International Journal of Gynecological Cancer最新文献

{"title":"Identification and stratification of placenta percreta with gynecologic oncologist management.","authors":"Jessian Louis Munoz, Logan Michelle Blankenship, Kayla Evonne Ireland, Patrick Shannon Ramsey, Georgia A McCann","doi":"10.1136/ijgc-2024-005850","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005850","url":null,"abstract":"<p><strong>Objective: </strong>Gynecologic oncologist involvement in the surgical team of patients with placenta percreta has shown improved patient outcomes. Yet, stratification of cases is dependent on identification of placenta percreta by ultrasonography which has a poor detection rate. To allow patients to receive optimal team management by pre-operative stratification our objective was to identify the pre-operative characteristics of patients with previously underdiagnosed placenta percreta.</p><p><strong>Methods: </strong>A retrospective single institution case-control study was performed from January 2010 to December 2022 of singleton, non-anomalous pregnancies with suspicion for placenta accreta spectrum (PAS). Ultrasonography was used as the primary method of detection. Final inclusion was dependent on histology confirmation of PAS and degree of invasion. We explored the role of concurrent antenatal magnetic resonance imaging (MRI) on patients with previously unrecognized placenta percreta.</p><p><strong>Results: </strong>During the 13 year study period, 140 cases of histologically confirmed PAS were managed by our team and met inclusion criteria. A total of 72 (51.4%) cases were for placenta percreta and 27 (37.5%) of these were diagnosed pre-operatively while 45 (62.5%) were only diagnosed post-operatively. Comparison between these two groups revealed patient body mass index (BMI) >30 kg/m² was independently associated with unrecognized placenta percreta (p=0.006). No findings by MRI were associated with mischaracterization of placenta percreta. Yet, concurrent MRI assessment of patients with BMI >30 kg/m² (n=18), increased placenta percreta detection by 11 cases (61%).</p><p><strong>Conclusion: </strong>The ability to determine pre-operatively which patients are more likely to have placenta percreta allows for gynecologic oncologists to be involved in the most complex cases in a planned manner. This study shows that women at risk for placenta accreta spectrum, who are obese (BMI >30 kg/m²), may benefit from further assessment with pre-operative MRI to facilitate appropriate staffing and team availability for cases of placenta percreta.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346244","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":"ESGE/ESGO/SERGS consensus statement on surgical steps in minimally invasive surgery in gynecologic oncology: transperitoneal and extraperitioneal approach for paraaortic lymphadenectomy.","authors":"Ramon Rovira, Liliana Mereu, François Planchamp, Henrik Falconer, Ahmed El-Balat, Marc Barahona, Anna Fagotti, Denis Querleu, Cagatay Taskiran","doi":"10.1136/ijgc-2024-005796","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005796","url":null,"abstract":"<p><strong>Introduction: </strong>Assessment of retroperitoneal nodes is an important part of the surgical staging of gynecologic cancers. Although pelvic and paraaortic lymphadenectomy have been widely described by different authors, there is little consensus on the description of the different surgical steps for each procedure. An Intergroup Committee on Onco-Gyn Minimally Invasive Surgery has been established with members of the European Society for Gynecological Endoscopy (ESGE), European Society of Gynaecological Oncology (ESGO) and the Society of European Robotic Gynaecological Surgery (SERGS). The Intergroup Committee has various objectives: writing down a surgical description of the technique, which will be assessed by a group of experts following a formal consensus method and developing a specific Objective Structured Assessment of Technical Skills (OSATS) scale for each procedure.</p><p><strong>Methods: </strong>A hierarchical task analysis was conducted by a working group of eight experts from the three societies in order to identify the surgical steps of transperitoneal and extraperitoneal approach in paraaortic lymphadenectomy. The selection of the definitive surgical steps was confirmed by a group of 19 experts from the different societies, following a formal consensus method. Two rounds of Delphi panel rating were considered necessary for achieving an agreement. The consensus agreement identified 29 surgical steps in transperitoneal and 17 surgical steps in extraperitoneal approach to complete a paraaortic lymphadenectomy. Once the description of the procedure and the consensus were established, an Objective specific Scale for the Assessment of Technical Skills for Paraaortic lymphadenectomy (PA-OSATS) in the transperitoneal and extraperitoneal approach was developed.</p><p><strong>Results: </strong>In the first round of rating we found that 28 steps out of 29 in the transperitoneal approach and 13 out of 17 in the extraperitoneal approach did not reach a strong degree of agreement. They were reformulated based on comments made by the experts, and submitted to a second round of rating and this finally achieved an agreement.</p><p><strong>Conclusion: </strong>We defined a list of surgical steps in transperitoneal and extraperitoneal approach in paraaortic lymphadenectomy and a specific PA-OSATS scale for these procedures. This tool will be useful for teaching, assessing and standardizing this surgical procedure.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346242","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":"Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema.","authors":"Jvan Casarin, Gabriella Schivardi, Valeria Artuso, Anna Giudici, Tommaso Meschini, Luigi De Vitis, Vincenzo Granato, Antonio Lembo, Antonella Cromi, Andrea Mariani, Giorgio Bogani, Francesco Multinu, Fabio Ghezzi","doi":"10.1136/ijgc-2024-005670","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005670","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the lymphatic-specific morbidity (specifically, lower extremity lymphedema) associated with laparoscopic management of early-stage endometrial cancer using the sentinel lymph node (SLN) algorithm by type of actual nodal assessment.</p><p><strong>Methods: </strong>An ambispective study was conducted on consecutive patients surgically treated for apparent early-stage endometrial cancer who underwent laparoscopic staging according to the National Comprehensive Cancer Network SLN algorithm at a single institution from January 2020 to August 2023. Data on patient characteristics, surgical details, and post-operative complications were collected. Lymphedema screening was performed using a validated questionnaire.</p><p><strong>Results: </strong>A total of 239 patients were analyzed, with a questionnaire response rate of 85.4%. The study population was grouped based on actual surgical staging: hysterectomy+SLN (54.8%), hysterectomy+systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). The prevalence of lymphedema was significantly lower in the hysterectomy+SLN group compared with the hysterectomy+systematic pelvic lymphadenectomy group (21.4% vs 44.6%, p=0.003). Multivariable analysis showed a threefold increase in the risk of lymphedema for the hysterectomy+systematic pelvic lymphadenectomy group compared with the hysterectomy+SLN group: OR 3.11 (95% CI 1.47 to 6.58). No significant associations were found between lymphedema and other patient or tumor characteristics.</p><p><strong>Conclusion: </strong>In the setting of a laparoscopic approach for early-stage endometrial cancer surgery, SLN mapping is associated with a significant reduction in lymphatic complications compared with a systematic lymph node dissection. Our findings provide additional evidence endorsing the adoption of SLN mapping during minimally invasive surgery for endometrial cancer. This technique ensures comparable diagnostic accuracy and also minimizes complications.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307742","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-reducing salpingo-oophorectomy for hereditary breast and ovarian cancer patients with vaginal natural orifice transluminal endoscopic surgery (vNOTES).","authors":"Masato Tamate, Motoki Matsuura, Sachiko Nagao, Shoko Kurokawa, Taishi Akimoto, Tsuyoshi Saito","doi":"10.1136/ijgc-2024-005944","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005944","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307743","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":"Dynamic changes in <i>TP53</i> mutated circulating tumor DNA predicts outcome of patients with high-grade ovarian carcinomas.","authors":"Maria Kfoury, Clément Bonnet, Nicolas Delanoy, Karen Howarth, Christophe Marzac, Etienne Rouleau, Jean-Baptiste Micol, Alexandra Leary","doi":"10.1136/ijgc-2024-005581","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005581","url":null,"abstract":"<p><p>There is a lack of biomarkers to predict outcome following initial treatment in patients with high-grade ovarian cancer. We hypothesized that monitoring <i>TP53</i> mutation (<i>TP53m</i>) in circulating tumor DNA (ctDNA) could be a tumor-specific biomarker. Patients enrolled in a prospective study (NCT03010124) consented to analysis of biological samples through the disease course. ctDNA was extracted and analyzed to detect the presence of <i>TP53m</i> Next-generation sequencing was performed on tumor tissue to detect <i>TP53m</i> and on whole blood to detect clonal hematopoiesis of indeterminate potential (CHIP).A total of 102 samples were sequentially collected from 26 patients. ctDNA was detected in all patients at diagnosis. The same <i>TP53m</i> was found in ctDNA and tumor tissue in 77% of patients. <i>TP53m</i> in ctDNA was not CHIP related. During neoadjuvant chemotherapy, increasing ctDNA was associated with failure to achieve complete interval cytoreductive surgery in 60% of patients. Rising ctDNA or de novo <i>TP53m</i> seemed to be associated with a trend for worst survival compared with decrease or complete clearance: progression-free survival 10 versus 26.5 months, HR 3.2. Despite macroscopically complete surgery, 30% of patients had detectable ctDNA post-operatively and had worse survival than those with undetectable ctDNA. Monitoring TP53m in ctDNA during chemotherapy or after surgery could help guide the best adjuvant therapy.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307740","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":"The rise of antibody-drug conjugates in advanced endometrial cancer.","authors":"Mariana Carvalho Gouveia, Thamires Haick Martins da Silveira, Mariana Scaranti","doi":"10.1136/ijgc-2024-006091","DOIUrl":"https://doi.org/10.1136/ijgc-2024-006091","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307744","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":"Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: inverse propensity score weighted analysis.","authors":"Antonino Ditto, Fabio Martinelli, Marco Dri, Umberto Leone Roberti Maggiore, Giorgio Bogani, Shigeky Kusamura, Biagio Paolini, Edgardo Somigliana, Francesco Raspagliesi","doi":"10.1136/ijgc-2024-005418","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005418","url":null,"abstract":"<p><strong>Objective: </strong>To report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy.</p><p><strong>Methods: </strong>Patients with pre-operative stage IA1 with lymphovascular space invasion, IA2 and IB1 cervical cancer (any grade) were included (2018 International Federation of Gynecology and Obstetrics staging system). Inclusion criteria comprised age (18-44 years), histology (squamous, adenocarcinoma, or adenosquamous) and absence of previous/concomitant cancer. A thorough counseling about oncological and obstetrical potential risks was mandatory for patients asking for fertility sparing. Results for consecutive patients who underwent fertility-sparing surgery (cervical conization and nodal evaluation) were analyzed and compared with results for patients treated with radical surgery. Oncological outcomes were assessed with a propensity score adjustment with inverse probability of treatment weighting.</p><p><strong>Results: </strong>Overall, 109 patients were included in the study. Ten patients abandoned the fertility-sparing route because of nodal involvement (n=5), margin positive (n=2), or because patients requested radical treatment (n=3). Sentinel node mapping was performed in 19 of 49 (38.8%) patients in the fertility-sparing surgery group. Among the patients in the fertility-sparing group, 6 (12.2%) patients relapsed. 34 (69.4%) patients attempted to conceive. Pre-operative covariates selected to define the probability of having either fertility-sparing or radical surgery were well balanced using inverse probability of treatment weighting. Pathological features were similar between the groups, including grading, histotype, stage, and lymphovascular space invasion. After a median follow-up of 38.8 (range 5-186) months there were no differences in progression-free survival (p=0.32) and overall survival (p=0.74) between the fertility-sparing and radical hysterectomy groups. The results after inverse probability of treatment weighting adjustment did not show significant differences in progression-free survival (p=0.72) and overall survival (p=0.71) between the groups.</p><p><strong>Conclusion: </strong>Fertility-sparing surgery based on conization plus laparoscopic lymph node evaluation, may be considered safe and effective for patients with early-stage cervical cancer.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307741","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":"Hepatic hilum cytoreductive surgery for ovarian cancer relapse.","authors":"Myriam Gracia, Constantino Fondevila, Alicia Hernández, Isabel Prieto, María Alonso-Espias, Ignacio Zapardiel","doi":"10.1136/ijgc-2024-005285","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005285","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286480","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":"Advancing cervical cancer prevention in Africa: ESGO’s strategic initiatives and collaborative efforts","authors":"Houssein El Hajj, Reda Hemida, Nadja Taumberger, Ibrahim Friko, Omar Gassama, Doreen Ramogola-Masire, Fetlework Gubena, Odigonma Ikpeze, Claire Bagenda Nakazzi, Murat Gultekin","doi":"10.1136/ijgc-2024-006059","DOIUrl":"https://doi.org/10.1136/ijgc-2024-006059","url":null,"abstract":"Cervical cancer is a significant global health issue, especially in low- and middle-income countries where disparities in epidemiology, clinicopathology, management, immunity, and drug access are stark.[1][1] In 2022, it was the fourth most common and lethal cancer worldwide. Africa experiences some","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269875","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":"Improving diverse patient enrollment in clinical trials, focusing on Hispanic and Asian populations: recommendations from an interdisciplinary expert panel","authors":"Bhavana Pothuri, Premal Thaker, Adrienne Moore, Rosa Espinosa, Kara Medina, Deborah Collyar, Kathleen Lutz, Mihaela C Munteanu, Brian Slomovitz","doi":"10.1136/ijgc-2024-005751","DOIUrl":"https://doi.org/10.1136/ijgc-2024-005751","url":null,"abstract":"Lack of patient diversity in clinical trial enrollment remains an obstacle to achieving equitable healthcare outcomes. Under-representation has resulted in non-generalizable clinical knowledge, inequitable access to treatment, and health disparities among minority and disadvantaged groups. A multidisciplinary panel was convened to consider the challenges of diverse patient accrual and provide actionable solutions to improve representation in clinical trials. The panel was comprised of participants with knowledge in gynecologic oncology and included physician, advanced practice nurse, patient navigator, patient advocate, and pharmaceutical industry representation. Focus was given to recruitment barriers for Asian and Hispanic patients. The panel identified several areas of concern, including explicit and implicit biases for the physician and care teams, language and cultural nuances, inadequate inclusion of family in the decision-making process, and under-representation of women in clinical trials. The panel also identified the important role patient navigators, nurses, and advanced practice providers have in patient recruitment from under-represented populations. The role of study sponsors, and global and regional initiatives, to address historic disparities in clinical trial recruitment were also considered critical. The actionable solutions proposed should enable study sponsors and clinical trial sites to achieve greater diversity in enrollment globally.","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269701","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}