Guangdong Medical College

Mismatch repair-deficient (dMMR) advanced or recurrent endometrial carcinoma presents a therapeutic challenge, and the role of preoperative immunotherapy prior to its guideline incorporation (2020–2022) remained unexplored. We report three patients with dMMR endometrial carcinoma who received preoperative anti‑PD‑1 therapy (sintilimab). Case 1 (locally recurrent vaginal mass) was treated with sintilimab monotherapy, achieving a pathological complete response. Case 2 (stage IVB with bulky uterine and osseous metastases) received sintilimab combined with carboplatin/docetaxel, attaining partial response. Case 3 (recurrent disease with renal impairment) received sintilimab plus megestrol acetate, which yielded a marked biochemical response (98.6% CA125 reduction) enabling resection despite radiographic stable disease. All patients underwent R0 resection and remained recurrence‑free after a median follow‑up of 36 months, with no grade ≥ 3 adverse events. Exploratory biomarker analysis revealed cGAS‑STING pathway activation in all tumors. These findings provide early real‑world evidence that preoperative anti‑PD‑1 therapy is a feasible and effective strategy for converting unresectable dMMR endometrial carcinoma to resectable disease, supporting further investigation in larger studies.

BackgroundPostpartum women frequently experience psychological distress, physical morbidities, and sub-optimal maternal–neonatal care skills. Structured discharge planning may mitigate these problems, yet its overall effectiveness and the active ingredients underpinning benefit remain unclear.ObjectiveTo synthesis randomized and quasi-experimental evidence on the effectiveness of discharge planning interventions for improving postpartum women’s health outcomes and to identify intervention characteristics that modify this effectiveness.MethodsNine electronic databases (including PubMed, Web of Science, PsycINFO, CINAHL, EMBASE, Cochrane Library, CNKI, Wanfang, and SinoMed) were searched from inception to 10 May 2025. Randomized controlled trials (RCTs) and quasi-experimental studies evaluating discharge planning interventions aimed at postpartum women were eligible. Two reviewers independently screened records, assessed risk of bias using the Cochrane RoB 2.0 and ROBINS-I tools, and extracted data. The odds ratio (OR) with its 95% confidence interval (CI) was used as the primary statistical measure. For continuous variables, the standardized mean difference (SMD) was used. Statistical heterogeneity was quantified using the I2 statistic.ResultsTwenty-one studies (13 RCTs and 8 quasi-experimental studies) involving 33,096 participants from nine countries were included. Discharge planning produced moderate-to-large improvements in: mental health – depressive symptoms (SMD = −0.64; 95% CI: −1.27, −0.01) and anxiety (SMD = −1.29; 95% CI: −2.22, −0.37); self-care and neonatal-care competence (OR = 2.34; 95% CI: 1.20, 4.58); and breastfeeding self-efficacy (SMD = 2.86; 95% CI: 1.63, 4.08). Interventions integrating predischarge education, post-discharge telephone follow-up, and information-based communication platforms tended to demonstrate larger effect sizes.ConclusionThis systematic review and meta-analysis indicates that structured discharge planning programs implemented in hospital-based maternity wards during the early postpartum period can improve maternal mental health, self-care capacity, and maternal–neonatal outcomes. The evidence, derived from both randomized controlled trials and pragmatic quasi-experimental studies conducted in routine clinical settings, suggests that ward- or institution-level discharge interventions are effective and scalable strategies for optimizing postnatal transitions.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251055810, registered 20/05/2025.