International Journal of Gynecological Cancer最新文献

High-grade serous carcinoma is the most lethal gynecological malignancy. Although serous tubal intra-epithelial carcinoma is increasingly recognized as a precursor to high-grade serous carcinoma, its optimal management remains controversial. This review examines the controversies in serous tubal intra-epithelial carcinoma pathogenesis, diagnosis, management, and follow-up, highlighting the need for collaboration, standardized guidelines, and further research to improve patient outcomes.

Mucinous ovarian carcinoma (MOC) is a rare subtype of epithelial ovarian cancer, comprising less than 5% of all cases, and distinguished by its unique molecular, histologic, and clinical features. Its rarity and marked differences from other ovarian cancer subtypes have led to significant controversies regarding its diagnosis, surgical strategies, and systemic therapies. Accurate differentiation between primary and metastatic MOCs remains a critical challenge because of their overlapping features with gastrointestinal cancers, often leading to misclassification. This can result in suboptimal management and impaired patient outcomes, thus highlighting the importance of high-quality pathologic reviews. The surgical approach to MOC is highly controversial. In early-stage disease, fertility-sparing surgery should be systematically considered in young patients, although its feasibility requires careful consideration. In addition, systematic staging lymphadenectomy, which has been de-escalated for patients with expansile MOC, is recommended for those with early-stage infiltrative MOC. In advanced-stage disease, where tumors are often bulky and chemoresistant, the benefits of extensive cytoreduction must be balanced against surgical morbidities. MOC poses significant challenges for systemic treatment owing to its poor response rate to standard ovarian cancer chemotherapy regimens. Alternative therapeutic strategies offer promise but lack robust clinical validation, including gastrointestinal-based regimens, HER2-targeted antibody-drug conjugates (eg, trastuzumab deruxtecan), and immune checkpoint inhibitors for microsatellite unstable MOC. Furthermore, pre-clinical and early phase trials have suggested the potential of combination strategies, including RAS pathway and WEE1 inhibitors. Addressing these controversies requires a multidisciplinary approach that underscores the importance of histologic subtyping and molecular profiling to guide personalized treatment. International collaboration is essential for overcoming the rarity of MOC by enabling larger studies and global registries. These efforts are pivotal for improving diagnostic accuracy, expanding therapeutic options, and, ultimately, enhancing outcomes in patients with this challenging malignancy.

Uterine serous carcinoma and uterine carcinosarcoma are among the rarest but most lethal endometrial cancer sub-types, accounting for 15% of all cases, and are responsible for more than 50% of related deaths. These malignancies are distinguished by a high likelihood of metastasis and multisite recurrence, making them biologically different from other endometrial cancer sub-types. This review aims to analyze the existing evidence regarding molecular classification, new biomarkers, and innovative treatment approaches for these high-risk tumors. Herein, we explored the role of biomarkers, including HER2, TP53, and mismatch repair deficiency/microsatellite instability hypermutated and their influence on treatment strategies, surveillance approaches, the potential role of circulating tumor deoxyribonucleic acid, novel precision-based treatment options, and disparate survival outcomes for non-Hispanic Black and other underserved minority patients, along with strategies to improve outcomes for these patients. Substantial progress has been made in the last 5 years, prompting the following question: What lies ahead in the next 5 years? Our current understanding of uterine serous carcinoma and carcinosarcoma underscores the necessity of continuing to prioritize biomarker-driven therapies and the development of novel treatments through clinical trials while integrating these new strategies with traditional approaches, such as surgical resection and cytotoxic chemotherapy.

Objective: The Russian invasion of Ukraine in February 2022 caused a mass displacement of over 6 million people, including many women requiring urgent medical care, such as those with gynecologic malignancies. The disruption of cancer treatment in conflict zones poses critical challenges because timely oncologic care is vital for patient survival. This study, conducted by the European Network of Young Gynecologic Oncologists, aimed to assess the health care responses provided to Ukrainian gynecologic oncology patients across European countries during the first 6 months of the conflict.

Methods: A cross-sectional survey was distributed to European Network of Young Gynecologic Oncologists members between July and August 2022, gathering insights from health care providers about their experiences in managing Ukrainian gynecologic oncology patients. The survey explored the medical needs of displaced patients, challenges encountered, and the resources available. Descriptive statistics were used for data analysis.

Results: During the study period, approximately 400 gynecologic oncology patients fleeing Ukraine received care in 38 European health care centers represented by the respondents (N = 50). Surgical interventions (54%), chemotherapy (40%), and specialist consultations (32%) were identified as the most common medical needs. The key barriers to care included language difficulties (44%), lack of previous medical documentation (40%), and inconsistencies in treatment protocols between centers. Psychological support was notably insufficient, with 36% of respondents reporting a lack of adequate resources for addressing mental health needs.

Conclusions: The study identifies critical barriers to the continuity of gynecologic oncology care for displaced patients during humanitarian crises. Addressing language barriers, ensuring access to patient medical histories, and providing psychological support are essential to improve care for refugees. The findings underscore the importance for international collaboration and the development of robust frameworks for delivering oncologic care during crises.

Objective: The phase III LION trial found no therapeutic benefit from systematic lymphadenectomy in patients with advanced ovarian cancer with optimal upfront cytoreduction and normal-appearing lymph nodes. Patients were randomized intra-operatively, excluding those who could not be operated on when they were tumor-free or had suspicious/bulky lymph nodes upon inspection or palpation. This analysis focused on the outcomes of the group excluded because of bulky lymph nodes alone.

Methods: This was a monocentric, retrospective subgroup analysis of a randomized controlled trial conducted at Charité University Hospital. We evaluated the same patients as in the LION trial. Tumor-free patients with presumed bulky/suspicious lymph nodes underwent full systematic lymphadenectomy after exclusion. Patients were analyzed according to the same endpoints as the LION trial and compared with those of the original study.

Results: Overall, 202 patients with a median age of 61 years (range; 37-74) were included; 83.6% had stage III/IV disease (n = 122) and predominantly high-grade serous histology (72%, n = 145). The rate of complete tumor resection was significantly lower in intra-operatively excluded patients (45%, n = 55) than in those included (92%, n = 112), with a significant negative impact on overall and progression-free survival (p = .042). Only 60% (n = 33) of the originally excluded patients had histologically positive lymph nodes, although 38.8% (n = 21) were presumed to be bulky by the surgeon. There was no significant difference in progression-free survival or overall survival between the patients who underwent optimal surgery and were excluded from the original LION study versus those included, regardless of their histological lymph node status and whether a lymphadenectomy was performed (p = .4, 95% CI 24.8 to 39).

Conclusion: Patients with ovarian cancer, when operated on upfront without macroscopic residual disease, have the same survival regardless of whether they have bulky nodes as long as any bulky lymph nodes are removed. Moreover, we demonstrated that intra-operative lymph node evaluation by a surgeon is subjective and often inaccurate.

Objective: This study aimed to evaluate the association between pre-operative progesterone receptor (PR) and p53 expression and prognosis in pre-operative grade 2 endometrioid endometrial carcinoma compared with grade 1 and grade 3 carcinomas.

Methods: Three European endometrial carcinoma cohort studies were included. Patients with pre-operative grade 2 endometrioid carcinoma and known pre-operative PR and p53 status were included (n = 400), as were patients with pre-operative grade 1 (n = 602) or grade 3 (n = 148) endometrioid carcinomas. Kaplan-Meier and Cox regression analyses were performed to analyze disease-specific and disease-free survival.

Results: Patients with pre-operative grade 2 endometrial carcinoma and wild-type p53 plus PR-positive expression showed a similar 7-year disease-specific survival to grade 1 endometrial carcinoma patients (95.8% vs 97.5%, p = .13), while the 7-year disease-specific survival of patients with grade 2 endometrial carcinoma with p53 aberrant and/or negative PR expression (83.5%) was significantly lower (p < .001). The combination of these markers was an independent prognostic factor in multivariate Cox regression analyses.

Conclusions: The prognostic impact of pre-operative p53 and PR expression in patients with grade 2 endometrioid endometrial carcinoma supports a modified binary grading system in which grade 2 patients should be pre-operatively classified as low- or high-grade depending on p53 and PR expression.