International Journal of Gynecological Cancer最新文献

{"title":"Differences in first-line chemosensitivity assessed by ELIMination rate constant K in advanced serous ovarian cancer: evidence from Western and Japanese Trials in a Gynecologic Cancer InterGroup meta-analysis.","authors":"Pauline Corbaux, Benoit You, Iain McNeish, Stephen Welch, Anna V Tinker, Mansoor R Mirza, Kristina Lindemann, Tatsuo Kagimura, Isabelle L Ray-Coquard, Fabien Subtil, Julien Péron, Karen Carty, Caroline Kelly, Olivier Colomban, Eleni Karamouza, Adrian Cook, Xavier Paoletti, Rosalind M Glasspool, Nozomu Yanaihara","doi":"10.1016/j.ijgc.2026.104805","DOIUrl":"10.1016/j.ijgc.2026.104805","url":null,"abstract":"<p><strong>Objective: </strong>Growing evidence suggests potential ethnic and geographical variations in chemotherapy efficacy. The CA125 ELIMination rate constant K score is a pragmatic and reproducible indicator of tumor chemosensitivity in newly diagnosed ovarian cancer. We compared ELIMination rate constant K distributions and prognostic performances between patients enrolled in Japanese and Western trials who had stage III/IV serous ovarian cancer from the Gynecologic Cancer InterGroup individual-patient-data Meta-Analysis in OVarian cancer.</p><p><strong>Methods: </strong>The ELIMination rate constant K values were previously estimated for 5884 women receiving first-line chemotherapy for ovarian cancer. Data from 246 women enrolled in the Japanese JGOG-3016 trial were compared to 2561 patients from Western trials. ELIMination rate constant K was analyzed as a binary variable (favorable ≥1.0 vs unfavorable <1.0). Prognostic value for progression-free survival and overall survival was assessed using univariable and multi-variable models. A standardization cut-off specific to patients enrolled in the Japanese trial was explored using maximally selected rank statistics.</p><p><strong>Results: </strong>KELIM was significantly higher in patients enrolled in the Japanese trial (median 0.071 day^-1 vs 0.056 day^-1; p <.0001). Using the standard cut-off, favorable ELIMination rate constant K was independently associated with improved progression-free survival (hazard ratio 0.59, 95% confidence interval 0.43 to 0.83) and overall survival (hazard ratio 0.53, 95% confidence interval 0.36 to 0.79) in patients from the Japanese trial. Applying the exploratory cut-off of 0.07 day^-1 strengthened prognostic discrimination (progression-free survival: hazard ratio 0.35, 95% confidence interval 0.25 to 0.49, p <.0001; overall survival: hazard ratio 0.40, 95% confidence interval 0.26 to 0.61, p <.0001).</p><p><strong>Conclusions: </strong>Potential higher ELIMination rate constant K-assessed chemosensitivity is suggested in patients from Japan with advanced serous ovarian cancer, warranting further prospective validation and investigation into underlying biological and environmental determinants and implications for personalized therapeutic strategies.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104805"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420839","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":"Clinical relevance of CA125 in low-grade serous ovarian cancer: a retrospective multi-center JAGO/NOGGO study.","authors":"Chiara Flethe, Mina Netkova-Heintzen, Magdalena Postl, Laura Tascón Padrón, Christina Tauber, Elisa Sieghartsleitner, Maximilian Pruss, Matthias Kohlen, Annette Aigner, Christina Grech, Klaus Pietzner, Friederike Stroisch, Jalid Sehouli","doi":"10.1016/j.ijgc.2026.104760","DOIUrl":"10.1016/j.ijgc.2026.104760","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the association of CA125 levels at pre-defined clinical time points with survival outcomes and to evaluate its role in recurrence detection in low-grade serous ovarian cancer.</p><p><strong>Methods: </strong>In this retrospective multi-center cohort study, patients with low-grade serous ovarian cancer of all International Federation of Gynecology and Obstetrics stages treated between 2007 and 2023 at 9 tertiary centers in Germany and Austria were included. Clinical data and serial CA125 measurements were extracted from medical records at pre-defined time points: diagnosis, after debulking surgery, during adjuvant therapy, follow-up, and recurrence. Associations with progression-free survival and overall survival were analyzed using Kaplan-Meier estimates and Cox regression. Sensitivity of CA125 for recurrence detection was assessed.</p><p><strong>Results: </strong>A total of 368 patients were included; 84.2% had International Federation of Gynecology and Obstetrics stage IIB to IV disease. Median baseline CA125 was 113 U/mL, declining to 16 U/mL after primary treatment and remaining below 35 U/mL during follow-up. A 10-fold increase in baseline CA125 was associated with worse overall survival (hazard ratio 2.24, 95% confidence interval 1.37 to 3.67), remaining significant after adjustment for International Federation of Gynecology and Obstetrics stage, residual disease, age, and ascites (hazard ratio 1.90; 95% confidence interval 1.13 to 3.19). Elevated post-operative CA125 was associated with shorter progression-free survival. Persistently elevated CA125 after 6 cycles of adjuvant chemotherapy was associated with a higher hazard of progression or death (hazard ratio 5.54; 95% confidence interval 2.21 to 13.9). At recurrence, CA125 detected most relapses; however, 15.7% occurred despite normal marker levels, corresponding to a sensitivity of 84% (95% CI 74.0 to 90.4).</p><p><strong>Conclusions: </strong>CA125 in low-grade serous ovarian cancer correlates with disease stage, reflects treatment response, and shows prognostic relevance for progression-free survival at pre-defined clinical time points. It may support recurrence detection but should not be used as a stand-alone marker.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104760"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175786","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":"Association between pembrolizumab-based therapy exposure and survival outcomes in metastatic or recurrent uterine carcinosarcoma: a multi-center real-world study.","authors":"Yen-Ling Lai, Seongyun Lim, Koping Chang, Hyun-Soo Kim, Jung Chen, Tyan-Shin Yang, Ying-Chih Tseng, Yu-Li Chen, Yoo-Young Lee","doi":"10.1016/j.ijgc.2026.104869","DOIUrl":"10.1016/j.ijgc.2026.104869","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between exposure to pembrolizumab-based therapy in the post-platinum setting and survival outcomes in patients with metastatic or recurrent uterine carcinosarcoma.</p><p><strong>Methods: </strong>In this retrospective study, patients with metastatic or recurrent uterine carcinosarcoma treated at three tertiary centers between January 2008 and April 2025 were included. Patients received various treatment modalities after recurrence or progression in the post-platinum setting. Survival outcomes were analyzed according to whether patients were exposed to pembrolizumab-based therapy after recurrence or progression. Survival after recurrence and overall survival were evaluated using Kaplan-Meier analyses and Cox proportional hazards models. Additional analyses using inverse probability of treatment weighting, doubly robust methods, and time-dependent Cox models were performed.</p><p><strong>Results: </strong>A total of 147 patients were included, of whom 42 (28.6%) received pembrolizumab-based therapy in the post-platinum setting. In multi-variable analyses, pembrolizumab-based therapy exposure was independently associated with improved survival after recurrence (hazard ratio 0.44, 95% confidence interval 0.24 to 0.83, p = .01) and overall survival (hazard ratio 0.48; 95% confidence interval 0.26 to 0.89, p =.02). Positive peritoneal washing cytology was independently associated with poorer survival outcomes. In time-dependent Cox analyses using inverse probability of treatment weighting, pembrolizumab-based therapy exposure remained significantly associated with improved survival after recurrence (hazard ratio 0.56, 95% confidence interval 0.33 to 0.96, p =.035), whereas the association with overall survival was no longer statistically significant.</p><p><strong>Conclusions: </strong>Exposure to pembrolizumab-based therapy in the post-platinum setting was associated with improved survival after recurrence in patients with metastatic or recurrent uterine carcinosarcoma. These findings support the potential clinical relevance of pembrolizumab-based therapy in the post-platinum setting and warrant further prospective validation.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104869"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative Nutritional Risk Screening 2002-based nomograms for predicting post-operative complications after cytoreductive surgery for ovarian cancer: a multi-center retrospective cohort study.","authors":"Ran Chu, Wenna Hu, Dehui Zhang, Xiao Song, Wei Tian, Yingzi Zhao, Hongqing Wang, Ming Liu","doi":"10.1016/j.ijgc.2026.104832","DOIUrl":"10.1016/j.ijgc.2026.104832","url":null,"abstract":"<p><strong>Objective: </strong>Malnutrition is common in ovarian cancer and may increase post-operative morbidity, yet standardized nutritional screening tools are rarely used in perioperative risk prediction models. This study aimed to develop and validate nomograms for predicting clinically significant perioperative complications after cytoreductive surgery for ovarian cancer, incorporating Nutritional Risk Screening 2002 as a key predictor.</p><p><strong>Methods: </strong>This multi-center retrospective cohort study included patients with ovarian cancer undergoing cytoreductive surgery at 3 tertiary hospitals between January 2021 and December 2024. The primary outcome was Clavien-Dindo grade ≥II complications during hospitalization. Two logistic regression-based nomograms were developed: a pre-operative model (model 1) and a perioperative model with intra-operative variables (model 2). Performance was evaluated by area under the receiver operating characteristic curve, calibration, decision curve analysis, net re-classification improvement, and integrated discrimination improvement.</p><p><strong>Results: </strong>A total of 867 patients were assigned to a development cohort (n = 607) and a validation cohort (n = 260). The overall incidence of Clavien-Dindo grade ≥II complications was 18.0% (156/867). Model 1 achieved area under the receiver operating characteristic curves of 0.675 and 0.665 in the development and validation cohorts, respectively, while model 2 achieved area under the receiver operating characteristic curves of 0.694 and 0.692. Both models showed acceptable calibration and potential clinical utility. Compared with model 1, model 2 improved risk re-classification, with significant net re-classification improvement and integrated discrimination improvement in the development cohort and significant integrated discrimination improvement in the validation cohort.</p><p><strong>Conclusions: </strong>Nomograms incorporating Nutritional Risk Screening 2002 may support preliminary risk stratification for clinically significant perioperative complications after cytoreductive surgery for ovarian cancer. Further external validation and prospective evaluation are warranted.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104832"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584427","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":"Beyond p53 status: the continued importance of histopathologic features for predicting lymph node metastasis in endometrial cancer.","authors":"Amelia Favier, Julia Le Tan, Aurélie Siret, Estelle Sestito, Lucie Jaouen, Justine Varinot, Florence Coulet, Quentin Letourneur, Olivier Buhard, Cyrus Chagari, Yohann Dabi, Cyril Touboul, Catherine Uzan, Alex Duval, Geoffroy Canlorbe","doi":"10.1016/j.ijgc.2026.104820","DOIUrl":"10.1016/j.ijgc.2026.104820","url":null,"abstract":"<p><strong>Objective: </strong>To identify predictors of lymph node metastasis according to molecular alterations, including mismatch repair-deficient, POLE-mutated, and p53-abnormal status, while preserving the contribution of established clinicopathologic features in patients with presumed early-stage endometrial cancer.</p><p><strong>Methods: </strong>This retrospective multi-center study included 477 patients with presumed early-stage International Federation of Gynecology and Obstetrics stage I to II endometrial cancer who underwent primary surgical management with lymph node staging. Associations between molecular alterations and lymph node metastasis were evaluated using two sequential multi-variable logistic regression models. The first model included histopathologic and molecular variables, and the second additionally incorporated lymphovascular space invasion, which is reliably assessed only post-operatively.</p><p><strong>Results: </strong>Most tumors were low-grade endometrioid (n = 294, 61.6%), and 118 (24.7%) were non-endometrioid. In the first multi-variable analysis, lymph node metastasis was independently associated with ≥50% myometrial invasion (adjusted odds ratio 9.15, 95% confidence interval 4.85 to 17.28, p =.001), non-endometrioid type (adjusted odds ratio 2.12, 95% confidence interval 1.16 to 3.88, p =.014), and p53-abnormal status (adjusted odds ratio 2.13, 95% confidence interval 1.10 to 4.13, p =.024). When lymphovascular space invasion was included in the model, only ≥50% myometrial invasion (adjusted odds ratio 4.76, 95% confidence interval 2.41 to 9.38, p <.001) and lymphovascular space invasion (adjusted odds ratio 4.32, 95% confidence interval 2.41 to 7.72, p <.001) remained independently associated with nodal metastasis.</p><p><strong>Conclusions: </strong>Although p53 abnormalities may help identify patients at higher risk of nodal metastasis before surgery, deep myometrial invasion and lymphovascular space invasion remain key determinants of nodal involvement.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104820"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420819","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 decision-making preferences around treatment in patients with advanced and recurrent uterine cancer.","authors":"Gabrielle M Sudilovsky, Cheska Zoleta, Bridget Huepfel, Nita K Lee, Sarah A Ackroyd","doi":"10.1016/j.ijgc.2026.104834","DOIUrl":"10.1016/j.ijgc.2026.104834","url":null,"abstract":"<p><strong>Objective: </strong>Advanced and recurrent uterine cancer has a poor prognosis despite emerging treatment options, complicating the decision-making process. This study aimed to assess patient decision preferences and identify important factors in treatment choices to investigate whether these preferences vary by clinical and demographic characteristics, including race.</p><p><strong>Methods: </strong>This was a mixed-methods cross-sectional study, with the administration of validated surveys on quality of life and shared decision-making. Participants with advanced or recurrent uterine cancer at a single urban academic medical center completed an exploratory survey tool and a semi-structured interview. Descriptive statistical analysis, logistic regression, and thematic qualitative analysis were performed.</p><p><strong>Results: </strong>A total of 110 patients were included, with a mean age of 65.7 years. Fifty-three (48.2%) patients identified as White, and 46 (41.8%) identified as Black. Sixty patients (60/110, 54%) preferred \"shared decision-making,\" with no association between this preference and demographics, co-morbidities, or disease characteristics (all P > .1). Participants who were currently employed preferred shared decision-making compared with those who were not employed (odds ratio 0.32, 0.12-0.88, p < .05). While participants reported a range of factors influencing their treatment decisions, the most frequently identified were treatment efficacy (78%), physician recommendation (73%), and side effects (54%). Top decision preferences varied by race: White participants ranked treatment efficacy or physician recommendation more often than Black patients (treatment efficacy, White 86.8% vs Black 70.8%, p < .05; physician recommendation, White 84.9% vs Black 64.6%, p = .02), while more Black participants than White participants reported \"length of treatment visits\" as the most important factor (Black 18.8% vs White 3.8%, p = .02).</p><p><strong>Conclusions: </strong>The majority of participants with advanced and recurrent uterine cancer preferred shared decision-making. Various factors, such as treatment efficacy, physician recommendation, and side effects, among others, are important in decision-making processes. Individual patient characteristics such as race, employment status, and others should be considered in a patient-centered approach to care.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104834"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497347","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":"International Papillomavirus Society statement on reputed treatments for human papillomavirus infection and human papillomavirus-related diseases: evidence, risks, and standards for clinical evaluation.","authors":"Laila Sara Arroyo Mühr, Chemtai Mungo, Kimon Chatzistamatiou, Shuk On Annie Leung, Suzanne M Garland","doi":"10.1016/j.ijgc.2026.104950","DOIUrl":"10.1016/j.ijgc.2026.104950","url":null,"abstract":"<p><p>Human papillomavirus is the most common sexually transmitted infection and the necessary cause of cervical cancer, as well as a proportion of other anogenital and oropharyngeal cancers. Although most infections clear spontaneously, persistent oncogenic human papillomavirus infection may lead to precancer and cancer. There is therefore a need for effective and globally accessible therapies that either promote sustained clearance of human papillomavirus infection or safely treat human papillomavirus-related lesions, particularly in settings where ablative or excisional procedures are not readily available. However, no therapy has demonstrated proven and durable efficacy in eradicating human papillomavirus infection itself, although some non-ablative interventions have shown efficacy in treating specific human papillomavirus-related lesions. We conducted a narrative review of currently available and emerging interventions promoted for the treatment of human papillomavirus infection or human papillomavirus-related lesions, including approved topical agents, oral formulations, immunotherapies, therapeutic vaccines, molecular inhibitors, and widely marketed commercial products. Evidence was synthesized from clinical trials, systematic reviews, clinical guidelines, health technology assessments, and policy recommendations, and assessed using a structured evidence-evaluation framework. Some agents, including immune modulators and sinecatechins, are approved for external anogenital warts but do not reliably eliminate underlying human papillomavirus infection. Selected topical therapies, particularly 5-fluorouracil, have demonstrated efficacy in randomized trials for regression of cervical intraepithelial neoplasia in specific clinical contexts, but do not represent validated antiviral eradication therapies. Photodynamic therapy, intralesional immunotherapy, therapeutic vaccines, and molecular inhibitors remain investigational, with insufficient evidence for routine clinical use. Probiotics, nutritional supplements, vaginal gels, and other commercially promoted products also lack robust evidence. In the absence of proven therapies that eradicate human papillomavirus infection, current management relies on surveillance, evidence-based treatment of precancerous lesions, vaccination, and screening. The proposed framework may support professional societies in evaluating emerging interventions and providing clear, evidence-based guidance to health care professionals, policymakers, patients, and the public.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104950"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874048","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":"Approach to the hepato-gastric region in gynecological malignancies.","authors":"Giulio Ricotta, Alejandra Martinez, Gwenaël Ferron","doi":"10.1016/j.ijgc.2026.104801","DOIUrl":"10.1016/j.ijgc.2026.104801","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104801"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404653","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":"Predicting high-grade lesions and cervical cancer with supervised machine learning algorithms.","authors":"Laura C López-Alza, Dauris L Mejía-Pérez, Jairo Amaya-Guio, Alvaro D Orjuela-Cañon","doi":"10.1016/j.ijgc.2026.104997","DOIUrl":"https://doi.org/10.1016/j.ijgc.2026.104997","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate machine learning models for predicting high-grade squamous intra-epithelial lesions and cervical intra-epithelial neoplasia grade 2 or higher using sociodemographic and clinical parameters.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the Subred Norte (Bogotá, Colombia), a public health network, between 2018 and 2024. Records lacking sociodemographic data were excluded. To address the 10% class imbalance, random under-sampling was applied to train balanced models, which were then compared with the original imbalanced models.</p><p><strong>Results: </strong>The final sample included 4367 patients (aged 21 to 65 years) with cytology, colposcopy, or biopsy reports. The real-world prevalence of histopathologically confirmed cervical intra-epithelial neoplasia grade 2 or higher in this cohort was 10%. Five machine learning classification methods were tested across 2 datasets: 2018-2022 (n = 3139, excluding human papillomavirus history due to under-reporting) and 2023-2024 (n = 1228, including human papillomavirus history). On the original imbalanced dataset (without human papillomavirus history), the random forest model achieved an area under the receiver operating characteristic curve of 0.91 and a specificity of 99%, but had a sensitivity of only 41%. After applying random under-sampling, the random forest model's sensitivity improved to 89%, with a precision of 84%. For the dataset including human papillomavirus history, the support vector machine model achieved the highest balanced performance, yielding similar metrics. However, because these models were developed and evaluated strictly within a single institution, these balanced metrics represent optimistic internal validation performance.</p><p><strong>Conclusions: </strong>Machine learning models show promising performance for predicting cervical intra-epithelial neoplasia grade 2 or higher, with improved sensitivity after addressing class imbalance. These findings support further external, multi-center validation before clinical implementation.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104997"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127522","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":"Neoadjuvant chemotherapy plus cadonilimab followed by extra-fascial hysterectomy for International Federation of Gynecology and Obstetrics stage IB2 cervical cancer: a prospective, multi-center, single-arm, phase 2 trial.","authors":"Yingjie Hu, Hanxu Cheng, Jing Chen, Shuting Chen, Yingyan Han, Chaoyang Sun, Gang Chen, Kezhen Li","doi":"10.1016/j.ijgc.2025.104457","DOIUrl":"10.1016/j.ijgc.2025.104457","url":null,"abstract":"<p><strong>Background: </strong>Radical hysterectomy remains the standard treatment for stage IB2 cervical carcinoma but is often accompanied by considerable peri-operative and long-term complications that impair quality of life. The increasing emphasis on functional preservation has prompted exploration of less extensive surgical options, whereas neoadjuvant chemoimmunotherapy may induce tumor downstaging, enabling more conservative surgery without compromising oncologic safety.</p><p><strong>Primary objective: </strong>To evaluate the feasibility of extra-fascial hysterectomy after neoadjuvant chemoimmunotherapy as an alternative to radical hysterectomy in patients with stage IB2 cervical cancer.</p><p><strong>Study hypothesis: </strong>Neoadjuvant chemoimmunotherapy promotes tumor regression and risk factor reduction, allowing patients with IB2 cervical cancer to meet pre-defined ConCerV-based criteria for extra-fascial hysterectomy while maintaining acceptable oncologic and quality-of-life outcomes.</p><p><strong>Trial design: </strong>This is a multi-center, prospective, single-arm phase II trial. After 3 cycles of neoadjuvant chemoimmunotherapy (nab-paclitaxel, cisplatin, and cadonilimab), patients with post-treatment tumor size ≤2 cm who meet the ConCerV-based criteria on cone biopsy will undergo extra-fascial hysterectomy. Others will proceed to radical hysterectomy.</p><p><strong>Major inclusion/exclusion criteria: </strong>Eligible patients have treatment-naïve International Federation of Gynecology and Obstetrics 2018 stage IB2 cervical cancer. Acceptable histologic sub-types include squamous cell carcinoma (all grades), common-type adenocarcinoma (grade 1/2 or Silva pattern A/B), and adenosquamous carcinoma (grade 1/2).</p><p><strong>Primary endpoint: </strong>The proportion of patients meeting pre-defined ConCerV-based criteria after neoadjuvant chemoimmunotherapy.</p><p><strong>Sample size: </strong>50.</p><p><strong>Estimated dates for completing accrual and presenting results: </strong>The recruitment is expected to be finalized by September 2027, with the primary analysis scheduled to occur 3 months after the final patient completes treatment and long-term follow-up at 2 and 5 years.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06289751.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104457"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046561","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}