Journal of Gynecologic Oncology最新文献

{"title":"Diagnostic accuracy of the droplet digital PCR POLE mutation test in endometrial cancer: comparison with Sanger sequencing and NGS.","authors":"Yung-Taek Ouh, Hyun-Woong Cho, Kyung-Jin Min, Jae-Kwan Lee, Yikyeong Chun, Jin Hwa Hong","doi":"10.3802/jgo.2026.37.e83","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e83","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy of droplet digital polymerase chain reaction (ddPCR) for detecting polymerase epsilon (POLE) mutations in endometrial cancer (EC), comparing it with traditional Sanger sequencing and next-generation sequencing (NGS).</p><p><strong>Methods: </strong>Tumor DNA from 132 patients with EC was analyzed initially using both ddPCR and Sanger sequencing. Discordant cases (n=20) underwent further analysis using NGS as the reference standard. This study compared the sensitivity, specificity, and overall concordance of ddPCR against Sanger sequencing results, validated by NGS.</p><p><strong>Results: </strong>Among the 20 discrepant samples, ddPCR detected POLE mutations in 15 cases (75%). All ddPCR results matched exactly with NGS findings, including the detection of 11 low-frequency mutations missed by Sanger sequencing. ddPCR also corrected 2 false-positive results initially identified by Sanger sequencing. No false negatives were detected by ddPCR.</p><p><strong>Conclusion: </strong>ddPCR demonstrated superior sensitivity and specificity in detecting POLE mutations compared to Sanger sequencing and showed perfect agreement with NGS. With its rapid turnaround, simplicity, and cost-effectiveness, ddPCR is highly suitable for routine clinical use, potentially enhancing patient management and outcomes in EC.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574228","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":"One more opportunity in early-stage cervical cancer: the role of photodynamic therapy in managing positive surgical margins.","authors":"Alexander Dushkin, Tatyana Grishacheva, Stanislav Afanasiev, Irina Dushkina, Akmaral Khangeldi, Alexander Karaulov, Maxim Afanasyev","doi":"10.3802/jgo.2026.37.e91","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e91","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate recurrence of squamous intraepithelial lesions (SILs) and human papillomavirus (HPV) infection after photodynamic therapy (PDT) in patients with early-stage cervical cancer (CC) and positive surgical margins.</p><p><strong>Methods: </strong>We retrospectively analyzed 46 patients aged 25 to 52 years with stage IA-IB invasive CC treated with PDT. Chlorin e6-based photosensitizers were used to irradiate both the cervical canal and surface with standardized doses. Patients were stratified by residual tumor status (R₁₋₂ vs. R₀/SIL⁺). Outcomes were assessed by HPV testing, cytology and pelvic magnetic resonance imaging. The primary endpoint was relapse-free survival (RFS) with complete response (CR) defined by HPV negativity and absence of cytological or radiological abnormalities.</p><p><strong>Results: </strong>At 12 months, all patients achieved CR with complete HPV clearance and no residual lesions. At 48 months, overall RFS rate was 74.0% (95% confidence interval [CI]=49.5-87.9). SILs recurrence occurred in 3.7% of patients. Outcomes were slightly better in the R₁₋₂ group than in the R₀/SIL⁺ group without significant differences. Four patients (8.7%) subsequently had vaginal deliveries. In multivariable analysis, older age was associated with higher relapse risk (hazard ratio [HR]=1.27; 95% CI=1-1.6; p=0.047) as was a greater number of lifetime sexual partners (HR=1.08; 95% CI=1.01-1.15; p=0.019).</p><p><strong>Conclusion: </strong>PDT demonstrates promising efficacy as a minimally invasive, fertility-preserving treatment for early-stage CC with positive surgical margins. The high rate of HPV eradication and durable RFS support its evaluation as an adjunct or alternative to repeat surgery in selected patients.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574261","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 impact of cervicovaginal microbiome on HPV infection in vaccinated young Korean women.","authors":"Jaehyun Cho, Sorim Do, Kyunghoon Kim, Ha Kyun Chang, Hyun Hoon Chung","doi":"10.3802/jgo.2026.37.e88","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e88","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prevalence of high-risk human papillomavirus (hrHPV) infection and its association with cervicovaginal microbiome (CVM) diversity among young Korean women who received human papillomavirus (HPV) vaccination.</p><p><strong>Methods: </strong>Seventy-two Korean women aged 20-35 years were enrolled in Seoul, South Korea. Cervicovaginal samples were analyzed using liquid-based cytology, HPV genotyping, and 16S rRNA sequencing. Alpha diversity and microbial compositions were compared according to HPV infection and cytology results.</p><p><strong>Results: </strong>The prevalence of hrHPV infection was 44.4% (n=32), with HPV 39 and 52 being the most common types. Women with abnormal cytology or hrHPV positivity exhibited significantly higher microbial alpha diversity (Shannon index, p<0.05). bacterial vaginosis-associated bacteria (BVAB) such as <i>Gardnerella leopoldii</i>, <i>G. vaginalis</i>, and <i>Megasphaera lornae</i> were significantly associated with hrHPV positivity, along with <i>Lactobacillus iners</i> showed a strong positive correlation with microbial diversity, abnormal cytology, and hrHPV infection (p<0.001).</p><p><strong>Conclusion: </strong>Despite national HPV vaccination, hrHPV infection remains common among young Korean women, primarily driven by non-vaccine types. The dominance of <i>L. iners</i> and enrichment of BVAB were key microbial features associated with hrHPV infection and abnormal cytology, suggesting that ecological imbalance in the CVM may contribute to viral persistence. These findings highlight the potential role of microbiome modulation as a complementary approach in post-vaccination HPV management and prevention.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574234","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 HER2 status in endometrial carcinoma using endometrial, gastric, and breast cancer criteria: focus on HER2-low.","authors":"Heesoo Yoon, Yeon Bi Han, Dong Hoon Suh, Kidong Kim, Jae Hong No, Yong Beom Kim, Hyojin Kim","doi":"10.3802/jgo.2026.37.e86","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e86","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate human epidermal growth factor receptor 2 (HER2) status in endometrial carcinoma (EC) using 3 different criteria, assess its association with clinicopathological and molecular characteristics, and investigate intertumoral heterogeneity and prognostic significance, focusing on HER2-low.</p><p><strong>Methods: </strong>HER2 immunohistochemistry was performed on whole-slide sections from 365 EC and interpreted using EC, gastric cancer (GC), and breast cancer (BC) criteria. Silver in situ hybridization was performed for 2+/3+ cases. Intertumoral heterogeneity was assessed in 30 matched primary and recurrent/metastatic tumors.</p><p><strong>Results: </strong>Among 365 ECs, HER2-positive tumors (2.0%) were strongly associated with serous histology, high-grade, and the p53-abnormal (p53-abn) subgroup (p<0.001). HER2-low (45.7% by EC criteria and 18% by GC/BC criteria) was associated with advanced stage (p=0.045) and high-grade tumors (p=0.009), respectively. HER2-expression was enriched in p53-abn (60.4%, 37.7%), high-/advanced-risk (56.2%, 60.0%), and International Federation of Gynecology and Obstetrics III-IV (60.0%, 62.5%) tumors. Intertumoral heterogeneity was substantial (40.0%, 30.0%), reflecting dynamic changes, particularly in serous histology (p=0.018) and high-grade tumors (p=0.034). Based on GC/BC criteria, HER2-low status was an independent prognostic factor for recurrence in high- and advanced-risk groups compared with HER2-0 (p=0.040).</p><p><strong>Conclusion: </strong>HER2 status in EC varies across scoring criteria, supporting the need for standardized interpretation. HER2 expression, including HER2-low, was more prevalent in biologically aggressive subsets, and HER-low showed prognostic relevance in high-/advanced-risk patients, supporting its potential value as a therapeutic target for antibody-drug conjugate therapy. The dynamic nature of HER2 across disease progression further supports the need for reassessment in recurrent or metastatic lesions.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574264","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":"Effect of first-line poly(ADP-ribose) polymerase inhibitor on second-line platinum-based chemotherapy in epithelial ovarian cancer.","authors":"Yusuke Toyohara, Mayu Yunokawa, Ryo Nimura, Eitaro Funada, Risako Ozawa, Kei Kato, Shogo Nishino, Mayumi Kamata, Motoko Kanno, Atsushi Fusegi, Akiko Abe, Sachiho Netsu, Makiko Omi, Yoichi Aoki, Terumi Tanigawa, Sanshiro Okamoto, Hidetaka Nomura, Hiroyuki Kanao","doi":"10.3802/jgo.2026.37.e82","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e82","url":null,"abstract":"<p><strong>Objective: </strong>Research on platinum sensitivity after poly(ADP-ribose) polymerase (PARP) inhibitor administration, which offers prognostic benefits for first-line treatment of advanced epithelial ovarian cancer (EOC), is limited. Here, we evaluated the impact of first-line maintenance therapy with PARP inhibitors on the efficacy of second-line platinum-based chemotherapy in patients with advanced EOC.</p><p><strong>Methods: </strong>We retrospectively analyzed 100 patients with platinum-sensitive recurrent EOC who received second-line platinum-based chemotherapy between 2015 and 2024. The PARP inhibitor group included 35 patients who received PARP inhibitors as first-line maintenance, whereas the control group included 65 patients who did not. Overall response rate, post-recurrence progression-free survival (PFS), and post-recurrence overall survival (OS) were compared between the groups. Subgroup analyses were conducted using homologous recombination deficiency status and platinum-free interval (PFI).</p><p><strong>Results: </strong>The overall response rate was significantly lower in the PARP inhibitor group (25.7%) compared with the control group (89.2%, p<0.001). Median post-recurrence PFS and OS were significantly shorter in the PARP inhibitor group compared to that in the control group. In the PARP inhibitor group, homologous recombination deficiency-positive patients did not show better outcomes than homologous recombination deficiency-negative patients. Moreover, the overall response rate for patients with 6-12 months PFI was particularly poor in the PARP inhibitor group.</p><p><strong>Conclusion: </strong>First-line PARP inhibitor maintenance therapy may reduce the efficacy of subsequent platinum-based chemotherapy, potentially inducing platinum resistance. These findings highlight the need to reconsider treatment strategies and predictive biomarkers for second-line therapy following PARP inhibitor exposure in relapsed EOC.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574203","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":"Primary chemoradiation versus radical hysterectomy with lymphadenectomy for stage IIICr cervical cancer without parametrial involvement: gynecologic oncology research investigators collaboration study (GORILLA-1002).","authors":"Kyung Hee Han, Eunjung Yang, Namkyeong Kim, Joo-Hyuk Son, Tae Wook Kong, Seung-Hyuk Shim, Dong Hoon Suh, Suk-Joon Chang, Hee Seung Kim","doi":"10.3802/jgo.2026.37.e89","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e89","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness and adverse events of primary chemoradiation versus radical hysterectomy with pelvic or para-aortic lymphadenectomy in patients with 2018 International Federation of Gynecology and Obstetrics stage IIICr cervical cancer without clinical parametrial involvement.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with stage IIICr cervical cancer who had pelvic or para-aortic lymph nodes measuring at least 1 cm in short diameter on preoperative imaging between 2000 and 2020. Primary chemoradiation consisted of external beam radiation therapy and brachytherapy, while adjuvant chemoradiation following radical surgery was administered based on pathological results.</p><p><strong>Results: </strong>A total of 204 patients underwent primary chemoradiation (n=66) or radical hysterectomy with systematic lymphadenectomy (n=138). There were no significant differences in disease stage or histological type between the groups. In patients with tumors ≥4 cm, primary chemoradiation improved progression-free survival (PFS) compared to radical surgery (5-year survival: 91.1% vs. 61.7%; p<0.005). Favorable factors for PFS included stage IIIC1 disease, primary chemoradiation, and tumor size <4 cm. Stage IIIC1 was associated with better PFS and overall survival than stage IIIC2 (p=0.048 and p=0.020, respectively). Central recurrence was more common after primary chemoradiation, while pelvic sidewall or distant recurrence was more frequent after radical hysterectomy with lymphadenectomy (p=0.009). Anemia was more frequent in the primary chemoradiation group, while lymphedema was less common than in the radical surgery group.</p><p><strong>Conclusion: </strong>Primary chemoradiation may be more effective than radical hysterectomy with systematic lymphadenectomy in patients with stage IIICr cervical cancer without parametrial invasion.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574241","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":"Diagnostic accuracy of intraoperative frozen section at radical abdominal trachelectomy for early-stage cervical cancer.","authors":"Risa Matsuda, Hiroshi Nishio, Akihisa Ueno, Tomoya Matsui, Takashi Iwata, Hajime Okita, Wataru Yamagami","doi":"10.3802/jgo.2026.37.e18","DOIUrl":"10.3802/jgo.2026.37.e18","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative frozen section examination is crucial for confirming the oncological safety of radical abdominal trachelectomy (RAT) for early-stage cervical cancer. This study evaluated the diagnostic accuracy of frozen section during RAT at our institution.</p><p><strong>Methods: </strong>We retrospectively identified patients with International Federation of Gynecology and Obstetrics 2008 stage IA1-IB1 (tumor size ≤2 cm) cervical cancer treated between 2002 and 2021. In performing RAT, frozen section analysis was routinely performed on uterine surgical margins and grossly enlarged lymph nodes, and was confirmed to be negative. Medical records were reviewed to compare the frozen section diagnoses with the final pathology.</p><p><strong>Results: </strong>Among the 326 patients initially planned to undergo RAT, 298 (91.4%) underwent RAT, while 28 (8.6%) were converted to radical hysterectomy. The histological types were squamous cell carcinoma in 251 (77.0%) patients and adenocarcinoma in 67 (20.6%). Of 361 frozen section for surgical margins, 4 false negatives were identified. Discrepancies were due to freezing artifacts, staining quality on frozen sections, and slight differences in cross-sections between frozen and paraffin-embedded sections. Among 446 intraoperative lymph-node biopsies, one false-negative was recorded. Sensitivities of frozen section examination were 93.5% (58/62) for surgical margins and 94.1% (16/17) for lymph nodes. Lymph-node metastases were identified in systematic lymphadenectomy specimens of 21/326 (6.4%) patients planned to undergo RAT, with 10/21 (47.6%) detected intraoperatively. Lymph-node metastases were found in 7/112 (6.3%) patients without lymph-node biopsy.</p><p><strong>Conclusion: </strong>Frozen section examination during RAT provides satisfactory diagnostic performance, although biopsy of grossly enlarged lymph nodes is an unreliable method.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e18"},"PeriodicalIF":3.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086366","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":"Impact of lymph node staging on survival in presumed early-stage ovarian cancer: a multicentric retrospective study.","authors":"Samia Ouasti, Julie Alline, Yohan Kerbage, Elie Zerbib, Lobna Ouldamer, Sofiane Bendifallah, Cyrille Huchon, Jerome Lorenzini, Vincent Lavoué, Emilie Raimond, Helène Costaz, Pierre Francois Dupré, Olivier Graesslin, Jennifer Uzan, Geoffroy Canlorbe, Henri Azaïs, Xavier Carcopino, Cyril Touboul, Camille Mimoun, Yohann Dabi","doi":"10.3802/jgo.2026.37.e31","DOIUrl":"10.3802/jgo.2026.37.e31","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the impact of comprehensive staging on survival outcomes in this population.</p><p><strong>Methods: </strong>Patients who underwent surgery for epithelial ovarian cancer in one of the 14 Francogyn cancer centers between 2000 and 2020 were included in the study. The primary analysis evaluated the impact of lymphadenectomy on overall survival and recurrence-free survival. Lymph node count was analyzed as a continuous variable, and its association with survival, considered as a continuous outcome was assessed using linear regression (secondary analysis). Survival was compared using the log-rank test, and multivariate analysis was performed using a Cox model.</p><p><strong>Results: </strong>A total of 467 patients with presumed early-stage epithelial ovarian cancer were included, of which 198 underwent complete lymphadenectomy and 266 did not. No significant association was found between lymph node staging and survival in the primary analysis, possibly due to limited statistical power and a selection bias, as patients without lymphadenectomy had more favorable disease profiles (p=0.600 and p=0.700, respectively). Complete lymphadenectomy was associated with a significantly higher risk of complications (34.5% vs. 14%, p<0.001). In secondary analysis, the number of para-aortic lymph nodes harvested was identified as an independent predictor of both overall survival and recurrence-free survival (p=0.007 and p=0.002, respectively). Histological characteristics and adjuvant chemotherapy also showed a significant correlation with improved survival outcomes.</p><p><strong>Conclusion: </strong>Extensive para-aortic lymphadenectomy in early-stage epithelial ovarian cancer is associated with better overall and recurrence-free survival but comes with an increased risk of complications.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e31"},"PeriodicalIF":3.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564000","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":"Possible overestimation of treatment effects of pelvic and para-aortic lymphadenectomy for early-stage ovarian clear cell carcinoma: a retrospective propensity-score weighted multi-center cohort study.","authors":"Naoki Horikawa, Yoshihide Inayama, Miki Otsuki, Kota Yamauchi, Saya Kiyoshige, Yukiko Taga, Kazuki Yamano, Maki Umemiya, Motonori Matsubara, Yukio Yamanishi, Takahito Ashihara, Ikuko Emoto, Masaki Mandai, Ken Yamaguchi","doi":"10.3802/jgo.2026.37.e24","DOIUrl":"10.3802/jgo.2026.37.e24","url":null,"abstract":"<p><strong>Objective: </strong>The treatment effects of lymphadenectomy in early-stage ovarian clear cell carcinoma (OCCC) reported in previous studies may have been overestimated owing to confounding factors. This study aimed to investigate the treatment effect of pelvic and para-aortic lymphadenectomy (PeNPAN) in early-stage OCCC, with careful adjustment for potential confounders.</p><p><strong>Methods: </strong>This retrospective multi-center cohort study involved women with preoperatively suspected stage I OCCC. We included patients who underwent surgery for OCCC between 2005 and 2019 at 11 affiliated institutions. The exposure (PeNPAN) group comprised patients who underwent PeNPAN. The primary outcome was disease-free survival (DFS). Additionally, hazard ratios (HRs) of lymphadenectomy for DFS were estimated using unadjusted and propensity score-weighted Cox regression models and biased models applied in previous studies. To identify strong confounders, we further examined factors associated with recurrence that differed between the groups.</p><p><strong>Results: </strong>We analyzed 304 women who underwent surgery for preoperatively suspected stage I OCCC. The unadjusted HR for DFS was 0.63 (95% confidence interval [CI]=0.36-1.09; p=0.10), and the propensity-score adjusted HR was 0.82 (95% CI=0.42-1.58; p=0.55). The biased model showed a statistically significant HR of 0.59 (95% CI=0.36-1.00; p=0.048). Adhesions in the Douglas' pouch and cardiovascular disease were associated with recurrence and were more prevalent in the control group, suggesting potential confounders.</p><p><strong>Conclusion: </strong>After adjusting for potential confounders, the observed treatment effects of lymphadenectomy in the biased models were no longer statistically significant. Future investigations should carefully account for possible confounders, including intraoperative adhesions and comorbidities.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e24"},"PeriodicalIF":3.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029961","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":"Reevaluating the vesicouterine pouch: histological evidence for optimal dissection planes in oncologic surgery.","authors":"Kenro Chikazawa, Satoru Muro, Ken Imai, Tomoyuki Kuwata, Keiichi Akita","doi":"10.3802/jgo.2026.37.e16","DOIUrl":"10.3802/jgo.2026.37.e16","url":null,"abstract":"<p><p>During dissection of the vesicouterine pouch, entering from the uterine body side may lead to an inappropriate plane that scrapes the uterine body, whereas dissecting from the bladder side often facilitates smoother separation of the vesicouterine pouch. This suggests that multiple dissectible layers exist in the vesicouterine pouch. In this study, we aimed to investigate the midline structures, which are crucial in oncologic surgeries. Overall, six halves of three cadavers were used. They had no history of lower abdomen or pelvic condition. No fasciae or septum-like structures were observed between the bladder and uterine and vaginal walls. A magnified image revealed several layers of connective tissue that were irregularly interspersed between the muscular layer of the bladder and vagina. Histological analysis demonstrated that the vesicouterine pouch consists of multiple dissectible layers, differing from descriptions in traditional surgical textbooks. Specifically, the pubocervical fascia and vesicovaginal septum were absent in the mid-sagittal section. Instead, multiple layers of connective tissue were irregularly interspersed within the bladder's muscular layer. This finding is particularly important in oncologic surgeries, as it highlights the risk of cancer exposure at the dissection margins in cases with deep muscular invasion or stromal invasion. Additionally, it suggests that initiating dissection from the bladder side facilitates entry into the correct dissectible plane, reducing the risk of exposing malignant tissue.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e16"},"PeriodicalIF":3.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956672","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}