International Journal of Gynecological Cancer最新文献

Objective: This study aimed to assess the predictive performance of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator in estimating 30-day post-operative complications and mortality among patients undergoing elective gynecologic oncology surgery.

Methods: This single-center retrospective cohort study included 789 patients who underwent elective gynecologic oncology surgery at a tertiary center between January 2016 and February 2025. Pre-operative data for 19 risk factors included in the ACS NSQIP calculator were extracted from patient records. Individual complication risks were calculated and compared with actual post-operative outcomes using binary logistic regression analysis, receiver operating characteristic curve analysis, and the Brier score.

Results: Severe complications, defined on the basis of ACS NSQIP composite criteria, occurred in 6.5% of patients, while "any complication" was observed in 10.1%. The ACS NSQIP model demonstrated excellent predictive performance for mortality (area under the curve [AUC] = 0.965, Brier = 0.006), good performance for cardiac complications (AUC = 0.885), although calibration was moderate (Brier = 0.077), and acceptable performance for venous thromboembolism (AUC = 0.789, Brier = 0.006). The model showed acceptable discrimination and calibration for serious complications (AUC = 0.701, Brier = 0.057), whereas predictive accuracy for "any complication" was fair but statistically significant (AUC = 0.657, Brier = 0.086). Acceptable discriminatory performance was also observed for surgical site infection (AUC = 0.776, Brier = 0.037) and re-operation (AUC = 0.725, Brier = 0.011). In contrast, despite moderate AUC values, predictive performance for renal failure and pneumonia was limited, as associations were not statistically significant in logistic regression analyses. The model performed poorly for sepsis, urinary tract infection, and re-admission.

Conclusions: The ACS NSQIP Surgical Risk Calculator provides a clinically applicable tool for pre-operative risk assessment in gynecologic oncology surgery, particularly for predicting mortality and selected systemic complications, including cardiac events and venous thromboembolism.

Objective: To describe the clinicopathologic phenotypes of endometrial cancer across molecular sub-types and to identify independent predictors of nodal metastasis and sentinel lymph node (SLN) mapping failure.

Methods: This multicenter retrospective study included 2592 endometrial cancer patients with defined molecular classification and SLN mapping. Continuous variables are reported as medians. Tumors were classified as POLE-mutated, mismatch repair-deficient, p53-abnormal, or no specific molecular profile. When hormone receptor status was available, no specific molecular profile tumors were further sub-classified according to European Society of Gynaecological Oncology/European Society for Therapeutic Radiology and Oncology/European Society of Pathology 2025 criteria.

Results: Molecular sub-types exhibited distinct phenotypes: POLE-mutated tumors occurred in younger patients (median 56 years), with the lowest body mass index (27.0 kg/m²), smallest tumor size (26 mm), and the lowest nodal metastasis rate (8.0%); p53-abnormal tumors affected older patients (67 years), with the largest tumors (35 mm), frequent non-endometrioid histology (78.4%), and the highest nodal metastasis rate (26.1%); mismatch repair-deficient tumors showed intermediate age (63 years), body mass index (28.5), predominantly endometrioid histology (90.4%), substantial lymphovascular space invasion (28.3%), and a 19.4% nodal metastasis rate; no specific molecular profile tumors, the most common group (55.6%), had the highest body mass index (29.0 kg/m²), were low-grade in 84.2% of cases and endometrioid in 92.5%, and exhibited a low metastasis rate (11.0%). Among no specific molecular profile tumors with available hormone receptor status, a high-risk-like sub-group (22%), characterized by hormone receptor negativity and/or high-grade histology, displayed aggressive features macro-metastases (18.2%), SLN mapping failure (24.3%), substantial lymphovascular space invasion (33.2%), deep myometrial invasion (54.3%), and cervical stromal involvement (23.1%) (resembling a "p53-abnormal-like" phenotype despite their molecular profile). At multivariate analysis, molecular sub-type was not an independent predictor of nodal involvement (p=.20) or SLN mapping failure (p=.75).

Conclusions: Molecular sub-types in endometrial cancer reflect distinct and reproducible phenotypes. However, classic histopathologic features remain the strongest predictors of nodal spread and SLN detection failure.

Objective: The prognostic significance of pre-diagnostic physical activity in cervical cancer remains unclear. This study examined the association between pre-diagnostic physical activity and all-cause mortality among women with cervical cancer.

Methods: In a population-based cohort study using nationwide South Korean registry data, 8833 women aged 19 to 79 years with newly diagnosed cervical cancer who completed health screenings within 1 year before diagnosis were analyzed. Physical activity was self-reported and categorized by intensity, duration, and total energy expenditure in metabolic equivalent task-minutes per week. All-cause mortality was assessed using multi-variable Cox proportional hazards models with sub-group analyses by Surveillance, Epidemiology, and End Results stage and age.

Results: Among the study population, 64.9% had localized, 23.7% regional, and 5.0% distant disease. Higher total energy expenditure was associated with reduced mortality. Compared with <500 metabolic equivalent task-minutes per week, 500 to 1499 metabolic equivalent task-minutes per week was associated with lower mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.98). Physical activity intensity alone was not independently associated with mortality; however, among patients with localized disease, vigorous-intensity activity (HR 0.64, 95% CI 0.43 to 0.95) and regular exercise (HR 0.62, 95% CI 0.43 to 0.88) were associated with lower mortality. Among patients aged ≥65 years, associations between physical activity and mortality were observed mainly in localized-stage disease, with no significant associations in other stages or younger age groups.

Conclusions: Higher levels of pre-diagnostic physical activity were associated with improved survival in women with localized cervical cancer, particularly among those aged ≥65 years. These findings suggest that pre-diagnostic physical activity may have prognostic relevance in specific patient sub-groups.

Objective: The role of bilateral salpingo-oophorectomy at the time of radical hysterectomy for cervical adenocarcinoma remains controversial. We aim to study the impact of bilateral salpingo-oophorectomy on overall survival of women undergoing radical hysterectomy for treatment of cervical cancer, specifically, with adenocarcinoma histology.

Methods: We conducted a retrospective analysis of the National Cancer Database during 2004-2022. We included women aged 18 to 45 years, with a diagnosis of cervical adenocarcinoma, who underwent radical hysterectomy with or without bilateral salpingo-oophorectomy. Clinicopathologic characteristics, treatment patterns, and outcomes were compared. Kaplan-Meier survival estimates and Cox proportional hazards models were used to evaluate overall survival.

Results: A total of 6061 patients with adenocarcinoma were identified: 4606 (76.0%) underwent hysterectomy with bilateral salpingo-oophorectomy and 1455 (24.0%) without. Patients in the bilateral salpingo-oophorectomy group were older (median 39 vs 37 years, p < .001). Adjuvant chemotherapy (871 [19.2%] vs 194 [13.5%]) and radiotherapy (1085 [24.3%] vs 247 [17.9%]) were more frequently used in the bilateral salpingo-oophorectomy group (p < .001). On unadjusted analysis, bilateral salpingo-oophorectomy was associated with inferior survival in adenocarcinoma 83.9% versus 87.0% alive at 190 months (log-rank p = .022). After adjustment for age, race, adjuvant therapy, and disease stage, bilateral salpingo-oophorectomy was not associated with survival (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.78 to 1.26). For the whole cohort, including adenocarcinoma and squamous cell carcinoma, the Cox regression concluded that bilateral salpingo-oophorectomy is associated with worse survival (adjusted HR 1.19, 95% CI 1.04 to 1.36). For adenocarcinoma stage I disease with no adjuvant radiotherapy or chemotherapy (n = 3893), overall survival was similar between groups (log-rank p = .758).

Conclusions: Bilateral salpingo-oophorectomy does not confer a survival advantage and may worsen long-term survival, particularly, in squamous cell carcinoma. Ovarian preservation is oncologically safe in early-stage cervical cancer, including adenocarcinoma, and should be routinely considered for pre-menopausal women without evidence of ovarian involvement.