Archives of Gynecology and Obstetrics最新文献

{"title":"The microbiology of amniotic fluid sludge: a systematic review and meta-analysis","authors":"Elena Shipitsyna,&nbsp;Olga Pachulia,&nbsp;Vladislava Khalenko,&nbsp;Ekaterina Kopteeva,&nbsp;Anastasiya Sazonova,&nbsp;Natalya Zhestkova,&nbsp;Olesya Bespalova","doi":"10.1007/s00404-026-08492-2","DOIUrl":"10.1007/s00404-026-08492-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Amniotic fluid sludge (AFS) is a sonographic finding associated with intra-amniotic infection and spontaneous preterm birth. The microbial composition of AFS remains poorly characterized. This systematic review and meta-analysis aimed to consolidate existing data on microbial prevalence in AFS and identify consistent microbial patterns.</p><h3>Methods</h3><p>A systematic search of MEDLINE (PubMed), Dimensions, and OpenAlex was conducted from inception to February 11, 2026. Studies reporting the prevalence of microorganisms in AFS (minimum 10 cases) from pregnant women with AFS diagnosed via transvaginal ultrasound were included. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment, with a third reviewer resolving discrepancies. Random-effects meta-analysis of proportions was used to pool overall and pathogen-specific prevalence.</p><h3>Results</h3><p>Four studies comprising 85 women met inclusion criteria. The pooled prevalence of any microorganism was 35% (95%CI 22–48%), with moderate heterogeneity (I² = 36.8%). <i>Ureaplasma</i> spp. were the most frequently detected pathogens (pooled prevalence 17%, 95%CI 8–27%). Sensitivity analysis revealed that sampling technique was a source of heterogeneity in this dataset; excluding the single study using transvaginal amniocentesis reduced the pooled prevalence to 28% (95%CI 17–41%) and eliminated statistical heterogeneity (I² = 0.0%). Transvaginally collected samples exhibited significantly greater microbial diversity (median 2 vs. 1 microorganism/sample, <i>p</i> = 0.005) and contained vaginal commensals, suggesting possible contamination.</p><h3>Conclusion</h3><p>In transabdominal cohorts, the pooled prevalence of microorganisms (any) in amniotic fluid sludge was 28% (95%CI 17–41%), with <i>Ureaplasma</i> spp. emerging as the predominant pathogen when an infectious agent was identified. Transvaginal amniocentesis resulted in greater microbial diversity and detection of vaginal commensals, consistent with contamination. Our findings suggest that transabdominal sampling should be the preferred methodological approach for future studies of AFS microbiology.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histological evaluation of hysterectomy specimens after NovaSure® endometrial ablation in patients with atypical endometrial hyperplasia or endometrial carcinoma","authors":"Oliver M. Schleicher,&nbsp;Alaa Hamzeh,&nbsp;Julia Gocke,&nbsp;Patrik Poeschke,&nbsp;Frederik A. Stuebs,&nbsp;Stefanie Burghaus,&nbsp;Felix Heindl,&nbsp;Arndt Hartmann,&nbsp;Matthias W. Beckmann,&nbsp;Christian Matek,&nbsp;Julius Emons","doi":"10.1007/s00404-026-08497-x","DOIUrl":"10.1007/s00404-026-08497-x","url":null,"abstract":"<div><h3>Background</h3><p>Treatment with NovaSure® endometrial ablation is approved for patients with heavy menstrual bleeding (HMB) without evidence of malignant or premalignant lesions. This analysis addresses the rare but clinically relevant situation in which endometrial carcinoma (EC) or atypical hyperplasia (AEH) is identified histologically after endometrial ablation in premenopausal patients.</p><h3>Objective</h3><p>Histological evaluation of hysterectomy specimens with correlation to clinical parameters in patients undergoing hysterectomy after incidental histological diagnosis of AEH or EC following NovaSure® endometrial ablation.</p><h3>Methods</h3><p>A retrospective single-center analysis was conducted on more than 400 patients who underwent NovaSure® endometrial ablation at our center between January 2020 and February 2025. Patients with AEH or EC for whom subsequent hysterectomy specimens were available were included. Histological evaluation was performed and independently reviewed to assess residual endometrium, residual endometrial atypia or carcinoma, and ablation-related histomorphological changes.</p><h3>Results</h3><p>A total of 11 patients (AEH <i>n</i> = 8; EC <i>n</i> = 3) underwent subsequent hysterectomy after NovaSure® endometrial ablation. Six out of eight patients with AEH showed no residual atypia in the hysterectomy specimens (2/8 with focal residual atypia), and no residual invasive carcinoma was detected in any of the three carcinoma cases. Histopathological analysis showed pronounced postablative changes, including necrosis, fibrosis, zonation, and vascular and lymphatic alterations.</p><h3>Conclusion</h3><p>This descriptive study provides a clinicopathological characterization of patients with EC or AEH who underwent hysterectomy after endometrial ablation. In these patients, no preprocedural evidence of endometrial pathology was present, and the diagnosis was established solely through routine histopathological examination of curettage specimens obtained immediately before the ablation procedure. Histological assessment revealed pronounced changes, highlighting specific diagnostic challenges and underscoring the importance of careful patient selection and thorough diagnostic evaluation before NovaSure® ablation. Within the limitations of this study, no evidence was found that prior endometrial ablation compromises oncological outcome.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08497-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing clinical decision-making between colposcopists and large language models in cervical dysplasia management: a pilot prospective multicenter study","authors":"Jan Lennart Stalp,&nbsp;Juliane Alexandra Schneider,&nbsp;Lena Steinkasserer,&nbsp;Jens Hachenberg,&nbsp;Matthias Jentschke,&nbsp;Peter Hillemanns,&nbsp;Dominik Wolff,&nbsp;Agnieszka Denecke","doi":"10.1007/s00404-026-08498-w","DOIUrl":"10.1007/s00404-026-08498-w","url":null,"abstract":"<div><h3>Purpose</h3><p>This prospective multicenter study aimed to compare the decision-making abilities of board-certified colposcopists and two commercially available large language models (LLM), ChatGPT-4o and ChatGPT-5, in cervical dysplasia management.</p><h3>Methods</h3><p>Twenty-three anonymized real-life patient cases with multiple-choice (MC) questions regarding treatment decisions were used to assess answer quality. Ten board-certified colposcopists and the two LLMs addressed the MC questions. The gold standard was defined by two guideline authors. LLMs were prompted to justify their responses. Concordance rates were calculated and compared across all questions and histopathological subgroups, including cervical intraepithelial neoplasia (CIN), unspecific histopathological results, and cervical cancer cases.</p><h3>Results</h3><p>Clinicians and LLMs achieved similar overall concordance rates compared to the gold standard (69.6% for clinicians, 69.6% for ChatGPT-4o, and 65.2% for ChatGPT-5). ChatGPT-5 outperformed clinicians in precancerous lesions (81.8% vs. 66.4%), while clinicians excelled in complex cases with unspecific histopathology (86% vs. 60%). Clinicians showed a tendency to overtreat low-grade lesions (CIN I), opting for more intensive surveillance. ChatGPT-4o performed better than ChatGPT-5 in cervical cancer cases, though both models struggled with these scenarios.</p><h3>Conclusion</h3><p>This study highlights the potential of LLMs as decision support tools in cervical dysplasia management, particularly for straightforward cases like precancerous lesions. However, clinicians remain superior in handling complex or ambiguous cases. The tendency of clinicians to overtreat low-grade lesions may offer the potential to test the implementation of a decision support tool for those cases. While LLMs show promise, exploring open-ended clinical scenarios and integrating retrieval-augmented generation could enhance their practical application.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08498-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148269724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PTHrP-associated hypercalcemia in gynecologic malignancies: a scoping review","authors":"Shara Maria Bohne,&nbsp;Florian Wegwitz,&nbsp;Judith Kruse-Wieczorek,&nbsp;Laura Langer,&nbsp;Julia Gallwas,&nbsp;Philipp Ströbel,&nbsp;Mir Fuad Hasanov","doi":"10.1007/s00404-026-08488-y","DOIUrl":"10.1007/s00404-026-08488-y","url":null,"abstract":"<div><h3>Purpose </h3><p>Parathyroid hormone-related peptide (PTHrP) is a peptide hormone that shares structural similarity with parathyroid hormone (PTH) and binds to the same receptor, leading to increased calcium levels. Humoral hypercalcemia of malignancy (HHM) is typically mediated by tumor-derived PTHrP and accounts for the majority of cases of malignancy-associated hypercalcemia, whereas it is rarely observed in benign conditions. The purpose of this study was to systematically review the literature to map and provide a structured and transparent overview of reported cases of HHM in malignant gynecologic tumors.</p><h3>Methods</h3><p>A systematic literature search was conducted in PubMed/MEDLINE and Web of Science, complemented by manual reference screening and additional searches using Google Scholar, identifying relevant articles published between 1973 and 2025. Clinical and biochemical characteristics were extracted and analyzed descriptively.</p><h3>Results</h3><p>A total of 51 reported cases were identified, including 29 ovarian, 12 uterine, 5 vulvar, and 5 cervical tumors. Among the 29 cases in which serum PTHrP was measured, levels were elevated in 28 patients. In the remaining cases, suppressed PTH levels, exclusion of alternative causes, or indirect evidence from tissue immunohistochemistry (IHC) supported PTHrP involvement. Preoperative calcium levels ranged from 10.5 to 21.3 mg/dL. Following tumor resection, both PTHrP and calcium levels declined and normalized in most patients.</p><h3>Conclusion</h3><p>These findings suggest that although rare, PTHrP-mediated hypercalcemia represents a clinically relevant paraneoplastic phenomenon in gynecologic malignancies. Prospective studies with standardized biochemical and tissue-based assessment are needed to clarify its epidemiology and clinical significance.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08488-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality control monitoring of euploid frozen embryo transfers","authors":"Michael S. Awadalla","doi":"10.1007/s00404-026-08474-4","DOIUrl":"10.1007/s00404-026-08474-4","url":null,"abstract":"<div><h3>Purpose</h3><p>The goal of this study is to determine factors associated with fetal heartbeat and live birth rate for euploid frozen embryo transfers.</p><h3>Methods</h3><p>This is a retrospective cohort study of IVF patients at a single private practice in Cincinnati, Ohio undergoing single frozen euploid embryo transfer from 1/1/2023 to 7/31/2025. Variables assessed are embryo transfer protocol, genetic testing laboratory, physician who performed the embryo transfer, and embryologist. The main outcomes of interest are fetal heartbeat and live birth rate per single euploid frozen embryo transfer.</p><h3>Results</h3><p>Fetal heartbeat rate was significantly associated with the frozen embryo transfer protocol (<i>p</i> &lt; 0.01). Modified natural FET protocols without oral medication (such as letrozole) had the highest fetal heartbeat rate of 66% compared to the average fetal heartbeat rate of 52%. Fetal heartbeat rate was also associated with the genetic testing laboratory (<i>p</i> &lt; 0.01) and the day of embryo biopsy (<i>p</i> &lt; 0.01). Fetal heartbeat was not associated with any of the other modifiable measures evaluated including the embryologist performing the biopsy or the physician performing the embryo transfer.</p><h3>Conclusion</h3><p>At our center, the highest ongoing pregnancy rate per euploid embryo is seen with modified natural FET protocols without oral medication (such as letrozole).</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13500435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 effectiveness of etonogestrel implant in Chinese women requiring contraception: a multicenter, prospective, observational study","authors":"Xinyan Liu,&nbsp;Xiaoye Wang,&nbsp;Xiao’ou Xu,&nbsp;Yanfei Zhou,&nbsp;Wenxia Ma,&nbsp;Li Jiang,&nbsp;Qiwei Qi,&nbsp;Jian Li,&nbsp;Tinghui Yu,&nbsp;John W. Grunden,&nbsp;Chengliang Xiong","doi":"10.1007/s00404-026-08433-z","DOIUrl":"10.1007/s00404-026-08433-z","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the overall safety and effectiveness of the etonogestrel implant radiopaque in real-world clinical settings in China.</p><h3>Methods</h3><p>A multicenter, prospective, single-arm, observational study was conducted in women (aged ≥ 18 years) across 31 centers in China (March 2016–July 2021). The implant was prescribed as part of routine clinical practice. Primary outcomes included overall safety and topical (local) safety profile; secondary outcomes included participant and physician satisfaction and contraceptive effectiveness of the etonogestrel implant.</p><h3>Results</h3><p>Of 1,901 women using the etonogestrel implant, 45.5% completed the 3-year study. The mean (SD) age of the women was 32.1 (5.6) years and the mean (SD) implant exposure duration was 783.7 (388.7) days. Overall, 47.9% reported drug-related adverse events (AEs; excluding topical AEs), 1.1% reported serious AEs, and 10.4% reported topical AEs after insertion. Vaginal bleeding (15.6%) was the most frequent drug-related AE. At 36 months after insertion or upon removal, most women were satisfied (38.9%) or very satisfied (23.7%) with the implant. Among 96 physicians who completed questionnaires following the first insertion, 57.3% were very satisfied and 38.5% were satisfied. Most (98.9%) of the physicians reported satisfaction following their first removal procedure. Of them, 65.3% were very satisfied and 33.7% were satisfied. One (1.1%) physician was neither satisfied nor dissatisfied. One (0.05%) in-treatment pregnancy was reported.</p><h3>Conclusion</h3><p>Safety findings from this study in China’s real-world clinical setting were consistent with the clinical development program without unexpected safety signals. Observed contraceptive effectiveness was consistent with established evidence for the implant, with general satisfaction reported among Chinese women.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic actinomycosis: diagnostic challenges and management strategies based on a retrospective case series and literature review","authors":"Shuxu Tian,&nbsp;Chenchen Geng,&nbsp;Yue Wu,&nbsp;Kexin Huang,&nbsp;Shumin Chen,&nbsp;Xiucheng Fan,&nbsp;Weiwen Fan","doi":"10.1007/s00404-026-08441-z","DOIUrl":"10.1007/s00404-026-08441-z","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic actinomycosis is a rare, chronic infection caused by <i>Actinomyces</i> species, most associated with prolonged intrauterine device (IUD) use. Due to its nonspecific clinical presentation, it is frequently misdiagnosed as malignancy or other inflammatory conditions. This study aims to analyze the clinical features, diagnostic approaches, and outcomes of pelvic actinomycosis through a retrospective review of four cases and a supporting literature review.</p><h3>Case description</h3><p>We reviewed the medical records of four female patients diagnosed with pelvic actinomycosis between 2021 and 2025. Diagnostic modalities included imaging, physical examination, cervical cytology, endometrial biopsy, and histopathological analysis. Empirical antibiotic therapy was administered to confirmed cases. All patients had a history of prolonged IUD use. Imaging frequently revealed pelvic masses with inflammatory features. In all cases, <i>Actinomyces</i> was identified via cytology or histopathology. Three of the four patients were diagnosed preoperatively, thus preventing unnecessary surgical interventions. Long-term antibiotic therapy led to clinical resolution in most patients.</p><h3>Conclusion</h3><p>Pelvic actinomycosis should be considered in women with chronic pelvic symptoms and a history of long-term IUD use. Early identification through cytology or biopsy can reduce surgical morbidity. Increased awareness and its inclusion in the gynecologic differential diagnosis may improve patient prognoses.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08441-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postpartum hemorrhage in placenta accreta spectrum patients with prophylactic abdominal aorta balloon occlusion: a retrospective cohort study.","authors":"Ying Zha, Yun Zhao, Min Peng, Huan Zhang, Tingting Jiang, Sheng Zhao, Wenzhong Yang, Yin Xie, E Liao, Hui Xie, Lei Zhao, Wei Ren, Na Zhang, Xiaoying Wei, Jing Bao, Hui Du, Yaping Hu, Wanjiang Zeng, Yuanming Feng, Guoqiang Sun","doi":"10.1007/s00404-026-08456-6","DOIUrl":"10.1007/s00404-026-08456-6","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic abdominal aortic balloon occlusion (AABO) is a hemostasis intervention for patients with placenta accreta spectrum (PAS). However, many PAS patients with prophylactic AABO still experience postpartum hemorrhage (PPH). This study aimed to investigate the risk factors for PPH in PAS patients undergoing prophylactic AABO.</p><p><strong>Methods: </strong>This retrospective study (2018-2024) was conducted at a tertiary hospital. PAS women undergoing prophylactic AABO before cesarean section were enrolled and divided into the PPH group and the non-PPH (NPPH) group. The clinical characteristics, ultrasound and magnetic resonance imaging (MRI) findings, and delivery outcomes were compared. The LASSO regression and multivariable logistic regression were used to identify risk factors for PPH and to construct a nomogram prediction model.</p><p><strong>Results: </strong>In total, 126 women were included, of whom 56 experienced PPH (44.4%). Compared to those in the NPPH group, the PPH group had higher gravidity (P = 0.022) and parity (P = 0.002), fewer gestational weeks at cesarean (34.9 vs. 35.6, P = 0.026), higher ultrasound scores (11 vs. 7, P < 0.001) and MRI-based PAS grades (P < 0.001). By integrating the results of the two regression methods, we constructed the nomogram to predict PPH risk. The ROC curve of the nomogram showed moderate discriminative ability, with an AUC of 0.749 (95% CI: 0.664-0.834).</p><p><strong>Conclusions: </strong>Prophylactic AABO does not completely prevent the occurrence of PPH. The nomogram intergrating gravidity, parity, ultrasound score and MRI-based PAS grades can assist clinicians in identifying high-risk PAS patients at an early stage, which is beneficial for the preoperative assessment.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indication-dependent heterogeneity in the effect of double-suture cerclage: concerns over indication classification and a call for stratified analysis","authors":"Yong-Jin Park,&nbsp;Moon-Il Park","doi":"10.1007/s00404-026-08480-6","DOIUrl":"10.1007/s00404-026-08480-6","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08480-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormonal therapy or chemotherapy for advanced endometrial cancer? A mixed-methods study assessing physicians’ attitudes","authors":"Willem Jan van Weelden,&nbsp;Julia Mesu,&nbsp;Petronella B. Ottevanger,&nbsp;Johanna M.A. Pijnenborg,&nbsp;Johanna W.M. Aarts","doi":"10.1007/s00404-026-08486-0","DOIUrl":"10.1007/s00404-026-08486-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Hormonal therapy and chemotherapy are common systemic therapy options in advanced and recurrent endometrial cancer. There is limited consensus on factors that affect therapy selection. This study aims to gain insight into those factors at the level of clinical decision-making and at the level of patient- and tumor-specific factors.</p><h3>Methods</h3><p>We performed an international cross-sectional study among medical oncologists and gynecologists. The survey consisted of (1) statements about barriers and facilitators that affect the process of decision-making and (2) hypothetical vignette cases investigating three patients and tumor factors that were tested with three levels each. Results were analyzed with descriptive statistics and linear mixed-effects models.</p><h3>Results</h3><p>167 physicians responded to the survey. The most important facilitating factors were: understanding the patient’s personal context and the role of multidisciplinary tumor board discussions. The most important barrier was the lack of evidence for prediction of response to hormonal therapy and chemotherapy. The three patient and tumor factors included in the vignette cases were severity of symptoms, performance status, and progesterone-receptor (PR) expression in the tumor. PR expression and performance status were most discriminative, with high PR expression and poor performance status favoring hormonal therapy.</p><h3>Conclusion</h3><p>The provision of personalized care in palliative treatment of endometrial cancer can be improved by multidisciplinary tumor board discussions with the personal context and preference of the patient in mind. The patient factors, severity of symptoms and WHO performance status, and the tumor factor, PR tumor expression, were most relevant for selecting hormonal therapy or chemotherapy.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08486-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}