Pub Date : 2025-10-17DOI: 10.1016/j.ygyno.2025.09.003
Sharonne Holtzman , Evan Myers , Laura J. Havrilesky , Diane Yamada , Sarah Ackroyd , Kristen Zeligs , Monica Prasad-Hayes , Konstatin Zakashansky , Teresa Boitano , Warner Huh , Stephanie V. Blank
Objective
To examine the trends and geographic distribution of US GO fellowship programs over time and analyze GO specific procedures by regions.
Methods
Using the publicly available data from the NRMP, the number of GO fellowship programs and positions between 2004 and 2023 was obtained. The number of programs and positions in each geographic region was calculated. Total number of GO cases was calculated based on SEER data by region, with GO-specific cases categorized as early cervical cancer and advanced ovarian cases as surrogates. Growth rates were calculated for the study period and a simple linear regression analysis was performed to study the significant trends by years.
Results
The Northeast exhibited the highest position growth (B = 0.49, p < 0.001), whereas program expansion was most rapid in the West (B = 0.42, p < 0.001). From 2004 to 2021, early-stage cervical cancer cases per fellow declined significantly across all regions (p < 0.001), with the Midwest decreasing the most by 68.2 % (from 85 to 27 cases). Similarly, advanced ovarian cancer cases per fellow decreased, with the Midwest experiencing a 70 % decline (from 202 to 60 cases) and the West demonstrating the greatest rate of decline at 8.86 fewer cases per fellow per year (p < 0.001).
Conclusions
There is a geographic imbalance in new programs and positions relative to the number of GO cases per fellow with surgical cases by fellow varying significantly by geographic region. These data raise the issue of an unmet need in considering the future of our profession.
{"title":"Gynecologic oncology fellowship trends: Supply outpacing demand, geographical maldistribution","authors":"Sharonne Holtzman , Evan Myers , Laura J. Havrilesky , Diane Yamada , Sarah Ackroyd , Kristen Zeligs , Monica Prasad-Hayes , Konstatin Zakashansky , Teresa Boitano , Warner Huh , Stephanie V. Blank","doi":"10.1016/j.ygyno.2025.09.003","DOIUrl":"10.1016/j.ygyno.2025.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the trends and geographic distribution of US GO fellowship programs over time and analyze GO specific procedures by regions.</div></div><div><h3>Methods</h3><div>Using the publicly available data from the NRMP, the number of GO fellowship programs and positions between 2004 and 2023 was obtained. The number of programs and positions in each geographic region was calculated. Total number of GO cases was calculated based on SEER data by region, with GO-specific cases categorized as early cervical cancer and advanced ovarian cases as surrogates. Growth rates were calculated for the study period and a simple linear regression analysis was performed to study the significant trends by years.</div></div><div><h3>Results</h3><div>The Northeast exhibited the highest position growth (B = 0.49, <em>p</em> < 0.001), whereas program expansion was most rapid in the West (B = 0.42, <em>p</em> < 0.001). From 2004 to 2021, early-stage cervical cancer cases per fellow declined significantly across all regions (p < 0.001), with the Midwest decreasing the most by 68.2 % (from 85 to 27 cases). Similarly, advanced ovarian cancer cases per fellow decreased, with the Midwest experiencing a 70 % decline (from 202 to 60 cases) and the West demonstrating the greatest rate of decline at 8.86 fewer cases per fellow per year (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>There is a geographic imbalance in new programs and positions relative to the number of GO cases per fellow with surgical cases by fellow varying significantly by geographic region. These data raise the issue of an unmet need in considering the future of our profession.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 162-166"},"PeriodicalIF":4.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318162","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}
Pub Date : 2025-10-17DOI: 10.1016/j.ygyno.2025.10.005
Tabea Maurer , Matthias H. Belau , Birgit-Christiane Zyriax , Götz Welsch , Bettina Jagemann , Jenny Chang-Claude , Anne Daubmann , Anika Buchholz , Alexander Fierenz , Karin Glismann , Annika Moeller , Jalid Sehouli , Hannah Woopen , Pauline Wimberger , Philipp Harter , Sabrina Kaiser , Nicolai Maass , Marion Kiechle , Tobias Engler , Barbara Schmalfeldt , Holger Schulz
Background
Ovarian cancer patients face treatment-related challenges such as malnutrition and muscle wasting associated with cancer cachexia. If left untreated, these complications can severely impact quality of life and autonomy. The BENITA study aims to develop and evaluate a tailored exercise and nutrition program during and after first-line chemotherapy. Phase I focused on program development and optimization; Phase II will test its effectiveness in a randomized controlled trial.
Methods
Semi-structured interviews were conducted with patients, survivors, physicians, nutrition and physiotherapy experts, and a health insurance representative. Thematic analysis following Braun and Clarke was used to identify key insights for program design and implementation.
Results
Patients' motivation to engage in exercise and nutrition was driven by enjoyment and external encouragement. Barriers included chemotherapy-induced fatigue, physical weakness, and psychological strain. Uncertainty about safe training post-surgery was common. Regular support from healthcare professionals was seen as essential for confidence and adherence.
Discussion
Findings highlight the need for a personalized, flexible program tailored to ovarian cancer patients' needs. A blended digital approach combining self-guided elements with professional support could improve implementation, offering customized exercise routines, nutrition plans, and regular check-ins to facilitate patient-centered participation.
{"title":"Development and optimization of an integrated exercise and nutrition program for ovarian cancer patients: Phase I of the BENITA multi-center study","authors":"Tabea Maurer , Matthias H. Belau , Birgit-Christiane Zyriax , Götz Welsch , Bettina Jagemann , Jenny Chang-Claude , Anne Daubmann , Anika Buchholz , Alexander Fierenz , Karin Glismann , Annika Moeller , Jalid Sehouli , Hannah Woopen , Pauline Wimberger , Philipp Harter , Sabrina Kaiser , Nicolai Maass , Marion Kiechle , Tobias Engler , Barbara Schmalfeldt , Holger Schulz","doi":"10.1016/j.ygyno.2025.10.005","DOIUrl":"10.1016/j.ygyno.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian cancer patients face treatment-related challenges such as malnutrition and muscle wasting associated with cancer cachexia. If left untreated, these complications can severely impact quality of life and autonomy. The BENITA study aims to develop and evaluate a tailored exercise and nutrition program during and after first-line chemotherapy. Phase I focused on program development and optimization; Phase II will test its effectiveness in a randomized controlled trial.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with patients, survivors, physicians, nutrition and physiotherapy experts, and a health insurance representative. Thematic analysis following Braun and Clarke was used to identify key insights for program design and implementation.</div></div><div><h3>Results</h3><div>Patients' motivation to engage in exercise and nutrition was driven by enjoyment and external encouragement. Barriers included chemotherapy-induced fatigue, physical weakness, and psychological strain. Uncertainty about safe training post-surgery was common. Regular support from healthcare professionals was seen as essential for confidence and adherence.</div></div><div><h3>Discussion</h3><div>Findings highlight the need for a personalized, flexible program tailored to ovarian cancer patients' needs. A blended digital approach combining self-guided elements with professional support could improve implementation, offering customized exercise routines, nutrition plans, and regular check-ins to facilitate patient-centered participation.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 167-173"},"PeriodicalIF":4.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318173","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ygyno.2025.10.007
Uisuk Kim , Byeong-Chan Oh , Jaekyung Bae , Sokbom Kang
Objective
This study aimed to evaluate treatment patterns and survival outcomes by histologic subtype and stage in malignant ovarian sex cord-stromal tumors (SCSTs), focusing on the impact of adjuvant chemotherapy to inform histology-specific treatment strategies.
Methods
This retrospective cohort study identified adult patients newly diagnosed with malignant ovarian SCSTs using nationwide claims data from Korea (2012–2019). Patients were classified into granulosa-type and other subtypes. Treatment patterns, including upfront cytoreductive surgery and adjuvant chemotherapy, were described. Overall survival (OS) and time to first subsequent therapy or death (TFST) were estimated using Kaplan–Meier methods and compared across subgroups. In localized-stage patients undergoing upfront surgery, the association between adjuvant chemotherapy and survival outcomes was further evaluated. Sensitivity and landmark analyses assessed the robustness of findings.
Results
Among 314 patients (256 granulosa-type and 58 non-granulosa), localized disease was more common in both groups (granulosa-type: 68.4 %, non-granulosa: 67.2 %). Most patients received upfront cytoreductive surgery (granulosa-type: 88.7 %, non-granulosa: 89.7 %, overall: 88.9 %), while adjuvant chemotherapy was more commonly administered in non-granulosa tumors. In the localized-stage subgroup, adjuvant chemotherapy was associated with longer TFST in non-granulosa SCSTs (5-year TFST: 94.1 % vs. 61.9 %), whereas no significant benefit was observed in granulosa-type tumors. OS remained high (>85 %) across all histologic subtypes and treatment.
Conclusions
This study supports upfront cytoreductive surgery as the primary treatment for ovarian SCSTs and suggests the role of adjuvant chemotherapy should be guided by histologic subtype. These findings support histology-driven treatment strategies and the need for prospective studies to optimize individualized management.
目的：本研究旨在评估恶性卵巢性索间质瘤（SCSTs）的组织学亚型和分期的治疗模式和生存结果，重点关注辅助化疗的影响，为组织特异性治疗策略提供信息。方法：本回顾性队列研究使用韩国2012-2019年全国索赔数据，确定新诊断为恶性卵巢SCSTs的成年患者。患者分为颗粒型和其他亚型。治疗模式，包括前期细胞减少手术和辅助化疗，被描述。使用Kaplan-Meier方法估计总生存期（OS）和到首次后续治疗或死亡的时间（TFST），并在亚组间进行比较。在接受前期手术的局部期患者中，进一步评估辅助化疗与生存结果之间的关系。敏感性和里程碑分析评估了研究结果的稳健性。结果：314例患者（颗粒型256例，非颗粒型58例）中，两组均以局限性病变多见（颗粒型68.4%，非颗粒型67.2%）。大多数患者接受了前期细胞减缩手术（颗粒型：88.7%，非颗粒型：89.7%，总体：88.9%），而辅助化疗更常见于非颗粒性肿瘤。在局部期亚组中，辅助化疗与非颗粒性SCSTs中更长的TFST相关（5年TFST: 94.1% vs. 61.9%），而在颗粒型肿瘤中没有观察到明显的益处。在所有组织学亚型和治疗中，OS仍然很高（bbb85 %）。结论：本研究支持前期细胞减少手术作为卵巢SCSTs的主要治疗方法，并提示辅助化疗的作用应根据组织学亚型进行指导。这些发现支持组织学驱动的治疗策略和前瞻性研究的需要，以优化个体化管理。
{"title":"Survival outcomes and treatment patterns in malignant ovarian sex cord-stromal tumors: A population-based analysis","authors":"Uisuk Kim , Byeong-Chan Oh , Jaekyung Bae , Sokbom Kang","doi":"10.1016/j.ygyno.2025.10.007","DOIUrl":"10.1016/j.ygyno.2025.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate treatment patterns and survival outcomes by histologic subtype and stage in malignant ovarian sex cord-stromal tumors (SCSTs), focusing on the impact of adjuvant chemotherapy to inform histology-specific treatment strategies.</div></div><div><h3>Methods</h3><div>This retrospective cohort study identified adult patients newly diagnosed with malignant ovarian SCSTs using nationwide claims data from Korea (2012–2019). Patients were classified into granulosa-type and other subtypes. Treatment patterns, including upfront cytoreductive surgery and adjuvant chemotherapy, were described. Overall survival (OS) and time to first subsequent therapy or death (TFST) were estimated using Kaplan–Meier methods and compared across subgroups. In localized-stage patients undergoing upfront surgery, the association between adjuvant chemotherapy and survival outcomes was further evaluated. Sensitivity and landmark analyses assessed the robustness of findings.</div></div><div><h3>Results</h3><div>Among 314 patients (256 granulosa-type and 58 non-granulosa), localized disease was more common in both groups (granulosa-type: 68.4 %, non-granulosa: 67.2 %). Most patients received upfront cytoreductive surgery (granulosa-type: 88.7 %, non-granulosa: 89.7 %, overall: 88.9 %), while adjuvant chemotherapy was more commonly administered in non-granulosa tumors. In the localized-stage subgroup, adjuvant chemotherapy was associated with longer TFST in non-granulosa SCSTs (5-year TFST: 94.1 % vs. 61.9 %), whereas no significant benefit was observed in granulosa-type tumors. OS remained high (>85 %) across all histologic subtypes and treatment.</div></div><div><h3>Conclusions</h3><div>This study supports upfront cytoreductive surgery as the primary treatment for ovarian SCSTs and suggests the role of adjuvant chemotherapy should be guided by histologic subtype. These findings support histology-driven treatment strategies and the need for prospective studies to optimize individualized management.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 146-153"},"PeriodicalIF":4.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312796","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}
Pub Date : 2025-10-15DOI: 10.1016/j.ygyno.2025.09.010
Charles A. Powell , Ira S. Winer , Christopher M. Tarney , Stéphanie Gaillard , Róisín E. O'Cearbhaill
Interstitial lung disease (ILD) is a potentially serious and sometimes fatal complication of targeted therapies, including antibody-drug conjugates and immunotherapies, in gynecologic oncology. Risk factors include pre-existing lung disease, advanced age and prior thoracic radiation. Early detection, patient and clinician education, and prompt multidisciplinary collaboration are critical to mitigate ILD morbidity and mortality. This Society of Gynecologic Oncology clinical practice statement provides evidence-based recommendations for the diagnosis, grading and management of ILD associated with gynecologic cancer therapies, emphasizing the importance of baseline risk assessment, ongoing monitoring and standardized intervention protocols to optimize patient outcomes.
{"title":"Interstitial lung disease in targeted therapies: A Society of Gynecologic Oncology clinical practice statement","authors":"Charles A. Powell , Ira S. Winer , Christopher M. Tarney , Stéphanie Gaillard , Róisín E. O'Cearbhaill","doi":"10.1016/j.ygyno.2025.09.010","DOIUrl":"10.1016/j.ygyno.2025.09.010","url":null,"abstract":"<div><div>Interstitial lung disease (ILD) is a potentially serious and sometimes fatal complication of targeted therapies, including antibody-drug conjugates and immunotherapies, in gynecologic oncology. Risk factors include pre-existing lung disease, advanced age and prior thoracic radiation. Early detection, patient and clinician education, and prompt multidisciplinary collaboration are critical to mitigate ILD morbidity and mortality. This Society of Gynecologic Oncology clinical practice statement provides evidence-based recommendations for the diagnosis, grading and management of ILD associated with gynecologic cancer therapies, emphasizing the importance of baseline risk assessment, ongoing monitoring and standardized intervention protocols to optimize patient outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 137-145"},"PeriodicalIF":4.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307766","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}
Pub Date : 2025-10-14DOI: 10.1016/j.ygyno.2025.09.017
Victoria M. Ettorre , Stefania Bellone , Natalia Buza , Pei Hui , Tobias Max Philipp Hartwich , Cem Demirkiran , Michelle Greenman , Namrata Sethi , Luca Palmieri , Alessandro D. Santin
Background
HER2-targeted treatments are an important therapeutic option for a subset of uterine serous carcinoma (USC) patients. We evaluated the concordance of routine immunohistochemistry (IHC) testing and fluorescence in situ hybridization (FISH) for HER2 expression versus next generation sequencing (NGS) by a commercial platform (Foundation Medicine), and comprehensive whole exome sequencing (WES).
Methods
Two groups of USC patients with IHC and FISH results for HER2 were compared for concordance with matched NGS data (152 USC patients) and WES (76 USC patients) performed at the Yale Center for Genome Analysis (YCGA). Clinical HER2 positivity was defined as 3+ IHC staining or 2+ IHC staining with reflex gene amplification utilizing fluorescent-in-situ-hybridization (FISH). NGS HER2 positivity was defined as ERBB2 amplifications identified in the NGS/WES report.
Results
In the IHC/NGS group, the overall correlation was 81 % (p < 0.001), which improved to 85 % (p < 0.001) when IHC/FISH and NGS were performed on the same pathology tissue block of a particular specimen. In the IHC/WES group, the overall correlation was similar at 82 % (p < 0.001). NGS captured 1 additional patient missed by IHC/FISH, while WES captured 11 additional patients not identified by IHC/FISH.
Conclusions
The correlation of HER2 IHC/FISH with NGS and WES ranges between 80 and 85 %, with improvement in correlation when testing is performed on the same tissue block. WES may be superior to commercially available NGS platforms in the detection/identification of HER2 treatment-eligible patients. While highly correlated, these results confirm that IHC should not be abandoned in the evaluation of patients eligible for HER2-targeted therapy.
{"title":"Immunohistochemistry, next generation sequencing (NGS), and whole exome sequencing concordance in HER2 testing in uterine serous carcinoma: a retrospective analysis","authors":"Victoria M. Ettorre , Stefania Bellone , Natalia Buza , Pei Hui , Tobias Max Philipp Hartwich , Cem Demirkiran , Michelle Greenman , Namrata Sethi , Luca Palmieri , Alessandro D. Santin","doi":"10.1016/j.ygyno.2025.09.017","DOIUrl":"10.1016/j.ygyno.2025.09.017","url":null,"abstract":"<div><h3>Background</h3><div>HER2-targeted treatments are an important therapeutic option for a subset of uterine serous carcinoma (USC) patients. We evaluated the concordance of routine immunohistochemistry (IHC) testing and fluorescence in situ hybridization (FISH) for HER2 expression versus next generation sequencing (NGS) by a commercial platform (Foundation Medicine), and comprehensive whole exome sequencing (WES).</div></div><div><h3>Methods</h3><div>Two groups of USC patients with IHC and FISH results for HER2 were compared for concordance with matched NGS data (152 USC patients) and WES (76 USC patients) performed at the Yale Center for Genome Analysis (YCGA). Clinical HER2 positivity was defined as 3+ IHC staining or 2+ IHC staining with reflex gene amplification utilizing fluorescent-in-situ-hybridization (FISH). NGS HER2 positivity was defined as ERBB2 amplifications identified in the NGS/WES report.</div></div><div><h3>Results</h3><div>In the IHC/NGS group, the overall correlation was 81 % (<em>p</em> < 0.001), which improved to 85 % (p < 0.001) when IHC/FISH and NGS were performed on the same pathology tissue block of a particular specimen. In the IHC/WES group, the overall correlation was similar at 82 % (<em>p</em> < 0.001). NGS captured 1 additional patient missed by IHC/FISH, while WES captured 11 additional patients not identified by IHC/FISH.</div></div><div><h3>Conclusions</h3><div>The correlation of HER2 IHC/FISH with NGS and WES ranges between 80 and 85 %, with improvement in correlation when testing is performed on the same tissue block. WES may be superior to commercially available NGS platforms in the detection/identification of HER2 treatment-eligible patients. While highly correlated, these results confirm that IHC should not be abandoned in the evaluation of patients eligible for HER2-targeted therapy.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 131-136"},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299735","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}
Pub Date : 2025-10-13DOI: 10.1016/j.ygyno.2025.10.001
Brittany A. Borden , Adela Rodriguez-Hernandez , Magan Trottier , Miki Horiguchi , Jamie D. Weyandt , Carolyn Horton , Linda M. Polfus , Brittany L. Bychkovsky , Colin C. Young , Judy E. Garber , Jessica D. St. Laurent , Huma Q. Rana
Objective
To describe the cancer histories of individuals with a SMARCA4 germline pathogenic/likely pathogenic variant (gPV) obtained through clinical laboratory-based testing to aid in informing guidance surrounding surveillance and prevention for individuals with gPV.
Methods
This retrospective cohort study analyzed individuals with a SMARCA4 gPV identified by multigene panel testing for hereditary cancer at a single commercial clinical laboratory (2014–2024). Descriptive statistics were used to summarize individuals with a gPV in SMARCA4. Age at diagnosis of small cell carcinoma of the ovary hypercalcemic type (SCCOHT) and of unspecified ovarian cancer among individuals with a SMARCA4 gPV was enumerated using cumulative distribution functions.
Results
Among genotyped individuals, 137 had a SMARCA4 gPV. After applying exclusion criteria, 127 individuals were included in the analysis. Individuals with a SMARCA4 gPV were predominately female (74.8 %), and 53.5 % (n = 68) had a history of cancer. Of the females with a cancer history, SCCOHT (17.9 %) and ovarian cancer not otherwise specified (7.4 %) were reported. SCCOHT accounted for 29.8 % of cancer diagnoses among females aged ≤50 years. All SCCOHT cases among individuals with SMARCA4 gPVs were diagnosed by age 40.
Conclusion
Our data support the inclusion of SMARCA4 in genetic testing for hereditary early-onset ovarian cancer, enumerate the ages of SCCOHT diagnosis, and highlight the need for prospective penetrance studies to improve counseling and management for patients and their families.
{"title":"SMARCA4 pathogenic variants: Gynecological cancer histories from a laboratory tested cohort","authors":"Brittany A. Borden , Adela Rodriguez-Hernandez , Magan Trottier , Miki Horiguchi , Jamie D. Weyandt , Carolyn Horton , Linda M. Polfus , Brittany L. Bychkovsky , Colin C. Young , Judy E. Garber , Jessica D. St. Laurent , Huma Q. Rana","doi":"10.1016/j.ygyno.2025.10.001","DOIUrl":"10.1016/j.ygyno.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the cancer histories of individuals with a <em>SMARCA4</em> germline pathogenic/likely pathogenic variant (gPV) obtained through clinical laboratory-based testing to aid in informing guidance surrounding surveillance and prevention for individuals with gPV.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed individuals with a <em>SMARCA4</em> gPV identified by multigene panel testing for hereditary cancer at a single commercial clinical laboratory (2014–2024). Descriptive statistics were used to summarize individuals with a gPV in <em>SMARCA4</em>. Age at diagnosis of small cell carcinoma of the ovary hypercalcemic type (SCCOHT) and of unspecified ovarian cancer among individuals with a <em>SMARCA4</em> gPV was enumerated using cumulative distribution functions.</div></div><div><h3>Results</h3><div>Among genotyped individuals, 137 had a <em>SMARCA4</em> gPV. After applying exclusion criteria, 127 individuals were included in the analysis. Individuals with a <em>SMARCA4</em> gPV were predominately female (74.8 %), and 53.5 % (<em>n</em> = 68) had a history of cancer. Of the females with a cancer history, SCCOHT (17.9 %) and ovarian cancer not otherwise specified (7.4 %) were reported. SCCOHT accounted for 29.8 % of cancer diagnoses among females aged ≤50 years. All SCCOHT cases among individuals with <em>SMARCA4</em> gPVs were diagnosed by age 40.</div></div><div><h3>Conclusion</h3><div>Our data support the inclusion of <em>SMARCA4</em> in genetic testing for hereditary early-onset ovarian cancer, enumerate the ages of SCCOHT diagnosis, and highlight the need for prospective penetrance studies to improve counseling and management for patients and their families.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 125-130"},"PeriodicalIF":4.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292002","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}
Pub Date : 2025-10-09DOI: 10.1016/j.ygyno.2025.09.018
Roman Kocian , Christhardt Kohler , Jaroslav Klat , Jiri Jarkovsky , Ignacio Zapardiel , Giampaolo Di Martino , Luc van Lonkhuijzen , Michal Zikan , Octavio Arencibia Sanchez , Blanca Gil-Ibanez , Francesco Raspagliesi , Jiri Presl , Lubos Minar , Radim Marek , Peter Kascak , Pavel Havelka , Martin Michal , Toon Van Gorp , Kristyna Nemejcova , Pavel Dundr , David Cibula
Objective
To assess sentinel lymph node (SLN) bilateral detection rate, anatomical distribution, and tracer performance in early-stage cervical cancer patients undergoing primary surgery, based on data from the prospective multicenter SENTIX trial.
Methods
Patients with FIGO 2018 stage IA1 (LVSI+) to IB2 cervical cancer and no suspicious lymph nodes on preoperative imaging were enrolled in the SENTIX trial. SLN biopsy was performed using blue dye (BD), radiocolloid (RC), indocyanine green (ICG), or their combinations. Only patients with successful bilateral SLN detection and negative intraoperative frozen section proceeded to radical hysterectomy or fertility-sparing surgery. SLN locations and metastatic status were documented by anatomical region and centrally reviewed for consistency.
Results
Among 724 patients who underwent SLN biopsy, the overall bilateral detection rate was 92.3 %, with the highest rate (100 %) achieved using ICG and RC combination. If mapping-failure cases were considered, the bilateral detection rate would be 84.6 %. Most SLNs (91.6 %) were located at pelvic level I, predominantly in the external iliac and interiliac regions. SLNs above the interiliac bifurcation were infrequent (2.7 %), and isolated positive SLNs in pelvic level II were rare (1.3 %). No SLNs were identified in paraaortic regions. Bilateral detection was unaffected by BMI, histology, or prior conization. Although detection was slightly lower in tumors >2 cm, bilateral rates exceeded 90 %.
Conclusions
SLN mapping demonstrated high bilateral detection across tracers and patient subgroups. Nearly all SLNs were confined to pelvic level I, underscoring anatomical predictability. These results demonstrate reproducible SLN mapping in tumors ≤4 cm and may help inform individualized surgical planning.
{"title":"Sentinel lymph node mapping in early-stage cervical cancer: Results from the SENTIX prospective multicenter study","authors":"Roman Kocian , Christhardt Kohler , Jaroslav Klat , Jiri Jarkovsky , Ignacio Zapardiel , Giampaolo Di Martino , Luc van Lonkhuijzen , Michal Zikan , Octavio Arencibia Sanchez , Blanca Gil-Ibanez , Francesco Raspagliesi , Jiri Presl , Lubos Minar , Radim Marek , Peter Kascak , Pavel Havelka , Martin Michal , Toon Van Gorp , Kristyna Nemejcova , Pavel Dundr , David Cibula","doi":"10.1016/j.ygyno.2025.09.018","DOIUrl":"10.1016/j.ygyno.2025.09.018","url":null,"abstract":"<div><h3>Objective</h3><div>To assess sentinel lymph node (SLN) bilateral detection rate, anatomical distribution, and tracer performance in early-stage cervical cancer patients undergoing primary surgery, based on data from the prospective multicenter SENTIX trial.</div></div><div><h3>Methods</h3><div>Patients with FIGO 2018 stage IA1 (LVSI+) to IB2 cervical cancer and no suspicious lymph nodes on preoperative imaging were enrolled in the SENTIX trial. SLN biopsy was performed using blue dye (BD), radiocolloid (RC), indocyanine green (ICG), or their combinations. Only patients with successful bilateral SLN detection and negative intraoperative frozen section proceeded to radical hysterectomy or fertility-sparing surgery. SLN locations and metastatic status were documented by anatomical region and centrally reviewed for consistency.</div></div><div><h3>Results</h3><div>Among 724 patients who underwent SLN biopsy, the overall bilateral detection rate was 92.3 %, with the highest rate (100 %) achieved using ICG and RC combination. If mapping-failure cases were considered, the bilateral detection rate would be 84.6 %. Most SLNs (91.6 %) were located at pelvic level I, predominantly in the external iliac and interiliac regions. SLNs above the interiliac bifurcation were infrequent (2.7 %), and isolated positive SLNs in pelvic level II were rare (1.3 %). No SLNs were identified in paraaortic regions. Bilateral detection was unaffected by BMI, histology, or prior conization. Although detection was slightly lower in tumors >2 cm, bilateral rates exceeded 90 %.</div></div><div><h3>Conclusions</h3><div>SLN mapping demonstrated high bilateral detection across tracers and patient subgroups. Nearly all SLNs were confined to pelvic level I, underscoring anatomical predictability. These results demonstrate reproducible SLN mapping in tumors ≤4 cm and may help inform individualized surgical planning.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 118-124"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267711","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}
Pub Date : 2025-10-09DOI: 10.1016/j.ygyno.2025.09.012
V. Garg , E. Armstrong , A. Celeste , C. Wang , A. Shukla , A. Tesfu , O. Odujoko , A. Madariaga , Y.C. Lee , L. Wang , H. Alqaisi , P. Soberanis , B. Grant , D. Braik , T. Chawla , E. Shlomovitz , A. Veneziani , N. Dhani , R. Grant , N. Jivraj , S. Lheureux
Objectives
This prospective study aimed to assess the feasibility of a risk-stratified, multidisciplinary ambulatory approach for managing malignant bowel obstruction (MBO) in patients with advanced gynecological cancer.
Methods
A clinical risk-based MBO triage system was implemented by incorporating bowel function assessments, management regimes, and educational tools. An interdisciplinary team (IDT) guided treatment decisions. At risk patients received proactive management through nursing phone calls for up to 4 weeks, while patients with MBO continued proactive management for up to 8 weeks based on symptom resolution. The primary endpoint was the ratio of days alive and out of the hospital to days in the hospital within 60 days post-MBO diagnosis.
Results
92 patients (median age 62 years [range 31–83]) were enrolled. At enrollment, 49 % (n = 45) had MBO, and 51 % (n = 47) were at risk of MBO development. 7 % (n = 3) at-risk patients progressed to MBO in 4 weeks, while 93 % had symptom resolution with proactive outpatient management.
Overall, 62 % (n = 57) of patients developed MBO during study period. Among these, 93 % (n = 53) needed inpatient care, with a median stay of 12.5 days (range 0–57) in the first 60 days. Median OS after MBO was 5.7 months (95 % CI, 3.6–8.4). The median of hospital-to-home ratio was 0.3 (range 0–19) within 60 days. MBO resolved in 42 % (n = 24) of the patients. Microbiome analysis showed lower Shannon diversity and species richness for MBO patients compared to those at risk.
Conclusion
This study confirms the feasibility of ambulatory management for MBO patients, using a risk-based MBO triage system guided by IDT.
{"title":"Multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in patients with advanced gynecological cancers: A prospective study","authors":"V. Garg , E. Armstrong , A. Celeste , C. Wang , A. Shukla , A. Tesfu , O. Odujoko , A. Madariaga , Y.C. Lee , L. Wang , H. Alqaisi , P. Soberanis , B. Grant , D. Braik , T. Chawla , E. Shlomovitz , A. Veneziani , N. Dhani , R. Grant , N. Jivraj , S. Lheureux","doi":"10.1016/j.ygyno.2025.09.012","DOIUrl":"10.1016/j.ygyno.2025.09.012","url":null,"abstract":"<div><h3>Objectives</h3><div>This prospective study aimed to assess the feasibility of a risk-stratified, multidisciplinary ambulatory approach for managing malignant bowel obstruction (MBO) in patients with advanced gynecological cancer.</div></div><div><h3>Methods</h3><div>A clinical risk-based MBO triage system was implemented by incorporating bowel function assessments, management regimes, and educational tools. An interdisciplinary team (IDT) guided treatment decisions. At risk patients received proactive management through nursing phone calls for up to 4 weeks, while patients with MBO continued proactive management for up to 8 weeks based on symptom resolution. The primary endpoint was the ratio of days alive and out of the hospital to days in the hospital within 60 days post-MBO diagnosis.</div></div><div><h3>Results</h3><div>92 patients (median age 62 years [range 31–83]) were enrolled. At enrollment, 49 % (<em>n</em> = 45) had MBO, and 51 % (<em>n</em> = 47) were at risk of MBO development. 7 % (<em>n</em> = 3) at-risk patients progressed to MBO in 4 weeks, while 93 % had symptom resolution with proactive outpatient management.</div><div>Overall, 62 % (<em>n</em> = 57) of patients developed MBO during study period. Among these, 93 % (<em>n</em> = 53) needed inpatient care, with a median stay of 12.5 days (range 0–57) in the first 60 days. Median OS after MBO was 5.7 months (95 % CI, 3.6–8.4). The median of hospital-to-home ratio was 0.3 (range 0–19) within 60 days. MBO resolved in 42 % (<em>n</em> = 24) of the patients. Microbiome analysis showed lower Shannon diversity and species richness for MBO patients compared to those at risk.</div></div><div><h3>Conclusion</h3><div>This study confirms the feasibility of ambulatory management for MBO patients, using a risk-based MBO triage system guided by IDT.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 110-117"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267710","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}
Pub Date : 2025-10-06DOI: 10.1016/j.ygyno.2025.09.015
Justin Wei-Jia Lim , Oleksandra Dzyubak , Michal Moshkovich , Manjula Maganti , Kathy Han , Anjelica Hodgson , Sarah E. Ferguson , Soyoun Rachel Kim
Objective
To compare the revised FIGO 2023 endometrial cancer (EC) staging system to the previous FIGO 2009 schema, assessing stage migration and prognostic capability.
Methods
Patients who underwent EC surgical staging (including sentinel lymph node biopsy or lymphadenectomy) between May 2015 and July 2023 were restaged from FIGO 2009 to FIGO 2023 (n = 538). Overall survival (OS) and progression-free survival (PFS) for substages were estimated using the Kaplan-Meier method and compared using log-rank test.
Results
Stage migration occureed in 26.8 % of cases (n = 144) with almost all upstaged (n = 143, 99.3 %). Upstaging included migration from stage IA to II (97/301, 32.2 %) and stage IB to II (46/85, 54.1 %). No significant differences in OS or PFS were noted between FIGO 2023 stage II substages (IIA vs. IIB vs. IIC vs. IICmp53abn; pOS = 0.53 and pPFS = 0.59). When FIGO 2023 stage IIC and IICmp53abn were stratified by initial FIGO 2009 substages (52 IIC: 23 IA, 21 IB, 8 II; and 101 IICmp53abn: 67 IA, 17 IB, 17 II), significant differences in OS and PFS were identified between FIGO 2009 substages IA vs. IB vs. II (p < 0.05).
Conclusions
The FIGO 2023 EC staging revision has resulted in significant upstaging from IA/IB to II, due to incorporation of lymphovascular space invasion, histology, and molecular profiles. No significant differences in survival were found between FIGO 2023 stage II substages, suggesting lack of discriminatory ability. Significant survival differences were seen within stages IIC and IICmp53abn when stratified by initial FIGO 2009 substages, suggesting FIGO 2023 IIC and IICmp53abn are heterogeneous cohorts.
{"title":"Impact of FIGO 2023 staging criteria on stage migration and survival outcomes in early-stage endometrial cancer: A retrospective cohort study","authors":"Justin Wei-Jia Lim , Oleksandra Dzyubak , Michal Moshkovich , Manjula Maganti , Kathy Han , Anjelica Hodgson , Sarah E. Ferguson , Soyoun Rachel Kim","doi":"10.1016/j.ygyno.2025.09.015","DOIUrl":"10.1016/j.ygyno.2025.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the revised FIGO 2023 endometrial cancer (EC) staging system to the previous FIGO 2009 schema, assessing stage migration and prognostic capability.</div></div><div><h3>Methods</h3><div>Patients who underwent EC surgical staging (including sentinel lymph node biopsy or lymphadenectomy) between May 2015 and July 2023 were restaged from FIGO 2009 to FIGO 2023 (<em>n</em> = 538). Overall survival (OS) and progression-free survival (PFS) for substages were estimated using the Kaplan-Meier method and compared using log-rank test.</div></div><div><h3>Results</h3><div>Stage migration occureed in 26.8 % of cases (<em>n</em> = 144) with almost all upstaged (<em>n</em> = 143, 99.3 %). Upstaging included migration from stage IA to II (97/301, 32.2 %) and stage IB to II (46/85, 54.1 %). No significant differences in OS or PFS were noted between FIGO 2023 stage II substages (IIA vs. IIB vs. IIC vs. IICm<sub>p53abn</sub>; p<sub>OS</sub> = 0.53 and p<sub>PFS</sub> = 0.59). When FIGO 2023 stage IIC and IICm<sub>p53abn</sub> were stratified by initial FIGO 2009 substages (52 IIC: 23 IA, 21 IB, 8 II; and 101 IICm<sub>p53abn</sub>: 67 IA, 17 IB, 17 II), significant differences in OS and PFS were identified between FIGO 2009 substages IA vs. IB vs. II (<em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>The FIGO 2023 EC staging revision has resulted in significant upstaging from IA/IB to II, due to incorporation of lymphovascular space invasion, histology, and molecular profiles. No significant differences in survival were found between FIGO 2023 stage II substages, suggesting lack of discriminatory ability. Significant survival differences were seen within stages IIC and IICm<sub>p53abn</sub> when stratified by initial FIGO 2009 substages, suggesting FIGO 2023 IIC and IICm<sub>p53abn</sub> are heterogeneous cohorts.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 93-101"},"PeriodicalIF":4.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244395","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}
Pub Date : 2025-10-06DOI: 10.1016/j.ygyno.2025.09.014
Dana M. Chase , Helen Q. Huang , Wei Deng , Wui-Jin Koh , William Rodgers , William Small Jr , Kevin Albuquerque , Jyoti Mayadev , Charles A. Leath , Bradley Monk , Beob-Jong Kim , Dae-Yeon Kim , Chi Heum Cho , Jae-Weon Kim , Jae Hong No , Laura Holman , Ashley Stuckey , Denise Fabian , Alexandra H. Smick , Lari Wenzel , Sang Young Ryu
Objective
To prospectively evaluate the impact of adjuvant chemoradiation (RT + CIS) versus radiation (RT) on quality of life (QOL) and patient-reported outcomes (PROs) among patients with intermediate-risk, stage I-IIA cervical cancer treated with radical hysterectomy and pelvic lymphadenectomy.
Methods
Patients enrolled in GOG-0263 completed PRO/QOL assessments at baseline, 3, 7, and 36 weeks using the FACT-Cx Trial Outcome Index (FACT-Cx TOI), FACT/GOG-Neurotoxicity subscale (FACT/GOG-Ntx-4), the worst pain item from the Brief Pain Inventory (BPI), and five gastrointestinal/genitourinary (GI/GU) symptom items. Linear mixed models adjusted for baseline score, treatment, age, performance status, and country.
Results
Among 316 randomized eligible patients (RT + CIS: n = 158; RT: n = 158), questionnaire completion rates were 98 %, 90 %, 88 %, and 81 % at baseline, weeks 3, 7, and 36, respectively. Patients receiving RT + CIS reported a mean FACT-Cx TOI score 5.1 points lower than RT at 3 weeks (97.5 % CI: −8.6 to −1.6; p = 0.004) and 6.3 points lower at 7 weeks (97.5 % CI: −10.2 to −2.4; p = 0.002). By 36 weeks, scores had returned to baseline in both groups, with no significant difference (p = 0.386). Patient-reported neuropathy scores (FACT/GOG-Ntx-4) did not differ significantly between groups at any time point (p = 0.82). Patient-reported GI/GU symptoms and pain worsened at 3 weeks in both arms, followed by recovery to baseline by 36 weeks.
Conclusion
QOL declined in both groups after treatment initiation, with greater short-term deterioration in the RT + CIS group. By 36 weeks, QOL and other PROs returned to baseline in both groups. Neuropathy, GI/GU symptoms, and pain showed no significant differences between treatment arms over time.
{"title":"Patient-reported outcomes of a randomized phase III clinical trial of adjuvant radiation versus chemoradiation in intermediate risk, stage I/IIA cervical cancer patients treated with initial radical hysterectomy and pelvic lymphadenectomy (NRG/GOG-0263)","authors":"Dana M. Chase , Helen Q. Huang , Wei Deng , Wui-Jin Koh , William Rodgers , William Small Jr , Kevin Albuquerque , Jyoti Mayadev , Charles A. Leath , Bradley Monk , Beob-Jong Kim , Dae-Yeon Kim , Chi Heum Cho , Jae-Weon Kim , Jae Hong No , Laura Holman , Ashley Stuckey , Denise Fabian , Alexandra H. Smick , Lari Wenzel , Sang Young Ryu","doi":"10.1016/j.ygyno.2025.09.014","DOIUrl":"10.1016/j.ygyno.2025.09.014","url":null,"abstract":"<div><h3>Objective</h3><div>To prospectively evaluate the impact of adjuvant chemoradiation (RT + CIS) versus radiation (RT) on quality of life (QOL) and patient-reported outcomes (PROs) among patients with intermediate-risk, stage I-IIA cervical cancer treated with radical hysterectomy and pelvic lymphadenectomy.</div></div><div><h3>Methods</h3><div>Patients enrolled in GOG-0263 completed PRO/QOL assessments at baseline, 3, 7, and 36 weeks using the FACT-Cx Trial Outcome Index (FACT-Cx TOI), FACT/GOG-Neurotoxicity subscale (FACT/GOG-Ntx-4), the worst pain item from the Brief Pain Inventory (BPI), and five gastrointestinal/genitourinary (GI/GU) symptom items. Linear mixed models adjusted for baseline score, treatment, age, performance status, and country.</div></div><div><h3>Results</h3><div>Among 316 randomized eligible patients (RT + CIS: <em>n</em> = 158; RT: n = 158), questionnaire completion rates were 98 %, 90 %, 88 %, and 81 % at baseline, weeks 3, 7, and 36, respectively. Patients receiving RT + CIS reported a mean FACT-Cx TOI score 5.1 points lower than RT at 3 weeks (97.5 % CI: −8.6 to −1.6; <em>p</em> = 0.004) and 6.3 points lower at 7 weeks (97.5 % CI: −10.2 to −2.4; <em>p</em> = 0.002). By 36 weeks, scores had returned to baseline in both groups, with no significant difference (<em>p</em> = 0.386). Patient-reported neuropathy scores (FACT/GOG-Ntx-4) did not differ significantly between groups at any time point (<em>p</em> = 0.82). Patient-reported GI/GU symptoms and pain worsened at 3 weeks in both arms, followed by recovery to baseline by 36 weeks.</div></div><div><h3>Conclusion</h3><div>QOL declined in both groups after treatment initiation, with greater short-term deterioration in the RT + CIS group. By 36 weeks, QOL and other PROs returned to baseline in both groups. Neuropathy, GI/GU symptoms, and pain showed no significant differences between treatment arms over time.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"202 ","pages":"Pages 102-109"},"PeriodicalIF":4.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244445","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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