Journal of International Obstetrics and Gynecology

Research Progress on Mechanism and Intervention of Ferroptosis in Polycystic Ovary Syndrome

WANG Zi-wei, YANG Ying, WANG Jia-lai, CHEN Chen-chen, LIN Na-na, ZHANG Yan-li, CHANG Hui

2026, 53 (5): 481-486. doi: 10.12280/gjfckx.20260313

Abstract ( 35 )

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Ferroptosis, an iron-dependent form of programmed cell death, has been recently implicated in the pathogenesis of ovarian dysfunction in polycystic ovary syndrome (PCOS). Studies have revealed that hyperandrogenism may induce granulosa cell ferroptosis via mechanisms such as the androgen receptor-nuclear receptor coactivator 4 (NCOA4)-ferritinophagy axis and the endoplasmic reticulum stress-acyl-CoA synthetase long-chain family member 4 (ACSL4)/activating transcription factor 4 (ATF4)-mediated lipid peroxidation pathway, etc. Non-coding RNAs are involved in regulating granulosa cell ferroptosis through competing endogenous RNA mechanisms. Impairment of the AMP-activated protein kinase (AMPK)/nuclear factor-erythroid 2-related factor 2 (Nrf2) signaling pathway increases susceptibility of granulosa cells to ferroptosis. Regarding intervention strategies, traditional Chinese medicine monomers, compound prescriptions, and chemical agents have demonstrated promising therapeutic potential by upregulating the glutathione peroxidase 4 (GPX4)/solute carrier family 7 member 11 (SLC7A11) axis, inhibiting ACSL4 and 5-lipoxygenase, activating the AMPK/Nrf2 pathway, or targeting iron metabolism and autophagy pathways. However, current studies are predominantly conducted in animal models and at the cellular level, with limited evidence for clinical translation. Further exploration is needed for the identification of ferroptosis-related biomarkers and the evaluation of the efficacy and safety of targeted intervention strategies.

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The Role of Insulin-Like Growth Factor Binding Protein 7 in Obstetric and Gynecological Diseases

YAO Yu, CHEN Xiang-nan, WU Xiao-ke

2026, 53 (5): 487-492. doi: 10.12280/gjfckx.20260359

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Insulin-like growth factor binding protein 7 (IGFBP7), as a multifunctional secreted glycoprotein, plays a significant role in the physiology and pathology of the female reproductive system. It influences follicular development, endometrial receptivity, and embryo implantation by participating in processes such as cell proliferation, apoptosis, invasion and migration, insulin resistance, immune microenvironment modulation, and angiogenesis. IGFBP7 exhibits high disease specificity across different microenvironments and participates in the development and progression of obstetric and gynecological diseases through multiple signaling pathways. Studies have shown that the abnormal expression of IGFBP7 is closely associated with gynecological tumors (e.g., ovarian cancer, endometrial carcinoma), pregnancy-related disorders (e.g., hyperemesis gravidarum, miscarriage, gestational diabetes mellitus, pregnancy-related acute kidney injury), polycystic ovary syndrome and endometriosis. This review elaborates on the biological characteristics of IGFBP7 and its regulatory functions in the female reproductive system, summarizes its differential roles in various obstetric and gynecological diseases, and discusses future research directions to provide novel insights for disease prevention, diagnosis, and treatment.

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Correlation and Comorbidity Characteristics between Pelvic Floor Dysfunction and Postpartum Depression

GUO Xiao-juan, CHEN Shao-hui

2026, 53 (5): 493-498. doi: 10.12280/gjfckx.20260380

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Pelvic floor dysfunction and postpartum depression are both common conditions in postpartum women, posing serious threats to maternal physical and mental health and reducing postpartum quality of life. There is a significant bidirectional association and comorbidity between the two disorders. Studies have confirmed that physical discomfort caused by pelvic floor dysfunction can easily trigger depressive moods, while depression states may reduce compliance with pelvic floor rehabilitation, creating a vicious cycle. Obstetric injuries, obesity, and vitamin D deficiency are shared risk factors for both conditions. Dysfunction of hypothalamic-pituitary-adrenal axis, estrogen imbalance, and chronic inflammation are the core physiological mechanisms underlying their comorbidity. Current clinical diagnosis and treatment often remain fragmented, lacking targeted intervention strategies for comorbidity. Comprehensive approaches, such as pelvic floor rehabilitation combined with psychotherapy and targeted pharmacological treatments, can effectively alleviate comorbid symptoms. However, existing studies predominantly rely on subjective assessments, and the mechanisms underlying comorbidity, as well as prevention and treatment systems, remain inadequate. Future research should further explore the comorbidity mechanisms, improve integrated screening systems for postpartum physical and mental health, and establish holistic intervention models to provide a theoretical basis for the prevention and treatment of physical and mental health in postpartum women.

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Research Progress of Ding Kun Dan for Menopausal Symptoms

PAN Yue, TANG Liang-dan

2026, 53 (5): 499-504. doi: 10.12280/gjfckx.20260473

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Menopausal symptoms can significantly and adversely affect women′s quality of life, mental health, and long-term health. Currently, menopausal hormone therapy (MHT) is a key approach for managing menopausal symptoms. However, some patients seek alternative treatments due to contraindications, concerns about hormone-related risks, or personal preference. Existing research suggests that Ding Kun Dan alone may improve menopausal symptoms and sex hormone levels, and its combination with MHT may further enhance overall symptom relief, including sleep quality and anxiety or depressive symptoms. Its mechanism may involve regulating ovarian function and steroid hormone biosynthesis, the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) related signaling pathway, oxidative stress, energy metabolism, and neurotransmitters. For patients unwilling to undergo MHT or those desiring complementary intervention with traditional Chinese medicine, Ding Kun Dan holds potential clinical value. However, current clinical studies have limited sample sizes, and mechanistic evidence is largely derived from non-menopausal models. Its efficacy, safety, and appropriate target populations still require validation through high-quality research.

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Analysis of Seven Cases of Perianal Endometriosis

WANG Xin, XU Jing

2026, 53 (5): 505-509. doi: 10.12280/gjfckx.20260077

Abstract ( 32 )

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Objective: To delineate the clinical features, diagnostic characteristics, and treatment strategies for perianal endometriosis (PEM), aiming to enhance recognition and management of this rare condition. Methods: A retrospective analysis was conducted on seven patients with pathologically confirmed PEM who were admitted to Affiliated Hospital of Jining Medical University from January 2014 to December 2024. Results: All patients had a history of vaginal delivery, of whom four had a history of episiotomy, and three had a history of perineal lacerations. The latency period (interval from the first vaginal delivery to symptom onset) varied widely, ranging from a few months to 19 years. Clinical presentations included perianal masses or pain, with three cases showing symptom exacerbation correlating with the menstrual cycle. Four patients were initially admitted with anorectal disorders such as perianal abscess, mixed hemorrhoids, or anal fistula. All patients underwent resection of the ectopic lesions, and postoperative pathological examination confirmed the diagnosis of PEM. Conclusions: PEM exhibits variable latency and is prone to misdiagnosis. In women with a history of vaginal delivery presenting with perianal masses or pain, PEM should be considered. Detailed obstetric history and imaging examination are crucial for accurate diagnosis, and complete surgical excision is essential for achieving a favorable prognosis.

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Pelvic Abscess with Vaginal Foreign Body in An Adolescent: A Case Report

XIAO Jing-jing, LI Yue-qin, JIA Sheng-nan, ZHUANG Yu-wei, WANG Jun-jie

2026, 53 (5): 510-513. doi: 10.12280/gjfckx.20260349

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Pelvic abscess in adolescent females without a history of sexual activity is clinically rare. It is often caused by occult etiologies, presents with non-specific clinical manifestations, and carries a high rate of misdiagnosis and missed diagnosis, which can easily lead to delays in treatment. We report a case of an 11-year-old adolescent female. The patient initially presented with persistent fever. After receiving anti-infective therapy in department of pediatric internal medicine, her symptoms showed no improvement, and the condition progressed, leading to low-grade fever and dull lower abdominal pain. Imaging studies revealed a large, mixed echogenicity pelvic mass of undetermined nature. The patient underwent emergency laparoscopic exploration. Intraoperatively, extensive pelvic adhesions, a left tubo-ovarian abscess, and bilateral pyosalpinx were observed. Simultaneously, a retained plastic bottle cap was removed from the vagina. Postoperatively, the patient received standardized anti-infective and supportive therapy. The clinical symptoms resolved completely, and the prognosis was favorable. Retention of a genital tract foreign body is an occult high-risk factor for pelvic abscess in adolescents. Due to the absence of a sexual history and a concealed history of foreign body contact, clinical recognition is challenging. For adolescent girls with fever of unknown origin who are unresponsive to anti-infective therapy, routine screening for vaginal foreign bodies and pelvic suppurative lesions is necessary. Early completion of imaging studies and timely surgical intervention should be implemented to avoid long-term complications such as pelvic adhesions, thereby protecting the reproductive health and fertility of adolescent females.

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Application of Single-Cell RNA Sequencing Technology in Studying the Pathogenesis of Preeclampsia

JIANG Nan, LIANG Shu-zhen, HE Bi-wei, YANG Xing-yu, CHENG Wei-wei

2026, 53 (5): 514-520. doi: 10.12280/gjfckx.20260234

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Preeclampsia (PE) is a severe complication during pregnancy, and its pathogenesis involves the dynamic imbalance of multiple cell types and complex molecular networks at the maternal-fetal interface. However, the specific cellular and molecular mechanisms remain incompletely elucidated. Single-cell RNA sequencing (scRNA-seq) can resolve the cellular composition and gene expression profiles of complex tissues at the single-cell level, providing a powerful tool for uncovering the cellular heterogeneity of PE. This review systematically summarized the progress in the application of scRNA-seq to studies of PE-related tissues, cell types, and gene expression changes. scRNA-seq analysis has revealed subtype-specific functional abnormalities of trophoblasts and molecular alterations related to immune evasion in placental tissues; in maternal peripheral blood, it has identified PE-characteristic immune cell subsets and demonstrated significant differences in immune cell types between early-onset and late-onset PE; in the myometrium and umbilical cord blood tissues, cellular atlases have been constructed, providing clues for understanding the multisystem involvement in PE. scRNA-seq holds potential applications in PE subtype classification, non-invasive biomarkers screening, and potential intervention targets identifying, thereby providing references for the precise diagnosis and treatment of PE.

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The Role of Galectin-9 in the Pathogenesis of Preeclampsia

LEI Ya-qi, WANG Yong-hong

2026, 53 (5): 521-524. doi: 10.12280/gjfckx.20260288

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Preeclampsia (PE) is a hypertensive disorder of pregnancy characterized primarily by hypertension and proteinuria, and is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Currently, the pathogenesis of PE remains incompletely understood, mainly being associated with mechanisms such as inadequate remodeling of uterine spiral arteries, excessive activation of inflammatory immunity, and damage to vascular endothelial cells. Recent studies have found that galectin-9 (Gal-9), an important member of the β-galactoside-binding lectin family, is involved in the development of PE through multiple pathways, including regulating immune cell function by binding to T cell immunoglobulin and mucin domain-containing protein 3 (TIM3) and CD44, participating in placental trophoblast invasion and vascular remodeling, and mediating oxidative stress and inflammatory responses. This review summarizes the role of Gal-9 in the pathogenesis of PE.

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Research Progress on Intrapartum Ultrasound Multi-Parameter Quantitative Assessment for Early Diagnosis and Decision Support in Dystocia

XIAO Kang, LIANG Guang-ju, YANG Ying-jie, LIU Tao

2026, 53 (5): 525-529. doi: 10.12280/gjfckx.20260333

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Intrapartum ultrasound multi-parameter quantitative assessment is based on indices such as the angle of progression (AOP), head-perineum distance (HPD), midline angle (MLA), occiput-spine angle (OSA) and cervico-thoracic angle (CCA), etc. This technique transforms the spatial relationship between the fetus and the maternal pelvis into objective geometric parameters. It provides a novel approach for the early clinical identification of dystocia and assists in clinical decision-making. Current studies indicate that AOP and HPD hold clear value in predicting spontaneous vaginal delivery and evaluating the difficulty of instrumental delivery. The combination of multiple parameters with artificial intelligence analysis can help identify causes of dystocia such as persistent occiput posterior position and fetal head asynclitism in advance. However, the technique currently faces challenges including the absence of a unified standard operating procedure, lack of an established standardized training system, and inability to accurately measure uterine contraction force. Future efforts should focus on conducting large-scale, multicenter randomized controlled trials to validate the actual effectiveness of ultrasound quantitative parameter-based intrapartum intervention protocols in reducing cesarean section rates and optimizing maternal and neonatal outcomes, thereby providing evidence-based support for precise management of labor.

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Analysis of Influencing Factors for Adverse Fetal Outcomes in Preeclampsia Based on Competing Risk Model and Construction of A Nomogram Model

WANG Ting, GUAN Biao, ZHANG Hui-juan

2026, 53 (5): 530-535. doi: 10.12280/gjfckx.20251315

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Objective: To explore the influencing factors of adverse fetal outcomes in patients with preeclampsia (PE) based on a competing risk model and to construct a nomogram model. Methods: The clinical data of 338 PE patients admitted to the Second People's Hospital of Wuhu from January 2018 to October 2024 were retrospectively analyzed. A competing risk model was used to evaluate the influencing factors for adverse fetal outcomes in PE patients. A nomogram was plotted using the R3.4.3 software package, and the model was validated using the Bootstrap method. Calibration curves and receiver operator characteristic (ROC) curves were drawn to evaluate the calibration and predictive performance of the model. Results: The incidence rate of adverse fetal outcomes in PE patients was 46.75% (158/338), with the target event (adverse fetal outcomes due to PE) occurring at a rate of 37.87% (128/338), and the competing event (iatrogenic termination of pregnancy due to severe maternal complications before the occurrence of the target event) occurring at a rate of 8.88% (30/338). There were statistically significant differences among the three groups in gestational age at onset, abnormal umbilical artery blood flow, albumin (Alb), 24 h urine protein quantification, D-dimer (D-D), lactate dehydrogenase (LDH), and total bilirubin (TBIL) (all P<0.05). Multivariate competing risk model analysis showed that abnormal umbilical artery blood flow, high levels of 24 h urine protein quantification, high D-D levels, high LDH levels, and high TBIL levels were risk factors for adverse fetal outcomes in PE patients (all P<0.05), while advanced gestational age at onset and high Alb levels were protective factors (all P<0.05). The nomogram model constructed based on these influencing factors had a validated concordance index of 0.832, and its calibration curve showed good agreement with the ideal curve. The ROC curve demonstrated that the area under the curve, sensitivity, and specificity of the model for predicting adverse fetal outcomes in PE patients were 0.914, 87.97% and 85.00%, respectively. Conclusions: In the presence of competing risks, gestational age at onset, umbilical artery blood flow, Alb, 24 h urine protein quantification, D-D, LDH and TBIL are all influencing factors for adverse fetal outcomes in PE patients. The nomogram model constructed based on these factors exhibit good calibration and predictive performance.

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Spontaneous Uterine Rupture in the Third Trimester Following High-Intensity Focused Ultrasound Treatment: A Case Report

HE Yan-hong, CHEN Xiao-qin, LAN Liu-bing

2026, 53 (5): 536-539. doi: 10.12280/gjfckx.20251504

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Uterine rupture is a severe obstetric complication that poses a significant threat to maternal and fetal life. We report a case of a dichorionic twin pregnancy complicated by spontaneous uterine rupture in the third trimester. The patient had undergone high-intensity focused ultrasound (HIFU) treatment for adenomyosis and conceived via in vitro fertilization-embryo transfer one year after the procedure. She presented with acute lower abdominal pain in the third trimester. Ultrasound examination revealed intrauterine fetal demise of one twin and fetal distress in the other, necessitating an emergency cesarean section. Uterine rupture was confirmed intraoperatively. The delivered newborn had a weak heartbeat and succumbed despite active resuscitation. In conjunction with a review of five similar cases reported in the literature, we propose that the occurrence of uterine rupture during pregnancy following HIFU treatment may be associated with factors such as the size and location of the uterine fibroids or adenomyotic lesions, treatment energy parameters and exposure duration, and the interval between HIFU treatment and conception. Given the non-specific clinical presentation of this condition, clinicians should maintain a high index of suspicion for uterine rupture in patients presenting with abdominal pain in the second or third trimester, conduct a detailed medical history, and closely monitor fetal heart rate changes to facilitate early recognition.

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Spontaneous Reaccumulation of Amniotic Fluid after Preterm Prelabor Rupture of Membranes at 14 Weeks in A Dichorionic Diamniotic Twin Pregnancy: A Case Report

BAI Lu-lu, ZHAO Lei

2026, 53 (5): 540-543. doi: 10.12280/gjfckx.20260153

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Very early preterm prelabor rupture of membrane (PPROM) refers to PPROM occurring before 24 weeks of gestation, when the fetus is not yet viable, often leading to extreme prematurity and high perinatal mortality. The occurrence of very early PPROM in twin pregnancies is relatively rare and is typically associated with a poor prognosis. Reaccumulation of amniotic fluid is uncommon in PPROM but is associated with improved perinatal outcomes. This report describes a case of dichorionic diamniotic twin pregnancy where PPROM occurred at 14⁺⁵ weeks of gestation. Ultrasound indicated that the amniotic fluid depth for fetus A was only 0.7 cm. After 8 days of expectant management, the leakage of amniotic fluid ceased, and by 17⁺⁴ weeks of gestation, the amniotic fluid depth for fetus A had gradually recovered to 2.1 cm. The pregnancy was successfully prolonged to 29⁺³ weeks of gestation, at which point a cesarean section was performed due to antepartum hemorrhage, resulting in the delivery of two live-born infants. Fetus A was hospitalized for 121 days and fetus B for 62 days. Follow-up assessment at 3 months and 8 months of age showed favorable growth and development. This case suggests that, in the absence of infection, active and individualized expectant management may create conditions for spontaneous healing of the membranes, and that reaccumulation of amniotic fluid is a key factor in improving maternal and neonatal outcomes.

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Research Progress on the Perioperative Management of Focused Ultrasound Ablation Surgery for Uterine Fibroid

LOU Shun-ping, HUANG Ye-fang, ZHU Chao-xi, YANG Lei-lei, XU Hao-fei, HE Min, HE Zhe-lin, ZHU Hong-qiu

2026, 53 (5): 544-550. doi: 10.12280/gjfckx.20260127

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Focused ultrasound ablation surgery (FUAS), as a minimally invasive and non-invasive technique for treating uterine fibroids, has therapeutic efficacy influenced by multiple perioperative factors. Currently, the traditional "preoperative-intraoperative-postoperative" three-phase division is insufficient to cover the key points of whole-process management. By summarizing and analyzing studies related to the perioperative period of FUAS for uterine fibroids, this review precisely divides the FUAS perioperative period into five stages: pre-FUAS phase, early-FUAS phase, FUAS phase, late-FUAS phase, and FUAS postoperative follow-up phase. The core characteristics and comprehensive intervention strategies for each stage are systematically outlined. The pre-FUAS phase focuses on precise preoperative evaluation and pharmacological pretreatment; the early-FUAS phase emphasizes preoperative preparation and physical-psychological management; the FUAS phase centers on intraoperative safety and prevention of adverse reactions; the late-FUAS phase addresses early postoperative rehabilitation and management of complications; and the FUAS postoperative follow-up phase prioritizes long-term management and prevention of recurrence. By establishing a full-cycle management protocol supplemented by integrated traditional Chinese and Western medicine interventions, a standardized FUAS diagnosis and treatment system is formed, aiming to precisely enhance the clinical efficacy of uterine fibroid treatment.

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Role and Mechanism of Cytokeratin in Epithelial Ovarian Cancer

YI Si-yu, WANG Fen

2026, 53 (5): 551-555. doi: 10.12280/gjfckx.20260113

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Epithelial ovarian cancer (EOC) is the most common pathological type of ovarian cancer, characterized by insidious onset, high malignancy, a propensity for recurrence, and chemoresistance, resulting in a generally poor prognosis. Cytokeratin (CK) is a core cytoskeletal protein of epithelial cells that not only participates in maintaining the structural integrity of epithelial tissues, but also serves as a specific marker for epithelial-derived tumors, playing a significant role in the pathological diagnosis, typing, and prognostic evaluation of EOC. Furthermore, recent studies have revealed that CK family members (e.g., CK19 and CK23) can influence the proliferation, epithelial-mesenchymal transition, and chemoresistance of EOC cells by regulating mechanisms such as the Wnt signaling pathway and transforming growth factor-β/Smad signaling pathway, thereby promoting the initiation, progression, and drug resistance of EOC. Additionally, CK may serve as an indirect intervention target for traditional Chinese medicine compounds or active ingredients, demonstrating potential therapeutic value. This review summarized research progress on CK in the pathogenesis, clinical diagnosis, prognosis assessment, and targeted intervention of EOC, aiming to provide theoretical references for early screening, precise treatment, overcoming drug resistance, and prognostic evaluation of EOC.

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Research Progress on the Mechanism of Acquired Resistance to Cisplatin and PARP Inhibitors in Epithelial Ovarian Cancer

WAN Tao, TAO Yao, WANG Hou-mei, XIAO Zi-wen

2026, 53 (5): 556-562. doi: 10.12280/gjfckx.20260302

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Epithelial ovarian cancer is the most common pathological type of ovarian cancer. The standard first-line treatment regimen consists of platinum-based chemotherapy combined with maintenance therapy using poly (ADP-ribose) polymerase (PARP) inhibitors. However, acquired resistance severely impacts long-term patient survival. Cisplatin resistance involves enhanced drug efflux and detoxification, increased DNA damage repair capacity [especially through homologous recombination repair (HRR) and non-homologous end joining (NHEJ) pathways], abnormal epigenetic regulation, tumor stem cell mediated resistance, tumor microenvironment mediated resistance, inhibition of cell death pathways, and tumor metabolic reprogramming. PARP inhibitors resistance include restoration of HRR function, restoration of replication fork stability, alterations in drug targets, non-HRR-dependent mechanisms [such as drug efflux pumps, epigenetic changes, nuclear factor-κB pathway abnormalities], and microRNA regulation. Both types of resistance are highly dependent on the integrity of DNA damage repair pathways and exhibit cross-resistance at specific nodes, such as BRCA1 secondary splice-site mutations (SSMs), lymphoid enhancer-binding factor 1 (LEF1), lactic acid-X-ray repair cross-complementing protein 4 (XRCC4) axis, and the helicase-like transcription factor (HELQ) - PARP1 interaction. Based on these mechanisms, strategies such as combining ataxia telangiectasia mutated and Rad3-related kinase (ATR) inhibitors with PARP inhibitors, targeting LEF1 or HELQ, and inducing ferroptosis hold promise for overcoming resistance.

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Application of Non-Invasive Screening and Immune Assessment Biomarkers in the Comprehensive Management of Endometrial Carcinoma

ZHU Chen-xu, WANG Cai-zhu, SHEN Rong

2026, 53 (5): 563-568. doi: 10.12280/gjfckx.20260392

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The diagnosis and treatment of endometrial carcinoma are gradually shifting from traditional histomorphological assessment to molecular classification and comprehensive precision management. However, the early non-invasive identification, prediction of immunotherapy efficacy, and recurrence monitoring still lack stable and reliable biomarkers. In the early non-invasive screening phase, serum proteins, circulating tumor cells, metabolomics, and circulating nucleic acids (circulating tumor DNA and exosomal circular RNA) significantly enhance the detection capability for extremely low-abundance tumor signals. Post-diagnosis immune assessment relies on checkpoints such as programmed death-ligand 1 (PD-L1), the tumor microenvironment (tertiary lymphoid structures), molecular classification, and novel immune regulatory genes to define tumor immunogenicity and predict immunotherapy response rates. Confronting the high heterogeneity of tumors, the integration of artificial intelligence and multi-omics technologies has overcome traditional diagnostic bottlenecks. Multimodal artificial intelligence, by integrating clinical and pathological features, substantially optimizes risk prediction and personalized decision-making. In the future, the combination and dynamic evaluation of multiple biomarkers are inevitable trends for improving precision diagnostic and therapeutic efficacy. There is an urgent need for multicenter prospective studies to standardize detection protocols and accelerate clinical translation to improve prognosis.

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Impact and Predictive Value of Glycolipid Transfer Protein on the Prognosis of Patients with Locally Advanced Cervical Cancer Treated with Neoadjuvant Chemotherapy Combined with Immunotherapy Followed by Radiotherapy

LIU Xiao-yu, LU Xiu-rong, LI Ya-ru, ZHAO Wei-wei, ZHANG Fan, CHEN Jiang-ping

2026, 53 (5): 569-578. doi: 10.12280/gjfckx.20260322

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Objective: To investigate the role of glycolipid transfer protein (GLTP) in neoadjuvant chemotherapy combined with immunotherapy followed by radiotherapy for locally advanced cervical cancer and its prognostic value. Methods: mRNA and clinical data of 306 cervical cancer patients from The Cancer Genome Atlas (TCGA) and 300 patients from the GSE44001 dataset were screened and downloaded. Weighted gene co-expression network analysis (WGCNA) was used to identify prognosis- and immune-related modules in cervical cancer patients, and the target gene GLTP was selected. Batch effect correction was performed to adjust for batch differences in gene expression data of locally advanced cervical cancer from TCGA and GSE44001, followed by dataset integration. The expression of GLTP mRNA in cervical cancer tissues versus normal tissues was analyzed using TNMplot and GEPIA websites. 41 patients with locally advanced cervical cancer [FIGO stage (2018 edition) ⅠB3-ⅣA] diagnosed and treated at The First Affiliated Hospital of Hebei North University from January 2021 to January 2022 were enrolled to analyze the relationship between GLTP expression and clinicopathological characteristics, as well as prognostic factors. The IOBR software package (MCP-counter method) was employed to analyze the association of GLTP with immune cells and immune checkpoint-related molecules. Results: GLTP was identified as both an immune-related module gene and a prognosis-related gene in cervical cancer from the TCGA database through WGCNA. Analysis via TNMplot and GEPIA showed that GLTP mRNA expression was significantly higher in cervical cancer tissues than that in normal tissues (all P<0.05). Immunohistochemical staining revealed a higher positive-expression rate of GLTP in cervical cancer tissues compared with normal tissues (68.29% vs. 43.90%, P=0.026). Significant differences in PD-L1 expression and objective response were observed between GLTP-positive and GLTP-negative patients (all P<0.05). Multivariate COX regression analysis indicated that patients with an effective objective response (HR=6.096, 95%CI: 2.242-16.573, P<0.001) and positive expression of GLTP (HR=9.115, 95%CI: 3.006-27.639, P<0.001) had a higher cancer-specific survival (CSS) rate after treatment. The overall CSS rate was better in GLTP-positive patients than in GLTP-negative patients (Log-rank P<0.001). Receiver operator characteristic curve analysis showed that GLTP had a certain predictive value for cervical cancer prognosis (the area under the curve is 0.742). Using a cut-off value of 6.67, 266 patients were divided into high- and low-GLTP-expression groups. Spearman correlation analysis revealed a negative correlation between GLTP expression and immune score (r=-0.19, P<0.001). The high-GLTP-expression group exhibited lower numbers of T cells, CD4+T cells, cytotoxic T lymphocytes, natural killer cells, as well as lower expression of immune checkpoint related molecules TIGIT, CD160, LAG3, CD200R1, CD276, CTLA4, CD27, CD40LG, CD244, CD200, CD48 and ICOS, compared with the low-GLTP-expression group (all P<0.05). Conversely, expression of TNFRSF25 and TNFRSF9 were higher in the high-GLTP-expression group (all P<0.05). Conclusions: GLTP is highly expressed in cervical cancer tissues and influences the prognosis of patients receiving neoadjuvant chemotherapy combined with immunotherapy followed by radiotherapy, suggesting its potential as a predictive biomarker for immunotherapy efficacy.

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Burden and Forecast of Ovarian Cancer in China and Globally from 1990 to 2023

FENG Shu-jie, CHEN Jiao, LI Yang-xi

2026, 53 (5): 579-586. doi: 10.12280/gjfckx.20260061

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Objective: To analyze the disease burden of ovarian cancer (OC) in China and globally from 1990 to 2023, and to predict its changing trends from 2024 to 2040. Methods: Data on the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) for OC in China and globally from 1990 to 2023 were extracted from the 2023 Global Burden of Disease database. The Joinpoint regression model was used to analyze the temporal trends of OC, and to calculate the annual percentage change (APC) and average annual percentage change (AAPC). Decomposition analysis was employed to quantify the influencing factors changes in the OC disease burden. The Bayesian age-period-cohort model was used to predict the changing trends of the OC disease burden in China and globally from 2024 to 2040. Results: From 1990 to 2023, the ASIR, ASPR, ASMR, and ASDR for OC in China showed a declining trend, with AAPCs of -0.77%, -0.35%, -1.14%, and -1.41%, respectively (all P<0.05). Globally, the ASMR for OC showed a declining trend (AAPC=-0.19%, P<0.05), while the ASIR and ASPR showed an increasing trend, with AAPCs of 0.09% and 0.33%, respectively (both P<0.05); the ASDR remained generally stable (AAPC=-0.02%, P>0.05). However, from 2020 to 2023, the disease burden of OC both in China and globally showed an increasing trend. Analysis of disease burden across different age groups showed that in 2023, the peak crude prevalence rate of OC in China occurred in the 50-54 years age group (50.12 per 100 000), and the peak crude incidence rate occurred in the 65-69 years age group (12.83 per 100 000). Globally, the peak crude prevalence rate was in the 60-64 years age group (84.02 per 100 000), and the peak crude incidence rate was in the 85-89 years age group (30.95 per 100 000). Decomposition analysis indicated that population aging was the primary reason for the increasing OC burden in China, while population growth was the main factor for the increasing global OC burden. From 2024 to 2040, the ASIR, ASPR, ASMR, and ASDR for OC in China and globally are projected to continue rising. Conclusions: The overall burden of OC in China and globally showed a declining trend from 1990 to 2023, but has shown an increasing trend since 2020 and is projected to continue rising. OC screening strategies in China need to focus on women over 50 years old, strengthen screening and public prevention efforts and investment, and draw on international advanced diagnosis and treatment experiences to effectively reduce the OC disease burden.

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Ovarian Yolk Sac Tumor with Myometrial Invasion and Extreme Elevation of Alpha-Fetoprotein: A Case Report

WANG Hao-yu, SUN Wen-xue, WANG Meng-zhen, ZHANG Yi-ming

2026, 53 (5): 587-590. doi: 10.12280/gjfckx.20260002

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Yolk sac tumor is a highly malignant yet curable germ cell tumor. We report a case of advanced-stage (FIGO stage Ⅲ) pure ovarian yolk sac tumor characterized by extreme serum alpha-fetoprotein (AFP) elevation (>60 500 ng/mL) and rare direct myometrial invasion. The patient underwent cytoreductive surgery followed by postoperative bleomycin, etoposide, and cisplatin (BEP) chemotherapy. A rapid decline in AFP was achieved post-treatment; however, early objective evidence of bleomycin pulmonary toxicity, manifested as a decline in pulmonary function. Through dynamic assessment of tumor response and toxic effects, and with intensive pulmonary function monitoring, the patient completed the planned BEP regimen. Serum AFP level subsequently normalized (14.47 ng/mL), imaging demonstrated a significant reduction in peritoneal lesions and complete resolution of the splenic metastasis, indicating a favorable prognosis. This case demonstrates that standardized multimodal therapy can achieve significant efficacy even in the presence of an extremely high tumor burden. Furthermore, for young women presenting with a pelvic mass, abnormal AFP elevation, and abnormal uterine morphology, the possibility of local invasion by a yolk sac tumor should be considered.

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Primary Ovarian Borderline Mucinous Adenofibroma with Mucinous Adenocarcinoma: A Case Report

DING Jian-hua, LI Wei, WANG Huai-tao, LI Guang-ning, SUN Na, SHANG Ran, HAN Xiang-chun

2026, 53 (5): 591-596. doi: 10.12280/gjfckx.20251460

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Primary ovarian borderline mucinous adenofibroma with mucinous adenocarcinoma is clinically rare. We report a case of a 47-year-old female patient who presented with a self-palpable pelvic mass that was gradually enlarging, accompanied by occasional lower abdominal pain. Transvaginal ultrasound revealed a medium-echogenic mass in the left adnexal region. The patient initially underwent complete tumor resection, followed by hysterectomy, right salpingo-oophorectomy, appendectomy, omentectomy, and regional lymphadenectomy at a higher-level hospital. Postoperative pathology confirmed the diagnosis as primary ovarian borderline mucinous adenofibroma with mucinous adenocarcinoma, stage ⅠA. The patient recovered well postoperatively with no signs of recurrence. Ovarian mucinous tumors are more commonly metastatic than primary. Diagnosis requires comprehensive evaluation based on clinical history, imaging examination, surgical exploration, gastrointestinal endoscopy, and immunohistochemical findings. A definitive diagnosis can only be made after excluding metastasis from tumors of the digestive system, endometrium, cervix, and other sites. Surgery is the primary treatment modality.

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Ipsilateral Ovarian Endometrioma Following Surgery for Mature Teratoma in An Adolescent Female: A Case Report

SHEN Qing-li, YI Li-sha, SHI Quan, YUAN Li, AI Bin

2026, 53 (5): 597-600. doi: 10.12280/gjfckx.20260142

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We report a rare case of an ipsilateral ovarian endometrioma occurring after surgery for a mature teratoma in an adolescent. The patient was 12 years old. At the age of 11, she underwent laparoscopic cystectomy for a left ovarian mature teratoma. Menarche occurred two months postoperatively. One year and 8 months later, she presented with abdominal pain. Re-examination revealed a new cystic mass in the ipsilateral ovary. Laparoscopic exploration showed dense adhesions between the left adnexa and the omentum/intestinal serosa, as well as a cystic mass of the left ovary. The postoperative pathological diagnosis confirmed an ovarian endometrioma. No typical endometriotic lesions were identified elsewhere in the pelvis. Postoperative management involved a six-month course of a short-term combined oral contraceptive, and no recurrence has been detected during a follow-up period of 1 year and 10 months. This case suggests that the localized adhesive microenvironment caused by ovarian surgery, possibly in synergy with early postoperative menarche, may contribute to the localized development of an endometrioma in the ipsilateral ovary. For adolescent females with a history of ovarian surgery, endometriosis should be included in the differential diagnosis for postoperative pelvic masses. Furthermore, emphasis should be placed on intraoperative adhesion prevention and long-term postoperative physical and psychological management.

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