Journal of Gynecologic Oncology最新文献

{"title":"The prognostic significance and role of adjuvant therapy for low-volume nodal metastasis in apparent early stage endometrial cancer: an updated systematic review and meta-analysis.","authors":"Yuan Zhuang, Yue Xu, Panxia Deng, Shengnan Wang, Huilong Nie, Hua Yang","doi":"10.3802/jgo.2025.36.e67","DOIUrl":"10.3802/jgo.2025.36.e67","url":null,"abstract":"<p><strong>Objective: </strong>Sentinel lymph node biopsy (SLNB) has improved detection of low-volume node metastasis (LVNM) in endometrial cancer (EC), but its prognostic significance and the need for adjuvant therapy (AT) remain unclear.</p><p><strong>Methods: </strong>A comprehensive search was performed until August 31, 2024 in multiple databases and sources. From 21 studies, 65,228 apparent early-stage EC patients were identified: 370 with macrometastases (MAC), 526 with micrometastases (MM), 2,138 with isolated tumor cells (ITCs), and 62,194 with negative nodes.</p><p><strong>Results: </strong>Findings indicated: 1) The MM group had a lower risk of recurrence or progression (R/P) than the MAC group (risk ratio [RR]=0.49; 95% confidence interval [CI]=0.31-0.78; p=0.002), higher risk than the negative nodes group (RR=2.07; 95% CI=1.59-2.68; p<0.001), and similar risk to the ITC group (RR=0.67; 95% CI=0.44-1.02; p=0.060). 2) The MM group had higher 3-year progression-free survival (PFS) (RR=1.36; 95% CI=1.21-1.52; p<0.001) and overall survival (OS) (RR=1.22; 95% CI=1.09-1.37; p<0.001) than the MAC group, similar to the ITC and negative nodes groups. 3) The ITC group had a lower R/P risk and higher 3-year PFS/OS than the MAC group, similar to the negative nodes group. 4) AT reduced the R/P risk in the MM group (RR=0.41; 95% CI=0.22-0.76; p=0.005) and increased 3-year OS in the ITC group (RR=1.06; 95% CI=1.04-1.08; p<0.001).</p><p><strong>Conclusion: </strong>Early-stage EC with LVNM had better prognostic outcomes than MAC, and AT may improve outcomes of LVNM patients. More evidence from prospective randomized controlled trials is needed to confirm these findings due to the inherent biases of retrospective studies.</p><p><strong>Trial registration: </strong>PROSPERO Identifier: CRD42022364536.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e67"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414421","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":"SPOCK2 promotes the invasion and migration of ovarian cancer cells through FAK signaling pathway.","authors":"Xiaoli Zheng, Hua Wu, Weipei Zhu","doi":"10.3802/jgo.2025.36.e98","DOIUrl":"10.3802/jgo.2025.36.e98","url":null,"abstract":"<p><strong>Objective: </strong>Ovarian cancer is one of the most prevalent malignancies worldwide, with the highest mortality rate among gynecological cancers. This study aims to investigate the molecular mechanisms of SPOCK2 in ovarian cancer progression and metastasis and evaluate its potential as a therapeutic target.</p><p><strong>Methods: </strong>The expression levels of SPOCK2 in ovarian cancer tissues and normal tissues were analyzed using data from The Cancer Genome Atlas (TCGA) and immunohistochemistry experiments. Functional assays, including epithelial-mesenchymal transition (EMT), invasion, and migration assays, were performed in high-grade serous ovarian cancer (HGSOC) cells to explore the role of SPOCK2. The interaction between SPOCK2 and ITGA3 and the subsequent activation of focal adhesion kinase (FAK) signaling were investigated. In vivo experiments were conducted to validate the effects of SPOCK2 knockdown on tumor metastasis and invasiveness.</p><p><strong>Results: </strong>SPOCK2 expression was significantly upregulated in ovarian cancer tissues compared to normal tissues and was associated with poor prognosis. Functional assays demonstrated that SPOCK2 promotes EMT, invasion, and migration in HGSOC cells by interacting with ITGA3 and activating FAK signaling. In vivo experiments confirmed that SPOCK2 knockdown significantly suppressed tumor metastasis and invasiveness.</p><p><strong>Conclusion: </strong>This study highlights the critical role of the SPOCK2/ITGA3 axis in driving ovarian cancer progression and provides evidence for SPOCK2 as a potential molecular marker and therapeutic target. These findings offer new insights into the early diagnosis and treatment of ovarian cancer, with significant clinical implications for improving patient outcomes.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e98"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988561","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":"Risk of CIN2+ in women aged >60 years with abnormal cervical cancer screening: a multicenter retrospective cohort study from the Thai Gynecologic Cancer Society research group.","authors":"Nida Jareemit, Warangkana Kolaka, Jitima Tiyayon, Siriwan Tangjitgamol, Perapong Inthasorn, Ruai Kittikhun, Nuttavut Kantathavorn","doi":"10.3802/jgo.2025.36.e83","DOIUrl":"10.3802/jgo.2025.36.e83","url":null,"abstract":"<p><strong>Objective: </strong>To study patterns of abnormal cervical cancer screening in women aged >60 years and explore the risk and predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2+).</p><p><strong>Methods: </strong>This retrospective cohort study examined 1,596 women aged >60 years with abnormal cervical cancer screening results from eight Thai cancer centers. Those who underwent hysterectomy were excluded. Patient characteristics, previous and current cervical cancer screening results, and histopathology data were collected and analyzed.</p><p><strong>Results: </strong>Mean age was 68.2±7.2 years. The abnormal screening results were normal cytology with positive high-risk human papillomavirus (0.9%), atypical squamous cells of undetermined significance (37.7%), low-grade squamous intraepithelial lesion (12%), atypical squamous cell cannot exclude high-grade lesion (11.7%), high-grade squamous intraepithelial lesion (12.7%), atypical glandular cell (20.1%), squamous cell carcinoma (4.3%), and adenocarcinoma (0.7%). Risk of CIN2+ in women with abnormal screening was 17.9% (95% confidence interval [CI]=16.1-19.8); among those with available histopathology, the risk was 28.8% (95% CI=26.1-31.7). Univariable logistic regression showed that age >70 years, sexual activity within 1 year, previous abnormal/no screening, previous CIN2+ pathology, presence of symptoms, and high-grade cytology were significant predictors of CIN2+. In the multivariable analysis, lack of previous screening (adjusted odds ratio=4.05; 95% CI=1.91-8.60; p<0.001) and high-grade cytology (adjusted odds ratio=7.00; 95% CI=3.34-14.67; p<0.001) were independent predictors of CIN2+.</p><p><strong>Conclusion: </strong>Continuing cervical cancer screening in women aged >60 years should be individualized based on their risk factors, particularly for those who have never been screened.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e83"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012533","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":"Bevacizumab in frontline chemotherapy improved the survival outcome for advanced ovarian clear cell carcinoma: a multicenter retrospective analysis.","authors":"Shinichi Tate, Toshiyuki Seki, Kyoko Nishikimi, Youichi Unno, Mizue Itoi, Sadatomo Ikeda, Nobuhisa Yoshikawa, Hidehiko Akashi, Eitaro Suzuki, Naotake Tanaka, Takashi Hirakawa, Hiroaki Kajiyama, Hirokuni Takano, Kosuke Yoshihara, Kaori Koga, Aikou Okamoto, Makio Shozu","doi":"10.3802/jgo.2025.36.e80","DOIUrl":"10.3802/jgo.2025.36.e80","url":null,"abstract":"<p><strong>Objective: </strong>Advanced ovarian clear cell carcinoma (OCCC) is associated with poor outcomes owing to chemoresistance. Bevacizumab (Bev) is increasingly being used to treat advanced ovarian cancer; however, its efficacy in OCCC remains unclear. This study evaluated the treatment outcomes of frontline bevacizumab chemotherapy in patients with OCCC.</p><p><strong>Methods: </strong>This retrospective multi-institutional study included patients diagnosed with advanced OCCC at eight institutions in Japan between 2008 and 2018. Patients were categorized into pre and post-market groups based on the Bev approval dates. Progression-free survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate methods. Additionally, patients were classified into Bev-treated (Bev+) and non-Bev-treated (Bev-) groups, and their prognoses were compared.</p><p><strong>Results: </strong>A total of 96 patients were in the pre-market group and 82 in the post-market group. The post-market group had a significantly higher proportion of patients with poor performance status and patients who underwent interval debulking surgery (p<0.01 and p<0.01, respectively). Univariate analysis demonstrated a better PFS in the post-market group (p=0.041). In multivariate analysis, better PFS (hazard ratio [HR]=0.52; p=0.002) and OS (HR=0.47; p=0.002) were observed in the post-market group than in the pre-market group. Bev+ patients had significantly better PFS and OS than Bev- patients in univariate (p<0.001 and p<0.001, respectively) and multivariate analyses (PFS: HR=0.36; p<0.001 and OS: HR=0.21; p=0.001, respectively).</p><p><strong>Conclusion: </strong>Incorporating Bev into frontline chemotherapy may improve outcomes in patients with advanced OCCC.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":"e80"},"PeriodicalIF":3.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730300","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":"Safety and efficacy of radical hysterectomy based on embryo development-originated in the treatment of early cervical cancer: a single-arm meta-analysis.","authors":"Yang Wang, Qiao Lu, Jing Na, Xinyou Wang, Ya Li, Shichao Han, Jun Wang","doi":"10.3802/jgo.2026.37.e8","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e8","url":null,"abstract":"<p><strong>Objective: </strong>Cervical cancer is the leading malignancy in terms of both incidence and mortality among cancers of the female reproductive system, and initial surgical treatment is still one of the main treatments. However, for many years, radical hysterectomy based on traditional anatomical principles has failed to substantially improve oncological outcomes for cervical cancer patients or reduce the incidence of perioperative complications. In recent years, radical surgery grounded in the membrane anatomy concept of embryonic development has demonstrated promising oncological outcomes in colorectal cancer surgery. Research in the field of cervical cancer, however, remains in its early stages, although it is steadily garnering increased attention. Consequently, this meta-analysis seeks to systematically assess the safety and efficacy of radical hysterectomy, rooted in embryonic developmental principles, for the treatment of early-stage cervical cancer.</p><p><strong>Methods: </strong>This study systematically searched PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and CNKI databases for relevant studies published from their inception to October 2024. Data on 5-year recurrence-free survival (RFS), overall survival (OS), and surgical complications were collected for further analysis.</p><p><strong>Results: </strong>Eight studies involving 1,226 patients were included in the meta-analysis. The surgical complication rate was 35.2%. Two studies reported a 5-year RFS of 86% and an OS of 88%.</p><p><strong>Conclusion: </strong>Radical hysterectomy based on embryo development-originated shows good safety and efficacy in treating early-stage cervical cancer.</p><p><strong>Trial registration: </strong>PROSPERO Identifier: CRD42024602098.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000759","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":"Subsequent primary cancer incidence in cervical cancer survivors: insights from a comprehensive cohort study utilizing combined Japanese population-based cancer registries.","authors":"Mikiko Asai-Sato, Masahiko Sakaguchi, Seiki Kanemura, Toshitaka Morishima, Kei Kawana, Yohei Miyagi, Kayoko Katayama","doi":"10.3802/jgo.2026.37.e12","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e12","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the incidence of subsequent primary cancer (SPC) among cervical cancer survivors in Japan.</p><p><strong>Methods: </strong>Data from the cancer registries of Osaka, Kanagawa, and Miyagi prefectures were combined. The cohort included individuals diagnosed with invasive and in situ cervical cancer between 1980 and 2010, with the SPC incidence evaluated until 2015. The incidence and standardized incidence ratio (SIR) for different SPC sites were calculated. In addition, the association between SPC and radiotherapy was examined via competitive regression analysis.</p><p><strong>Results: </strong>A total of 49,824 cervical cancer survivors were followed for up to 35 years, during which 4,507 (9.0%) of these survivors experienced SPC. Aside from the initial cancer, SPC was the most common cause of death among cervical cancer survivors. The most frequent SPC sites were the colorectal, breast, lung, and stomach, consistent with the frequency in the general population. A significant increase in the SIRs for bladder, lung, and colorectal cancers was observed (2.52, 1.63, and 1.44, respectively). Individuals who underwent radiotherapy had a higher risk of developing bladder cancer than those who did not, with a subdistribution hazard ratio of 2.28. The SIR for lung cancer significantly increased, particularly for the smoking-associated types, indicating the influence of smoking habits among survivors. Increased risk of specific SPCs was seen in both invasive and in situ cancer survivors.</p><p><strong>Conclusion: </strong>Cervical cancer survivors should be informed about the risks of SPCs and educated on the prevention methods. Our study provides valuable insights into specific actions SPC prevention.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956641","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":"Maintenance therapy for platinum-sensitive recurrent ovarian cancer with a history of PARPi administration.","authors":"Fumio Asano, Mai Momomura, Hiromi Shibuya, Hironori Matsumoto, Tohru Morisada, Yoichi Kobayashi","doi":"10.3802/jgo.2026.37.e15","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e15","url":null,"abstract":"<p><strong>Objective: </strong>This study explored new insights into the selection criteria for maintenance therapy for platinum-sensitive recurrent ovarian cancer by comparing the efficacy of poly(ADP-ribose) polymerase inhibitors (PARPis) and bevacizumab in patients with a history of PARPi administration.</p><p><strong>Methods: </strong>Between April 2014 and December 2024, 81 patients underwent maintenance therapy with either PARPi (52 patients) or bevacizumab (29 patients) at our institution. The primary endpoint was progression-free survival (PFS) after the end of the last chemotherapy treatment.</p><p><strong>Results: </strong>The median PFS did not differ significantly between the PARPi and bevacizumab groups (9 vs. 12 months, p=0.942). Similarly, in the propensity score-matched cohort (15 pairs), no significant difference was observed between the PARPi and bevacizumab groups (p=0.444). In the PARPi group, a history of PARPi administration was associated with a significant difference in PFS in both univariate and multivariate analyses (PARPi-naïve vs. PARPi-experienced: 12 vs. 4 months, p=0.002; hazard ratio=3.24, 95% confidence interval=1.56-6.69). In the bevacizumab group, a history of PARPi administration was not associated with a significant difference in PFS. Among patients with a history of PARPi administration, the bevacizumab group had a significantly better PFS than the PARPi group (PARPi rechallenge vs. bevacizumab: 4 vs. 12 months, p=0.042), and the proportion of patients experiencing platinum-resistant recurrence during maintenance therapy was higher in the PARPi rechallenge group (58.8%) than in the bevacizumab group (20.0%) (p=0.049).</p><p><strong>Conclusion: </strong>Maintenance therapy with bevacizumab may be more beneficial for patients with platinum-sensitive recurrent ovarian cancer who have a history of PARPi administration.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956965","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 relationship between histopathological data and molecular alterations with oncological outcomes in endometrioid-type endometrial cancers and a novel POLE mutation.","authors":"Elif Aksahin, Fuat Demirkiran, Tugan Bese, Sukru Cebi, Abdullah Serdar Acikgoz, Basak Ozge Kayan, Yeliz Aykanat, Ismail Yilmaz, Ayse Namal, Ayse Ilvan, Omer Uysal, Macit Arvas","doi":"10.3802/jgo.2026.37.e6","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e6","url":null,"abstract":"<p><strong>Objective: </strong>To identify molecular subgroups in endometrioid endometrial cancer (EEC), evaluate their association with clinicohistopathological characteristics, and define low-intermediate risk groups by integrating these parameters.</p><p><strong>Methods: </strong>This retrospective-cohort study included 1,040 patients who underwent surgery between January 2000 and June 2022. Among 900 EEC cases, 72 recurred. Patients with tumor recurrence (n=62) and those without (n=52) were matched. POLE exons 9-14 were examined using Sanger sequencing. p53 and mismatch repair (MMR) protein expression were assessed via immunohistochemistry.</p><p><strong>Results: </strong>The molecular subgroups were POLE mutation (POLE-mut) 5%, mismatch repair-deficient (MMR-d) 43%, p53 mutation (p53-mut) 5%, and non-specific molecular profile (NSMP) 42%. 5% of cases displayed multiple molecular mutations. POLE-mut were more prevalent in high-grade tumors (p=0.026). MMR-d tumors exhibited higher rates of lymphovascular space invasion and myometrial invasion ≥50% (p=0.032, p=0.020). No recurrences occurred in POLE-mut tumors (p=0.002), while MMR-d was significantly associated with recurrence (p=0.002). Median disease-free survival (DFS) for MMR-d, p53-mut, and NSMP were 34, 49, and 107 months, respectively. Median overall survival (OS) for these groups was 128, 102, and 181 months. Multivariate Cox-regression analysis employing the Backward-Stepwise method identified stage as the strongest predictor of DFS, and grade and stage as predictors of OS.</p><p><strong>Conclusion: </strong>POLE mutations were linked to the most favorable molecular prognostic factor. NSMP cases showed the longest DFS and OS, while p53-mut had the shortest OS. Except for POLE, molecular features alone were insufficient for establishing risk groups, highlighting the continued importance of histopathology in EEC management.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956675","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":"Timing of adjuvant radiotherapy for early-stage endometrial carcinoma: a single-center retrospective cohort study.","authors":"Zihan Yan, Wenhui Wang, Shuning Jiao, Kang Ren, Xiaorong Hou, Ke Hu, Fuquan Zhang","doi":"10.3802/jgo.2026.37.e14","DOIUrl":"https://doi.org/10.3802/jgo.2026.37.e14","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the appropriate timing of radiotherapy (RT) after hysterectomy in women with early-stage endometrial cancer (EC).</p><p><strong>Methods: </strong>We analyzed the data of 1,062 patients with early-stage EC who underwent postoperative RT at our hospital between April 1999 and November 2020. Restricted cubic spline were used to explore the relationship between the surgery-radiotherapy interval (SRI) and local recurrence-free survival (LRFS). The maximally selected rank statistics method was used to identify the optimal threshold for SRI. The overall survival (OS), disease-free survival (DFS), LRFS, and distant metastasis-free survival (DMFS) rates were estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression.</p><p><strong>Results: </strong>In entire cohort, patients with SRI ≤42 days had worse survival. In multivariate analysis, SRI was an independent prognostic factor for OS (p=0.011), DFS (p=0.019), LRFS (p=0.013) and DMFS (p=0.050). However, in piecewise Cox regression, the significance of SRI for DMFS disappeared. In the subgroup analysis, the optimal cut-off value for SRI in the high-intermediate risk (HIR) and high-risk (HR) groups was 33 days. Multivariate analysis showed that SRI was an independent prognostic factor only for LRFS (p=0.033) and marginally associated with OS (p=0.055).</p><p><strong>Conclusion: </strong>The timing of postoperative RT is crucial in patients with early-stage EC. Adjuvant RT should be initiated as soon as the vaginal cuff is healed, while for HIR and HR patients, it should be initiated within 33 days.</p>","PeriodicalId":15868,"journal":{"name":"Journal of Gynecologic Oncology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956697","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":"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":"https://doi.org/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":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}