Pub Date : 2025-03-14DOI: 10.1016/j.ygyno.2025.03.012
Julia Salinaro , Kamaljeet Singh , Natalie Sands , Victoria Gill , Shriya Perati , Nicole James , Shreenidhi Sharma , Apsra Nasir , Paul DiSilvestro , Katherine Miller , Matthew Oliver , Cara Mathews
Objectives
Although multiple HER2 scoring criteria exist, the optimal strategy to identify patients with gynecologic malignancies who may benefit from HER2-directed therapies remains unknown. The objectives of this study were to assess the distribution and concordance of HER2 scores in endometrial and ovarian cancer.
Methods
One hundred five tumor specimens from 94 patients with endometrial or epithelial ovarian cancer (EOC) who underwent Caris tumor profiling from 11/2022 to 01/2025 were identified from a retrospective database. Each sample was assigned a HER2 immunohistochemistry (IHC) score of 0, 1+, 2+, or 3+ using breast, endometrial, and gastric criteria. ERBB2 amplification and HER2 IHC scores were abstracted from Caris reports. Patient characteristics and HER2 score distributions were analyzed using descriptive statistics and Fisher's exact test. Matrix correlation coefficients were used to assess HER2 score concordance.
Results
A total of 105 samples underwent internal triplicate HER2 scoring – 63 EOC and 42 endometrial. A higher percentage of patients with endometrial cancer were HER2-high compared to those with EOC (45.2–50 % vs 20.6 %, p < 0.05). Internal triplicate HER2 score concordance was strong (r ≥ 0.96, p < 0.001) but weaker when compared to Caris scores (r = 0.66). Of the 23 discordant HER2 results, 13 would have changed therapy eligibility (56.5 %). Only 12 patients (12.7 %) had intermediate or high ERBB2 amplification.
Conclusions
A clinically significant percentage of patients had HER2-high tumors regardless of tumor type. HER2 score concordance was strong within each sample but weaker when compared to Caris scores. Incorporating multi-site testing and/or validation of external IHC into any gynecologic HER2 scoring algorithm should be considered.
{"title":"Distribution and concordance of HER2 scores in endometrial and ovarian cancer","authors":"Julia Salinaro , Kamaljeet Singh , Natalie Sands , Victoria Gill , Shriya Perati , Nicole James , Shreenidhi Sharma , Apsra Nasir , Paul DiSilvestro , Katherine Miller , Matthew Oliver , Cara Mathews","doi":"10.1016/j.ygyno.2025.03.012","DOIUrl":"10.1016/j.ygyno.2025.03.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Although multiple HER2 scoring criteria exist, the optimal strategy to identify patients with gynecologic malignancies who may benefit from HER2-directed therapies remains unknown. The objectives of this study were to assess the distribution and concordance of HER2 scores in endometrial and ovarian cancer.</div></div><div><h3>Methods</h3><div>One hundred five tumor specimens from 94 patients with endometrial or epithelial ovarian cancer (EOC) who underwent Caris tumor profiling from 11/2022 to 01/2025 were identified from a retrospective database. Each sample was assigned a HER2 immunohistochemistry (IHC) score of 0, 1+, 2+, or 3+ using breast, endometrial, and gastric criteria. <em>ERBB2</em> amplification and HER2 IHC scores were abstracted from Caris reports. Patient characteristics and HER2 score distributions were analyzed using descriptive statistics and Fisher's exact test. Matrix correlation coefficients were used to assess HER2 score concordance.</div></div><div><h3>Results</h3><div>A total of 105 samples underwent internal triplicate HER2 scoring – 63 EOC and 42 endometrial. A higher percentage of patients with endometrial cancer were HER2-high compared to those with EOC (45.2–50 % vs 20.6 %, <em>p</em> < 0.05). Internal triplicate HER2 score concordance was strong (<em>r</em> ≥ 0.96, <em>p</em> < 0.001) but weaker when compared to Caris scores (<em>r</em> = 0.66). Of the 23 discordant HER2 results, 13 would have changed therapy eligibility (56.5 %). Only 12 patients (12.7 %) had intermediate or high <em>ERBB2</em> amplification.</div></div><div><h3>Conclusions</h3><div>A clinically significant percentage of patients had HER2-high tumors regardless of tumor type. HER2 score concordance was strong within each sample but weaker when compared to Caris scores. Incorporating multi-site testing and/or validation of external IHC into any gynecologic HER2 scoring algorithm should be considered.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 115-121"},"PeriodicalIF":4.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619116","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 : 2025-03-13DOI: 10.1016/j.ygyno.2025.03.009
Anette Engh , Corina Silvia Rueegg , Pernille K. Bjerre Trent , Linn Ø. Opheim , Ida Engeskaug , Nina Jebens Nordskar , Arnhild Bakken , Jostein Steene-Johannessen , Ane Gerda Z. Eriksson , Lene Thorsen
Objective
The aims of this cross-sectional study were to describe the prevalence of self-reported lower extremity lymphedema (LEL) by different physical activity (PA) levels and to examine if higher levels of PA are associated with lower odds of self-reported LEL among endometrial cancer survivors.
Methods
Women treated for assumed early-stage endometrial cancer between 2006 and 2021 were invited to complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ) and the Physical Activity Frequency, Intensity, and Duration (PAFID) questionnaire. Responses of PAFID were converted into metabolic equivalent of task minutes per week (MET-min/week), and participants were categorized into different PA levels: meeting (≥500 MET-min/week) versus not meeting PA guidelines; low active (<500 MET-min/week), active (500–1000 MET-min/week), and high active (>1000 MET-min/week); and PA quartiles.
Results
Among 1077 included, the prevalence of LEL was 48 %, 32 %, and 32 % among the low active, active, and high active survivors, respectively. Compared to the low active, the active survivors had 40 % lower odds of LEL (OR 0.60, 95 % CI 0.44–0.81), but no further reduction was observed among the high active survivors (OR 0.71, 95 % CI 0.47–1.06). According to PA quartiles, higher PA levels were associated with lower odds of LEL, but not in a linear dose-response way.
Conclusion
Findings suggest that regular PA according to the current PA guidelines is associated with decreased the odds of self-reported LEL among endometrial cancer survivors; however, causality of association needs to be verified in a longitudinal setting.
{"title":"Physical activity and lower extremity lymphedema among endometrial cancer survivors: A population-based cross-sectional study","authors":"Anette Engh , Corina Silvia Rueegg , Pernille K. Bjerre Trent , Linn Ø. Opheim , Ida Engeskaug , Nina Jebens Nordskar , Arnhild Bakken , Jostein Steene-Johannessen , Ane Gerda Z. Eriksson , Lene Thorsen","doi":"10.1016/j.ygyno.2025.03.009","DOIUrl":"10.1016/j.ygyno.2025.03.009","url":null,"abstract":"<div><h3>Objective</h3><div>The aims of this cross-sectional study were to describe the prevalence of self-reported lower extremity lymphedema (LEL) by different physical activity (PA) levels and to examine if higher levels of PA are associated with lower odds of self-reported LEL among endometrial cancer survivors.</div></div><div><h3>Methods</h3><div>Women treated for assumed early-stage endometrial cancer between 2006 and 2021 were invited to complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ) and the Physical Activity Frequency, Intensity, and Duration (PAFID) questionnaire. Responses of PAFID were converted into metabolic equivalent of task minutes per week (MET-min/week), and participants were categorized into different PA levels: meeting (≥500 MET-min/week) versus <em>not</em> meeting PA guidelines; low active (<500 MET-min/week), active (500–1000 MET-min/week), and high active (>1000 MET-min/week); and PA quartiles.</div></div><div><h3>Results</h3><div>Among 1077 included, the prevalence of LEL was 48 %, 32 %, and 32 % among the low active, active, and high active survivors, respectively. Compared to the low active, the active survivors had 40 % lower odds of LEL (OR 0.60, 95 % CI 0.44–0.81), but no further reduction was observed among the high active survivors (OR 0.71, 95 % CI 0.47–1.06). According to PA quartiles, higher PA levels were associated with lower odds of LEL, but not in a linear dose-response way.</div></div><div><h3>Conclusion</h3><div>Findings suggest that regular PA according to the current PA guidelines is associated with decreased the odds of self-reported LEL among endometrial cancer survivors; however, causality of association needs to be verified in a longitudinal setting.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 82-88"},"PeriodicalIF":4.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610209","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}
Pub Date : 2025-03-12DOI: 10.1016/j.ygyno.2025.03.006
William A. Zammarrelli III , Subhiksha Nandakumar , Elizabeth Kertowidjojo , Bastien Nguyen , Lea A. Moukarzel , Arnaud Da Cruz Paula , Eric V. Rios-Doria , Shaleigh A. Smith , Amir Momeni-Boroujeni , Vicky Makker , Carol Aghajanian , Walid K. Chatila , Jennifer J. Mueller , Nadeem R. Abu-Rustum , Nikolaus Schultz , Lora H. Ellenson , Britta Weigelt
Objective
The molecular underpinnings of primary treatment-naïve endometrial carcinoma (EC) are well described. Here we sought to characterize the genomic landscape of distant metastatic EC.
Methods
Distant metastatic ECs from a total of 1888 cases subjected to a clinical panel sequencing between 4/2015 and 6/2020 were identified, and their genomic profiles, affected pathways and actionable alterations were compared to those of 711 primary ECs. Wilcoxon and Fisher's exact tests were used for continuous and categorical variables, respectively, and p-values adjusted for multiple hypothesis-testing.
Results
Distant EC metastases (n = 137) of the lung (n = 66, 48 %), liver (n = 21, 15 %), soft tissue (n = 15, 11 %), distant lymph nodes (n = 15, 11 %), gastrointestinal tract (n = 10, 7 %), central nervous system (n = 5, 4 %), bone (n = 4, 3 %), and renal system (n = 1, 1 %) were included. Distant EC metastases were most commonly of copy number (CN)-high/TP53 abnormal (42 %) or CN-low/no specific molecular profile (NSMP) (39 %) molecular subtype; 18 % were microsatellite instability (MSI)-high/mismatch repair (MMR)-deficient and 1 % were of POLE molecular subtype. Distant EC metastases were significantly more chromosomally unstable compared to primary ECs across molecular subtypes (p < 0.0001). CTNNB1 mutations were more prevalent in distant CN-low/NSMP and MSI-high/MMR-deficient metastases compared to primary ECs (q < 0.1). Clinically actionable alterations were significantly less common in metastatic ECs (27 % vs 37 % primary; p = 0.025). PI3K, p53 and epigenetic pathways were the most altered pathways among all anatomic sites.
Conclusions
Distant metastatic ECs are more frequently chromosomally unstable but less commonly exhibit hypermutator phenotypes. Exploitation of genetic differences of metastatic EC is warranted for targeted treatment strategy development.
{"title":"The genomic landscape of distant metastatic endometrial cancer","authors":"William A. Zammarrelli III , Subhiksha Nandakumar , Elizabeth Kertowidjojo , Bastien Nguyen , Lea A. Moukarzel , Arnaud Da Cruz Paula , Eric V. Rios-Doria , Shaleigh A. Smith , Amir Momeni-Boroujeni , Vicky Makker , Carol Aghajanian , Walid K. Chatila , Jennifer J. Mueller , Nadeem R. Abu-Rustum , Nikolaus Schultz , Lora H. Ellenson , Britta Weigelt","doi":"10.1016/j.ygyno.2025.03.006","DOIUrl":"10.1016/j.ygyno.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>The molecular underpinnings of primary treatment-naïve endometrial carcinoma (EC) are well described. Here we sought to characterize the genomic landscape of distant metastatic EC.</div></div><div><h3>Methods</h3><div>Distant metastatic ECs from a total of 1888 cases subjected to a clinical panel sequencing between 4/2015 and 6/2020 were identified, and their genomic profiles, affected pathways and actionable alterations were compared to those of 711 primary ECs. Wilcoxon and Fisher's exact tests were used for continuous and categorical variables, respectively, and <em>p</em>-values adjusted for multiple hypothesis-testing.</div></div><div><h3>Results</h3><div>Distant EC metastases (<em>n</em> = 137) of the lung (<em>n</em> = 66, 48 %), liver (<em>n</em> = 21, 15 %), soft tissue (<em>n</em> = 15, 11 %), distant lymph nodes (n = 15, 11 %), gastrointestinal tract (<em>n</em> = 10, 7 %), central nervous system (<em>n</em> = 5, 4 %), bone (<em>n</em> = 4, 3 %), and renal system (n = 1, 1 %) were included. Distant EC metastases were most commonly of copy number (CN)-high/<em>TP53</em> abnormal (42 %) or CN-low/no specific molecular profile (NSMP) (39 %) molecular subtype; 18 % were microsatellite instability (MSI)-high/mismatch repair (MMR)-deficient and 1 % were of <em>POLE</em> molecular subtype. Distant EC metastases were significantly more chromosomally unstable compared to primary ECs across molecular subtypes (<em>p</em> < 0.0001). <em>CTNNB1</em> mutations were more prevalent in distant CN-low/NSMP and MSI-high/MMR-deficient metastases compared to primary ECs (q < 0.1). Clinically actionable alterations were significantly less common in metastatic ECs (27 % vs 37 % primary; <em>p</em> = 0.025). PI3K, p53 and epigenetic pathways were the most altered pathways among all anatomic sites.</div></div><div><h3>Conclusions</h3><div>Distant metastatic ECs are more frequently chromosomally unstable but less commonly exhibit hypermutator phenotypes. Exploitation of genetic differences of metastatic EC is warranted for targeted treatment strategy development.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 89-97"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600943","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 : 2025-03-12DOI: 10.1016/j.ygyno.2025.03.002
Kristina Lindemann , Franziska Siegenthaler , Karin T. Lande , Carlos Casas-Arozamena , Daniel Nebdal , Tilman T. Rau , Erling A. Hoivik , Michael D. Mueller , Rose Meng Gold , Sara Imboden , Ben Davidson , Camilla Krakstad , Therese Sørlie
Objective
At present, no reliable blood-based biomarkers have been established for patients with endometrial cancer. Liquid biopsies, which can detect circulating tumor DNA (ctDNA), provide a non-invasive way to assess prognosis, monitor tumor evolution and treatment response. We aimed to examine the feasibility and performance of ctDNA as a prognostic tool in a multi-center cohort of EC patients with matched tumor samples.
Methods
Blood plasma samples were collected preoperatively from 83 patients at three European cancer centers. Circulating cell-free DNA (cfDNA) was isolated and analyzed using the Oncomine™ Pan-Cancer cell-free assay. Tumor tissue from 56 of the 83 patients was subjected to whole-exome sequencing, and clinical data were collected for oncological outcome assessment.
Results
The mean input of cfDNA was 8.17 ng (range 1.47–29.12 ng). Sixteen (19.3 %) patients were considered ctDNA positive with mutations in one or more genes. Most alterations detected in plasma were concordant with mutations found in the matched tumor for the paired cases. The preoperative presence of ctDNA was associated with a significantly higher rate of recurrence (37.5 % vs 11.9 %, P = 0.024). Although eight of the 14 (57 %) patients with recurrence were negative for ctDNA at diagnosis, positive ctDNA status remained an independent predictor of recurrence also when controlling for other known histopathologic risk factors (HR 5.49, 95 % CI 1.5–20, P = 0.010).
Conclusions
Our results demonstrated the feasibility of using an off-the-shelf gene panel to detect ctDNA in patients with endometrial cancer. ctDNA positivity was significantly associated with worse oncological outcomes.
{"title":"Prognostic value of assessing ctDNA in patients with endometrial carcinoma - an international multicenter study","authors":"Kristina Lindemann , Franziska Siegenthaler , Karin T. Lande , Carlos Casas-Arozamena , Daniel Nebdal , Tilman T. Rau , Erling A. Hoivik , Michael D. Mueller , Rose Meng Gold , Sara Imboden , Ben Davidson , Camilla Krakstad , Therese Sørlie","doi":"10.1016/j.ygyno.2025.03.002","DOIUrl":"10.1016/j.ygyno.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>At present, no reliable blood-based biomarkers have been established for patients with endometrial cancer. Liquid biopsies, which can detect circulating tumor DNA (ctDNA), provide a non-invasive way to assess prognosis, monitor tumor evolution and treatment response. We aimed to examine the feasibility and performance of ctDNA as a prognostic tool in a multi-center cohort of EC patients with matched tumor samples.</div></div><div><h3>Methods</h3><div>Blood plasma samples were collected preoperatively from 83 patients at three European cancer centers. Circulating cell-free DNA (cfDNA) was isolated and analyzed using the Oncomine™ Pan-Cancer cell-free assay. Tumor tissue from 56 of the 83 patients was subjected to whole-exome sequencing, and clinical data were collected for oncological outcome assessment.</div></div><div><h3>Results</h3><div>The mean input of cfDNA was 8.17 ng (range 1.47–29.12 ng). Sixteen (19.3 %) patients were considered ctDNA positive with mutations in one or more genes. Most alterations detected in plasma were concordant with mutations found in the matched tumor for the paired cases. The preoperative presence of ctDNA was associated with a significantly higher rate of recurrence (37.5 % vs 11.9 %, <em>P</em> = 0.024). Although eight of the 14 (57 %) patients with recurrence were negative for ctDNA at diagnosis, positive ctDNA status remained an independent predictor of recurrence also when controlling for other known histopathologic risk factors (HR 5.49, 95 % CI 1.5–20, <em>P</em> = 0.010).</div></div><div><h3>Conclusions</h3><div>Our results demonstrated the feasibility of using an off-the-shelf gene panel to detect ctDNA in patients with endometrial cancer. ctDNA positivity was significantly associated with worse oncological outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 98-105"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600944","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 : 2025-03-09DOI: 10.1016/j.ygyno.2025.02.023
Jeanne Carter , Helen Q. Huang , Bradley J. Monk , Yong-Beom Kim , Moon-Hong Kim , Ashley Stuckey , Danielle L. Vicus , Laura L. Holman , Aimee C. Fleury , J. Matthew Pearson , Nitika Thawani , Mark Shahin , Jayanthi Lea , Sharon E. Robertson , David Warshal , Floor J. Backes , Colleen Feltmate , Ivy Wilkinson-Ryan , Allan Covens
Objective
To examine patient outcomes before and after cone biopsy (CB) or simple hysterectomy (SH) and pelvic lymph node dissection (PLND) for bladder, bowel, and sexual function, quality of life (QOL), cancer worry, reproductive concerns, and lymphedema.
Methods
We stratified women with stage IA1 (lymphovascular space invasion–positive) and IA2-IB1 (≤2 cm) cervical carcinoma by fertility preservation (CB) or none (SH) with PLND. All patients completed study questionnaires at baseline (preoperatively) and postoperatively at 4–6 weeks and 6-, 12-, 18-, and 24-months, consisting of: Functional Assessment Cancer Therapy - Cervical Cancer (FACT-Cx); Female Sexual Functioning Index (FSFI), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS) items; Gynecologic Cancer Lymphedema Questionnaire (GCLQ); Impact of Events Scale (IES); and Reproductive Concerns Scale (RCS).
Results
We enrolled 224 patients from 10/12 to 10/21, with 72 choosing CB and 152 SH. A total of 169 patients (54 CB; 115 SH) were eligible for QOL analysis and completed baseline assessment with at least one follow-up assessment. Postoperatively in both groups, bladder and bowel function slightly decreased but recovered over time, sexual function declined at 6 weeks but improved over time, QOL increased, and cancer worry decreased. As per the GCLQ, 12 patients reported a diagnosis of lymphedema with a GCLQ score change ≥4 (6 CB; 6 SH).
Conclusions
Nonradical surgery for early-stage cervical cancer is associated with excellent QOL and small decreases in physical function (bladder, bowel, sexual) that quickly improve postoperatively to baseline or above. Lymphedema rates were low but present in both groups.
{"title":"Evaluation of physical function and quality of life before and after nonradical surgical therapy for stage IA1 and IA2-IB1 cervical cancer (GOG-0278)","authors":"Jeanne Carter , Helen Q. Huang , Bradley J. Monk , Yong-Beom Kim , Moon-Hong Kim , Ashley Stuckey , Danielle L. Vicus , Laura L. Holman , Aimee C. Fleury , J. Matthew Pearson , Nitika Thawani , Mark Shahin , Jayanthi Lea , Sharon E. Robertson , David Warshal , Floor J. Backes , Colleen Feltmate , Ivy Wilkinson-Ryan , Allan Covens","doi":"10.1016/j.ygyno.2025.02.023","DOIUrl":"10.1016/j.ygyno.2025.02.023","url":null,"abstract":"<div><h3>Objective</h3><div>To examine patient outcomes before and after cone biopsy (CB) or simple hysterectomy (SH) and pelvic lymph node dissection (PLND) for bladder, bowel, and sexual function, quality of life (QOL), cancer worry, reproductive concerns, and lymphedema.</div></div><div><h3>Methods</h3><div>We stratified women with stage IA1 (lymphovascular space invasion–positive) and IA2-IB1 (≤2 cm) cervical carcinoma by fertility preservation (CB) or none (SH) with PLND. All patients completed study questionnaires at baseline (preoperatively) and postoperatively at 4–6 weeks and 6-, 12-, 18-, and 24-months, consisting of: Functional Assessment Cancer Therapy - Cervical Cancer (FACT-Cx); Female Sexual Functioning Index (FSFI), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS) items; Gynecologic Cancer Lymphedema Questionnaire (GCLQ); Impact of Events Scale (IES); and Reproductive Concerns Scale (RCS).</div></div><div><h3>Results</h3><div>We enrolled 224 patients from 10/12 to 10/21, with 72 choosing CB and 152 SH. A total of 169 patients (54 CB; 115 SH) were eligible for QOL analysis and completed baseline assessment with at least one follow-up assessment. Postoperatively in both groups, bladder and bowel function slightly decreased but recovered over time, sexual function declined at 6 weeks but improved over time, QOL increased, and cancer worry decreased. As per the GCLQ, 12 patients reported a diagnosis of lymphedema with a GCLQ score change ≥4 (6 CB; 6 SH).</div></div><div><h3>Conclusions</h3><div>Nonradical surgery for early-stage cervical cancer is associated with excellent QOL and small decreases in physical function (bladder, bowel, sexual) that quickly improve postoperatively to baseline or above. Lymphedema rates were low but present in both groups.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 50-58"},"PeriodicalIF":4.5,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579382","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 : 2025-03-08DOI: 10.1016/j.ygyno.2025.03.003
Victoria L. Bae-Jump , Michael W. Sill , Paola A. Gehrig , Jason D. Merker , David L. Corcoran , Adam D. Pfefferle , Michele C. Hayward , Joan L. Walker , Andrea R. Hagemann , Steven E. Waggoner , Roisin E. O'Cearbhaill , Megan E. McDonald , Mitchell I. Edelson , Paul A. DiSilvestro , Amy L. McNally , Aimee Fleury , Ramey D. Littell , Frederick R. Ueland , Heather A. Lankes , Carol Aghajanian
Introduction
We evaluated the efficacy of the addition of the anti-diabetic drug metformin to standard-of-care paclitaxel and carboplatin (PC) in patients with advanced and recurrent endometrial cancer (EC).
Methods
In this phase II/III trial, EC patients with chemotherapy-naïve stage III/IVA (with measurable disease) and stage IVB or recurrent (with or without measurable disease) disease were randomly assigned to PC/metformin (850 mg BID) versus PC/placebo. Metformin or placebo was continued as maintenance therapy after completion of PC until disease progression. The primary endpoint of phase II was progression-free survival (PFS). The primary endpoint of phase III was overall survival (OS). Secondary endpoints were objective response, duration of response, and toxicity.
Results
From 3/17/2014 to 12/22/2017, 448 patients were randomized to phase II/III studies, and the data were frozen for interim analysis. The phase II study deemed metformin worthy of further investigation in the phase III study. The interim phase III analysis stopped accrual for futility on 2/1/2018. The addition of metformin to PC had a slightly higher hazard of death compared to the PC regimen (HR = 1.088; 90% CI 0.803 to 1.475), which was sufficient to close the study early. The PFS had (HR = 0.814; 90% CI 0.635 to 1.043). At a median follow-up of 10 months and 121 deaths, median OS was not determined and 28 months, on PC/placebo and PC/metformin, respectively.
Conclusion
The hazard ratios for PFS and OS endpoints was not sufficiently decreased with the addition of metformin to PC to justify continuing the trial.
{"title":"A randomized phase II/III study of paclitaxel/carboplatin/metformin versus paclitaxel/carboplatin/placebo as initial therapy for measurable stage III or IVA, stage IVB, or recurrent endometrial cancer: An NRG oncology/GOG study","authors":"Victoria L. Bae-Jump , Michael W. Sill , Paola A. Gehrig , Jason D. Merker , David L. Corcoran , Adam D. Pfefferle , Michele C. Hayward , Joan L. Walker , Andrea R. Hagemann , Steven E. Waggoner , Roisin E. O'Cearbhaill , Megan E. McDonald , Mitchell I. Edelson , Paul A. DiSilvestro , Amy L. McNally , Aimee Fleury , Ramey D. Littell , Frederick R. Ueland , Heather A. Lankes , Carol Aghajanian","doi":"10.1016/j.ygyno.2025.03.003","DOIUrl":"10.1016/j.ygyno.2025.03.003","url":null,"abstract":"<div><h3>Introduction</h3><div>We evaluated the efficacy of the addition of the anti-diabetic drug metformin to standard-of-care paclitaxel and carboplatin (PC) in patients with advanced and recurrent endometrial cancer (EC).</div></div><div><h3>Methods</h3><div>In this phase II/III trial, EC patients with chemotherapy-naïve stage III/IVA (with measurable disease) and stage IVB or recurrent (with or without measurable disease) disease were randomly assigned to PC/metformin (850 mg BID) <em>versus</em> PC/placebo. Metformin or placebo was continued as maintenance therapy after completion of PC until disease progression. The primary endpoint of phase II was progression-free survival (PFS). The primary endpoint of phase III was overall survival (OS). Secondary endpoints were objective response, duration of response, and toxicity.</div></div><div><h3>Results</h3><div>From 3/17/2014 to 12/22/2017, 448 patients were randomized to phase II/III studies, and the data were frozen for interim analysis. The phase II study deemed metformin worthy of further investigation in the phase III study. The interim phase III analysis stopped accrual for futility on 2/1/2018. The addition of metformin to PC had a slightly higher hazard of death compared to the PC regimen (HR = 1.088; 90% CI 0.803 to 1.475), which was sufficient to close the study early. The PFS had (HR = 0.814; 90% CI 0.635 to 1.043). At a median follow-up of 10 months and 121 deaths, median OS was not determined and 28 months, on PC/placebo and PC/metformin, respectively.</div></div><div><h3>Conclusion</h3><div>The hazard ratios for PFS and OS endpoints was not sufficiently decreased with the addition of metformin to PC to justify continuing the trial.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 66-74"},"PeriodicalIF":4.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579383","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}
Pub Date : 2025-03-08DOI: 10.1016/j.ygyno.2025.03.004
Kevin Tyan , Kevin X. Liu , Alicia C. Smart , Colleen M. Feltmate , Neil S. Horowitz , Michael G. Muto , Michael J. Worley Jr. , Kevin M. Elias , Joyce F. Liu , Alexi A. Wright , Panagiotis A. Konstantinopoulos , Susana M. Campos , Ursula A. Matulonis , Idalid Franco , Larissa J. Lee , Martin T. King , M. Aiven Dyer
Background
There are limited data around adjuvant radiotherapy following surgical management for patients with early-stage uterine carcinosarcoma (UCS). We compared outcomes for patients with early-stage UCS who underwent adjuvant chemotherapy (CT) and pelvic external beam radiotherapy (EBRT) vs. CT and vaginal brachytherapy (VBT) vs. radiation therapy (EBRT or VBT) alone.
Methods
A retrospective analysis was performed of patients diagnosed with FIGO stage I-II UCS from 2002 to 2020 who received adjuvant radiotherapy, with or without CT, following definitive surgery. Clinical and treatment characteristics and clinical outcomes were assessed. Kaplan-Meier method and log-rank test was used for clinical outcomes. Cox proportional-hazards modeling was used for multivariable analysis.
Results
98 patients were analyzed, of whom 38 received CT + EBRT, 31 received CT + VBT, and 29 received RT-alone (18 EBRT, 11 VBT). For the CT + EBRT, CT + VBT, and RT-alone groups, median follow up was 93.5, 50.2, and 143.0 months, and 3-year PFS was 78.7 %, 67.6 %, and 58.2 %, respectively. CT + EBRT was associated with improved PFS compared to RT alone (p = 0.01), but not compared to CT + VBT (p = 0.22). There were 4 locoregional recurrences in the CT + EBRT group (10.5 %), 8 in the CT + VBT group (25.8 %), and 5 in the RT-alone group (17.2 %). On multivariable analysis, RT-alone trended towards shorter time to progression (TTP) compared to CT + EBRT (p = 0.05), with similar TTP compared to CT + VBT (p = 0.83).
Conclusions
In one of the largest retrospective cohorts of early-stage UCS, adjuvant CT + EBRT, but not CT + VBT, improved outcomes compared to RT-alone. Larger prospective studies are needed to investigate the role of different radiation modalities in UCS.
{"title":"Role of adjuvant radiotherapy modality on clinical outcomes for early-stage uterine carcinosarcoma","authors":"Kevin Tyan , Kevin X. Liu , Alicia C. Smart , Colleen M. Feltmate , Neil S. Horowitz , Michael G. Muto , Michael J. Worley Jr. , Kevin M. Elias , Joyce F. Liu , Alexi A. Wright , Panagiotis A. Konstantinopoulos , Susana M. Campos , Ursula A. Matulonis , Idalid Franco , Larissa J. Lee , Martin T. King , M. Aiven Dyer","doi":"10.1016/j.ygyno.2025.03.004","DOIUrl":"10.1016/j.ygyno.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data around adjuvant radiotherapy following surgical management for patients with early-stage uterine carcinosarcoma (UCS). We compared outcomes for patients with early-stage UCS who underwent adjuvant chemotherapy (CT) and pelvic external beam radiotherapy (EBRT) vs. CT and vaginal brachytherapy (VBT) vs. radiation therapy (EBRT or VBT) alone.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed of patients diagnosed with FIGO stage I-II UCS from 2002 to 2020 who received adjuvant radiotherapy, with or without CT, following definitive surgery. Clinical and treatment characteristics and clinical outcomes were assessed. Kaplan-Meier method and log-rank test was used for clinical outcomes. Cox proportional-hazards modeling was used for multivariable analysis.</div></div><div><h3>Results</h3><div>98 patients were analyzed, of whom 38 received CT + EBRT, 31 received CT + VBT, and 29 received RT-alone (18 EBRT, 11 VBT). For the CT + EBRT, CT + VBT, and RT-alone groups, median follow up was 93.5, 50.2, and 143.0 months, and 3-year PFS was 78.7 %, 67.6 %, and 58.2 %, respectively. CT + EBRT was associated with improved PFS compared to RT alone (<em>p</em> = 0.01), but not compared to CT + VBT (<em>p</em> = 0.22). There were 4 locoregional recurrences in the CT + EBRT group (10.5 %), 8 in the CT + VBT group (25.8 %), and 5 in the RT-alone group (17.2 %). On multivariable analysis, RT-alone trended towards shorter time to progression (TTP) compared to CT + EBRT (<em>p</em> = 0.05), with similar TTP compared to CT + VBT (<em>p</em> = 0.83).</div></div><div><h3>Conclusions</h3><div>In one of the largest retrospective cohorts of early-stage UCS, adjuvant CT + EBRT, but not CT + VBT, improved outcomes compared to RT-alone. Larger prospective studies are needed to investigate the role of different radiation modalities in UCS.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 75-81"},"PeriodicalIF":4.5,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579531","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 : 2025-03-07DOI: 10.1016/j.ygyno.2025.03.005
Allan Covens , Helen Q. Huang , Bradley J. Monk , Yong-Beom Kim , Moon-Hong Kim , Paul DiSilvestro , Danielle Vicus , Laura L. Holman , Almee Fleury , J. Matthew Pearson , Nitika Thawani , Mark S. Shahin , Jayanthi S. Lea , Sharon E. Robertson , David Warshal , Floor Backes , Colleen Feltmate , Summer Dewdney , Mario M. Leitao , Ivy Wilkinson-Ryan , Jeanne Carter
Objective
To estimate the efficacy and perioperative morbidity of nonradical surgery (simple hysterectomy [SH] or cone biopsy [CB] plus pelvic lymphadenectomy [PLND] and to report pregnancy outcomes after CB.
Methods
Prospective international study with 3-year follow-up of patients with stage IA1 (lymphovascular space invasion–positive) to IB1 (≤2 cm) cervical cancer stratified by fertility preservation (CB) or none (SH) (both with PLND). Criteria included ≤10 mm stromal invasion and negative margins on loop electrosurgical excision procedure or CB.
Results
We enrolled 224 patients: 72 (32 %) CB and 152 (68 %) SH. Of those, 23 patients (5 CB; 18 SH) were deemed ineligible or refused surgery; 14 % had stage IA1, 28 % stage IA2, and 58 % stage IB1 disease; and 65 % had squamous carcinoma, 32 % adenocarcinoma, and 3 % adenosquamous carcinoma. We found adverse events (grade ≥ 3) within 30 days of surgery in 1 CB and 7 SH patients. In the CB group, 31 patients desired pregnancy during the study and 16 pregnancies occurred. Of those, 4 were spontaneous abortions, 3 were preterm deliveries, and 9 were full-term deliveries. After a median follow-up of 37 months (range 0.2–93 months), 3 patients in the CB group experienced recurrence (3-year recurrence-free survival, 94.8 %, and subsequently underwent hysterectomy), compared to none in the SH group.
Conclusions
Non-radical surgery for early-stage cervical cancer appears safe, with low morbidity. Patients treated by CB and PLND can achieve successful pregnancies. Recurrences in the cervix after CB can occur and require diligent surveillance to attain high cure rates.
{"title":"Evaluation of efficacy and fertility after nonradical surgical therapy (extra fascial hysterectomy or cone biopsy, with pelvic lymphadenectomy) for stage IA1, IA2, and IB1 cervical cancer (GOG-0278)","authors":"Allan Covens , Helen Q. Huang , Bradley J. Monk , Yong-Beom Kim , Moon-Hong Kim , Paul DiSilvestro , Danielle Vicus , Laura L. Holman , Almee Fleury , J. Matthew Pearson , Nitika Thawani , Mark S. Shahin , Jayanthi S. Lea , Sharon E. Robertson , David Warshal , Floor Backes , Colleen Feltmate , Summer Dewdney , Mario M. Leitao , Ivy Wilkinson-Ryan , Jeanne Carter","doi":"10.1016/j.ygyno.2025.03.005","DOIUrl":"10.1016/j.ygyno.2025.03.005","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the efficacy and perioperative morbidity of nonradical surgery (simple hysterectomy [SH] or cone biopsy [CB] plus pelvic lymphadenectomy [PLND] and to report pregnancy outcomes after CB.</div></div><div><h3>Methods</h3><div>Prospective international study with 3-year follow-up of patients with stage IA1 (lymphovascular space invasion–positive) to IB1 (≤2 cm) cervical cancer stratified by fertility preservation (CB) or none (SH) (both with PLND). Criteria included ≤10 mm stromal invasion and negative margins on loop electrosurgical excision procedure or CB.</div></div><div><h3>Results</h3><div>We enrolled 224 patients: 72 (32 %) CB and 152 (68 %) SH. Of those, 23 patients (5 CB; 18 SH) were deemed ineligible or refused surgery; 14 % had stage IA1, 28 % stage IA2, and 58 % stage IB1 disease; and 65 % had squamous carcinoma, 32 % adenocarcinoma, and 3 % adenosquamous carcinoma. We found adverse events (grade ≥ 3) within 30 days of surgery in 1 CB and 7 SH patients. In the CB group, 31 patients desired pregnancy during the study and 16 pregnancies occurred. Of those, 4 were spontaneous abortions, 3 were preterm deliveries, and 9 were full-term deliveries. After a median follow-up of 37 months (range 0.2–93 months), 3 patients in the CB group experienced recurrence (3-year recurrence-free survival, 94.8 %, and subsequently underwent hysterectomy), compared to none in the SH group.</div></div><div><h3>Conclusions</h3><div>Non-radical surgery for early-stage cervical cancer appears safe, with low morbidity. Patients treated by CB and PLND can achieve successful pregnancies. Recurrences in the cervix after CB can occur and require diligent surveillance to attain high cure rates.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 59-65"},"PeriodicalIF":4.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562644","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 : 2025-03-06DOI: 10.1016/j.ygyno.2025.02.022
Xiaosen Li , Zhenpeng Wang , Xiaxia Man , Xiangpeng Dai , Qi Zhou , Songling Zhang
Epithelial ovarian carcinoma (EOC), the most lethal gynecologic cancer, is often diagnosed at advanced stages, which urge us to explore the novel therapeutic strategies. Mouse models have played a crucial role in elucidating the molecular mechanisms for the development ovarian cancer and its therapeutic strategies. However, there are still various challenges in modeling the genetic drivers of ovarian cancer in animal models. Here, we provided an overview of the research advances for the molecular mechanisms underlying EOC development, therapeutic strategies, the CRISPR genome editing technology and its generated EOC models. The review also comprehensively discussed the advantages and obstacles of CRISPR in generating EOC mouse models and the promising therapeutic approach by correcting the oncogenes of EOC through in vivo delivery of gene-edited components. The development of more precise animal models, along with a deeper understanding of EOC molecular mechanisms, will dramatically benefit the investigation and treatment of EOC.
{"title":"Research advances CRISPR gene editing technology generated models in the study of epithelial ovarian carcinoma","authors":"Xiaosen Li , Zhenpeng Wang , Xiaxia Man , Xiangpeng Dai , Qi Zhou , Songling Zhang","doi":"10.1016/j.ygyno.2025.02.022","DOIUrl":"10.1016/j.ygyno.2025.02.022","url":null,"abstract":"<div><div>Epithelial ovarian carcinoma (EOC), the most lethal gynecologic cancer, is often diagnosed at advanced stages, which urge us to explore the novel therapeutic strategies. Mouse models have played a crucial role in elucidating the molecular mechanisms for the development ovarian cancer and its therapeutic strategies. However, there are still various challenges in modeling the genetic drivers of ovarian cancer in animal models. Here, we provided an overview of the research advances for the molecular mechanisms underlying EOC development, therapeutic strategies, the CRISPR genome editing technology and its generated EOC models. The review also comprehensively discussed the advantages and obstacles of CRISPR in generating EOC mouse models and the promising therapeutic approach by correcting the oncogenes of EOC through <em>in vivo</em> delivery of gene-edited components. The development of more precise animal models, along with a deeper understanding of EOC molecular mechanisms, will dramatically benefit the investigation and treatment of EOC.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 34-44"},"PeriodicalIF":4.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562698","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}
Pub Date : 2025-03-06DOI: 10.1016/j.ygyno.2025.02.017
Francesco La Torre , Yannick Hurni , Elisa Farsi , Eleonora Nardi , Francesca Castiglione , Flavia Sorbi , Maria Cristina Petrella , Massimiliano Fambrini , Felice Petraglia
Background/objective
Adenomyosis is a benign uterine disorder characterized by an inflammatory and hyperestrogenic state. Its association with endometrial cancer (EC) remains controversial. This study aimed to investigate the correlation between adenomyosis and the pathological, immunohistochemical (IHC), and molecular features of EC.
Methods
This retrospective cohort study analyzed 172 patients with EC who underwent surgical staging. Patients were stratified into two groups based on the presence of adenomyosis. The primary endpoint was the prevalence of FIGO stage ≥IB disease. Secondary endpoints included tumor histotype, grade, lymphovascular invasion, IHC markers, and molecular alterations. Logistic regression was performed to identify independent predictors of adverse pathological features.
Results
Adenomyosis was identified in 37.2 % of EC patients. These patients were younger, less likely to be postmenopausal, and exhibited significantly lower rates of FIGO stage ≥IB disease, deep myometrial invasion, lymphovascular invasion, and extrauterine spread. Multivariate analysis confirmed adenomyosis as an independent protective factor against FIGO stage ≥IB disease. This protective effect could be attributed to the altered myometrial microenvironment in adenomyosis, characterized by inflammation, smooth muscle hyperplasia, and fibrosis, which appears to limit tumor invasiveness. No significant differences were observed in IHC or molecular profiles, although a trend toward higher prevalence of KRAS mutations was observed in patients with adenomyosis.
Conclusion
Adenomyosis was associated with a lower prevalence of FIGO stage ≥IB disease, deep myometrial invasion, lymphovascular invasion, and extrauterine spread. These findings suggest that structural changes in the myometrial microenvironment may play a role in limiting tumor invasiveness and spread, warranting further investigation.
{"title":"Adenomyosis associated with endometrial cancer: Possible correlation with pathological, immunohistochemical and molecular characteristics","authors":"Francesco La Torre , Yannick Hurni , Elisa Farsi , Eleonora Nardi , Francesca Castiglione , Flavia Sorbi , Maria Cristina Petrella , Massimiliano Fambrini , Felice Petraglia","doi":"10.1016/j.ygyno.2025.02.017","DOIUrl":"10.1016/j.ygyno.2025.02.017","url":null,"abstract":"<div><h3>Background/objective</h3><div>Adenomyosis is a benign uterine disorder characterized by an inflammatory and hyperestrogenic state. Its association with endometrial cancer (EC) remains controversial. This study aimed to investigate the correlation between adenomyosis and the pathological, immunohistochemical (IHC), and molecular features of EC.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 172 patients with EC who underwent surgical staging. Patients were stratified into two groups based on the presence of adenomyosis. The primary endpoint was the prevalence of FIGO stage ≥IB disease. Secondary endpoints included tumor histotype, grade, lymphovascular invasion, IHC markers, and molecular alterations. Logistic regression was performed to identify independent predictors of adverse pathological features.</div></div><div><h3>Results</h3><div>Adenomyosis was identified in 37.2 % of EC patients. These patients were younger, less likely to be postmenopausal, and exhibited significantly lower rates of FIGO stage ≥IB disease, deep myometrial invasion, lymphovascular invasion, and extrauterine spread. Multivariate analysis confirmed adenomyosis as an independent protective factor against FIGO stage ≥IB disease. This protective effect could be attributed to the altered myometrial microenvironment in adenomyosis, characterized by inflammation, smooth muscle hyperplasia, and fibrosis, which appears to limit tumor invasiveness. No significant differences were observed in IHC or molecular profiles, although a trend toward higher prevalence of KRAS mutations was observed in patients with adenomyosis.</div></div><div><h3>Conclusion</h3><div>Adenomyosis was associated with a lower prevalence of FIGO stage ≥IB disease, deep myometrial invasion, lymphovascular invasion, and extrauterine spread. These findings suggest that structural changes in the myometrial microenvironment may play a role in limiting tumor invasiveness and spread, warranting further investigation.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"195 ","pages":"Pages 45-49"},"PeriodicalIF":4.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551533","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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