International Journal of Gynecological Cancer最新文献

Objective: This survey aimed to evaluate trends in sentinel lymph node (SLN) biopsy for endometrial cancer among members of the European Society of Gynecologic Oncology (ESGO) and the International Gynecologic Cancer Society (IGCS).

Methods: We conducted an online cross-sectional survey among gynecologic oncologists over 40 years of age consisting of 30 questions. It was distributed to ESGO and IGCS members via Survey Monkey and Qualtrics between September and December 2022. Surveys were excluded in the analysis if >50% of questions were incomplete. Statistical analysis, performed with SPSS version 27.0.

Results: A total of 302 (70.2%) of 430 participants completed the survey, with 159 (52.6%) affiliated with ESGO and 143 (47.4%) with IGCS. The majority were male 206 (68.2%), and 170 (56.3%) were based in Europe. Most respondents (n = 261, 86.4%) were certified gynecologic oncologists. Indocyanine green was the most common tracer used (n = 234, 77.5%), with higher rates of blue dye injections among IGCS respondents (p = .002). The predominant injection volume was 4 cm³ (51%, n = 154). Most respondents (n = 232, 76.8%) used a combined superficial and deep ectocervical injection technique, with a higher proportion of superficial injections alone in the IGCS respondents (25.9% vs 11.9%, p = .003). Nearly half of the respondents (44.4%, n = 134) started SLN mapping at the uterine artery and continued dissecting laterally. In cases of mapping failure, 77.5% (n = 234) opted for side-specific lymphadenectomy. The Memorial Sloan Kettering Cancer Center algorithm was followed by 69.5% (n = 210), with 45.7% (n = 138) routinely using ex-vivo green fluorescence or gamma counter measurements. Finally, there was a higher adoption of immunohistochemistry for SLN ultra-staging in ESGO (n = 116, 73%) compared to the IGCS respondents (n = 94, 65.7%), (p = .047).

Conclusions: This study showed significant variations in SLN biopsy practices for endometrial cancer, underscoring the need for global standardization through harmonized guidelines, consistent training, and international collaboration to improve staging accuracy and patient outcomes.

Surgery quality in gynecology oncology trials varies, potentially biasing results. This systematic review examines methods for assuring surgical quality in multi-center gynecologic oncology trials and the impact on patient outcomes. A systematic search (2000-2023) was conducted in Medline, Embase, and Web of Science. Multi-center randomized controlled trials reporting on surgical endometrial and cervical cancer trials and lymph node harvest, short-term mortality, or conversion rate were included. Studies were assessed using a 10-point checklist to determine surgical quality. This was used to assess the association with variation in lymph node harvest, post-operative mortality, and conversion rate. Overall, 5963 titles and abstracts were screened for their eligibility and 10 studies reporting on 22 surgical-only arms were included for further analysis. The total number of included patients was 7434 from 366 centers. Analysis showed that standardization of surgical approach (β = -6.6, 95%, p = .043), standardization of the extent of lymphadenectomy (β = -2.432, p = .004), video assessment pre-trial (β = -3.492, p = .04) and monitoring of data including clinical outcome measures (β = -4.018, p = .009) were significantly associated with reducing variation in lymph node harvest. It also showed that standardization of the extent of lymphadenectomy (β = -0.718, p < .001) and pre-trial case/procedure volume assessment (β = -0.531, p = .049) were significantly associated with reducing short-term mortality. The regression model showed standardization of the extent of lymphadenectomy (β = -3.123, p = .034) was significantly associated with reducing conversion rate. In conclusion, the heterogeneity of surgical quality measures showed that there is no clear consensus on the approach to delivering surgical quality assurance in gynecology oncology trials. The analysis in this evidence synthesis has shown a potential association between different aspects of surgical quality assurance and clinical outcomes. Further research is required to develop a framework ensuring surgical quality deliverance in gynecology oncology trials.

Cervical cancer is a major global health issue, ranking as the fourth most common cancer in women worldwide. Depending on stage, histology, and patient factors, the standard management of cervical cancer is a combination of treatment approaches, including (fertility- or non-fertility-sparing) surgery, radiotherapy, platinum-based chemotherapy, and novel systemic therapies such as bevacizumab, immune checkpoint inhibitors, and antibody-drug conjugates. While ambitious global initiatives seek to eliminate cervical cancer as a public health problem, the management of cervical cancer continues to evolve with major advances in imaging modalities, surgical approaches, identification of histopathological risk factors, radiotherapy techniques, and biomarker-driven personalized therapies. In particular, the introduction of immune checkpoint inhibitors has dramatically altered the treatment of cervical cancer, leading to significant survival benefits in both locally advanced and metastatic/recurrent settings. As the landscape of cervical cancer therapies continues to evolve, the aim of the present review is to provide a comprehensive discussion of the current state and the latest practice-changing updates in cervical cancer.

Objective: In the phase 2 OVARIO trial (NCT03326193) investigating niraparib-bevacizumab first-line maintenance, median progression-free survival was 14.2 months (95% confidence interval (CI) 8.6 to 16.8) for patients with homologous recombination (HR)-proficient (HRp) epithelial ovarian cancer, and 12.1 months (95% CI8.0-not evaluated) for patients with undefined HR status. However, real-world data are limited for patients who receive niraparib-bevacizumab first-line maintenance therapy. The COMB1NE study describes real-world clinical outcomes (time to treatment discontinuation; time to next treatment) in patients with epithelial ovarian cancer who received niraparib-bevacizumab first-line maintenance, regardless of first-line bevacizumab use.

Methods: This real-world, retrospective study used a US nationwide electronic health record-derived deidentified database. Eligible patients were 18 years or older at initial epithelial ovarian cancer diagnosis and initiated niraparib-bevacizumab first-line maintenance (January 1, 2017-September 2, 2022) following first-line treatment. The index date was the start of first-line maintenance. Patients were followed until death, last clinical activity, or end of study, whichever occurred first. Time to treatment discontinuation and time to next treatment, a proxy for real-world progression-free survival, were estimated using the Kaplan-Meier method.

Results: Among 59 included patients, the median age was 67 years (interquartile range (IQR) 61-76), and 81.4% had stage III/IV epithelial ovarian cancer at diagnosis. Overall, 83.1% of patients had BRCA wild-type with either HRp or HR status unknown disease. Median time to treatment discontinuation of first-line maintenance was 11.8 months (95% CI 8.7 to 13.5). Median time to next treatment was 14.1 months (95% CI 11.3 to 16.6). At 6 months after index, 77.9% of patients had not initiated second-line treatment; at 12 months, 61.3% had not.

Conclusion: In this real-world study of patients receiving niraparib-bevacizumab first-line maintenance, the majority of whom had HRp/HR status unknown, the median time to next treatment was consistent with observed progression-free survival in patients with similar HR status in the OVARIO study.