Objectives: To evaluate the predictive significance of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the prognosis of high-grade endometrial carcinoma and to establish a novel predictive model. Design: A retrospective multicenter study. Setting: Fifteen hospitals of the Chinese Endometrial Carcinoma Consortium. Population: This study included 910 high-grade epithelial endometrial carcinoma patients from the multicenter who underwent initial surgical treatment between January 1, 2005, and December 31, 2019. Methods: Data was retrospectively obtained from the medical records and follow-up information of patients. Cox proportional hazard regression models were developed to predict the risk of recurrence and death at 3, 5, and 10 years, and the models were validated and calibrated. The area under the curve was used to measure the predictive performance of the model. Main outcomes measures: Disease-free survival and overall survival. Result: Platelet-lymphocyte ratio and neutrophil-lymphocyte ratio were risk factors for recurrence, and neutrophil-lymphocyte ratio was a risk factor for death. We established models for predicting death and recurrence. In the validation cohort, the area under receiver operating characteristic curve of disease-free survival model at 3,5 and 10 years was 0.72, 0.77, 0.77, and of overall survival model was 0.72, 0.81, and 0.84. Kaplan–Meier survival analysis showed a significant difference between low-risk and high-risk groups. Conclusions: Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are risk factors affecting the prognosis of high-grade endometrial carcinoma patients. This novel prediction model for high-grade endometrial carcinoma can provide accurate postoperative risk classification and prognosis prediction for patients. Keywords: Endometrial carcinoma, prognostic model, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio

Background In cervical cancer, the benefits of sentinel lymph node biopsy (SLNB) have long been confined by the lack of precise intraoperative pathological examination. Objective To determine the diagnostic performance and optimal protocol of frozen section examination (FSE) in SLNB for cervical cancer. Search Strategy PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure were searched from inception to July 30, 2019. Selection Criteria Studies reporting the data of SLNB combined with FSE in cervical cancer were included. Data Collection and Analysis Two independent reviewers extracted the data. Bivariate mixed-effects regression model was applied for analyses. Sensitivity of FSE in detecting SLN metastasis was the primary diagnostic indicator for evaluation. Main Results The pooled sensitivity of FSE among 31 eligible studies (1887 patients) was 0.77 (95% CI 0.66–0.85) with high heterogeneity (I2=69.73%). Two representative FSE protocols were identified from 26 studies, described as equatorial (E-protocol, SLN was bisected) and latitudinal (L-protocol, SLN was cut at intervals). Meta-regression showed that FSE protocol was the only source of heterogeneity (p<0.001). The pooled sensitivity was 0.86 (95% CI 0.79–0.91, I2=0%) and 0.59 (0.46–0.72, I2=58.47%) for FSE using L- and E- protocol, respectively. The pooled sensitivity of FSE using L-protocol would reach 0.97 (0.89–0.99) if only marcometastases were considered. These findings were robust to sensitivity analyses. Conclusions With L-protocol, FSE can provide precise intraoperative pathology for SLNB, which enables immediate decision-making for individualized managements. Keywords Cervical cancer, sentinel lymph node, metastasis, frozen section, sensitivity, meta-analysis.