International Journal of Gynecological Cancer最新文献

Objective: This study aimed to assess the readability of patient-facing gynecologic cancer clinical trial information on National Cancer Institute-Designated Comprehensive Cancer Center (NCI-CCCs) websites.

Methods: This was a cross-sectional analysis of publicly accessible information pertaining to gynecologic cancer clinical trials on NCI-CCC's websites in September 2023. Clinical trial descriptions for endometrial, cervical, and ovarian cancers were assessed. Websites with limited to no descriptive information regarding their clinical trials were excluded. Readability was assessed using Readability Studio Professional Edition software for 5 readability metrics (FORCAST, Fry, Gunning Fog, Raygor Estimate, and SMOG).

Results: Of 56 NCI-CCCs evaluated, 78% (n = 44) had information pertaining to gynecologic cancer clinical trials and gynecologic clinical trial descriptions for readability analysis. A total of 14% (n = 8) lacked clinical trial descriptions and linked to Clinicaltrials.gov and 7% (n = 4) only had information available through additional inquiry within the cancer center. The overall mean reading level across all NCI-CCCs was 15th-grade or collegiate-level reading. The specific readability metric analyses were as follows: FORCAST: 12.4 (range; 9.7-14.7), Fry: 17 (range; 13-17), Gunning Fog: 16.8 (range; 10-19), Raygor Estimate: 16 (range; 7-17), and SMOG: 16.5 (range; 11.4-19). Clinical trial information was stratified by the National Cancer Institute Geographic Management of Cancer Health Disparities Program, with no statistically significant differences in readability or complexity.

Conclusions: In this analysis of publicly available patient-facing information on NCI-CCC websites regarding gynecologic cancer clinical trials, the readability scores were above the high school level across the United States, which far exceeds the recommended readability metric of sixth grade by the National Institutes of Health. Opportunities exist to improve the readability of gynecologic cancer clinical trial online literature, which may facilitate patient access, participation, and understanding.

Objective: Interest in long-term outcomes of radical hysterectomy for cervical cancer has increased, especially after the LACC trial findings, which showed worse outcomes for minimally invasive surgery. However, limited information is available on 10-year oncological outcomes, particularly, recurrence and survival. The primary objective of this study was to analyze the 10-year oncological outcomes of patients with International Federation of Gynecology and Obstetrics 2009 stage IB1 cervical cancer treated with radical hysterectomy performed via minimally invasive or open approaches.

Methods: This retrospective, multi-center, observational study updates the data from the SUCCOR cohort. Patients diagnosed between January 2013 and December 2014 with tumors ≤4 cm without extra-cervical metastasis and treated with radical hysterectomy as the primary treatment were included, and a 10-year follow-up after surgery was successfully conducted.

Results: A total of 556 patients were analyzed. The median age was 46 years (range; 18-82). The most common final International Federation of Gynecology and Obstetrics 2009 stage was IB1, 474 patients (85%), and the most common histology was squamous carcinoma, 376 patients (67.6%). The 5-year disease-free survival was 93%, and the 10-year disease-free survival was 90%. The overall survival was 97% at 5 years and 89% at 10 years. During follow-up, 9% (n = 49) of patients experienced recurrences, 78% (n = 38) within the first 5 years. Comparing surgical approaches, 10-year disease-free survival was 92% for minimally invasive surgery and 88% for open surgery (p = .12). Similarly, 10-year overall survival was 92% for minimally invasive surgery and 88% for open surgery (p = .12). Post-recurrence disease-specific survival was 47% at 60 months and 39% at 96 months. The 2-year survival after recurrence was 80% for late recurrences (>5 years) versus 69% for early recurrences.

Conclusions: The overall survival after radical hysterectomy at 5-years was 97% in patients with early-stage cervical cancer. The recurrence rate at 10 years was 9%. No differences in 10-year survival were observed between the surgical approaches.

Objectives: Primary ovarian leiomyosarcomas are exceptionally rare, constituting less than 1% of ovarian tumors, and they typically have a poor prognosis. The available data on the management of these tumors are sparse, with limited publications mainly comprising small retrospective series that include multiple histologic types. The aim is to evaluate the clinical, surgical, pathologic characteristics and clinical outcome of patient affected by primary ovarian leiomyosarcomas.

Methods: Using the national database (NetSarc), we conducted a retrospective study of the outcomes of primary ovarian leiomyosarcomas at 18 French Sarcoma Group centers. Patients with any International Federation of Gynecology and Obstetrics stage of primary ovarian leiomyosarcoma at first diagnosis and available follow-up were included.

Results: A total of 39 patients with primary ovarian leiomyosarcomas were included: 35 had localized disease and 4 had metastatic disease. The median tumor size was 134 mm. Radical and wide surgery was performed on 21 (62%) and 13 patients (38%), respectively. Tumor grade 3, presence of necrosis, mitoses ≥20 high-power field, and high Ki-67 expression >30% were reported in 17 of 34 (50%), 29 of 34 (85%), 17 of 34 (50%), and 17 of 27 patients (63%), respectively. Positive estrogen receptor expression was reported in 14 of 27 patients (52%), whereas progesterone receptor expression was observed in 10 of 27 patients (37%). Adjuvant chemotherapy was administered in 12 of 34 patients (35%), whereas pelvic adjuvant radiotherapy in 8 of 34 (23%). Of the early-stage primary ovarian leiomyosarcomas, 9 had isolated pelvic recurrence, whereas 18 had parenchymal distant metastases. A total of 15 patients (44%) died of disease. In early-stage primary ovarian leiomyosarcomas, high mitotic counts and progesterone receptor negativity were variables associated with worse survival.

Conclusions: Surgery is the cornerstone of treatment for early-stage primary ovarian leiomyosarcoma, whereas the role of adjuvant treatment remains unclear. Some pathologic features were associated with poorer survival. Owing to the rarity of ovarian leiomyosarcomas, referring patients to expert sarcoma centers is highly recommended.

Objective: To evaluate the prognosis and fertility of patients with stage II to IV borderline ovarian tumors who underwent fertility-sparing surgery.

Methods: This retrospective single-institution study included patients aged <40 years with stage II to IV borderline ovarian tumors at the First Affiliated Hospital of Zhengzhou University between January 2007 and March 2023. The primary outcome was disease-free survival. The association of disease-free survival was assessed using the Kaplan-Meier and Cox proportional hazards methods.

Results: A total of 144 patients were included in this study. Based on whether fertility-sparing surgery was performed, the patients were categorized into 2 groups: a fertility-sparing surgery group with 96 patients (66.67%) and a radical surgery group with 48 patients (33.3%). There were differences between the 2 groups in terms of age (27.36 ± 6.42 vs 34.67 ± 5.43, p < .001), pregnancy history (53.1%; 51/96) vs 81.2% (39/48), p = .001), maximum tumor diameter (103.00 [76.25, 148.25] vs 88.50 [60.25, 124.75], p = .011), involvement of bilateral ovaries (45.83%; [44/96] vs 66.67% [32/48], p = .018), and whether postoperative adjuvant chemotherapy (15.6% [15/96] vs 31.2% [15/48], p = .030). The median follow-up time after primary cytoreduction was 67.0 months (interquartile range; 44.0-101.75). At the end of the observation period, 32 (22.2%) patients experienced recurrence. There were 3 (2.1%) deaths and 2 cases (1.4%) of survival with tumors. Multivariate Cox proportional hazards regression analysis showed that fertility-sparing surgery, incomplete cytoreduction, micropapillary subtype, International Federation of Gynecology and Obstetrics stage III, and invasive implants were independent risk factors for poor disease-free survival. Among the patients with fertility intentions (41 cases), 34 (82.9%) had successful pregnancies. Twenty-nine patients (70.7%) had successful births, and 3 patients were pregnant at the time of study completion.

Conclusions: Fertility-sparing surgery may be feasible and considered for patients lacking other significant risk factors for disease-free survival, including incomplete cytoreduction, micropapillary subtype, International Federation of Gynecology and Obstetrics stage III, and invasive implants.

Objective: The success of surgery in ovarian cancer is based on achieving complete cytoreduction. In order to achieve the best outcomes, patients are triaged into either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. Current methods using computed tomography (CT) scans have limited accuracy in predicting optimal cytoreduction outcomes. This study investigated whether pre-operative blood count markers of inflammation could predict optimal cytoreduction, aiding in the triaging decision.

Methods: We conducted a retrospective chart review of patients with ovarian cancer stage IIIc to IV, treated at two medical centers in Israel between 2003 and 2019. Patients were categorized into those undergoing primary operation and those receiving neoadjuvant chemotherapy followed by interval debulking surgery. Pre-operative complete blood counts were used to calculate neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Statistical analyses were used to determine optimal cutoff values of hematologic markers to predict the likelihood of achieving optimal cytoreduction.

Results: Overall, 282 women fit the inclusion criteria, of which 133 underwent primary surgery and 149 had interval debulking surgery. Platelet-lymphocyte ratio was the only hematologic marker found to be significantly correlated with patient designation based on CT scans. The platelet-lymphocyte ratio cutoff value of 177 was identified as the optimal threshold (area under the curve 0.628, 95% CI 0.562 to 0.693, p < .001). Patients with levels >177 had significantly lower rates of complete debulking (R0) compared to those with levels ≤177 (33.3% vs 52.9%, p = .023) CONCLUSIONS: A platelet-lymphocyte ratio of 177 may serve as an adjunct marker alongside CT imaging in predicting optimal cytoreduction in ovarian cancer patients. Prospective studies are required to validate these findings and explore the integration of platelet-lymphocyte ratio into existing predictive models.

Objective: The CHAR1ZMA study described real-world duration of first-line maintenance niraparib monotherapy among patients with epithelial ovarian cancer.

Methods: This retrospective study used a US nationwide, electronic-health-record-derived, de-identified database. Eligible patients were aged ≥18 years with epithelial ovarian cancer who initiated first-line maintenance niraparib monotherapy (January 2017-December 2022 [inclusive]) following first-line platinum-based chemotherapy. Niraparib monotherapy duration was measured as the time to treatment discontinuation, estimated using Kaplan-Meier methodology, overall and stratified by treatment duration (early discontinuers [≤90 days]; non-early discontinuers [>90 days or did not discontinue]). Analyses were repeated in a sub-group of patients with homologous recombination-deficient tumors.

Results: Toxicity was the most common reason for niraparib discontinuation among early discontinuers (67.7%) and was less frequent among non-early discontinuers (18.1%). Dose modifications were less frequent among early discontinuers (29.8%) than non-early discontinuers (53.6%). Disease progression was the most common reason for niraparib discontinuation among non-early discontinuers (74.8%) and was less frequent among early discontinuers (30.4%). The observed median treatment duration was 7.2 months (95% CI 6.0 to 8.1) overall (N = 560) and was 4.5 months longer among non-early discontinuers (11.7 months [95% CI 9.8 to 14.7]; n = 399). In the homologous recombination-deficient sub-group (n = 144), the observed median treatment duration was 11.6 months (95% CI 7.8. to 16.1) and was 5.1 months longer among non-early discontinuers (16.7 months [95% CI 12.0 to 22.8]; n = 114).

Conclusion: In this real-world study of patients with epithelial ovarian cancer receiving first-line maintenance niraparib monotherapy, drug toxicity was the most common reason for treatment discontinuation in early discontinuers. Effective and early clinical management of drug toxicity may help mitigate these adverse events, allowing patients to remain on niraparib maintenance treatment longer and experience the potential full therapeutic benefit.