Gynecologic oncology最新文献

{"title":"Hitting the mark—or missing it? The promise and peril of biomarkers in endometrial cancer","authors":"Ramez N. Eskander , Domenica Lorusso","doi":"10.1016/j.ygyno.2026.02.034","DOIUrl":"10.1016/j.ygyno.2026.02.034","url":null,"abstract":"","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages A1-A2"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485763","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":"Extending eligibility criteria for sentinel lymph node biopsy in vulvar cancer: An update on the GroSNaPET study","authors":"Simona Maria Fragomeni ,&nbsp;Angela Collarino ,&nbsp;Alex Federico ,&nbsp;Giusi Pisano ,&nbsp;Sara Ammar ,&nbsp;Luca Zagaria ,&nbsp;Pia Clara Pafundi ,&nbsp;Giacomo Corrado ,&nbsp;Stefano Gentileschi ,&nbsp;Anna Caretto ,&nbsp;Vittoria Rufini ,&nbsp;Anna Fagotti ,&nbsp;Giorgia Garganese","doi":"10.1016/j.ygyno.2026.01.011","DOIUrl":"10.1016/j.ygyno.2026.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Sentinel node biopsy (SNB) is the standard approach for nodal staging in clinically node-negative (cN0) patients with unifocal vulvar cancer ≤4 cm. Patients outside these criteria undergo lymphadenectomy, although many prove node-negative. The prospective GroSNaPET study evaluated SNB followed by lymphadenectomy in these patients. This report presents updated outcomes, long-term follow-up, and complication data.</div></div><div><h3>Materials and methods</h3><div>This single-center prospective study included cN0 patients ineligible for standard SNB due to ≥1 of the following: tumor &gt;4 cm, multifocality, prior excision or (chemo)radiotherapy, unilateral nodal involvement, or relapse. All patients underwent SNB followed by complete lymphadenectomy. Histopathology was the reference standard. Complications were graded by Clavien–Dindo system. Diagnostic accuracy and survival outcomes were assessed with standard methods.</div></div><div><h3>Results</h3><div>Seventy-two patients (114 groins) were enrolled. The preoperative lymphoscintigraphic SNB identification rate was 94.7%. Among 265 sentinel nodes removed, 19 (7.2%) showed metastases, involving 16/108 groins (14.8%). Overall, 17/108 groins resulted metastatic. The proportion of false negatives over the entire study population was 0.9% (1/108), with a false negative rate of 5.9% (1/17). The negative predictive value was 98.9% and the diagnostic accuracy was 99.1%. Postoperative complications occurred in 70.8% cases, mainly lymphedema (19.7%) and lymphoceles (12%); 17% were Clavien–Dindo grade ≥ III. Median follow-up was 54.5 months; 22 recurrences (30.6%, including 3 inguinal) and 15 deaths (20.8%) were recorded. 5-year Disease Free Survival and Overall Survival were 65.6% and 82.7%.</div></div><div><h3>Conclusions</h3><div>SNB is accurate and safe beyond standard criteria. This study provides a robust comparison for GroSNaPET 2, which omits lymphadenectomy when SN is negative.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 15-22"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076707","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":"BRCA1 and BRCA2 carriers: Perceptions of endometrial cancer risk","authors":"Mark E. Sherman ,&nbsp;Laura Pacheco-Spann ,&nbsp;Susan Friedman ,&nbsp;Diane Rose ,&nbsp;William D. Foulkes ,&nbsp;Christopher C. DeStephano ,&nbsp;Kristina A. Butler ,&nbsp;Kathryn J. Ruddy ,&nbsp;Zhihui Fang ,&nbsp;Lauren E. Haydu","doi":"10.1016/j.ygyno.2026.01.235","DOIUrl":"10.1016/j.ygyno.2026.01.235","url":null,"abstract":"<div><h3>Objective</h3><div>To survey knowledge, preferred information sources, and risk tolerance for EC among <em>BRCA1</em> and <em>BRCA2</em> pathogenic variant (PV) carriers.</div></div><div><h3>Methods</h3><div>Electronic survey of 332 anonymous women. Descriptive statistics presented.</div></div><div><h3>Results</h3><div>Participants included non-Hispanic White (89.3%) United States residents (91.7%), with mean age of 45 years; 50.6% were <em>BRCA 1</em> and 45.7% were <em>BRCA 2</em> carriers; 56.7% had undergone risk-reducing surgery, including hysterectomy in 44.3%. Most cited reasons for hysterectomy were physician recommendation and EC risk. Among women with intact uteri, 42.2% or participants indicated that they would undergo hysterectomy if EC risk was ≥15%. When queried about specific EC risk factors, responses of “don't know” (if risk is increased or decreased) were given for 30.9%–75.5%, and specifically for <em>BRCA1</em>: 55.2% and for <em>BRCA2</em>: 72.6%. Participants expressed preferences for sources of information about EC risk (decreasing order) as gynecologic oncologists; medical oncologists; genetic counselors and gynecologists. Respondents indicated that providers recommended hysterectomy for 36.0%, against hysterectomy for 15.7% or gave conflicting information for 16.6%.</div></div><div><h3>Conclusions</h3><div>Many carriers have limited knowledge of EC risk and do not receive consistent counseling about hysterectomy.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 23-31"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076706","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":"Remarkable preclinical activity of trastuzumab-deruxtecan (T-DXd) in FISH-negative, HER2 IHC 1+ and 2+ expressing primary endometrial cancer cell lines and xenografts","authors":"Luca Palmieri ,&nbsp;Stefania Bellone ,&nbsp;Cem Demirkiran ,&nbsp;Tobias M.P. Hartwich ,&nbsp;Namrata Sethi ,&nbsp;Victoria M. Ettorre ,&nbsp;Sarah Ottum ,&nbsp;Michelle Greenman ,&nbsp;Natalia Buza ,&nbsp;Pei Hui ,&nbsp;Emanuele Perrone ,&nbsp;Francesco Fanfani ,&nbsp;Anna Fagotti ,&nbsp;Elena Ratner ,&nbsp;Alessandro D. Santin","doi":"10.1016/j.ygyno.2026.02.004","DOIUrl":"10.1016/j.ygyno.2026.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>Antibody-drug conjugates (ADCs) targeting the human epidermal growth factor receptor 2 (HER2) such as trastuzumab deruxtecan (T-DXd) may offer a novel therapeutic option for endometrial cancer patients with HER2-overexpressing tumors. However, the activity of T-DXd in endometrial cancer patients with low HER2 expression (IHC 2+ or 1+, FISH negative) remains unreported. Accordingly, the objectives of this study were to evaluate T-DXd preclinical activity both in-vitro and in-vivo against primary FISH-negative endometrial endometrioid cancer (EEC) cell lines with IHC 1+ to 2+ HER2 expressions.</div></div><div><h3>Methods</h3><div>Primary FISH-negative EEC cell lines with low HER2 expression were characterized by immunohistochemistry (IHC), flow cytometry (mean fluorescence intensity, MFI) and FISH assays.</div><div>T-DXd efficacy was investigated in vitro by evaluating cell viability, DNA damage, antibody-dependent cell cytotoxicity and bystander killing. In vivo activity was assessed in HER2 2+ and 1+ FISH-negative EEC xenograft mouse model.</div></div><div><h3>Results</h3><div>T-DXd demonstrated significant in-vitro cytotoxicity in HER2 FISH-negative, IHC 2+ and 1+ cell lines. By contrast, in the HER2 IHC 0 cell line, no significant difference in cell death was observed between T-DXd and Control ADC. In vivo, T-DXd was highly effective in tumor growth suppression and significantly prolonged overall survival in both HER2 IHC 2+ and 1+ xenograft mouse models.</div></div><div><h3>Conclusions</h3><div>T-DXd showed remarkable preclinical activity against HER2 FISH-negative, IHC-low EEC both in-vitro and in-vivo. These findings support its use beyond HER2-high expression and may represent a novel and effective treatment option for patients with HER2-low EEC who have progressed on standard chemotherapy and immunotherapy.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 65-73"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197610","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":"Survival benefit of platinum-based chemotherapy in non-surgically treated advanced ovarian cancer: A nationwide study","authors":"Prakriti Garkhail ,&nbsp;Petrisia C. de Bruin ,&nbsp;Ingrid A. Boere ,&nbsp;Maaike A. van der Aa ,&nbsp;Willemien J. van Driel ,&nbsp;Heleen J. van Beekhuizen ,&nbsp;Gatske M. Nieuwenhuyzen-de Boer","doi":"10.1016/j.ygyno.2026.01.772","DOIUrl":"10.1016/j.ygyno.2026.01.772","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with ovarian cancer who do not undergo surgery are underreported in literature. This study evaluated the impact of chemotherapy on survival in ovarian cancer patients who did not undergo cytoreductive surgery. Survival was compared between those who initiated chemotherapy and those who did not, and between patients who continued beyond three cycles and those who discontinued, adjusting for patient characteristics.</div></div><div><h3>Methods</h3><div>All patients diagnosed with ovarian cancer between 2018 and 2022 and not surgically treated were identified from the Netherlands Cancer Registry. Kaplan-Meier and Accelerated Failure Time models were used to evaluate the association between chemotherapy and survival.</div></div><div><h3>Results</h3><div>In total, 1780 patients who did not undergo cytoreductive surgery were included, 57.2% (<em>N</em> = 1018) were treated with platinum-based chemotherapy. Median overall survival in patients who initiated chemotherapy was 11.1 months (95% CI: 10.48–12.16) versus 1.8 months (95% CI: 1.74–2.07) in patients who did not (<em>p</em> &lt; 0.0001). In multivariable analysis, chemotherapy was associated with longer survival (Time Ratio: 4.10, 95% CI: 3.35–5.01, p &lt; 0.0001). Of patients who started chemotherapy, 70.5% (<em>N</em> = 691) received at least three cycles, and 47.9% (<em>N</em> = 469) received six cycles. Median overall survival in patients who stopped after three cycles was 9.9 months (95% CI: 8.1–12.4) versus 17.4 months (95% CI: 16.0–19.1) in patients who continued (<em>p</em> &lt; 0.001). Continuation beyond three cycles was associated with longer survival (Time Ratio: 1.58, 95% CI: 1.24–2.01, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>These findings support continuing platinum-based chemotherapy for up to six cycles in patients who do not undergo surgery, as this is associated with improved overall survival.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 45-53"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179127","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":"Clinico-pathological characteristics of adult granulosa cell tumors of the ovary and the role of staging surgery: A national database study","authors":"Liselotte Petersen Due ,&nbsp;Zohreh Ketabi ,&nbsp;Claus Høgdall ,&nbsp;Emma Louise Kaderly Rasmussen ,&nbsp;Sven Hoedt Karstensen ,&nbsp;Finn Friis Lauszus ,&nbsp;Tine Henrichsen Schnack","doi":"10.1016/j.ygyno.2026.01.769","DOIUrl":"10.1016/j.ygyno.2026.01.769","url":null,"abstract":"<div><h3>Objective</h3><div>The role of staging surgery in women with Adult Ovarian Granulosa Cell Tumors (AGCT) remains uncertain. This study aimed to assess if omitting secondary staging surgery is safe amongst women who were incompletely staged at primary surgery using recurrence rate as the primary outcome. Furthermore, we sought to identify risk factors for recurrence which may be informative for selection of patients for conservative treatment.</div></div><div><h3>Methods</h3><div>Women diagnosed with AGCT between 2005 and 2019 were identified using data from nationwide Danish Databases (DGCD and NPR). Patients undergoing primary staging surgery, those undergoing incomplete staging surgery with secondary staging and those undergoing incomplete staging not followed by secondary staging. Adjusted binary logistic regression and Cox analyses were used to assess recurrence risk and recurrence free survival.</div></div><div><h3>Results</h3><div>We identified 223 cases with AGCT in Denmark. The recurrence rates were 17%, and 4.8% in patients undergoing complete and incomplete primary staging surgery, respectively (<em>p</em> &lt; 0.015). FIGO Stage (1A vs. ≥IC), tumor size, and high mitotic activity were identified as risk factors of recurrence. The risk of recurrence among patients who were conservatively treated after incomplete primary staging surgery was very low (4.8%), which could be explained by a low-risk profile (high proportion of stage IA, small tumors, and low/moderate mitotic activity) among these patients.</div></div><div><h3>Conclusion</h3><div>In a real-world setting, omitting secondary staging surgery seems safe in primary incompletely staged patients with a low-risk recurrence profile.</div><div>We confirmed that FIGO stage, tumor size, and mitotic activity are all significantly associated with the risk of recurrence in incompletely staged patients.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 74-81"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197577","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":"Para-aortic lymphadenectomy after negative PET-CT in locally advanced cervical cancer: a continuous monocentric series of 320 cases","authors":"Mathilde Daix-Moreux ,&nbsp;Houssein EL Hajj ,&nbsp;Stéphanie Schérier ,&nbsp;Désirée Deandréis ,&nbsp;Ines Chaffai ,&nbsp;Elaine Limkin ,&nbsp;Sophie Espenel ,&nbsp;Patricia Pautier ,&nbsp;Alexandra Leary ,&nbsp;Judith Michels ,&nbsp;Catherine Genestie ,&nbsp;Philippe Morice ,&nbsp;Sébastien Gouy","doi":"10.1016/j.ygyno.2026.02.012","DOIUrl":"10.1016/j.ygyno.2026.02.012","url":null,"abstract":"<div><h3>Objective</h3><div>Assess the accuracy of preoperative PET-CT in detecting para-aortic nodal metastasis in patients with locally-advanced cervical cancer, using routine laparoscopic para-aortic lymphadenectomy and evaluate its impact on patient outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a cohort of 320 patients with locally advanced cervical cancer patients (2007–2020). All patients had negative para-aortic PET-CT findings and underwent staging laparoscopic para-aortic lymphadenectomy up to the left renal vein. Collected data included patients and tumors' characteristics, surgical procedures, and complications. The association between nodal status, size of metastatic nodes and survivals were also analyzed.</div></div><div><h3>Results</h3><div>Twenty-nine (9%) patients had para-aortic nodal metastases: 11 &lt; 5 mm and 18 &gt; 5 mm. The rates of false negative results for para-aortic nodal metastases were significantly correlated with the pelvic lymph node status on PET-CT imaging: 3.3% in patients without pelvic uptake compared to 16.9% in patients with pelvic uptake (<em>p</em> &lt; 0.001), but not significantly linked with its laterality, uni or bilateral uptake. Patients with nodal metastases ≤5 mm did not have a different survival from pN0 patients but those with metastases &gt;5 mm had an increased risk of death (HR = 2.79 (95%CI [1.19–6.54], <em>p</em> = 0.02). Among 12 patients in whom para-aortic nodal metastases location is known, 4 (33%) had isolated nodes above the inferior mesenteric artery).</div></div><div><h3>Conclusion</h3><div>Para-aortic lymphadenectomy may be omitted in locally advanced cervical cancer patients without pelvic lymph node uptake on PET-CT. It remains valuable in patients with pelvic uptake. If performed, dissection up to the left renal vein allows for an accurate assessment of the para-aortic area.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 99-105"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258027","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":"CDO1 and CELF4 methylation assay as the dominant predictor of endometrial cancer: A cohort analysis across pre- and post-menopausal cohorts","authors":"Xiuzhen Wang ,&nbsp;Lang Zheng ,&nbsp;Genhai Zhu ,&nbsp;Shengtan Wang ,&nbsp;Wei Li ,&nbsp;Jun Liu ,&nbsp;Haocheng Gao ,&nbsp;Xiaohang Liu ,&nbsp;Guifei Li ,&nbsp;Lei Li ,&nbsp;Lan Hong","doi":"10.1016/j.ygyno.2026.01.776","DOIUrl":"10.1016/j.ygyno.2026.01.776","url":null,"abstract":"<div><h3>Background</h3><div>The rising global incidence of endometrial cancer (EC) necessitates the development of non-invasive, accurate detection methods to improve early diagnosis and optimize referrals for hysteroscopy. This study evaluated the diagnostic and triage value of a CDO1 and CELF4 methylation (CISENDO) assay using cervical scrapings for EC detection, and its independent association with EC across menopausal statuses.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 573 participants for diagnostic hysteroscopy were enrolled, including 524 non-EC, 41 EC, and 8 endometrial intraepithelial neoplasia (EIN) cases. The diagnostic performance of the CISENDO assay, alone and combined with endometrial thickness (ET) measured by transvaginal ultrasound (TVS), was assessed. Analyses were stratified by menopausal status. Univariate and multivariate logistic regression identified independent EC predictors.</div></div><div><h3>Results</h3><div>The CISENDO assay demonstrated high discriminatory performance. In premenopausal women with EC, sensitivity was 89.7%, specificity 93.0%, and AUC 0.91. In postmenopausal women with EC, sensitivity was 91.7%, specificity 91.8%, and AUC 0.92. Combining CISENDO with ET increased sensitivity (96.6% premenopausal; 100% postmenopausal) but reduced specificity. Notably, 55.2% of premenopausal EC cases had ET &lt;11 mm but were CISENDO-positive, while 52.7% of non-EC postmenopausal women with ET ≥5 mm were CISENDO-negative. Multivariable analysis identified the CISENDO assay as the strongest independent predictor of EC (adjusted OR = 103.9 in premenopausal and 118.0 in postmenopausal women; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The non-invasive CDO1 and CELF4 methylation assay demonstrates high diagnostic accuracy for EC and represents a promising tool for non-invasive diagnosis and triage, particularly in women at high risk for EC and those with early-stage disease.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 82-92"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201438","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":"Risk of memory impairment in gynecologic cancer survivors in the Women's Health Initiative: Untangling effects of age, comorbidities, and cancer","authors":"Benjamin J. Matthews ,&nbsp;Electra D. Paskett ,&nbsp;Eric McLaughlin ,&nbsp;Diane Von Ah ,&nbsp;Rowan Chlebowski ,&nbsp;Chloe M. Hery ,&nbsp;Michael Pennell ,&nbsp;Tracy Vannorsdall ,&nbsp;Longjian Liu ,&nbsp;Aladdin H. Shadyab ,&nbsp;Kathy Pan ,&nbsp;Stephanie L. Wethington","doi":"10.1016/j.ygyno.2026.01.006","DOIUrl":"10.1016/j.ygyno.2026.01.006","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether gynecologic cancer history predicts worsened self-reported memory outcomes, accounting for the interaction of age and comorbidities.</div></div><div><h3>Methods</h3><div>Nested case-control study of cancer survivors enrolled in the ancillary Life and Longevity After Cancer (LILAC) study of the Women's Health Initiative (WHI) and matched cancer-free WHI participants, longitudinally followed after initial enrollment from 1993 to 1998. Postmenopausal women with incident endometrial or ovarian cancer during the WHI were compared to cancer-free women matched up to 5:1 to survivors. Participants with pre-existing cognitive dysfunction, neurodegenerative disease, or multiple cancers were excluded. The primary outcome was self-reported “moderate/severe memory problems” ≥12 months following cancer diagnosis of the index survivor. Associations of pre-diagnosis conditions with later memory problems were examined through cause-specific hazards models, accounting for competing mortality risk.</div></div><div><h3>Results</h3><div>Primary analyses included 1395 survivors and 5364 cancer-free controls. In multivariable analysis, cancer history was associated with decreased self-reported memory problems (cause-specific hazard ratio [csHR] 0.71 [0.57–0.87], <em>p</em> = 0.001). The only factors independently predictive of future memory concerns were increasing age (5-year increase; csHR 1.96 [1.84–2.09], <em>p</em> &lt; 0.001), cardiovascular disease (hypertension csHR 1.24 [1.03–1.50]; major cardiovascular events csHR 1.85 [1.28–2.68], <em>p</em> = 0.002), diabetes (csHR 1.47 [1.10–1.96], <em>p</em> = 0.01), and depression (csHR 1.47 [1.11–1.95], <em>p</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>After accounting for mortality differences, gynecologic cancer survivors experienced reduced hazard for self-reported moderate/severe memory problems. In this population, significant memory symptoms may represent aging and comorbidity effects more than cancer-related outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 1-8"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146045261","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":"Pre-operative cross-sectional imaging of chest, abdomen, pelvis is not cost-effective for low-grade endometrial cancer","authors":"Isabel Beshar MD MPhil ,&nbsp;Arian Khorshid MD ,&nbsp;Sahana Somasegar MD, MS ,&nbsp;L’Oréal Kennedy MD, DNP ,&nbsp;Danielle Blemur MD ,&nbsp;Lauren Tostrud MD ,&nbsp;Amer Karam MD","doi":"10.1016/j.ygyno.2026.02.001","DOIUrl":"10.1016/j.ygyno.2026.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>Increasing numbers of patients are presenting with metastatic burden of endometrial cancer. Currently, guidelines recommend that pre-operative imaging for surgical planning be guided by patient symptoms, risk assessment, and clinical suspicion for disease. Cross-sectional computerized tomography (CT) imaging is not recommended for low-grade disease due to the low risk of distant spread in this group; however, longitudinal data has demonstrated a marked increase in the utilization of preoperative CT imaging in this patient population over the last decade.</div></div><div><h3>Methods</h3><div>In this cost-effectiveness analysis, a decision analytic model was made to compare the utility of pre-operative CT imaging versus standard-of-care transvaginal ultrasound (TVUS) in low-risk patients with presumed grade 1–2 endometrioid endometrial cancer. Costs adjusted for 2025 $USD healthcare perspective and quality-adjusted life years (QALY) were inputted into the model. A probabilistic sensitivity analysis (PSA) nested within a Monte Carlo simulation was used to assess outcomes over 5-years.</div></div><div><h3>Results</h3><div>The mean cost in the CT imaging arm was marginally increased compared to undergoing care in the TVUS arm: $41,462 (95% CI $41,407-41,517) versus $40,144 (95% CI $40,104-40,184). In addition, CT imaging had nominally lower quality of life (3.92 QALY versus 4.05 QALY). Overall, foregoing CT imaging results in a higher incremental net monetary benefit ($14,716) compared to performing CT imaging.</div></div><div><h3>Conclusion</h3><div>Routine addition of CT imaging for pre-operative evaluation in low-risk endometrial cancer does not represent a value-based use of healthcare resources.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"206 ","pages":"Pages 93-98"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146226571","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}