Pub Date : 2025-11-24DOI: 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.
{"title":"Radiation therapy for the gynecologic oncologist","authors":"Han T. Cun , Sabrina M. Bedell , John Kimball , David K. Gaffney , Yasmin Hasan","doi":"10.1016/j.ygyno.2025.10.030","DOIUrl":"10.1016/j.ygyno.2025.10.030","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 79-90"},"PeriodicalIF":4.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603614","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}
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。
{"title":"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","authors":"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","doi":"10.1016/j.ygyno.2025.11.008","DOIUrl":"10.1016/j.ygyno.2025.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>Of 74 patients (“On PARPi” <em>n</em> = 46; “Not on PARPi” <em>n</em> = 28), 2 L-PFS and OS were significantly shorter in the “On PARPi” group <strong>compared with the “Not on PARPi” group</strong> (median 2 L-PFS 7.0 <em>vs.</em> 18.0 months; HR 3.51, <em>P</em> < 0.001; median OS 15.1 <em>vs.</em> 39.1 months; HR 2.33, <em>P</em> = 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 (<em>P</em> = 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 (<em>P</em> = 0.0497).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 70-78"},"PeriodicalIF":4.1,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577752","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 : 2025-11-22DOI: 10.1016/j.ygyno.2025.11.009
Madeline Rhind , Khadijah Abdulhaleem , Ryan Zhu , Kelly Wei , Jenny Yi , Amy Jamieson , Lars-Christian Horn , Lien Hoang , Yvette Drew
Objective
Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with limited treatment options for advanced disease. This study investigates potential antibody drug conjugate (ADC) targets and explores the immune microenvironment in VSCC.
Methods
Immunohistochemistry (IHC) was performed on tissue microarrays (TMAs) with cores from patients with VSCC to evaluate 6 potential ADC targets: Human Epidermal Growth Factor Receptor 2 (HER2), Trophoblast Cell Surface Antigen 2 (TROP2), Tissue Factor (TF), NECTIN4, Folate Receptor Alpha (FOLR1) and Claudin-18.2 (CLDN18.2). Expression of TROP2, TF and NECTIN4 was quantified using H-score. Multiplex IHC assessed immune markers (CD3+, CD8+, CD68+, PD-1/PD-L1) and combined positive scores (CPS) for programmed death-ligand 1 (PD-L1) were calculated. Clinical data was collected, including p16 and p53 status.
Results
CLDN18.2 and FOLR1 were negative in all cases (n = 108) and HER2 expression was seen in only 2 cases. Intermediate to high H-score (100−300) was observed for TF in 73 % (n = 78), TROP2 in 74 % (n = 80), and NECTIN4 in 53 % (n = 57). All cases had a PD-L1 CPS ≥1 and median CPS was 66 (IQR 28–100) Exploratory analysis suggests ADC marker expression was not dependent on human papillomavirus (HPV) status. However, HPV-independent tumors appeared to have a higher infiltration of CD8+ and CD68+ cells and higher median CPS compared to HPV-associated tumors.
Conclusions
These findings are hypothesis generating and provide rationale for future clinical trials of ADCs and immune checkpoint inhibitors in VSCC. Results suggest HPV-independent tumors may be immunogenically active.
{"title":"Exploring novel therapeutic targets in vulvar squamous cell carcinoma","authors":"Madeline Rhind , Khadijah Abdulhaleem , Ryan Zhu , Kelly Wei , Jenny Yi , Amy Jamieson , Lars-Christian Horn , Lien Hoang , Yvette Drew","doi":"10.1016/j.ygyno.2025.11.009","DOIUrl":"10.1016/j.ygyno.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with limited treatment options for advanced disease. This study investigates potential antibody drug conjugate (ADC) targets and explores the immune microenvironment in VSCC.</div></div><div><h3>Methods</h3><div>Immunohistochemistry (IHC) was performed on tissue microarrays (TMAs) with cores from patients with VSCC to evaluate 6 potential ADC targets: Human Epidermal Growth Factor Receptor 2 (HER2), Trophoblast Cell Surface Antigen 2 (TROP2), Tissue Factor (TF), NECTIN4, Folate Receptor Alpha (FOLR1) and Claudin-18.2 (CLDN18.2). Expression of TROP2, TF and NECTIN4 was quantified using H-score. Multiplex IHC assessed immune markers (CD3+, CD8+, CD68+, PD-1/PD-L1) and combined positive scores (CPS) for programmed death-ligand 1 (PD-L1) were calculated. Clinical data was collected, including p16 and p53 status.</div></div><div><h3>Results</h3><div>CLDN18.2 and FOLR1 were negative in all cases (<em>n</em> = 108) and HER2 expression was seen in only 2 cases. Intermediate to high H-score (100−300) was observed for TF in 73 % (<em>n</em> = 78), TROP2 in 74 % (<em>n</em> = 80), and NECTIN4 in 53 % (<em>n</em> = 57). All cases had a PD-L1 CPS ≥1 and median CPS was 66 (IQR 28–100) Exploratory analysis suggests ADC marker expression was not dependent on human papillomavirus (HPV) status. However, HPV-independent tumors appeared to have a higher infiltration of CD8+ and CD68+ cells and higher median CPS compared to HPV-associated tumors.</div></div><div><h3>Conclusions</h3><div>These findings are hypothesis generating and provide rationale for future clinical trials of ADCs and immune checkpoint inhibitors in VSCC. Results suggest HPV-independent tumors may be immunogenically active.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 63-69"},"PeriodicalIF":4.1,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577794","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 : 2025-11-20DOI: 10.1016/j.ygyno.2025.11.001
Jo’an Tankou , Sofia Ruau , Anjali Walia , Michael Toboni , Hollie Noia , Maggie Mullen , Kevin Lu , David Mutch , Matthew A. Powell , Emanuel F. Petricoin , Katherine C. Fuh
Objective
Improved treatment options for HER2-expressing tumors are needed, particularly receptor targeted therapies. The receptor tyrosine kinase AXL, which is overexpressed in aggressive endometrial cancers, has been shown to heterodimerize with HER2 and drive resistance to anti-HER2 therapies in other cancers. We investigated this interaction in high-risk endometrial cancer and evaluated whether the AXL inhibitor batiraxcept could enhance the therapeutic effect of trastuzumab.
Methods
We utilized three high-risk primary endometrial cancer cell lines (ARK1 and ARK2, uterine serous carcinoma; PUC198, grade 3 endometrioid adenocarcinoma). Immunofluorescence and proximity ligation assays were performed on an ARK2 tumor, and proximity ligation assay was performed on PUC198 cells to assess the physical interaction of HER2 and AXL. Cells were treated with vehicle, batiraxcept, trastuzumab, or both, and colony formation, cell viability, and Matrigel invasion assays were used to assess cell proliferation and invasion. Expression levels of 214 proteins implicated in carcinogenesis were measured via reverse phase protein array. Treatments were also administered to mice injected with ARK1 and ARK2, and tumor burden evaluated via dissection.
Results
Our results demonstrate that AXL and HER2 co-localize and interact in high-risk endometrial cancer cells. We also showed that batiraxcept addition to trastuzumab decreased cell viability and worked synergistically to reduce cell proliferation and invasion in vitro and tumor burden in vivo. Reverse phase protein array analysis revealed that the proteins HER2, phosphorylated HSP-27, Ki-67, LRG1, and LDH-A were downregulated by trastuzumab, and further downregulated by the combination therapy.
Conclusions
Our findings support the combination of batiraxcept and trastuzumab as a promising therapeutic strategy for aggressive HER2+ endometrial cancer.
{"title":"AXL inhibition improves the therapeutic efficacy of trastuzumab in high-risk endometrial cancer","authors":"Jo’an Tankou , Sofia Ruau , Anjali Walia , Michael Toboni , Hollie Noia , Maggie Mullen , Kevin Lu , David Mutch , Matthew A. Powell , Emanuel F. Petricoin , Katherine C. Fuh","doi":"10.1016/j.ygyno.2025.11.001","DOIUrl":"10.1016/j.ygyno.2025.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>Improved treatment options for HER2-expressing tumors are needed, particularly receptor targeted therapies. The receptor tyrosine kinase AXL, which is overexpressed in aggressive endometrial cancers, has been shown to heterodimerize with HER2 and drive resistance to anti-HER2 therapies in other cancers. We investigated this interaction in high-risk endometrial cancer and evaluated whether the AXL inhibitor batiraxcept could enhance the therapeutic effect of trastuzumab.</div></div><div><h3>Methods</h3><div>We utilized three high-risk primary endometrial cancer cell lines (ARK1 and ARK2, uterine serous carcinoma; PUC198, grade 3 endometrioid adenocarcinoma). Immunofluorescence and proximity ligation assays were performed on an ARK2 tumor, and proximity ligation assay was performed on PUC198 cells to assess the physical interaction of HER2 and AXL. Cells were treated with vehicle, batiraxcept, trastuzumab, or both, and colony formation, cell viability, and Matrigel invasion assays were used to assess cell proliferation and invasion. Expression levels of 214 proteins implicated in carcinogenesis were measured <em>via</em> reverse phase protein array. Treatments were also administered to mice injected with ARK1 and ARK2, and tumor burden evaluated <em>via</em> dissection.</div></div><div><h3>Results</h3><div>Our results demonstrate that AXL and HER2 co-localize and interact in high-risk endometrial cancer cells<em>.</em> We also showed that batiraxcept addition to trastuzumab decreased cell viability and worked synergistically to reduce cell proliferation and invasion <em>in vitro</em> and tumor burden <em>in vivo</em>. Reverse phase protein array analysis revealed that the proteins HER2, phosphorylated HSP-27, Ki-67, LRG1, and LDH-A were downregulated by trastuzumab, and further downregulated by the combination therapy.</div></div><div><h3>Conclusions</h3><div>Our findings support the combination of batiraxcept and trastuzumab as a promising therapeutic strategy for aggressive HER2+ endometrial cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 52-62"},"PeriodicalIF":4.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573361","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 : 2025-11-20DOI: 10.1016/j.ygyno.2025.10.038
Judith Kraiczy , Bo Yu
Objective
Serous tubal intraepithelial carcinoma (STIC) is the immediate precursor lesion for high-grade serous ovarian carcinoma (HGSOC) and harbors universal TP53 mutations. The lack of an appropriate in vitro model for STIC presents a major challenge in studying its pathogenesis. We aimed to develop a human in vitro model that mimics STIC lesions.
Methods
Using CRISPR-Cas9 gene editing, we generated human fallopian tube epithelial organoids with TP53 loss-of-function mutations (TP53-/- FTOs). We characterized TP53-/- FTOs on a cellular and molecular level using immunofluorescence confocal imaging, copy number variation (CNV) analysis, and RNA sequencing.
Results
TP53-/- FTOs recapitulated key features of STIC lesions. They exhibited increased proliferation and nuclear abnormalities, including nuclear enlargement and atypical mitotic figures. Copy number variation analysis revealed aneuploidy in some TP53-/- FTOs. Compared to unedited controls, TP53-/- FTOs demonstrated significant transcriptomic changes, including the downregulation of DNA repair genes and upregulation of epithelial-mesenchymal transition (EMT) pathways. Similar to STIC lesions, TP53-/- FTOs showed a marked reduction in ciliated cells and ciliogenesis-associated gene expression.
Conclusions
These findings suggest that p53 loss in FTOs promotes a proliferative and genomically unstable state that is conducive to carcinogenesis. The TP53-/- FTO model we have generated provides a valuable tool for studying early events in ovarian carcinogenesis and for developing new strategies for the early detection and prevention of ovarian cancer.
{"title":"Human fallopian tube epithelial organoids with TP53 mutation recapitulate features of serous tubal intraepithelial carcinoma (STIC)","authors":"Judith Kraiczy , Bo Yu","doi":"10.1016/j.ygyno.2025.10.038","DOIUrl":"10.1016/j.ygyno.2025.10.038","url":null,"abstract":"<div><h3>Objective</h3><div>Serous tubal intraepithelial carcinoma (STIC) is the immediate precursor lesion for high-grade serous ovarian carcinoma (HGSOC) and harbors universal <em>TP53</em> mutations. The lack of an appropriate <em>in vitro</em> model for STIC presents a major challenge in studying its pathogenesis. We aimed to develop a human <em>in vitro</em> model that mimics STIC lesions.</div></div><div><h3>Methods</h3><div>Using CRISPR-Cas9 gene editing, we generated human fallopian tube epithelial organoids with <em>TP53</em> loss-of-function mutations (<em>TP53</em><sup><em>-</em>/-</sup> FTOs). We characterized <em>TP53</em><sup><em>-</em>/-</sup> FTOs on a cellular and molecular level using immunofluorescence confocal imaging, copy number variation (CNV) analysis, and RNA sequencing.</div></div><div><h3>Results</h3><div><em>TP53</em><sup><em>-</em>/-</sup> FTOs recapitulated key features of STIC lesions. They exhibited increased proliferation and nuclear abnormalities, including nuclear enlargement and atypical mitotic figures. Copy number variation analysis revealed aneuploidy in some <em>TP53</em><sup><em>-</em>/-</sup> FTOs. Compared to unedited controls, <em>TP53</em><sup><em>-</em>/-</sup> FTOs demonstrated significant transcriptomic changes, including the downregulation of DNA repair genes and upregulation of epithelial-mesenchymal transition (EMT) pathways. Similar to STIC lesions, <em>TP53</em><sup><em>-</em>/-</sup> FTOs showed a marked reduction in ciliated cells and ciliogenesis-associated gene expression.</div></div><div><h3>Conclusions</h3><div>These findings suggest that p53 loss in FTOs promotes a proliferative and genomically unstable state that is conducive to carcinogenesis. The <em>TP53</em><sup><em>-</em>/-</sup> FTO model we have generated provides a valuable tool for studying early events in ovarian carcinogenesis and for developing new strategies for the early detection and prevention of ovarian cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"203 ","pages":"Pages 198-208"},"PeriodicalIF":4.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568907","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 : 2025-11-19DOI: 10.1016/j.ygyno.2025.11.007
Yiran Shi , Leo Gkekos , Kenny A. Rodriguez-Wallberg , Irma Fredriksson , Magnus Frödin , Frida E. Lundberg , Anna L.V. Johansson
Introduction
Around 5 in 100,000 pregnancies are affected by maternal gynecologic cancer, and the incidence is increasing. We investigated if gynecologic cancer diagnosed during pregnancy influences the risk of adverse obstetric and perinatal outcomes.
Material and methods
This population-based matched study included singleton births registered between 1973 and 2017 in the Swedish Medical Birth Register to women without previous cancer (N = 4,481,808). Births where maternal cancer of the genital organs were diagnosed during pregnancy (n = 269) were identified, and 26,900 cancer-free comparators were matched on maternal age and year of delivery, and birth order. Adjusted conditional logistic and multinomial logistic regression were used to estimate odds ratios (OR) and relative risk ratios (RRR).
Results
Among the 269 women diagnosed with cancer, 196 were cervical cancer, 64 ovarian cancer and 9 other gynecologic cancer types. Maternal gynecologic cancer was associated with higher risks of preterm birth (34–36 weeks: RRR 8.7, 95 % CI 6.2–12.1; 32–33 weeks: 41.0, 26.5–63.5; <32 weeks: 34.8, 22.9–53.0) and cesarean delivery (OR 11.6, 95 % CI 9.0–15.0). Planned preterm delivery was significantly (p < 0.001) more common in cases (36.6 %) than comparator births (0.4 %), as was spontaneous preterm delivery (9.7 % vs 4.4 %, p < 0.001). A higher risk of stillbirth was observed (OR 4.4, 95 % CI 1.6–12.1) based on 4 events among cases, who were all delivered preterm.
Conclusions
Gynecologic cancer during pregnancy was associated with higher risks of preterm birth and adverse preterm-related outcomes. The risks of maternal pregnancy complications and low birth weight for gestational age were similar to those of cancer-free births.
导读：每10万名孕妇中约有5人患有妇科癌症，且发病率呈上升趋势。我们调查了怀孕期间诊断的妇科癌症是否会影响不良产科和围产期结局的风险。材料和方法：这项以人群为基础的匹配研究包括1973年至2017年在瑞典医学出生登记处登记的未患癌症的单胎出生妇女（N = 4,481,808）。确定了在怀孕期间被诊断出患有生殖器官癌症的产妇（n = 269），并根据产妇的年龄、分娩年份和出生顺序匹配26900名无癌症的比较者。采用调整条件逻辑回归和多项逻辑回归估计优势比（OR）和相对风险比（RRR）。结果：269名确诊为癌症的女性中，196名为宫颈癌，64名为卵巢癌，9名为其他妇科癌症。产妇妇科癌症与早产的高风险相关(34-36周：RRR 8.7, 95% CI 6.2-12.1； 32-33周：41.0,26.5-63.5；结论：妊娠期妇科癌症与早产的高风险和不良的早产相关结局相关。孕妇妊娠并发症和低胎龄出生体重的风险与无癌症分娩的风险相似。
{"title":"Obstetric and perinatal outcomes following a diagnosis of gynecologic cancer during pregnancy","authors":"Yiran Shi , Leo Gkekos , Kenny A. Rodriguez-Wallberg , Irma Fredriksson , Magnus Frödin , Frida E. Lundberg , Anna L.V. Johansson","doi":"10.1016/j.ygyno.2025.11.007","DOIUrl":"10.1016/j.ygyno.2025.11.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Around 5 in 100,000 pregnancies are affected by maternal gynecologic cancer, and the incidence is increasing. We investigated if gynecologic cancer diagnosed during pregnancy influences the risk of adverse obstetric and perinatal outcomes.</div></div><div><h3>Material and methods</h3><div>This population-based matched study included singleton births registered between 1973 and 2017 in the Swedish Medical Birth Register to women without previous cancer (<em>N</em> = 4,481,808). Births where maternal cancer of the genital organs were diagnosed during pregnancy (<em>n</em> = 269) were identified, and 26,900 cancer-free comparators were matched on maternal age and year of delivery, and birth order. Adjusted conditional logistic and multinomial logistic regression were used to estimate odds ratios (OR) and relative risk ratios (RRR).</div></div><div><h3>Results</h3><div>Among the 269 women diagnosed with cancer, 196 were cervical cancer, 64 ovarian cancer and 9 other gynecologic cancer types. Maternal gynecologic cancer was associated with higher risks of preterm birth (34–36 weeks: RRR 8.7, 95 % CI 6.2–12.1; 32–33 weeks: 41.0, 26.5–63.5; <32 weeks: 34.8, 22.9–53.0) and cesarean delivery (OR 11.6, 95 % CI 9.0–15.0). Planned preterm delivery was significantly (<em>p</em> < 0.001) more common in cases (36.6 %) than comparator births (0.4 %), as was spontaneous preterm delivery (9.7 % vs 4.4 %, p < 0.001). A higher risk of stillbirth was observed (OR 4.4, 95 % CI 1.6–12.1) based on 4 events among cases, who were all delivered preterm.</div></div><div><h3>Conclusions</h3><div>Gynecologic cancer during pregnancy was associated with higher risks of preterm birth and adverse preterm-related outcomes. The risks of maternal pregnancy complications and low birth weight for gestational age were similar to those of cancer-free births.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 44-51"},"PeriodicalIF":4.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556758","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 : 2025-11-17DOI: 10.1016/j.ygyno.2025.11.005
Michael D. Toboni , Elizabeth T. Evans , Carly Bess Scalise , Melissa Hardesty , Tara Berman , Kaitlyn Dinkins , Fibiana Oladipo , Nicole Hook , Jenifer Ferguson , Punashi Dutta , Jennah Moore , Bailee Oliver , Minetta C. Liu , Adam C. ElNaggar , Charles A. Leath III , Rebecca C. Arend
Objectives
Recommendations for the length of maintenance therapy with poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with ovarian cancer (OC) are derived from clinical trials with various durations of therapy. Here, we evaluated whether circulating tumor DNA (ctDNA) predicted recurrence/progression in OC patients receiving PARPi maintenance.
Methods
This was a multi-center retrospective cohort study of real-world data from commercial ctDNA testing (Signatera™, Natera, Inc.) in patients with OC on PARPi maintenance following response to penultimate platinum-based therapy. Clinical data were collected on stage, setting, pathologic subtype, and biomarker status.
Results
Fifty-three patients with OC were analyzed, with samples collected: i) prior to starting PARPi (pre-PARPi; N = 12), ii) during the first 12 months on PARPi (early; N = 34), and iii) beyond 12 months of PARPi therapy (late; N = 26). ctDNA was detected prior to PARPi initiation in 58 % (7/12) of patients, and none experienced sustained ctDNA clearance on PARPi therapy. Notably, none of the ctDNA-negative patients recurred at the last known clinical follow-up. Persistent/conversion to ctDNA positivity within the first 3 months of therapy was associated with significantly shorter progression-free survival (PFS) (p = 0.01). Patients who were serially ctDNA-negative/cleared ctDNA within 6 months on therapy had significantly improved PFS compared to those who were persistently positive/converted to positive (p = 0.003). Correlation with CA-125 and BRCA/HR status was not significant.
Conclusions
ctDNA status on-PARPi was a stronger predictor of disease progression compared to CA-125 or BRCA/HR status. While additional analyses are warranted, our data suggest that ctDNA is a promising biomarker for therapeutic decision-making.
{"title":"Circulating tumor DNA monitoring in ovarian cancer patients receiving PARPi maintenance therapy: Can we further personalize treatment?","authors":"Michael D. Toboni , Elizabeth T. Evans , Carly Bess Scalise , Melissa Hardesty , Tara Berman , Kaitlyn Dinkins , Fibiana Oladipo , Nicole Hook , Jenifer Ferguson , Punashi Dutta , Jennah Moore , Bailee Oliver , Minetta C. Liu , Adam C. ElNaggar , Charles A. Leath III , Rebecca C. Arend","doi":"10.1016/j.ygyno.2025.11.005","DOIUrl":"10.1016/j.ygyno.2025.11.005","url":null,"abstract":"<div><h3>Objectives</h3><div>Recommendations for the length of maintenance therapy with poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with ovarian cancer (OC) are derived from clinical trials with various durations of therapy. Here, we evaluated whether circulating tumor DNA (ctDNA) predicted recurrence/progression in OC patients receiving PARPi maintenance.</div></div><div><h3>Methods</h3><div>This was a multi-center retrospective cohort study of real-world data from commercial ctDNA testing (Signatera™, Natera, Inc.) in patients with OC on PARPi maintenance following response to penultimate platinum-based therapy. Clinical data were collected on stage, setting, pathologic subtype, and biomarker status.</div></div><div><h3>Results</h3><div>Fifty-three patients with OC were analyzed, with samples collected: i) prior to starting PARPi (pre-PARPi; <em>N</em> = 12), ii) during the first 12 months on PARPi (early; <em>N</em> = 34), and iii) beyond 12 months of PARPi therapy (late; <em>N</em> = 26). ctDNA was detected prior to PARPi initiation in 58 % (7/12) of patients, and none experienced sustained ctDNA clearance on PARPi therapy. Notably, none of the ctDNA-negative patients recurred at the last known clinical follow-up. Persistent/conversion to ctDNA positivity within the first 3 months of therapy was associated with significantly shorter progression-free survival (PFS) (<em>p</em> = 0.01). Patients who were serially ctDNA-negative/cleared ctDNA within 6 months on therapy had significantly improved PFS compared to those who were persistently positive/converted to positive (<em>p</em> = 0.003). Correlation with CA-125 and BRCA/HR status was not significant.</div></div><div><h3>Conclusions</h3><div>ctDNA status on-PARPi was a stronger predictor of disease progression compared to CA-125 or BRCA/HR status. While additional analyses are warranted, our data suggest that ctDNA is a promising biomarker for therapeutic decision-making.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 37-43"},"PeriodicalIF":4.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549208","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 : 2025-11-14DOI: 10.1016/j.ygyno.2025.10.037
Wanying Bao , Xinlin He , Yue Huang , Aoshuang Xing , Zhengyu Li
Objective
This study aimed to evaluate the survival and surgical safety of using a uterine manipulator during laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer.
Methods
We retrospectively analyzed 673 patients with FIGO stage IB1 – IIA1 cervical cancer who underwent LRH between 2019 and 2022. Patients were divided into the uterine manipulator group (n = 395) and the uterine manipulator-free group (n = 278). Propensity score matching (PSM) was performed to minimize confounding effects. Statistical analysis was conducted on perioperative characteristics, pathological results, and follow-up data.
Results
In the unmatched cohort, no significant differences were observed between the uterine manipulator and uterine manipulator-free groups in 3-year disease-free survival (DFS) rates (94.43 % [95 % CI, 92.20 % – 96.72 %] vs. 93.88 % [95 % CI, 91.11% – 96.74 %]; P = 0.88) or overall survival (OS) rates (98.47 % [95 % CI, 97.27 % – 99.69 %] vs. 96.76 % [95 % CI, 94.70 % – 98.86 %]; P = 0.72). In the PSM-matched cohort, 3-year DFS (P = 0.53) and OS (P = 0.94) also showed no significant difference. Five-year survival rates were consistent with these findings. After PSM, multivariate Cox regression analysis identified FIGO stage (2018) IIA1 (HR, 5.82; 95 % CI, 1.11–30.69; P = 0.038) and ovarian invasion (HR, 26.82; 95 % CI, 1.22–589.87; P = 0.037) as the independent risk factors for 3-year DFS. No significant differences were found in major intraoperative complications.
Conclusion
In patients with FIGO stage IB1 – IIA1 cervical cancer, uterine manipulator use during laparoscopic radical hysterectomy does not impact survival and safety.
{"title":"Effect of uterine manipulator on stage IB1 to IIA1 cervical cancer: A retrospective cohort study","authors":"Wanying Bao , Xinlin He , Yue Huang , Aoshuang Xing , Zhengyu Li","doi":"10.1016/j.ygyno.2025.10.037","DOIUrl":"10.1016/j.ygyno.2025.10.037","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the survival and surgical safety of using a uterine manipulator during laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 673 patients with FIGO stage IB1 – IIA1 cervical cancer who underwent LRH between 2019 and 2022. Patients were divided into the uterine manipulator group (<em>n</em> = 395) and the uterine manipulator-free group (<em>n</em> = 278). Propensity score matching (PSM) was performed to minimize confounding effects. Statistical analysis was conducted on perioperative characteristics, pathological results, and follow-up data.</div></div><div><h3>Results</h3><div>In the unmatched cohort, no significant differences were observed between the uterine manipulator and uterine manipulator-free groups in 3-year disease-free survival (DFS) rates (94.43 % [95 % CI, 92.20 % – 96.72 %] vs. 93.88 % [95 % CI, 91.11% – 96.74 %]; <em>P</em> = 0.88) or overall survival (OS) rates (98.47 % [95 % CI, 97.27 % – 99.69 %] vs. 96.76 % [95 % CI, 94.70 % – 98.86 %]; <em>P</em> = 0.72). In the PSM-matched cohort, 3-year DFS (<em>P</em> = 0.53) and OS (<em>P</em> = 0.94) also showed no significant difference. Five-year survival rates were consistent with these findings. After PSM, multivariate Cox regression analysis identified FIGO stage (2018) IIA1 (HR, 5.82; 95 % CI, 1.11–30.69; <em>P</em> = 0.038) and ovarian invasion (HR, 26.82; 95 % CI, 1.22–589.87; <em>P</em> = 0.037) as the independent risk factors for 3-year DFS. No significant differences were found in major intraoperative complications.</div></div><div><h3>Conclusion</h3><div>In patients with FIGO stage IB1 – IIA1 cervical cancer, uterine manipulator use during laparoscopic radical hysterectomy does not impact survival and safety.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 27-36"},"PeriodicalIF":4.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523372","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 : 2025-11-14DOI: 10.1016/j.ygyno.2025.11.002
Ashton B. Ariola , Birx Nolan , Lynette Johnson , Mary J. Cunningham
Objective
This study aimed to evaluate the effects of anatomical variation in cervical diameter and length on bilateral sentinel lymph node (SLN) mapping outcomes in endometrial carcinoma.
Methods
A retrospective cohort study was conducted including 341 patients with endometrial carcinoma who underwent SLN mapping from 2016 to 2019, via superficial and deep intracervical injection of indocyanine green at the 3′ and 9′ o'clock positions. Preoperative characteristics abstracted from chart review include BMI, age, and prior abdominal surgery. Peri- and postoperative collected characteristics included number of sentinel lymph nodes detected, cervix diameter and length, uterine weight and diameter, FIGO grade, estimated blood loss, operation length, and the American Society of Anesthesiologists (ASA) physical status classification.
Results
Increased cervical diameter was independently associated with mapping failure (OR 2.13; 95 % CI, 1.27–3.58; p = 0.004) while variations in cervical length were not. Higher BMI and older age were also significantly associated with unsuccessful mapping.
Conclusions
Cervical diameter is an important variable predicting failure to map bilateral sentinel lymph nodes during surgical staging of endometrial carcinoma. Modification of injection techniques based on cervical diameter should be considered for investigation to improve SLN mapping outcomes.
目的：探讨宫颈直径和长度的解剖变化对子宫内膜癌双侧前哨淋巴结（SLN）定位结果的影响。方法：对2016 - 2019年341例子宫内膜癌患者进行回顾性队列研究，在3′和9′位置进行宫颈浅表和深部注射吲哚菁绿。从图表回顾中提取的术前特征包括BMI、年龄和既往腹部手术。围手术期和术后收集的特征包括检测到的前哨淋巴结数量、宫颈直径和长度、子宫重量和直径、FIGO分级、估计失血量、手术时长以及美国麻醉医师协会（ASA）的身体状态分类。结果：宫颈直径增加与定位失败独立相关（OR 2.13; 95% CI, 1.27-3.58; p = 0.004），而宫颈长度变化与定位失败无关。较高的BMI和年龄也与不成功的定位显著相关。结论：宫颈直径是子宫内膜癌手术分期中预测双侧前哨淋巴结定位失败的重要变量。应考虑根据颈椎直径修改注射技术，以改善SLN制图结果。
{"title":"The impact of cervical diameter on success of sentinel lymph node mapping in endometrial carcinoma: A retrospective cohort study","authors":"Ashton B. Ariola , Birx Nolan , Lynette Johnson , Mary J. Cunningham","doi":"10.1016/j.ygyno.2025.11.002","DOIUrl":"10.1016/j.ygyno.2025.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the effects of anatomical variation in cervical diameter and length on bilateral sentinel lymph node (SLN) mapping outcomes in endometrial carcinoma.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted including 341 patients with endometrial carcinoma who underwent SLN mapping from 2016 to 2019, via superficial and deep intracervical injection of indocyanine green at the 3′ and 9′ o'clock positions. Preoperative characteristics abstracted from chart review include BMI, age, and prior abdominal surgery. Peri- and postoperative collected characteristics included number of sentinel lymph nodes detected, cervix diameter and length, uterine weight and diameter, FIGO grade, estimated blood loss, operation length, and the American Society of Anesthesiologists (ASA) physical status classification.</div></div><div><h3>Results</h3><div>Increased cervical diameter was independently associated with mapping failure (OR 2.13; 95 % CI, 1.27–3.58; <em>p</em> = 0.004) while variations in cervical length were not. Higher BMI and older age were also significantly associated with unsuccessful mapping.</div></div><div><h3>Conclusions</h3><div>Cervical diameter is an important variable predicting failure to map bilateral sentinel lymph nodes during surgical staging of endometrial carcinoma. Modification of injection techniques based on cervical diameter should be considered for investigation to improve SLN mapping outcomes.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 23-26"},"PeriodicalIF":4.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523375","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 : 2025-11-13DOI: 10.1016/j.ygyno.2025.10.034
Rachel L. Furuya , Whitney Grither , Mark G. Evans , Sharon Wu , Jaclyn F. Hechtman , Harris B. Krause , Andrew Elliott , Cara Mathews , Matthew T. Oliver , Katherine Miller , Shuanzeng Wei , Rouba Ali-Fehmi , David A. Bryant , Matthew J. Oberley , Matthew A. Powell , Premal H. Thaker
Background
Immunohistochemistry (IHC) testing is the primary method to determine HER2 status at many institutions, often with reflex to in situ hybridization (ISH). DNA- and RNA- based platforms are emerging for HER-2 assessment. While approved IHC algorithms exist for HER2 scoring in breast and gastric carcinomas, neither has been validated in endometrial cancer. This study seeks to compare them and evaluate patterns of DNA and RNA expression.
Methods
263 endometrioid endometrial adenocarcinoma (EEA), 275 serous endometrial carcinoma (SEC), and 214 uterine carcinosarcoma (UCS) specimens were randomly selected. Previously stained HER2 IHC slides underwent blinded review by two board-certified pathologists and were scored utilizing gastric and breast criteria. Tumors were analyzed for ERBB2 copy number amplification by DNA sequencing and ERBB2 RNA expression by RNA sequencing. Statistical significance was determined using unpaired t-test.
Results
Concordance between scoring algorithms was high for HER2-positive (95 %) and HER2-negative (88 %) cases. Of discordant tumors, the majority (89.7 % of EEA, 68.8 % of SEC, and 81.8 % of UCS) were negative by breast but equivocal by gastric criteria. RNA expression levels were significantly different between discordant cases and negative cases and between negative and equivocal cases. HER2-positivity was associated with worse survival in EEC, improved in SEC, and no difference in UCS.
Conclusions
Breast and gastric scoring criteria show high concordance in endometrial carcinoma, with discordance primarily in equivocal tumors. RNA expression may help stratify equivocal from negative cases. Further study is needed to determine whether HER2 alterations at the DNA, RNA, or protein level predict response to newer generation HER2-targeted therapies.
{"title":"Comparison of breast and gastric HER2 immunohistochemistry (IHC) scoring criteria in the assessment of endometrial carcinoma","authors":"Rachel L. Furuya , Whitney Grither , Mark G. Evans , Sharon Wu , Jaclyn F. Hechtman , Harris B. Krause , Andrew Elliott , Cara Mathews , Matthew T. Oliver , Katherine Miller , Shuanzeng Wei , Rouba Ali-Fehmi , David A. Bryant , Matthew J. Oberley , Matthew A. Powell , Premal H. Thaker","doi":"10.1016/j.ygyno.2025.10.034","DOIUrl":"10.1016/j.ygyno.2025.10.034","url":null,"abstract":"<div><h3>Background</h3><div>Immunohistochemistry (IHC) testing is the primary method to determine HER2 status at many institutions, often with reflex to in situ hybridization (ISH). DNA- and RNA- based platforms are emerging for HER-2 assessment. While approved IHC algorithms exist for HER2 scoring in breast and gastric carcinomas, neither has been validated in endometrial cancer. This study seeks to compare them and evaluate patterns of DNA and RNA expression.</div></div><div><h3>Methods</h3><div>263 endometrioid endometrial adenocarcinoma (EEA), 275 serous endometrial carcinoma (SEC), and 214 uterine carcinosarcoma (UCS) specimens were randomly selected. Previously stained HER2 IHC slides underwent blinded review by two board-certified pathologists and were scored utilizing gastric and breast criteria. Tumors were analyzed for <em>ERBB2</em> copy number amplification by DNA sequencing and ERBB2 RNA expression by RNA sequencing. Statistical significance was determined using unpaired <em>t</em>-test.</div></div><div><h3>Results</h3><div>Concordance between scoring algorithms was high for HER2-positive (95 %) and HER2-negative (88 %) cases. Of discordant tumors, the majority (89.7 % of EEA, 68.8 % of SEC, and 81.8 % of UCS) were negative by breast but equivocal by gastric criteria. RNA expression levels were significantly different between discordant cases and negative cases and between negative and equivocal cases. HER2-positivity was associated with worse survival in EEC, improved in SEC, and no difference in UCS.</div></div><div><h3>Conclusions</h3><div>Breast and gastric scoring criteria show high concordance in endometrial carcinoma, with discordance primarily in equivocal tumors. RNA expression may help stratify equivocal from negative cases. Further study is needed to determine whether HER2 alterations at the DNA, RNA, or protein level predict response to newer generation HER2-targeted therapies.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"204 ","pages":"Pages 17-22"},"PeriodicalIF":4.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512659","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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