Gynecologic oncology最新文献

{"title":"Mesonephric-like adenocarcinoma of the female genital tract: Pathologic diagnosis, clinical outcomes, and novel therapeutics","authors":"Kari L. Ring ,&nbsp;Anne M. Mills ,&nbsp;Brooke E. Howitt ,&nbsp;Rachel N. Grisham ,&nbsp;Elizabeth D. Euscher ,&nbsp;Hyun-Soo Kim ,&nbsp;Ann H. Klopp ,&nbsp;David L. Kolin ,&nbsp;W. Glenn McCluggage ,&nbsp;Jelena Mirkovic ,&nbsp;Kay J. Park ,&nbsp;Eliane Aoun ,&nbsp;Chika Awujo ,&nbsp;Ji Son ,&nbsp;Samuel C. Mok ,&nbsp;Sammy Ferri-Borgogno ,&nbsp;David S. Hong ,&nbsp;Lien Hoang ,&nbsp;Amir A. Jazaeri ,&nbsp;Jeffrey A. How ,&nbsp;Karen H. Lu","doi":"10.1016/j.ygyno.2025.04.583","DOIUrl":"10.1016/j.ygyno.2025.04.583","url":null,"abstract":"<div><div>In 2016, McCluggage and colleagues first defined mesonephric-like adenocarcinoma (MLA) of the uterus and extra-uterine sites. Following this initial description, the World Health Organization officially recognized MLA as a type of uterine and ovarian carcinoma and subsequent studies have further refined the morphologic definition, immunohistochemical profile, molecular underpinnings, and clinical behavior in this rare entity. A consortium of pathologists, gynecologic oncologists, medical oncologists, radiation oncologists, as well as basic science collaborators with expertise in MLA was convened to develop consensus regarding the pathologic diagnosis, and to identify unanswered questions and priority areas for research. Here, we review the current understanding of MLA from a pathologic, molecular, and clinical standpoint.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 57-65"},"PeriodicalIF":4.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869910","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":"A phase I clinical trial of radiation therapy, durvalumab and tremelimumab in recurrent gynecologic cancer","authors":"Kelly J. Fitzgerald,&nbsp;Panagiotis Konstantinopoulos,&nbsp;Ursula Matulonis,&nbsp;Joyce Liu,&nbsp;Neil Horowitz,&nbsp;Elizabeth Lee,&nbsp;David L. Kolin,&nbsp;Larissa Lee,&nbsp;Martin King","doi":"10.1016/j.ygyno.2025.04.006","DOIUrl":"10.1016/j.ygyno.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>Dual immune checkpoint blockade (ICB) may synergize with palliative radiotherapy (RT) to improve responses in patients with recurrent/metastatic gynecologic cancer. We conducted an open label prospective phase I trial to assess the safety and tolerability of ICB plus RT.</div></div><div><h3>Methods</h3><div>Patients with recurrent/metastatic endometrial, ovarian, cervical, vaginal or vulvar cancer were eligible. The safety lead-in cohort A was treated with programmed death ligand (PD-L1) inhibitor durvalumab 1500 mg IV q4 weeks and palliative RT of 25 Gy in 5 fractions to a single abdominopelvic lesion. Cohort B also received 4 cycles of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor tremelimumab 75 mg IV. The primary endpoint was the rate of dose-limiting toxicities (DLTs) in patients on protocol 8 weeks after RT. Secondary endpoints included the overall response rate (ORR) in non-irradiated lesions.</div></div><div><h3>Results</h3><div>16 patients were enrolled, with 12 able to be assessed for the primary endpoint. Zero DLTs occurred in cohort A and 1 in cohort B. One patient in cohort B with platinum resistant ovarian cancer with two metastatic sites (a pelvic mass irradiated prior to trial enrollment and a peritoneal nodule irradiated on protocol) had a dramatic reduction in disease burden and remains off all therapy &gt;3 years. The ORR of non-irradiated lesions was 0 %.</div></div><div><h3>Conclusions</h3><div>Combining durvalumab, tremelimumab and RT to a single lesion had limited DLTs but no response in non-irradiated lesions in unselected patients with recurrent gynecologic malignancies. One patient with oligometastatic disease experienced prolonged durable benefit. Clinical trial information: <span><span>NCT03277482</span><svg><path></path></svg></span></div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 51-56"},"PeriodicalIF":4.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860736","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":"Reduced symptoms of late radiation tissue injury of the vagina after treatment with hyperbaric oxygen therapy: A retrospective analysis of 19 patients","authors":"M.M. Möring ,&nbsp;A.C. Valkenburg ,&nbsp;N. Schuur-van’t Hof ,&nbsp;H.J. van Beekhuizen ,&nbsp;C.A. Lansdorp","doi":"10.1016/j.ygyno.2025.04.003","DOIUrl":"10.1016/j.ygyno.2025.04.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Hyperbaric oxygen therapy (HBOT) is a well-established treatment for late radiation tissue injury (LRTI) of the pelvis, such as radiation-cystitis and -proctitis, but not for LRTI of the vagina. This study aims to describe the outcomes of patients with vaginal symptoms after HBOT.</div></div><div><h3>Methods</h3><div>The records of all patients with LRTI of the vagina, referred for HBOT from a tertiary hospital, between 2010 and 2020 were retrospectively analyzed. Patients with a non-vaginal primary complaint, fistulas, or incomplete HBOT treatment (&lt;20 sessions) were excluded. Outcomes included patient- and physician-reported symptoms (such as dyspareunia, dryness, bleeding, and anatomical changes) and quality-of-life questionnaires. Outcomes were assessed at baseline, after HBOT, 3 months after HBOT, and during yearly follow-up. Responders were defined as patients with ≥1 vaginal symptoms improving after treatment.</div></div><div><h3>Results</h3><div>19 Patients (median age 42) received an average of 40 sessions of HBOT (80 min of 100 % oxygen at 2.5 ATA). 15/19 patients (79 %) were responders at the end of treatment (median of 3 symptoms improving). The symptoms most responsive to HBOT were ulceration (89 %), dyspareunia (82 %), pain (71 %), and changes in anatomy like stenosis or fibrosis (80 %). Response was maintained during 3 month follow-up in 14/15 patients. No major adverse events of HBOT were reported.</div></div><div><h3>Conclusion</h3><div>A majority of patients had a lasting improvement of vaginal complaints after HBOT in this study. Based on this study and the generic effects of HBOT in LRTI, HBOT should be considered as a treatment option for patients with ongoing complaints of the vagina due to LRTI.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 27-33"},"PeriodicalIF":4.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856090","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":"Pattern of recurrence of the molecular subgroups in stage I high-grade endometrial cancer","authors":"Alicia León-Castillo ,&nbsp;Nanda Horeweg ,&nbsp;Elke E.M. Peters ,&nbsp;Natalja ter Haar ,&nbsp;Vincent T.H.B.M. Smit ,&nbsp;Cor D. de Kroon ,&nbsp;Marie Boennelycke ,&nbsp;Estrid Hogdall ,&nbsp;Claus Hogdall ,&nbsp;Remi R.A. Nout ,&nbsp;Carien L. Creutzberg ,&nbsp;Tjalling Bosse ,&nbsp;Gitte Ortoft","doi":"10.1016/j.ygyno.2025.04.576","DOIUrl":"10.1016/j.ygyno.2025.04.576","url":null,"abstract":"<div><h3>Objective</h3><div>Patterns of recurrence may impact the possibilities for salvage treatment and prognosis of patients with endometrial carcinoma (EC). We evaluated the recurrence rate and distribution pattern of the molecular EC subgroups in patients with stage I high-grade disease without adjuvant treatment and those staged by lymphadenectomy.</div></div><div><h3>Method</h3><div>412 high-grade EC from the Danish Gynecological Cancer Database were molecularly profiled and classified into <em>POLE</em> mutant (<em>POLE</em>mut), mismatch repair deficient (MMRd), p53-abnormal (p53abn) or no specific molecular profile (NSMP) EC. Patients with stage II-IV (FIGO 2009) or residual disease after surgery were excluded. Crude and actuarial recurrence rates were calculated.</div></div><div><h3>Results</h3><div>Stage I high-grade <em>POLE</em>mut and MMRd EC rarely recurred (5-year overall recurrence rate 7 % (95 % CI 3–16) and 6 % (95 % CI 2–22), respectively), also when not receiving adjuvant treatment. Stage I high-grade NSMP and p53abn EC had high recurrence rates (5-year overall recurrence rate 29 % (95 % CI 16–48) and 35 % (95 % CI 27–45), respectively), mostly presenting with abdominal (NSMP EC <em>n</em> = 1 (3.0 %); p53abn EC <em>n</em> = 28 (22.4 %)) or distant recurrences (NSMP EC <em>n</em> = 8 (24.2 %); p53abn EC <em>n</em> = 21 (16.8 %)).</div></div><div><h3>Conclusion</h3><div>Stage I high-grade EC present more frequently with abdominal and distant recurrences rather than isolated loco-regional recurrences, independently of molecular subgroup. Stage I high-grade <em>POLE</em>mut EC and MMRd EC have a favorable prognosis with few recurrences, even with no adjuvant treatment. Stage I high-grade NSMP and p53abn EC have a high recurrence rate, frequently with abdominal or distant recurrences, underscoring the need to investigate more effective adjuvant systemic treatments for these patients.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 43-50"},"PeriodicalIF":4.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860604","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":"Disparities in hysterectomy-corrected endometrial cancer incidence trends by histologic subtype among racial/ethnic groups in California, 2012–2019","authors":"Jingjing Xie ,&nbsp;Frances B. Maguire ,&nbsp;Brenda M. Hofer ,&nbsp;Julianne J.P. Cooley ,&nbsp;Hui A. Chen ,&nbsp;Arti Parikh-Patel ,&nbsp;Theresa H.M. Keegan","doi":"10.1016/j.ygyno.2025.04.581","DOIUrl":"10.1016/j.ygyno.2025.04.581","url":null,"abstract":"<div><h3>Background</h3><div>Hysterectomy-corrected endometrial cancer incidence among racial/ethnic minority groups by histologic subtype and age group has not been well studied. To examine recent trends in hysterectomy-corrected endometrial cancer rates among California women by histologic subtype, race/ethnicity, and age group.</div></div><div><h3>Methods</h3><div>We estimated hysterectomy prevalence from the Behavioral Risk Factor Surveillance System. Hysterectomy-corrected age-standardized endometrial cancer incidence rates (per 100,000 women) by endometrioid and non-endometrioid subtypes, age at diagnosis, and race and ethnicity from 2012 to 2019 were calculated using California Cancer Registry data. Incidence rates and annual percentage changes (APC) were estimated.</div></div><div><h3>Results</h3><div>Among endometrioid subtypes, American Indian women had the highest incidence (62.9 per 100,000). Incidence rates also significantly increased among Asians/Pacific Islanders (1.69 %), with an increase of 7.14 % and 7.39 % for women aged 45–54 and 55–64, respectively, though these did not reach statistical significance. In addition, Hispanics had an increased incidence rate (3.02 %) from 2012 to 2019, with a particularly sharp rise (18.42 %) observed in Hispanics aged 25–34 years between 2016 and 2019. For non-endometrioid subtypes, non-Hispanic Blacks had the highest incidence (29.4 per 100,000), with the ≥65 age group showing an upward trend (9.39 % increase from 2012 to 2016) before significantly declining by 8.16 % from 2017 to 2019. American Indians had the second-highest incidence (14.1 per 100,000), but no significant trend was observed, likely due to the small sample size of this population.</div></div><div><h3>Conclusions</h3><div>Our findings show that race/ethnicity is associated with endometrial cancer incidence and underscore the importance of jointly examining racial/ethnic disparities with age and histologic subtype.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 34-42"},"PeriodicalIF":4.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860745","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":"STK11 adnexal tumor: A newly recognized entity that expands the spectrum of neoplasms associated with Peutz-Jeghers syndrome","authors":"Jennifer A. Bennett ,&nbsp;Esther Oliva ,&nbsp;Robert H. Young","doi":"10.1016/j.ygyno.2025.04.001","DOIUrl":"10.1016/j.ygyno.2025.04.001","url":null,"abstract":"","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 25-26"},"PeriodicalIF":4.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856089","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":"Temporal trends of sentinel lymph node biopsy without lymphadenectomy at cervical cancer surgery","authors":"Emmeline L. Friedman ,&nbsp;X. Mona Guo ,&nbsp;Katelyn B. Furey ,&nbsp;Alice J. Lee ,&nbsp;Shinya Matsuzaki ,&nbsp;Mamoru Kakuda ,&nbsp;Mariya Kobayashi ,&nbsp;Michiko Kodama ,&nbsp;Hiroyuki Kanao ,&nbsp;Maximilian Klar ,&nbsp;Lynda D. Roman ,&nbsp;Jason D. Wright ,&nbsp;Koji Matsuo","doi":"10.1016/j.ygyno.2025.04.519","DOIUrl":"10.1016/j.ygyno.2025.04.519","url":null,"abstract":"<div><h3>Objective</h3><div>To assess temporal trends of sentinel lymph node biopsy alone without additional lymphadenectomy at surgery for cervical cancer in the United States.</div></div><div><h3>Methods</h3><div>This retrospective cohort study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Study population was 13,498 patients with American Joint Commission on Cancer T1 classification cervical cancer who underwent anti-cancer surgery either with hysterectomy, trachelectomy, or cervical excision and additional surgical nodal evaluation from 2004 to 2021. Temporal trends were assessed with linear segment regression model. In exploratory analysis, survival was assessed with multivariable Cox proportional hazard regression model.</div></div><div><h3>Results</h3><div>Utilization rate of sentinel lymph node biopsy with or without lymphadenectomy increased from 0.2% to 15.1% in 2004–2018 (<em>P-trend</em>&lt;0.001), followed by stabilization after 2018 (15.1% to 17.3%, <em>P-trend</em>=0.752). Utilization rate of sentinel lymph node biopsy alone without additional lymphadenectomy exceeded the rate of concurrent sentinel lymph node biopsy together with lymphadenectomy in 2018 (8.8% versus 6.3%). Following this surgery-shift in 2018, sentinel lymph node biopsy alone without additional lymphadenectomy continued to increase from 8.8% to 11.3% between 2018 and 2021 (<em>P-trend</em>&lt;0.001). In 2021, nearly two thirds of sentinel lymph node evaluation were performed by sentinel lymph node biopsy alone without additional lymphadenectomy (65.2%). Sentinel lymph node biopsy alone and sentinel lymph node biopsy with additional lymphadenectomy had comparable cervical cancer-specific survival (5-year rates 96.5% versus 95.7%, <em>P</em>=0.828) and overall survival (95.3 % versus 94.6 %, <em>P</em> =0.893).</div></div><div><h3>Conclusion</h3><div>This population-based assessment suggests that the majority of sentinel lymph node assessments for cervical cancer after the late-2010s were performed without additional lymphadenectomy.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 182-191"},"PeriodicalIF":4.5,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848671","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":"Safety and feasibility of same day discharge for robotic hysterectomy and staging for endometrial cancer","authors":"Leah Grcevich ,&nbsp;Olena Chuzhyk ,&nbsp;Andrea Giannini ,&nbsp;Michaela E. McGree ,&nbsp;Angela J. Fought ,&nbsp;Ilaria Capasso ,&nbsp;Gabriella Schivardi ,&nbsp;Giuseppe Cucinella ,&nbsp;Gretchen Glaser ,&nbsp;Carrie Langstraat ,&nbsp;Kristina Butler","doi":"10.1016/j.ygyno.2025.04.517","DOIUrl":"10.1016/j.ygyno.2025.04.517","url":null,"abstract":"<div><h3>Objectives</h3><div>Same day discharge (SDD) is well established for benign minimally invasive hysterectomy, but its adoption for endometrial cancer has been met with some concerns. This multicenter study investigates outcomes for endometrial cancer patients discharged on the same day following robotic hysterectomy and lymphadenectomy.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed endometrial cancer patients treated with robotic hysterectomy and lymphadenectomy from January 2019 to December 2021. We collected clinical, pathologic, and surgical data, and reviewed medical records for unscheduled contacts, acute visits, or readmissions within 30 days postoperatively. Logistic regression models were used to assess associations with non-SDD.</div></div><div><h3>Results</h3><div>Of 690 patients, 208 (30.1 %) required overnight observation. Indications for observation included nausea/vomiting (14.9 %), persistent sedation (9.1 %), hypoxia (7.7 %), and urinary retention (7.2 %). In 123 patients (59.1 %), the admission reason was undocumented. Univariate analysis revealed that factors associated with overnight observation included age (OR 1.19 per 10 years, <em>P</em> = 0.04), BMI (OR 1.10 per 5 kg/m², P = 0.04), ASA score ≥ 3 (OR 1.53, <em>P</em> = 0.01), operative time (OR 1.52 per 60 min, <em>P</em> &lt; 0.01), and other comorbidities. Unscheduled contacts were most frequently due to uncontrolled pain (12 SDD patients, 14 non-SDD) and urinary tract infection (15 SDD, 13 non-SDD). Twelve SDD patients (2.5 %) and four non-SDD patients (1.9 %) were readmitted within 30 days.</div></div><div><h3>Conclusions</h3><div>For patients undergoing robotic hysterectomy and lymphadenectomy for endometrial cancer, no significant differences in unscheduled contact, 30-day readmission, or reoperation were observed between SDD and non-SDD cohorts. Factors associated with non-SDD included chronic kidney disease, anticoagulation, conversion to laparotomy, and procedure timing.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 19-24"},"PeriodicalIF":4.5,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848277","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":"TP53 somatic evolution in the normal endometrium of Black and White individuals","authors":"Eric Rios-Doria ,&nbsp;Elizabeth U. Parker ,&nbsp;Brendan F. Kohrn ,&nbsp;Mindy Pike ,&nbsp;Coohleen Coombes ,&nbsp;Elena Latorre-Esteves ,&nbsp;Daniel J. Reiter ,&nbsp;Jeanne Fredrickson ,&nbsp;Ronit Katz ,&nbsp;Elizabeth M. Swisher ,&nbsp;Kemi M. Doll ,&nbsp;Rosa Ana Risques","doi":"10.1016/j.ygyno.2025.04.002","DOIUrl":"10.1016/j.ygyno.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div><em>TP53</em> mutations are the main drivers of aggressive, high-risk endometrial carcinomas commonly diagnosed in Black individuals. However, <em>TP53</em> mutations have also been identified in benign, non-cancerous tissues. We sought to understand the <em>TP53</em> mutational landscape in benign endometrium throughout the lifespan of Black and White individuals, accounting for structural socioeconomic context.</div></div><div><h3>Methods</h3><div>Ultra-sensitive <em>TP53</em> mutation detection was performed with high-depth duplex sequencing (∼13,000×) in DNA extracted from histologically normal endometrium collected at autopsy (69 % of cases) or surgery (31 % of cases) from 83 individuals ages 0 to 81 (31 Black and 52 White, median age 35 years) without endometrial cancer. Histologically normal endometrium was also collected from 10 White individuals with endometrial cancer.</div></div><div><h3>Results</h3><div>We identified 266 coding <em>TP53</em> mutations in the normal endometrium of individuals without endometrial cancer, 57 % of which were pathogenic. The number, pathogenicity, and size of <em>TP53</em> mutant clones in normal endometrium increased with age. Multivariable models showed no significant association between race or socioeconomic metrics and <em>TP53</em> mutation frequency in normal endometrium. An exploratory analysis on the histologically normal endometrium of White individuals with endometrial cancer identified the tumor mutations at low levels in the normal biopsy of 5 out of 6 cases.</div></div><div><h3>Conclusions</h3><div>Our study revealed prevalent <em>TP53</em> somatic evolution in benign endometrium across human lifespan and no racial differences in this cohort of predominantly younger individuals. Future studies should consider the analysis of larger cohorts with older individuals to detect potential effects of racial disparities on <em>TP53</em> somatic evolution later in life.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 1-10"},"PeriodicalIF":4.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848270","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":"Disparities in facility-level adoption of minimally invasive interval debulking surgery for advanced ovarian cancer","authors":"Roni Nitecki Wilke ,&nbsp;Chi-Fang Wu ,&nbsp;Alexa Kanbergs ,&nbsp;Alexandra S. Bercow ,&nbsp;Nuria Agusti ,&nbsp;David Viveros-Carreño ,&nbsp;Abigail S. Zamorano ,&nbsp;Jose Alejandro Rauh-Hain ,&nbsp;Alexander Melamed","doi":"10.1016/j.ygyno.2025.04.518","DOIUrl":"10.1016/j.ygyno.2025.04.518","url":null,"abstract":"<div><h3>Objective</h3><div>Facility-level disparities in the adoption of minimally invasive (MIS) interval debulking surgery (IDS) among Commission-on-Cancer–accredited programs in the United States were examined.</div></div><div><h3>Methods</h3><div>Patients with stage IIIC or IV epithelial ovarian cancer (2010−2021) who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Analytical periods were categorized as the preadoption (2010 to 2014) and postadoption (2015 to 2021) periods. We defined “Adopter” facilities as those that significantly increased their use of MIS for IDS after 2015 and “non-adopter” facilities as those that restricted the use of this approach after 2015. Hospital-level variation in the use of IDS via MIS was estimated and then adopter programs were matched with non-adopter programs. We examined the associations between characteristics of interest—Black-serving (top 5 %), serving a high proportion of uninsured patients (top 5 %), high-volume (top quartile), and academic—and the tendency to perform IDS using logistic regressions.</div></div><div><h3>Results</h3><div>We identified 5464 patients treated in 141 adopter facilities and 4820 patients treated in 141 non-adopter facilities. Adopter facilities were less likely than non-adopter facilities to be Black-serving (odds ratio [OR], 0.66; 95 % CI, 0.55–0.79; <em>P</em> &lt; 0.001) and to have a high proportion of uninsured patients (OR, 0.73; 95 % CI, 0.61–0.87, <em>P</em> &lt; 0.001) and more likely to be high-volume centers (OR, 1.48; 95 % CI, 1.35–1.60; <em>P</em> &lt; 0.001) and academic institutions (OR, 1.89; 95 % CI, 1.74–2.04, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>As MIS IDS is adopted in the United States, minoritized patients may have unequal access depending on where they receive care.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"197 ","pages":"Pages 11-18"},"PeriodicalIF":4.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848276","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}