International Journal of Gynecological Cancer最新文献

{"title":"Laparoscopic tumor load as an independent prognostic marker in advanced ovarian cancer: a 3-year cohort study.","authors":"Marco D'Indinosante, Giacomo Guidi, Diana Giannarelli, Claudia Diella, Andrea Rosati, Riccardo Oliva, Alice Zampolini Faustini, Denis Querleu, Giovanni Scambia, Anna Fagotti","doi":"10.1016/j.ijgc.2025.101965","DOIUrl":"10.1016/j.ijgc.2025.101965","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between pre-operative tumor load, progression-free survival, and overall survival in patients with advanced epithelial ovarian cancer.</p><p><strong>Methods: </strong>Patients diagnosed with The International Federation of Gynecology and Obstetrics (FIGO) stage III to IV primary ovarian, tubal, or peritoneal carcinoma, who underwent intraoperative abdominal disease spread assessment using the laparoscopic predictive index value (PIV) at the Gynecologic Oncology Unit of the Policlinico-Agostino Gemelli University Hospital-IRCCS, Rome, from January 2018 to December 2020, were included. Patients were divided into 2 groups based on median laparoscopic PIV at diagnosis in our population: group A (low tumor load) with PIV from 0 to 6, group B (high tumor load), with PIV from 8 to 12, and/or with extensive miliary carcinomatosis and mesentery retraction.</p><p><strong>Results: </strong>During the study period, 817 patients with newly diagnosed advanced epithelial ovarian cancer were included, with a median age of 60 years (range;18-87), a median CA125 level of 584 (range; 5-6262), and ascites presence in 436 cases (54.0%). With a median follow-up of 51.0 months (95% CI 49.5 to 52.5), 571 (69.9%) recurrences and 388 (47.5%) deaths were observed. The median progression-free and overall survival were 22.0 months (95% CI 19.8 to 24.2) and 53.0 months (95% CI 48.7 to 57.3), respectively. A statistically significant correlation between PIV and risk of recurrence or death was observed (p < .001). The median progression-free survival was 27 months for PIV < 8 versus 16 months for PIV ≥ 8 (p < .001). The 5-year survival rate was 54.8 % (95% CI 49.1 to 60.5) for PIV < 8 and 30.4% (95% CI 23.7 to 37.1) for PIV ≥ 8 (p < .001). This correlation was maintained in the subgroup analysis by stage. Specifically, for FIGO stage III, the 5-year survival rate was 57.2 % for the group with PIV < 8 and 26.3 % for the group with PIV ≥ 8; for FIGO stage IV, it was 47.9 % for the group with PIV < 8, and 32.8 % for the group with PIV ≥ 8. In multivariate analysis, PIV was confirmed as an independent prognostic factor for both progression-free and overall survival, along with BRCA status and residual tumor after surgery, as well as ascites for progression-free survival and age for overall survival.</p><p><strong>Conclusions: </strong>This study underscores tumor burden at diagnosis, quantified by PIV, as a key independent prognostic factor in advanced ovarian cancer, irrespective of FIGO stage or BRCA status, even in the era of maintenance therapies.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 8","pages":"101965"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567428","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":"Value of frozen section to tailor surgical staging in apparent early-stage epithelial ovarian cancer.","authors":"Stefano Di Berardino, Nicolò Bizzarri, Marianna Ciancia, Francesca Moro, Belen Padial Urtueta, Claudia Marchetti, Gian Franco Zannoni, Giovanni Scambia, Anna Fagotti","doi":"10.1016/j.ijgc.2025.101746","DOIUrl":"10.1016/j.ijgc.2025.101746","url":null,"abstract":"<p><strong>Objective: </strong>Frozen section (FS) has been shown to have high accuracy in determining ovarian malignancy. However, its utility in guiding surgical approaches, particularly, lymph node staging, for early-stage epithelial ovarian cancer remains unclear. This study aimed to evaluate the post-test positive probability of FSs in identifying cases requiring lymph node or peritoneal staging. The secondary aims were sensitivity, specificity, and accuracy assessments.</p><p><strong>Methods: </strong>This retrospective study analyzed patients undergoing surgery for early-stage epithelial ovarian cancer with FS performed on ovarian masses between July 2007 and March 2023 at a tertiary center. The FS results were compared with the final histology (gold standard paraffin sections). The FS cases were categorized based on further actions as follows: lymph node staging (type A), peritoneal staging only (type B), or no additional procedures (type C). The patients were divided into group 1 (requiring lymph node and peritoneal staging) and group 2 (requiring only peritoneal staging). A comparison between specialized and general pathology diagnoses was also performed. Incorrect FS assessments were classified as under-diagnosed or over-diagnosed.</p><p><strong>Results: </strong>Of the 715 patients, group 1 had appropriate staging in 425 of 447 cases, with 4.9% over-treatment. In group 2, staging was correct in 109 of 195 cases, with 44.1% under-treatment. For type A FSs, the post-test positive probability was 95% (95% CI 93% to 97%), with sensitivity, specificity, and accuracy rates of 76.4%, 86.1%, and 78.6%, respectively. For type B FSs, the post-test positive probability was 56% (95% CI 50% to 61%), with sensitivity, specificity, and accuracy rates of 68.6%, 84.5%, and 81%, respectively. There was no significant difference in the agreement between the specialized and general pathology groups (p = 0.92).</p><p><strong>Conclusions: </strong>Frozen sections suggestive of a cancer diagnosis requiring peritoneal and lymph node staging in a population with apparent early-stage epithelial ovarian cancer are highly reliable. In the case of FSs suggesting only peritoneal staging, malignancy is frequently underestimated.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101746"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692047","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":"Follow-up strategies for patients with cervical cancer who achieved complete response after definitive chemoradiotherapy.","authors":"Yeon Joo Kim, Ye Jin Yoo, Jung Yoon Jang, Yong-Man Kim, Young Seok Kim","doi":"10.1016/j.ijgc.2025.101933","DOIUrl":"10.1016/j.ijgc.2025.101933","url":null,"abstract":"<p><strong>Objective: </strong>In patients who have achieved a complete response following definitive concurrent chemoradiotherapy for cervical cancer, there remains limited guidance for follow-up strategies despite a recurrence rate of 10% to 20%. We assessed the value of meticulous cross-sectional imaging for follow-up and identified subgroups that could benefit from intensive surveillance among those achieving complete response.</p><p><strong>Methods: </strong>We reviewed the medical records of cervical cancer patients and assessed primarily with pelvic magnetic resonance imaging (MRI) and/or positron emission tomography (PET)-computed tomography (CT) at 3 months post-concurrent chemoradiotherapy. Follow-ups were conducted every 3 months for 2 years, followed by biannual evaluations. Follow-up protocols included Pap smears, X-rays, tumor markers, CT, MRI, and PET-CT, as determined by the attending physician. We analyzed the sites of failure, detection methods, and prognostic factors.</p><p><strong>Results: </strong>The median follow-up duration was 61.3 months (range; 6.5-244.6). Among 428 patients with complete response, 86 patients (20.1%) experienced recurrences, predominantly distant metastases (86%). Of all recurrences, 67.4% were asymptomatic, and symptomatic recurrences were significantly associated with poorer overall survival compared to asymptomatic cases (HR 2.23, p = .003), predominantly detected through cross-sectional imaging. Chest CT or PET-CT identified the majority of chest metastases (75.7%). Multivariate analysis revealed significant risk factors for poor overall survival: extended-field radiotherapy, age ≥57; for locoregional recurrence: extended-field radiotherapy, tumor size ≥4 cm, non-squamous cell carcinoma, absence of diagnostic PET-CT; and for distant metastasis: extended-field radiotherapy, 2-dimensional radiotherapy.</p><p><strong>Conclusions: </strong>Even in patients achieving complete response, rigorous surveillance using abdominal-pelvic CT or MRI is advisable, particularly for those with high-risk factors, as it enables early detection of asymptomatic recurrences, which correlates with improved survival. Additionally, for patients treated with extended-field radiotherapy, incorporating chest CT in the follow-up is also recommended.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101933"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247707","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":"Reproducibility of positive AGO score in predicting complete cytoreduction in recurrent low-grade ovarian cancers.","authors":"Emel Canaz, Elena I Braicu, Hagen Kulbe, Eser Ozyurek, Jacek P Grabowski, Jalid Sehouli","doi":"10.1016/j.ijgc.2025.101966","DOIUrl":"10.1016/j.ijgc.2025.101966","url":null,"abstract":"<p><strong>Objective: </strong>The Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score has been proposed to facilitate patient selection for secondary cytoreductive surgery. However, this model has not been validated for low-grade subtypes of ovarian cancer. This study evaluates the reproducibility of a positive AGO score in predicting complete resection in recurrent low-grade epithelial cancers.</p><p><strong>Methods: </strong>We retrospectively analyzed 76 patients with recurrent grade-I serous, grade-I/II endometrioid, and mucinous ovarian cancers who underwent cytoreductive surgery between January 2001 and April 2023. Univariate and logistic regression analyses were performed to evaluate associations between clinical factors and surgical outcomes.</p><p><strong>Results: </strong>Complete resection was achieved in 31 of 55 patients (56.3%) undergoing surgery at first recurrence and in 9 of 21 patients (42.9%) in subsequent treatment lines. Among patients experiencing first recurrence with a treatment-free interval of ≥6 months, the positive predictive value of the AGO score for complete resection was 70.6%. However, multivariate analysis revealed that Eastern Cooperative Oncology Group score (p = .62), International Federation of Gynecology and Obstetrics stage (p = 1.00), ascites (p = .14), and residual disease after primary surgery (p = .59) were not independent predictors of complete resection at first recurrence. Results were consistent in subgroup analyses, including serous and endometrioid subtypes with a treatment-free interval of ≥6 months. Ascites ≥500 mL was present in only 7.9% of patients, while 92.1% had no or low-volume (<500 mL) ascites. Diffuse carcinomatosis was observed in 58.7% of patients. In patients who had achieved complete resection at primary surgery, a treatment-free interval of >28 months was associated with higher complete resection rates (83.3% vs 50%, p = .038).</p><p><strong>Conclusions: </strong>Our study highlights a critical limitation of the AGO score in low-grade ovarian cancers. None of the clinical elements included in the AGO score were independently associated with surgical results. Despite the high positive predictive value, a positive AGO score may not reliably predict complete resection in patients with recurrent low-grade ovarian cancers and should be interpreted with caution.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 8","pages":"101966"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567430","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":"Subclonal loss of DNA mismatch repair proteins in endometrial carcinomas: an unusual pattern with distinct molecular characteristics.","authors":"Graziele Bovolim, Sara Oliveira Silva, Bruna Tirapelli Gonçalves, Giovana Torrezan, Alexandre André Anastasio Balieiro da Costa, Marina De Brot, Dirce Maria Carraro, Marcelo Corassa, Glauco Baiocchi, Louise De Brot","doi":"10.1016/j.ijgc.2025.101951","DOIUrl":"10.1016/j.ijgc.2025.101951","url":null,"abstract":"<p><strong>Objective: </strong>Subclonal loss of mismatch repair (MMR) proteins in endometrial carcinoma has recently been identified through immunohistochemistry (IHC) evaluations, characterized by discrete areas of tumors with complete loss of nuclear expression adjacent to tumor cells with retaining expression. Controversies persist regarding reporting findings and managing such cases. Therefore, we conducted a detailed clinicopathological and molecular analysis on a large cohort of endometrial carcinoma cases with subclonal loss of MMR proteins to explore potential reclassification into different molecular categories that could influence diagnostic and treatment strategies.</p><p><strong>Methods: </strong>Eligible endometrial carcinoma cases underwent IHC evaluation for PMS2/MLH1/MSH2/MSH6. Cases showing subclonal loss of MMR proteins underwent macrodissection of both proficient and deficient MMR expression areas, followed by testing for microsatellite instability (Idylla), MLH1 promoter methylation (next-generation sequencing), POLE mutations (next-generation sequencing), and p53 expression (IHC). The proposed molecular evaluation was performed in both proficient and deficient areas. Clinical and pathological data for patients with subclonal loss were also analyzed.</p><p><strong>Results: </strong>We evaluated 356 cases of endometrial carcinoma, identifying subclonal loss in 16 patients (4.4%), predominantly endometrioid (15 cases, 93.75%) and International Federation of Gynecology and Obstetrics stage I (13 cases, 81.25%). Subclonal loss of MSH6 occurred independently in 6 cases (37.5%), and concurrently with subclonal loss of MLH1 in 2 cases (12.5%). Complete loss of MLH1/PMS2 was observed in 2 cases (12.5%). MLH1 promoter methylation was detected in 6 cases (37.5%), with 4 cases showing methylation in both areas analyzed. POLE mutations were found in 3 cases (18.75%), occurring in both deficient and proficient areas. The correlation between IHC findings and molecular results varied, providing valuable predictive and prognostic insights that could guide treatment decisions in some patients.</p><p><strong>Conclusions: </strong>Molecular evaluation should be standard practice in all endometrial carcinoma cases exhibiting subclonal loss of MMR proteins to accurately delineate tumor characteristics. Subclonal loss should be reported distinctly, warranting a more comprehensive diagnostic approach to enhance tumor classification.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 8","pages":"101951"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567431","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":"Rare intra-tumoral colonization of Fusobacterium nucleatum in endometrial cancer.","authors":"Mariana Bisarro Dos Reis, Denise Almeida Araújo Basso, Murilo Bonatelli, Gustavo Noriz Berardinelli, Gustavo Ramos Teixeira, Ricardo Dos Reis, Rui Manuel Reis","doi":"10.1016/j.ijgc.2025.101979","DOIUrl":"10.1016/j.ijgc.2025.101979","url":null,"abstract":"<p><p>The presence of Fusobacterium nucleatum has been associated with gynecological disorders, namely endometriosis and pregnancy complications; however, its role in endometrial cancer remains unexplored. This study aimed to assess the presence of intra-tumoral F nucleatum in endometrial carcinoma tissues and its association with patients' clinicopathological and molecular features. A total of 260 patients were included, and a droplet digital polymerase chain reaction assay was employed to detect F nucleatum in formalin-fixed paraffin-embedded tumor tissues. F nucleatum was detected in only 3 cases (1.2%), and none exhibited high bacterial levels, even within the 79 microsatellite instability-high molecular subgroup. These findings suggest that intra-tumoral F nucleatum does not play an oncogenic role in endometrial cancer.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 8","pages":"101979"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608312","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":"To cut or not to cut (completely): navigating the surgical sweet spot.","authors":"Heng-Cheng Hsu, Pedro T Ramirez","doi":"10.1016/j.ijgc.2025.101998","DOIUrl":"10.1016/j.ijgc.2025.101998","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 8","pages":"101998"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698478","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":"10-step technique for hepatic mobilization: essential anatomy and surgical approach.","authors":"Tiermes Marina, Víctor Lago, Pablo Padilla-Iserte, Berta Díaz-Feijoo, Santiago Domingo","doi":"10.1016/j.ijgc.2025.102031","DOIUrl":"https://doi.org/10.1016/j.ijgc.2025.102031","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 10","pages":"102031"},"PeriodicalIF":4.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953367","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":"Insights from the European Society for Medical Oncology (ESMO) Gynaecological Cancers Congress 2025.","authors":"Letícia Vecchi Leis, Mariana Carvalho Gouveia, Jéssica Monteiro Vasconcellos, Mariana Scaranti","doi":"10.1016/j.ijgc.2025.102025","DOIUrl":"https://doi.org/10.1016/j.ijgc.2025.102025","url":null,"abstract":"<p><p>The European Society for Medical Oncology Gynaecological Cancers Congress 2025, held in Vienna from June 19 to 21, brought together over 1150 participants from 82 countries to discuss recent advances in the management of gynecological cancers. With 17 scientific sessions and 126 abstract presentations, the congress served as a key platform for presenting innovations in the treatment of ovarian, cervical, uterine, vaginal, and vulvar cancers. This paper highlights and analyzes the most relevant studies presented, focusing on emerging treatment strategies, clinical trial outcomes, and translational research. By critically examining these contributions, we aim to provide a concise overview of the evolving landscape of gynecologic oncology and its implications for clinical practice.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 10","pages":"102025"},"PeriodicalIF":4.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953251","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 survival: reclaiming quality of life after cervical cancer treatment.","authors":"Daniele Assad Suzuki, Mariana Carvalho Gouveia, Marcela Bonalumi Dos Santos, Mariana Scaranti","doi":"10.1016/j.ijgc.2025.102026","DOIUrl":"https://doi.org/10.1016/j.ijgc.2025.102026","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"35 10","pages":"102026"},"PeriodicalIF":4.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873102","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}