Pub Date : 2025-11-08DOI: 10.1016/j.gore.2025.101986
Nora Badiner , Laurel Guthrie , Emily Stevenson , Andrew Folkerts , Joseph Mkandawire , Roslyn YX Ghui , Cassandra Graybill , Ryan Hayton , Moses Kasumba , Linda Hong , Sharon Lum , Mark Reeves , Yevgeniya Ioffe
Introduction
Malawi has the second-highest incidence and highest cervical cancer-attributed mortality worldwide. National HIV prevalence is 7.7%. Malawi implemented the Cervical Cancer Control Plan in 1999. We conducted an exploratory study of a non-government, hospital-based cervical cancer screening program established in the Southern Region.
Methods
We performed a retrospective review of outcomes from a cervical cancer screening program at a 275-bed rural mission hospital from 1/2016 – 12/2021. Female patients 18 years and older presenting for cervical cancer screening were included. Outcomes included trends in screening modality, return screening rates, abnormal screening rates, and the COVID pandemic impact. Data abstracted included demographics, HIV status, screening modality, and follow-up information.
Results
15,432 patients were screened for cervical cancer during the study period, with an overall increase in annual number of patients screened, despite the COVID-19 pandemic. Screening was initially performed via Pap testing; Visual inspection with acetic acid became the most common screening modality in 2019 (69.4%).
HIV prevalence among screened patients increased over the study period to 82.0% in 2021 and was higher among return screening patients (89.0%). 4.3% of HIV-negative and 7.2% of HIV-positive women demonstrated abnormal screening results.
Conclusion
Despite the COVID-19 pandemic, the number of patients screened for cervical cancer annually increased over the study period. HIV prevalence in this study was much higher than the national prevalence. These results emphasize the successful collaboration between a national program, private hospital, and HIV treatment centers, and highlight the need to increase screening among healthy women in the community.
{"title":"Exploratory study of a long-term hospital-based cervical cancer screening program in a high HIV prevalence area of rural Malawi","authors":"Nora Badiner , Laurel Guthrie , Emily Stevenson , Andrew Folkerts , Joseph Mkandawire , Roslyn YX Ghui , Cassandra Graybill , Ryan Hayton , Moses Kasumba , Linda Hong , Sharon Lum , Mark Reeves , Yevgeniya Ioffe","doi":"10.1016/j.gore.2025.101986","DOIUrl":"10.1016/j.gore.2025.101986","url":null,"abstract":"<div><h3>Introduction</h3><div>Malawi has the second-highest incidence and highest cervical cancer-attributed mortality worldwide. National HIV prevalence is 7.7%. Malawi implemented the Cervical Cancer Control Plan in 1999. We conducted an exploratory study of a non-government, hospital-based cervical cancer screening program established in the Southern Region.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of outcomes from a cervical cancer screening program at a 275-bed rural mission hospital from 1/2016 – 12/2021. Female patients 18 years and older presenting for cervical cancer screening were included. Outcomes included trends in screening modality, return screening rates, abnormal screening rates, and the COVID pandemic impact. Data abstracted included demographics, HIV status, screening modality, and follow-up information.</div></div><div><h3>Results</h3><div>15,432 patients were screened for cervical cancer during the study period, with an overall increase in annual number of patients screened, despite the COVID-19 pandemic. Screening was initially performed via Pap testing; Visual inspection with acetic acid became the most common screening modality in 2019 (69.4%).</div><div>HIV prevalence among screened patients increased over the study period to 82.0% in 2021 and was higher among return screening patients (89.0%). 4.3% of HIV-negative and 7.2% of HIV-positive women demonstrated abnormal screening results.</div></div><div><h3>Conclusion</h3><div>Despite the COVID-19 pandemic, the number of patients screened for cervical cancer annually increased over the study period. HIV prevalence in this study was much higher than the national prevalence. These results emphasize the successful collaboration between a national program, private hospital, and HIV treatment centers, and highlight the need to increase screening among healthy women in the community.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101986"},"PeriodicalIF":1.3,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.gore.2025.101978
Elizabeth R. Smith , Isaac R.L. Xu , Kathy Qi Cai , Sophia H.L. George , Matthew P. Schlumbrecht , Tian-Li Wang , Ie-Ming Shih , Xiang-Xi Xu
Objective
Although paclitaxel is widely used to treat several solid cancers, the initial response rate in ovarian cancer is ∼60 %, but only ∼30 % in recurrent ovarian cancer. The basis of resistance remains poorly understood, and predictive biomarkers are currently unavailable. Nuclear Lamin A/C proteins determine the sturdiness of the nuclear envelope and were suggested to influence the sensitivity of the malignant cells to undergo paclitaxel-induced micronucleation and cell death. The relationship between Lamin A/C expression in ovarian cancer tissues and progression free survival (PFS) and overall survival (OS) in advanced ovarian cancer patients, most of whom had been treated at least once with platinum and taxane, was investigated.
Methods
Ovarian cancer samples in tumor microarrays were immunostained for Lamin A/C and analyzed for Lamin A/C expression in tumor cells. On the basis of this expression, tumors were stratified as either Lamin A/C-low or Lamin A/C-high. Overall survival and PFS were assessed using Kaplan-Meier plots.
Results
Both age and Lamin A/C expression correlate with OS, where older (> 60 years) and higher Lamin A/C expression aligned with lower survival. Lamin A/C expression was a predictor of OS independently of age. The median OS for the Lamin A/C-low group was 58 months versus 34.5 months for the high-expression group.
Conclusions
A significant correlation was found between Lamin A/C expression and OS, which implies that strong, widespread Lamin A/C expression in primary tumor tissues may be a predictive marker for paclitaxel sensitivity and thus survival, supporting a proposed paclitaxel mechanism in inducing micronucleation of cancer cells.
{"title":"Inverse correlation between Lamin A/C and survival in ovarian cancer: implications for predicting responsiveness to taxane-based chemotherapy","authors":"Elizabeth R. Smith , Isaac R.L. Xu , Kathy Qi Cai , Sophia H.L. George , Matthew P. Schlumbrecht , Tian-Li Wang , Ie-Ming Shih , Xiang-Xi Xu","doi":"10.1016/j.gore.2025.101978","DOIUrl":"10.1016/j.gore.2025.101978","url":null,"abstract":"<div><h3>Objective</h3><div>Although paclitaxel is widely used to treat several solid cancers, the initial response rate in ovarian cancer is ∼60 %, but only ∼30 % in recurrent ovarian cancer. The basis of resistance remains poorly understood, and predictive biomarkers are currently unavailable. Nuclear Lamin A/C proteins determine the sturdiness of the nuclear envelope and were suggested to influence the sensitivity of the malignant cells to undergo paclitaxel-induced micronucleation and cell death. The relationship between Lamin A/C expression in ovarian cancer tissues and progression free survival (PFS) and overall survival (OS) in advanced ovarian cancer patients, most of whom had been treated at least once with platinum and taxane, was investigated.</div></div><div><h3>Methods</h3><div>Ovarian cancer samples in tumor microarrays were immunostained for Lamin A/C and analyzed for Lamin A/C expression in tumor cells. On the basis of this expression, tumors were stratified as either Lamin A/C-low or Lamin A/C-high. Overall survival and PFS were assessed using Kaplan-Meier plots.</div></div><div><h3>Results</h3><div>Both age and Lamin A/C expression correlate with OS, where older (> 60 years) and higher Lamin A/C expression aligned with lower survival. Lamin A/C expression was a predictor of OS independently of age. The median OS for the Lamin A/C-low group was 58 months versus 34.5 months for the high-expression group.</div></div><div><h3>Conclusions</h3><div>A significant correlation was found between Lamin A/C expression and OS, which implies that strong, widespread Lamin A/C expression in primary tumor tissues may be a predictive marker for paclitaxel sensitivity and thus survival, supporting a proposed paclitaxel mechanism in inducing micronucleation of cancer cells.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101978"},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.gore.2025.101980
Atieh Karimzadeh , Ali Kazemi Abadi , Hani Ghadri , Sevil Hakimi , Leila Allahqoli , Veronika Günther , Afrooz Mazidimoradi , Hamid Salehiniya , Antonio Simone Laganà , Ibrahim Alkatout
Background
Endometrial cancer (EC) is a prevalent gynecologic malignancy associated with escalating mortality rates. Surgical interventions continue to be the primary treatment modality for EC, with a growing utilization of minimally invasive surgeries (MIS) such as robotic-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS). Given the technical advantages of RALS, this study aimed to compare the surgical outcomes of RALS and CLS in the management of EC.
Methods
A systematic search was conducted on three electronic databases, namely PubMed, Scopus, and ISI Web of Science, up to June 2024 with no date restriction. Randomized controlled trials and cohort studies that compared surgical outcomes, intraoperative parameters, and short-term postoperative outcomes between RALS and CLS in women with EC were included in the analysis. Data on age, body mass index (BMI)kg/m2, dissected lymph nodes, operative time, estimated blood loss, intraoperative complications (conversion rate to laparotomy and injuries), and short-term postoperative outcomes (length of hospital stay and complications) in both groups were collected and analyzed using R software (version 4.2.3). Weighted mean and standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were used for continuous outcomes, while binary outcomes were analyzed using pooled odds ratios (ORs) with 95 % CIs using random-effects models. The risk of bias in the included studies was assessed.
Results
Sixteen studies with 2,725 patients were included. RALS was associated with longer operative time (170.0 vs. 152.6 min; SMD = 0.5) but lower blood loss (109.1 vs. 180.1 mL; SMD = −0.66), fewer conversions to laparotomy (OR = 0.29), reduced intraoperative injuries (OR = 0.32), and shorter hospital stay (2.91 vs. 3.36 days; SMD = −0.4) compared to CLS. However, postoperative complications were more frequent with RALS (OR = 1.8). Most studies had methodological limitations, with over 70 % rated as “poor,” and substantial heterogeneity was observed.
Conclusion
RALS provides specific advantages over CLS, including reduced blood loss, fewer conversions, and shorter hospitalization, but it is associated with longer operative time and higher postoperative complication rates. Results may primarily reflect outcomes from high-volume or experienced surgeons, limiting generalizability. Further high-quality prospective studies, including detailed patient-level and surgeon experience data, are needed to clarify the relative benefits, cost-effectiveness, and long-term outcomes of RALS versus CLS.
背景子宫内膜癌（EC）是一种常见的妇科恶性肿瘤，死亡率不断上升。手术干预仍然是EC的主要治疗方式，微创手术（MIS）如机器人辅助腹腔镜手术（RALS）和传统腹腔镜手术（CLS）的应用越来越多。鉴于RALS的技术优势，本研究旨在比较RALS和CLS治疗EC的手术效果。方法系统检索PubMed、Scopus和ISI Web of Science三个电子数据库，检索截止日期为2024年6月，无日期限制。随机对照试验和队列研究比较了EC患者RALS和CLS的手术结果、术中参数和短期术后结果。收集两组患者的年龄、体重指数（BMI）kg/m2、清扫淋巴结、手术时间、预估出血量、术中并发症（开腹转复率和损伤）、术后短期结局（住院时间和并发症）等数据，采用R软件（4.2.3版）进行分析。连续结局采用95%置信区间（ci）的加权平均和标准化平均差异（SMDs），而二元结局采用95% ci的合并优势比（ORs），采用随机效应模型进行分析。对纳入研究的偏倚风险进行评估。结果纳入16项研究，2725例患者。与CLS相比，RALS与更长的手术时间（170.0 vs. 152.6 min; SMD = 0.5）、更低的出血量（109.1 vs. 180.1 mL; SMD = - 0.66）、更少的剖腹手术（OR = 0.29）、更少的术中损伤（OR = 0.32）和更短的住院时间（2.91 vs. 3.36天；SMD = - 0.4）相关。然而，RALS患者术后并发症发生率更高（OR = 1.8）。大多数研究都有方法学上的局限性，超过70%的研究被评为“差”，并且观察到大量的异质性。结论rals与CLS相比具有明显的优势，包括出血量减少、转诊次数少、住院时间短，但手术时间较长，术后并发症发生率较高。结果可能主要反映高容量或经验丰富的外科医生的结果，限制了通用性。需要进一步的高质量前瞻性研究，包括详细的患者水平和外科医生经验数据，以阐明RALS与CLS的相对益处、成本效益和长期结果。
{"title":"Comparative outcomes of laparoscopic versus robotic-assisted laparoscopic techniques in the surgical staging of endometrial cancer: A systematic review and meta-analysis","authors":"Atieh Karimzadeh , Ali Kazemi Abadi , Hani Ghadri , Sevil Hakimi , Leila Allahqoli , Veronika Günther , Afrooz Mazidimoradi , Hamid Salehiniya , Antonio Simone Laganà , Ibrahim Alkatout","doi":"10.1016/j.gore.2025.101980","DOIUrl":"10.1016/j.gore.2025.101980","url":null,"abstract":"<div><h3>Background</h3><div>Endometrial cancer (EC) is a prevalent gynecologic malignancy associated with escalating mortality rates. Surgical interventions continue to be the primary treatment modality for EC, with a growing utilization of minimally invasive surgeries (MIS) such as robotic-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS). Given the technical advantages of RALS, this study aimed to compare the surgical outcomes of RALS and CLS in the management of EC.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on three electronic databases, namely PubMed, Scopus, and ISI Web of Science, up to June 2024 with no date restriction. Randomized controlled trials and cohort studies that compared surgical outcomes, intraoperative parameters, and short-term postoperative outcomes between RALS and CLS in women with EC were included in the analysis. Data on age, body mass index (BMI)kg/m<sup>2</sup>, dissected lymph nodes, operative time, estimated blood loss, intraoperative complications (conversion rate to laparotomy and injuries), and short-term postoperative outcomes (length of hospital stay and complications) in both groups were collected and analyzed using R software (version 4.2.3). Weighted mean and standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were used for continuous outcomes, while binary outcomes were analyzed using pooled odds ratios (ORs) with 95 % CIs using random-effects models. The risk of bias in the included studies was assessed.</div></div><div><h3>Results</h3><div>Sixteen studies with 2,725 patients were included. RALS was associated with longer operative time (170.0 vs. 152.6 min; SMD = 0.5) but lower blood loss (109.1 vs. 180.1 mL; SMD = −0.66), fewer conversions to laparotomy (OR = 0.29), reduced intraoperative injuries (OR = 0.32), and shorter hospital stay (2.91 vs. 3.36 days; SMD = −0.4) compared to CLS. However, postoperative complications were more frequent with RALS (OR = 1.8). Most studies had methodological limitations, with over 70 % rated as “poor,” and substantial heterogeneity was observed.</div></div><div><h3>Conclusion</h3><div>RALS provides specific advantages over CLS, including reduced blood loss, fewer conversions, and shorter hospitalization, but it is associated with longer operative time and higher postoperative complication rates. Results may primarily reflect outcomes from high-volume or experienced surgeons, limiting generalizability. Further high-quality prospective studies, including detailed patient-level and surgeon experience data, are needed to clarify the relative benefits, cost-effectiveness, and long-term outcomes of RALS versus CLS.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101980"},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.gore.2025.101988
Délya Valcourt-Gendron , Basile Tessier-Cloutier , Xing Zeng , Reitan Ribeiro , Shuk On Annie Leung , Victoria Mandilaras , Lili Fu , Tuyet Nhung Ton Ton Nu , Lara Richer , Lucy Gilbert , Laurence Bernard
Background
Low-grade endometrial stromal sarcoma (LG-ESS) is the most common type of endometrial stromal malignancy, yet treatment options are limited, particularly in advanced or recurrent cases that are resistant to hormonal therapy.
Case Presentation
We describe a 48-year-old patient with recurrent stage IVB LG-ESS who was treated with a combination of doxorubicin and trabectedin, followed by trabectedin maintenance; a protocol extrapolated from leiomyosarcoma treatment. Following failure to hormonal therapy, this regimen demonstrated disease stabilization, particularly in pelvic metastases.
Conclusion
Our results highlight the potential role of this chemotherapy combination in hormonal therapy-resistant LG-ESS, a malignancy with limited systemic therapeutic options. This is the first reported case of LG-ESS achieving prolonged stable disease with doxorubicin-trabectedin therapy and trabectedin maintenance. Given the manageable toxicity profile and encouraging tumor control, further studies should explore its potential role in LG-ESS management.
{"title":"Use of doxorubicin and trabectedin in low-grade endometrial stromal sarcoma: A case report","authors":"Délya Valcourt-Gendron , Basile Tessier-Cloutier , Xing Zeng , Reitan Ribeiro , Shuk On Annie Leung , Victoria Mandilaras , Lili Fu , Tuyet Nhung Ton Ton Nu , Lara Richer , Lucy Gilbert , Laurence Bernard","doi":"10.1016/j.gore.2025.101988","DOIUrl":"10.1016/j.gore.2025.101988","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade endometrial stromal sarcoma (LG-ESS) is the most common type of endometrial stromal malignancy, yet treatment options are limited, particularly in advanced or recurrent cases that are resistant to hormonal therapy.</div></div><div><h3>Case Presentation</h3><div>We describe a 48-year-old patient with recurrent stage IVB LG-ESS who was treated with a combination of doxorubicin and trabectedin, followed by trabectedin maintenance; a protocol extrapolated from leiomyosarcoma treatment. Following failure to hormonal therapy, this regimen demonstrated disease stabilization, particularly in pelvic metastases.</div></div><div><h3>Conclusion</h3><div>Our results highlight the potential role of this chemotherapy combination in hormonal therapy-resistant LG-ESS, a malignancy with limited systemic therapeutic options. This is the first reported case of LG-ESS achieving prolonged stable disease with doxorubicin-trabectedin therapy and trabectedin maintenance. Given the manageable toxicity profile and encouraging tumor control, further studies should explore its potential role in LG-ESS management.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101988"},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Low-grade endometrial stroma sarcoma is a very rare mesenchymal neoplasm, that is usually found inside the uterine corpus. It is very uncommon that LG-ESS arises from extrauterine foci.
Case presentation
We report the case of a 31-year-old patient diagnosed with extrauterine LG-ESS arising from deep infiltrating endometriosis. Primary symptoms, diagnostic workflow, operating method, and the outcome will be described, as well as a short review of the current literature about the optimal treatment for young LG-ESS patients within the reproductive window.
Conclusions
Long-term surveillance is imperative for patients with LG-ESS given the potential for late recurrences. Although extrauterine LG-ESS represents an exceedingly rare gynecologic malignancy, establishing standardized treatment approaches is critical to optimize therapeutic efficacy and improve patient outcomes.
{"title":"Low-grade endometrial stromal sarcoma arising from extrauterine deep infiltrating endometriosis: a rare, but important differential diagnosis and short review of the literature","authors":"Lina Judit Schiestl , Simin Schadmand-Fischer , Evangelos Tagkalos , Udo Raab , Pia-Elisabeth Baqué , Nadja Hamscho , Friedrich Kommoss , Dennis Jung , Valerie Linz , Marcus Schmidt , Annette Hasenburg , Roxana Schwab","doi":"10.1016/j.gore.2025.101985","DOIUrl":"10.1016/j.gore.2025.101985","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade endometrial stroma sarcoma is a very rare mesenchymal neoplasm, that is usually found inside the uterine corpus. It is very uncommon that LG-ESS arises from extrauterine foci.</div></div><div><h3>Case presentation</h3><div>We report the case of a 31-year-old patient diagnosed with extrauterine LG-ESS arising from deep infiltrating endometriosis. Primary symptoms, diagnostic workflow, operating method, and the outcome will be described, as well as a short review of the current literature about the optimal treatment for young LG-ESS patients within the reproductive window.</div></div><div><h3>Conclusions</h3><div>Long-term surveillance is imperative for patients with LG-ESS given the potential for late recurrences. Although extrauterine LG-ESS represents an exceedingly rare gynecologic malignancy, establishing standardized treatment approaches is critical to optimize therapeutic efficacy and improve patient outcomes.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101985"},"PeriodicalIF":1.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.gore.2025.101984
Amaya Martinez Mesa , Alexandra Diggs , Leslie H. Clark
Background
Polycythemia is a rare paraneoplastic phenomenon associated with benign and malignant tumors, including uterine leiomyomas. Few cases of secondary erythrocytosis due to erythropoietin (EPO)-producing fibroids have been reported. Tumor resection is the mainstay of treatment for paraneoplastic polycythemia.
Case
We describe a 44-year-old woman who presented with a large uterine mass and elevated hemoglobin and hematocrit. Evaluation included elevated serum EPO level. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy for bulky adenopathy. Final histopathology confirmed a benign leiomyoma. Following surgery, HGB level normalized.
Conclusion
Although uncommon, EPO-secreting uterine fibroids should be considered in the differential for erythrocytosis, particularly when other causes are not evident.
{"title":"Erythropoietin-Secreting uterine leiomyoma presenting with secondary erythrocytosis: A case report","authors":"Amaya Martinez Mesa , Alexandra Diggs , Leslie H. Clark","doi":"10.1016/j.gore.2025.101984","DOIUrl":"10.1016/j.gore.2025.101984","url":null,"abstract":"<div><h3>Background</h3><div>Polycythemia is a rare paraneoplastic phenomenon associated with benign and malignant tumors, including uterine leiomyomas. Few cases of secondary erythrocytosis due to erythropoietin (EPO)-producing fibroids have been reported. Tumor resection is the mainstay of treatment for paraneoplastic polycythemia.</div></div><div><h3>Case</h3><div>We describe a 44-year-old woman who presented with a large uterine mass and elevated hemoglobin and hematocrit. Evaluation included elevated serum EPO level. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy for bulky adenopathy. Final histopathology confirmed a benign leiomyoma. Following surgery, HGB level normalized.</div></div><div><h3>Conclusion</h3><div>Although uncommon, EPO-secreting uterine fibroids should be considered in the differential for erythrocytosis, particularly when other causes are not evident.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101984"},"PeriodicalIF":1.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.gore.2025.101983
Michelle Greenman , Yasmin Abozenah , Yifang Eva Pan , Elena S. Ratner , Gary Altwerger
BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective adjuvant therapy to cytoreductive surgery in recurrent epithelial ovarian cancer. However, platinum hypersensitivity poses a significant barrier in the platinum-sensitive setting. While intravenous desensitization protocols for platinum hypersensitive patients are standard of care, strategies for safe delivery of platinum agents during HIPEC remain unclear.
Case PresentationWe report a 45-year-old woman with high-grade serous carcinoma of the fallopian tube who initially underwent primary cytoreduction followed by adjuvant carboplatin-paclitaxel chemotherapy and PARP inhibitor maintenance. She subsequently developed platinum-sensitive recurrence and was retreated with carboplatin-paclitaxel but experienced a severe hypersensitivity reaction at the 12th total cycle, requiring epinephrine. Given her platinum-sensitive disease and isolated recurrence, she was considered for secondary cytoreductive surgery with HIPEC. A multidisciplinary team created a modified cisplatin desensitization strategy derived from our previous established institution four step carboplatin desensitization regimen, with pre-medications and a stepwise intraperitoneal perfusion protocol with escalating cisplatin concentrations over 90 min for delivery during HIPEC. The patient tolerated the procedure well and recovered uneventfully. She was discharged on postoperative day six.
Conclusion
This case, to our knowledge, is the first reported in gynecologic oncology to demonstrate the feasibility of safely delivering HIPEC with cisplatin in a patient with prior carboplatin hypersensitivity. As HIPEC adoption expands in platinum-sensitive recurrent ovarian cancer, platinum hypersensitivity will become an increasing challenge. This report underscores the need for further study of intraperitoneal desensitization strategies and cross-reactivity risks, offering a potential for extending HIPEC to patients with platinum hypersensitivity.
{"title":"HIPEC with cisplatin desensitization at the time of secondary debulking in a patient with a prior carboplatin hypersensitivity reaction","authors":"Michelle Greenman , Yasmin Abozenah , Yifang Eva Pan , Elena S. Ratner , Gary Altwerger","doi":"10.1016/j.gore.2025.101983","DOIUrl":"10.1016/j.gore.2025.101983","url":null,"abstract":"<div><div>BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective adjuvant therapy to cytoreductive surgery in recurrent epithelial ovarian cancer. However, platinum hypersensitivity poses a significant barrier in the platinum-sensitive setting. While intravenous desensitization protocols for platinum hypersensitive patients are standard of care, strategies for safe delivery of platinum agents during HIPEC remain unclear.</div><div>Case PresentationWe report a 45-year-old woman with high-grade serous carcinoma of the fallopian tube who initially underwent primary cytoreduction followed by adjuvant carboplatin-paclitaxel chemotherapy and PARP inhibitor maintenance. She subsequently developed platinum-sensitive recurrence and was retreated with carboplatin-paclitaxel but experienced a severe hypersensitivity reaction at the 12th total cycle, requiring epinephrine. Given her platinum-sensitive disease and isolated recurrence, she was considered for secondary cytoreductive surgery with HIPEC. A multidisciplinary team created a modified cisplatin desensitization strategy derived from our previous established institution four step carboplatin desensitization regimen, with pre-medications and a stepwise intraperitoneal perfusion protocol with escalating cisplatin concentrations over 90 min for delivery during HIPEC. The patient tolerated the procedure well and recovered uneventfully. She was discharged on postoperative day six.</div></div><div><h3>Conclusion</h3><div>This case, to our knowledge, is the first reported in gynecologic oncology to demonstrate the feasibility of safely delivering HIPEC with cisplatin in a patient with prior carboplatin hypersensitivity. As HIPEC adoption expands in platinum-sensitive recurrent ovarian cancer, platinum hypersensitivity will become an increasing challenge. This report underscores the need for further study of intraperitoneal desensitization strategies and cross-reactivity risks, offering a potential for extending HIPEC to patients with platinum hypersensitivity.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101983"},"PeriodicalIF":1.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.gore.2025.101982
Kayla Paulosky , Pegah Blustein , Amanda Fader , Matthew Jacob Lankiewicz , Samuel M. Law , Emily MacArthur
Acquired aplastic anemia may rarely present as a paraneoplastic syndrome primarily associated with thymomas and lymphoma. We describe the first case, to our knowledge, of paraneoplastic aplastic anemia secondary to high-grade serous primary peritoneal carcinoma (PPC). A 63-year-old female with a pathogenic germline BRCA1 mutation was found to have pancytopenia at the time of PPC diagnosis. She received granulocyte colony-stimulating factor (GCSF), thrombopoietin (TPO) mimetic, and immunosuppressive therapy with prednisone prior to primary cytoreductive surgery to no apparent gross residual disease. Stage IIIC2 PPC was confirmed on pathology. Her post-operative course was complicated by a large bowel anastomotic leak and sepsis in the setting of neutropenia. Persistent pancytopenia led to the diagnosis of severe aplastic anemia on serial bone marrow biopsies. She was treated with anti-thymocyte globulin (ATG) and cyclosporine and subsequently received adjuvant chemotherapy with weekly cisplatin and subsequent addition of weekly paclitaxel, resulting in reduction in her serum Cancer Antigen-125 (CA-125) and no radiographic evidence of disease. Despite initial response, her clinical deterioration and her decision to forego further cancer- or aplastic anemia-directed therapy resulted in transition to home hospice care, and she was discharged 119 days after admission. This case report highlights the importance of multi-disciplinary collaboration to manage the medical complexities of paraneoplastic aplastic anemia secondary to a gynecologic malignancy.
{"title":"Severe, refractory paraneoplastic aplastic anemia secondary to primary peritoneal carcinoma: a case report","authors":"Kayla Paulosky , Pegah Blustein , Amanda Fader , Matthew Jacob Lankiewicz , Samuel M. Law , Emily MacArthur","doi":"10.1016/j.gore.2025.101982","DOIUrl":"10.1016/j.gore.2025.101982","url":null,"abstract":"<div><div>Acquired aplastic anemia may rarely present as a paraneoplastic syndrome primarily associated with thymomas and lymphoma. We describe the first case, to our knowledge, of paraneoplastic aplastic anemia secondary to high-grade serous primary peritoneal carcinoma (PPC). A 63-year-old female with a pathogenic germline BRCA1 mutation was found to have pancytopenia at the time of PPC diagnosis. She received granulocyte colony-stimulating factor (GCSF), thrombopoietin (TPO) mimetic, and immunosuppressive therapy with prednisone prior to primary cytoreductive surgery to no apparent gross residual disease. Stage IIIC2 PPC was confirmed on pathology. Her post-operative course was complicated by a large bowel anastomotic leak and sepsis in the setting of neutropenia. Persistent pancytopenia led to the diagnosis of severe aplastic anemia on serial bone marrow biopsies. She was treated with anti-thymocyte globulin (ATG) and cyclosporine and subsequently received adjuvant chemotherapy with weekly cisplatin and subsequent addition of weekly paclitaxel, resulting in reduction in her serum Cancer Antigen-125 (CA-125) and no radiographic evidence of disease. Despite initial response, her clinical deterioration and her decision to forego further cancer- or aplastic anemia-directed therapy resulted in transition to home hospice care, and she was discharged 119 days after admission. This case report highlights the importance of multi-disciplinary collaboration to manage the medical complexities of paraneoplastic aplastic anemia secondary to a gynecologic malignancy.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101982"},"PeriodicalIF":1.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.gore.2025.101977
Naba Ali , Katherine D. Sykes Martin , Rachel Tobillo , Karthik Meiyappan , Ashley McCook-Veal , Jeffrey Switchenko , Sean Dresser , Sarah Dilley , Kristen D. Starbuck , Namita Khanna , Joseph Shelton , Ashish Patel , Tony Eng , Beryl Manning-Geist , Jill S. Remick
Purpose/Objectives
The standard treatment for locally advanced cervical cancer (LACC) is concurrent chemoradiation and brachytherapy (CRT-B). Fistula formation is a serious complication of pelvic radiation; however, risk factors and outcomes are not well described. We sought to identify the incidence, risk factors and prognosis of radiation-induced fistula in women who underwent CRT-B for LACC.
Materials/Methods
Patients with FIGO IB2-IV cervical cancer treated with CRT-B at a single institution from 2013 to 2022 were reviewed. Patient and treatment characteristics were analyzed. The primary endpoint was fistula incidence. Logistic regression model was performed to assess factors associated with fistula. Fistula-free survival and overall survival were estimated using the Kaplan-Meier method.
Results
Thirteen (9 %) of 150 reviewed patients developed fistula with median follow up of 20 months (CI: 22.8–35.4). Fistula symptoms resolved in 8/13 patients (62 %). Two-year overall survival and fistula-free survival was 72.0 % (CI: 62.6–79.5) and 91.6 % (CI: 84.9–95.4), respectively. On univariate analysis, higher BMI was associated with decreased fistula risk (OR 0.90, CI: 0.82–1.00; p = 0.048). Current smoking (OR 8.37, CI: 2.58–27.22; p < 0.001), lack of MRI guidance (OR 4.77, CI: 1.42–15.97; p = 0.011) and disease extension into bladder (OR 3.99, CI: 1.27–12.53; p = 0.018), were associated with increased fistula risk. On multivariable analysis, only current smoking (OR 5.14, CI: 1.43–18.48; p = 0.012) was associated with increased fistula risk.
Conclusions
Patients treated with CRT-B for LACC have a 9% risk of fistula formation. MRI guidance may be useful in brachytherapy planning to reduce the risk of toxicity.
目的/目的局部晚期宫颈癌（LACC）的标准治疗是同步放化疗和近距离放疗（CRT-B）。瘘管形成是骨盆放射治疗的严重并发症；然而，风险因素和结果并没有很好地描述。我们试图确定因LACC而接受CRT-B治疗的女性放射诱发瘘的发生率、危险因素和预后。材料/方法回顾2013年至2022年在单一机构接受CRT-B治疗的FIGO IB2-IV宫颈癌患者。分析患者及治疗特点。主要终点为瘘管发生率。采用Logistic回归模型评估瘘相关因素。采用Kaplan-Meier法估计无瘘生存期和总生存期。结果150例患者中有13例（9%）出现瘘管，中位随访20个月（CI: 22.8-35.4）。8/13例（62%）患者的瘘管症状得到缓解。两年总生存率和无瘘生存率分别为72.0% （CI: 62.6-79.5）和91.6% （CI: 84.9-95.4）。在单因素分析中，较高的BMI与瘘风险降低相关（OR 0.90, CI: 0.82-1.00; p = 0.048）。当前吸烟（OR 8.37, CI: 2.58-27.22; p < 0.001）、缺乏MRI指导（OR 4.77, CI: 1.42-15.97; p = 0.011）和疾病扩展至膀胱（OR 3.99, CI: 1.27-12.53; p = 0.018）与瘘管风险增加相关。在多变量分析中，只有当前吸烟（OR 5.14, CI: 1.43-18.48; p = 0.012）与瘘风险增加相关。结论接受CRT-B治疗的LACC患者有9%的瘘管形成风险。MRI指导可能有助于近距离治疗计划，以减少毒性风险。
{"title":"Risk factors and clinical outcomes of radiation-induced fistula after chemoradiation and image-guided brachytherapy for locally advanced cervical cancer","authors":"Naba Ali , Katherine D. Sykes Martin , Rachel Tobillo , Karthik Meiyappan , Ashley McCook-Veal , Jeffrey Switchenko , Sean Dresser , Sarah Dilley , Kristen D. Starbuck , Namita Khanna , Joseph Shelton , Ashish Patel , Tony Eng , Beryl Manning-Geist , Jill S. Remick","doi":"10.1016/j.gore.2025.101977","DOIUrl":"10.1016/j.gore.2025.101977","url":null,"abstract":"<div><h3>Purpose/Objectives</h3><div>The standard treatment for locally advanced cervical cancer (LACC) is concurrent chemoradiation and brachytherapy (CRT-B). Fistula formation is a serious complication of pelvic radiation; however, risk factors and outcomes are not well described. We sought to identify the incidence, risk factors and prognosis of radiation-induced fistula in women who underwent CRT-B for LACC.</div></div><div><h3>Materials/Methods</h3><div>Patients with FIGO IB2-IV cervical cancer treated with CRT-B at a single institution from 2013 to 2022 were reviewed. Patient and treatment characteristics were analyzed. The primary endpoint was fistula incidence. Logistic regression model was performed to assess factors associated with fistula. Fistula-free survival and overall survival were estimated using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Thirteen (9 %) of 150 reviewed patients developed fistula with median follow up of 20 months (CI: 22.8–35.4). Fistula symptoms resolved in 8/13 patients (62 %). Two-year overall survival and fistula-free survival was 72.0 % (CI: 62.6–79.5) and 91.6 % (CI: 84.9–95.4), respectively. On univariate analysis, higher BMI was associated with decreased fistula risk (OR 0.90, CI: 0.82–1.00; p = 0.048). Current smoking (OR 8.37, CI: 2.58–27.22; p < 0.001), lack of MRI guidance (OR 4.77, CI: 1.42–15.97; p = 0.011) and disease extension into bladder (OR 3.99, CI: 1.27–12.53; p = 0.018), were associated with increased fistula risk. On multivariable analysis, only current smoking (OR 5.14, CI: 1.43–18.48; p = 0.012) was associated with increased fistula risk.</div></div><div><h3>Conclusions</h3><div>Patients treated with CRT-B for LACC have a 9% risk of fistula formation. MRI guidance may be useful in brachytherapy planning to reduce the risk of toxicity.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101977"},"PeriodicalIF":1.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145463532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.gore.2025.101981
Khrystyna Levytska , SeungYong Han , Allison E. Axtell , Malaika W. Amneus , Brandon Ing , Scott E. Lentz
Objective
Describe surgical outcomes of patients undergoing HIPEC with cisplatin (C) alone or cisplatin/paclitaxel (CP), compared to interval debulking surgery (IDS) without HIPEC, and stratify disease-free survival (DFS) by treatment and homologous recombination (HR) status.
Methods
Retrospective chart review of patients with advanced ovarian cancer undergoing IDS with and without HIPEC between 2018–2024. DFS was compared using a log rank test. Cox proportional hazards model was used to test association between treatment group and recurrence.
Results
74 patients were included: 20 in no HIPEC, 28 in HIPEC-C, and 26 in HIPEC-CP groups. Duration of surgery was shortest in no HIPEC group (159 ± 64 min vs HIPEC-C 377 ± 54 min vs HIPEC-CP 400 ± 48 min, p < 0.0001). Post-operatively, there was no difference in days to return of bowel function (p = 0.17) or Grade II-IV complications (p = 0.39). HIPEC-C group had longest time to discharge (4.5 ± 1.2 post-operative days vs no HIPEC 3.8 ± 1.9 vs HIPEC-CP 3.6 ± 0.9, p = 0.002). Twenty-nine (39.2 %) patients were HR deficient (HRD). Median DFS did not differ between treatment groups (no HIPEC 17.0 months vs HIPEC-C 13.87 months vs HIPEC-CP 19.25 months, p = 0.853). Median DFS was higher in HRD vs HRP (HR proficient) patients (40.5 months vs 11.4 months, HR 0.32 (95 % CI: 0.19–0.57, p = 0.0001).
Conclusions
Addition of paclitaxel to cisplatin at the time of IDS with HIPEC had no effect on peri-operative morbidity. No differences in DFS were seen between treatment groups. HRD group had a significantly longer DFS, when compared to HRP. Tumor genetics and HR status likely drive response to treatment in advanced ovarian cancer.
目的描述HIPEC患者单用顺铂(C)或顺铂/紫杉醇（CP）的手术结果，与不使用HIPEC的间隔减压手术（IDS）进行比较，并通过治疗和同源重组（HR）状态对无病生存（DFS）进行分层。方法回顾性分析2018-2024年晚期卵巢癌合并和不合并HIPEC的IDS患者。DFS采用对数秩检验进行比较。采用Cox比例风险模型检验治疗组与复发率的相关性。结果74例患者：无HIPEC组20例，HIPEC- c组28例，HIPEC- cp组26例。无HIPEC组手术时间最短（159±64 min vs . HIPEC- c 377±54 min vs . HIPEC- cp 400±48 min, p < 0.0001）。术后肠功能恢复天数（p = 0.17）和II-IV级并发症（p = 0.39）无差异。HIPEC- c组出院时间最长（术后4.5±1.2天vs未HIPEC组3.8±1.9天vs HIPEC- cp组3.6±0.9天，p = 0.002）。29例（39.2%）患者为HR缺陷（HRD）。治疗组间的中位DFS无差异（无HIPEC 17.0个月vs HIPEC- c 13.87个月vs HIPEC- cp 19.25个月，p = 0.853）。HRD患者的中位DFS高于HRP （HR精通）患者(40.5个月vs 11.4个月，HR 0.32 （95% CI: 0.19-0.57, p = 0.0001）。结论在IDS合并HIPEC时顺铂加用紫杉醇对围手术期发病率无影响。治疗组间DFS无差异。与HRP相比，HRD组的DFS明显更长。肿瘤遗传学和HR状态可能驱动对晚期卵巢癌治疗的反应。
{"title":"Homologous recombination status drives disease-free survival in patients with advanced ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy at the time of interval debulking surgery","authors":"Khrystyna Levytska , SeungYong Han , Allison E. Axtell , Malaika W. Amneus , Brandon Ing , Scott E. Lentz","doi":"10.1016/j.gore.2025.101981","DOIUrl":"10.1016/j.gore.2025.101981","url":null,"abstract":"<div><h3>Objective</h3><div>Describe surgical outcomes of patients undergoing HIPEC with cisplatin (C) alone or cisplatin/paclitaxel (CP), compared to interval debulking surgery (IDS) without HIPEC, and stratify disease-free survival (DFS) by treatment and homologous recombination (HR) status.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients with advanced ovarian cancer undergoing IDS with and without HIPEC between 2018–2024. DFS was compared using a log rank test. Cox proportional hazards model was used to test association between treatment group and recurrence.</div></div><div><h3>Results</h3><div>74 patients were included: 20 in no HIPEC, 28 in HIPEC-C, and 26 in HIPEC-CP groups. Duration of surgery was shortest in no HIPEC group (159 ± 64 min <em>vs</em> HIPEC-C 377 ± 54 min <em>vs</em> HIPEC-CP 400 ± 48 min, p < 0.0001). Post-operatively, there was no difference in days to return of bowel function (p = 0.17) or Grade II-IV complications (p = 0.39). HIPEC-C group had longest time to discharge (4.5 ± 1.2 post-operative days <em>vs</em> no HIPEC 3.8 ± 1.9 <em>vs</em> HIPEC-CP 3.6 ± 0.9, p = 0.002). Twenty-nine (39.2 %) patients were HR deficient (HRD). Median DFS did not differ between treatment groups (no HIPEC 17.0 months <em>vs</em> HIPEC-C 13.87 months <em>vs</em> HIPEC-CP 19.25 months, p = 0.853). Median DFS was higher in HRD <em>vs</em> HRP (HR proficient) patients (40.5 months <em>vs</em> 11.4 months, HR 0.32 (95 % CI: 0.19–0.57, p = 0.0001).</div></div><div><h3>Conclusions</h3><div>Addition of paclitaxel to cisplatin at the time of IDS with HIPEC had no effect on <em>peri</em>-operative morbidity. No differences in DFS were seen between treatment groups. HRD group had a significantly longer DFS, when compared to HRP. Tumor genetics and HR status likely drive response to treatment in advanced ovarian cancer.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101981"},"PeriodicalIF":1.3,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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