International Journal of Gynecological Cancer最新文献

Gynecologic cancers remain a leading cause of morbidity and mortality in women, and recent years have marked an inflection point through the consolidation of immunotherapy, the maturation of antibody-drug conjugates, and broader biomarker implementation. This narrative review synthesizes key clinical and translational advances across ovarian, endometrial, and cervical cancers in 2025, emphasizing implications for treatment selection and sequencing. In advanced ovarian cancer, TRUST re-examined surgical timing, supporting primary cytoreduction in selected resectable patients, whereas ICON8B suggested that weekly paclitaxel with carboplatin and bevacizumab may improve outcomes in high-risk disease. Platinum-resistant ovarian cancer saw the most disruptive progress: mirvetuximab soravtansine validated folate receptor-α as a therapeutic target, with overall survival benefit in high-expressing tumors; trastuzumab deruxtecan expanded actionable HER2 disease, with greatest activity in tumors rated 3+ by immunohistochemistry; and combination strategies, including relacorilant plus nab-paclitaxel and pembrolizumab plus weekly paclitaxel ± bevacizumab, delivered clinically meaningful survival signals, underscoring the need for harmonized biomarker strategies and proactive toxicity mitigation. In endometrial cancer, the Cancer Genome Atlas-based molecular classification increasingly informs risk stratification and adjuvant tailoring; long-term PORTEC-3 data refine escalation for p53-abnormal disease and de-escalation considerations for POLE-mutant tumors. In advanced disease, first-line chemo-immunotherapy has matured, with overall survival updates in mismatch repair-deficient tumors and a consistent progression-free survival benefit across diverse mismatch repair-proficient sub-groups, whereas adjuvant immunotherapy remains in evolution after KEYNOTE-B21. In cervical cancer, pembrolizumab added to definitive chemoradiotherapy set a new benchmark in locally advanced disease, and ultra-sensitive circulating tumor DNA analyses emerged as a powerful prognostic tool to enable post-treatment risk-adapted strategies. Collectively, the 2025 data set reinforces a "right therapy, right patient, right time" paradigm and prioritizes confirmatory antibody-drug conjugate trials, resistance biology, and dynamic biomarkers to translate gains into durable, equitable benefit.

Objective: TRAMANT was a multicenter, randomized phase II study assessing the non-inferiority of trabectedin (TRB) as maintenance therapy in patients with relapsed ovarian cancer who responded to initial treatment with pegylated liposomal doxorubicin (PLD) + TRB.

Methods: Patients with partially platinum-sensitive recurrent ovarian cancer, defined by a platinum-free interval of 6-12 months, were randomly assigned to receive either TRB alone or continued combination therapy. The primary endpoint was progression-free survival, with secondary endpoints including overall survival, objective response rate, and quality of life assessments.

Results: Sixty-seven patients were enrolled (median age, 59 years; range; 41-74); most had International Federation of Gynecology and Obstetrics stage III disease (70%) and high-grade serous carcinoma (85%). The median time to recurrence after prior platinum therapy was 8.5 months (range; 6-12), and the median follow-up was 24 months (range; 6-44). Patients received a median of 6 cycles in both arms. Median progression-free survival was 9.8 months with TRB and 16.6 months with PLD + TRB; overall survival was comparable (19.1 vs 23.8 months). Grade 3-4 adverse events occurred in 21% (TRB) and 17% (PLD + TRB), with neutropenia and anemia being the most common toxicities.

Conclusions: The results suggest that TRB may be a viable maintenance option for patients with relapsed ovarian cancer, providing a sustained response with favorable tolerability. Nonetheless, the small sample size underscores the need for further research to validate these findings. Studies with larger cohorts are necessary to confirm these results and optimize treatment strategies for recurrent ovarian cancer.

Objective: Expert pathology review plays a crucial role in gynecologic oncology, where diagnostic complexity can substantially affect patient management and medico-legal accountability. This study aimed to assess the frequency, nature, and impact of diagnostic revisions arising from second opinion evaluations of gynecologic lesions.

Methods: We retrospectively analyzed 319 consecutive cases of gynecologic lesions submitted for second opinion review by a senior gynecologic pathologist at a tertiary referral center between 2018 and 2024. Each case was categorized as concordant, minorly discrepant, or majorly discrepant compared with the referring diagnosis. Clinical impact and medico-legal relevance were systematically evaluated.

Results: Of the 319 reviewed cases, 47.0% were fully concordant with the original diagnosis, whereas 34.5% exhibited major discrepancies and 18.5% minor discrepancies. The most frequent sources of diagnostic disagreement involved tumor histotype, grade, and determination of the primary site. Ovarian and endometrial specimens accounted for most revisions. Diagnostic reinterpretation led to changes in clinical management in 54.9% of cases, and potential medico-legal implications were identified in 11.3%.

Conclusions: Expert second opinion pathology in gynecologic oncology revealed a high rate of diagnostically and clinically significant revisions. Routine implementation of specialist review for complex or high-risk gynecologic lesions is strongly recommended to improve diagnostic accuracy, guide appropriate patient care, and reduce medico-legal risk.

Objective: Low-grade serous ovarian cancer is a rare epithelial ovarian cancer subtype characterized by high resistance to chemotherapy. Development of novel, effective, targeted treatments for recurrent low-grade serous ovarian cancer remains an unmet medical need. We evaluated FOLR1 expression in a cohort of low-grade serous ovarian cancer patients and the preclinical and clinical activity of mirvetuximab soravtansine, an antibody-drug conjugate targeting FOLR1, in vivo in a patient-derived xenograft model and in a heavily pretreated low-grade serous ovarian cancer patient progressing after chemotherapy, aromatase inhibitor, and MEK inhibitor treatment.

Methods: FOLR1 expression was evaluated in 27 low-grade serous ovarian cancer patients using immunohistochemistry. The efficacy of mirvetuximab soravtansine was assessed in vivo in a low-grade serous ovarian cancer patient-derived xenograft model in severe combined immunodeficient mice, as well as in a patient harboring a recurrent low-grade serous ovarian cancer resistant to standard treatment modalities.

Results: FOLR1 expression was detected in all 27 (100%) low-grade serous ovarian cancer cases, with 21 of 27 (78%) of the samples demonstrating 2+/3+ in ≥75% of tumor cells. In vivo studies in mice demonstrated that mirvetuximab soravtansine inhibited tumor growth and prolonged survival in a low-grade serous ovarian cancer patient-derived xenograft model derived from a patient progressing after chemotherapy/aromatase inhibitor/MEK inhibitor. Clinical evidence further supported the therapeutic activity of mirvetuximab soravtansine in a FOLR1-positive low-grade serous ovarian cancer patient, as indicated by a prolonged partial response after 8 months of treatment.

Conclusions: FOLR1 is overexpressed in a large percentage of low-grade serous ovarian cancers. Mirvetuximab soravtansine may represent a novel treatment option for low-grade serous ovarian cancer patients progressing after standard treatment modalities. Clinical trials with mirvetuximab soravtansine in FOLR1-positive low-grade serous ovarian cancers are warranted.

Objective: This study aimed to evaluate clinical and pathological factors associated with the occurrence of empty node packets during sentinel lymph node mapping in patients with endometrial cancer.

Methods: We performed a retrospective cohort study including patients with histologically confirmed endometrial carcinoma who underwent sentinel lymph node mapping between November 2012 and December 2023. An empty node packet was defined as the intra-operative removal of a presumed sentinel node with no lymphoid tissue identified on final pathological examination. Logistic regression models were used to identify independent predictors.

Results: Of 489 patients who had sentinel lymph node mapped, 23 (4.7%) had an empty node packet. In the univariate analysis, body mass index and myometrial invasion were significantly associated (p < .05). In the multi-variable analysis, only body mass index remained independently associated (odds ratio 1.075, 95% confidence interval 1.01 to 1.14, p = .022) with an empty node packet. Tumor histology, grade, type of tracer, and surgical approach were not associated. No nodal recurrences occurred in patients with an empty node packet.

Conclusions: Empty node packets are uncommon but clinically relevant during sentinel lymph node mapping for endometrial cancer. Higher body mass index was the only independent predictor, underscoring the influence of patient-related factors on mapping accuracy.

Objective: Endometrial cancer is the most common gynecologic malignancy in developed countries, and minimally invasive surgery is increasingly used. However, comparisons among surgical approaches regarding patient-centered outcomes remain scarce. In this study, we aimed to compare patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) between minimally invasive (robotic and laparoscopic) and open surgeries for endometrial cancer staging, and to assess functional, physical, and emotional domains.

Methods: This cross-sectional study was conducted at Barretos Cancer Hospital (Brazil) with retrospective clinical data and prospective collection of PROMs and PREMs. A total of 182 women with histologically confirmed endometrial cancer underwent robotic (n = 29), laparoscopic (n = 91), or open surgery (n = 62) between January 2020 and December 2023. Statistical analyses were descriptive and univariate to explore associations between surgical approach and outcomes.

Results: Overall, PROMs were highest in the robotic group (72.2 ± 6.6), followed by laparoscopic (70.8 ± 6.4) and open (70.2 ± 7.4). PREMs showed a similar pattern-robotic (98.8 ± 4.1), open (97.5 ± 3.9), and laparoscopic (97.0 ± 6.1). Robotic surgery achieved higher satisfaction (99.7 ± 7.2), sexual function (78.1 ± 23.9), and quality of life (86.6 ± 12.6). Laparoscopy favored mobility (88.6 ± 18.8) and daily activities (89.4 ± 21.7), while open surgery had higher emotional wellbeing (80.8 ± 21.6) but more gastrointestinal symptoms.

Conclusions: Robotic surgery yielded better satisfaction, quality of life, and sexual function; laparoscopy improved mobility and daily activities; and open surgery enhanced emotional wellbeing. PROMs and PREMs proved feasible for evaluating patient-centered outcomes and revealed meaningful differences supporting personalized surgical decisions.