International Journal of Gynecological Cancer最新文献

Objective: This study aimed to evaluate the efficacy, optimal timing, and safety of incorporating pelvic radiotherapy into chemotherapy and immunotherapy regimens with or without bevacizumab for stage IVB cervical cancer.

Methods: A retrospective analysis was conducted on patients with stage IVB cervical cancer treated at Hunan Cancer Hospital between January 2018 and December 2024. Patients were divided according to treatment modality into radiotherapy group A (pelvic radiotherapy + chemotherapy + immunotherapy ± bevacizumab; n = 83), radiotherapy group B (pelvic radiotherapy + chemotherapy ± bevacizumab; n = 45), chemotherapy group A (immunotherapy + chemotherapy ± bevacizumab; n = 19), and chemotherapy group B (chemotherapy ± bevacizumab; n = 29). Efficacy was evaluated every 2 to 3 cycles. Patients without disease progression or with unresolved symptoms from primary local lesions received pelvic radiotherapy plus brachytherapy. Systemic treatments continued for 6 to 8 cycles, followed by maintenance immunotherapy with or without bevacizumab. Maintenance treatment was only provided to patients undergoing immunotherapy. Progression-free survival, overall survival, and adverse reactions were assessed.

Results: A total of 176 patients were evaluated. The median follow-up was 31 months (range; 5-79). Median progression-free survival for the pelvic radiotherapy + immunotherapy + chemotherapy, pelvic radiotherapy + chemotherapy, immunotherapy + chemotherapy, and chemotherapy groups was 15, 12, 7, and 4 months, respectively; similarly, median overall survival was not reached and was 29, 13, and 13 months, respectively. Progression-free survival and overall survival were significantly higher in the radiotherapy groups (all p < .05). Radiotherapy initiated within ≤3 chemotherapy cycles resulted in longer progression-free survival (16 vs 10 months, p = .002) and overall survival (not reached vs 26 months, p = .045). Immunotherapy for >1 year yielded better outcomes (median progression-free survival, 22 months; median overall survival, not reached) than ≤1 year or none (all p < .05). Common adverse events included leukopenia, thrombocytopenia, thyroid dysfunction (23/102), and intestinal perforation (4.7%).

Conclusions: Pelvic radiotherapy combined with chemotherapy and immunotherapy was significantly associated with better progression-free survival and overall survival in stage IVB cervical cancer. Early radiotherapy (≤3 cycles) and immunotherapy for >1 year showed stronger survival associations.

Objective: Age-standardized cervical cancer rates have fallen worldwide since 1990, yet demographic aging may be increasing the absolute burden among older women; evidence specific to those aged 60 years and older remains fragmented.

Methods: We analyzed Global Burden of Disease 2021 estimates (1990-2021). Outcomes included counts and age-standardized rates for incidence, mortality, and disability-adjusted life-years, plus estimated annual percentage change. We examined the age-specific trends in women aged ≥ 60 years by sociodemographic index and applied a frontier framework (an efficiency benchmark mapping the minimum observed burden at each sociodemographic index; "distance to frontier" denotes the shortfall) to quantify performance gaps.

Results: Despite falling age-standardized rates for incidence, mortality, and disability-adjusted life years, absolute cases and deaths among women aged 60 years and older increased with population growth and aging. Declines were limited at ages 85 years or older. Frontier analysis indicated large, potentially avoidable gaps and wide dispersion at comparable levels of the sociodemographic index: high settings improved most; high-middle and middle settings improved modestly; low-middle settings, notably at ages 70 to 84 years, lagged; and low settings remained high. Mortality dominated disability-adjusted life-years, implying that rate reductions have not yielded proportional survival gains at advanced ages.

Conclusions: Cervical cancer control is challenged by population aging, which elevates the absolute burden in older women even as age-standardized rates decline. Risk-based human papillomavirus screening with self-collection and geriatric assessment-guided treatment must be prioritized to convert rate declines into fewer deaths and less disability in older women.

Objective: This study aimed to prospectively evaluate whether hospital case volume is positively associated with both the outcome and the quality of care of uterine corpus cancer in Belgium.

Methods: This was a prospective, observational, registration-based, real-world database study. Hospital case volume was categorized according to the total number of patients treated on average per year: low (<10/y), medium (10-19/y), and high (≥20/y). Adjusting for patient case mix and intra-hospital correlations, logistic and Cox proportional hazards regression were used to test for associations between hospital case volume and a multi-disciplinary set of process and outcome indicators. Sub-group analyses by recurrence risk were performed for overall survival and disease-free survival.

Results: In total, 4178 patients diagnosed with a primary cancer of the uterine corpus between 2012 and 2016 in Belgium were included. Compared with patients treated in high-volume hospitals, patients treated in low-volume hospitals were more likely to die of any cause within 5 years after diagnosis (adjusted hazard ratio 1.37, p < .01), as were patients treated in medium-volume hospitals (adjusted hazard ratio 1.18, p < .05). Similar results were observed in the sub-group analyses, but only among patients with high-intermediate-risk and high-risk disease. In contrast, hazards for disease-free survival did not differ by hospital case volume, neither in the total study population nor in the sub-group analyses by recurrence risk. Furthermore, analysis of the process indicators showed that patients treated in low- and medium-volume hospitals were less likely to receive multiple guideline-recommended procedures compared with those treated in high-volume hospitals, including minimally invasive surgery, surgical lymph node staging, staging omentectomy, and adjuvant chemotherapy.

Conclusions: On average, increased hospital case volume was positively associated with improved overall survival and quality of care, supporting centralization of uterine corpus cancer care into high-volume reference centers in Belgium.

This retrospective study compared clinico-pathological characteristics and survival of large cell to small cell neuroendocrine carcinomas of the uterine cervix identified in the Commission-on-Cancer's National Cancer Database from 2004 to 2022 (n = 2051). Large cell neuroendocrine carcinoma, reported in 16.3%, was more likely to be T1 classification (37.1% vs 29.5%) and have smaller cervical tumor (median size, 47 and 59 mm) but less likely to be T3 classification (15.6% vs 22.4%) and N1 classification (36.8% vs 45.1%) than small cell neuroendocrine carcinoma (all, p < .05). In propensity score inverse probability of treatment weighting, large cell neuroendocrine carcinoma had overall survival comparable to small cell neuroendocrine carcinoma (5-year rates, 33.8% vs 30.9%, hazard ratio 1.02, 95% confidence interval 0.86 to 1.20). This survival association was consistent across stage I, II, III, and IV diseases. In the secondary cohort of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, cause-specific survival from cervical cancer was similar between large cell and small cell neuroendocrine carcinomas (5-year rates, 36.1% vs 39.1%, hazard ratio 1.25, 95% confidence interval 0.88 to 1.76). In conclusion, these data suggest that large cell neuroendocrine carcinoma represents less than 20% of neuroendocrine carcinomas of the uterine cervix, and although tumor characteristics appear to be less aggressive, oncologic outcomes are dismal and similar to small cell neuroendocrine carcinoma.

Objective: To evaluate the morbidity of sentinel lymph node (SLN) biopsy with carbon nanoparticle suspension mapping compared to pelvic lymphadenectomy in patients with early-stage cervical cancer.

Methods: This prospective study consecutively enrolled patients who were diagnosed pre-operatively with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IA2 to IB1 cervical cancer with histologically confirmed squamous-cell carcinoma or adenocarcinoma. Randomization was performed before surgery, and participants were assigned to undergo a SLN biopsy with carbon nanoparticle suspension (the biopsy group) or a pelvic lymphadenectomy (the lymphadenectomy group). The primary endpoint was lymph-related morbidity, and secondary endpoints included oncologic outcomes.

Results: A total of 208 patients were randomized to the biopsy group (104 cases) and the lymphadenectomy group (104 cases). Lymph-related complications, including lower extremity lymphedema (3.8% vs 19.2%, relative risk 0.20, 95% confidence interval [CI] 0.07 to 0.57, p < .01) and pelvic lymphoceles (18.3% vs 43.3%, p < .01), were significantly reduced in the biopsy group compared to the lymphadenectomy group. The incidence of neurological complications in the biopsy group, including those occurring during the peri-operative period and at the 6-month follow-up, and the occurrence of venous thrombosis, was significantly reduced (p < .05). In addition, the biopsy group demonstrated significantly shorter operative times (p < .01), lower pelvic drainage volumes (p < .01), shorter pelvic drainage times (p < .01), and decreased post-operative hospital stays (p = .02). Oncologic outcomes were comparable in the 2 groups, with the median follow-up of 18-month disease-free survival rates of 98.2% in the biopsy group and 95.2% in the lymphadenectomy group (hazard ratio 0.51, 95% CI 0.10 to 2.55, p = .42).

Conclusions: SLN biopsy using carbon nanoparticle suspension as a substitute for pelvic lymphadenectomy can reduce post-operative morbidity, particularly lymph-related complications, with comparable short-term oncologic safety in FIGO stage IA2 to IB1 cervical cancer.

Objectives: To evaluate survival outcomes and patterns of failure in small cell neuroendocrine carcinoma of the cervix treated with curative-intent chemoradiotherapy at a tertiary referral center.

Methods: Patients with International Federation of Gynecology and Obstetrics 2009 stage IB to IIIB small cell neuroendocrine carcinoma of the cervix treated between 1996 and 2017 were retrospectively reviewed. All underwent baseline magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT). Definitive chemoradiotherapy consisted of pelvic external-beam radiotherapy (45 Gy/25 fractions) with high-dose-rate brachytherapy (Equivalent Dose in 2Gy fractions (EQD2) >85 Gy) and concurrent platinum-etoposide chemotherapy, followed by 2 sequential cycles. Patients who underwent primary surgery followed by adjuvant chemoradiotherapy were analyzed separately. Survival outcomes were estimated using Kaplan-Meier analysis.

Results: Thirty-two patients were included; 26 received definitive chemoradiotherapy and 6 underwent surgery followed by adjuvant radiotherapy. Median follow-up was 48 months (interquartile range; 12-213). Five-year overall survival and progression-free survival were 54.6% and 49.7%, respectively. Pelvic control was high (88%), with no local relapses in patients with stage ≤IIA disease. Distant relapse occurred in 44% of patients, predominantly para-aortic (57%) and visceral (lung, liver, bone). Node-negative patients achieved significantly higher 5-year overall survival (70.6% vs 31.3%, p = .04) and progression-free survival (66.9% vs 22.4%, p = .01).

Conclusions: Definitive chemoradiotherapy achieves excellent loco-regional control and durable survival in small cell neuroendocrine carcinoma of the cervix, particularly in early-stage and node-negative disease. Distant relapse remains the predominant failure pattern, highlighting the need for improved systemic approaches. These results support omission of radical surgery in well-staged early-stage patients managed with modern chemoradiotherapy.

"ESMO 2025 Highlights: Top Studies in Gynecologic Oncology" provides an expert summary of the most impactful research presented at the European Society for Medical Oncology (ESMO) Congress 2025, held in Berlin, Germany, from October 17 to 21, 2025. This 5-day congress brought together over 37,000 participants from 174 countries and territories, featuring 661 speakers, 213 sessions, and 2927 abstracts, including 112 late-breaking abstracts, 170 proffered papers, 214 mini-orals, and 2543 posters (of which 649 were e-posters). In the field of gynecologic oncology, 145 posters, 7 mini orals, and 5 proffered paper presentations covered key topics such as immunotherapy, targeted therapies, maintenance strategies, surgical innovation, and real-world evidence. This review highlights the studies with the greatest potential to influence clinical practice and shape future research in ovarian, endometrial, cervical, and rare gynecologic cancers.

Objective: Endometrial cancer is the most common gynecologic malignancy in the United States and a leading cause of gynecologic cancer mortality worldwide. Although most cases are diagnosed early, 15% to 25% present with advanced disease and have poor outcomes. The prognostic significance of cervical involvement in advanced endometrial cancer remains unclear. This study evaluated cervical stromal involvement using the International Federation of Gynecology and Obstetrics 2023 classification in a large advanced-stage cohort.

Methods: We performed a retrospective cohort study of 363 patients with advanced-stage endometrial cancer surgically treated at a single institution between 2005 and 2022. Cervical involvement was defined as stromal infiltration. Clinical, pathological, and treatment variables were collected. Disease-free survival and overall survival were assessed with Kaplan-Meier estimates and Cox proportional hazards models. Disease-free survival was further analyzed adjusting for American Society of Anesthesiologists (ASA) classification, tumor grade, and lymphovascular space invasion.

Results: Cervical involvement was observed in 122 patients (33.6%). Univariate analysis showed reduced disease-free survival in patients with cervical involvement (5-year disease-free survival: 39.8% vs 48.3%; hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.87, p = .02), while overall survival differences were not significant. After adjustment, cervical involvement lost independent prognostic significance (disease-free survival: HR 1.20, 95% CI 0.85 to 1.69, p = .29). ASA status, high tumor grade, and lymphovascular space invasion remained strong predictors of recurrence. Surgical approach did not impact survival outcomes.

Conclusions: Cervical involvement reflects tumor aggressiveness but is not an independent predictor of recurrence or survival in advanced endometrial cancer.