Gynecologic oncology最新文献_第5页

Optimising management of women with HPV (not 16/18): Findings from a national HPV screening program 优化女性HPV（非16/18）的管理：来自国家HPV筛查计划的发现。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-12-01 DOI: 10.1016/j.ygyno.2025.11.012

Monjura Nisha , Ya-Lun Liang , Deborah Bateson , Marion Saville , C. David Wrede , David Goldsbury , Marc Arbyn , Karen Canfell , Megan A. Smith

Background

Australian guidelines updated in 2021 recommend a second 12-month follow-up HPV test, instead of immediate colposcopy, for participants with HPV (not 16/18) and negative/low-grade cytology at both primary screening and 12-month follow-up (excepting Aboriginal and/Torres Strait Islander women, those aged ≥50 years or ≥2 years overdue for primary screening). We examined the safety of this change using naturally-occurring variation in colposcopy timing after a 12-month follow-up test.

Methods

Using National Cancer Screening Register data (December 2017–April 2022), we employed Kaplan-Meier analyses to estimate the cumulative incidence of serious cervical abnormalities in those with colposcopy within six months (immediate) versus 12–18 months (deferred) after 12-month follow-up. Analyses were restricted to women who, at their primary screening test, were aged 25–69 years and not ≥2 years overdue, and stratified by age group, Indigenous status, socio-economic status, state/territory, and year of primary screening.

Results

Among 31,499 women with immediate colposcopy and 2562 with deferred colposcopy, the cumulative incidence of cervical intraepithelial neoplasia grade 3 or worse was slightly higher at 24 months in the deferred group (8.3 %; 95 % CI: 6.9–9.9 %) compared to the immediate group (5.7 %; 95 % CI: 5.3–6.0 %). By 36 months, the difference was small and not significant (deferred: 11.3 %; 95 % CI: 8.6–14.7 % vs immediate: 9.9 %; 95 % CI: 8.8–11.2 %). Similar patterns were observed in stratified analyses, except for Aboriginal and Torres Strait Islander women, where a difference persisted to 36 months (deferred: 28.1 %; 95 % CI: 13.4–52.9 % vs immediate: 7.0 %; 95 % CI: 4.4–11.0 %).

Conclusions

Our findings support the safety of updated guidelines for deferring colposcopy and the different recommendation for Aboriginal and Torres Strait Islander women. Although these data do not directly support the different recommendation for those aged ≥50 years, longer follow-up studies are required, given the potential for delayed detection of covert canal lesions in this age group.

背景：2021年更新的澳大利亚指南建议，对于HPV（非16/18）和在初级筛查和12个月随访时细胞学阴性/低级别的参与者（原住民和/托雷斯海峡岛民妇女除外，年龄≥50岁或≥2年逾期进行初级筛查），进行第二次12个月随访HPV检测，而不是立即阴道镜检查。在12个月的随访试验后，我们使用阴道镜检查时间的自然变化来检查这种改变的安全性。方法：使用国家癌症筛查登记数据（2017年12月- 2022年4月），我们采用Kaplan-Meier分析来估计在12个月随访后，阴道镜检查患者在6个月内（立即）与12-18个月内（延迟）严重宫颈异常的累积发生率。分析仅限于进行初次筛查时年龄在25-69岁且逾期不超过2年的妇女，并按年龄组、土著地位、社会经济地位、州/地区和初次筛查年份进行分层。结果：在31499名立即阴道镜检查和2562名延迟阴道镜检查的女性中，延迟组在24个月时宫颈上皮内瘤变3级或更严重的累积发生率（8.3%;95% CI: 6.9- 9.9%）略高于立即组（5.7%;95% CI: 5.3- 6.0%）。到36个月时，差异很小且不显著（延迟：11.3%;95% CI: 8.6- 14.7% vs即时：9.9%;95% CI: 8.8- 11.2%）。在分层分析中也观察到类似的模式，除了原住民和托雷斯海峡岛民妇女，差异持续到36个月（延迟：28.1%;95% CI: 13.4- 52.9% vs立即：7.0%;95% CI: 4.4- 11.0%）。结论：我们的研究结果支持更新的阴道镜检查指南的安全性，以及对土著和托雷斯海峡岛民妇女的不同建议。尽管这些数据并不能直接支持对年龄≥50岁的患者的不同建议，但考虑到该年龄组隐匿性椎管病变可能被延迟发现，需要更长的随访研究。

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引用次数: 0

Corrigendum to “Oncologic outcomes of minimally invasive surgery vs. abdominal hysterectomy in patients with low-risk, early-stage cervical cancer: A retrospective analysis of KGOG 1028 data based on SHAPE trial eligibility criteria” [Gynecologic Oncology 197 (2025) 91–95]. “低风险早期宫颈癌患者微创手术与腹式子宫切除术的肿瘤预后：基于SHAPE试验资格标准的KGOG 1028数据回顾性分析”[妇科肿瘤学197(2025)91-95]的勘误。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-12-01 DOI: 10.1016/j.ygyno.2025.10.011

Jaekyung Bae , Uisuk Kim , E. Sun Paik , Myong Cheol Lim , Moon-Hong Kim , Yun Hwan Kim , Eun Seop Song , Seok Ju Seong , Dong Hoon Suh , Jong-Min Lee , Chulmin Lee , Chel Hun Choi , Sokbom Kang

引用次数: 0

Corrigendum to ‘The outcome of waiting for radiotherapy in locally advanced cervical cancer’ [Gynecologic Oncology 190S1 2249, Vol. 190, Supplement 1, S361, November 2024] “局部晚期宫颈癌等待放疗的结果”的勘误表[妇科肿瘤学190S1 2249， Vol. 190，增刊1，S361，十一月2024]

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-29 DOI: 10.1016/j.ygyno.2025.11.010

David Cantú-de León, Jairo Aarón Rubio Cordero, Guillermo Moreno Flores, Lenny Gallardo-Alvarado, Rebeca Ramirez-Morales, Ma Delia Perez-Montiel

引用次数: 0

Prognostic and immunological significance of tryptophan metabolic enzymes across endometrial cancer molecular subtypes 色氨酸代谢酶在子宫内膜癌分子亚型中的预后和免疫学意义

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-26 DOI: 10.1016/j.ygyno.2025.10.039

Racheal Louise Johnson , Georgia Mappa , Narinder Gahir , Katie E. Allen , Albina Zubayraeva , Bahar Ebtehaj , Amudha Thangavelu , Georgios Theophilou , Richard Hutson , Timothy Broadhead , David Nugent , Diederick De Jong , Sarika Munot , Alexandros Laios , Michele Cummings , Nicolas M. Orsi

Background

The kynurenine pathway is a key immunosuppressive mechanism implicated in resistance to immune checkpoint inhibitors (ICIs). This study investigated expression of tryptophan-metabolising enzymes (IDO1, TDO2, IL4I1) and their relationship with the immune microenvironment across molecular subtypes of endometrial cancer (EC).

Methods

A cohort of 570 ECs was classified as mismatch repair-deficient (MMRd), p53-mutant (p53mut), or no specific molecular profile (NSMP). Expression of IDO1, TDO2, IL4I1, PD-L1, kynurenine, and immune markers (CD8, FOXP3, CD68, CD163) was assessed by immunohistochemistry and quantified in tumour and stromal compartments using QuPath. Associations with disease-specific survival (DSS) were analysed using correlation testing, Kaplan–Meier, and Cox regression.

Results

IDO1, TDO2, and IL4I1 correlated strongly with immune infiltrate density. High IDO1 tumour expression was linked to improved DSS in NSMP and p53mut tumours (p < 0.05), consistent with an “inflamed” phenotype. In contrast, high TDO2 stromal expression predicted reduced DSS in NSMP patients (p < 0.05). Elevated IL4I1 tumour expression was associated with improved DSS in MMRd tumours (p < 0.05). A high CD163:CD8 ratio independently predicted worse DSS in p53mut tumours (p < 0.05). Both TDO2 and IL4I1 were highly expressed high-risk tumours, particularly p53mut cases.

Conclusions

Tryptophan-kynurenine enzymes shape the immune landscape of EC in a subtype-specific manner. High IDO1 was linked to favourable outcomes in p53mut and NSMP cases, whereas TDO2 predicted poor prognosis. The CD163:CD8 ratio emerged as an independent marker of poor survival. These findings support therapeutic strategies combining dual IDO1/TDO2 inhibition or targeting the IL4I1– aryl hydrocarbon receptor (AhR) axis to enhance immunotherapy efficacy in EC.

背景犬尿氨酸途径是免疫检查点抑制剂（ICIs）耐药的关键免疫抑制机制。本研究探讨了色氨酸代谢酶（IDO1, TDO2, IL4I1）在子宫内膜癌（EC）分子亚型中的表达及其与免疫微环境的关系。方法将570例ec分为错配修复缺陷型（MMRd）、p53突变型（p53mut）和无特异性分子谱型（NSMP）。采用免疫组织化学方法评估IDO1、TDO2、IL4I1、PD-L1、犬尿氨酸和免疫标志物（CD8、FOXP3、CD68、CD163）的表达，并使用QuPath对肿瘤和间质室进行定量。使用相关检验、Kaplan-Meier和Cox回归分析与疾病特异性生存（DSS）的关联。结果tsido1、TDO2、IL4I1与免疫浸润密度呈显著相关。高IDO1肿瘤表达与NSMP和p53mut肿瘤的DSS改善有关（p < 0.05），与“炎症”表型一致。相比之下，高TDO2基质表达预测NSMP患者DSS降低（p < 0.05）。MMRd肿瘤中IL4I1肿瘤表达升高与DSS改善相关（p < 0.05）。高CD163:CD8比值独立预测p53mut肿瘤的DSS恶化（p < 0.05）。TDO2和IL4I1都是高表达的高危肿瘤，尤其是p53mut病例。结论色氨酸-犬尿氨酸酶以亚型特异性的方式塑造了EC的免疫景观。高IDO1与p53mut和NSMP病例的良好预后相关，而TDO2预测预后不良。CD163:CD8比值成为生存不良的独立标志物。这些发现支持联合双重IDO1/TDO2抑制或靶向IL4I1 -芳烃受体（AhR）轴的治疗策略来提高EC的免疫治疗效果。

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引用次数: 0

Updates to post-treatment surveillance after curative intent treatment for patients with gynecologic cancers: A Society of Gynecologic Oncology clinical practice statement 妇科癌症患者治疗意图治疗后监测的最新进展：妇科肿瘤学会临床实践声明

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-26 DOI: 10.1016/j.ygyno.2025.11.014

Ritu Salani , David Atallah , Amanda N. Fader , Marina Frimer , Andreas Obermair , Rene Pareja , Marilyn Huang

Gynecologic malignancies accounted for ∼15 % of new cancer cases and cancer survivors in 2022. Advances in cancer care are expected to improve outcomes, and the growth in survivorship is expected to increase by over 25 % in the next several years. After completion of primary therapy, follow-up care is designed to monitor patients for recurrence; however, the evidence for surveillance recommendations is weak and often based on retrospective studies, resulting in wide variability in clinical practice.

Therefore, understanding the most clinically efficient tools to detect cancer recurrence, particularly when interventions can lead to survival and/or quality of life improvements, is a priority. Currently, symptom review and physical examination are reportedly the most effective methods to detect recurrence across gynecologic tumor types. Interestingly, tests such as vaginal cytology, which have negligible benefit in recurrence detection, are still frequently utilized in the posttreatment evaluation of patients. Similarly, imaging is often routinely used without proven benefit; however, it is important to note that imaging may play a role in specific settings. Lastly, incorporating novel serum biomarkers and emerging tests, such as circulating tumor DNA (ctDNA), requires additional studies. This article is designed to provide an update on best practices for surveillance in gynecologic cancer patients after curative intent primary therapy.

2022年，妇科恶性肿瘤占癌症新病例和癌症幸存者的15%。癌症治疗的进步有望改善预后，预计在未来几年内，生存率的增长将超过25%。完成初级治疗后，随访护理旨在监测患者的复发情况；然而，监测建议的证据薄弱，往往基于回顾性研究，导致临床实践存在很大差异。因此，了解临床最有效的检测癌症复发的工具，特别是当干预措施可以改善生存和/或生活质量时，是一个优先事项。目前，症状回顾和体格检查是诊断妇科肿瘤复发最有效的方法。有趣的是，诸如阴道细胞学之类的检测在复发检测方面的益处微不足道，但仍然经常用于患者的治疗后评估。同样，影像学检查也经常被常规使用，但没有得到证实；然而，重要的是要注意成像可能在特定情况下发挥作用。最后，结合新的血清生物标志物和新出现的测试，如循环肿瘤DNA (ctDNA)，需要进一步的研究。这篇文章的目的是提供最新的最佳做法，监测妇科癌症患者在治愈意图的主要治疗后。

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引用次数: 0

Surgery versus definitive radiotherapy in the management of stage I-II small cell neuroendocrine carcinoma of the cervix: A systematic review and meta-analysis 手术与放疗对I-II期宫颈小细胞神经内分泌癌的治疗：一项系统综述和荟萃分析

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-26 DOI: 10.1016/j.ygyno.2025.11.015

Kevin Yijun Fan , Rania Chehade , Andrew Yuanbo Wang , Anjali Sachdeva , Farideh Tavangar , Helen J. MacKay , Amandeep S. Taggar

Background

Small cell neuroendocrine carcinoma of the cervix (SCNECC) is a rare malignancy with poor prognosis. Optimal management of stage I-II disease remains uncertain, with guidelines variably recommending primary surgery or definitive radiotherapy. This study aimed to compare overall survival (OS) in patients with stage I-II SCNECC treated with primary surgery versus definitive radiotherapy through a systematic review and meta-analysis of the current literature.

Methods

Medline and Embase were searched for English-language studies reporting OS for stage I-II SCNECC treated with either primary surgery or definitive radiotherapy. Studies with ≥5 patients per treatment group were included. Hazard ratios (HR) for OS were pooled using a random-effects meta-analysis. Heterogeneity was assessed with I². The impact of including stage IIB patients was evaluated using a Likelihood Ratio Test comparing Cox proportional hazards models.

Results

Of 621 unique records, five studies met the inclusion criteria, encompassing 650 patients treated for stage I-II SCNECC between 1987 and 2012 in 38 hospitals across three countries. Among these patients, 474 underwent primary surgery and 176 received definitive radiotherapy. Of all patients, 84 % received chemotherapy. Median follow-up ranged from 31 to 83 months, and median OS ranged from 21 to 111 months. The pooled HR for OS favoured primary surgery compared to definitive radiotherapy (HR 0.53; 95 % CI 0.31–0.91; p = 0.021). Inter-study heterogeneity was substantial (I² = 64 %, p = 0.024). Inclusion of stage IIB patients did not significantly affect the overall HR (p = 0.914).

Conclusions

In stage I-II SCNECC, primary surgery is associated with longer OS compared to definitive radiotherapy. While findings are limited by the retrospective nature of included studies and potential selection bias, these results support consideration of surgical consultation for eligible patients as part of a multidisciplinary decision-making process. Prospective studies and inter-institutional collaboration are urgently needed to define optimal treatment strategies in this rare malignancy.

背景：宫颈小细胞神经内分泌癌（SCNECC）是一种罕见的恶性肿瘤，预后差。I-II期疾病的最佳治疗方法仍不确定，指南不同地推荐初级手术或最终放疗。本研究旨在通过对当前文献的系统回顾和荟萃分析，比较I-II期SCNECC患者接受原发性手术和最终放疗的总生存率（OS）。方法检索medline和Embase中报告I-II期SCNECC原发性手术或最终放射治疗出现OS的英文研究。每个治疗组纳入≥5例患者的研究。采用随机效应荟萃分析合并OS的风险比（HR）。用I2评估异质性。采用比较Cox比例风险模型的似然比检验评估纳入IIB期患者的影响。在621项独特记录中，有5项研究符合纳入标准，涵盖了1987年至2012年期间在三个国家38家医院接受I-II期SCNECC治疗的650名患者。在这些患者中，474人接受了原发性手术，176人接受了最终放疗。在所有患者中，84%接受了化疗。中位随访时间为31 ~ 83个月，中位OS为21 ~ 111个月。与最终放疗相比，OS的总HR更倾向于初始手术（HR 0.53; 95% CI 0.31-0.91; p = 0.021）。研究间异质性显著（I2 = 64%, p = 0.024）。纳入IIB期患者对总HR没有显著影响（p = 0.914）。结论在I-II期SCNECC中，与最终放疗相比，初次手术有更长的生存期。虽然研究结果受到纳入研究的回顾性性质和潜在的选择偏倚的限制，但这些结果支持考虑将符合条件的患者的手术会诊作为多学科决策过程的一部分。迫切需要前瞻性研究和机构间合作来确定这种罕见恶性肿瘤的最佳治疗策略。

{"title":"Surgery versus definitive radiotherapy in the management of stage I-II small cell neuroendocrine carcinoma of the cervix: A systematic review and meta-analysis","authors":"Kevin Yijun Fan , Rania Chehade , Andrew Yuanbo Wang , Anjali Sachdeva , Farideh Tavangar , Helen J. MacKay , Amandeep S. Taggar","doi":"10.1016/j.ygyno.2025.11.015","DOIUrl":"10.1016/j.ygyno.2025.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Small cell neuroendocrine carcinoma of the cervix (SCNECC) is a rare malignancy with poor prognosis. Optimal management of stage I-II disease remains uncertain, with guidelines variably recommending primary surgery or definitive radiotherapy. This study aimed to compare overall survival (OS) in patients with stage I-II SCNECC treated with primary surgery versus definitive radiotherapy through a systematic review and meta-analysis of the current literature.</div></div><div><h3>Methods</h3><div>Medline and Embase were searched for English-language studies reporting OS for stage I-II SCNECC treated with either primary surgery or definitive radiotherapy. Studies with ≥5 patients per treatment group were included. Hazard ratios (HR) for OS were pooled using a random-effects meta-analysis. Heterogeneity was assessed with <em>I</em><sup><em>2</em></sup>. The impact of including stage IIB patients was evaluated using a Likelihood Ratio Test comparing Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Of 621 unique records, five studies met the inclusion criteria, encompassing 650 patients treated for stage I-II SCNECC between 1987 and 2012 in 38 hospitals across three countries. Among these patients, 474 underwent primary surgery and 176 received definitive radiotherapy. Of all patients, 84 % received chemotherapy. Median follow-up ranged from 31 to 83 months, and median OS ranged from 21 to 111 months. The pooled HR for OS favoured primary surgery compared to definitive radiotherapy (HR 0.53; 95 % CI 0.31–0.91; <em>p</em> = 0.021). Inter-study heterogeneity was substantial (I<sup>2</sup> = 64 %, <em>p</em> = 0.024). Inclusion of stage IIB patients did not significantly affect the overall HR (<em>p</em> = 0.914).</div></div><div><h3>Conclusions</h3><div>In stage I-II SCNECC, primary surgery is associated with longer OS compared to definitive radiotherapy. While findings are limited by the retrospective nature of included studies and potential selection bias, these results support consideration of surgical consultation for eligible patients as part of a multidisciplinary decision-making process. Prospective studies and inter-institutional collaboration are urgently needed to define optimal treatment strategies in this rare malignancy.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 118-123"},"PeriodicalIF":4.1,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621581","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

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-25 DOI: 10.1016/j.ygyno.2025.11.013

Sarah E. Soppe , Tzy-Mey Kuo , Georgios Lyratzopoulos , Mindy C. DeRouen , Benjamin B. Albright , Victoria L. Bae-Jump , Chris D. Baggett , Stephanie Wheeler , Caroline A. Thompson

Objective

Most ovarian cancer (OC) patients are diagnosed at a late stage with poor survival. Factors that enable early-stage diagnoses are poorly understood; this study explores differences in pre-diagnostic healthcare utilization for relevant symptoms and diagnoses to identify factors potentially impacting stage at diagnosis.

Methods

We identified OC patients in the North Carolina state cancer registry (2009–2019) with linked multi-payer insurance claims in the year pre-diagnosis. We compared frequency of claims for symptoms of OC and diagnoses often initially ascribed to them, including anxiety, menopausal symptoms, and gastrointestinal disorders, during the month before OC diagnosis and earlier (1–12 months before), stratified by early vs. late-stage.

Results

Out of 2495 patients, 822 (33 %) were diagnosed at an early stage. On the absolute scale, patients with an early stage were nearly twice as likely to present with pelvic pain during the month pre-diagnosis (20 % (95 % CI:(17 %–23 %) vs.11 % (95 % CI:10–13 %)), with patients with late stage more frequently presenting with abdominal and gastrointestinal complaints. In the year pre-diagnosis, 54 % (95 % CI:51–57 %) of patients with early-stage and 52 % (95 % CI:50–54 %) with late-stage were diagnosed with a gastrointestinal disorder, most commonly gastroesophageal reflux disease (GERD). Over 20 % had healthcare encounters for a symptom or related diagnosis as early as 10 months before OC diagnosis.

Conclusions

Differences in symptomatic presentation may explain some early-stage diagnoses, though these were minor. Gastrointestinal disorder diagnoses such as GERD may be an underappreciated hallmark of the pathway to OC diagnosis and should be considered when assessing time to diagnosis using claims.

目的卵巢癌（OC）患者大多诊断为晚期，生存期较差。人们对早期诊断的因素了解甚少；本研究旨在探讨诊断前对相关症状和诊断的医疗保健利用差异，以确定可能影响诊断阶段的因素。方法：我们在北卡罗来纳州癌症登记处（2009-2019）中确定了在诊断前一年相关的多付款人保险索赔的OC患者。我们比较了在卵巢癌诊断前一个月和更早（1-12个月前）的卵巢癌症状和通常最初归因于这些症状的诊断（包括焦虑、更年期症状和胃肠道紊乱）的索赔频率，并按早期和晚期进行分层。结果2495例患者中，早期确诊822例（33%）。在绝对规模上，早期患者在诊断前一个月出现盆腔疼痛的可能性几乎是前者的两倍(20% (95% CI: 17% - 23%) vs. 11% (95% CI:10 - 13%))，晚期患者更频繁地出现腹部和胃肠道不适。在诊断前一年，54% （95% CI:51 - 57%）的早期患者和52% （95% CI:50 - 54%）的晚期患者被诊断为胃肠道疾病，最常见的是胃食管反流病（GERD）。超过20%的人早在卵巢癌诊断前10个月就因症状或相关诊断就诊。结论症状表现的差异可以解释一些早期诊断，尽管这些差异很小。胃肠道疾病的诊断，如胃食管反流，可能是OC诊断途径的一个未被充分认识的标志，在使用索赔评估诊断时间时应予以考虑。

{"title":"Symptom-related care and diagnoses before ovarian cancer detection: Patterns and differences by cancer stage","authors":"Sarah E. Soppe , Tzy-Mey Kuo , Georgios Lyratzopoulos , Mindy C. DeRouen , Benjamin B. Albright , Victoria L. Bae-Jump , Chris D. Baggett , Stephanie Wheeler , Caroline A. Thompson","doi":"10.1016/j.ygyno.2025.11.013","DOIUrl":"10.1016/j.ygyno.2025.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>Most ovarian cancer (OC) patients are diagnosed at a late stage with poor survival. Factors that enable early-stage diagnoses are poorly understood; this study explores differences in pre-diagnostic healthcare utilization for relevant symptoms and diagnoses to identify factors potentially impacting stage at diagnosis.</div></div><div><h3>Methods</h3><div>We identified OC patients in the North Carolina state cancer registry (2009–2019) with linked multi-payer insurance claims in the year pre-diagnosis. We compared frequency of claims for symptoms of OC and diagnoses often initially ascribed to them, including anxiety, menopausal symptoms, and gastrointestinal disorders, during the month before OC diagnosis and earlier (1–12 months before), stratified by early vs. late-stage.</div></div><div><h3>Results</h3><div>Out of 2495 patients, 822 (33 %) were diagnosed at an early stage. On the absolute scale, patients with an early stage were nearly twice as likely to present with pelvic pain during the month pre-diagnosis (20 % (95 % CI:(17 %–23 %) vs.11 % (95 % CI:10–13 %)), with patients with late stage more frequently presenting with abdominal and gastrointestinal complaints. In the year pre-diagnosis, 54 % (95 % CI:51–57 %) of patients with early-stage and 52 % (95 % CI:50–54 %) with late-stage were diagnosed with a gastrointestinal disorder, most commonly gastroesophageal reflux disease (GERD). Over 20 % had healthcare encounters for a symptom or related diagnosis as early as 10 months before OC diagnosis.</div></div><div><h3>Conclusions</h3><div>Differences in symptomatic presentation may explain some early-stage diagnoses, though these were minor. Gastrointestinal disorder diagnoses such as GERD may be an underappreciated hallmark of the pathway to OC diagnosis and should be considered when assessing time to diagnosis using claims.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 100-108"},"PeriodicalIF":4.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621579","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

Intraperitoneal infusion of stem cell-derived natural killer cells in recurrent epithelial ovarian cancer patients: Results of the phase 1 INTRO-01 trial 腹腔输注干细胞来源的自然杀伤细胞治疗复发性上皮性卵巢癌患者：i期INTRO-01试验的结果

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-24 DOI: 10.1016/j.ygyno.2025.11.006

Janneke S Hoogstad-van Evert , Paul K J D de Jonge , Petra L M Zusterzeel , Willemijn Hobo , Anniek B van der Waart , Hanny Fredrix , Lisanne Janssen , Maud Wuts , Lynn Bosmans , Ellen Spijkers , Merlize Djojoatmo , Veronica Castaño Rodriguez , Anna L de Goede , Bert van der Reijden , Arnold van der Meer , Nicolaas Schaap , Ruud Bekkers , Joop H Jansen , Nelleke Ottevanger , Harry Dolstra

Introduction

Epithelial ovarian cancer (EOC) patients exhibit a poor 5-year overall survival rate of approximately 40 %, underscoring the urgent need for innovative therapies. Allogeneic natural killer (NK) cell therapy presents a promising and safe therapeutic option, given its ability to discriminate between normal and malignant cells with potent cytotoxic effects against malignant cells.

Methods

We present the first-in-human study exploiting the safety of the NK cell product designated RNK001, derived ex vivo from umbilical cord blood-derived hematopoietic stem and progenitor cells. This phase 1 INTRO-01 trial (NCT03539406) was initiated to assess the feasibility, safety, and toxicity of intraperitoneal (IP) infusion of RNK001 in EOC patients exhibiting elevated CA125 levels at the second recurrence. RNK001 infusion was supported by IP IL-2 in six patients, and was preceded in one patient by lymphodepleting chemotherapy with cyclophosphamide/fludarabine.

Results

RNK001 consisted of 1.2 to 3.0 × 10⁹ highly activated CD56⁺CD3⁻ NK cells and was well tolerated, with neither evidence of graft-versus-host disease nor cytokine release syndrome. One patient experienced a grade 3 transient elevation in liver enzymes, another patient exhibited grade 3 ileus caused by disease progression. Notably, five out seven patients demonstrated a reduction in CA125 serum levels of 20–53 % at 14 days post-infusion. Furthermore, one patient achieved a clinical and biochemical response with radiological stable disease and a progression-free survival of 9 months.

Conclusion

These findings suggest that intraperitoneal RNK001-based immunotherapy can be safely administered to recurrent EOC patients without inducing severe toxicity, while clinical and biochemical responses warrant further development.

上皮性卵巢癌（EOC）患者的5年总生存率约为40%，这表明迫切需要创新的治疗方法。同种异体自然杀伤（NK）细胞疗法是一种很有前途的安全的治疗选择，因为它能够区分正常细胞和恶性细胞，并对恶性细胞具有强大的细胞毒性作用。方法：我们首次在人类身上进行了NK细胞产品RNK001的安全性研究，RNK001是从脐带血来源的造血干细胞和祖细胞中分离出来的。这项i期INTRO-01试验（NCT03539406）的启动是为了评估在第二次复发时CA125水平升高的EOC患者中腹腔注射RNK001的可行性、安全性和毒性。在6例患者中，RNK001输注由IP IL-2支持，在1例患者之前，使用环磷酰胺/氟达拉滨进行淋巴细胞消耗化疗。结果：RNK001由1.2 ~ 3.0 × 109个高度活化的CD56+CD3- NK细胞组成，耐受性良好，无移植物抗宿主病和细胞因子释放综合征的证据。一名患者经历了3级肝酶的短暂升高，另一名患者表现出疾病进展引起的3级肠梗阻。值得注意的是，7名患者中有5名在输注后14天CA125血清水平下降了20- 53%。此外，一名患者获得了临床和生化反应，放射学稳定，无进展生存期为9个月。结论：基于rnk001的腹腔免疫疗法可安全用于复发性EOC患者，且无严重毒性，临床和生化反应有待进一步研究。

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引用次数: 0

Radiation therapy for the gynecologic oncologist 妇科肿瘤学家的放射治疗。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-24 DOI: 10.1016/j.ygyno.2025.10.030

Han T. Cun , Sabrina M. Bedell , John Kimball , David K. Gaffney , Yasmin Hasan

Radiation therapy for the gynecologic oncology patient has evolved in the last century but continues to be an integral component of care for women with pelvic malignancies. This review discusses the essential aspects of physics, radiobiology, and imaging for radiation therapy. It aims to review the increasing indications for radiation therapy in gynecologic neoplasms such as for oligometastatic disease and palliative measures. It also discusses the widespread adoption of IMRT, increasing use of SBRT and proton beam therapy, and modernization of brachytherapy in gynecological cancer, while also touching on the interdigitation of immunotherapy, as well as the impact of molecular factors in adjuvant endometrial cancer treatment. Radiation oncology, like other oncologic disciplines, continues to evolve to provide less morbidity with improved outcomes and experience for our patients. And thus, the following review discusses innovations in radiotherapy used in gynecologic malignancies today and the advances we see impacting the field of gynecologic oncology moving forward.

妇科肿瘤患者的放射治疗在上个世纪已经发展，但仍然是女性盆腔恶性肿瘤护理的一个组成部分。本文综述了放射治疗的物理、放射生物学和影像学的基本方面。它的目的是审查越来越多的适应症放射治疗妇科肿瘤，如低转移性疾病和姑息措施。它还讨论了IMRT的广泛采用，SBRT和质子束治疗的增加使用，以及妇科癌症近距离治疗的现代化，同时也触及了免疫治疗的交叉，以及分子因素在子宫内膜癌辅助治疗中的影响。放射肿瘤学，像其他肿瘤学学科一样，不断发展，为我们的患者提供更低的发病率和更好的结果和经验。因此，下面的回顾讨论了今天用于妇科恶性肿瘤的放射治疗的创新以及我们看到的影响妇科肿瘤领域向前发展的进展。

引用次数: 0

Impact of platinum-free interval and bevacizumab on second-line chemotherapy following progression on first-line PARP inhibitor maintenance in advanced ovarian cancer: A retrospective cohort study 无铂间期和贝伐单抗对晚期卵巢癌一线PARP抑制剂维持进展后二线化疗的影响：一项回顾性队列研究

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-22 DOI: 10.1016/j.ygyno.2025.11.008

Miki Hayakawa , Hiromichi Nakajima , Kenichi Harano , Shogo Watanabe , Saki Tsuchimochi , Mao Uematsu , Misao Fukuda , Chikako Funasaka , Chihiro Kondoh , Nobuaki Matsubara , Yoichi Naito , Ako Hosono , Masashi Wakabayashi , Kazuaki Takahashi , Hiroshi Tanabe , Toru Mukohara

Objective

To compare second-line (2 L) outcomes between patients with advanced ovarian cancer whose disease relapsed on first-line (1 L) PARP inhibitor (PARPi) maintenance (“On PARPi”) and those who were Not on PARPi at relapse (“Not on PARPi”), and to determine the effect of platinum-free interval (PFI) and bevacizumab.

Methods

A single-center retrospective study (2018–2025) was conducted in patients whose disease relapsed after a response to 1 L platinum-based chemotherapy. The endpoints from the start of 2 L therapy were progression-free survival (2 L-PFS) and overall survival (OS).

Results

Of 74 patients (“On PARPi” n = 46; “Not on PARPi” n = 28), 2 L-PFS and OS were significantly shorter in the “On PARPi” group compared with the “Not on PARPi” group (median 2 L-PFS 7.0 vs. 18.0 months; HR 3.51, P < 0.001; median OS 15.1 vs. 39.1 months; HR 2.33, P = 0.019). This difference persisted in the platinum-sensitive subgroup (PFI ≥ 6 months). In the platinum-sensitive subgroup, a significant interaction between PFI and group (P = 0.012) confirmed that the detrimental effect of being in the “On PARPi” group was greatest in patients with a PFI ≥ 12 months. For the “On PARPi” group, 2 L bevacizumab independently improved 2 L-PFS (HR 0.22) and OS (HR 0.23). For the responders to 2 L platinum-based chemotherapy, bevacizumab maintenance improved OS compared with PARPi rechallenge (P = 0.0497).

Conclusion

Disease progression on 1 L PARPi maintenance was associated with poorer outcomes after subsequent chemotherapy. Incorporating bevacizumab into 2 L chemotherapy and maintenance was associated with improved survival.

目的比较晚期卵巢癌复发患者在一线（1l） PARP抑制剂（PARPi）维持治疗（“PARPi”）和复发时未使用PARPi（“不使用PARPi”）的二线（2l）结局，并确定无铂间期（PFI）和贝伐单抗的影响。方法采用单中心回顾性研究（2018-2025），对1 L铂类化疗后复发的患者进行研究。从2l治疗开始的终点是无进展生存期（2l - pfs）和总生存期（OS）。结果74例患者（“On PARPi”n = 46；“Not On PARPi”n = 28）中，“On PARPi”组2例L-PFS和OS明显短于“Not On PARPi”组（中位2 L-PFS 7.0 vs. 18.0个月；HR 3.51, P < 0.001；中位OS 15.1 vs. 39.1个月；HR 2.33, P = 0.019）。这种差异在铂敏感亚组（PFI≥6个月）中持续存在。在铂敏感亚组中，PFI和组之间的显著相互作用（P = 0.012）证实，在PFI≥12个月的患者中，处于“On PARPi”组的有害影响最大。对于“On PARPi”组，2l贝伐单抗独立改善了2 L- pfs （HR 0.22）和OS （HR 0.23）。对于2l铂基化疗的应答者，与PARPi再挑战相比，贝伐单抗维持改善了OS （P = 0.0497）。结论维持1 L PARPi时疾病进展与后续化疗预后较差相关。将贝伐单抗纳入2l化疗和维持与生存率提高相关。

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