Gynecologic oncology最新文献

Eco-responsible and rational interval debulking surgery for high-grade ovarian carcinomas: An observational, ambispective cohort study. 高级别卵巢癌的生态负责和合理的间隔减容手术：一项观察性、双视角队列研究。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-02-05 DOI: 10.1016/j.ygyno.2026.01.771

Sarah Hodent, Naoual Bakrin, Pascal Rousset, Vahan Kepenekian, Witold Gertych, Pierre Descargues, Laurent Villeneuve, Mojgan Devouassoux-Shisheboran, Marion Favretto, Benoit You, Pierre-Adrien Bolze, Lucie Gaillot-Durand, Jonathan Lopez, Olivier Glehen, Alexis Trecourt

Background: Since the workload generated by interval debulking surgeries (IDS) for advanced high-grade tubo-ovarian carcinomas is high in the surgical pathology department (SPD), we aimed to assess the impacts of implementing an eco-responsible protocol to manage specimens from IDS.

Methods: The protocol (ECO-IDS) defined the specimens to send to the SPD and the sampling strategy during gross examination. Twenty patients were prospectively included (post-ECO-IDS group). A retrospective cohort of 20 patients, who did not benefit from the protocol, was built (pre-ECO-IDS group). Criteria compared were: the number of jars sent/paraffin blocks prepared, pathology procedures' carbon footprint, financial cost of specimen processing, time for pathology report validation, and chemotherapy response score (CRS). Next-generation sequencing (NGS) was performed to ensure the feasibility of molecular techniques on the post-ECO-IDS samples.

Results: The median number of jars sent per patient was 4 (post-ECO-IDS group) versus 14 (pre-ECO-IDS group; p < 0.0001). The median number of paraffin blocks prepared per patient was 12.5 (post-ECO-IDS group) versus 38 (pre-ECO-IDS group; p < 0.0001). The median carbon footprint per patient was 8.6 KgCO₂eq (post-ECO-IDS group) versus 24.1 KgCO₂eq (pre-ECO-IDS group; p < 0.0001). The median financial cost was €25.5 (post-ECO-IDS group) versus €57.9 (pre-ECO-IDS group; p < 0.0001). The mean time for pathology report validation was 7.5 days (post-ECO-IDS group) versus 10 days (pre-ECO-IDS group; p = 0.0131). There was no difference in CRS between both groups. NGS identified TP53 variants in 19/20 (95%) tumors.

Conclusion: Our protocol reduced environmental impacts, financial costs, and time to pathology report validation, without compromising the quality/safety of histopathology results.

背景：由于手术病理科（SPD）对晚期高级别输卵管性卵巢癌的间歇减容手术（IDS）产生的工作量很大，我们的目的是评估实施生态负责任的方案来管理IDS标本的影响。方法：采用ECO-IDS协议，明确了在大体检查时送SPD的标本和取样策略。前瞻性纳入20例患者（eco - ids后组）。建立了一个回顾性队列，包括20名未从方案中受益的患者（eco - ids前组）。比较的标准是：发送的罐子数量/制备的石蜡块数量，病理程序的碳足迹，标本处理的财务成本，病理报告验证的时间和化疗反应评分（CRS）。进行下一代测序（NGS）以确保分子技术在eco - ids后样品上的可行性。结果：每位患者发送的罐子中位数为4个（eco - ids后组），而14个（eco - ids前组）；p2eq （eco - ids后组），而24.1 KgCO2eq （eco - ids前组）。结论：我们的方案减少了环境影响、财务成本和病理报告验证的时间，而不影响组织病理学结果的质量/安全性。

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引用次数: 0

Clear cell carcinoma of cervix and vagina: A review of 63 cases in the post-DES era. 后des时代63例宫颈阴道透明细胞癌回顾性分析。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-02-05 DOI: 10.1016/j.ygyno.2026.01.773

Reem Saab, Alejandra Brazan, Gary B Chisholm, Naomi R Gonzales, Michael Frumovitz, Pamela T Soliman

Objective: To describe the clinical characteristics and oncologic outcomes of cervical and vaginal clear cell carcinoma (cCCC, vCCC) in the post-DES era.

Methods: This is a retrospective cross-sectional study of patients diagnosed with cCCC and vCCC between 2000 and 2024. Cervical cancer was staged using the International Federation of Gynecology and Obstetrics (FIGO) 2018 system and categorized as early stage (IA1-IB2, IIA1), locally advanced (IB3, IIA2-IVA) and advanced (IVB). Overall survival (OS) and recurrence-free survival (RFS) were estimated with the Kaplan-Meier product-limit estimator and modeled via Cox proportional hazards regression.

Results: A total of 63 patients were included: 51 cervical and 12 vaginal. Among cCCC, recurrence occurred in 21 patients (41.2%), with a median OS of 12.96 years (95% CI 8.83, 15.5). Early-stage disease was associated with a higher OS (p-value = 0.01) and RFS (p-value = 0.00049) compared to locally advanced and advanced disease. Lymph node metastasis was associated with poor OS (p-value = 0.0001) and RFS (p-value = 0.0113). In the vCCC group, recurrence was identified in 10 patients (83.3%), with a median OS of 3.26 years (95% CI 0.77, 6.75). Compared to cCCC, vCCC had worse prognosis with lower OS (p-value = 0.0009) and RFS (p-value = 0.0029).

Conclusion: Patients with cCCC have more favorable outcomes than those with vCCC, with stage and lymph node metastasis serving as predictors of survival outcomes in cCCC.

目的：探讨后des时代宫颈及阴道透明细胞癌（cCCC, vCCC）的临床特点及预后。方法：这是一项2000年至2024年间诊断为cCCC和vCCC的患者的回顾性横断面研究。宫颈癌分期采用国际妇产科联合会（FIGO） 2018系统，分为早期（IA1-IB2、IIA1）、局部晚期（IB3、IIA2-IVA）和晚期（IVB）。总生存期（OS）和无复发生存期（RFS）用Kaplan-Meier产品极限估计值估计，并通过Cox比例风险回归建模。结果：共纳入63例患者，其中宫颈51例，阴道12例。在cCCC中，21例（41.2%）患者出现复发，中位OS为12.96年（95% CI 8.83, 15.5）。与局部晚期和晚期疾病相比，早期疾病具有更高的OS （p值= 0.01）和RFS （p值= 0.00049）。淋巴结转移与较差的OS （p值= 0.0001）和RFS （p值= 0.0113）相关。在vCCC组中，10例患者（83.3%）复发，中位OS为3.26年（95% CI 0.77, 6.75）。与cCCC相比，vCCC预后较差，OS （p值= 0.0009）和RFS （p值= 0.0029）均较低。结论：cCCC患者预后优于vCCC患者，分期和淋巴结转移可作为cCCC患者生存预后的预测因素。

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引用次数: 0

Substratification of mismatch repair deficient endometrial cancers based on mechanism of MMR loss can provide prognostic and predictive refinement 基于MMR缺失机制的错配修复缺陷子宫内膜癌的亚分层可以提供预后和预测的改进。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.ygyno.2026.01.233

Amy Jamieson , Sila Rogan , Allen W. Zhang , Spencer D. Martin , Samuel Leung , Derek Chiu , Kathryn McRae , Sarah J. Mah , Stefan Kommoss , Aline Talhouk , David G. Huntsman , C. Blake Gilks , Jessica N. McAlpine

Background

Mismatch repair deficient (MMRd) endometrial carcinomas (EC) encompass 25–30% of ECs. Identifying MMRd directs Lynch Syndrome testing and immune checkpoint inhibitor (ICI) therapy. Our aim was to characterize the clinicopathologic and molecular features of MMRd ECs treated in the pre-ICI era.

Methods

MMRd ECs were identified retrospectively and tumors underwent selective immunohistochemistry and hotspot panel sequencing.

Results

MMRd ECs (n = 899) were predominantly FIGO 2009 stage I (77%), endometrioid histotype (92%), with 14% lymph node metastases (LNM). Lymphovascular invasion and myoinvasion were prognostic in MMRd ECs, but grade and histotype were not. Patients with MLH1 loss (80%) were older with higher BMI, had more deeply invasive tumors and more LNM compared to patients with MSH2/MSH6/isolated PMS2 loss (20%). Worse outcomes were observed with MLH1 loss; 18% of patients recurred and 10% died of disease compared to 7% and 4% with MSH2/MSH6/isolated PMS2 loss. MLH1 loss tumors had lower CD8+ tumor infiltrating lymphocyte densities, which were associated with worse prognosis. ER, PR, L1CAM and CTNNB1 were not associated with outcomes in MMRd ECs. There was no difference in outcomes between patients with MMRd-p53abn (N = 150, multiple classifiers) and MMRd ECs with wildtype p53 expression. Outcomes were identical for chemoradiation vs radiation alone for ESMO high risk or high/advanced/metastatic risk groups combined.

Conclusion

MLH1 loss identifies a subset of MMRd ECs with worse outcomes and lower CD8+ densities supporting substratification of this molecular subtype. Grade, histotype, ER, PR, L1CAM, CTNNB1 and p53 status do not add prognostic refinement within MMRd EC.

背景：错配修复缺陷（MMRd）子宫内膜癌（EC）占ECs的25-30%。确定MMRd指导Lynch综合征检测和免疫检查点抑制剂（ICI）治疗。我们的目的是描述在前ici时代治疗的MMRd ECs的临床病理和分子特征。方法：回顾性鉴定MMRd ECs，对肿瘤进行选择性免疫组化和热点组测序。结果：MMRd ECs （n = 899）主要为FIGO 2009 I期（77%），子宫内膜样组织型（92%），淋巴结转移（LNM）占14%。淋巴血管浸润和肌浸润是影响MMRd ECs预后的因素，但分级和组织型无关。与MSH2/MSH6/分离性PMS2丢失的患者（20%）相比，MLH1丢失的患者（80%）年龄较大，BMI较高，肿瘤深度浸润性更强，LNM更多。MLH1缺失的结果更差；18%的患者复发，10%的患者死于疾病，而MSH2/MSH6/分离性PMS2丢失分别为7%和4%。MLH1缺失肿瘤CD8+肿瘤浸润淋巴细胞密度较低，预后较差。ER、PR、L1CAM和CTNNB1与MMRd ec的预后无关。MMRd-p53abn患者（N = 150，多分类）与野生型p53表达的MMRd ECs患者的结局无差异。对于ESMO高风险或高/晚期/转移性风险组合，放化疗与单独放化疗的结果相同。结论：MLH1缺失确定了MMRd ECs的一个亚群，其预后较差，CD8+密度较低，支持该分子亚型的亚分层。分级、组织类型、ER、PR、L1CAM、CTNNB1和p53状态不能改善MMRd EC的预后。

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引用次数: 0

Understanding patient priorities: Sexual health and hereditary ovarian cancer syndromes 了解患者的优先事项：性健康和遗传性卵巢癌综合征

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-02-01 DOI: 10.1016/j.ygyno.2025.12.010

Luiza Perez , Amita Kulkarni , Steve Lopez , Jesse T. Brewer , Xiaoyue Ma , Shoshana M. Rosenberg , Melissa K. Frey

Background

Patients with hereditary breast and ovarian cancer syndromes are frequently recommended risk-reducing salpingo-oophorectomy years before natural menopause. While effective in reducing cancer-related morbidity and mortality, salpingo-oophorectomy increases the risk of sexual dysfunction. This study explores patient experiences and perspectives on integrating sexual health support within hereditary cancer syndrome care.

Methods

From 02/2023–11/2023, we conducted a cross-sectional survey study at a gynecologic oncology clinic. Patients at increased genetic risk for breast and ovarian cancer completed a 26-question survey adapted from previous literature. Descriptive and univariate analyses were performed.

Results

Of 81 patients approached, 75 (93 %) participated. Median age was 42 years (IQR 13.5); 46 (61 %) had prior risk-reducing surgery, and 22 (29 %) had history of breast cancer. Sixty-six (88 %) reported that sexuality and intimacy were important and 57 (76 %) felt these issues should be addressed by the healthcare team. Sixty (80 %) preferred discussing sexual health with a physician. Patients welcomed discussions at multiple timepoints, including before risk-reducing surgery (46, 61 %) and during follow-up (67, 89 %). Twenty-six (35 %) felt it was too overwhelming to address sexual health at the time of pathogenic variant diagnosis. Key interests included consequences of risk-reducing treatments (58, 77 %) and strategies for maintaining sexuality and intimacy (49, 65 %).

Conclusion

Sexual health is a significant concern for patients with hereditary breast and ovarian cancer risk. Most prefer physician-led conversations throughout different stages of care. These findings underscore the importance of a proactive, patient-centered approach to sexual health communication in this population.

背景：患有遗传性乳腺癌和卵巢癌综合征的患者经常被推荐在自然绝经前几年进行输卵管-卵巢切除术以降低风险。虽然输卵管卵巢切除术能有效降低癌症相关的发病率和死亡率，但却增加了性功能障碍的风险。本研究探讨患者的经验和观点整合性健康支持遗传性癌症综合征的护理。方法于2023年2月~ 2023年11月在某妇科肿瘤门诊进行横断面调查研究。乳腺癌和卵巢癌遗传风险增加的患者完成了一项26个问题的调查，该调查改编自以前的文献。进行了描述性和单变量分析。结果81例患者中，75例（93%）参与了治疗。中位年龄42岁（IQR 13.5）；46例（61%）有过降低风险的手术，22例（29%）有乳腺癌病史。66人（88%）认为性行为和亲密关系很重要，57人（76%）认为这些问题应该由医疗团队来解决。60%（80%）的人更愿意与医生讨论性健康问题。患者欢迎在多个时间点进行讨论，包括降低风险手术前（46.61%）和随访期间（67.89%）。26人（35%）认为在诊断致病变异时处理性健康问题太过困难。主要兴趣包括降低风险治疗的后果（58.77%）和维持性行为和亲密关系的策略（49.65%）。结论性健康是遗传性乳腺癌和卵巢癌患者的重要风险因素。大多数人更喜欢在治疗的不同阶段与医生进行对话。这些发现强调了在这一人群中积极主动、以患者为中心的性健康沟通方法的重要性。

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引用次数: 0

BRCA1 and BRCA2 carriers: Perceptions of endometrial cancer risk BRCA1和BRCA2携带者：子宫内膜癌风险的认知

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-30 DOI: 10.1016/j.ygyno.2026.01.235

Mark E. Sherman , Laura Pacheco-Spann , Susan Friedman , Diane Rose , William D. Foulkes , Christopher C. DeStephano , Kristina A. Butler , Kathryn J. Ruddy , Zhihui Fang , Lauren E. Haydu

Objective

To survey knowledge, preferred information sources, and risk tolerance for EC among BRCA1 and BRCA2 pathogenic variant (PV) carriers.

Methods

Electronic survey of 332 anonymous women. Descriptive statistics presented.

Results

Participants included non-Hispanic White (89.3%) United States residents (91.7%), with mean age of 45 years; 50.6% were BRCA 1 and 45.7% were BRCA 2 carriers; 56.7% had undergone risk-reducing surgery, including hysterectomy in 44.3%. Most cited reasons for hysterectomy were physician recommendation and EC risk. Among women with intact uteri, 42.2% or participants indicated that they would undergo hysterectomy if EC risk was ≥15%. When queried about specific EC risk factors, responses of “don't know” (if risk is increased or decreased) were given for 30.9%–75.5%, and specifically for BRCA1: 55.2% and for BRCA2: 72.6%. Participants expressed preferences for sources of information about EC risk (decreasing order) as gynecologic oncologists; medical oncologists; genetic counselors and gynecologists. Respondents indicated that providers recommended hysterectomy for 36.0%, against hysterectomy for 15.7% or gave conflicting information for 16.6%.

Conclusions

Many carriers have limited knowledge of EC risk and do not receive consistent counseling about hysterectomy.

目的调查BRCA1和BRCA2致病变异（PV）携带者对EC的知识、偏好信息来源和风险承受能力。方法对332名匿名女性进行电子调查。提供描述性统计数据。结果研究对象包括非西班牙裔白人（89.3%）、美国居民（91.7%），平均年龄45岁；BRCA 1型携带者50.6%，BRCA 2型携带者45.7%；56.7%的人接受了降低风险的手术，其中44.3%的人接受了子宫切除术。大多数被引用的子宫切除术的原因是医生建议和EC风险。在子宫完整的女性中，42.2%的参与者表示，如果EC风险≥15%，她们将接受子宫切除术。当被问及具体的EC危险因素时，30.9%-75.5%的人回答“不知道”（风险是否增加或减少），特别是BRCA1: 55.2%, BRCA2: 72.6%。作为妇科肿瘤学家，参与者表达了对EC风险信息来源的偏好（降序排列）；医疗肿瘤学家;遗传咨询师和妇科医生。受访者表示，提供者推荐子宫切除术的比例为36.0%，反对子宫切除术的比例为15.7%，或提供相互矛盾的信息的比例为16.6%。结论许多携带者对宫内妊娠风险的认识有限，且未接受子宫切除术的相关咨询。

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引用次数: 0

Extending eligibility criteria for sentinel lymph node biopsy in vulvar cancer: An update on the GroSNaPET study 扩大外阴癌前哨淋巴结活检的资格标准：GroSNaPET研究的最新进展

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-30 DOI: 10.1016/j.ygyno.2026.01.011

Simona Maria Fragomeni , Angela Collarino , Alex Federico , Giusi Pisano , Sara Ammar , Luca Zagaria , Pia Clara Pafundi , Giacomo Corrado , Stefano Gentileschi , Anna Caretto , Vittoria Rufini , Anna Fagotti , Giorgia Garganese

Introduction

Sentinel node biopsy (SNB) is the standard approach for nodal staging in clinically node-negative (cN0) patients with unifocal vulvar cancer ≤4 cm. Patients outside these criteria undergo lymphadenectomy, although many prove node-negative. The prospective GroSNaPET study evaluated SNB followed by lymphadenectomy in these patients. This report presents updated outcomes, long-term follow-up, and complication data.

Materials and methods

This single-center prospective study included cN0 patients ineligible for standard SNB due to ≥1 of the following: tumor >4 cm, multifocality, prior excision or (chemo)radiotherapy, unilateral nodal involvement, or relapse. All patients underwent SNB followed by complete lymphadenectomy. Histopathology was the reference standard. Complications were graded by Clavien–Dindo system. Diagnostic accuracy and survival outcomes were assessed with standard methods.

Results

Seventy-two patients (114 groins) were enrolled. The preoperative lymphoscintigraphic SNB identification rate was 94.7%. Among 265 sentinel nodes removed, 19 (7.2%) showed metastases, involving 16/108 groins (14.8%). Overall, 17/108 groins resulted metastatic. The proportion of false negatives over the entire study population was 0.9% (1/108), with a false negative rate of 5.9% (1/17). The negative predictive value was 98.9% and the diagnostic accuracy was 99.1%. Postoperative complications occurred in 70.8% cases, mainly lymphedema (19.7%) and lymphoceles (12%); 17% were Clavien–Dindo grade ≥ III. Median follow-up was 54.5 months; 22 recurrences (30.6%, including 3 inguinal) and 15 deaths (20.8%) were recorded. 5-year Disease Free Survival and Overall Survival were 65.6% and 82.7%.

Conclusions

SNB is accurate and safe beyond standard criteria. This study provides a robust comparison for GroSNaPET 2, which omits lymphadenectomy when SN is negative.

前哨淋巴结活检（SNB）是临床淋巴结阴性(cN0)≤4 cm的单灶外阴癌患者淋巴结分期的标准方法。不符合这些标准的患者接受淋巴结切除术，尽管许多患者证明淋巴结阴性。前瞻性GroSNaPET研究评估了这些患者SNB后的淋巴结切除术。本报告提供最新的结果、长期随访和并发症数据。材料和方法本单中心前瞻性研究纳入了cN0例因以下≥1项而不符合标准SNB的患者：肿瘤≥4cm，多灶性，既往切除或（化疗）放疗，单侧淋巴结累及或复发。所有患者均行SNB，然后行完全淋巴结切除术。组织病理学为参考标准。并发症采用Clavien-Dindo分级。采用标准方法评估诊断准确性和生存结果。结果纳入72例患者（114例腹股沟）。术前淋巴显像SNB检出率为94.7%。在265个前哨淋巴结中，19个（7.2%）出现转移，涉及16/108腹股沟（14.8%）。总体而言，108例腹股沟中有17例发生转移。假阴性占整个研究人群的比例为0.9%(1/108)，假阴性率为5.9%（1/17）。阴性预测值为98.9%，诊断准确率为99.1%。术后并发症发生率为70.8%，主要为淋巴水肿（19.7%）和淋巴囊肿（12%）；17%为Clavien-Dindo≥III级。中位随访时间为54.5个月；22例复发（30.6%，其中3例腹股沟），15例死亡（20.8%）。5年无病生存率和总生存率分别为65.6%和82.7%。结论snb超标准、准确、安全。本研究为GroSNaPET 2提供了一个强有力的比较，当SN阴性时，GroSNaPET 2省略了淋巴结切除术。

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引用次数: 0

Granulosa cell tumors: Initial surgical approach and recurrence 颗粒细胞瘤：最初的手术入路和复发

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-27 DOI: 10.1016/j.ygyno.2025.12.012

Erin Dwyer , L’Oreal Kennedy , Danika Bethune , Ronit Katz , Barbara Goff

Objective: Granulosa cell tumors account for 3–5% of ovarian cancers with a risk of recurrence of 10–25% in those with stage I disease. Our objective was to evaluate clinical factors associated with disease recurrence, with special attention to the role of initial surgical approach (minimally invasive vs. open abdominal) in recurrence risk.

Methods: All patients treated for GCT at University of Washington between 1980 and 2020 were included in the study. Retrospective review of demographic, medical/family/history, treatment and recurrence was performed. Descriptive statistical analysis of clinical and pathologic features, Kaplan-Meier curves, and Cox proportional hazards regression were performed.

Results: 174 patients were evaluated and 62 were eliminated due to incomplete data. 112 patients were included in the analysis sample with a median follow up time of 126 months (range 12–482 months) and median age of 46 years (IQR 37–55). Stage at diagnosis was primarily IA or IC. Surgical approach was open in 59% (N = 66), laparoscopic in 34% (N = 38), and robotic in 5% (N = 5) of patients. Tumor rupture was more common among the minimally invasive surgical approaches, compared to an open approach. Stage, need for adjuvant chemotherapy, and tumor rupture were associated with an increased risk of recurrence during the follow up period. Among patients with tumor rupture, 55% of patients had a recurrence event during the follow up period.

Conclusion: Tumor rupture at the time of surgery is a significant risk factor for recurrence. There is a higher risk of tumor rupture with minimally invasive surgery. Care should be taken to avoid iatrogenic tumor rupture.

目的：颗粒细胞肿瘤占卵巢癌的3-5%，在I期疾病中复发风险为10-25%。我们的目的是评估与疾病复发相关的临床因素，特别关注初始手术入路（微创与开腹）在复发风险中的作用。方法：1980年至2020年期间在华盛顿大学接受GCT治疗的所有患者纳入研究。对人口统计学、病史/家族史、治疗和复发情况进行回顾性分析。对临床和病理特征、Kaplan-Meier曲线和Cox比例风险回归进行描述性统计分析。结果：174例患者被评估，62例因数据不完整而被淘汰。112例患者纳入分析样本，中位随访时间126个月（范围12-482个月），中位年龄46岁（IQR 37-55岁）。诊断阶段主要为IA或IC。59% （N = 66）患者采用开放手术入路，34% （N = 38）患者采用腹腔镜手术入路，5% （N = 5）患者采用机器人手术入路。与开放入路相比，微创手术入路中肿瘤破裂更为常见。在随访期间，分期、是否需要辅助化疗和肿瘤破裂与复发风险增加相关。在肿瘤破裂的患者中，55%的患者在随访期间出现复发事件。结论：手术时肿瘤破裂是复发的重要危险因素。微创手术有较高的肿瘤破裂风险。应注意避免医源性肿瘤破裂。

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引用次数: 0

Risk of memory impairment in gynecologic cancer survivors in the Women's Health Initiative: Untangling effects of age, comorbidities, and cancer 妇女健康倡议中妇科癌症幸存者的记忆障碍风险：年龄、合并症和癌症的影响

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-26 DOI: 10.1016/j.ygyno.2026.01.006

Benjamin J. Matthews , Electra D. Paskett , Eric McLaughlin , Diane Von Ah , Rowan Chlebowski , Chloe M. Hery , Michael Pennell , Tracy Vannorsdall , Longjian Liu , Aladdin H. Shadyab , Kathy Pan , Stephanie L. Wethington

Objective

To assess whether gynecologic cancer history predicts worsened self-reported memory outcomes, accounting for the interaction of age and comorbidities.

Methods

Nested case-control study of cancer survivors enrolled in the ancillary Life and Longevity After Cancer (LILAC) study of the Women's Health Initiative (WHI) and matched cancer-free WHI participants, longitudinally followed after initial enrollment from 1993 to 1998. Postmenopausal women with incident endometrial or ovarian cancer during the WHI were compared to cancer-free women matched up to 5:1 to survivors. Participants with pre-existing cognitive dysfunction, neurodegenerative disease, or multiple cancers were excluded. The primary outcome was self-reported “moderate/severe memory problems” ≥12 months following cancer diagnosis of the index survivor. Associations of pre-diagnosis conditions with later memory problems were examined through cause-specific hazards models, accounting for competing mortality risk.

Results

Primary analyses included 1395 survivors and 5364 cancer-free controls. In multivariable analysis, cancer history was associated with decreased self-reported memory problems (cause-specific hazard ratio [csHR] 0.71 [0.57–0.87], p = 0.001). The only factors independently predictive of future memory concerns were increasing age (5-year increase; csHR 1.96 [1.84–2.09], p < 0.001), cardiovascular disease (hypertension csHR 1.24 [1.03–1.50]; major cardiovascular events csHR 1.85 [1.28–2.68], p = 0.002), diabetes (csHR 1.47 [1.10–1.96], p = 0.01), and depression (csHR 1.47 [1.11–1.95], p = 0.008).

Conclusions

After accounting for mortality differences, gynecologic cancer survivors experienced reduced hazard for self-reported moderate/severe memory problems. In this population, significant memory symptoms may represent aging and comorbidity effects more than cancer-related outcomes.

目的考虑年龄和合并症的相互作用，评估妇科癌症病史是否能预测自我报告记忆结果的恶化。方法对参加妇女健康倡议（WHI）的辅助癌症后生活和长寿（LILAC）研究的癌症幸存者和匹配的无癌症WHI参与者进行了回顾性病例对照研究，从1993年至1998年首次入组后进行了纵向随访。在WHI期间发生子宫内膜癌或卵巢癌的绝经后妇女与无癌症妇女的比例为5:1。排除已有认知功能障碍、神经退行性疾病或多种癌症的参与者。主要结局是在癌症诊断后≥12个月的指数幸存者自我报告的“中度/重度记忆问题”。通过病因特异性风险模型检查了诊断前条件与后来记忆问题的关联，并考虑了相互竞争的死亡风险。结果初步分析纳入1395名幸存者和5364名无癌对照。在多变量分析中，癌症病史与自我报告的记忆问题减少相关（病因特异性风险比[csHR] 0.71 [0.57-0.87], p = 0.001）。唯一独立预测未来记忆问题的因素是年龄增加（5年增加；csHR 1.96 [1.84-2.09], p < 0.001）、心血管疾病（高血压csHR 1.24[1.03-1.50]；主要心血管事件csHR 1.85 [1.28-2.68], p = 0.002）、糖尿病（csHR 1.47 [1.10-1.96], p = 0.01）和抑郁症（csHR 1.47 [1.11-1.95], p = 0.008）。在考虑死亡率差异后，妇科癌症幸存者自我报告的中度/重度记忆问题的风险降低。在这一人群中，显著的记忆症状可能代表着衰老和共病的影响，而不是癌症相关的结果。

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引用次数: 0

Expression of antibody drug conjugate target antigens in ovarian sex cord stromal Tumors 抗体药物偶联靶抗原在卵巢性索间质瘤中的表达

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.ygyno.2026.01.234

Allison L. Brodsky , Elio Tahan , Joseph Celestino , Ximing Tang , Maria G. Raso , Sherita Meyer-Gauen , Alexandra Bercow , Barrett Lawson , R. Tyler Hillman

Objective

The purpose of this study is to determine antibody-drug conjugate (ADC) target antigen expression in ovarian sex cord stromal tumors (SCSTs).

Methods

This was a retrospective, single-institution study examining SCSTs for immunohistochemical (IHC) expression of antigens targeted by five FDA-approved ADCs (TROP-2, HER2, folate receptor alpha, nectin-4, and tissue factor) plus expression of delta-like ligand 3 (DLL3), the target of tarlatamab-dlle, a bispecific T-cell engager. Demographic and clinical information were abstracted from medical records. Differences in H-scores were evaluated using the Wilcoxon rank-sum tests and correlation between variables was assessed using Spearman's rank correlation coefficient.

Results

Thirty-two SCST samples from thirty individual patients were included. The most common diagnosis was adult type granulosa cell tumor. Minimal to no staining was observed for the antigens TROP-2, HER2, folate receptor alpha, nectin-4, and DLL3. Frequent staining for tissue factor was observed in adult GCTs with a median H-score of 49.6 (interquartile range: 1.3–122.8) and 72% had ≥1% expression of tissue factor. A modest positive correlation between H-score and estrogen receptor positivity was noted (Spearman's rho = 0.49, p = 0.06). The tissue factor H-score for the single juvenile GCT was 43.2 and for the two Sertoli Leydig tumors, H-scores were 1 and 10.2.

Conclusion

The pervasive absence of HER2, folate receptor alpha, DLL3, TROP-2, and nectin-4 expression in SCSTs suggests ADCs targeting these antigens may be of limited clinical benefit. The design of clinical trials investigating the use of tissue factor-targeting ADCs for the treatment of adult GCTs warrants future consideration.

目的探讨抗体-药物偶联靶抗原在卵巢性索间质瘤（SCSTs）中的表达。方法：这是一项回顾性的单机构研究，检测了SCSTs中5种fda批准的adc （TROP-2、HER2、叶酸受体α、连接素-4和组织因子）靶向抗原的免疫组化（IHC）表达，以及delta-样配体3 （DLL3）的表达，DLL3是双特异性t细胞结合剂tarlatamab-dlle的靶标。从病历中提取人口统计和临床信息。采用Wilcoxon秩和检验评估h分数的差异，采用Spearman秩相关系数评估变量之间的相关性。结果纳入30例患者的32份SCST样本。最常见的诊断为成人型颗粒细胞瘤。抗原TROP-2、HER2、叶酸受体α、nectin-4和DLL3几乎没有染色。成人gct中组织因子染色频繁，h值中位数为49.6（四分位数范围为1.3-122.8），72%的组织因子表达≥1%。h -评分与雌激素受体阳性呈正相关（Spearman’s rho = 0.49, p = 0.06）。单发幼年型GCT的组织因子h -评分为43.2，两例Sertoli Leydig肿瘤的h -评分分别为1和10.2。结论HER2、叶酸受体α、DLL3、TROP-2和nectin-4在SCSTs中普遍缺乏表达，提示针对这些抗原的adc的临床益处可能有限。研究使用组织因子靶向adc治疗成人gct的临床试验设计值得未来考虑。

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引用次数: 0

Survival comparison analysis between cervical squamous cell carcinoma and adenocarcinoma with a special focus on the HPV status 宫颈鳞状细胞癌和腺癌的生存比较分析，特别关注HPV状态

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.ygyno.2026.01.012

Deepti Jain , Marya Wahidi , Judy Effendi , Lien Hoang , Cristina Terinte , Anna Pesci , Takako Kiyokawa , Isabel Alvarado-Cabrero , Esther Oliva , Natalia Rakislova , Ana Felix , Douglas Allison , Esther Guerra , Andres Roma , Oluwole Fadare , Gulisa Turashvili , Carlos Parra-Herran , Gozde Kir , Ahmet Erbagci , Anne Mills , Rouba Ali-Fehmi

Background

Our study examines impact of HPV status and patient-specific characteristics on recurrence-free survival (RFS) and overall survival (OS) for SCC and ECA.

Methods

This multi-continental retrospective study analyzed clinicopathologic data of 634 patients with microscopically confirmed cervical cancer (CC; only SCC and ECA) across Asia, Europe, and North America. HPV status was determined using PCR or HPV in situ hybridization (ISH) for both HR-HPV (SCC and ECA) and LR-HPV (SCC), using same platform. Descriptive analysis and Cox regression models were produced.

Results

Out of total 634 patients, 533 (84.1%) were HPVA and 101 (15.9%) were HPVI. 65% had SCC morphology (88.1%: HPVA; 11.9%: HPVI) and 35% had ECA differentiation (76.6%: HPVA; 23.4%: HPVI). Compared to ECA, patients with SCC were older (median age: 51 vs. 45 years old; p < 0.001), had higher HPVA status (88.1% vs. 76.6%; p < 0.001), and a higher rate of lymph-vascular invasion (LVI; 64.8% vs. 56.8%; p = 0.004). However, patients with ECA had a higher rate of metastases to pelvic organs (13.5% vs. 2.4%; p < 0.001). In univariable analysis, HPV status, tumor type, higher FIGO stage, older age, LVI positive, lymph node metastasis (LNM), and adjuvant treatment were all associated with impaired RFS and OS (all p ≤ 0.007). In multivariable analysis, LVI, HPV status, institution, and tumor type remained significant for RFS, while age at diagnosis, FIGO stage, LVI, and tumor type remained significant for OS.

Conclusion

Tumor type and HPV status play significant role in determining survival outcomes in CC.

本研究探讨了HPV状态和患者特异性特征对SCC和ECA的无复发生存期（RFS）和总生存期（OS）的影响。方法：这项多大洲回顾性研究分析了亚洲、欧洲和北美634例显微镜下确诊的宫颈癌（CC，仅SCC和ECA）患者的临床病理资料。HR-HPV （SCC和ECA）和LR-HPV （SCC）在同一平台上采用PCR或HPV原位杂交（ISH）检测HPV状态。采用描述性分析和Cox回归模型。结果634例患者中，hpv为533例（84.1%），hpv为101例（15.9%）。65%有SCC形态（88.1%:HPVA; 11.9%: HPVI）， 35%有ECA分化（76.6%:HPVA; 23.4%: HPVI）。与ECA相比，SCC患者年龄更大（中位年龄：51比45岁；p < 0.001）， HPVA状态更高（88.1%比76.6%;p < 0.001），淋巴血管侵袭率更高（LVI； 64.8%比56.8%;p = 0.004）。然而，ECA患者的盆腔器官转移率更高（13.5% vs. 2.4%; p < 0.001）。在单变量分析中，HPV状态、肿瘤类型、较高的FIGO分期、年龄、LVI阳性、淋巴结转移（LNM）和辅助治疗均与RFS和OS受损相关（均p≤0.007）。在多变量分析中，LVI、HPV状态、机构和肿瘤类型对RFS仍然具有显著性，而诊断年龄、FIGO分期、LVI和肿瘤类型对OS仍然具有显著性。结论肿瘤类型和HPV状态对CC患者的生存预后有重要影响。

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引用次数: 0