0% (20/40), respectively. FGFR1 expression intensity and positive rate were higher in tumors with a maximum diameter greater than 5 cm than in tumors with a maximum diameter smaller than 5 cm (P<0.05). The AUC of FGFR1 combined with ADM, VEGFR3, and TIE1 was 0.876 (95%CI: 0.788-0.964, P<0.001).

There was no typical clinical manifestation of IVL. A history of the previous cesarean section indicated a lower cumulative recurrence-free survival rate and shorter recurrence interval. It was hard to diagnose IVL by sonography, radiography, or frozen section pathology. FGFR1, ADM, VEGFR3, and TIE1 were all highly expressed in IVL, and the efficacy of the combination of the four molecules in diagnosing IVL was higher than that of imaging and classical vascular endothelial markers, which are expected to be promising molecular diagnostic markers.

To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis.

Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN).

A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively.

AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

To explore the risk factors of colorectal advanced adenomas (AA) and construct a nomogram to predict the risk of colorectal AAs.

Clinical data of patients were retrospectively collected who underwent their first colonoscopy from January 2017 to December 2020 in the First Affiliated Hospital of Nanjing Medical University and were pathologically confirmed harboring colorectal polyps. A credible random split-sample method was used to divide data into training and validation cohorts (split ratio=7∶3). Univariate and multivariate logistic regression analysis were used to identify the predictors of colorectal advanced adenomas, and a nomogram was developed based on the above results. The validation cohort was used for internal validation of the nomogram. The discriminatory value of the nomogram was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The consistency between actual outcomes and predicted probabilities was evaluated by the calibration curve. The clinical validity of the model was evaluated by the decision analysis curve (DCA).

A total of 1 936 patients with colorectal polyps were eligible. Including 1 356 patients in the training cohort (840 males and 516 females), and 580 patients in the validation cohort (379 males and 201 females), with the mean ages of (57.4±9.8) and (57.6±9.7) years, respectively. There were 1 502 (77.6%) patients without AAs and 434 [22.4%,1-9 mm 73(16.8%) cases、>9-<20 mm 271(62.5%) cases、≥20 mm 90(20.7%) cases] patients with AAs. The regression analysis found that age (OR=1.018, 95%CI:1.003-1.033), fatty liver (OR=1.870, 95%CI:1.274-2.744), low-density lipoprotein (LDL) (OR=1.378, 95%CI:1.159-1.637), fecal occult blood test (FOBT) (OR=2.597, 95%CI:1.857-3.631), and location of adenomas [proximal (OR=2.869, 95%CI:1.727-4.764), distal (OR=2.791, 95%CI:1.721-4.527)] were identified as predictors of colorectal AAs. The AUC of the nomogram was 0.664 (95%CI:0.630-0.698) in the training cohort and 0.640 (95%CI:0.587-0.693) in the validation cohort. The calibration curve showed good consistency between the predicted and actual risk, and the Hosmer-Lemeshow (H-L) test P value was 0.830 and 0.150 in the training cohort and the validation cohort. DCA demonstrated that the nomogram had a better clinical application value.

A nomogram with five predictors, including age, fatty liver, LDL, FOBT, and location of adenomas, helped predict the risk of colorectal AAs in patients with polyps and implemented colorectcal cancer stratified screening strategy for colonoscopy in the high-risk population.

To explore the feasibility and safety of laterally extended endopelvic resection (LEER) for advanced and recurrent gynecological malignancies with pelvic sidewall involvement and to evaluate this therapeutic potential of this novel salvage treatment. The clinicopathological data of 5 patients with gynecological malignancies who received laparoscopic LEER treatment in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to September 2021 were retrospectively analyzed, including 3 cases of recurrent cervical cancer, 1 case of primary advanced endometrial cancer and 1 case of pelvic aggressive angiomyxoma. Among them, four patients achieved complete resection (R0) with a negative resection margin; the other patient with recurrent cervical cancer did not complete surgery because of the extreme risk of continuing surgery. The median operation time was 345 (225-482) minutes and the median blood loss was approximately 300 (200-600) ml. Complications occurred in three patients, including lymphocysts, urinary tract infections, and deep venous thrombosis of the lower extremities. Within a median follow-up time of 283 (128-715) days, 4 patients survived tumor-free, and 1 patient died. The high rate of complete resection (R0) and the encouraging oncological outcomes suggest that LEER may be an alternative treatment option for patients with advanced and recurrent gynecological malignancies involving the pelvic sidewall.

To investigate the effect and clinical value of morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy. A total of 42 patients who underwent laparoscopic myomectomy and morcellation through posterior vaginal fornix in the Second Affiliated Hospital of Soochow University from June 2019 to June 2021 were retrospectively analyzed. After the uterine fibroids were removed, the fibroids were placed into the extraction bag, tightening the mouth of the bag with a traction wire to make it airtight. After the uterine incisions were sutured, the extraction bag was taken out through the posterior fornix of the vagina, and the fibroids were broken up with a scalpel in the bag and taken out. The fibroids were successfully removed from the 42 patients through the posterior fornix of the vagina. There were no fibroids fragments found in the peritoneal cavity and vagina. There were no malignant cells or spindle cells found in the peritoneal lavage cytology before and after the operation. After filling the extraction bags with water, there was no leakage. There were 39 cases of uterine leiomyoma, 2 cases of cell-rich uterine leiomyoma, and 1 case of smooth muscle tumor of uncertain malignant potential in postoperative pathological diagnosis. Forty-two cases were followed up for 6 to 30 months. The posterior vaginal fornix incision healed well and there was no recurrence or metastasis. Morcellation within disposable extraction bag with traction wire through posterior vaginal fornix in laparoscopic myomectomy is a safe and feasible method for fibroids removal, which may help to reduce the dissemination of iatrogenic tumors.

To investigate the feasibility and safety of total laparoscopic cardia function preserving gastrectomy for gastric carcinoma. Clinical data of 10 patients undergoing total laparoscopic cardia function preserving gastrectomy for gastric carcinoma from November 2020 to December 2021 were retrospectively collected. There were 7 males and 3 females. The mean age was (66.1±12.9) years (ranged from 38 to 86 years). All of the 10 patients were successfully performed total laparoscopic cardia function preserving gastrectomy without conversion to laparotomy. The time of digestive tract reconstruction was (24.8±3.3) min (20-30 min), and the intraoperative blood loss was (35±24) ml(20-100 ml). The time of postoperative exhaust was (2.5±0.9) days(2-3 d), the time of postoperative liquid diet was (2.25±0.87) days(2-3 d), postoperative hospital stay was (9.5±2.1) days(6-13 d). No surgical complications such as bleeding, anastomotic fistula or anastomotic stenosis occurred. Postoperative pathology showed that the proximal and distal margins of resected specimens were negative. Patients were followed up for 2 to 15 months, respectively. No death or tumor recurrence and metastasis occurred during the follow-up period. There were no symptoms of reflux after operation. Compared with total gastrectomy and proximal gastrectomy, total laparoscopic cardia function preserving gastrectomy can theoretically reduce the incidence of reflux esophagitis. We used manual suture method for digestive tract reconstruction, which can reduce the application of 2-3 stapling studs and reduce the cost of surgical materials. Compared with subtotal gastrectomy, total laparoscopic cardia function preserving gastrectomy has the advantages of more thorough lymph node dissection, with little residual gastric tissue; therefore, the blood supply is relatively better. The incidence of reflux esophagitis of total laparoscopic cardia function preserving gastrectomy for gastric cancer may was lower than total gastrectomy.

Patients with myelodysplastic syndrome (MDS) are prone to severe infection due to agranulocytosis and reduced immunity. Infectious endocarditis (IE) is a rare infection, which is characterized by fever, heart valve murmur, heart valve growth, vascular and immunological abnormalities, and may be combined with brain, lung or spleen embolism. Because of its atypical clinical manifestations, it is easy to miss or misdiagnose. This article aims to improve clinicians' understanding of hematological diseases with IE by reviewing the history of diagnosis and treatment of a patient with MDS with IE.

The prevention, diagnosis and targeted treatment of donor-specific antibody (DSA) are the key to the clinical diagnosis and treatment of antibody-mediated rejection (AMR) in renal transplantation. Insufficient intensity of immunosuppressive therapy to control the immune response elicited by allogeneic human leukocyte antigen (HLA) is responsible for the production of DSA in recipients. Kidney transplant recipients should be tested for HLA antibodies regularly after operation, and whether positive HLA antibodies have donor specificity should be analyzed. Comprehensive DSA characteristics and pathological biopsy diagnosis should be used to clarify its clinical significance in time, so as to guide further rational treatment. For DSA, we should focus on prevention, regular detection and active and appropriate treatment to prevent the causal development of a series of adverse events in the course of AMR disease, so as to improve the long-term survival rate of transplanted kidney.

With the popularization of cervical cancer screening and the use of human papillomavirus (HPV) vaccine, the incidence of cervical squamous cell carcinoma has decreased significantly, but the relative incidence of cervical adenocarcinoma has increased, and it is showing a younger trend. Cervical adenocarcinoma is a group of heterogeneous tumors with different histomorphology, etiology, molecular drivers and clinical outcomes. An effective pathological classification system is of great significance for the accurate formulation of its prevention and treatment strategies. Based on recent studies, the International Diagnostic Criteria and Classification of Cervical Adenocarcinoma (IECC), which combines etiology and morphology, and the Silva classification system based on invasion pattern have important guiding value for the diagnosis and individualized treatment of cervical adenocarcinoma. The advances in molecular pathology research have provided some genetic evidence for the new classification of cervical adenocarcinoma. Molecular detection is expected to be a tool for classification and prognosis assessment, and provide a basis for determining suitable targeted therapy. This article reviews the pathological classification of cervical adenocarcinoma in recent years.

Radical cervicectomy is a safe and feasible fertility-preserving surgical method for patients with early cervical cancer. Surgical approaches include transvaginal, laparotomy, and laparoscopy. The LACC study published in 2018 showed that when radical total hysterectomy was performed for early cervical cancer, the disease-free survival rate and overall survival rate of minimally invasive (ordinary laparoscopic and robotic laparoscopic) surgery were lower than that of open surgery. By reviewing the relevant literature published at home and abroad in recent years, this paper summarized the related surgical methods of cervical cancer to preserve fertility function. The data showed that for early cervical cancer (tumor diameter<2 cm) of radical cervicectomy, laparoscopic surgery did not have an increase in disease mortality and recurrence, and was superior to open surgery in terms of fertility outcome.

Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) gene mutations represents a class of lung cancer with certain therapeutic specificities, that is, tyrosine kinase inhibitors (TKIs) are preferred for the first-line treatment of advanced NSCLC patients with EGFR-sensitive mutations. However, as the third most common exon 20 insertion mutation (ex20ins) among EGFR mutations, the response to tumor treatment is not consistent with that of sensitive mutations, and the overall response to TKIs is not ideal. This article introduces the clinical characteristics and prognosis of EGFR ex20ins NSCLC, and focuses on its response to different treatment modalities such as TKIs, chemotherapy and immunotherapy, so as to provide reference for clinicians in treatment decision-making.