Gynecologic oncology最新文献

Diabetes mellitus complications associated with recurrence of stage I endometrioid endometrial cancer: A single-center retrospective study 与 I 期子宫内膜样内膜癌复发相关的糖尿病并发症：单中心回顾性研究

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-17 DOI: 10.1016/j.ygyno.2024.09.007

Objective

Identifying clinical features that are associated with recurrence of endometrioid endometrial carcinoma (EEC) in patients with diabetes mellitus (DM).

Methods

A single-center retrospective cohort study was performed on patients with a diagnosis of both DM and Stage I EEC. Clinical and pathologic features were analyzed in relation to 5-year progression free survival (PFS). Kaplan-Meier Curves and Cox proportional hazard ratios were utilized to assess effect on 5-year PFS.

Results

A total of 539 patients were included, with biopsy proven recurrence in 86 (18 %), and 456 (82 %) with no evidence of recurrence. Age, BMI, HgbA1c, metformin use, number of antihyperglycemic medications, use of adjuvant radiation, and surgical approach were not associated with differences in PFS. Presence of end-organ complications associated with diabetes was correlated with worse PFS (HR 1.78, 95 % CI 1.1–2.9, P = 0.02), and specifically diabetic neuropathy was associated with higher rates of recurrence (HR 3.6, 95 % CI 2.1–6.2, P < 0.01). In this cohort, PFS was independently associated with extent of myoinvasion (HR 2.33, 95 % CI 1.4–3.7, P < 0.01) as well as both microsatellite instability (HR 3.43, 95 % CI 1.8–6.6, P < 0.01), and no specific molecular profile (HR 0.3, 95 % CI 0.2–0.6, P < 0.01) molecular subtypes.

Conclusions

In patients with DM and EEC, extent of myoinvasion and TCGA molecular subtype correlated with worse PFS. Control of DM as evidenced by HgbA1c, BMI, and use of antihyperglycemic medications did not correlate with PFS in our cohort of patients with Stage I EEC, while the presence of diabetic neuropathy was associated with a higher risk of recurrence. These results highlight importance of evaluating diabetes severity and molecular subtype in endometrial cancer patients.

目的确定与糖尿病（DM）患者子宫内膜样内膜癌（EEC）复发相关的临床特征。方法对诊断为DM和I期EEC的患者进行了一项单中心回顾性队列研究。分析了临床和病理特征与5年无进展生存期（PFS）的关系。结果共纳入 539 例患者，其中 86 例（18%）活检证实复发，456 例（82%）无复发证据。年龄、体重指数（BMI）、血红蛋白A1c、二甲双胍的使用、降糖药物的数量、辅助放射的使用以及手术方式与PFS的差异无关。糖尿病相关内脏并发症的存在与较差的 PFS 相关（HR 1.78，95 % CI 1.1-2.9，P = 0.02），特别是糖尿病神经病变与较高的复发率相关（HR 3.6，95 % CI 2.1-6.2，P <0.01）。在该队列中，PFS 与肌层浸润程度（HR 2.33，95 % CI 1.4-3.7，P < 0.01）以及微卫星不稳定性（HR 3.43，95 % CI 1.8-6.6，P < 0.结论在DM和EEC患者中，肌层浸润程度和TCGA分子亚型与较差的PFS相关。在我们的I期EEC患者队列中，通过HgbA1c、体重指数（BMI）和使用降糖药物证明的DM控制情况与PFS无关，而糖尿病神经病变的存在与较高的复发风险相关。这些结果凸显了评估子宫内膜癌患者糖尿病严重程度和分子亚型的重要性。

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引用次数: 0

Concurrent POLE hotspot mutations and mismatch repair deficiency/microsatellite instability in endometrial cancer: A challenge in molecular classification 子宫内膜癌中并发的 POLE 热点突变和错配修复缺陷/微卫星不稳定性：分子分类的挑战

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-13 DOI: 10.1016/j.ygyno.2024.09.008

Objective

Endometrial carcinoma (EC) has different molecular subtypes associated with varied prognosis. We sought to characterize the molecular features of ECs with POLE hotspot mutations and concurrent mismatch repair (MMR) deficiency/high microsatellite instability (MSI).

Methods

We identified POLE-mutated (POLEmut), MMR-deficient (MMRd)/MSI-high (MSI-H), or combined POLEmut/MMRd ECs subjected to clinical tumor-normal panel sequencing between 2014 and 2023. Clonality of somatic mutations, MSI scoring, tumor mutational burden (TMB), proportion of somatic insertions and deletions (indels), and single base substitution (SBS) mutational signatures were extracted.

Results

We identified 41 ECs harboring POLE exonuclease domain hotspot mutations, 138 MMRd and/or MSI-H ECs, and 14 POLEmut/MMRd ECs. Among the 14 POLEmut/MMRd ECs, 11 (79 %) exhibited clonal POLE hotspot mutations; 4 (29 %) had a dominant POLE-related mutational signature, 4 (29 %) displayed dominant MMRd-related signatures, and 6 (43 %) had mixtures of POLE, aging/clock, MMRd, and POLEmut/MMRd-related SBS mutational signatures. The number of single nucleotide variants was higher in POLEmut/MMR-proficient (MMRp) and in POLEmut/MMRd ECs compared to POLE wild-type (wt)/MMRd EC (both p < 0.001). Small indels were enriched in POLEwt/MMRd ECs (p < 0.001). TMB was highest in POLEmut/MMRd EC compared to POLEmut/MMRp and POLEwt/MMRd ECs (both p < 0.001). Of 14 patients with POLEmut/MMRd EC, 21 % had a recurrence, versus 10 % of those with POLEmut/MMRp EC. Similar findings were noted in 3 POLEmut ECs in patients with Lynch syndrome; akin to somatic POLEmut ECs, these tumors had high TMB.

Conclusion

POLEmut/MMRd ECs may be genetically distinct. Further studies are needed to assess the impact on outcomes and treatment response within this population.

目的子宫内膜癌（EC）具有不同的分子亚型，预后各异。我们试图描述具有 POLE 热点突变和同时存在错配修复（MMR）缺陷/高微卫星不稳定性（MSI）的子宫内膜癌的分子特征。我们提取了体细胞突变的克隆性、MSI评分、肿瘤突变负荷（TMB）、体细胞插入和缺失（indels）比例以及单碱基置换（SBS）突变特征。结果我们发现了41例携带POLE外切酶域热点突变的ECs、138例MMRd和/或MSI-H ECs以及14例POLEmut/MMRd ECs。在14个POLEmut/MMRd ECs中，11个（79%）表现出克隆性POLE热点突变；4个（29%）具有显性POLE相关突变特征，4个（29%）显示出显性MMRd相关特征，6个（43%）具有POLE、老化/时钟、MMRd和POLEmut/MMRd相关SBS突变特征的混合物。与POLE野生型（wt）/MMRd EC相比，POLEmut/MMR-picient (MMRp)和POLEmut/MMRd EC的单核苷酸变异数量更高（均为p <0.001）。POLEwt/MMRd EC 中富含小的嵌合体（p < 0.001）。与 POLEmut/MMRp 和 POLEwt/MMRd ECs 相比，POLEmut/MMRd EC 中的 TMB 最高（均为 p < 0.001）。14 名 POLEmut/MMRd EC 患者中有 21% 复发，而 POLEmut/MMRp EC 患者中只有 10%复发。林奇综合征患者中的 3 例 POLEmut EC 也有类似发现；与体细胞型 POLEmut EC 相似，这些肿瘤的 TMB 也很高。需要进一步研究以评估其对这一人群的预后和治疗反应的影响。

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引用次数: 0

Financial toxicity: Moving from describing the problem toward developing interventions 财务毒性：从描述问题到制定干预措施

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-13 DOI: 10.1016/j.ygyno.2024.09.009

引用次数: 0

Impact of immune, inflammatory and nutritional indices on outcome in patients with locally advanced cervical cancer treated with definitive (chemo)radiotherapy 免疫、炎症和营养指数对接受确定性（化疗）放疗的局部晚期宫颈癌患者预后的影响

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-12 DOI: 10.1016/j.ygyno.2024.09.005

Objective

Systemic immune, inflammatory, and nutritional indices are prognostic across multiple tumor sites. Comprehensive analysis of these markers in patients with locally advanced cervical cancer (LACC) treated with definitive (chemo)radiotherapy [(C)RT] is limited and may assist with future prognostication.

Methods

For this retrospective cohort study, patients with LACC treated with definitive (C)RT were identified from a comprehensive cancer center's clinicopathological database. Pre-treatment indices were derived including systemic immune-inflammation index (SII), platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), albumin to alkaline phosphatase ratio (AAPR) and prognostic nutritional index (PNI). Univariate analysis was performed for PFS and OS. ROC curves were analyzed to determine optimal cut points. PFS and OS were assessed by the Kaplan-Meier method and Log-Rank test. Multivariate analysis was performed using Cox regression.

Results

196 patients were identified: median follow-up 7 years (IQR 2–11). Higher SII (≤700 vs >700; p = 0.01), higher PLR (≤ 250 vs >250; p < 0.001) and higher NLR (≤ 5 vs >5; p = 0.003) were associated with worse PFS. Higher SII (≤700 vs >700: p = 0.02), higher PLR (≤ 250 vs >250: p < 0.001) and higher NLR (≤ 5 vs >5; p = 0.01) were associated with worse OS. On multivariate analysis, SII, NLR and PLR were independently associated with PFS. SII and PLR were independently associated with OS.

Conclusions

SII and PLR were independently associated with PFS and OS in patients with LACC treated with definitive (C)RT. NLR was independently associated with PFS. High inflammatory state is associated with shorter survival suggesting this as a target for interventions if validated in future studies.

目的系统免疫、炎症和营养指标对多个肿瘤部位的预后都有影响。在这项回顾性队列研究中，研究人员从一家综合癌症中心的临床病理数据库中找到了接受确定性（化学）放疗[（C）RT]治疗的局部晚期宫颈癌（LACC）患者。得出的治疗前指数包括全身免疫炎症指数（SII）、血小板淋巴细胞比值（PLR）、中性粒细胞淋巴细胞比值（NLR）、单核细胞淋巴细胞比值（MLR）、白蛋白与碱性磷酸酶比值（AAPR）和预后营养指数（PNI）。对 PFS 和 OS 进行了单变量分析。分析 ROC 曲线以确定最佳切点。PFS 和 OS 采用 Kaplan-Meier 法和 Log-Rank 检验进行评估。采用 Cox 回归法进行多变量分析。结果 196 例患者的中位随访时间为 7 年（IQR 2-11）。较高的 SII（≤700 vs >700；p = 0.01）、较高的 PLR（≤250 vs >250；p <0.001）和较高的 NLR（≤5 vs >5；p = 0.003）与较差的 PFS 相关。较高的 SII（≤700 vs >700：p = 0.02）、较高的 PLR（≤250 vs >250：p <0.001）和较高的 NLR（≤5 vs >5；p = 0.01）与较差的 OS 相关。多变量分析显示，SII、NLR和PLR与PFS独立相关。结论SII和PLR与接受确定性（C）RT治疗的LACC患者的PFS和OS独立相关。NLR与PFS独立相关。高炎症状态与较短的生存期相关，如果在未来的研究中得到验证，这将成为干预的目标。

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引用次数: 0

Results of a randomized phase II trial of paclitaxel and carboplatin versus bleomycin, etoposide and cisplatin for newly diagnosed and recurrent Chemonaive stromal ovarian tumors: An NRG oncology/gynecologic oncology group study14 紫杉醇和卡铂与博来霉素、依托泊苷和顺铂治疗新诊断和复发的切莫纳间质卵巢肿瘤的随机 II 期试验结果：NRG 肿瘤学/妇科肿瘤学小组研究14

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-12 DOI: 10.1016/j.ygyno.2024.09.002

Objectives

To assess the efficacy and toxicity of paclitaxel and carboplatin (PC) compared to bleomycin, etoposide, and cisplatin (BEP) for treatment of newly diagnosed Stage IIA-IV or recurrent chemotherapy-naive ovarian sex cord-stromal tumors (SCST).

Methods

This phase II noninferiority trial randomly assigned patients to receive PC (6 cycles P 175 mg/m2 and C AUC = 6 IV every 3 weeks), or BEP (4 cycles B 20 units/m2 IV push day 1, E 75 mg/m2 IV days 1–5, and cisplatin 20 mg/m2 IV days 1–5 every 3 weeks). The primary endpoint was progression- free survival (PFS). This trial is registered with ClinicalTrials.gov, NCT01042522.

Results

At the interim analysis, 63 patients (31 PC and 32 B.P. had accrued between Feb 8, 2010 and Apr 30, 2020. Median age was 48 years. 87% had granulosa cell tumors. 37% had measurable disease. The DSMB closed accrual early for futility of PC arm. The futility analysis was supported by an estimated HR = 1.11 [95% CI: 0.57 to 2.13] which exceeded the pre-determined threshold for non-inferiority (1.10). Median PFS was 27.7 months [11.2 to 41.0] for PC and 19.7 months for BEP [95% CI: 10.4–52.7]. PC patients had fewer grade 3 or higher adverse events (PC 77% vs BEP 90%).

Conclusions

The study met its pre-specified criterion for stopping early for futility and so failed to demonstrate non-inferiority of PC versus BEP in ovarian SCSTs, in a non-inferiority test with a hazard ratio margin of 1.1. Both PC and BEP may be considered in patients with advanced/recurrent SCST.

目的评估紫杉醇和卡铂（PC）与博来霉素、依托泊苷和顺铂（BEP）治疗新诊断的 IIA-IV 期或复发性化疗无效卵巢性索间质肿瘤（SCST）的疗效和毒性。方法这项 II 期非劣效试验随机分配患者接受 PC（6 个周期，P 175 mg/m2 和 C AUC = 6 IV，每 3 周一次）或 BEP（4 个周期，B 20 单位/m2 IV 推注第 1 天，E 75 mg/m2 IV 第 1-5 天，顺铂 20 mg/m2 IV 第 1-5 天，每 3 周一次）治疗。主要终点是无进展生存期（PFS）。该试验已在 ClinicalTrials.gov 登记，编号为 NCT01042522。结果在中期分析时，共有 63 名患者（31 名 PC 和 32 名 B.P.）在 2010 年 2 月 8 日至 2020 年 4 月 30 日期间入组。中位年龄为 48 岁。87%的患者患有颗粒细胞肿瘤。37%患有可测量的疾病。DSMB 因 PC 治疗组无效而提前结束了应计制。无效性分析结果显示，估计 HR = 1.11 [95% CI：0.57 至 2.13]，超过了预先确定的非劣效性阈值（1.10）。PC和BEP的中位PFS分别为27.7个月[11.2-41.0]和19.7个月[95% CI：10.4-52.7]。PC患者发生3级或以上不良事件的比例较低（PC 77% vs BEP 90%）。结论该研究达到了预先指定的因无效而提前终止的标准，因此未能证明PC与BEP在卵巢SCST中的非劣效性，非劣效性试验的危险比值为1.1。对于晚期/复发性 SCST 患者，PC 和 BEP 均可考虑使用。

{"title":"Results of a randomized phase II trial of paclitaxel and carboplatin versus bleomycin, etoposide and cisplatin for newly diagnosed and recurrent Chemonaive stromal ovarian tumors: An NRG oncology/gynecologic oncology group study14","authors":"","doi":"10.1016/j.ygyno.2024.09.002","DOIUrl":"10.1016/j.ygyno.2024.09.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the efficacy and toxicity of paclitaxel and carboplatin (PC) compared to bleomycin, etoposide, and cisplatin (BEP) for treatment of newly diagnosed Stage IIA-IV or recurrent chemotherapy-naive ovarian sex cord-stromal tumors (SCST).</p></div><div><h3>Methods</h3><p>This phase II noninferiority trial randomly assigned patients to receive PC (6 cycles P 175 mg/m2 and C AUC = 6 IV every 3 weeks), or BEP (4 cycles B 20 units/m2 IV push day 1, E 75 mg/m2 IV days 1–5, and cisplatin 20 mg/m2 IV days 1–5 every 3 weeks). The primary endpoint was progression- free survival (PFS). This trial is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT01042522</span><svg><path></path></svg></span>.</p></div><div><h3>Results</h3><p>At the interim analysis, 63 patients (31 PC and 32 B.P. had accrued between Feb 8, 2010 and Apr 30, 2020. Median age was 48 years. 87% had granulosa cell tumors. 37% had measurable disease. The DSMB closed accrual early for futility of PC arm. The futility analysis was supported by an estimated HR = 1.11 [95% CI: 0.57 to 2.13] which exceeded the pre-determined threshold for non-inferiority (1.10). Median PFS was 27.7 months [11.2 to 41.0] for PC and 19.7 months for BEP [95% CI: 10.4–52.7]. PC patients had fewer grade 3 or higher adverse events (PC 77% vs BEP 90%).</p></div><div><h3>Conclusions</h3><p>The study met its pre-specified criterion for stopping early for futility and so failed to demonstrate non-inferiority of PC versus BEP in ovarian SCSTs, in a non-inferiority test with a hazard ratio margin of 1.1. Both PC and BEP may be considered in patients with advanced/recurrent SCST.</p></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168741","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}

引用次数: 0

Cervical squamous cell carcinoma outcomes across continents: A retrospective study 各大洲宫颈鳞状细胞癌的预后：回顾性研究

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-11 DOI: 10.1016/j.ygyno.2024.09.006

Objective

To assess the influence of geographies and race on the survival outcomes in patients diagnosed with cervical squamous cell carcinoma (CSCC) across three continents.

Methods

This multicontinental retrospective study was conducted in 8 hospitals across Asia, Europe, and North America (NA). Clinicopathologic data of 595 patients with presumed early stages of CSCC, treated surgically, with curative intent was collected. Descriptive analysis and Cox regression models were produced.

Results

A total of 595 patients, consisting of 445 (74.8 %) white, 75 (12.6 %) Blacks, and 75 (12.6 %) Asian patients were included. Geographical distribution comprised 69 % of patients from NA, 22 % from Europe, and 9 % from Asia. The median age at diagnosis was 46 years. The median overall survival (OS) and relapse-free survival (RFS) were 22.09 years and 21.19 years, respectively. Patient characteristics varied significantly across geographical regions, except for consensus tumor grade. Patients in Europe from middle-income countries with limited CC screening had a substantially higher risk of death than those in NA (HR, 1.79; 95 % CI, 1.13 to 2.79; p = 0.015). Patients from single center in Japan had higher risk of relapse than those from the four heterogeneous NA centers (sub-distribution hazard ratio, 2.19; 95 % CI, 1.22 to 3.95; p = 0.009), although OS did not differ significantly. Race remained statistically insignificant for survival outcomes across the three continents but seemed to influence survival outcomes in NA centers.

Conclusion

Our study highlights impact of geographies and races on CSCC survival outcomes, emphasizing the need of considering these factors when developing targeted interventions against CSCC.

方法这项多洲回顾性研究在亚洲、欧洲和北美洲（NA）的 8 家医院进行。研究收集了 595 名推测为 CSCC 早期患者的临床病理数据，这些患者均接受过治愈性手术治疗。结果共纳入 595 例患者，其中白人 445 例（74.8%），黑人 75 例（12.6%），亚裔 75 例（12.6%）。地理分布方面，69%的患者来自北美洲，22%来自欧洲，9%来自亚洲。确诊时的中位年龄为 46 岁。总生存期（OS）和无复发生存期（RFS）的中位数分别为 22.09 年和 21.19 年。除肿瘤分级一致外，不同地区的患者特征差异很大。来自欧洲中等收入国家、CC筛查有限的患者的死亡风险远高于北欧国家的患者（HR，1.79；95 % CI，1.13 至 2.79；P = 0.015）。来自日本单一中心的患者复发风险高于来自四个不同的 NA 中心的患者（亚分布危险比，2.19；95 % CI，1.22 至 3.95；p = 0.009），但 OS 并无显著差异。我们的研究强调了地域和种族对 CSCC 生存结果的影响，强调在制定针对 CSCC 的干预措施时需要考虑这些因素。

{"title":"Cervical squamous cell carcinoma outcomes across continents: A retrospective study","authors":"","doi":"10.1016/j.ygyno.2024.09.006","DOIUrl":"10.1016/j.ygyno.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the influence of geographies and race on the survival outcomes in patients diagnosed with cervical squamous cell carcinoma (CSCC) across three continents.</p></div><div><h3>Methods</h3><p>This multicontinental retrospective study was conducted in 8 hospitals across Asia, Europe, and North America (NA). Clinicopathologic data of 595 patients with presumed early stages of CSCC, treated surgically, with curative intent was collected. Descriptive analysis and Cox regression models were produced.</p></div><div><h3>Results</h3><p>A total of 595 patients, consisting of 445 (74.8 %) white, 75 (12.6 %) Blacks, and 75 (12.6 %) Asian patients were included. Geographical distribution comprised 69 % of patients from NA, 22 % from Europe, and 9 % from Asia. The median age at diagnosis was 46 years. The median overall survival (OS) and relapse-free survival (RFS) were 22.09 years and 21.19 years, respectively. Patient characteristics varied significantly across geographical regions, except for consensus tumor grade. Patients in Europe from middle-income countries with limited CC screening had a substantially higher risk of death than those in NA (HR, 1.79; 95 % CI, 1.13 to 2.79; <em>p</em> = 0.015). Patients from single center in Japan had higher risk of relapse than those from the four heterogeneous NA centers (sub-distribution hazard ratio, 2.19; 95 % CI, 1.22 to 3.95; <em>p</em> = 0.009), although OS did not differ significantly. Race remained statistically insignificant for survival outcomes across the three continents but seemed to influence survival outcomes in NA centers.</p></div><div><h3>Conclusion</h3><p>Our study highlights impact of geographies and races on CSCC survival outcomes, emphasizing the need of considering these factors when developing targeted interventions against CSCC.</p></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168739","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}

引用次数: 0

Systematic review – Adjuvant radiotherapy of the vulva in primary vulvar cancer 系统综述 - 原发性外阴癌的外阴辅助放射治疗

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-11 DOI: 10.1016/j.ygyno.2024.09.003

Objective

Adjuvant radiotherapy to the vulva in vulvar squamous cell carcinoma (VSCC) is frequently performed albeit strong evidence is lacking. This systematic review aims to summarize the current literature on this topic.

Methods

19 retrospective studies were included and analyzed, focusing on the primary outcome of local recurrence.

Results

The publications present conflicting results. While the benefit of adjuvant radiotherapy to the groins in case of node-positive VSCC is well established, the indication criteria and effectiveness of adjuvant radiotherapy to the vulva remain unclear. Based on the studies included in this review, the current evidence suggests that adjuvant radiotherapy to the vulva might not significantly reduce the risk of recurrence or only in certain subgroups.

Conclusion

Most of the studies do not consider individual risk factors such as HPV status, resection margin, lymph node stage, grading and others. As a result, the comparability and reliability of these findings are limited. This review aims to highlight the need of further research addressing the risk stratification, considering both oncologic risk factors and adverse events.

目的尽管缺乏有力的证据，但外阴鳞状细胞癌（VSCC）的外阴辅助放疗仍经常被采用。本系统综述旨在总结目前有关这一主题的文献。方法纳入并分析了19项回顾性研究，重点关注局部复发这一主要结果。虽然对结节阳性 VSCC 患者进行腹股沟辅助放疗的益处已得到证实，但外阴辅助放疗的适应症标准和有效性仍不明确。结论大多数研究并未考虑HPV状态、切除边缘、淋巴结分期、分级等个体风险因素。因此，这些研究结果的可比性和可靠性有限。本综述旨在强调进一步研究风险分层的必要性，同时考虑肿瘤风险因素和不良事件。

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引用次数: 0

Timely targeted testing for hereditary cancer syndromes – Importance of clinician-facilitated cascade testing in the first year post-diagnosis 遗传性癌症综合征的及时定向检测 - 诊断后第一年由临床医生协助进行级联检测的重要性

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-10 DOI: 10.1016/j.ygyno.2024.09.001

Objective

Cascade testing for hereditary cancer syndromes allows relatives to estimate cancer risk and pursue prevention and early detection strategies. The current paradigm relies on patient coordinated care, resulting in only one-third of relatives successfully completing testing. Studies suggest that team-based approaches, where clinicians facilitate testing, can increase uptake. As institutions consider implementing such programs, understanding patient characteristics associated with interest is crucial for resource allocation. We aim to assess interest in clinician-facilitated testing and evaluate barriers.

Methods

Patients with cancer-associated pathogenic variants seen at a gynecologic oncology clinic were offered clinician-facilitated cascade testing. Patient interest and demographic variables were recorded and patients that declined were interviewed regarding the decision.

Results

From 11/2023–4/2024, 139 patients were offered clinician-facilitated cascade testing. Median patient age was 43 years (IQR 17), 97 (69.8 %) self-identified as White and 101 (72.7 %) as non-Hispanic. Fifty-six (40.3 %) patients harbored a BRCA1 pathogenic variant, 37 (26.6 %) BRCA2, and 46 (33.1 %) other cancer-associated genes. Fifty-seven (41.0 %) patients expressed interest in the intervention. Interested patients were more likely to have been diagnosed in the prior year vs. patients who were not interested on univariate (OR 4.6, 95 % CI 2.0–10.2, P = 0.0002) and multivariable analyses (adjusted OR 3.8, 95 % CI 1.622–9.009, P = 0.0022).

Conclusions

Our study demonstrates that patients are almost five time more likely to be interested in cascade genetic testing within the first year of diagnosis of a pathogenic variant. Given the utility of such programs and their resource requirements, targeting this population could maximize effectiveness and uptake of cascade services.

目的通过遗传性癌症综合征的级联检测，亲属可以估算癌症风险，并采取预防和早期检测策略。目前的模式依赖于患者的协调护理，结果只有三分之一的亲属成功完成了检测。研究表明，以团队为基础、由临床医生协助进行检测的方法可以提高检测率。在医疗机构考虑实施此类计划时，了解与兴趣相关的患者特征对于资源分配至关重要。我们的目的是评估患者对临床医生协助的检测的兴趣并评估障碍。方法在妇科肿瘤诊所就诊的癌症相关致病变异患者可在临床医生协助下进行级联检测。结果从 2023 年 11 月至 2024 年 4 月，139 名患者接受了临床医生协助的级联检测。患者年龄中位数为 43 岁（IQR 17），97 人（69.8%）自我认同为白人，101 人（72.7%）为非西班牙裔。56名患者（40.3%）携带BRCA1致病变异基因，37名患者（26.6%）携带BRCA2致病变异基因，46名患者（33.1%）携带其他癌症相关基因。57名（41.0%）患者表示对干预感兴趣。在单变量分析（OR 4.6，95 % CI 2.0-10.2，P = 0.0002）和多变量分析（调整后 OR 3.8，95 % CI 1.622-9.009，P = 0.0022）中，有兴趣的患者与无兴趣的患者相比更有可能在前一年确诊。考虑到此类项目的实用性及其资源需求，针对这一人群的基因检测可最大限度地提高级联服务的有效性和吸收率。

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引用次数: 0

Response to the letter to the editor: Referring to the manuscript entitled “Surgical nodal assessment for endometrial hyperplasia – A meta-analysis and systematic review” 回复致编辑的信：参考题为 "子宫内膜增生的手术结节评估--荟萃分析和系统综述 "的手稿

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-10 DOI: 10.1016/j.ygyno.2024.09.004

引用次数: 0

Real-world trends in the use of maintenance therapy in ovarian cancer across the United States from 2017 to 2021 2017 年至 2021 年全美卵巢癌患者使用维持疗法的实际趋势

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2024-09-10 DOI: 10.1016/j.ygyno.2024.08.026

Objective

We assessed real-world trends in the use of maintenance therapy [MT] (i.e., polyADP-ribose polymerase inhibitors (PARPi) and/or bevacizumab following platinum-based chemotherapy), among U.S. patients with ovarian cancer.

Methods

Using Medicare and commercial administrative health claims data from Optum's de-identified Clinformatics® Data Mart Database, we identified patients who had been diagnosed with ovarian cancer between January 1, 2010, and March 31, 2021, and received platinum-based chemotherapy and MT. Multivariable logistic regression and Cox proportional hazards regression were used to evaluate associations between demographic and clinical characteristics and MT use.

Results

Our study included 6339 patients, with a median age of 70 years. The majority were White (70.1 %), Medicare-insured (71.9 %), and were treated in the South (42.5 %). Of the 31.5 % who received MT, 18.1 % received bevacizumab alone, 10.2 % PARPi alone, and 3.3 % both. After adjusting for insurance type, PARPi and bevacizumab use increased significantly from 2017 to 2020. Patients with a high Elixhauser comorbidity index were more likely to receive MT than were patients with a low index [OR (95 % CI): 1.46 (1.28–1.67), p < 0.0001]. PARPi use was significantly associated with treatment in the South [1.42 (1.10–1.83), p = 0.01]. Compared to patients who received neither agents, those who received bevacizumab, alone or in combination with PARPi, had a higher risk of death [HR = 2.02 (95 % CI: 1.70–2.28, p < 0.0001) and 1.66 (1.24–2.23), p = 0.001, respectively].

Conclusions

The majority of patients with ovarian cancer are not utilizing maintenance therapy after platinum-based chemotherapy. Age, comorbidity status, and geographic region of treatment were associated with MT use. Understanding the factors and real-world outcomes associated with MT use is important to support patients in making value concordant and informed decisions.

方法利用Optum去标识化Clinformatics® Data Mart数据库中的医疗保险和商业行政健康索赔数据，我们确定了2010年1月1日至2021年3月31日期间确诊为卵巢癌并接受铂类化疗和MT治疗的患者。多变量逻辑回归和 Cox 比例危险度回归用于评估人口统计学特征和临床特征与 MT 使用之间的关系。大多数患者为白人（70.1%），有医疗保险（71.9%），在南方接受治疗（42.5%）。在接受 MT 治疗的 31.5% 患者中，18.1% 仅接受贝伐单抗治疗，10.2% 仅接受 PARPi 治疗，3.3% 同时接受两种治疗。调整保险类型后，PARPi和贝伐单抗的使用率从2017年到2020年显著增加。Elixhauser合并症指数高的患者比指数低的患者更有可能接受MT治疗[OR（95 % CI）：1.46（1.28-1.67），p <0.0001]。PARPi的使用与南部地区的治疗明显相关[1.42 (1.10-1.83), p = 0.01]。与两种药物均未使用的患者相比，单独或与PARPi联合使用贝伐单抗的患者死亡风险更高[HR = 2.02 (95 % CI: 1.70-2.28, p < 0.0001)和1.66 (1.24-2.23), p = 0.001]。年龄、合并症状况和治疗地区与MT的使用有关。了解与MT使用相关的因素和实际结果对于帮助患者做出价值一致的知情决定非常重要。

{"title":"Real-world trends in the use of maintenance therapy in ovarian cancer across the United States from 2017 to 2021","authors":"","doi":"10.1016/j.ygyno.2024.08.026","DOIUrl":"10.1016/j.ygyno.2024.08.026","url":null,"abstract":"<div><h3>Objective</h3><p>We assessed real-world trends in the use of maintenance therapy [MT] (i.e., polyADP-ribose polymerase inhibitors (PARPi) and/or bevacizumab following platinum-based chemotherapy), among U.S. patients with ovarian cancer.</p></div><div><h3>Methods</h3><p>Using Medicare and commercial administrative health claims data from Optum's de-identified Clinformatics® Data Mart Database, we identified patients who had been diagnosed with ovarian cancer between January 1, 2010, and March 31, 2021, and received platinum-based chemotherapy and MT. Multivariable logistic regression and Cox proportional hazards regression were used to evaluate associations between demographic and clinical characteristics and MT use.</p></div><div><h3>Results</h3><p>Our study included 6339 patients, with a median age of 70 years. The majority were White (70.1 %), Medicare-insured (71.9 %), and were treated in the South (42.5 %). Of the 31.5 % who received MT, 18.1 % received bevacizumab alone, 10.2 % PARPi alone, and 3.3 % both. After adjusting for insurance type, PARPi and bevacizumab use increased significantly from 2017 to 2020. Patients with a high Elixhauser comorbidity index were more likely to receive MT than were patients with a low index [OR (95 % CI): 1.46 (1.28–1.67), <em>p</em> < 0.0001]. PARPi use was significantly associated with treatment in the South [1.42 (1.10–1.83), <em>p</em> = 0.01]. Compared to patients who received neither agents, those who received bevacizumab, alone or in combination with PARPi, had a higher risk of death [HR = 2.02 (95 % CI: 1.70–2.28, <em>p</em> < 0.0001) and 1.66 (1.24–2.23), <em>p</em> = 0.001, respectively].</p></div><div><h3>Conclusions</h3><p>The majority of patients with ovarian cancer are not utilizing maintenance therapy after platinum-based chemotherapy. Age, comorbidity status, and geographic region of treatment were associated with MT use. Understanding the factors and real-world outcomes associated with MT use is important to support patients in making value concordant and informed decisions.</p></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164732","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}

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