首页 > 最新文献

Gynecologic oncology最新文献

英文 中文
Metformin for patients with advanced stage ovarian cancer: A randomized phase II placebo-controlled trial
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-08 DOI: 10.1016/j.ygyno.2025.02.001
Iris L. Romero , Ernst Lengyel , Andrea E. Wahner Hendrickson , Gustavo C. Rodriguez , Charles A. Leath III , Rodney P. Rocconi , Michael J. Goodheart , Summer Dewdney , Theodore Karrison , Gini F. Fleming , S. Diane Yamada

Objective

The primary aim of this study was to determine if metformin, an oral biguanide administered with first-line chemotherapy and continued as maintenance therapy, improves progression-free survival (PFS) for patients with advanced-stage ovarian cancer.

Methods

Patients with pathologically confirmed advanced-stage ovarian cancer undergoing primary debulking or neoadjuvant platinum-based chemotherapy followed by surgery were eligible to participate. Patients were randomized 1:1 to receive platinum/taxane-based chemotherapy with metformin 850 mg orally twice per day or placebo, followed by maintenance therapy (metformin or placebo) for two years from the date of randomization.

Results

108 evaluable patients were enrolled; 54 were randomly assigned to metformin, and 54 to placebo. Sixty-six percent (n = 71) received neoadjuvant therapy, 31 % (n = 33) primary debulking surgery, and 88 % (n = 93) had tumors of high-grade serous histology. The primary endpoint, PFS, was not significantly different between the treatment groups (1-sided p-value = 0.31; adjusted hazard ratio [HR] = 0.87, 95 % confidence interval [CI]: 0.56–1.36). Median PFS was 15.4 months (95 % CI: 11.2–23,5) for metformin and 14.3 months (95 % CI: 11.6–18.0) for placebo. Overall survival (OS) was not significantly different (2-sided p-value = 0.21; adjusted HR = 1.49, 95 % CI: 0.86–2.59), with a median of 40.7 months (95 % CI: 28.0–48.2) for metformin versus 43.8 months (95 % CI: 35.3–57.2) for placebo. The addition of metformin was well tolerated, and there were no differences in toxicity between the two groups.

Conclusion

Although it was well-tolerated, adding metformin to first-line platinum/taxane-based therapy does not improve PFS or OS for patients with newly diagnosed advanced stage ovarian cancer.
{"title":"Metformin for patients with advanced stage ovarian cancer: A randomized phase II placebo-controlled trial","authors":"Iris L. Romero ,&nbsp;Ernst Lengyel ,&nbsp;Andrea E. Wahner Hendrickson ,&nbsp;Gustavo C. Rodriguez ,&nbsp;Charles A. Leath III ,&nbsp;Rodney P. Rocconi ,&nbsp;Michael J. Goodheart ,&nbsp;Summer Dewdney ,&nbsp;Theodore Karrison ,&nbsp;Gini F. Fleming ,&nbsp;S. Diane Yamada","doi":"10.1016/j.ygyno.2025.02.001","DOIUrl":"10.1016/j.ygyno.2025.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>The primary aim of this study was to determine if metformin, an oral biguanide administered with first-line chemotherapy and continued as maintenance therapy, improves progression-free survival (PFS) for patients with advanced-stage ovarian cancer.</div></div><div><h3>Methods</h3><div>Patients with pathologically confirmed advanced-stage ovarian cancer undergoing primary debulking or neoadjuvant platinum-based chemotherapy followed by surgery were eligible to participate. Patients were randomized 1:1 to receive platinum/taxane-based chemotherapy with metformin 850 mg orally twice per day or placebo, followed by maintenance therapy (metformin or placebo) for two years from the date of randomization.</div></div><div><h3>Results</h3><div>108 evaluable patients were enrolled; 54 were randomly assigned to metformin, and 54 to placebo. Sixty-six percent (<em>n</em> = 71) received neoadjuvant therapy, 31 % (<em>n</em> = 33) primary debulking surgery, and 88 % (<em>n</em> = 93) had tumors of high-grade serous histology. The primary endpoint, PFS, was not significantly different between the treatment groups (1-sided <em>p</em>-value = 0.31; adjusted hazard ratio [HR] = 0.87, 95 % confidence interval [CI]: 0.56–1.36). Median PFS was 15.4 months (95 % CI: 11.2–23,5) for metformin and 14.3 months (95 % CI: 11.6–18.0) for placebo. Overall survival (OS) was not significantly different (2-sided p-value = 0.21; adjusted HR = 1.49, 95 % CI: 0.86–2.59), with a median of 40.7 months (95 % CI: 28.0–48.2) for metformin versus 43.8 months (95 % CI: 35.3–57.2) for placebo. The addition of metformin was well tolerated, and there were no differences in toxicity between the two groups.</div></div><div><h3>Conclusion</h3><div>Although it was well-tolerated, adding metformin to first-line platinum/taxane-based therapy does not improve PFS or OS for patients with newly diagnosed advanced stage ovarian cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"194 ","pages":"Pages 18-24"},"PeriodicalIF":4.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348769","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
Chemotherapy Response Score (CRS): A comprehensive review of its prognostic and predictive value in High-Grade Serous Carcinoma (HGSC)
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-06 DOI: 10.1016/j.ygyno.2025.01.012
Gian Franco Zannoni , Giuseppe Angelico , Saveria Spadola , Emma Bragantini , Giancarlo Troncone , Filippo Fraggetta , Angela Santoro
Ovarian carcinoma, the second most common gynecological cancer in Western countries, is frequently diagnosed at advanced stages, necessitating complex treatment strategies. While cytoreductive surgery remains the standard for improving survival, neoadjuvant chemotherapy (NACT) has become essential for cases unsuitable for immediate surgery, aiming to reduce tumor burden preoperatively. Introduced in 2015, the Chemotherapy Response Score (CRS) is now a key histopathological tool for assessing response to NACT, stratifying patients into three response categories. CRS3 is associated with improved progression-free survival (PFS) and overall survival (OS), while CRS1 and CRS2 are linked to poorer outcomes. Validated across clinical cohorts, CRS has proven valuable not only as a prognostic tool but also as a predictor for molecular-targeted therapies, such as PARP inhibitors, especially in BRCA wild-type patients. Studies also suggest a potential role for CRS in guiding the use of PD-L1 inhibitors, especially in partial responders (CRS1 and CRS2), where immunotherapy may complement chemotherapy. In the present paper we exlored the actual knowledge on CRS scoring for ovarian carcinoma. Diagnostic and prognostic implications of CRS as well as its correlation with therapeutic response and other biomarkers are discussed.
{"title":"Chemotherapy Response Score (CRS): A comprehensive review of its prognostic and predictive value in High-Grade Serous Carcinoma (HGSC)","authors":"Gian Franco Zannoni ,&nbsp;Giuseppe Angelico ,&nbsp;Saveria Spadola ,&nbsp;Emma Bragantini ,&nbsp;Giancarlo Troncone ,&nbsp;Filippo Fraggetta ,&nbsp;Angela Santoro","doi":"10.1016/j.ygyno.2025.01.012","DOIUrl":"10.1016/j.ygyno.2025.01.012","url":null,"abstract":"<div><div>Ovarian carcinoma, the second most common gynecological cancer in Western countries, is frequently diagnosed at advanced stages, necessitating complex treatment strategies. While cytoreductive surgery remains the standard for improving survival, neoadjuvant chemotherapy (NACT) has become essential for cases unsuitable for immediate surgery, aiming to reduce tumor burden preoperatively. Introduced in 2015, the Chemotherapy Response Score (CRS) is now a key histopathological tool for assessing response to NACT, stratifying patients into three response categories. CRS3 is associated with improved progression-free survival (PFS) and overall survival (OS), while CRS1 and CRS2 are linked to poorer outcomes. Validated across clinical cohorts, CRS has proven valuable not only as a prognostic tool but also as a predictor for molecular-targeted therapies, such as PARP inhibitors, especially in BRCA wild-type patients. Studies also suggest a potential role for CRS in guiding the use of PD-L1 inhibitors, especially in partial responders (CRS1 and CRS2), where immunotherapy may complement chemotherapy. In the present paper we exlored the actual knowledge on CRS scoring for ovarian carcinoma. Diagnostic and prognostic implications of CRS as well as its correlation with therapeutic response and other biomarkers are discussed.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"194 ","pages":"Pages 1-10"},"PeriodicalIF":4.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143347594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Barriers to early detection: Insurance denials for breast MRI screening in women with germline BRCA1/2 mutations 早期发现的障碍:生殖系BRCA1/2突变妇女乳腺MRI筛查的保险拒绝。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2024.12.016
S. Gordhandas , C. Gellman , S. Ingber , T. Yen , R. Kahn , S. Kyana , A. Taffuri , S. Sokolowski , D. Martinez , P. Garcia , S. Mullangi , K. Long Roche , N. Abu-Rustum , D. Mangino , M. Pilewskie , E. Sutton , E. Aviki

Objectives

Women with germline BRCA1/2 pathogenic variants (gBRCA1/2) are recommended to undergo annual breast MRI and mammography. Our objective was to describe the frequency of insurance denials for annual breast MRIs in women with gBRCA1/2 and determine denial trends.

Methods

Women with gBRCA1/2 following in a high-risk breast cancer clinic with breast MRIs ordered from 2020 to 2021 were identified and cross-referenced with a database of insurance denials. Radiology records were queried to determine if screening breast MRIs were performed in 2020 and 2021. Rates of MRI denials and outcomes after appeal were determined.

Results

There were 682 women with gBRCA1/2 who had screening breast MRIs ordered from 2020 to 2021, including 318 (47 %) BRCA1, 356 (52 %) BRCA2, and 8 (1 %) with both. 73 women (11 %) had an MRI denied. Women insured through Medicaid had the highest rates of denials (2020: 7 %, 2021: 18 %), followed by commercial insurance (2020: 6 %, 2021: 9 %). There were significantly more denials in 2021 compared to 2020 (p = 0.044), and 2021 denials were more likely to be denied on appeal. Of women with denials, 4 (14 %) in 2020 and 5 (11 %) in 2021 did not have a screening MRI performed. One patient with DCIS had an MRI denial prior to diagnosis.

Conclusion

Breast MRI insurance denials were present in 11 % of this high-risk cohort, and 14 % of women with denials did not undergo annual screening. There were significantly more denials in 2021, suggesting worsening barriers for these patients and added burden on providers to appeal for appropriate screening tests.
目的:建议携带生殖系BRCA1/2致病变异(gBRCA1/2)的女性每年进行乳房MRI和乳房x光检查。我们的目的是描述患有gBRCA1/2的女性每年乳腺mri的保险拒绝频率,并确定拒绝趋势。方法:对2020年至2021年在高风险乳腺癌诊所接受乳腺mri检查的患有gBRCA1/2的女性进行鉴定,并与保险拒绝数据库进行交叉参考。研究人员查询了放射学记录,以确定是否在2020年和2021年进行了乳房核磁共振筛查。确定MRI拒绝率和上诉后的结果。结果:从2020年到2021年,682名患有gBRCA1/2的女性接受了乳房mri筛查,其中318名(47%)患有BRCA1, 356名(52%)患有BRCA2, 8名(1%)患有两者。73名女性(11%)拒绝接受核磁共振检查。通过医疗补助计划投保的妇女的拒绝率最高(2020年:7%,2021年:18%),其次是商业保险(2020年:6%,2021年:9%)。与2020年相比,2021年的拒绝数量明显更多(p = 0.044), 2021年的拒绝更有可能在上诉中被拒绝。在否认的女性中,2020年有4人(14%)和2021年有5人(11%)没有进行MRI筛查。一名DCIS患者在诊断前有MRI否认。结论:在这个高风险队列中,11%的女性存在乳腺MRI保险拒绝,14%的女性拒绝接受年度筛查。2021年,拒绝接受治疗的人数明显增加,这表明这些患者面临的障碍加剧,并增加了提供者呼吁进行适当筛查测试的负担。
{"title":"Barriers to early detection: Insurance denials for breast MRI screening in women with germline BRCA1/2 mutations","authors":"S. Gordhandas ,&nbsp;C. Gellman ,&nbsp;S. Ingber ,&nbsp;T. Yen ,&nbsp;R. Kahn ,&nbsp;S. Kyana ,&nbsp;A. Taffuri ,&nbsp;S. Sokolowski ,&nbsp;D. Martinez ,&nbsp;P. Garcia ,&nbsp;S. Mullangi ,&nbsp;K. Long Roche ,&nbsp;N. Abu-Rustum ,&nbsp;D. Mangino ,&nbsp;M. Pilewskie ,&nbsp;E. Sutton ,&nbsp;E. Aviki","doi":"10.1016/j.ygyno.2024.12.016","DOIUrl":"10.1016/j.ygyno.2024.12.016","url":null,"abstract":"<div><h3>Objectives</h3><div>Women with germline <em>BRCA1/2</em> pathogenic variants (<em>gBRCA1/2</em>) are recommended to undergo annual breast MRI and mammography. Our objective was to describe the frequency of insurance denials for annual breast MRIs in women with g<em>BRCA1/2</em> and determine denial trends.</div></div><div><h3>Methods</h3><div>Women with g<em>BRCA1/2</em> following in a high-risk breast cancer clinic with breast MRIs ordered from 2020 to 2021 were identified and cross-referenced with a database of insurance denials. Radiology records were queried to determine if screening breast MRIs were performed in 2020 and 2021. Rates of MRI denials and outcomes after appeal were determined.</div></div><div><h3>Results</h3><div>There were 682 women with g<em>BRCA1/2</em> who had screening breast MRIs ordered from 2020 to 2021, including 318 (47 %) <em>BRCA1</em>, 356 (52 %) <em>BRCA2</em>, and 8 (1 %) with both. 73 women (11 %) had an MRI denied. Women insured through Medicaid had the highest rates of denials (2020: 7 %, 2021: 18 %), followed by commercial insurance (2020: 6 %, 2021: 9 %). There were significantly more denials in 2021 compared to 2020 (<em>p</em> = 0.044), and 2021 denials were more likely to be denied on appeal. Of women with denials, 4 (14 %) in 2020 and 5 (11 %) in 2021 did not have a screening MRI performed. One patient with DCIS had an MRI denial prior to diagnosis.</div></div><div><h3>Conclusion</h3><div>Breast MRI insurance denials were present in 11 % of this high-risk cohort, and 14 % of women with denials did not undergo annual screening. There were significantly more denials in 2021, suggesting worsening barriers for these patients and added burden on providers to appeal for appropriate screening tests.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 20-23"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927092","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 stromal invasion and molecular characterization in stage II-IV endometrial cancers 宫颈间质浸润与II-IV期子宫内膜癌的分子特征。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2024.12.013
Luigi A. De Vitis , Fiorella E. Reyes-Baez , Gabriella Schivardi , Maryam Shahi , Angela J. Fought , Michaela E. McGree , Ilaria Capasso , Leah Grcevich , Ilaria Betella , Mariacristina Ghioni , Elena Guerini-Rocco , Giovanni D. Aletti , William Cliby , Francesco Multinu , Carrie L. Langstraat , Andrea Mariani , Gretchen E. Glaser

Objective

The optimal treatment for patients with cervical stromal invasion (CSI) in endometrial cancer (EC) remains unclear. We aimed to test the prognostic role of molecular classification in EC patients with CSI.

Methods

A retrospective, multicenter review of EC patients with CSI was performed. EC cases were assigned to one of the molecular classes: POLE mutated (POLEmut), MMR deficient (MMRd), p53 abnormal (p53abn), or no specific molecular profile (NSMP). Three-year recurrence-free survival (RFS) from surgery was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were fit to adjust for confounders.

Results

Overall, 162 EC patients with CSI were identified: 70 (43.2 %) NSMP, 49 (30.2 %) p53abn, 40 (24.7 %) MMRd, 3 (1.9 %) POLEmut. POLEmut cases were excluded from further analysis, because of the small number of patients identified. At univariate analysis, molecular class was significantly associated with recurrence within 3 years after surgery (p = 0.04). Three-year RFS was 59.9 % (95 % confidence interval [CI], 46.1–77.8 %) for NSMP, 50.6 % (95 % CI, 34.9–73.2 %) for MMRd, and 33.1 % (95 % CI, 19.7–55.3 %) for p53abn. After adjusting for stage and grade, molecular class was no longer significantly associated with recurrence within three years (p = 0.28).

Conclusions

Traditional risk factors such as grade and stage remain critical in determining the prognosis of endometrial cancer with cervical stromal invasion. This study highlights the importance of integrating both molecular and morphological features in determining the prognosis of endometrial cancer, with particular emphasis on endometrioid histotypes.
目的:子宫内膜癌(EC)宫颈间质浸润(CSI)患者的最佳治疗方法仍不明确。我们的目的是检验分子分类在CSI子宫内膜癌患者中的预后作用:我们对患有 CSI 的子宫内膜癌患者进行了多中心回顾性研究。EC病例被归入其中一种分子分类:POLE突变(POLEmut)、MMR缺陷(MMRd)、p53异常(p53abn)或无特异性分子特征(NSMP)。手术后三年无复发生存期(RFS)采用 Kaplan-Meier 法估算。拟合考克斯比例危险回归模型以调整混杂因素:结果:总共发现了162名患有CSI的欧共体患者:70例(43.2%)NSMP,49例(30.2%)p53abn,40例(24.7%)MMRd,3例(1.9%)POLEmut。由于发现的患者人数较少,POLEmut 病例被排除在进一步分析之外。在单变量分析中,分子分类与术后三年内的复发显著相关(p = 0.04)。NSMP 的三年 RFS 为 59.9%(95% 置信区间 [CI],46.1-77.8%),MMRd 为 50.6%(95% 置信区间 [CI],34.9-73.2%),p53abn 为 33.1%(95% 置信区间 [CI],19.7-55.3%)。在对分期和分级进行调整后,分子分级与三年内复发的关系不再显著(p = 0.28):结论:分级和分期等传统风险因素仍是决定宫颈间质浸润子宫内膜癌预后的关键因素。这项研究强调了综合分子和形态特征来判断子宫内膜癌预后的重要性,尤其强调了子宫内膜样组织型。
{"title":"Cervical stromal invasion and molecular characterization in stage II-IV endometrial cancers","authors":"Luigi A. De Vitis ,&nbsp;Fiorella E. Reyes-Baez ,&nbsp;Gabriella Schivardi ,&nbsp;Maryam Shahi ,&nbsp;Angela J. Fought ,&nbsp;Michaela E. McGree ,&nbsp;Ilaria Capasso ,&nbsp;Leah Grcevich ,&nbsp;Ilaria Betella ,&nbsp;Mariacristina Ghioni ,&nbsp;Elena Guerini-Rocco ,&nbsp;Giovanni D. Aletti ,&nbsp;William Cliby ,&nbsp;Francesco Multinu ,&nbsp;Carrie L. Langstraat ,&nbsp;Andrea Mariani ,&nbsp;Gretchen E. Glaser","doi":"10.1016/j.ygyno.2024.12.013","DOIUrl":"10.1016/j.ygyno.2024.12.013","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal treatment for patients with cervical stromal invasion (CSI) in endometrial cancer (EC) remains unclear. We aimed to test the prognostic role of molecular classification in EC patients with CSI.</div></div><div><h3>Methods</h3><div>A retrospective, multicenter review of EC patients with CSI was performed. EC cases were assigned to one of the molecular classes: <em>POLE</em> mutated (POLEmut), MMR deficient (MMRd), p53 abnormal (p53abn), or no specific molecular profile (NSMP). Three-year recurrence-free survival (RFS) from surgery was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were fit to adjust for confounders.</div></div><div><h3>Results</h3><div>Overall, 162 EC patients with CSI were identified: 70 (43.2 %) NSMP, 49 (30.2 %) p53abn, 40 (24.7 %) MMRd, 3 (1.9 %) POLEmut. POLEmut cases were excluded from further analysis, because of the small number of patients identified. At univariate analysis, molecular class was significantly associated with recurrence within 3 years after surgery (<em>p</em> = 0.04). Three-year RFS was 59.9 % (95 % confidence interval [CI], 46.1–77.8 %) for NSMP, 50.6 % (95 % CI, 34.9–73.2 %) for MMRd, and 33.1 % (95 % CI, 19.7–55.3 %) for p53abn. After adjusting for stage and grade, molecular class was no longer significantly associated with recurrence within three years (<em>p</em> = 0.28).</div></div><div><h3>Conclusions</h3><div>Traditional risk factors such as grade and stage remain critical in determining the prognosis of endometrial cancer with cervical stromal invasion. This study highlights the importance of integrating both molecular and morphological features in determining the prognosis of endometrial cancer, with particular emphasis on endometrioid histotypes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 81-88"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970382","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
High prevalence of FAP+ cancer-associated fibroblasts predicts poor outcome in patients with high-grade serous ovarian cancer with high CD8 T-cell density
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2025.01.010
Sara Corvigno , Josefin Fernebro , Josefin Severin Karlsson , Artur Mezheieusky , Alfonso Martín-Bernabé , Laura Martin De La Fuente , Sofia Westbom-Fremer , Joseph W. Carlson , Christian Klein , Paivi Kannisto , Ingrid Hedenfalk , Susanne Malander , Arne Östman , Hanna Dahlstrand

Objective

Studies have implied that fibroblasts may act as regulators of immune cells in the tumor microenvironment (TME). We investigated the clinical relevance of fibroblast activation protein (FAP) positive stroma in high-grade serous ovarian cancer (HGSC) in relation to CD8+ lymphocyte's infiltration.

Methods

In a discovery cohort (N = 113) of HGSC, expression of FAP and CD8 in the TME was analyzed with immunohistochemistry. Results were correlated with overall survival (OS) and progression-free survival (PFS). The findings were validated in an independent cohort of HGSC (N = 121) and in public available datasets.

Results

High infiltration of CD8+ cells in the TME of HGSC was found to be associated with longer OS, as previously known. Increased expression of FAP was associated with shorter median PFS (11.4 vs. 18.6 months) in tumors with high density of CD8+ cells (HR 4.03, CI 95 % 1.38–11.72, p = 0.01). Similarly, in the validation cohort, high intensity of FAP in cases with high density of CD8+ cells was associated with shorter OS, 31.5 vs 76.9 months (HR 2.83; 95 % CI 1.17–6.86, p = 0.02). The results were consistent in multivariable analyses. The association between high FAP expression and poor outcome in high density CD8 HGSC was also confirmed in publicly available datasets.

Conclusions

The TME infiltration of FAP-positive fibroblasts is associated with poor prognosis in HGSC with high CD8+ cells density. Targeting the FAP+ subset of fibroblasts may unlock the local immune-activation in the TME thus enhance the positive prognostic effect of T-cells in ovarian cancer.
{"title":"High prevalence of FAP+ cancer-associated fibroblasts predicts poor outcome in patients with high-grade serous ovarian cancer with high CD8 T-cell density","authors":"Sara Corvigno ,&nbsp;Josefin Fernebro ,&nbsp;Josefin Severin Karlsson ,&nbsp;Artur Mezheieusky ,&nbsp;Alfonso Martín-Bernabé ,&nbsp;Laura Martin De La Fuente ,&nbsp;Sofia Westbom-Fremer ,&nbsp;Joseph W. Carlson ,&nbsp;Christian Klein ,&nbsp;Paivi Kannisto ,&nbsp;Ingrid Hedenfalk ,&nbsp;Susanne Malander ,&nbsp;Arne Östman ,&nbsp;Hanna Dahlstrand","doi":"10.1016/j.ygyno.2025.01.010","DOIUrl":"10.1016/j.ygyno.2025.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>Studies have implied that fibroblasts may act as regulators of immune cells in the tumor microenvironment (TME). We investigated the clinical relevance of fibroblast activation protein (FAP) positive stroma in high-grade serous ovarian cancer (HGSC) in relation to CD8+ lymphocyte's infiltration.</div></div><div><h3>Methods</h3><div>In a discovery cohort (<em>N</em> = 113) of HGSC, expression of FAP and CD8 in the TME was analyzed with immunohistochemistry. Results were correlated with overall survival (OS) and progression-free survival (PFS). The findings were validated in an independent cohort of HGSC (<em>N</em> = 121) and in public available datasets.</div></div><div><h3>Results</h3><div>High infiltration of CD8+ cells in the TME of HGSC was found to be associated with longer OS, as previously known. Increased expression of FAP was associated with shorter median PFS (11.4 vs. 18.6 months) in tumors with high density of CD8+ cells (HR 4.03, CI 95 % 1.38–11.72, <em>p</em> = 0.01). Similarly, in the validation cohort, high intensity of FAP in cases with high density of CD8+ cells was associated with shorter OS, 31.5 vs 76.9 months (HR 2.83; 95 % CI 1.17–6.86, <em>p</em> = 0.02). The results were consistent in multivariable analyses. The association between high FAP expression and poor outcome in high density CD8 HGSC was also confirmed in publicly available datasets.</div></div><div><h3>Conclusions</h3><div>The TME infiltration of FAP-positive fibroblasts is associated with poor prognosis in HGSC with high CD8+ cells density. Targeting the FAP+ subset of fibroblasts may unlock the local immune-activation in the TME thus enhance the positive prognostic effect of T-cells in ovarian cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 148-155"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143212369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A phase I study of temsirolimus in combination with metformin in patients with advanced or recurrent endometrial cancer temsirolimus联合二甲双胍治疗晚期或复发性子宫内膜癌的I期研究
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2024.12.019
Jibran Ahmed , Bettzy Stephen , Muhammad R. Khawaja , Yali Yang , Israa Salih , Elizve Barrientos-Toro , Maria Gabriela Raso , Daniel D. Karp , Sarina A. Piha-Paul , Anil K. Sood , Chaan S. Ng , Amber Johnson , Pamela T. Soliman , Funda Meric-Bernstam , Karen H. Lu , Aung Naing

Introduction

Molecular alterations in the PI3K/AKT and Ras/Raf/MEK/ERK pathways are frequently observed in patients with endometrial cancers. However, mTOR inhibitors, such as temsirolimus, have modest clinical benefits. In addition to inducing metabolic changes in cells, metformin activates AMPK, which in turn inhibits the mTOR pathway. In this phase 1 clinical trial we hypothesized that combining metformin with temsirolimus would potentiate the antitumor activity against advanced or recurrent endometrial cancer.

Methods

The dose-expansion cohort used a Simon Minimax two-stage design. The objectives of the endometrial cancer expansion cohort were to evaluate the clinical tumor response, as indicated by the objective response and clinical benefit rates, as well as an ongoing safety assessment of the combination treatment.

Results

Forty patients were enrolled in this study. The most common treatment-related adverse events (reported in 32 patients) were hypertriglyceridemia (n = 14), diarrhea (n = 13), mucositis (n = 13), anorexia (n = 12), and anemia (n = 10). The grade 3 adverse events were 2 instances each of anemia and thrombocytopenia and 1 instance each of mucositis, fatigue, weight loss, hypokalemia, hypophosphatemia, and increased aspartate aminotransferase and alanine transaminase levels. Among the 33 patients evaluable for response, objective response was seen in two (6 %; both partial responses), and 13 (39 %) patients had stable disease, including 11 for ≥4 months, representing a clinical benefit rate of 39 %.

Conclusions

The results of this single-center clinical trial showed that, in patients with advanced or recurrent endometrial cancer, metformin can be safely added to temsirolimus providing limited response without added safety concerns.
Clinical trial registration number: NCT01529593.
PI3K/AKT和Ras/Raf/MEK/ERK通路的分子改变在子宫内膜癌患者中经常观察到。然而,mTOR抑制剂,如替西莫司,具有适度的临床益处。除了诱导细胞代谢变化外,二甲双胍还激活AMPK,从而抑制mTOR通路。在这项1期临床试验中,我们假设二甲双胍联合替西莫司可以增强对晚期或复发性子宫内膜癌的抗肿瘤活性。方法:剂量扩展队列采用Simon Minimax两阶段设计。子宫内膜癌扩展队列的目的是评估临床肿瘤反应,如客观反应和临床获益率,以及联合治疗的持续安全性评估。结果:40例患者入组。最常见的治疗相关不良事件(32例患者报告)是高甘油三酯血症(n = 14)、腹泻(n = 13)、粘膜炎(n = 13)、厌食症(n = 12)和贫血(n = 10)。3级不良事件为贫血和血小板减少症各2例,粘膜炎、疲劳、体重减轻、低钾血症、低磷血症、天冬氨酸转氨酶和丙氨酸转氨酶水平升高各1例。在33例可评价缓解的患者中,2例(6%;13例(39%)患者病情稳定,其中11例持续时间≥4个月,临床获益率为39%。结论:这项单中心临床试验的结果表明,对于晚期或复发子宫内膜癌患者,二甲双胍可以安全地加入替西莫司,提供有限的反应,而不会增加安全性问题。临床试验注册号:NCT01529593。
{"title":"A phase I study of temsirolimus in combination with metformin in patients with advanced or recurrent endometrial cancer","authors":"Jibran Ahmed ,&nbsp;Bettzy Stephen ,&nbsp;Muhammad R. Khawaja ,&nbsp;Yali Yang ,&nbsp;Israa Salih ,&nbsp;Elizve Barrientos-Toro ,&nbsp;Maria Gabriela Raso ,&nbsp;Daniel D. Karp ,&nbsp;Sarina A. Piha-Paul ,&nbsp;Anil K. Sood ,&nbsp;Chaan S. Ng ,&nbsp;Amber Johnson ,&nbsp;Pamela T. Soliman ,&nbsp;Funda Meric-Bernstam ,&nbsp;Karen H. Lu ,&nbsp;Aung Naing","doi":"10.1016/j.ygyno.2024.12.019","DOIUrl":"10.1016/j.ygyno.2024.12.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Molecular alterations in the PI3K/AKT and Ras/Raf/MEK/ERK pathways are frequently observed in patients with endometrial cancers. However, mTOR inhibitors, such as temsirolimus, have modest clinical benefits. In addition to inducing metabolic changes in cells, metformin activates AMPK, which in turn inhibits the mTOR pathway. In this phase 1 clinical trial we hypothesized that combining metformin with temsirolimus would potentiate the antitumor activity against advanced or recurrent endometrial cancer.</div></div><div><h3>Methods</h3><div>The dose-expansion cohort used a Simon Minimax two-stage design. The objectives of the endometrial cancer expansion cohort were to evaluate the clinical tumor response, as indicated by the objective response and clinical benefit rates, as well as an ongoing safety assessment of the combination treatment.</div></div><div><h3>Results</h3><div>Forty patients were enrolled in this study. The most common treatment-related adverse events (reported in 32 patients) were hypertriglyceridemia (<em>n</em> = 14), diarrhea (<em>n</em> = 13), mucositis (n = 13), anorexia (<em>n</em> = 12), and anemia (<em>n</em> = 10). The grade 3 adverse events were 2 instances each of anemia and thrombocytopenia and 1 instance each of mucositis, fatigue, weight loss, hypokalemia, hypophosphatemia, and increased aspartate aminotransferase and alanine transaminase levels. Among the 33 patients evaluable for response, objective response was seen in two (6 %; both partial responses), and 13 (39 %) patients had stable disease, including 11 for ≥4 months, representing a clinical benefit rate of 39 %.</div></div><div><h3>Conclusions</h3><div>The results of this single-center clinical trial showed that, in patients with advanced or recurrent endometrial cancer, metformin can be safely added to temsirolimus providing limited response without added safety concerns.</div><div>Clinical trial registration number: <span><span>NCT01529593</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 73-80"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947783","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
Serum CA125 levels in the context of ProMisE molecular classification provides pre-operative prognostic information that can direct endometrial cancer management 在ProMisE分子分类的背景下,血清CA125水平提供了术前预后信息,可以指导子宫内膜癌的治疗。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2024.12.010
Andrea Neilson , Amy Jamieson , Derek Chiu , Samuel Leung , Amy Lum , Stefan Kommoss , David G. Huntsman , Aline Talhouk , C. Blake Gilks , Jessica N. McAlpine

Objective

Previous research suggests serum CA125 reflects extra-uterine disease in patients with endometrial carcinoma (EC). Our objective was to determine if CA125 can identify patients with extra-uterine and/or nodal metastases, the association of this biomarker with EC molecular subtype, and to explore an optimal cutoff in this context.

Methods

We assessed the association of CA125 levels with clinicopathologic and outcomes data on a cohort of 1107 molecularly classified EC.

Results

Abnormal CA125 (>35kU/L) was associated with higher stage and lymph node metastases (LNM) in all EC and in each molecular subtype on univariate (p < 0.01) and multivariate (p < 0.05) analyses. POLEmut had the lowest median CA125 level and proportion of CA125 abnormal patients, and p53abn the highest proportion (p < 0.001). CA125 > 35 kU/L had a sensitivity of 0.82, specificity 0.53, positive-predictive-value 0.92, and negative-predictive-value 0.31 for LNM, with similar values for stage>I. CA125 > 35 kU/L was associated with worse overall (OS), disease-specific (DSS), and progression-free survival (PFS) in all EC, p53abn (OS, DSS, PFS), NSMP (OS, DSS), and MMRd (OS, DSS) subtypes. CA125 > 35 kU/L demonstrated a relative risk (RR) of 2.50 with presence of stage III/IV disease (p < 0.001) and RR 18.4 for the presence of synchronous endometrial and ovarian carcinomas (SEOC)/co-existing adnexal malignancies (CAM) (p < 0.001). An exploratory cut point, optimized for correlation with DSS (CA125 > 24 kU/L) show similar association with clinical parameters and survival outcome.

Conclusions

CA125 levels are associated with molecular subtype, stage>I disease, and SEOC/CAM. CA125 remains a useful clinical tool in the triage of EC in the era of molecular classification.
目的:既往研究提示子宫内膜癌(EC)患者血清CA125可反映子宫外病变。我们的目的是确定CA125是否可以识别子宫外和/或淋巴结转移患者,该生物标志物与EC分子亚型的关联,并探索在这种情况下的最佳切断。方法:我们评估了CA125水平与1107例分子分类EC的临床病理和预后数据的关系。结果:CA125异常(bbb35ku /L)与所有EC和各分子亚型的高分期和淋巴结转移(LNM)相关,单变量(p35ku /L)对LNM的敏感性为0.82,特异性为0.53,阳性预测值为0.92,阴性预测值为0.31,>I期的值相似。CA125 > 35 kU/L与所有EC、p53abn (OS、DSS、PFS)、NSMP (OS、DSS)和MMRd (OS、DSS)亚型中较差的总(OS)、疾病特异性(DSS)和无进展生存(PFS)相关。CA125 > 35 kU/L与III/IV期疾病的相对危险度(RR)为2.50 (p 24 kU/L)与临床参数和生存结果有相似的相关性。结论:CA125水平与分子亚型、>I期疾病和SEOC/CAM相关。在分子分类时代,CA125仍然是诊断EC的有效临床工具。
{"title":"Serum CA125 levels in the context of ProMisE molecular classification provides pre-operative prognostic information that can direct endometrial cancer management","authors":"Andrea Neilson ,&nbsp;Amy Jamieson ,&nbsp;Derek Chiu ,&nbsp;Samuel Leung ,&nbsp;Amy Lum ,&nbsp;Stefan Kommoss ,&nbsp;David G. Huntsman ,&nbsp;Aline Talhouk ,&nbsp;C. Blake Gilks ,&nbsp;Jessica N. McAlpine","doi":"10.1016/j.ygyno.2024.12.010","DOIUrl":"10.1016/j.ygyno.2024.12.010","url":null,"abstract":"<div><h3>Objective</h3><div>Previous research suggests serum CA125 reflects extra-uterine disease in patients with endometrial carcinoma (EC). Our objective was to determine if CA125 can identify patients with extra-uterine and/or nodal metastases, the association of this biomarker with EC molecular subtype, and to explore an optimal cutoff in this context.</div></div><div><h3>Methods</h3><div>We assessed the association of CA125 levels with clinicopathologic and outcomes data on a cohort of 1107 molecularly classified EC.</div></div><div><h3>Results</h3><div>Abnormal CA125 (&gt;35kU/L) was associated with higher stage and lymph node metastases (LNM) in all EC and in each molecular subtype on univariate (<em>p</em> &lt; 0.01) and multivariate (<em>p</em> &lt; 0.05) analyses. <em>POLE</em>mut had the lowest median CA125 level and proportion of CA125 abnormal patients, and p53abn the highest proportion (<em>p</em> &lt; 0.001). CA125 &gt; 35 kU/L had a sensitivity of 0.82, specificity 0.53, positive-predictive-value 0.92, and negative-predictive-value 0.31 for LNM, with similar values for stage&gt;I. CA125 &gt; 35 kU/L was associated with worse overall (OS), disease-specific (DSS), and progression-free survival (PFS) in all EC, p53abn (OS, DSS, PFS), NSMP (OS, DSS), and MMRd (OS, DSS) subtypes. CA125 &gt; 35 kU/L demonstrated a relative risk (RR) of 2.50 with presence of stage III/IV disease (<em>p</em> &lt; 0.001) and RR 18.4 for the presence of synchronous endometrial and ovarian carcinomas (SEOC)/co-existing adnexal malignancies (CAM) (p &lt; 0.001). An exploratory cut point, optimized for correlation with DSS (CA125 &gt; 24 kU/L) show similar association with clinical parameters and survival outcome.</div></div><div><h3>Conclusions</h3><div>CA125 levels are associated with molecular subtype, stage&gt;I disease, and SEOC/CAM. CA125 remains a useful clinical tool in the triage of EC in the era of molecular classification.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 1-11"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PD-L1-Expression in primary and recurrent vulvar squamous cell cancer pd - l1在原发性和复发性外阴鳞状细胞癌中的表达。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2025.01.001
Frederik A. Stuebs , Antje Knöll , Arndt Hartmann , Leah-Sophie Leikauf , Christian Matek , Nelson John , Lothar Häberle , Matthias W. Beckmann , Carol I. Geppert

Background

Squamous cell vulvar carcinoma is a rare malignant disease of women. In higher tumor stages survival rates are poor. Therapy options are limited. Immunoncology plays an increasing role in the treatment of gynecology cancers. Data on the expression of PD-L1 in vulvar cancer are rare and contradictory. We sought to describe the expression of PD-L1 in VSCC in respect to the clinicopathologic characteristics of the tumor.

Study design

We conducted a retrospective analysis including women with primary and recurrent vulvar cancer between 2000 and 2021. A next generation tissue micro array (ngTMA) was constructed for the analysis of PD-L1 expression.

Results

In total 238 women with primary VSCC and 66 cases of local or distant recurrent vulvar cancer were included. 80 women with primary VSCC (33.6 %) had tumors with common positive score (CPS) <1 and 63 women (26.5 %) had tumors with CPS 1- < 10 and 95 women with CPS ≥10 (39.9 %). In the PD-L1 positive group the rates of p53+, groin metastasis, lymphatic invasion and tumor infiltration lymphocytes were higher as compared to PD-L1 negative (CPS <1). There was no significant influence of CPS in overall survival in addition to other prognostic factors (P = 0.13, likelihood ratio test).

Conclusion

PD-L1 expression in primary vulvar cancer is associated with poorer prognosis. Hence, PD-L1 is a possible target for immune checkpoint inhibitors and women might benefit from special treatment options.
背景:外阴鳞状细胞癌是一种罕见的女性恶性疾病。在较高的肿瘤阶段,生存率很低。治疗选择是有限的。免疫肿瘤学在妇科肿瘤的治疗中发挥着越来越重要的作用。关于PD-L1在外阴癌中的表达的数据很少且相互矛盾。我们试图描述PD-L1在VSCC中与肿瘤临床病理特征相关的表达。研究设计:我们进行了一项回顾性分析,包括2000年至2021年间患有原发性和复发性外阴癌的女性。构建下一代组织微阵列(ngTMA)用于分析PD-L1的表达。结果:本组共238例原发外阴鳞状细胞癌和66例局部或远处复发外阴癌。结论:PD-L1在原发性外阴癌中的表达与较差的预后相关。因此,PD-L1可能是免疫检查点抑制剂的靶点,女性可能受益于特殊的治疗选择。
{"title":"PD-L1-Expression in primary and recurrent vulvar squamous cell cancer","authors":"Frederik A. Stuebs ,&nbsp;Antje Knöll ,&nbsp;Arndt Hartmann ,&nbsp;Leah-Sophie Leikauf ,&nbsp;Christian Matek ,&nbsp;Nelson John ,&nbsp;Lothar Häberle ,&nbsp;Matthias W. Beckmann ,&nbsp;Carol I. Geppert","doi":"10.1016/j.ygyno.2025.01.001","DOIUrl":"10.1016/j.ygyno.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Squamous cell vulvar carcinoma is a rare malignant disease of women. In higher tumor stages survival rates are poor. Therapy options are limited. Immunoncology plays an increasing role in the treatment of gynecology cancers. Data on the expression of PD-L1 in vulvar cancer are rare and contradictory. We sought to describe the expression of PD-L1 in VSCC in respect to the clinicopathologic characteristics of the tumor.</div></div><div><h3>Study design</h3><div>We conducted a retrospective analysis including women with primary and recurrent vulvar cancer between 2000 and 2021. A next generation tissue micro array (ngTMA) was constructed for the analysis of PD-L1 expression.</div></div><div><h3>Results</h3><div>In total 238 women with primary VSCC and 66 cases of local or distant recurrent vulvar cancer were included. 80 women with primary VSCC (33.6 %) had tumors with common positive score (CPS) &lt;1 and 63 women (26.5 %) had tumors with CPS 1- &lt; 10 and 95 women with CPS ≥10 (39.9 %). In the PD-L1 positive group the rates of p53+, groin metastasis, lymphatic invasion and tumor infiltration lymphocytes were higher as compared to PD-L1 negative (CPS &lt;1). There was no significant influence of CPS in overall survival in addition to other prognostic factors (<em>P</em> = 0.13, likelihood ratio test).</div></div><div><h3>Conclusion</h3><div>PD-L1 expression in primary vulvar cancer is associated with poorer prognosis. Hence, PD-L1 is a possible target for immune checkpoint inhibitors and women might benefit from special treatment options.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 98-104"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Primary prevention of post-molar gestational trophoblastic neoplasia in high-risk complete hydatidiform mole: A single-dose prophylactic actinomycin D, associated with uterine evacuation - a long retrospective cohort study 高危完全葡萄胎磨牙后滋养细胞瘤的一级预防:单剂量预防性放线菌素D与子宫排空相关——一项长期回顾性队列研究。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2025.01.003
Elza Maria Hartmann Uberti , Lidia Rosi de Freitas Medeiros , Rodrigo Bernardes Cardoso , Karine Paiva Muller , Cassiano Burman Patias , Thaís Feiten Nunes , Rosilene Jara Reis , Josenel Maria Barcelos Marçal

Objective

To evaluate the efficacy of actinomycin D (ActD) as prophylactic chemotherapy (P-chem) in patients with high-risk complete hydatidiform mole (Hr-CHM) on progression to gestational trophoblastic neoplasia (GTN).

Methods

From 1996 to 2023, 426 Hr-CHMs were selected in a cohort of 1623 patients with gestational trophoblastic disease (GTD). From 1996 to 2023, 290 patients with Hr-CHMs received a single bolus dose of Act-D at the time of uterine evacuation (Hr-CHM P-chem group); 136 with the same risk factors did not receive P-chem (Hr-CHM control group). The variables assessed in post-molar GTN were incidence and morbidity considering hCG serum level at diagnosis, relapse frequency, hysterectomy rates.

Results

Post-molar GTN was diagnosed in 19 % of the patients with Hr-CHM P-Chem (55/290) and in 39.7 % of the patients in the Hr-CHM control group (54/136) (P < 0.001). The relative risk of developing post-molar GTN decreased by 52 % (RR = 0.48; 95 % CI: 0.35–0.66; P < 0.001), with a number needed to treat (NNT) of 5. Patients in the P-chem group had a lower hCG serum level (P = 0.007), lower risk of recurrence (P = 0.001) and lower risk of hysterectomy (P = 0.04), with no effect on time to GTN diagnosis (P = 0.09), first line chemotherapy response (P = 0.50) and time to remission (P = 0.72).

Conclusion

A single bolus dose of Act-D (1.25 mg/m2) given as P-chem during uterine evacuation in patients with Hr-CHM may safely prevent the incidence of post-molar GTN and reduce the morbidity associated with GTN. This prophylactic approach can be adopted at any trophoblastic disease center (TDC).
目的:评价放线菌素D (ActD)作为预防化疗(P-chem)对高危完全葡萄胎(Hr-CHM)进展为妊娠滋养细胞瘤(GTN)的疗效。方法:从1996年到2023年,从1623例妊娠滋养细胞疾病(GTD)患者中选择426例Hr-CHMs。1996年至2023年,290例Hr-CHM患者在子宫排空时接受单次大剂量Act-D (Hr-CHM P-chem组);危险因素相同的136例未接受P-chem治疗(Hr-CHM对照组)。后磨牙GTN评估的变量是考虑诊断时hCG血清水平、复发率和子宫切除术率的发病率和发病率。结果:Hr-CHM患者中有19%的患者诊断为后磨牙GTN (55/290), Hr-CHM对照组中有39.7%的患者诊断为后磨牙GTN (54/136) (P)。结论:Hr-CHM患者在子宫抽液过程中给予单剂量Act-D (1.25 mg/m2)作为P-chem,可安全预防后磨牙GTN的发生,降低GTN相关的发病率。这种预防方法可以在任何滋养细胞疾病中心(TDC)采用。
{"title":"Primary prevention of post-molar gestational trophoblastic neoplasia in high-risk complete hydatidiform mole: A single-dose prophylactic actinomycin D, associated with uterine evacuation - a long retrospective cohort study","authors":"Elza Maria Hartmann Uberti ,&nbsp;Lidia Rosi de Freitas Medeiros ,&nbsp;Rodrigo Bernardes Cardoso ,&nbsp;Karine Paiva Muller ,&nbsp;Cassiano Burman Patias ,&nbsp;Thaís Feiten Nunes ,&nbsp;Rosilene Jara Reis ,&nbsp;Josenel Maria Barcelos Marçal","doi":"10.1016/j.ygyno.2025.01.003","DOIUrl":"10.1016/j.ygyno.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of actinomycin D (Act<img>D) as prophylactic chemotherapy (P-chem) in patients with high-risk complete hydatidiform mole (Hr-CHM) on progression to gestational trophoblastic neoplasia (GTN).</div></div><div><h3>Methods</h3><div>From 1996 to 2023, 426 Hr-CHMs were selected in a cohort of 1623 patients with gestational trophoblastic disease (GTD). From 1996 to 2023, 290 patients with Hr-CHMs received a single bolus dose of Act-D at the time of uterine evacuation (Hr-CHM P-chem group); 136 with the same risk factors did not receive P-chem (Hr-CHM control group). The variables assessed in post-molar GTN were incidence and morbidity considering hCG serum level at diagnosis, relapse frequency, hysterectomy rates.</div></div><div><h3>Results</h3><div>Post-molar GTN was diagnosed in 19 % of the patients with Hr-CHM P-Chem (55/290) and in 39.7 % of the patients in the Hr-CHM control group (54/136) (<em>P</em> &lt; 0.001). The relative risk of developing post-molar GTN decreased by 52 % (RR = 0.48; 95 % CI: 0.35–0.66; <em>P</em> &lt; 0.001), with a number needed to treat (NNT) of 5. Patients in the P-chem group had a lower hCG serum level (<em>P</em> = 0.007), lower risk of recurrence (<em>P</em> = 0.001) and lower risk of hysterectomy (<em>P</em> = 0.04), with no effect on time to GTN diagnosis (<em>P</em> = 0.09), first line chemotherapy response (<em>P</em> = 0.50) and time to remission (<em>P</em> = 0.72).</div></div><div><h3>Conclusion</h3><div>A single bolus dose of Act-D (1.25 mg/m2) given as P-chem during uterine evacuation in patients with Hr-CHM may safely prevent the incidence of post-molar GTN and reduce the morbidity associated with GTN. This prophylactic approach can be adopted at any trophoblastic disease center (TDC).</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 105-112"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost-effectiveness of an additional hysterectomy after initially conservative treatment for cervical adenocarcinoma in situ 宫颈原位腺癌最初保守治疗后追加子宫切除术的成本-效果。
IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.ygyno.2025.01.005
M. Schaafsma , T.N. Schuurman , A.G. Siebers , R.L.M. Bekkers , M.C.G. Bleeker , P.L.M. Zusterzeel , C.H. Mom , J. Berkhof , K. Rozemeijer , N.E. van Trommel

Objective

Several European and American guidelines recommend to perform an additional hysterectomy in patients with cervical adenocarcinoma in situ (AIS), who initially received conservative treatment and who completed childbearing during follow-up. This study aimed to evaluate cost-effectiveness of performing an additional hysterectomy in comparison to expectative management.

Methods

This post-hoc analysis was based on a retrospective cohort of patients diagnosed with AIS, who were conservatively treated by a radical (i.e., negative surgical margins) large loop excision of the transformation zone (LLETZ) or cold-knife conisation (CKC) in the Netherlands between 1990 and 2021. Based on these data, we estimated and compared the harms, benefits, and costs in 1000 simulated patients, both with and without an additional hysterectomy five years after conservative treatment for AIS. In the sensitivity analyses, we varied the timing of the additional hysterectomy, the risk of recurrent high-grade cervical dysplasia and cervical cancer risk after AIS treatment, and the utility loss for hysterectomy.

Results

Less than 2 % of the patients who did not receive an additional hysterectomy after AIS developed cervical cancer. When an additional hysterectomy was performed, no quality adjusted life-years (QALYs) were gained and costs were 863 % higher (€6203,485 versus €644,238). Only when assuming no utility loss for a hysterectomy, QALYs were gained resulting in a cost-effectiveness ratio of €144,273, which is far above the cost-effectiveness threshold of €20,000.

Conclusion

It is not cost-effective to perform an additional hysterectomy after completion of childbearing in patients who were primarily treated by a radical LLETZ or CKC.
目的:一些欧洲和美国的指南建议对宫颈原位腺癌(AIS)患者进行额外的子宫切除术,这些患者最初接受了保守治疗,并在随访期间完成了生育。本研究旨在评估进行额外子宫切除术与预期治疗的成本效益。方法:这项事后分析是基于1990年至2021年间荷兰诊断为AIS的患者的回顾性队列,这些患者接受了根治性(即阴性手术切缘)大环切除转化区(LLETZ)或冷刀锥形(CKC)的保守治疗。基于这些数据,我们估计并比较了1000例模拟患者的危害、收益和成本,这些患者在AIS保守治疗5年后接受和不接受额外子宫切除术。在敏感性分析中,我们改变了额外子宫切除术的时间,AIS治疗后复发高级别宫颈发育不良和宫颈癌的风险,以及子宫切除术的效用损失。结果:在AIS后未接受额外子宫切除术的患者中,不到2%的患者发展为宫颈癌。当进行额外的子宫切除术时,没有获得质量调整生命年(QALYs),费用高出863%(6203,485欧元对644,238欧元)。只有在假设子宫切除术没有效用损失的情况下,获得qaly的成本效益比为144,273欧元,远高于20,000欧元的成本效益门槛。结论:在主要接受根治性LLETZ或CKC治疗的患者完成生育后进行额外的子宫切除术是不划算的。
{"title":"Cost-effectiveness of an additional hysterectomy after initially conservative treatment for cervical adenocarcinoma in situ","authors":"M. Schaafsma ,&nbsp;T.N. Schuurman ,&nbsp;A.G. Siebers ,&nbsp;R.L.M. Bekkers ,&nbsp;M.C.G. Bleeker ,&nbsp;P.L.M. Zusterzeel ,&nbsp;C.H. Mom ,&nbsp;J. Berkhof ,&nbsp;K. Rozemeijer ,&nbsp;N.E. van Trommel","doi":"10.1016/j.ygyno.2025.01.005","DOIUrl":"10.1016/j.ygyno.2025.01.005","url":null,"abstract":"<div><h3>Objective</h3><div>Several European and American guidelines recommend to perform an additional hysterectomy in patients with cervical adenocarcinoma in situ (AIS), who initially received conservative treatment and who completed childbearing during follow-up. This study aimed to evaluate cost-effectiveness of performing an additional hysterectomy in comparison to expectative management.</div></div><div><h3>Methods</h3><div>This post-hoc analysis was based on a retrospective cohort of patients diagnosed with AIS, who were conservatively treated by a radical (i.e., negative surgical margins) large loop excision of the transformation zone (LLETZ) or cold-knife conisation (CKC) in the Netherlands between 1990 and 2021. Based on these data, we estimated and compared the harms, benefits, and costs in 1000 simulated patients, both with and without an additional hysterectomy five years after conservative treatment for AIS. In the sensitivity analyses, we varied the timing of the additional hysterectomy, the risk of recurrent high-grade cervical dysplasia and cervical cancer risk after AIS treatment, and the utility loss for hysterectomy.</div></div><div><h3>Results</h3><div>Less than 2 % of the patients who did not receive an additional hysterectomy after AIS developed cervical cancer. When an additional hysterectomy was performed, no quality adjusted life-years (QALYs) were gained and costs were 863 % higher (€6203,485 versus €644,238). Only when assuming no utility loss for a hysterectomy, QALYs were gained resulting in a cost-effectiveness ratio of €144,273, which is far above the cost-effectiveness threshold of €20,000.</div></div><div><h3>Conclusion</h3><div>It is not cost-effective to perform an additional hysterectomy after completion of childbearing in patients who were primarily treated by a radical LLETZ or CKC.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"193 ","pages":"Pages 113-118"},"PeriodicalIF":4.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Gynecologic oncology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1