International Journal of Gynecological Cancer最新文献

Background: Vulvar squamous cell carcinoma incidence is increasing, especially among women under 60, largely attributed to human papillomavirus infections. Precursor pre-invasive vulvar lesions are frequently underdiagnosed. Routine vulvar inspection during cervical cancer screening could offer an opportunity for the detection of these lesions.

Objective: To emphasize the importance of integrating routine vulvar inspection during cervical cancer screening procedures and to raise awareness about the early detection of vulvar squamous cell carcinoma and its precursors to reduce the diagnostic delay of vulvar pathologies.

Methods: A multidisciplinary task force comprising experts from 4 international scientific societies was formed. A focused literature review was conducted, and consensus statements were developed through a structured voting process to ensure clinical relevance and comprehensiveness.

Results: The consensus defines key elements of normal vulvar anatomy, identifies potential pre-cancerous dermatoses, and highlights risk factors for vulvar malignancy. The consensus statements promote the integration of vulvar inspection into cervical cancer screening procedures, urging health care professionals across various levels to receive training and guidance in vulvar examinations and enhancing patient education. Health care providers are recommended to gather a brief history of vulvar symptoms, conduct comprehensive inspections of the vulvar area, and report any abnormalities. For patients with positive human papillomavirus or Pap tests, they should closely monitor vulvar findings, encourage self-examinations, and discuss risks for intra-epithelial or invasive neoplasia.

Conclusions: Establishing standardized practices in vulvar inspection during cervical cancer screening procedures along with public awareness, could significantly impact early detection and timely interventions of vulvar pathologies at cancer risk ultimately reducing the burden of vulvar cancers.

Objective: Evaluation of prognostic factors is crucial in patients with endometrial cancer for optimal treatment planning and prognosis assessment. This study proposes a deep learning pipeline for tumor and uterus segmentation from magnetic resonance imaging (MRI) images to predict deep myometrial invasion and cervical stroma invasion and thus assist clinicians in pre-operative workups.

Methods: Two experts consensually reviewed the MRIs and assessed myometrial invasion and cervical stromal invasion as per the International Federation of Gynecology and Obstetrics staging classification, to compare the diagnostic performance of the model with the radiologic consensus. The deep learning method was trained using sagittal T2-weighted images from 142 patients and tested with a 3-fold stratified test with 36 patients in each fold. Our solution is based on a segmentation module, which employed a 2-stage pipeline for efficient uterus in the whole MRI volume and then tumor segmentation in the uterus predicted region of interest.

Results: A total of 178 patients were included. For deep myometrial invasion prediction, the model achieved an average balanced test accuracy over 3-folds of 0.702, while experts reached an average accuracy of 0.769. For cervical stroma invasion prediction, our model demonstrated an average balanced accuracy of 0.721 on the 3-fold test set, while experts achieved an average balanced accuracy of 0.859. Additionally, the accuracy rates for uterus and tumor segmentation, measured by the Dice score, were 0.847 and 0.579 respectively.

Conclusion: Despite the current challenges posed by variations in data, class imbalance, and the presence of artifacts, our fully automatic approach holds great promise in supporting in pre-operative staging. Moreover, it demonstrated a robust capability to segment key regions of interest, specifically the uterus and tumors, highlighting the positive impact our solution can bring to health care imaging.

Objective: We sought to determine the safety and efficacy of the oral progesterone antagonist onapristone in combination with anastrozole in patients with recurrent progesterone receptor-positive adult-type granulosa cell tumor of the ovary.

Methods: This was a single-institution phase II study of patients with progesterone receptor-positive adult-type granulosa cell tumor who received at least 1 prior line of chemotherapy. Patients were enrolled from November 2021 to August 2022 and tissue was evaluated for progesterone receptor status via immunohistochemistry. Eligible patients had progesterone receptor expression ≥1% on tissue collected within 3 years of enrollment. Patients received 50 mg of onapristone extended-release twice daily and 1 mg of anastrozole by mouth daily until progression of disease or discontinuation of treatment. Adverse events were graded by Common Terminology Criteria for Adverse Events version 5.0. The primary end point was the overall response rate by Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end points were response duration, clinical benefit rate, progression-free survival, and safety.

Results: Fourteen patients with adult-type granulosa cell tumor enrolled and completed stage 1 accrual. There were no objective responses seen during the study period. The study was closed when further development of onapristone extended-release was discontinued. All 14 patients were evaluable, with median progression-free survival of 3.6 months (range; 1.7-7.1), a 6-month progression-free survival rate of 28.6% (range; 8.8%-52.4%), a 12-month progression-free survival rate of 10.7% (range; 0.8%-35.4%), and a clinical benefit rate of 42.9% (range; 17.7%-71.7%).

Conclusion: The study did not meet its primary end point. Although the combination of onapristone extended-release and anastrozole was well-tolerated, there were no objective responses in patients with progesterone receptor-positive adult-type granulosa cell tumor.

Objective: Endometrial carcinomas with mismatch repair deficiency (MMRd) and no specific molecular profile (NSMP) are considered to have intermediate prognoses. However, potential prognostic differences between these molecular subgroups remain unclear due to the lack of standardized control for clinicopathologic factors. This study aims to evaluate outcomes of MMRd and NSMP endometrial carcinomas across guideline-based clinicopathologic risk groups.

Methods: This study analyzed patients treated at a single tertiary center. Immunohistochemistry and polymerase-ϵ sequencing were performed for molecular classification. MLH1-deficient tumors underwent methylation-specific multiplex ligation-dependent probe amplification. Carcinomas were classified into clinicopathologic risk groups according to European guidelines.

Results: The analysis included 420 MMRd and 399 NSMP carcinomas. Among MMRd cases, 224 were subcategorized as MLH1-methylated or MLH1-non-methylated. Median follow-up was 71 months (range; 1-136). Survival differences were most notable in clinicopathologic medium-risk carcinomas, with the MMRd subgroup exhibiting poorer progression-free, disease-specific, and overall survival compared to NSMP. Adjusting for age and adjuvant therapy, MMRd still showed an association with progression-free survival. Both MLH1-methylated (n = 154) and MLH1-non-methylated tumors (n = 70) were associated with more aggressive clinicopathologic risk groups compared to NSMP, but only methylated tumors showed poorer outcomes.

Conclusion: The distinct outcomes for MMRd and NSMP in the clinicopathologic medium-risk group suggest that uterine risk factors may worsen the prognosis for MMRd endometrial carcinomas. Advanced stage may be the primary factor contributing to poor outcomes in high-risk-advanced metastatic carcinomas. Clinicopathologic factors may particularly worsen the prognosis of MLH1-methylated carcinomas.

Objective: The goal of this study was to evaluate safety after same-day discharge following minimally invasive hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia in patients with and without morbid obesity (body mass index 40 kg/m²). Our secondary objective was to identify barriers to same-day discharge.

Methods: Retrospective cohort study of patients undergoing minimally invasive hysterectomy for endometrial cancer and endometrial intraepithelial neoplasia from January 2016 to May 2022. Complications within 60 days of surgery were reviewed. Of those undergoing same-day discharge, we compared the 60-day complication rates between patients with and without morbid obesity. We compared demographic and clinical characteristics associated with same-day discharge.

Results: 1449 patients underwent minimally invasive hysterectomy during the study period, and 1029 (71%) were discharged the same day. 55 patients (5.3%) experienced a complication after same-day discharge. There was no difference in the frequency of complications between patients with (5.1%) and without (5.4%) morbid obesity (p = .86). Factors associated with not being discharged the same day included older age, higher body mass index, and several co-morbidities (all p < .05). Patients with morbid obesity were twice as likely to stay overnight after controlling for age, comorbidities, and surgical indication (adjusted OR 2.1, 95% CI 1.58 to 2.80).

Conclusion: Despite concerns about the safety of same-day discharge in patients with morbid obesity, 60-day complication rates are not significantly different for this group compared to patients with a body mass index <40 kg/m². Patients with morbid obesity were less likely to be discharged the same day after controlling for confounders.

Objective: The aim of this study was to examine disparities in 20-year incidence trends and mutations in advanced-stage uterine cancer in the United States, given poor survival rates.

Methods: Data were obtained from the United States Cancer Statistics for patients from 2001 to 2019 with International Federation of Gynecology and Obstetrics 2009 stage IVA and IVB uterine cancer. SEER∗Stat 8.3.9.2 and Joinpoint Regression Program 4.9.0.0 were used to calculate cancer incidence per 100,000 women, annual percentages, and average annual percent change (AAPC). The mutational landscape of advanced uterine cancer was explored using data from the Genomic Data Commons.

Results: In United States Cancer Statistics, 75,450 patients with advanced uterine cancer were identified with an annual percentage increase of 2.63% between 2001 and 2019 and significantly higher rates in Black, Hispanic, and Asian patients compared with White patients (AAPC Black: 3.56%, AAPC Hispanic: 3.12%, and AAPC Asian 3.06% vs AAPC White: 2.07%, each p < .001). AAPC in patients with serous carcinomas increased by 6.32% in Black vs 3.91% in White patients (p < .001). Furthermore, AAPC was 3.0% for Black patients vs 0.7% for White patients with leiomyosarcoma (p < .001). In the Genomic Data Commons, TP53 mutations were more common, and PTEN was less common in Black vs White patients, older vs younger patients, advanced vs early stage, or high- vs low-risk histologic subtypes (p < .05). Mutations in BRCA1, BRCA2, POLE, and PMS2 were less common in high- vs low-risk histologic subtypes (p < .05).

Conclusion: Advanced-stage uterine cancer rates are rising in the United States, particularly affecting Black and Hispanic women. Molecular differences exist by age, race, stage, and histology.

Objective: We evaluated the accuracy of oncologists' estimates of expected survival time in recurrent ovarian cancer.

Methods: Oncologists estimated expected survival time at baseline for each patient, who were then followed up for survival time. We hypothesized that oncologists' estimates of expected survival time would be independently significant predictors of survival, unbiased (approximately equal proportions [50%] living longer versus shorter than their expected survival time), or imprecise (<30% within 0.75-1.33 times their observed survival time). We also hypothesized that simple multiples (0.25, 0.5, 2, and 3) of each expected survival time would define ranges that accurately described 3 scenarios for survival time: worst-case (10% of participants with the shortest survival), typical (middle 50%), and best-case (10% with the longest survival) scenarios.

Results: There were 898 participants; the median (interquartile range) for expected survival time was 12 months (range; 8-14) and the median for observed survival time was 13 months (range; 12-14). Oncologists' estimates of expected survival time were independently significant predictors of observed survival time (HR 0.96 per month, 95% CI 0.94-0.98, p < .0001). As hypothesized, 55% lived longer than their expected survival time, 45% shorter than their expected survival time, and 23% of estimates of expected survival time were within 0.75 to 1.33 times their observed survival time. Simple multiples of the expected survival time provided ranges that accurately described 3 scenarios for survival time: 7% of patients died within 0.25 times their expected survival time (worst-case), 53% lived between 0.5 and 2 times their expected survival time (typical), and 13% lived longer than 3 times their expected survival time (best case).

Conclusion: Oncologists' estimates of expected survival time were independently significant predictors of survival time. Simple multiples of the expected survival time provided accurate ranges for scenarios for survival that are useful for explaining prognosis.