Background

We aimed to develop a high-quality real-world clinico-genomic gynecological oncology database in China for real-world evidence generation and better patient management.

Methods

NUWA project is the first nationwide gynecological oncology (GO) data-sharing platform that launched by the National Clinical Research Center for Obstetrics and Gynecology in China. The project started in August 2019 and aimed to link and integrate inpatient/outpatient clinical data, genomic data, as well as out-of-hospital follow-up data (e.g. LinkDoc call center) for developing a patient (pt)-level longitudinal clinico-genomic database in a HIPAA-compliant manner. The de-identified structured and unstructured data were extracted from electronic medical records (EMR) or other data sources (third-party genetic-testing company databases) via technology-aided manual abstraction. Rigorous data consistency check was performed daily by duplicate manual review to ensure the accuracy of data entry. The multi-source data were then linked and aggregated using a unique ID. Medical review for pt-level data was further conducted to ensure data quality.

Results

Up to May 2020, nine tertiary hospitals from 9 provinces or cities participated in the NUWA project, resulting in inpatient EMR data of 8486 ovarian cancer (OC) pts. The clinico-genomic data of 1114 OC pts were available and more genomic data are on the way. Of 8486 OC pts, 5942 (70.1%) received at least one follow-up phone call. The median follow-up time was 515 (range: 1-4993) days. In December 2021, 30 tertiary hospitals will collaborate on the platform that cover 19 provinces or cities in China, with estimated clinico-genomic data of over 6000 GO pts.

Conclusions

We present a new paradigm for rapidly aggregating multi-dimensional data into a large, scalable longitudinal clinico-genomic database in China. NVWA project will catalyze data sharing across China and thereby enable precision medicine in the field of GO.

Background

Majority of patients with cervical cancer in the high incidence regions present at an advanced stage,warranting definitive treatment with chemoradiation.Studies have shown that dose escalation to a biological equivalent dose (BED) of 90Gy or above is necessary for optimal locoregional control ,making brachytherapy(BT) boost an integral component in the radiotherapy(RT) management of cervical carcinoma.However , not all External Beam Radiation(EBRT) centres has inhouse brachytherapy.A reflection of this deficit could be the high mortality to incidence ratio found in low and middle income countries.Our study aims at estimating this deficit across 6 countries –With high and low incidence.

Methods

The incidence of cervical carcinoma was obtained from the global cancer observatory update 2018.The RT centre ,EBRT units and BT units availabe in each country was obtained from the IAEA radiation directory.Percentage requiring definitive or adjuvant radiation in each country was obtained from literature. Based on above data following calculations were made,

1) TOTAL NUMBER OF BT APPLICATIONS PER YEAR:

No.of new case * % requiring RT * 3 to 4 (optimal no. of BT fraction-3 or 4)

2) REQUIRED NO. OF APPLICATION PER DAY PER BT UNIT BASED ON EXISTING NO. OF BT UNIT:

Total BT applications per year /Total BT units /No. of working days (12monthx4weekx5days)

3) REQUIRED NO. OF APPLICATION PER DAY PER UNIT IF ALL CENTRES HAD INHOUSE BT UNIT:

Total BT applications per year/Total RT centres/No. of working days

Results

Conclusions

The high incidence of cervical cancer in certain regions could be attributed to the varying outreach of screening programs and HPV vaccination,however,high mortality due to cervical cancer,although multifactorial appears to be linked to the deficient infrastructure for optimal radiotherapy management .We suggest that by housing all EBRT centres with BT units ,especially in the high incidence countries, treatment quality can be improvised ,eventually leading to lower mortality rates due to cervical cancer .

Background

Lymphopenia has been suggested to reflect low host immune reactivity. Studies have shown that baseline lymphopenia is associated with poor prognosis in various malignancies. The impact of pretreatment lymphocyte count on survival in cervical cancer patients is investigated in this study.

Methods

A cohort of non-metastatic cervical cancer patients who completed definitive chemoradiation from January 2009 to December 2014, in a tertiary oncology centre, was included. Patients were restaged according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. Patients with active infection and autoimmune conditions were excluded. Definitive treatment included a combination of external radiotherapy and brachytherapy with concurrent weekly cisplatin 40mg/m². Baseline clinical information and pretreatment blood tests were collected. Log rank tests and multivariable Cox regression were used to evaluate the association between haematological parameters and survival. Study endpoints were overall survival (OS), progression free survival (PFS), late radiation-induced grade 3-4 toxicity.

Results

Median follow-up was 6.3 years with a total of 153 eligible cases in our study. Multivariate analysis confirmed pretreatment lymphocyte count to be an independent predictor of OS (adjusted hazard ratio 0.47; 95% confidence interval 0.30 – 0.97, p = 0.040) and PFS (adjusted hazard ratio 0.56; 95% confidence interval 0.32 – 0.98, p = 0.045), adjusted for age, performance status, FIGO stage, histology, Charlson comorbidity score and cumulative cisplatin dose. Lower pretreatment absolute lymphocyte count (<1.7x10⁹/L) was associated with significantly worse 5-year OS (76.1% vs 86.2%, p=0.033). Lymphocyte count was not associated with late radiation-induced grade 3-4 toxicity.

Conclusions

Pretreatment lymphocyte count is an independent predictor of both OS and PFS in cervical cancer patients receiving definitive chemoradiation. It should be considered as an integral component for building prognostic models for cervical cancer patients in future.

Background

Loss of skeletal muscle or sarcopenia is commonly seen in various types of malignancy, including ovarian cancer. While some studies suggest sarcopenia as prognostic factor associated with poor survival during chemotherapy, other studies shown no significant association between the two. This meta-analysis aims to investigate whether or not sarcopenia significantly associated with poor survival in ovarian cancer patients undergoing chemotherapy.

Methods

A systematic review was conducted using PRISMA guideline. Online databases (PubMed, PubMed Central and Google Scholar) were searched for relevant terms related to sarcopenia in ovarian cancer patients undergoing chemotherapy with overall survival as our outcome in this study. We used Newcastle Ottawa Scale to assess the quality of our studies. Meta-analysis was later performed using Review Software Manager.

Results

A total of 4 studies are eligible and therefore included in the analysis. All studies were observational studies consisting 653 patients with ovarian cancer. Our included studies each shows “good” quality according to Newcastle Ottawa Scale. Our meta-analysis showed no significant association between sarcopenia and overall survival in ovarian cancer patients receiving chemotherapy (HR 1.54; 95% CI 0.98-2.42; P = 0.06).

Conclusions

Our study result shows that sarcopenia did not influence overall survival of ovarian cancer patients receiving chemotherapy. Future studies should involve more number of patients.