Gynecologic oncology最新文献_第10页

Survival outcomes and treatment patterns in malignant ovarian sex cord-stromal tumors: A population-based analysis 恶性卵巢性索间质瘤的生存结局和治疗模式：一项基于人群的分析。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-16 DOI: 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。

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引用次数: 0

Interstitial lung disease in targeted therapies: A Society of Gynecologic Oncology clinical practice statement 间质性肺病的靶向治疗：妇科肿瘤学会临床实践声明。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-15 DOI: 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.

间质性肺疾病（ILD）是妇科肿瘤靶向治疗（包括抗体-药物偶联和免疫治疗）的潜在严重甚至有时致命的并发症。危险因素包括先前存在的肺部疾病、高龄和先前的胸部放疗。早期发现、患者和临床医生教育以及及时的多学科合作对于降低ILD的发病率和死亡率至关重要。本妇科肿瘤学会临床实践声明为与妇科癌症治疗相关的ILD的诊断、分级和管理提供了基于证据的建议，强调了基线风险评估、持续监测和标准化干预方案的重要性，以优化患者的预后。

引用次数: 0

Immunohistochemistry, next generation sequencing (NGS), and whole exome sequencing concordance in HER2 testing in uterine serous carcinoma: a retrospective analysis 免疫组织化学、下一代测序（NGS）和全外显子组测序在子宫浆液性癌HER2检测中的一致性：回顾性分析。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-14 DOI: 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.

背景：her2靶向治疗是子宫浆液性癌（USC）患者的重要治疗选择。我们评估了常规免疫组织化学（IHC）检测和荧光原位杂交（FISH）检测HER2表达与商业平台（基础医学）的下一代测序（NGS）和综合全外显子组测序（WES）的一致性。方法：将两组USC患者的IHC和FISH结果与耶鲁大学基因组分析中心（YCGA）进行的匹配NGS数据（152例USC患者）和WES数据（76例USC患者）的一致性进行比较。临床HER2阳性定义为3+ IHC染色或2+ IHC染色，利用荧光原位杂交（FISH）反射基因扩增。NGS HER2阳性定义为NGS/WES报告中确定的ERBB2扩增。结果：在IHC/NGS组中，HER2 IHC/FISH与NGS和WES的相关性在80 - 85%之间，当在同一组织块上进行检测时，相关性有所提高。在检测/鉴定HER2治疗合格患者方面，WES可能优于市售的NGS平台。虽然高度相关，但这些结果证实，在评估符合her2靶向治疗条件的患者时，不应放弃免疫组化。

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引用次数: 0

SMARCA4 pathogenic variants: Gynecological cancer histories from a laboratory tested cohort SMARCA4致病变异：来自实验室检测队列的妇科癌症病史

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-13 DOI: 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.

目的：描述通过临床实验室检测获得的SMARCA4种系致病/可能致病变异（gPV）个体的癌症病史，以帮助指导gPV个体的监测和预防。方法：本回顾性队列研究分析了单个商业临床实验室（2014-2024年）通过遗传性癌症多基因面板检测发现的SMARCA4 gPV个体。描述性统计用于总结SMARCA4中gPV的个体。采用累积分布函数对SMARCA4 gPV患者中诊断为卵巢高钙血症型小细胞癌（scoht）和未明确卵巢癌的年龄进行枚举。结果：在基因分型个体中，有137例具有SMARCA4 gPV。应用排除标准后，127人被纳入分析。具有SMARCA4 gPV的个体主要为女性（74.8%），53.5% （n = 68）有癌症史。在有癌症病史的女性中，有scot（17.9%）和卵巢癌（7.4%）。在年龄≤50岁的女性中，scot占癌症诊断的29.8%。SMARCA4 gpv患者中所有scot病例均在40岁前被诊断出来。结论：我们的数据支持将SMARCA4纳入遗传性早发性卵巢癌的基因检测，枚举scot诊断的年龄，并强调前瞻性外显率研究的必要性，以改善对患者及其家属的咨询和管理。

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引用次数: 0

Sentinel lymph node mapping in early-stage cervical cancer: Results from the SENTIX prospective multicenter study 早期宫颈癌前哨淋巴结定位：SENTIX前瞻性多中心研究的结果

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-09 DOI: 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.

目的基于前瞻性多中心SENTIX试验的数据，评估早期宫颈癌接受初级手术患者的前哨淋巴结（SLN）双侧检出率、解剖分布和示踪剂性能。方法FIGO 2018期IA1 （LVSI+）至IB2期宫颈癌患者，术前影像学检查无可疑淋巴结，纳入SENTIX试验。SLN活检采用蓝色染料（BD）、放射性胶体（RC）、吲哚菁绿（ICG）或其组合进行。只有双侧SLN检测成功且术中冷冻切片阴性的患者才进行根治性子宫切除术或保留生育能力手术。SLN的位置和转移状态按解剖区域记录，并集中审查一致性。结果在724例行SLN活检的患者中，总双侧检出率为92.3%，其中ICG和RC联合检出率最高（100%）。如果考虑测图失败病例，双侧检出率为84.6%。大多数sln（91.6%）位于骨盆一级，主要位于髂外和髂间区。髂间分叉以上的sln少见（2.7%），骨盆II级的孤立阳性sln罕见（1.3%）。在主动脉旁区未发现sln。双侧检测不受BMI、组织学或既往锥化的影响。虽然2厘米肿瘤的检出率略低，但双侧检出率超过90%。结论ssln图谱在示踪剂和患者亚组中具有较高的双侧检出率。几乎所有sln都局限于骨盆I级，强调了解剖学的可预测性。这些结果表明，≤4厘米的肿瘤可重复SLN定位，可能有助于个体化手术计划。

{"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}

引用次数: 0

Multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in patients with advanced gynecological cancers: A prospective study 晚期妇科癌症患者恶性肠梗阻（MAMBO）项目的多学科门诊管理：一项前瞻性研究

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-09 DOI: 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.

目的：本前瞻性研究旨在评估风险分层、多学科门诊治疗晚期妇科癌症患者恶性肠梗阻（MBO）的可行性。方法采用基于临床风险的MBO分诊系统，结合肠功能评估、管理制度和教育工具。一个跨学科小组（IDT）指导治疗决策。有风险的患者通过护理电话接受了长达4周的积极管理，而MBO患者根据症状缓解持续了长达8周的积极管理。主要终点是mbo诊断后60天内存活和出院天数与住院天数之比。结果入选92例患者（中位年龄62岁[范围31-83]）。入组时，49% （n = 45）有MBO， 51% （n = 47）有发展成MBO的风险。7%的高危患者（n = 3）在4周内进展为MBO，而93%的患者在积极的门诊治疗下症状得到缓解。总体而言，62% （n = 57）的患者在研究期间发生了MBO。其中，93% （n = 53）需要住院治疗，前60天的中位住院时间为12.5天（范围0-57天）。MBO术后中位OS为5.7个月（95% CI, 3.6-8.4）。60天内的医院与家庭比率中位数为0.3（范围0-19）。42% （n = 24）患者的MBO得到缓解。微生物组分析显示，与高危人群相比，MBO患者的Shannon多样性和物种丰富度较低。结论采用IDT指导下基于风险的MBO分诊系统对MBO患者进行门诊管理是可行的。

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引用次数: 0

Impact of FIGO 2023 staging criteria on stage migration and survival outcomes in early-stage endometrial cancer: A retrospective cohort study FIGO 2023分期标准对早期子宫内膜癌分期迁移和生存结局的影响：一项回顾性队列研究

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-06 DOI: 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. IICm_p53abn; p_OS = 0.53 and p_PFS = 0.59). When FIGO 2023 stage IIC and IICm_p53abn were stratified by initial FIGO 2009 substages (52 IIC: 23 IA, 21 IB, 8 II; and 101 IICm_p53abn: 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 IICm_p53abn when stratified by initial FIGO 2009 substages, suggesting FIGO 2023 IIC and IICm_p53abn are heterogeneous cohorts.

目的：比较修订后的FIGO 2023子宫内膜癌（EC）分期系统与之前的FIGO 2009方案，评估分期迁移和预后能力。方法：2015年5月至2023年7月期间接受EC手术分期（包括前哨淋巴结活检或淋巴结切除术）的患者从FIGO 2009重新分期至FIGO 2023 （n = 538）。使用Kaplan-Meier法估计各分期的总生存期（OS）和无进展生存期（PFS），并使用log-rank检验进行比较。结果：26.8% %的病例（n = 144）发生阶段性迁移，几乎全部抢占（n = 143,99.3 %）。前期包括从IA期迁移到II期（97/301,32.2% %）和IB期迁移到II期（46/85,54.1% %）。FIGO 2023 II期亚期之间OS或PFS无显著差异（IIA vs. IIB vs. IIC vs. IICmp53abn; pOS = 0.53,pPFS = 0.59）。当FIGO 2023分期IIC和IICmp53abn按最初的FIGO 2009亚期（52 IIC: 23 IA, 21 IB, 8 II；和101 IICmp53abn: 67 IA， 17 IB, 17 II）分层时，发现FIGO 2009亚期IA、IB和II之间OS和PFS的显著差异(p 结论：FIGO 2023 EC分期修订导致IA/IB到II的显著提前，这是由于淋巴血管间隙侵入、组织学和分子谱的结合。FIGO 2023 II期亚期间生存率无显著差异，提示缺乏区分能力。在FIGO 2009的初始亚阶段中，IIC期和IICmp53abn期的生存率存在显著差异，这表明FIGO 2023 IIC期和IICmp53abn期是异质队列。

{"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}

引用次数: 0

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) 一项随机III期临床试验的患者报告结果：辅助放疗与放化疗对初始根治性子宫切除术和盆腔淋巴结切除术治疗的中危I/IIA期宫颈癌患者（NRG/GOG-0263）。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-06 DOI: 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.

目的：前瞻性评价辅助放化疗（RT + CIS）与放疗（RT）对中危I-IIA期宫颈癌根治性子宫切除术和盆腔淋巴结切除术患者生活质量（QOL）和患者报告预后（PROs）的影响。方法：纳入GOG-0263的患者在基线、3、7和36周时使用FACT- cx试验结果指数（FACT- cx TOI）、FACT/ gog -神经毒性亚量表（FACT/GOG-Ntx-4）、简短疼痛量表（BPI）中的最严重疼痛项目和5个胃肠道/泌尿生殖系统（GI/GU）症状项目完成PRO/QOL评估。线性混合模型调整了基线评分、治疗、年龄、表现状态和国家。结果：在316名随机化的符合条件的患者中（RT + CIS: n = 158; RT: n = 158），在基线、第3周、第7周和第36周时，问卷完成率分别为98%、90%、88%和81%。接受RT + CIS的患者报告的FACT-Cx TOI平均评分在3周时比RT低5.1分（97.5% CI: -8.6至-1.6;p = 0.004），在7周时低6.3分（97.5% CI: -10.2至-2.4;p = 0.002）。36周时，两组得分均恢复到基线水平，差异无统计学意义（p = 0.386）。患者报告的神经病变评分（FACT/GOG-Ntx-4）在任何时间点组间无显著差异（p = 0.82）。患者报告的GI/GU症状和疼痛在3周时加重，随后在36周时恢复到基线。结论：治疗开始后两组患者的生活质量均有所下降，其中RT + CIS组短期恶化更大。36周时，两组患者的生活质量及其他指标均恢复到基线水平。随着时间的推移，神经病变、GI/GU症状和疼痛在治疗组之间没有显著差异。

{"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}

引用次数: 0

Evaluation of the significance of isolated tumor cells in gynecological cancers. 评价分离肿瘤细胞在妇科肿瘤中的意义。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-01 Epub Date: 2025-08-09 DOI: 10.1016/j.ygyno.2025.07.031

Zheng Yuan Ng, W Glenn McCluggage, Pavel Dundr, Martina Borcinova, David Cibula

In gynecological oncology, sentinel lymph node biopsy with ultrastaging is increasingly used in cervical, endometrial and vulvar cancers. Isolated tumor cells (ITCs) are encountered much more commonly in this scenario than when standard histologic evaluation of non-sentinel lymph nodes is performed. The prognostic implication of ITCs in gynecological cancers is not well defined and international guidelines do not offer clear guidance regarding the management of gynecological cancers with ITCs. The current size cut-off for defining ITCs, micrometastases and macrometastases in lymph nodes are arbitrary and based on weak data. The detection rate of ITCs is strongly influenced by the "intensity" of pathological ultrastaging which varies greatly and there are resource constraints related to pathology services. However, even with standardized and intensive protocols, ITCs are by definition too small to be detected in all cases, and therefore it is challenging to completely define their prognostic risk. Moreover, in the absence of definitive evidence excluding their contribution to recurrence risk, we suggest that ITCs should be regarded as a potential negative prognostic risk factor and managed accordingly in clinical practice.

在妇科肿瘤学中，前哨淋巴结活检与超声扫描越来越多地用于宫颈癌、子宫内膜癌和外阴癌。在这种情况下，孤立的肿瘤细胞（ITCs）比对非前哨淋巴结进行标准组织学评估时更常见。妇科肿瘤中ITCs的预后含义尚未得到很好的定义，国际指南也没有为伴有ITCs的妇科癌症的管理提供明确的指导。目前用于定义淋巴结ITCs、微转移和大转移的大小临界值是任意的，并且基于薄弱的数据。ITCs的检出率受病理超声“强度”的影响很大，病理超声“强度”变化很大，而且病理服务资源有限。然而，即使采用标准化和强化的方案，根据定义，ITCs太小，无法在所有病例中检测到，因此完全确定其预后风险是具有挑战性的。此外，在缺乏明确证据排除其对复发风险的贡献的情况下，我们建议应将ITCs视为潜在的负面预后风险因素，并在临床实践中进行相应的管理。

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引用次数: 0

Ovarian cancer after breast cancer in women with a BRCA1 or BRCA2 pathogenic variant. 携带BRCA1或BRCA2致病变异的女性患乳腺癌后患卵巢癌。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-01 Epub Date: 2025-08-09 DOI: 10.1016/j.ygyno.2025.07.030

Adriana I Apostol, Joanne Kotsopoulos, Jacek Gronwald, Raymond H Kim, Beth Y Karlan, Amber Aeilts, Teresa Ramón Y Cajal, Tuya Pal, Andrea Eisen, Louise Bordeleau, William D Foulkes, Fergus Couch, Dana Zakalik, Robert Fruscio, Ping Sun, Jan Lubinski, Nadine Tung, Christian F Singer, Pal Moller, Mev Dominguez-Valentin, Steven A Narod, Kelly Metcalfe

Objective: Inherited BRCA1/2 pathogenic variants (mutations) confer high lifetime risks of breast and ovarian cancers. Estimating the cumulative ovarian cancer risk following a breast cancer diagnosis in these women will help guide decisions regarding preventive salpingo-oophorectomy.

Methods: Women carrying a BRCA1 or BRCA2 mutation were followed after breast cancer and completed follow-up questionnaires every two years. The 15-year cumulative risk of ovarian cancer was estimated for women with a prior history of breast cancer and for matched control women without breast cancer.

Results: A total of 2084 BRCA carriers with breast cancer (1515 BRCA1, 569 BRCA2) were included. During a mean follow-up of 3.9 years, 71 ovarian/fallopian carcinomas were diagnosed (66 BRCA1, 5 BRCA2). The 15-year cumulative ovarian cancer risk was 14.9 % in BRCA1 and 5.1 % in BRCA2 carriers. Women with breast cancer were compared to those without; 1378 matched pairs were included. The 15-year cumulative risk of ovarian/fallopian cancer was 10.8 % in women with a history of breast cancer versus 25.9 % in those without. Among BRCA1 carriers, the risk was 12.2 % in women with breast cancer and 32.0 % in those without. Among BRCA2 carriers, the 15-year ovarian cancer risk was 2.0 % in both groups.

Conclusions: Ovarian cancer risk remains high in BRCA1/2 carriers following breast cancer diagnosis. For BRCA1 mutation carriers, the risk is lower than in women without breast cancer. However, for both BRCA1 and BRCA2 the ovarian cancer risk is elevated, and considering the poor prognosis associated with ovarian cancer, risk-reducing salpingo-oophorectomy is strongly recommended for women with BRCA-associated breast cancer.

目的：遗传性BRCA1/2致病性变异（突变）会导致乳腺癌和卵巢癌的高终生风险。评估这些女性在乳腺癌诊断后的累积卵巢癌风险将有助于指导预防性输卵管-卵巢切除术的决策。方法：携带BRCA1或BRCA2突变的女性在乳腺癌后进行随访，并每两年完成随访问卷。对有乳腺癌病史的妇女和没有乳腺癌的对照妇女进行了15年卵巢癌累积风险的估计。结果：共纳入2084例乳腺癌BRCA携带者（1515例BRCA1, 569例BRCA2）。在平均3.9年的随访期间，诊断出71例卵巢/输卵管癌（66例BRCA1, 5例BRCA2）。BRCA1携带者的15年累积卵巢癌风险为14.9%，BRCA2携带者为5.1%。研究人员将患有乳腺癌的女性与没有患乳腺癌的女性进行了比较；包括1378对匹配的配对。有乳腺癌病史的女性15年累积患卵巢癌/输卵管癌的风险为10.8%，而没有乳腺癌病史的女性为25.9%。在BRCA1携带者中，乳腺癌女性的风险为12.2%，非乳腺癌女性的风险为32.0%。在BRCA2携带者中，两组15年卵巢癌风险均为2.0%。结论：乳腺癌诊断后，BRCA1/2携带者患卵巢癌的风险仍然很高。BRCA1突变携带者患乳腺癌的风险低于没有患乳腺癌的女性。然而，BRCA1和BRCA2的卵巢癌风险均升高，考虑到与卵巢癌相关的不良预后，强烈建议brca相关乳腺癌患者进行降低风险的输卵管卵巢切除术。

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引用次数: 0