International Journal of Gynecological Cancer最新文献

{"title":"Extending the timing for secondary cytoreductive surgery after second-line chemotherapy in relapsed ovarian cancer: the EXTENSION study.","authors":"Carmine Conte, Luigi Congedo, Claudia Marchetti, Francesca Romana Scanu, Giulia Parise, Valentina Ghirardi, Andrea Rosati, Giovanni Scambia, Anna Fagotti","doi":"10.1016/j.ijgc.2025.101824","DOIUrl":"10.1016/j.ijgc.2025.101824","url":null,"abstract":"<p><strong>Objective: </strong>Relapse remains a major issue for patients with advanced epithelial ovarian cancer. Based on the DESKTOP III trial, international guidelines recommend secondary cytoreduction surgery when feasible before starting chemotherapy in platinum-sensitive relapsed ovarian cancer. Currently, neoadjuvant chemotherapy before secondary cytoreduction surgery is not advised outside of clinical trials. Recently, CHIPOR trial has shown the efficacy of secondary cytoreduction surgery with hyperthermic intra-peritoneal chemotherapy after neoadjuvant chemotherapy in an unselected population with platinum-sensitive relapsed ovarian cancer. The primary aim of this study was to assess the rate of potential delayed secondary cytoreduction surgery after 6 cycles of neoadjuvant chemotherapy.</p><p><strong>Methods: </strong>This retrospective, monocentric, observational study included patients with platinum-sensitive relapsed ovarian cancer deemed unsuitable for secondary cytoreductive surgery after evaluation by a multidisciplinary tumor board and/or diagnostic laparoscopy from January 2020 to December 2023. After 6 cycles of neoadjuvant chemotherapy, secondary cytoreduction surgery feasibility was evaluated by applying criteria for upfront secondary cytoreduction surgery in patients with at least a partial response at computed tomography scan.</p><p><strong>Results: </strong>Overall, 522 patients with platinum-sensitive relapsed ovarian cancer were evaluated; 165 were considered unsuitable for upfront secondary cytoreduction surgery and received second-line chemotherapy. After 6 cycles of neoadjuvant chemotherapy, secondary cytoreduction surgery was considered feasible in 48 patients (29.1%, group A), while 117 patients (70.9%, group B) remained ineligible for surgery. Predictors of secondary cytoreduction surgery feasibility were analyzed. Multivariate analysis identified a favorable modeled CA125 elimination rate constant K score at second-line chemotherapy (OR 7.29, 95% CI 2.91 to 18.30, p < .001) as the only independent predictor. Patients eligible for delayed secondary cytoreduction surgery showed significantly longer progression-free survival 2 and post-relapse survival (median progression-free survival 2 12.5 vs 7.9, p < .001; median post-relapse survival: not reached vs 28.5, p = .002).</p><p><strong>Conclusions: </strong>In a real-life approach in a tertiary oncological center, we showed that around 30% of women with platinum-sensitive relapsed ovarian cancer, initially deemed unsuitable for secondary cytoreduction surgery, can potentially undergo delayed secondary cytoreduction surgery following a favorable response to 6 cycles of neoadjuvant chemotherapy.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101824"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022939","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":"Evaluation of survival and mortality in pelvic exenteration for gynecologic malignancies: a systematic review, meta-analyses, and meta-regression study.","authors":"Violante Di Donato, Evangelos Kontopantelis, Emanuele De Angelis, Roberta Maria Arseni, Giusi Santangelo, David Cibula, Roberto Angioli, Francesco Plotti, Ludovico Muzii, Giuseppe Vizzielli, Roberto Tozzi, Vito Chiantera, Giuseppe Caruso, Andrea Giannini, Giovanni Scambia, Nadeem R Abu-Rustum, Pierluigi Benedetti Panici, Giorgio Bogani","doi":"10.1016/j.ijgc.2025.101829","DOIUrl":"10.1016/j.ijgc.2025.101829","url":null,"abstract":"<p><strong>Objective: </strong>Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology.</p><p><strong>Methods: </strong>A systematic search was conducted in January 2025 to identify studies on pelvic exenteration outcomes for gynecologic malignancies. Studies with at least 10 patients reporting 5-year overall survival or 30-day mortality were included. Data extracted included patient and surgical characteristics, and a scoring system based on study design, sample size, and center volume was used to include high-quality studies (score ≥3). Poisson regression models were used to analyze the associations between predictors and outcomes, with results expressed as incidence rate ratios and a 95% CI.</p><p><strong>Results: </strong>A total of 46 studies involving 4417 patients met the inclusion criteria. Most patients underwent pelvic exenteration for cervical cancer (N = 3183). Positive pelvic and aortic nodal involvement were key predictors of reduced 5-year overall survival, decreasing by 3.9% and 5.9% per 1% increase in nodal positivity, respectively. Pelvic wall involvement also significantly reduced survival by 15.9%. The 30-day mortality rate was 5.1%, with sepsis (27.2%) being the leading cause of death. Peri-operative mortality decreased significantly over time, with each year of publication associated with a 2.6% decrease in incidence rate. However, pelvic sidewall involvement and total exenteration increased 30-day mortality by 11.5% and 0.7%, respectively.</p><p><strong>Conclusions: </strong>Pelvic exenteration remains a viable but high-risk option for select patients with advanced gynecologic malignancies. Pre-operative assessment and multi-disciplinary planning are essential for optimizing outcomes.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 6","pages":"101829"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077756","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":"Circulating human papillomavirus DNA sequencing as a biomarker of response in advanced cervical cancer.","authors":"Emma Collier, Pamela Soberanis Pina, Michelle McMullen, Eduardo Gonzalez-Ochoa, Jinfeng Zou, Zhen Zhao, Lisa Avery, Valerie Bowering, Anthony Msan, Neesha Dhani, Amit M Oza, Kathy Han, Scott V Bratman, Stephanie Lheureux","doi":"10.1016/j.ijgc.2025.101755","DOIUrl":"10.1016/j.ijgc.2025.101755","url":null,"abstract":"<p><strong>Objective: </strong>Despite intense multi-modal treatment, the prognosis for advanced cervical cancer remains poor. The recent increase in cervical cancer cases worldwide highlights an urgent need for clinically validated biomarkers to guide patient management. Our pilot study investigates the utility of human papillomavirus (HPV) circulating tumor deoxy ribonucleic acid (ctDNA) in metastatic and recurrent cervical cancer. We investigated the association of HPV ctDNA levels, early kinetics, and detection of viral-host integration sites with response and outcomes.</p><p><strong>Methods: </strong>Serial plasma samples were prospectively collected from 21 patients with metastatic/recurrent cervical cancer. HPV ctDNA genotyping and quantification were conducted using a previously validated hybrid capture next-generation sequencing-based method. Mutation profiles within ctDNA were investigated simultaneously using a bespoke panel. In addition, high-confidence HPV integration was detected and quantified in ctDNA using SearcHPV. Differences in progression-free survival and overall survival were also evaluated between patients with high-confidence integration sites detected at baseline and those with low or no-confidence integration sites using the Kaplan-Meier method and log-rank tests to compare groups.</p><p><strong>Results: </strong>This pilot study cohort included 21 patients with HPV-associated cervical cancer. Treatments included front-line platinum-based chemotherapy without (n = 4) or with (n = 5) bevacizumab, bevacizumab monotherapy (n = 2), or subsequent therapy (n = 7). A total of 3 previously treated patients were included to study HPV kinetics during observation. At baseline, HPV ctDNA was detected in 20 of 21 patients (95.2%). From baseline to the first assessment, a change in HPV ctDNA was significantly associated with type of response in patients on treatment (n = 18) (p = .049) and across all patients (n = 21) (p = .008). A total of 26 unique mutations were detected in either plasma or tissue. Of these, 11 of 26 were only detected in plasma, 9 of 26 were only detected in tissue, and 6 of 26 were detected in plasma and tissue. Patients with a high-confidence HPV integration site detected within ctDNA at baseline have inferior overall survival compared with patients with low-confidence or undetectable integration.</p><p><strong>Conclusions: </strong>In this pilot study, a decrease in HPV ctDNA was associated with response to treatment in metastatic and recurrent cervical cancer. HPV site integration and mutation-based ctDNA may have application to personalized therapy and should be evaluated in larger studies.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101755"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692086","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":"Pocket guide based on the TNM and FIGO staging systems for classifying patients with locally advanced cervical cancer: a practical tool from the GINECO group for quick and easy management.","authors":"Jean-Sebastien Frenel, Tom Roynard, Cecile Loaec, Isabelle Ray-Coquard, Cyrus Chargari, Gwennael Ferron","doi":"10.1016/j.ijgc.2025.101908","DOIUrl":"10.1016/j.ijgc.2025.101908","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 6","pages":"101908"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077765","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":"Predictive factors for adnexal involvement in endometrial cancer FIGO stage IIIA.","authors":"Giorgia Dinoi, Domenica Lorusso, Eleonora La Fera, Stefano Restaino, Pia Clara Pafundi, Alessandro Gioè, Laura Naccarato, Emilia Palmieri, Lucia Musacchio, Ettore Di Stefano, Vincenzo Tarantino, Giovanni Scambia, Francesco Fanfani","doi":"10.1136/ijgc-2024-005482","DOIUrl":"10.1136/ijgc-2024-005482","url":null,"abstract":"<p><strong>Objective: </strong>Understanding ovarian involvement incidence and risk factors in women with endometrial cancer may inform the decision of ovary preservation.</p><p><strong>Methods: </strong>Our retrospective study included all consecutive fully surgically staged patients with endometrial cancer who underwent primary surgery between January 2005 and November 2021, assessing the incidence of ovarian metastasis, its role as a prognostic factor for recurrence and death, and evaluated predictors of adnexal involvement.</p><p><strong>Results: </strong>Women with International Federation of Gynecology and Obstetrics (FIGO) 2009 IIIA endometrial cancer comprised 2.3% of the population (36 of 1535 included patients), 23 (63.9%) with endometrioid histology, and a median age of 57.0 years (range 47.7-66.7). A higher body mass index, post-menopausal status, endometrioid histotype, and β-catenin expression were associated with a lower risk of adnexal involvement. Conversely, dMMR phenotype, p53 expression, myometrial infiltration >50%, lymphovascular space invasion, and cervical stromal invasion were independent predictors of an increased risk of adnexal involvement. A total of 145 (9.5%) patients had adnexal involvement, with an incidence rate of 0.27/100 person-days. Overall survival for FIGO (2009) stage IIIA was 88.9%.</p><p><strong>Conclusions: </strong>Our study showed that ovarian preservation may be considered for younger patients with low-risk endometrial cancer (G1 and G2 tumors, absence of lymphovascular space invasion, no cervical involvement, and myometrial invasion <50%), adding a favorable predictive role to higher body mass index and high β-catenin expression.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101846"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603603","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":"Correspondence on \"The prognostic value of tumor-infiltrating lymphocytes in vulvovaginal melanoma\" by Vanbockstael et al.","authors":"Wiebren Age Andries Tjalma","doi":"10.1016/j.ijgc.2025.101792","DOIUrl":"10.1016/j.ijgc.2025.101792","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 6","pages":"101792"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985281","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":"Isolated nodal involvement in early-stage ovarian serous borderline tumor.","authors":"Céline Ovaere, Camille Pasquesoone, Fabrice Narducci, Houssein El Hajj","doi":"10.1136/ijgc-2024-005690","DOIUrl":"10.1136/ijgc-2024-005690","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101892"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015614","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":"Cytoreductive surgery in advanced epithelial ovarian cancer: a real-world analysis guided by clinical variables, homologous recombination, and BRCA status.","authors":"Eliya Shachar, Yael Raz, Gilat Rotkop, Uriel Katz, Ido Laskov, Nadav Michan, Dan Grisaru, Ido Wolf, Tamar Safra","doi":"10.1016/j.ijgc.2025.101809","DOIUrl":"10.1016/j.ijgc.2025.101809","url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines endorse both interval and primary debulking cytoreductive surgeries in the treatment of epithelial ovarian cancer, emphasizing that the treatment strategy should be tailored to the patient's clinical condition and tumor burden. Despite these recommendations, experts have yet to agree on a definitive surgical approach.</p><p><strong>Methods: </strong>A retrospective longitudinal analysis of 929 women diagnosed with advanced-stage (International Federation of Gynecology and Obstetrics stage III-IV) epithelial ovarian cancer between January 2002 and January 2025 was conducted. The effects of interval debulking surgery versus primary debulking surgery on median overall survival and progression-free survival were evaluated. Additionally, we aimed to identify patients who may benefit from a particular surgical approach based on clinical variables, mutation in either of the BRCA1 or BRCA2 genes, and homologous recombination profile.</p><p><strong>Results: </strong>A total of 929 patients were diagnosed with stage III to IV disease (87.2%) and underwent either primary debulking (n = 389, 41.9%) or interval debulking surgery following neoadjuvant chemotherapy (n = 540, 58.1%). Patients treated with primary debulking had a longer median overall survival than those treated with interval debulking surgery (68.40 months, 95% CI 62.92 to 76.45 vs 52.01 months, 95% CI 47.15 to 57.86, HR 1.2, p = .0004). However, when adjusted for age at diagnosis, stage, histology, BRCA status, and tumor resectability, multivariate analysis demonstrated no significant difference in survival between the two surgical groups (HR 1.15, 95% CI 0.96 to 1.39, p = .12). Younger women (<69 years), stage III, and BRCA-wild-type and/or homologous recombination proficient had longer survival with primary debulking than with interval debulking surgery (74.55 months, 95% CI 65.35 to 93.27 vs 55.98 months, 95% CI 48.10 to 64.79, HR 1.38, p = .03). Patients with a pathogenic BRCA variant or homologous recombination deficient profile had similar survival outcomes with either debulking approach, regardless of age and disease stage (p > .05). Propensity score analysis demonstrated comparable median overall survival with the two surgical timings (64.39 months, 95% CI 58.38 to 71.23 vs 57.69 months, 95% CI 50.66 to 64.79, HR 1.33, p = .27).</p><p><strong>Conclusions: </strong>Our findings support the use of neoadjuvant chemotherapy followed by interval debulking surgery without compromising survival outcomes, regardless of age and stage, particularly among harder-to-treat patients. We identified a specific subset of patients who may benefit from primary debulking surgery as the optimal intervention. These findings advocate for a personalized treatment approach and the potential for tailored surgical strategies guided by patient clinical variables, homologous recombination, and genetic factors.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 6","pages":"101809"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018074","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":"Video-endoscopic inguinal sentinel lymph node biopsy with indocyanine green in vulvar cancer.","authors":"Filippo Maria Capomacchia, Nicolò Bizzarri, Aniello Foresta, Simona Fragomeni, Giorgia Garganese, Giovanni Scambia, Angelica Naldini","doi":"10.1136/ijgc-2024-005887","DOIUrl":"10.1136/ijgc-2024-005887","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101878"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107186","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 cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors.","authors":"Agnaldo Lopes da Silva Filho, Guilherme Reis Romualdo, Matheus Eduardo Soares Pinhati, Gabriel Lage Neves, Juliana Almeida Oliveira, Renato Moretti-Marques, Angélica Nogueira-Rodrigues, Audrey Tieko Tsunoda, Eduardo Batista Cândido","doi":"10.1136/ijgc-2024-005738","DOIUrl":"10.1136/ijgc-2024-005738","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the correlation between socioeconomic and healthcare factors and cervical cancer mortality rates, as well as the accessibility to prevention and treatment across Brazilian states and macroregions. The aim is to highlight the multifaceted challenge of addressing cervical cancer mortality, particularly in low-and middle-income countries.</p><p><strong>Methods: </strong>This ecological study analyzed public data from the Brazilian National Institute of Cancer (INCA), the National Institute of Geography and Statistics (IBGE), and the Brazilian Ministry of Health. Data were collected on indicators such as the Human Development Index (HDI), physician density, average household income, human papillomavirus (HPV) vaccine coverage, Pap smear screening rates, radiotherapy machine density, and non-White population rates by state and macroregion across Brazil. Spearman's rank correlation test and simple linear regression analysis were employed.</p><p><strong>Results: </strong>Cervical cancer mortality rates are statistically lower in women with health insurance, positive self-perception of health, located in states with a higher HDI, higher per capita household income, greater density of physicians, and higher availability of radiotherapy machines. In contrast, mortality rates proportionally increase according to poverty levels, as expected, and rates of non-White population. Considering public health, HDI scores significantly affected Pap smear test coverage, the number of radiotherapy machines, and HPV vaccine uptake. The North and the Southeast regions have, respectively, the lowest and the highest socioeconomic indicators, proportional to their mortality rates. No significant correlation was found between mortality rates and HPV vaccine or Pap smear coverage.</p><p><strong>Conclusions: </strong>Cervical cancer mortality in Brazil is significantly influenced by socioeconomic and healthcare disparities. This study provides a data-driven basis for public health strategies that address both medical and social determinants of health.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101851"},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375443","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}