Gynecologic oncology最新文献

{"title":"Anastomotic leakage in colorectal and ovarian cancer resections: A comparative cohort study","authors":"Radwa Hablase ,&nbsp;Jacqueline Steinke ,&nbsp;Aqsa Aslam ,&nbsp;Rhea Jose ,&nbsp;Konstantinos Palaiologos ,&nbsp;Christina Uwins ,&nbsp;Anil Tailor ,&nbsp;Jayanta Chatterjee ,&nbsp;Patricia Ellis ,&nbsp;Hersha Patel ,&nbsp;Andrea Scala ,&nbsp;Simon Butler-Manuel","doi":"10.1016/j.ygyno.2025.03.028","DOIUrl":"10.1016/j.ygyno.2025.03.028","url":null,"abstract":"<div><h3>Objective</h3><div>To compare anastomotic leak (AL) rates after colorectal resections performed by colorectal surgeons in ovarian and colorectal cancer surgeries, examining predictive risk factors, short-term and survival outcomes, and early AL markers in ovarian cancer patients.</div></div><div><h3>Methods</h3><div>Single-centre retrospective study comparing AL rates between 233 ovarian debulking surgeries from January 1, 2010, to December 31, 2022, and 408 gender-matched colorectal cancer patients from January 2014 to December 2022 at the Royal Surrey NHS Foundation Trust, UK. Predictive risk factors were assessed using logistic regression and the overall survival using log-rank tests and Cox proportional hazards model. Receiver operating characteristic (ROC) curves were plotted for C-reactive protein (CRP) values from postoperative days one to five.</div></div><div><h3>Results</h3><div>19 % of ovarian cancer patients underwent colorectal resection, of which 90 % had primary anastomosis. AL rates were 4.7 % and 1.9 % (<em>p</em> = 0.08) for the ovarian and colorectal groups respectively. Covering stoma rates were 11.6 % in the ovarian and 15 % in the colorectal group. 80 % in the ovarian group had rectosigmoid resections. Delays in chemotherapy and residual disease were independent risk factors for increased risk of death in ovarian interval debulking surgery. HR 1.03 (95 % CI: 1.01–1.05, <em>p</em> = 0.008) and HR 2.02 (95 % CI: 1.11–3.68, <em>p</em> = 0.021). CRP on days three and four had a 98 % negative predictive value at a cut-off of 286 mg/L and 232 mg/L, respectively.</div></div><div><h3>Conclusion</h3><div>Ovarian cancer patients are at high risk of AL. Preventative measures should be considered. Low CRP on post-operative days three and four may be used exclude AL.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 121-128"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECPPF stratification identifies occult high-risk subgroups in stage I, grade 1 or 2, ≤50 % invasive endometrial cancer: Candidates for adjuvant therapy","authors":"Jesus Gonzalez-Bosquet ,&nbsp;Maryam Shahi ,&nbsp;Siddhartha Yadav ,&nbsp;Nisha Kanwar ,&nbsp;Saba Alvand ,&nbsp;Carlos Sosa ,&nbsp;Sean C. Dowdy ,&nbsp;Kevin C. Halling ,&nbsp;S. John Weroha ,&nbsp;Jamie N. Bakkum-Gamez ,&nbsp;Karl C. Podratz","doi":"10.1016/j.ygyno.2025.03.030","DOIUrl":"10.1016/j.ygyno.2025.03.030","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether stratification with ECPPF (<em>E2F1</em> + <em>CCNA2</em> log2 expression and <em>POLE</em>, <em>PPP2R1A,</em> and <em>FBXW7</em> variants) could identify occult cases of high-risk endometrial cancer (EC) in a traditionally low-risk cohort.</div></div><div><h3>Methods</h3><div>We identified 97 cases of clinicopathologic low-risk endometrioid EC (defined as stage I, grade 1 or 2, limited [≤50 %] myometrial invasion) from The Cancer Genome Atlas (TCGA). Twelve cases had <em>POLE</em> mutations (mu) and 15 had <em>PPP2R1A</em>mu or <em>FBXW7</em>mu. Log2 <em>CCNA2</em> <em>+</em> <em>E2F1</em> expression was low (&lt;4.75) for 56 cases and high (&gt;4.75) for 19 (termed <em>CCNA2</em> <em>+</em> <em>E2F1 low</em> or <em>high</em>, respectively). <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and <em>PPP2R1A</em>mu/<em>FBXW7</em>mu were simultaneously present for 5 cases. Survival comparisons were based on log-rank tests.</div></div><div><h3>Results</h3><div>Five-year progression-free survival (PFS) curves for <em>POLE</em>mu and <em>CCNA2</em> <em>+</em> <em>E2F1</em> low differed substantially from <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and <em>PPP2R1</em>mu/<em>FBXW7</em>mu cases (<em>P</em> &lt; .001). The latter 2 subgroups, combined (<em>n</em> = 29) and designated as <em>molecular high risk</em> (MHR), had an estimated 5-year PFS &lt;50 %. Adverse outcomes were associated with MHR for cases harboring <em>CTNNB1</em>mu (<em>P</em> &lt; .001), <em>ARID1A</em>mu (<em>P</em> = .03), and <em>PTEN</em>mu (<em>P</em> = .002). TCGA classification was not prognostically significant for this cohort (<em>P</em> = .10), but ECPPF MHR identified compromised subgroups within major TCGA subclasses (<em>P</em> = .004). <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and expression of its downstream targets were positively correlated (<em>P</em> &lt; .001) with expression of genes involved in chemoresistance (ie, homologous recombination, cell cycle regulation, antiapoptotic processes).</div></div><div><h3>Conclusions</h3><div>ECPPF supports a taxonomy in which occult, high-risk disease is identified among cases traditionally considered low risk. With high-risk cases unlikely to respond to current first-line chemotherapy, case identification should prompt proactive therapeutic intervention with alternative molecular-based treatment targets.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 113-120"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring endometrial cancer risk stratification by copy number assessment","authors":"Casey M. Cosgrove ,&nbsp;Adrian A. Suarez ,&nbsp;Paulina J. Haight ,&nbsp;Alyssa Villacres ,&nbsp;Alexis Chassen ,&nbsp;Keith Brownewell ,&nbsp;Joseph P. McElroy ,&nbsp;Jessica Gillespie ,&nbsp;David E. Cohn ,&nbsp;Paul J. Goodfellow","doi":"10.1016/j.ygyno.2025.03.037","DOIUrl":"10.1016/j.ygyno.2025.03.037","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary management of endometrial cancer includes molecular classification. The primary objective of this study was to assess the prognostic significance of copy number changes evidenced by loss of heterozygosity (LOH) or allelic imbalance (AI).</div></div><div><h3>Methods</h3><div>Sequencing including <em>TP53</em>, <em>POLE</em> and MSI testing was performed. AI/LOH at 5 polymorphic markers (<em>D2S123, D5S2346, D17S250, D17S516</em> and <em>D17S1818</em>) was assessed. Micro-satellite stable (MSS) endometrial tumors were classified as having evidence of AI/LOH or no evidence of AI/LOH.</div></div><div><h3>Results</h3><div>482 MSS cases were evaluated for AI/LOH status. There were 226 (46.5 %) tumors with evidence of AI/LOH at ≥1 of the 5 markers and these were significantly associated with patients of older age and lower body mass index as well as tumors that were non-endometrioid histology, higher grade, demonstrated LVSI, and presented at more advanced stage. Most patients who developed recurrent disease had a tumor with AI/LOH (82.1 %). 3-year progression-free survivals (PFS) were 79.5 % in the AI/LOH group vs 95.6 % in the no AI/LOH group (<em>p</em> &lt; 0.0001). <em>TP53</em> mutation status was associated with PFS. 3-year PFS was significantly worse for the <em>TP53</em> mutated group at 55 % vs 96 % in <em>TP53</em> wild-type (<em>p</em> &lt; 0.0001). Of the 373 cases classified as having no specific molecular profile there was a 6.2 % recurrence rate with AI/LOH and 3.3 % recurrence with no AI/LOH.</div></div><div><h3>Conclusions</h3><div>AI/LOH assessment at a limited number of markers identifies endometrial cancers with higher risk features that are more likely to recur. Copy-number assessment utilizing clinically accessible testing strategies can provide an opportunity for improved risk stratification.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 99-106"},"PeriodicalIF":4.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STOMA study SToma-leak ratio in advanced ovarian cancer surgery: Results of a restrictive policy on the use of protective stoMAs","authors":"Virginia Vargiu ,&nbsp;Francesco Santullo ,&nbsp;Giovanni Scambia ,&nbsp;Angelica Naldini ,&nbsp;Diana Giannarelli ,&nbsp;Valerio Gallotta ,&nbsp;Claudio Lodoli ,&nbsp;Carlo Abatini ,&nbsp;Lorena Quagliozzi ,&nbsp;Giovanni Esposito ,&nbsp;Mara Iasevoli ,&nbsp;Fabio Pacelli ,&nbsp;Anna Fagotti","doi":"10.1016/j.ygyno.2025.03.032","DOIUrl":"10.1016/j.ygyno.2025.03.032","url":null,"abstract":"<div><h3>Objective</h3><div>Assessemnet of anastomotic leak rates following recto-sigmoid resection in advanced ovarian cancer surgery after implementing a restrictive stoma policy. Secondary objectives include identifying predictive factors for stoma creation, analyzing anastomotic leak management, and perioperative outcomes.</div></div><div><h3>Summary background data</h3><div>Recto-sigmoid resection is essential in advanced ovarian cancer treatment but carries risks like anastomotic dehiscence. The role of protective stomas remains uncertain, highlighting the need for targeted strategies.</div></div><div><h3>Methods</h3><div>This retrospective study includes data from 722 patients who underwent recto-sigmoid resection between January-2020 and December-2023 at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Patients were classified under liberal (2020−2021) or restrictive (2022−2023) stoma policies. The liberal approach relied on general surgeon preference without predefined criteria, while the restrictive policy introduced a systematic evaluation of risk factors by the gynecologic oncologist and the general surgeon in the surgical team before proceeding with ostomy creation.</div></div><div><h3>Results</h3><div>The restrictive policy significantly reduced stoma rates from 38.8 % to 11.1 % (<em>p</em> &lt; 0.001) without increasing anastomotic leaks (stable at 2.5 %, <em>p</em> = 1.000). Predictive factors for stoma included multiple bowel resections, inferior mesenteric artery closure, low anastomosis, and residual tumor. Patients with stomas experienced more severe postoperative complications (<em>p</em> = 0.007), prolonged hospital stays (<em>p</em> &lt; 0.001), and delayed chemotherapy (<em>p</em> = 0.018). No differences in anastomotic leak management were recorded among patients with and without ostomy.</div></div><div><h3>Conclusions</h3><div>A restrictive stoma policy reduced ostomy rates without affecting leak rates or mortality, supporting individualized surgical decision-making in ovarian cancer. Prospective studies are needed to clarify risk factors for leaks and validate the necessity of protective stomas.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 92-98"},"PeriodicalIF":4.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional volumetric rendering on augmented reality headsets for ovarian cancer cytoreduction planning: A Memorial Sloan Kettering Cancer Center Team Ovary study","authors":"Ryan M. Kahn ,&nbsp;Kimberly Murphy ,&nbsp;Tulsi Patel ,&nbsp;Effi Yeoshoua ,&nbsp;Emily Tian ,&nbsp;Lindsey Finch ,&nbsp;Qin Zhou ,&nbsp;Alexia Iasonos ,&nbsp;Paul Booth ,&nbsp;Joshua N. Honeyman ,&nbsp;Javin Schefflein ,&nbsp;Michael Crouch ,&nbsp;Sameer Kaza ,&nbsp;Vance Broach ,&nbsp;Ginger J. Gardner ,&nbsp;Kara Long Roche ,&nbsp;Yukio Sonoda ,&nbsp;Nadeem R. Abu-Rustum ,&nbsp;Dennis S. Chi","doi":"10.1016/j.ygyno.2025.03.040","DOIUrl":"10.1016/j.ygyno.2025.03.040","url":null,"abstract":"<div><h3>Objective</h3><div>New three-dimensional (3D) augmented reality technology represents an opportunity to improve presurgical planning. This study aimed to measure the accuracy of 3D volumetric rendering on augmented reality headsets to predict extent of disease prior to ovarian cancer cytoreductive surgery.</div></div><div><h3>Methods</h3><div>This single-institution prospective study took place from 03/01/2024 to 10/01/2024. Utilizing Medivis 3D augmented reality headsets, investigators reviewed volumetric renderings for patients with suspected advanced ovarian cancer prior to scheduled surgery and filled out a survey predicting presence of disease based on anatomic site. Pathology records were later reviewed to confirm the presence of disease. Statistical analyses included Cohen's kappa coefficient, sensitivity/specificity, and positive/negative predictive value measurements.</div></div><div><h3>Results</h3><div>We included 15 patients: 9 (60 %) with interval cytoreduction and 6 (40 %) with primary cytoreduction. For procedure, 14 (93 %) had complete gross resection and 1 (7 %) suboptimal cytoreduction (&gt;1 cm of residual disease). Using pathology results as the gold standard for each anatomic site, the 3D headset demonstrated accuracy of 100 % for omentum and pelvic lymph nodes; 93 % for para-aortic lymph nodes, right diaphragm, rectum, and liver; 87 % for small mesentery; and 80 % for small bowel serosa, spleen, and left diaphragm (<em>P</em> &gt; 0.05 for all).</div></div><div><h3>Conclusion</h3><div>The use of preoperative 3D volumetric rendering on augmented reality headsets to predict the extent of ovarian cancer spread showed high agreement with pathology across all anatomic sites studied. Additional research is needed to assess the potential role of this technology in improving surgical planning and patient outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 107-112"},"PeriodicalIF":4.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant treatment in stage I clear cell endometrial carcinoma: A population-based study of survival outcomes","authors":"Alyssa C Bujnak ,&nbsp;Danielle Greenberg ,&nbsp;Jenny Chang ,&nbsp;Jill Tseng","doi":"10.1016/j.ygyno.2025.03.051","DOIUrl":"10.1016/j.ygyno.2025.03.051","url":null,"abstract":"<div><h3>Objective</h3><div>Uterine clear cell carcinoma (UCCC) is a rare but aggressive histologic type of endometrial cancer. Recommendations for adjuvant treatment of early-stage UCCC remain vague. The objective of this study is to assess the impact of adjuvant treatment on survival outcomes of patients with stage I UCCC.</div></div><div><h3>Methods</h3><div>Using the Surveillance, Epidemiology and End Results database (SEER), patients with stage I UCCC were identified. Disease-specific survival (DSS) as well as overall survival (OS) for patients who underwent observation alone versus adjuvant treatment with either chemotherapy alone, radiotherapy (RT) alone, or chemotherapy plus RT, were analyzed by Kaplan-Meier (K-M) survival estimates and multivariate Cox proportion hazards model.</div></div><div><h3>Results</h3><div>The study included 881 patients with stage I UCCC. Kaplan-Meier estimates showed no difference in DSS among those who underwent observation versus adjuvant treatment. In the multivariate model for DSS, tumor size ≥40 mm was associated with an increased risk of death (HR 2.02, <em>p</em> = 0.0267) while living in a metropolitan county decreased the risk of death (HR 0.46, <em>p</em> = 0.009). The K-M curve for OS showed a significant difference among the four treatment groups (<em>p</em> = 0.0475), with a 10-year OS of 61 % for patients who received no adjuvant treatment versus 74 % for those receiving chemotherapy plus radiation. However, this difference was not significant in the multivariate analysis.</div></div><div><h3>Conclusions</h3><div>In this study of stage I UCCC, the use of adjuvant treatment did not confer a survival advantage. Observation may be considered an acceptable option although prospective research is needed.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 85-91"},"PeriodicalIF":4.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trop2-expression in primary vulvar squamous cell carcinoma","authors":"Frederik A. Stuebs ,&nbsp;Antje Knöll ,&nbsp;Arndt Hartmann ,&nbsp;Christian Matek ,&nbsp;Nelson John ,&nbsp;Lothar Häberle ,&nbsp;Matthias W. Beckmann ,&nbsp;Ramona Erber ,&nbsp;Carlos Bercebal ,&nbsp;Carol I. Geppert","doi":"10.1016/j.ygyno.2025.03.049","DOIUrl":"10.1016/j.ygyno.2025.03.049","url":null,"abstract":"<div><h3>Objectives</h3><div>Vulvar squamous cell carcinoma (VSCC) is a rare malignant disease but with increasing incidence. Therapeutic options are generally limited to surgery and radio-(chemo)therapy. New strategies for therapy are lacking. Trophoblast cell surface antigen 2 (Trop2) is a new target being used in different tumor entities. The purpose of the current research is to assess the expression of Trop2 in VSCC.</div></div><div><h3>Methods</h3><div>We constructed a next generation tissue micro array (ngTMA) including women with primary VSCC treated between 2000 and 2021 at the Department of Gynecology and Obstetrics, Erlangen University Hospital analyzing the expression of Trop2. Further clinicopathologic characteristics were analyzed: tumor stage, regional lymph node-status, venous-, lymphatic- and perineural sheath invasion, depth of invasion, grading, p16/p53 subtype and tumor infiltration lymphocytes.</div></div><div><h3>Results</h3><div>A total of 217 women were included. Trop2 was expressed in 100 % of VSCC. Women were split in two groups, the “low expression” and the “high expression” groups, according to the median of Trop2 (H-score: 279). p16+/p53- is the most common p16/p53 subtype in patients with high Trop2 expression. Trop2 favored a better prognosis in women with VSCC, hence not clinically impactful for the most common p16−/p53+ subtype.</div></div><div><h3>Conclusion</h3><div>The ubiquitous expression of Trop2 makes it an interesting potential target for the Trop2 directed antibody drug conjugate (ADC) sacituzumab govitecan (SG). Clinical trials evaluating the safety and effectiveness of SG in VSCC are needed.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 78-84"},"PeriodicalIF":4.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of residential segregation and health provider density on advanced stage endometrial cancer diagnoses","authors":"Ashly C. Westrick ,&nbsp;Zinzi Bailey ,&nbsp;Matthew Schlumbrecht","doi":"10.1016/j.ygyno.2025.03.041","DOIUrl":"10.1016/j.ygyno.2025.03.041","url":null,"abstract":"<div><h3>Introduction</h3><div>The influence of residential segregation and provider density on endometrial (EC) presentation is not fully known. Our objective was to determine associations between county-level obstetrics-gynecology provider density and residential segregation as measured by the Index of Concentration (ICE) at the Extremes on late-stage EC diagnoses in Florida.</div></div><div><h3>Methods</h3><div>All malignant EC cases were identified from 2001 to 2017 in the Florida Cancer Data System (FCDS). Using 5-year estimates from the 2013–2017 American Community Survey, five county-level ICE variables were calculated: economic (high vs low), race and/or ethnicity (non-Hispanic white [NHW] vs. non)-Hispanic Black [NHB] and NHW vs. Hispanic), and racialized economic segregation (low-income NHB vs. high-income NHW and low-income Hispanic vs. high-income NHW). County-level provider density was calculated. Multivariable-adjusted logistic regression models were specified to estimate the associations.</div></div><div><h3>Results</h3><div>There were 44,678 EC cases with stage information. More NHB women (27.1 %) were diagnosed with aggressive EC histologies relative to NHW (16.4 %) and Hispanic women (15.5 %) (<em>p</em> &lt; 0.001). NHB and Hispanic women had significantly greater odds of being diagnosed with later-stage EC compared to NHW women, regardless of residential segregation (OR: 1.46, 95 % CI: 1.36, 1.56 and OR: 1.09, 95 % CI: 1.01, 1.17, respectively). Women living in the most economically disadvantaged Hispanic segregated counties had greater odds of being diagnosed with later-stage EC compared to those living in more NHW segregated areas (OR: 1.16, 95 % CI: 1.00, 1.35). Provider density was not associated with later-stage diagnosis.</div></div><div><h3>Conclusion</h3><div>Advanced stage EC at diagnosis seems to be largely independent of provider density and residential segregation.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 62-68"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative conization in cervical cancer patients undergoing open abdominal radical hysterectomy: Results from a propensity-score matched study","authors":"Benjamin Wolf ,&nbsp;Dimitra Sofia Trantaki ,&nbsp;Lars-Christian Horn ,&nbsp;Bahriye Aktas ,&nbsp;Nadja Dornhöfer","doi":"10.1016/j.ygyno.2025.03.031","DOIUrl":"10.1016/j.ygyno.2025.03.031","url":null,"abstract":"<div><h3>Objective</h3><div>Conization is a common diagnostic tool in cervical cancer, but its prognostic impact prior to abdominal radical hysterectomy remains unclear. This study examines conization's influence on outcomes in early and advanced cervical cancer, the significance of cone specimen resection margins, and the impact of hysterectomy timing post-conization.</div></div><div><h3>Methods</h3><div>Data from the Leipzig Mesometrial Resection (MMR) trial were retrospectively analyzed for patients with primary cervical cancer staged IB1-IIB (2009-FIGO). Open abdominal radical hysterectomy was performed as total or extended mesometrial resection (TMMR/EMMR). Propensity score matching and survival comparisons were conducted using the Kaplan-Meier method and Cox proportional hazards regression modeling.</div></div><div><h3>Results</h3><div>Among 542 patients, 202 had conization during diagnostic workup. After 1:1 propensity score matching (163 patients per group), preoperative conization was associated with better recurrence-free (95.6 % vs. 82.3 %, HR 3.2, 95 % CI 1.4–7.0, <em>p</em> &lt; 0.01) and overall (99.2 % vs. 85.6 %, HR 6.3, 95 % CI 1.9–21.1, <em>p</em> &lt; 0.001) survival. In a multivariable Cox regression model, conization independently improved recurrence-free survival (HR 0.3, 95 % CI 0.1–0.6, <em>p</em> &lt; 0.01). The cumulative risk of distant recurrence was significantly higher without conization (sHR 14.9, 95 % CI 1.9–114.9, <em>p</em> = 0.01), with no difference in local recurrences. Completeness of tumor removal by conization (R-status) had no prognostic impact. Delayed radical hysterectomy ≥28 days post-conization was associated with improved overall survival (<em>p</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>Preoperative conization was associated with improved survival in cervical cancer patients undergoing open abdominal radical hysterectomy, irrespective of resection margin, nodal status, or parametrial involvement. Delaying radical hysterectomy by ≥28 days post-conization further enhanced survival and reduced distant metastases.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 69-77"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consolidation courses in low-risk gestational trophoblastic neoplasia and relapse rate: A MITO-9 retrospective study","authors":"Raffaella Cioffi ,&nbsp;Robert Fruscio ,&nbsp;Giulia Sabetta ,&nbsp;Alice Bergamini ,&nbsp;Cristina Dell'Oro ,&nbsp;Giovanna Scarfone ,&nbsp;Saverio Danese ,&nbsp;Gennaro Cormio ,&nbsp;Gabriella Ferrandina ,&nbsp;Sandro Pignata ,&nbsp;Giorgia Mangili","doi":"10.1016/j.ygyno.2025.03.033","DOIUrl":"10.1016/j.ygyno.2025.03.033","url":null,"abstract":"<div><h3>Objective</h3><div>Methotrexate (MTX) is the gold standard treatment for gestational trophoblastic neoplasia (GTN). It is administered until negative human chorionic gonadotropin (hCG) levels, after which consolidation courses are recommended. Aim of this study was to evaluate the relationship between number of consolidation courses and relapse rate.</div></div><div><h3>Methods</h3><div>Patients with low-risk GTN treated with first-line MTX between 1981 and 2022 in Italy were retrospectively identified. Exclusion criteria were exclusive surgical treatment, missing data on number of courses or non-standardized definitions of chemoresistance.</div></div><div><h3>Results</h3><div>Among 435 low-risk GTN patients, 333 were eligible. A total of 224 (67.2 %) patients achieved remission after treatment with first-line MTX. Forty-one patients (17.4 %) underwent 2 consolidation courses and had no relapse; 132 (56.1 %) received 3 consolidation courses with a relapse rate of 2.2 %; 39 patients (16.5 %) received more than 3 consolidation courses with a relapse rate of 10.2 %. Ninety-five percent of patients undergoing 2 consolidation courses had a FIGO score ≤ 4. Multivariate analysis showed that number of consolidation courses is not related to disease relapse in patients scoring 0–2.</div></div><div><h3>Conclusions</h3><div>Number of consolidation courses in low-risk GTN does not impact relapse rate. Our study demonstrates that patients with FIGO scores of 0,1 and 2 can safely receive 2 consolidation courses. Further studies should investigate the appropriate number of consolidation courses in patients with higher scores.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 54-58"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}