International Journal of Gynecological Cancer最新文献

{"title":"PARAGON-II cohort C: a phase II basket study of letrozole plus ribociclib in hormone receptor-positive, platinum-resistant, high-grade epithelial ovarian cancer.","authors":"Chee Khoon Lee, Danka S Zebic, Rachel L O'Connell, Yeh C Lee, Katherine E Francis, Bo Gao, Jeffrey C Goh, Sally Baron-Hay, Lawrence Kasherman, Ratnesh Srivastav, Christopher Steer, Tarek Meniawy, Sandy Simon, Deepa Mathur, Leanna Cheung, Margaret Wall, Clare L Scott, Alison Davis, Anna De Fazio, Sonia Yip, Michael Friedlander","doi":"10.1016/j.ijgc.2026.105600","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.105600","url":null,"abstract":"<p><strong>Objective: </strong>Hormone receptor expression is common in epithelial ovarian cancer, and endocrine therapy is included in guidelines for recurrent disease. Dysregulation of the cyclin-dependent kinase 4 and 6 pathway is frequent in high-grade serous carcinoma, providing a rationale for evaluating cyclin-dependent kinase 4 and 6 inhibition with endocrine therapy in hormone receptor-positive epithelial ovarian cancer. PARAGON-II Cohort C assessed letrozole plus ribociclib in hormone receptor-positive, PIK3CA wild-type, platinum-resistant ovarian cancer.</p><p><strong>Methods: </strong>PARAGON-II is a multi-center, phase II basket trial. Participants received letrozole 2.5 mg daily continuously plus ribociclib 600 mg (3-weeks-on/1-week-off) until progression or unacceptable toxicity. The primary end point was objective response rate by Response Evaluation Criteria in Solid Tumors version 1.1 or Gynecologic Cancer InterGroup CA125 criteria. Secondary end points included disease control rate, progression-free survival, patient-reported outcomes, and safety.</p><p><strong>Results: </strong>Thirty-two participants were enrolled (median age 64 years; 97% high-grade serous histology). Patients were heavily pre-treated: 56% had ≥3 prior lines, 69% had prior bevacizumab, and 25% prior Poly (ADP-ribose) polymerase inhibitors. Among 25 participants with measurable disease, the objective response rate was 4.0% (95% confidence interval 0.1 to 20.0; 1 partial response). There was 1 Gynecologic Cancer InterGroup CA125 response (3.3%; 95% confidence interval 0.1 to 17.2). In evaluable participants (n = 30), the 12-week disease control rate was 27.0%. Median progression-free survival was 1.9 months, with a 6-month progression-free survival rate of 16.0%. Grade ≥3 toxicities were mainly hematologic. Over half of the participants reported moderate-severe baseline abdominal symptoms, which were associated with significantly shorter survival. Patient-reported outcome scores declined over time, consistent with disease progression.</p><p><strong>Conclusions: </strong>Letrozole plus ribociclib demonstrated minimal clinical activity in heavily pre-treated hormone receptor-positive, PIK3CA wild-type, platinum-resistant ovarian cancer. These findings do not support further evaluation of this specific endocrine therapy and cyclin-dependent kinase 4 and 6 inhibitor combination in this population, although alternative endocrine-based strategies targeting different biological mechanisms may warrant investigation.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"105600"},"PeriodicalIF":5.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127452","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":"Access, training, and perceived barriers to robotic surgery in gynecologic practice: findings from a cross-sectional survey of Latin American surgeons.","authors":"Vanessa Alvarenga-Bezerra, Ana Flávia Nunes de Souza, Luiza Gama Ancona de Faria, Mariana Costa Rossette, Ricardo Dos Reis, Luciana Machado, Audrey Tieko Tsunoda, Gustavo Guitmann, Agnaldo Lopes da Silva-Filho, Glauco Baiocchi, Giorgio Conte Tondello, Florencia Noll, Cassio Bona Alves, Eduardo Câmara, Aldo López Blanco, Daniel Sanabria, David Isla Ortiz, Diego Odetto, Fernando Heredia M, Everardo Gutiérrez R, Paulo Ayroza Ribeiro, Mariano Tamura Vieira Gomes, Sérgio Podgaec, Renato Moretti-Marques","doi":"10.1016/j.ijgc.2026.104989","DOIUrl":"10.1016/j.ijgc.2026.104989","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate access to robotic platforms, training pathways, cumulative robotic surgical experience, perceived barriers, and factors associated with self-reported technical confidence among gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin America.</p><p><strong>Methods: </strong>This was an observational, cross-sectional survey conducted over 4 weeks using an electronic questionnaire. Gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin American countries were recruited through professional networks and organizations, with subsequent snowball sampling.</p><p><strong>Results: </strong>A total of 210 responses were analyzed, with the majority from Brazil (81.4%) and from practitioners working in private or mixed health care settings (95.7%). Access to robotic platforms was reported by 88.6% of respondents, mainly involving da Vinci Xi (68.6%) and da Vinci X (57.1%) systems. Training pathways were heterogeneous, including postgraduate programs (27.6%) and industry-sponsored courses (27.1%). In multivariable analysis, cumulative robotic surgical experience and perceived training adequacy were independently associated with technical confidence. For the animal model training variable, both participants with formal training without animal model exposure and those with animal model training reported higher technical confidence compared with participants with no formal training. Specific training modalities, such as simulation hours or fellowships, were not independently associated with technical confidence after adjustment. Economic barriers were nearly universal, with 91.4% identifying costs and insurance denial as the primary obstacle to implementation. Furthermore, 76.7% of respondents perceived access as highly concentrated in major urban centers.</p><p><strong>Conclusions: </strong>Among the surveyed gynecologic professionals, access to robotic surgery platforms was commonly reported, although perceived access remained limited by financial and geographic disparities. Support for structured training is widespread, but cumulative operative experience appears to be the key factor associated with technical confidence.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104989"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109316","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":"From innovation to access: closing the gap in global gynecologic oncology.","authors":"René Pareja, Pedro T Ramirez","doi":"10.1016/j.ijgc.2026.105603","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.105603","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"105603"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109378","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":"Operationalizing cervical cancer elimination: a health-system archetype framework for implementation.","authors":"Mauricio A Cuello, Marta Del Pino, Adriaan J C van den Brule, Elmar A Joura, Anisa Mburu, Fernanda Santos, Cristina Sani, Frederik Deman, Mihai C Stoicea, Alp Usubutun, Ivana Kholová, Emmanuel González, Fadi Mirza, Albert Gómez-Morillas","doi":"10.1016/j.ijgc.2026.104966","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104966","url":null,"abstract":"<p><p>Cervical cancer elimination is considered an achievable global health objective, yet progress toward the World Health Organization 90-70-90 targets remains highly uneven across countries and regions. Despite the effectiveness of human papillomavirus vaccination and human papillomavirus-based screening, implementation continues to be shaped by substantial variation in health-system readiness, program maturity, governance capacity, and service delivery infrastructure. This analysis proposes a pragmatic health-system archetype framework to support context-sensitive implementation of cervical cancer prevention strategies. The framework was informed by a multi-regional expert convening and an iterative synthesis of global evidence, World Health Organization guidance, and implementation experience. Three broad archetypes are described (evolving, transitional, and consolidated health systems), each reflecting distinct structural constraints and implementation capacities. In evolving systems, the primary challenge is establishing functional delivery platforms capable of supporting simplified, high-impact screening approaches. In transitional systems, the priority is consolidating program architecture during the shift from cytology-based to human papillomavirus-based screening. In consolidated systems, the focus shifts toward optimization, equity, and long-term sustainability of elimination gains. Across all archetypes, progress depends less on the availability of effective technologies than on their integration within health systems able to ensure continuity, accountability, and population reach. This framework is not intended as a country classification tool but as an analytical lens to support policy and program design. By aligning implementation pathways with system readiness, it offers a pragmatic approach to translate global targets into feasible, system-adapted action and accelerate equitable progress toward cervical cancer elimination.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104966"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108896","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":"Q-GOAL study: quality in gynecologic oncology advancement for learning: a global perspective.","authors":"Radwa Hablase, Alexander Shushkevich, Ana Tatiana Palacios Torres, Anisa Mburu, Houssein El Hajj, Nicolò Bizzarri, Stamatios Petousis, Joanna Kacperczyk-Bartnik, Sara Nasser, Basel Refky, Helena Obermair, Andrej Cokan, Alfiya Fatikhova, Angie Mora Calderón, Alfonso Lenin Salinas Miranda, Catalin Bogdan Coroleuca, Delfina Ramirez Jimenez, Emma Rose Allanson, Fernando M Heredia, Florencia Noll, Gabrijela Sopta Primorac, Giulio Bonaldo, Gvantsa Kochiashvili, Hiroshi Nishio, Ilya Tarasau, Julio Lau, Jorge Hoegl, Joan Flaubert Pérez Villena, Jeslyn Wong, Maria Clara Santia, Martin Hruda, María Elena Lara Hernández, Muhterem Melis Canturk, Osnat Elyashiv, Pajtim Asani, Pernille Trent, Raikhan Bolatbekova, Romelyn Imperio-Ongloa, Sarita Kumari, Sabrina Piedimonte, Tatiana Yelitza Quijano Atencio, Teresa Lucia Pan, Vanessa Alvarenga-Bezerra, Wilmot L Smith, Ya-Min Cheng, Zwimpfer Tibor Andrea, Geetu Bhandoria","doi":"10.1016/j.ijgc.2026.104868","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104868","url":null,"abstract":"<p><strong>Objective: </strong>Gynecologic oncology surgery is delivered by clinicians with diverse specialty backgrounds and varied training pathways. The Q-GOAL (Quality in Gynecologic Oncology Advancement for Learning) study aimed to explore the heterogeneity of these training experiences, identify common training structures and surgical exposure profiles, evaluate self-reported surgical confidence, and compare these findings across income levels.</p><p><strong>Methods: </strong>An open, cross-sectional, web-based survey was conducted between July and September 2025 using convenience and snowball sampling. The survey was distributed globally to trainees and consultants in obstetrics and gynecology, general surgery, gynecologic oncology, and surgical oncology. Descriptive statistics and exploratory unsupervised multi-variate analyses were performed.</p><p><strong>Results: </strong>A total of 1,035 clinicians participated (92% completion rate), of whom 64% were from low- and middle-income countries. Most respondents had an obstetrics and gynecology background, with general surgeons contributing a greater proportion in low- and middle-income countries than in high-income countries (23% vs 5.5%). Training pathways included dedicated sub-specialty programs, rotation-based training, and a small proportion reporting no formal training. Rotation-based training was associated with a less structured training environment in the latent class analysis. Multiple correspondence analysis identified distinct low-, intermediate-, and high-volume training profiles. Increased surgical exposure was associated with higher self-reported confidence, and income status remained an independent predictor of surgical confidence.</p><p><strong>Conclusions: </strong>The study demonstrated the diversity of the workforce delivering gynecologic oncology surgery globally. These findings highlight the need for internationally harmonized training standards and a minimum level of surgical exposure, while recognizing the differences among health care systems worldwide.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104868"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109013","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":"Mapping country-level structural capacity constraints in brachytherapy infrastructure for locally advanced cervical cancer in the Americas: a cross-sectional study.","authors":"David Viveros-Carreño, Nathalia Mora-Soto, Isabel Beshar, Claudia Cruz, Melissa Lopez Varon, Alejandro Gonzalez-Motta, Mariana Scaranti, Alejandro Rauh-Hain, Bradlley J Monk, René Pareja","doi":"10.1016/j.ijgc.2026.104863","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104863","url":null,"abstract":"<p><strong>Objective: </strong>To develop a reproducible public-data method for mapping country-level capacity constraints in brachytherapy infrastructure relevant to guideline-concordant treatment for locally advanced cervical cancer across the Americas, comparing expected disease-stage-specific need with reported brachytherapy unit counts.</p><p><strong>Methods: </strong>We performed a cross-sectional ecological study at the country/territory level. Incident cervical cancer cases among females in 2022 were taken from GLOBOCAN-derived extracts and were linked with radiotherapy infrastructure data from the International Atomic Energy Agency DIrectory of RAdiotherapy Centres for countries in the Americas. Expected locally advanced cervical cancer cases were estimated as 37.0% of incident cervical cancer cases; 25.8% and 52.1% were used as low-high sensitivity bounds. The primary metric was expected locally advanced cervical cancer cases per DIrectory of RAdiotherapy Centres-reported brachytherapy unit. Countries or territories with zero reported units, no DIrectory of RAdiotherapy Centres data available, or unavailable cancer burden data were classified separately. Countries with at least 1 unit and available burden data were grouped into quartiles of estimated capacity constraints.</p><p><strong>Results: </strong>The combined public-data register contained 37 unique countries/territories in the Americas region: 34 with cervical cancer burden data and 33 with DIrectory of RAdiotherapy Centres infrastructure information. Thirty countries/territories had both burden and infrastructure data; 29 had at least 1 reported brachytherapy unit. In the primary linked set, there were 77,764 incident cervical cancer cases, 28,773 expected locally advanced cervical cancer cases, and 1060 reported brachytherapy units. Among countries/territories with at least 1 unit, the median number of expected locally advanced cervical cancer cases per unit was 59.6 (interquartile range; 30.0-112.8) for 2022 data. The highest measurable capacity constraints occurred in Honduras (169.5), Paraguay (137.5), Nicaragua (133.4), Ecuador (132.6), and Guatemala (130.3). Central America had the highest regional capacity constraints (116.8), followed by South America (61.2), the Caribbean (53.0), and North America (12.7).</p><p><strong>Conclusions: </strong>Public-data analysis can identify plausible structural infrastructure capacity-constraint signals relevant to cervical cancer management in the Americas. The metric should be interpreted as indicating hypothesis-generating potential infrastructure capacity constraints, not patient-level treatment receipt, treatment quality, or operational capacity. The next phase should validate DIrectory of RAdiotherapy Centres data, geocode centers, model travel time, and link to patient-level treatment and outcome data where feasible to improve the capacity analysis.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104863"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109324","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":"Molecular classification, biomarker testing, and access to modern therapies in endometrial cancer across Latin America: an International Gynecologic Cancer Society survey.","authors":"Florencia Noll, Graziela Z Dal Molin, Floor Backes, Robert Naumann, Julian Di Guilmi, Diego Odetto, Juliana Rodriguez, David Cantu, Andrea Gadelha Guimares, Nadeem Abu-Rustum","doi":"10.1016/j.ijgc.2026.104963","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104963","url":null,"abstract":"<p><strong>Objective: </strong>To assess gynecologic oncology professionals' perspectives on biomarker testing and molecularly informed treatment for endometrial cancer across Latin America and to identify barriers to precision care adoption.</p><p><strong>Methods: </strong>This was a secondary analysis of a multi-national, cross-sectional, web-based International Gynecologic Cancer Society survey of 679 oncology professionals from Argentina, Brazil, Colombia, and Mexico that was administered in Spanish and Portuguese using the Research Electronic Data Capture platform from March to August 2025. Endometrial cancer-specific items were completed by 506 respondents (74.5%), who formed the denominator for the results reported below; the items covered biomarker testing, interpretation and application of molecular results, access to systemic therapies, treatment delays, and institutional barriers.</p><p><strong>Results: </strong>Biomarker testing was reportedly ordered by 54.7% to 84.7% of respondents across the four main country groups; in-house next-generation sequencing and POLE testing were limited (17.2% and 18.0% of respondents, respectively), with many centers relying on external laboratories, including somatic next-generation sequencing send-out rates of 49.3% in Argentina and 62.9% in Colombia. A gap between biomarker availability and clinical application was evident: only 28.0% to 58.2% across countries would add immunotherapy for advanced mismatch repair-deficient/microsatellite instability-high disease, and 29.3% to 54.9% would add human epidermal growth factor receptor 2-directed therapy for human epidermal growth factor receptor 2-positive advanced disease. Access to immunotherapy and lenvatinib was generally lower and more heterogeneous than access to standard treatments; time to initiation of primary treatment was most commonly 28 days to 3 months, but longer delays (>3 months) were reported in a substantial proportion of cases, particularly in Mexico (21.3%).</p><p><strong>Conclusions: </strong>Among gynecologic oncology professionals surveyed in Latin America, the central challenge in endometrial cancer care is not only access to biomarkers but also integration of molecular classification into therapeutic decision-making. Closing this gap requires improved access to key tests (POLE and next-generation sequencing-based assays), practical education in result interpretation, and more consistent access to targeted therapies.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104963"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108719","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":"Financial toxicity as a structural barrier to cervical cancer treatment in Sub-Saharan Africa.","authors":"Afrin F Shaffi, Kimbley A Omwodo, Anisa Mburu, Robert Mutengo, Julieta Lumati, Marcus J Rijken","doi":"10.1016/j.ijgc.2026.104902","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104902","url":null,"abstract":"<p><p>Cervical cancer remains one of the most common and preventable cancers among women in sub-Saharan Africa. Despite established curative treatments, most women present with locally advanced disease and many fail to complete therapy. Financial toxicity encompassing, direct medical costs, non-medical expenditures, income loss, and psychological distress, is an underrecognized but potentially important contributor to this treatment gap. This narrative review examines evidence on the magnitude, structural drivers, and consequences of financial toxicity in cervical cancer care across sub-Saharan Africa, and proposes system-level mitigation strategies. Targeted searches of PubMed, Embase, and Google Scholar (January 2013-April 2026), were supplemented by gray literature and reports from international health agencies. Thematic synthesis was conducted along the cervical cancer care continuum within a universal health coverage financial risk protection framework. The reviewed evidence suggests that financial toxicity is multi-dimensional, cumulative, and largely shaped by health-system organization. Quantitative studies report substantial out-of-pocket expenditure and catastrophic health spending, while qualitative studies consistently describe severe financial hardship, although definitions and measurement approaches vary across studies. Centralized radiotherapy services, requiring repeated long-distance travel over 5 to 6 weeks, appear to be an important structural contributor through transport, accommodation, and income-related costs. Available evidence further suggests that financial toxicity may contribute to delayed treatment initiation, missed radiotherapy sessions, incomplete chemoradiation, and treatment abandonment. This review also raises the hypothesis that, in radiotherapy-constrained settings, treatment pathway adaptation such as neoadjuvant chemotherapy followed by surgery may have financial as well as oncologic implications that warrant prospective evaluation. Direct evidence linking financial toxicity to survival outcomes remains limited. Reducing financial barriers will likely require health-system reforms, including decentralized service delivery where feasible, integration of financial navigation into oncology services, universal health coverage benefit packages covering the full cervical cancer care continuum, and treatment protocols that account for patients' financial burden.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104902"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109394","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":"Relative diagnostic performance and feasibility of filter paper for storing self-collected vaginal samples for human papillomavirus testing in Brazil: A cross-sectional study.","authors":"Priscila Grecca Pedrão, Welinton Yoshio Hirai, Guilherme Pires Losano, Gabriela Nayara Pascoal, Noadia Aparecida Viaro, Bruno de Oliveira Fonseca, Márcio Antoniazzi, Adriane Cristina Bovo, Sandra Moretti Jusselino Maniçoba Palopoli, Gabriela da Silva Oliveira, Raphael Luiz Haikel Júnior, Edmundo Carvalho Mauad, Adhemar Longatto-Filho, José Humberto Tavares Guerreiro Fregnani, Júlio César Possati-Resende, Ricardo Dos Reis","doi":"10.1016/j.ijgc.2026.104975","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104975","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the agreement and relative diagnostic performance of any-type high-risk human papillomavirus detection in self-collected vaginal samples stored on cellulose filter paper compared with clinician-collected cervical samples stored in SurePath™, using the Cobas 4800 human papillomavirus test. Acceptability and feasibility were evaluated as secondary outcomes.</p><p><strong>Methods: </strong>This cross-sectional study was conducted across six Barretos Cancer Hospital Prevention Units in Brazil. Participants provided paired samples: a self-collected vaginal sample stored on cellulose filter paper and a clinician-collected cervical sample stored in SurePath™. Human papillomavirus testing was performed using the Cobas 4800 human papillomavirus test. Primary outcomes included overall agreement, kappa coefficient, relative sensitivity, relative specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Acceptability was assessed via questionnaire, and feasibility was evaluated descriptively.</p><p><strong>Results: </strong>Among 1,290 paired sample sets submitted, 158 (12.2%) had an invalid result in at least one method, leaving 1,132 valid pairs for diagnostic performance analyses. Among valid pairs, high-risk human papillomavirus positivity was 37.4% (423/1,132) in self-collected filter-paper samples and 44.5% (504/1,132) in clinician-collected SurePath™ samples. Overall agreement was 90.9% (1,029/1,132) with a kappa of 0.813 (p < 0.001). Positive predictive value and negative predictive value were 97.4% and 87.0%, respectively. Relative sensitivity was 81.8% (95% confidence interval, 78.1 to 85.0%), relative specificity was 98.3% (95% confidence interval, 96.9 to 99.1%), and area under operating characteristic curve was 0.90 (95% confidence interval, 0.88 to 0.92). Self-sampling was highly acceptable: 99% (1,280/1,290) rated it easy, and 75% (971/1,290) preferred self-collection.</p><p><strong>Conclusions: </strong>Self-collected vaginal samples stored on cellulose filter paper showed strong agreement and high relative specificity compared with clinician-collected cervical samples in SurePath™. However, lower high-risk human papillomavirus positivity, reduced relative sensitivity, and higher invalid-result frequencies indicate that protocol optimization and clinical validation against cervical disease endpoints are required before implementation.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104975"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109403","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":"Scaling access to gynecologic oncology care: a network-based framework.","authors":"Audrey Tieko Tsunoda, Angelica Nogueira-Rodrigues, Glauco Baiocchi Neto, Bruno Roberto Braga Azevedo, Renato Moretti-Marques, Rosilene Jara Reis, Vanessa Alvarenga-Bezerra, Gustavo Guitmann, Agnaldo Lopes da Silva-Filho, Ricardo Dos Reis","doi":"10.1016/j.ijgc.2026.104981","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104981","url":null,"abstract":"<p><p>Access to gynecologic oncology care varies substantially across health care systems and is influenced by organizational, geographic, workforce, and referral network factors that extend beyond the availability of specialized services. Using Brazil as an illustrative case of a large middle-income country with a mixed public-private health system, we performed a narrative policy and health-systems analysis, integrating evidence from global cancer surgery, gynecologic oncology, health-system organization, and international models of cancer care delivery. The objective was to examine access to gynecologic oncology from a health-systems perspective and to develop a conceptual framework describing the organizational dimensions of access that may be applicable across diverse health care settings. The literature was examined to identify recurrent concepts related to the organization of gynecologic oncology care. These concepts were grouped into broader themes and progressively consolidated into the nine domains of the Brazilian-informed Gynecologic Oncology Access and Sustainability Framework: burden, geography, organization, workforce, quality, financing, education, digital integration, and sustainability. Building on the Global Cancer Surgery framework, we also propose an expanded model that considers safe, equitable, timely, and networked care as complementary dimensions of access. To support the interpretation of the proposed framework, we developed the Gynecologic Oncology Network Maturity Framework, a conceptual framework for network organizational development, together with a scalable four-tier model linking local services, regional cancer units, specialized referral hubs, and centers of excellence. The Brazilian-informed Gynecologic Oncology Access and Sustainability Framework is intended as a conceptual model to support the description, discussion, and planning of gynecologic oncology networks. The Gynecologic Oncology Network Maturity Framework is proposed as a conceptual framework for describing network organizational development and requires prospective validation before benchmarking applications. Together, these frameworks should be interpreted as a foundation for future empirical evaluation, refinement, and implementation across different health-system contexts.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 10","pages":"104981"},"PeriodicalIF":5.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109349","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}