Gynecologic oncology最新文献_第8页

Neoadjuvant chemotherapy modulates mast cell phenotypes and immune infiltration in high-grade serous carcinoma 新辅助化疗可调节高级别浆液性癌的肥大细胞表型和免疫浸润

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-01 DOI: 10.1016/j.ygyno.2025.10.014

Yuanchun Fan , Qiuman Wang , Huiyan Deng , Yueping Liu , Hui Zhang

Objective

The influence of neoadjuvant chemotherapy (NACT) on the immune landscape of high-grade serous carcinoma (HGSC) remains inadequately understood. This study aims to investigate the differential patterns of immune infiltration in HGSC tissues before and after NACT, as well as their clinical significance.

Methods

Immune infiltration patterns in HGSC tissues pre- and post-NACT were analyzed using our in-house RNA sequencing data (comprising 8 pre-NACT and 7 post-NACT tumor samples), three GEO datasets (GSE181597, GSE201600, GSE227666), and immunohistochemistry on 73 paired pre- and post-NACT samples. The response to NACT was evaluated using the Chemotherapy response score (CRS), categorizing patients as responders (CRS = 3) and non-responders (CRS = 1/2). Scissor and pseudotime analyses were conducted to investigate mast cell phenotype-associated cell populations and developmental trajectories utilizing single-cell RNA sequencing data (GSE165897).

Results

NACT prompted dynamic alterations in immune cell infiltration, notably characterized by an increase in CD8+ T cells and mast cell infiltration, which were corroborated by immunohistochemistry. Following NACT, there was a notable increase in KIT expression, particularly among responders, whereas no significant difference was detected between responders and non-responders prior to NACT. Elevated KIT expression was linked to a poor prognosis. There was a transition from CD52 + KIT+ mast cells to JUN+/TNFRSF12A+ subsets post-NACT.

Conclusions

Successful NACT was associated with a reduction in CD52 + KIT+ mast cells and an increase in the JUN+/TNFRSF12A+ subpopulation. The increased infiltration of KIT-expressing mast cells may serve as a prognostic biomarker for HGSC following NACT and represent a potential novel therapeutic target to enhance NACT efficacy.

目的新辅助化疗（NACT）对高级别浆液性癌（HGSC）免疫景观的影响尚不清楚。本研究旨在探讨NACT前后造血干细胞组织免疫浸润的差异模式及其临床意义。方法采用我们的内部RNA测序数据（包括8个nact前和7个nact后肿瘤样本）、3个GEO数据集（GSE181597、GSE201600、GSE227666）和免疫组化对73个配对nact前和nact后样本进行免疫浸润模式分析。使用化疗反应评分（CRS）评估NACT的反应，将患者分为反应者（CRS = 3）和无反应者（CRS = 1/2）。利用单细胞RNA测序数据（GSE165897），进行了剪刀和伪时间分析，以研究肥大细胞表型相关的细胞群和发育轨迹。结果snact可引起免疫细胞浸润的动态变化，主要表现为CD8+ T细胞和肥大细胞浸润的增加，免疫组织化学证实了这一点。在NACT之后，KIT表达显著增加，特别是在应答者中，而在NACT之前，应答者和无应答者之间没有显著差异。KIT表达升高与预后不良有关。nact后，从CD52 + KIT+肥大细胞向JUN+/TNFRSF12A+亚群转变。结论成功的NACT与CD52 + KIT+肥大细胞的减少和JUN+/TNFRSF12A+亚群的增加有关。表达kit的肥大细胞浸润增加可能作为NACT后HGSC的预后生物标志物，并代表了增强NACT疗效的潜在新治疗靶点。

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引用次数: 0

Amplifying SGO'S voice: The impact of the Society of Gynecologic Oncology (SGO) clinical practice committee publications in Gynecologic Oncology 放大SGO的声音：妇科肿瘤学会（SGO）临床实践委员会出版物在妇科肿瘤中的影响

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-11-01 DOI: 10.1016/j.ygyno.2025.11.011

Marilyn Huang , Carolyn McCourt , Matthew A. Powell , Karen H. Lu

引用次数: 0

A pilot study of nivolumab in combination with neoadjuvant and post-surgical chemotherapy in newly diagnosed ovarian cancer 纳武单抗联合新辅助和术后化疗治疗新诊断卵巢癌的初步研究

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-31 DOI: 10.1016/j.ygyno.2025.10.020

Sara Moufarrij , Claire F. Friedman , Samuel Freeman , Hunter Green , Nadeem R. Abu-Rustum , Vance Broach , Dennis S. Chi , Seth Cohen , Ginger Gardner , Rachel N. Grisham , Alexia Iasonos , Mario M. Leitao Jr. , Kara Long , Kay Park , William Tew , Andreas Wibmer , Qin Zhou , Carol Aghajanian , Britta Weigelt , Dmitriy Zamarin , Roisin E. O'Cearbhaill

Objective

To evaluate whether the addition of nivolumab to standard neoadjuvant chemotherapy (NACT) in previously untreated advanced-stage epithelial ovarian cancer (EOC) is safe and feasible.

Methods

In this single-institution pilot study (NCT03245892), patients with advanced EOC for whom NACT was considered the most appropriate initial therapy option were treated with intravenous nivolumab 360 mg with standard carboplatin and dose-dense paclitaxel NACT every 3 weeks for 3–6 cycles. Patients then underwent interval cytoreductive surgery (ICS) followed by another 3 cycles of post-operative treatment.

Results

Safety results were consistent with the known profile of the study drugs for the 21 patients treated. Seven (33 %) patients had grade 3/4 adverse events attributed to nivolumab, with one case of grade 3 infusion reaction making that patient unevaluable. Fifteen of the 20 (75 % [95 % CI, 50.9–91.3 %]) evaluable patients had complete gross resection at ICS, and 7 of 20 (35 % [95 % CI, 15.4–59.2 %]) achieved an optimal pathologic chemotherapy response score (CRS) of 3. Median progression-free survival was 15.6 months (95 % CI, 11.6–26.4 months), with a 2-year rate of 32.5 % (95 % CI, 12.8–54.1 %). Median overall survival was 50.7 months (95 % CI, 26.5 months–not evaluable), with a 2-year rate of 85 % (95 % CI, 60.4–94.9 %).

Conclusions

The combination of nivolumab with carboplatin and paclitaxel was safe and tolerable. Most patients achieved a complete gross resection and one-third had an optimal CRS at ICS. Further studies are needed to identify patients with ovarian cancer most likely to benefit from upfront immune checkpoint blockade.

目的评价在未经治疗的晚期上皮性卵巢癌（EOC）标准新辅助化疗（NACT）中加入纳武单抗是否安全可行。方法在这项单机构试点研究（NCT03245892）中，NACT被认为是最合适的初始治疗选择的晚期EOC患者每3周静脉注射nivolumab 360 mg，标准卡铂和剂量密集的紫杉醇NACT，共3 - 6个周期。然后患者接受间隔细胞减少手术（ICS），随后进行另外3个周期的术后治疗。结果21例患者的安全性结果与研究药物的已知特征一致。7例（33%）患者因纳武单抗发生3/4级不良事件，其中1例3级输液反应使该患者无法评估。20例可评估患者中有15例（75% [95% CI, 50.9 - 91.3%]）在ICS进行了完全大体切除，20例中有7例（35% [95% CI, 15.4 - 59.2%]）达到了最佳病理化疗反应评分（CRS） 3。中位无进展生存期为15.6个月（95% CI, 11.6-26.4个月），2年生存率为32.5% （95% CI, 12.8 - 54.1%）。中位总生存期为50.7个月（95% CI， 26.5个月，无法评估），2年生存率为85% （95% CI, 60.4 - 94.9%）。结论纳武单抗联合卡铂、紫杉醇治疗安全、耐受。大多数患者获得了完全的大体切除，三分之一的患者在ICS中获得了最佳的CRS。需要进一步的研究来确定卵巢癌患者最有可能从前期免疫检查点阻断中获益。

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引用次数: 0

Experiences of radiotherapy for treatment of Granulosa Cell Tumor of the ovary: insights from the GCT-survivor sisters 放疗治疗卵巢颗粒细胞瘤的经验：来自gct幸存者姐妹的见解

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-31 DOI: 10.1016/j.ygyno.2025.10.027

Victoria M. White , Linda M. Langdale , Kim D. Eroh , M. Kaye Ackermann , Susan Rodgers , Tasha E. Armour , Maria Alexiadis , Thomas W. Jobling , Peter J. Fuller , Simon Chu

Background

Optimal treatment of ovarian Granulosa Cell Tumors (GCT) is uncertain due to a lack of evidence from randomized trials. The role of radiotherapy is unclear and recommendations differ between countries. Through an ongoing collaboration with the multinational closed GCT Survivor Sisters (GCT-SS) Facebook™ group (membership n = 1800) we developed a survey to understand members' experiences of radiotherapy.

Methods

GCT-SS members (≥18+ years) were invited to complete the survey assessing i) diagnosis and treatment, ii) radiotherapy experiences and iii) radiotherapy impact. Two questions allowed free-text responses about radiotherapy experiences. Country of residence was assessed (USA, Canada, United Kingdom (UK), European Union (EU), Australia/New Zealand (Aus/NZ); Other). Logistic regression examined factors associated with radiotherapy.

Result

Surveys from 1017 members (96 % Adult-GCT) are analysed. Respondents were mostly from the USA (62 %), diagnosed post-2015 (67 %), and 44 % had recurrent disease. Overall, 12 % of respondents reported radiotherapy (9 % received, 3 % planned), mostly for recurrent (23 %) disease. In univariate analyses, radiotherapy for recurrent disease differed by country (p = .019) (Canada (12 %), UK (14 %), EU (14 %), Aus/NZ (36 %), USA (25 %)); age (p = .02) (≥50 (26 %) ≤50 (17 %)) having chemotherapy (p = .019) and hormonal therapy (p < .001). Analyses of open-ended questions found five themes: four positive (it worked; easier than other treatments, gave me back my life, gives hope) and one negative reflecting severe side-effects.

Conclusions

Radiotherapy for GCT is not common and reflects treatment recommendations in different countries. As women mostly report positive experiences, studies are needed to develop an evidence-base regarding its optimal timing and sequencing in managing GCT.

背景：由于缺乏随机试验的证据，卵巢颗粒细胞瘤（GCT）的最佳治疗方法尚不确定。放疗的作用尚不清楚，各国的建议也不尽相同。通过与跨国封闭的GCT幸存者姐妹（GCT- ss） Facebook™小组（成员n = 1800）的持续合作，我们开展了一项调查，以了解成员的放疗经历。方法邀请sgct - ss成员（≥18岁以上）完成调查，评估i)诊断和治疗，ii)放疗经验和iii)放疗影响。有两个问题是关于放射治疗经验的自由文本回答。评估居住国（美国、加拿大、英国、欧盟、澳大利亚/新西兰）；其他)。Logistic回归分析了与放疗相关的因素。结果分析了1017名成员（96%为成年gct）的调查结果。受访者大多来自美国（62%），2015年后确诊（67%），44%有复发性疾病。总体而言，12%的应答者报告了放射治疗（9%接受了放射治疗，3%计划放射治疗），主要用于复发性疾病（23%）。在单因素分析中，复发性疾病的放疗因国家而异（p = 0.019）（加拿大（12%）、英国（14%）、欧盟（14%）、澳大利亚/新西兰（36%）、美国（25%））；年龄(p = .02点)(≥50(26%)≤50 (17%)(p = .019)化疗和激素治疗(p & lt;措施)。对开放式问题的分析发现了五个主题：四个积极的主题（它有效；比其他治疗更容易，让我恢复了生活，给了我希望），一个消极的主题反映了严重的副作用。结论GCT的放疗并不常见，反映了不同国家的治疗建议。由于妇女大多报告积极的经历，需要研究建立一个关于管理GCT的最佳时间和顺序的证据基础。

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引用次数: 0

Preoperative molecular classification of endometrial cancer: Validation through biopsy and matched hysterectomy specimens 术前子宫内膜癌的分子分类：通过活检和匹配的子宫切除术标本进行验证

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-31 DOI: 10.1016/j.ygyno.2025.10.026

Takahiro Nozaki , Ikuko Sakamoto , Keiko Kagami , Kosuke Matsuda , Mitsunori Uchida , Yusuke Kouchi , Kenji Amemiya , Yosuke Hirotsu , Ryosuke Tajiri , Toshio Oyama , Masao Omata

Objective

To evaluate the concordance of molecular classification between preoperative endometrial biopsy and corresponding hysterectomy specimens in endometrial cancer, and to assess the feasibility of using biopsy specimens for genomic profiling and recurrence risk stratification.

Methods

We retrospectively analyzed 116 patients with endometrial carcinoma or uterine carcinosarcoma treated between 2014 and 2024. Molecular classification was performed using the ProMisE algorithm based on immunohistochemistry (IHC) for mismatch repair (MMR) proteins and p53, along with POLE mutational analysis. In addition, targeted next-generation sequencing (NGS) with a custom 57-gene panel was performed on both biopsy and hysterectomy specimens to evaluate the concordance of gene mutations.

Results

The concordance rates between biopsy and hysterectomy specimens were 97 % for MMR status, 96 % for p53 status, and 99 % for POLE mutations, with an overall molecular classification concordance of 91 %. NGS identified 1943 gene mutations, of which 714 (37 %) were classified as oncogenic. Among these, 64 % were shared between the two specimen types. Molecular classification using biopsy specimens effectively stratified recurrence risk (p < 0.001), with POLE-mutated tumors showing the most favorable outcomes and p53-abnormal tumors the poorest.

Conclusions

Molecular subtyping and targeted panel sequencing using endometrial biopsy specimens are feasible and show high concordance with hysterectomy-based results. This approach allows for preoperative risk assessment and supports personalized treatment planning in endometrial cancer.

目的评价子宫内膜癌术前子宫内膜活检与相应的子宫切除术标本分子分类的一致性，并评估活检标本用于基因组分析和复发风险分层的可行性。方法回顾性分析2014 ~ 2024年收治的116例子宫内膜癌或子宫癌肉瘤患者的临床资料。使用基于免疫组织化学（IHC）的ProMisE算法对错配修复（MMR）蛋白和p53进行分子分类，并进行POLE突变分析。此外，对活检和子宫切除术标本进行了定制的57个基因面板的靶向下一代测序（NGS），以评估基因突变的一致性。结果活检和子宫切除术标本中MMR状态的一致性率为97%，p53状态的一致性率为96%，POLE突变的一致性率为99%，总体分子分类一致性为91%。NGS鉴定出1943个基因突变，其中714个（37%）被归类为致癌基因。其中，64%在两种标本类型之间共享。活检标本的分子分类有效地分层了复发风险（p < 0.001）， pole突变的肿瘤表现出最有利的结果，p53异常的肿瘤表现最差。结论利用子宫内膜活检标本进行分子分型和靶向组测序是可行的，且与子宫切除术结果高度一致。这种方法允许术前风险评估和支持个性化治疗计划在子宫内膜癌。

{"title":"Preoperative molecular classification of endometrial cancer: Validation through biopsy and matched hysterectomy specimens","authors":"Takahiro Nozaki , Ikuko Sakamoto , Keiko Kagami , Kosuke Matsuda , Mitsunori Uchida , Yusuke Kouchi , Kenji Amemiya , Yosuke Hirotsu , Ryosuke Tajiri , Toshio Oyama , Masao Omata","doi":"10.1016/j.ygyno.2025.10.026","DOIUrl":"10.1016/j.ygyno.2025.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the concordance of molecular classification between preoperative endometrial biopsy and corresponding hysterectomy specimens in endometrial cancer, and to assess the feasibility of using biopsy specimens for genomic profiling and recurrence risk stratification.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 116 patients with endometrial carcinoma or uterine carcinosarcoma treated between 2014 and 2024. Molecular classification was performed using the ProMisE algorithm based on immunohistochemistry (IHC) for mismatch repair (MMR) proteins and p53, along with POLE mutational analysis. In addition, targeted next-generation sequencing (NGS) with a custom 57-gene panel was performed on both biopsy and hysterectomy specimens to evaluate the concordance of gene mutations.</div></div><div><h3>Results</h3><div>The concordance rates between biopsy and hysterectomy specimens were 97 % for MMR status, 96 % for p53 status, and 99 % for POLE mutations, with an overall molecular classification concordance of 91 %. NGS identified 1943 gene mutations, of which 714 (37 %) were classified as oncogenic. Among these, 64 % were shared between the two specimen types. Molecular classification using biopsy specimens effectively stratified recurrence risk (<em>p</em> < 0.001), with POLE-mutated tumors showing the most favorable outcomes and p53-abnormal tumors the poorest.</div></div><div><h3>Conclusions</h3><div>Molecular subtyping and targeted panel sequencing using endometrial biopsy specimens are feasible and show high concordance with hysterectomy-based results. This approach allows for preoperative risk assessment and supports personalized treatment planning in endometrial cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"203 ","pages":"Pages 105-111"},"PeriodicalIF":4.1,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419052","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

Neighborhood socioeconomic status and endometrial cancer mortality: Racial disparities persist across the spectrum 社区社会经济地位和子宫内膜癌死亡率：种族差异持续存在

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-30 DOI: 10.1016/j.ygyno.2025.10.018

Larissa Weirich Araujo , Maret L. Maliniak , Lauren E. Barber , Sarah E. Dilley , Lauren E. McCullough

Background

Black women are more likely to die from endometrial cancer (EC) than White women, with staggering racial disparities that have worsened with rising disease incidence and mortality. Our study examined the impact of neighborhood socioeconomic status (nSES) on EC mortality among non-Hispanic Black (NHB) and non-Hispanic White (NHW) U.S. women to better understand this stark mortality gap.

Methods

The U.S. Surveillance, Epidemiology, and End Results (SEER)-22 cancer registries database was queried for all NHW and NHB women diagnosed with malignant EC between 2006 and 2020. Age- and multivariable-adjusted Cox regression was used to evaluate the association between quintiles of census tract-level nSES and EC mortality.

Results

In multivariable-adjusted models, NHW women in the lowest nSES quintile had higher EC mortality than their NHW counterparts in the highest nSES quintile (HR: 1.43, 95 % CI: 1.36–1.50). The association was largely attenuated for NHB patients in the lowest and highest nSES quintiles (HR: 1.08, 95 % CI: 0.99–1.17). In common referent models, NHB patients in the highest SES neighborhoods had similar mortality (HR: 1.45, 95 % CI: 1.34–1.57) to NHW patients in the lowest SES neighborhoods (HR: 1.34, 95 % CI: 1.28–1.41).

Conclusions

Our findings indicate that higher neighborhood SES is protective for White but not Black patients with EC. These data suggest that relative affluence is not enough to overcome other factors contributing to the worse EC survival experienced by Black women in the US. Our study demonstrates this phenomenon for the first time among US women diagnosed with EC using national-level data.

黑人女性比白人女性更容易死于子宫内膜癌（EC），随着疾病发病率和死亡率的上升，种族差异越来越大。我们的研究考察了社区社会经济地位（nSES）对非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）美国妇女EC死亡率的影响，以更好地理解这种明显的死亡率差距。方法查询美国监测、流行病学和最终结果(SEER)-22癌症登记数据库，查询2006年至2020年期间诊断为恶性EC的所有NHW和NHB妇女。采用年龄和多变量校正的Cox回归来评估人口普查区水平nSES与EC死亡率五分位数之间的关系。结果在多变量调整模型中，nSES最低五分位数的NHW妇女的EC死亡率高于nSES最高五分位数的NHW妇女（HR: 1.43, 95% CI: 1.36 ~ 1.50）。在最低和最高nSES分位数的NHB患者中，这种关联在很大程度上减弱（HR: 1.08, 95% CI: 0.99-1.17）。在常见的参考模型中，最高社会地位社区的NHB患者与最低社会地位社区的NHW患者的死亡率相似（HR: 1.45, 95% CI: 1.34 - 1.57）（HR: 1.34, 95% CI: 1.28-1.41）。结论较高的社区SES对白人EC患者有保护作用，而对黑人EC患者无保护作用。这些数据表明，相对富裕并不足以克服导致美国黑人女性EC存活率较差的其他因素。我们的研究首次在美国诊断为EC的女性中使用国家级数据证明了这一现象。

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引用次数: 0

Description of first recurrence in advanced stage high grade serous ovarian cancer receiving intraperitoneal versus intravenous systemic treatment 晚期高级别浆液性卵巢癌首次复发接受腹腔与静脉系统治疗的描述

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-30 DOI: 10.1016/j.ygyno.2025.10.022

Auni Lindgren , Anouk Benseler , Liat Hogen , Taymaa May , Stephane Laframboise , Sarah E. Ferguson , Genevieve Bouchard-Fortier , Lisa Avery , Marcus Q. Bernardini

Objectives

To investigate the association of adjuvant intraperitoneal (IP) and intravenous (IV) chemotherapy with location and timing of recurrence in patients with advanced high grade serous ovarian cancer (HGSOC).

Methods

This retrospective cohort study includes patients with stage III or IV HGSOC who underwent optimal primary cytoreductive surgery (PCS) and subsequently received paclitaxel and platinum-based chemotherapy, either IP or IV, at a tertiary care institution between 2010 and 2020.

We performed adjusted multivariable logistic regressions to evaluate locations of first recurrence, and adjusted Cox proportional hazards models to assess the association of adjuvant chemotherapy administration and progression free survival.

Results

208 patients met inclusion criteria, of whom 152 (73 %) received IP and 56 (27 %) received IV chemotherapy. IP chemotherapy was associated with decreased intraperitoneal recurrence (odds radio (OR) 0.33 (95 % confidence interval (CI) 0.17–0.64). Extraperitoneal disease at diagnosis was the only factor associated with increased extraperitoneal recurrence (OR 4.09 (95 % CI 1.84–9.10)). Presence of lymph node disease at diagnosis and gross residual disease at PCS were associated with increased lymph node recurrence (OR 4.54 (95 %CI 2.35–9.04) and OR 2.43 (95 %CI 1.18–5.11) respectively).

After two years, the risk of recurrence was lower for patients who received IP, compared with IV, chemotherapy (HR 0.30 (95 % CI 0.17–0.53)).

Conclusions

For patients with HGSOC after optimal PCS, IP chemotherapy is associated with decreased intraperitoneal recurrence and decreased risk of recurrence after 2 years compared with IV chemotherapy. This highlights its value in peritoneal restricted disease.

目的探讨晚期高级别浆液性卵巢癌（HGSOC）患者辅助腹腔（IP）和静脉（IV）化疗与复发部位和时间的关系。方法：本回顾性队列研究纳入了2010年至2020年间在三级医疗机构接受最佳原发性细胞减少手术（PCS）并随后接受紫杉醇和铂类化疗（IP或IV）的III期或IV期HGSOC患者。我们进行了调整后的多变量logistic回归来评估首次复发的位置，并调整了Cox比例风险模型来评估辅助化疗给药与无进展生存期的关系。结果208例患者符合纳入标准，其中接受IP化疗152例（73%），静脉化疗56例（27%）。IP化疗与减少腹腔内复发相关(比值比（OR） 0.33（95%可信区间（CI） 0.17-0.64）。诊断时腹膜外病变是与腹膜外复发增加相关的唯一因素（OR 4.09 (95% CI 1.84-9.10)）。诊断时淋巴结病变的存在和PCS的大体残留病变与淋巴结复发率增加相关(OR分别为4.54 （95% CI 2.35-9.04）和2.43 （95% CI 1.18-5.11）。两年后，与IV化疗相比，接受IP化疗的患者复发风险较低（HR 0.30 (95% CI 0.17-0.53)）。结论对于最佳PCS后的HGSOC患者，与IV化疗相比，IP化疗可降低腹腔内复发和2年后复发风险。这突出了它在腹膜限制性疾病中的价值。

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引用次数: 0

Postmenopausal bleeding: Association of initial place of care with stage at diagnosis for uterine cancer 绝经后出血：起始治疗地点与子宫癌诊断分期的关系。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-29 DOI: 10.1016/j.ygyno.2025.10.015

Xiao Xu , Ling Chen , Marcella Nunez-Smith , Mitchell Clark , Jennifer S. Ferris , Yongmei Huang , Dawn L. Hershman , Jason D. Wright

Objective

Uterine cancer has no routine screening. Early diagnosis requires timely/appropriate evaluation of symptoms – most commonly postmenopausal bleeding (PMB). We examined initial place of care for PMB and its association with uterine cancer stage at diagnosis.

Methods

Using the Surveillance, Epidemiology and End Results-Medicare database with linked American Medical Association Physician Professional Data, we identified 15,443 patients aged ≥66 with uterine cancer who presented with PMB. Initial place of care was categorized as: office visit to an obstetrician/gynecologist, office visit to a physician of another specialty, or emergency department (ED) visit. Multivariable regressions were used to analyze the relationship between patient characteristics, initial place of care, and stage at diagnosis.

Results

Mean age of patients in the sample was 74.5 and 83.1 % were non-Hispanic White. 61.0 %, 27.8 %, and 11.2 % of patients had their first PMB claim filed from an office visit to an obstetrician/gynecologist, an office visit to a physician of another specialty, and an ED visit, respectively. Their median (10th-to-90th percentile) duration from first PMB claim to uterine cancer diagnosis was 20 (0–134), 32 (6–169), and 14 (0–92) days, respectively (P < 0.001). Patients whose first PMB claim was from an ED visit were more likely to have advanced stage cancer (e.g., adjusted OR [95 % CI] for having distant stage = 1.44 [1.16–1.80] compared to obstetrician/gynecologist visits and 1.31 [1.04–1.66] compared to other physician visits).

Conclusions

Initial place of care for PMB was associated with duration to diagnosis. Patients using ED as initial place of care tended to have more advanced uterine cancer.

目的：子宫癌未进行常规筛查。早期诊断需要及时/适当的症状评估-最常见的是绝经后出血（PMB）。我们研究了PMB的初始治疗地点及其与子宫癌诊断阶段的关系。方法：使用监测、流行病学和最终结果-医疗保险数据库与相关的美国医学会医师专业数据，我们确定了15443例年龄≥66岁的子宫癌患者，他们出现了PMB。最初的护理地点被分类为：产科医生/妇科医生的办公室访问，其他专业的医生的办公室访问，或急诊科（ED）访问。采用多变量回归分析患者特征、初始护理地点和诊断阶段之间的关系。结果：样本中患者的平均年龄为74.5岁，83.1%为非西班牙裔白人。分别有61.0%、27.8%和11.2%的患者首次提出PMB索赔是在产科医生/妇科医生的办公室就诊、其他专业医生的办公室就诊和急诊科就诊。他们的中位数（第10 -90个百分点）从首次PMB声称到诊断子宫癌的时间分别为20(0-134),32（6-169）和14（0-92）天(P结论：PMB的初始治疗地点与诊断的时间有关。使用ED作为初始护理地点的患者往往有更多的晚期子宫癌。

{"title":"Postmenopausal bleeding: Association of initial place of care with stage at diagnosis for uterine cancer","authors":"Xiao Xu , Ling Chen , Marcella Nunez-Smith , Mitchell Clark , Jennifer S. Ferris , Yongmei Huang , Dawn L. Hershman , Jason D. Wright","doi":"10.1016/j.ygyno.2025.10.015","DOIUrl":"10.1016/j.ygyno.2025.10.015","url":null,"abstract":"<div><h3>Objective</h3><div>Uterine cancer has no routine screening. Early diagnosis requires timely/appropriate evaluation of symptoms – most commonly postmenopausal bleeding (PMB). We examined initial place of care for PMB and its association with uterine cancer stage at diagnosis.</div></div><div><h3>Methods</h3><div>Using the Surveillance, Epidemiology and End Results-Medicare database with linked American Medical Association Physician Professional Data, we identified 15,443 patients aged ≥66 with uterine cancer who presented with PMB. Initial place of care was categorized as: office visit to an obstetrician/gynecologist, office visit to a physician of another specialty, or emergency department (ED) visit. Multivariable regressions were used to analyze the relationship between patient characteristics, initial place of care, and stage at diagnosis.</div></div><div><h3>Results</h3><div>Mean age of patients in the sample was 74.5 and 83.1 % were non-Hispanic White. 61.0 %, 27.8 %, and 11.2 % of patients had their first PMB claim filed from an office visit to an obstetrician/gynecologist, an office visit to a physician of another specialty, and an ED visit, respectively. Their median (10th-to-90th percentile) duration from first PMB claim to uterine cancer diagnosis was 20 (0–134), 32 (6–169), and 14 (0–92) days, respectively (<em>P</em> < 0.001). Patients whose first PMB claim was from an ED visit were more likely to have advanced stage cancer (e.g., adjusted OR [95 % CI] for having distant stage = 1.44 [1.16–1.80] compared to obstetrician/gynecologist visits and 1.31 [1.04–1.66] compared to other physician visits).</div></div><div><h3>Conclusions</h3><div>Initial place of care for PMB was associated with duration to diagnosis. Patients using ED as initial place of care tended to have more advanced uterine cancer.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"203 ","pages":"Pages 75-83"},"PeriodicalIF":4.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409064","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

Primary treatment and survival in malignant ovarian germ cell tumors: A nationwide population-based Swedish Gynecologic Cancer Group (SweGCG) study 恶性卵巢生殖细胞肿瘤的初级治疗和生存：一项基于全国人口的瑞典妇科癌症组（SweGCG）研究。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-29 DOI: 10.1016/j.ygyno.2025.10.019

Camilla Sköld , Angelique Flöter Rådestad , Katja Stenström Bohlin , Maria Bjurberg , Christer Borgfeldt , Kristina Hellman , Jenny-Maria Jönsson , Preben Kjølhede , Elisabeth Åvall Lundqvist , Cecilia Olsson , Karin Stålberg , Erik Holmberg , Pernilla Dahm Kähler

Objective

Although rare, malignant ovarian germ cell tumors (MOGCTs) account for 70 % of ovarian malignancies in women younger than 30 years. Given the rarity of MOGCTs and the limited population-based data, this study aims to examine national treatment patterns and survival in women with MOGCTs, with a focus on fertility-sparing surgery.

Methods

This nationwide population-based study included all women (≥18 years) diagnosed with MOGCTs 2008–2022 in the Swedish Quality Register for Gynecologic Cancer. Main outcome was 5- and 10-year survival. Cox proportional regression models were used in univariable and adjusted survival analyses.

Results

The study population included 184 women: 43 with dysgerminomas and 141 with non-dysgerminomas (including 59 immature teratomas, 33 teratomas with malignant transformation, 27 yolk sac tumors, and 22 other subtypes). All but one of the women underwent primary surgery; 54 % had fertility-sparing surgery, and no residual disease was achieved in 89 %. Adjuvant chemotherapy was given to 53 %. During a median follow-up of 5.6 years (range 0.1–15 years), 18 women died. No deaths occurred in women with fertility-sparing surgery. Ten-year relative survival was 95 % (95 % CI 88–103) and overall survival 88 % (95 % CI 82–93). Older age at diagnosis was associated with poorer survival (per year: HR 1.09, 95 % CI 1.05–1.14, p < 0.001), as was FIGO stage IV versus stage I (HR 58, 95 % CI 13–265, p < 0.001).

Conclusions

MOGCTs had excellent survival outcomes in this nationwide population-based study, and fertility-sparing surgery was deemed safe. Future efforts should focus on improving outcomes in older women and those with stage IV disease.

目的：恶性卵巢生殖细胞瘤虽然罕见，但在30岁以下女性卵巢恶性肿瘤中占70%。鉴于mogct的罕见性和有限的基于人群的数据，本研究旨在研究mogct患者的国家治疗模式和生存率，重点是保留生育能力的手术。方法：这项基于全国人群的研究纳入了瑞典妇科癌症质量登记处2008-2022年诊断为mogct的所有女性（≥18岁）。主要结局为5年和10年生存率。Cox比例回归模型用于单变量和校正生存分析。结果：研究人群包括184名女性：43名患有异常生殖细胞瘤，141名患有非异常生殖细胞瘤（包括59名未成熟畸胎瘤，33名畸胎瘤伴恶性转化，27名卵黄囊肿瘤和22名其他亚型）。除一人外，所有女性都接受了初级手术；54%的患者进行了保留生育能力的手术，89%的患者无残留疾病。53%给予辅助化疗。在中位随访5.6年（0.1-15年）期间，18名妇女死亡。接受保留生育能力手术的妇女未发生死亡。10年相对生存率为95% (95% CI 88-103)，总生存率为88% （95% CI 82-93）。诊断时年龄较大与较差的生存率相关（每年：HR 1.09, 95% CI 1.05-1.14, p）。结论：在这项基于全国人群的研究中，mogct有很好的生存结果，保留生育能力的手术被认为是安全的。未来的努力应集中于改善老年妇女和IV期疾病患者的预后。

{"title":"Primary treatment and survival in malignant ovarian germ cell tumors: A nationwide population-based Swedish Gynecologic Cancer Group (SweGCG) study","authors":"Camilla Sköld , Angelique Flöter Rådestad , Katja Stenström Bohlin , Maria Bjurberg , Christer Borgfeldt , Kristina Hellman , Jenny-Maria Jönsson , Preben Kjølhede , Elisabeth Åvall Lundqvist , Cecilia Olsson , Karin Stålberg , Erik Holmberg , Pernilla Dahm Kähler","doi":"10.1016/j.ygyno.2025.10.019","DOIUrl":"10.1016/j.ygyno.2025.10.019","url":null,"abstract":"<div><h3>Objective</h3><div>Although rare, malignant ovarian germ cell tumors (MOGCTs) account for 70 % of ovarian malignancies in women younger than 30 years. Given the rarity of MOGCTs and the limited population-based data, this study aims to examine national treatment patterns and survival in women with MOGCTs, with a focus on fertility-sparing surgery.</div></div><div><h3>Methods</h3><div>This nationwide population-based study included all women (≥18 years) diagnosed with MOGCTs 2008–2022 in the Swedish Quality Register for Gynecologic Cancer. Main outcome was 5- and 10-year survival. Cox proportional regression models were used in univariable and adjusted survival analyses.</div></div><div><h3>Results</h3><div>The study population included 184 women: 43 with dysgerminomas and 141 with non-dysgerminomas (including 59 immature teratomas, 33 teratomas with malignant transformation, 27 yolk sac tumors, and 22 other subtypes). All but one of the women underwent primary surgery; 54 % had fertility-sparing surgery, and no residual disease was achieved in 89 %. Adjuvant chemotherapy was given to 53 %. During a median follow-up of 5.6 years (range 0.1–15 years), 18 women died. No deaths occurred in women with fertility-sparing surgery. Ten-year relative survival was 95 % (95 % CI 88–103) and overall survival 88 % (95 % CI 82–93). Older age at diagnosis was associated with poorer survival (per year: HR 1.09, 95 % CI 1.05–1.14, <em>p</em> < 0.001), as was FIGO stage IV versus stage I (HR 58, 95 % CI 13–265, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>MOGCTs had excellent survival outcomes in this nationwide population-based study, and fertility-sparing surgery was deemed safe. Future efforts should focus on improving outcomes in older women and those with stage IV disease.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"203 ","pages":"Pages 59-66"},"PeriodicalIF":4.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409043","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

Letrozole plus anlotinib as a chemotherapy-free regimen for ER-positive platinum-resistant recurrent epithelial ovarian cancer patients following second-line platinum-based chemotherapy failure: A prospective, single-arm, open-label, phase II study 来曲唑加安洛替尼作为er阳性铂耐药复发性上皮性卵巢癌患者在二线铂基化疗失败后的无化疗方案：一项前瞻性，单组，开放标签，II期研究。

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology

Pub Date : 2025-10-29 DOI: 10.1016/j.ygyno.2025.10.023

Yizhi Wang , Jiarui Li , Yiting Yang , Xin Lu , Hong Xu , Shuhui Zhao , Wenbin Guan , Xipeng Wang

Objective

Estrogen receptor-positive (ER-positive) platinum-resistant recurrent epithelial ovarian cancer (PROC) patients following second-line platinum-based chemotherapy failure face the dilemma of limited therapeutic options. We aimed to evaluate the efficacy and safety of letrozole plus anlotinib for these patients.

Methods

We conducted a single-arm phase 2 study (NCT04720807) evaluating letrozole plus anlotinib in ER-positive PROC patients following second-line platinum-based chemotherapy failure. Patients received oral anlotinib 10 mg daily (days 1–14, q21d) and continuous oral letrozole 2.5 mg. Treatment was continued until disease progression, death, intolerant toxicity, or patient withdrawal. The primary endpoint was the objective response rate (ORR) according to RECIST version 1·1 and the GCIG criteria.

Results

Between January 2021 and December 2023, 30 patients were assessed for eligibility, and 27 patients were enrolled. The median age was 62 years (range 50–79). Seven patients achieved a partial response, while no patients showed a complete response, resulting in an ORR of 25·9 % (95 % CI, 11·8 %–46·6 %). The disease control rate was 74·1 % (95 % CI, 53·4 %–88·1 %). The median progression-free survival was 4·57 months (95 % CI, 4·07–9·66). Most adverse events were Grade 1–2 and manageable. Patients with a primary platinum-free interval exceeding 6 months, lower baseline CA-125 levels (<500 IU), or higher ER expression levels (≥ 25 % stained positive for ER) showed a statistically significant treatment benefit.

Conclusion

The combination of letrozole plus anlotinib demonstrated promising efficacy and manageable toxicity in the treatment of ER-positive PROC patients following second-line platinum-based chemotherapy failure.

目的：雌激素受体阳性（er阳性）铂耐药复发性上皮性卵巢癌（PROC）患者在二线铂类化疗失败后面临治疗选择有限的困境。我们的目的是评估来曲唑加安洛替尼对这些患者的疗效和安全性。方法：我们进行了一项单组2期研究（NCT04720807），评估来曲唑加安洛替尼在er阳性PROC患者二线铂类化疗失败后的疗效。患者接受每日口服安洛替尼10mg（第1-14天，q21d）和连续口服来曲唑2.5 mg。治疗一直持续到疾病进展、死亡、不耐受毒性或患者停药。主要终点是根据RECIST版本1.1和GCIG标准的客观缓解率（ORR）。结果：在2021年1月至2023年12月期间，30名患者被评估为合格，27名患者入组。中位年龄为62岁（范围50-79岁）。7例患者达到部分缓解，而没有患者显示完全缓解，导致ORR为25.9% （95% CI, 11.8% - 46.6%）。疾病控制率为74.1% （95% CI, 53.4% ~ 88.1%）。中位无进展生存期为4.57个月（95% CI, 4.07 - 9.66）。大多数不良事件为1-2级，可控制。结论：来曲唑加安洛替尼联合治疗二线铂基化疗失败后er阳性PROC患者具有良好的疗效和可控的毒性。

{"title":"Letrozole plus anlotinib as a chemotherapy-free regimen for ER-positive platinum-resistant recurrent epithelial ovarian cancer patients following second-line platinum-based chemotherapy failure: A prospective, single-arm, open-label, phase II study","authors":"Yizhi Wang , Jiarui Li , Yiting Yang , Xin Lu , Hong Xu , Shuhui Zhao , Wenbin Guan , Xipeng Wang","doi":"10.1016/j.ygyno.2025.10.023","DOIUrl":"10.1016/j.ygyno.2025.10.023","url":null,"abstract":"<div><h3>Objective</h3><div>Estrogen receptor-positive (ER-positive) platinum-resistant recurrent epithelial ovarian cancer (PROC) patients following second-line platinum-based chemotherapy failure face the dilemma of limited therapeutic options. We aimed to evaluate the efficacy and safety of letrozole plus anlotinib for these patients.</div></div><div><h3>Methods</h3><div>We conducted a single-arm phase 2 study (<span><span>NCT04720807</span><svg><path></path></svg></span>) evaluating letrozole plus anlotinib in ER-positive PROC patients following second-line platinum-based chemotherapy failure. Patients received oral anlotinib 10 mg daily (days 1–14, q21d) and continuous oral letrozole 2.5 mg. Treatment was continued until disease progression, death, intolerant toxicity, or patient withdrawal. The primary endpoint was the objective response rate (ORR) according to RECIST version 1·1 and the GCIG criteria.</div></div><div><h3>Results</h3><div>Between January 2021 and December 2023, 30 patients were assessed for eligibility, and 27 patients were enrolled. The median age was 62 years (range 50–79). Seven patients achieved a partial response, while no patients showed a complete response, resulting in an ORR of 25·9 % (95 % CI, 11·8 %–46·6 %). The disease control rate was 74·1 % (95 % CI, 53·4 %–88·1 %). The median progression-free survival was 4·57 months (95 % CI, 4·07–9·66). Most adverse events were Grade 1–2 and manageable. Patients with a primary platinum-free interval exceeding 6 months, lower baseline CA-125 levels (<500 IU), or higher ER expression levels (≥ 25 % stained positive for ER) showed a statistically significant treatment benefit.</div></div><div><h3>Conclusion</h3><div>The combination of letrozole plus anlotinib demonstrated promising efficacy and manageable toxicity in the treatment of ER-positive PROC patients following second-line platinum-based chemotherapy failure.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"203 ","pages":"Pages 67-74"},"PeriodicalIF":4.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409122","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