Journal of Gynecologic Oncology最新文献

Objective: This phase II study compared the efficacy and safety of lobaplatin versus cisplatin in concurrent chemoradiotherapy (CCRT) for elderly cervical cancer patients.

Methods: Elderly cervical cancer patients aged ≥65 years were randomly assigned (1:1) to lobaplatin-based (2 cycles of lobaplatin 30 mg/m² every 3 weeks) or cisplatin-based (5 cycles of cisplatin 40 mg/m² every week) CCRT. Radiotherapy included external beam radiotherapy (50.4 Gy in 28 fractions) and intracavitary brachytherapy (30 Gy in 5 fractions).

Results: From January 1, 2020, to December 31, 2023, 64 patients were enrolled: 31 were randomly assigned to the lobaplatin group and 33 to the cisplatin group. The lobaplatin group showed higher chemotherapy completion rates compared to the cisplatin group (83.9% vs. 54.5%, p=0.011). The objective response rate and disease control rate were comparable between 2 groups (93.5% vs. 93.9%, 96.8% vs. 97.0%). The 1- and 2-year overall survival rates of the lobaplatin group and the cisplatin group were 96.0% vs. 96.6%, 90.7% vs. 96.6%, respectively (p=0.558). The lobaplatin group had a lower incidence of nephrotoxicity (39.4% vs. 9.7%, p=0.006), and there was also a trend of lower grade 2-3 gastrointestinal toxicity (30.3% vs. 12.9%, p=0.059), although the incidence of grade 3-4 thrombocytopenia was higher (16.1% vs. 6.1%, p=0.295), the difference was not statistically significant.

Conclusion: Lobaplatin-based CCRT demonstrates comparable efficacy to cisplatin in elderly cervical cancer patients, with superior renal safety and improved gastrointestinal tolerability, establishing it as a viable alternative for cisplatin-intolerant populations.

Objective: Cervical intraepithelial neoplasia (CIN) grades 2 and 3 are precancerous lesions requiring timely treatment to prevent progression to invasive cancer. While conization is the standard therapy, it may negatively impact future fertility. This study evaluated the therapeutic efficacy of cervical laser vaporization compared with laser conization.

Methods: This retrospective study included patients with CIN2-3 who underwent laser vaporization or conization at NTT East Sapporo Medical Center between January 2018 and December 2022. Treatment selection was based on colposcopic findings, lesion grade, age, and fertility desire. Human papillomavirus (HPV) testing and cytology were performed before treatment and at 3 months postoperatively. Cytologic follow-up continued biannually for 2 years. The primary outcome was absence of cytologic abnormalities throughout the follow-up period. Patients lost to follow-up were excluded. Fisher's exact test was used for statistical comparisons.

Results: Of 319 patients (93 conization; 226 vaporization), the mean age was 41 in the conization group and 33 in the vaporization group. Despite the age difference, no significant differences were observed in 2-year cytologic cure rates or 3-month HPV clearance in CIN3 cases. HPV16 was the most common genotype, followed by HPV52 and HPV58.

Conclusion: A Laser vaporization showed comparable efficacy to conization in appropriately selected CIN2-3 cases. It may be a fertility-preserving option for younger patients. Strengthening HPV vaccination programs remains essential for reducing high-risk HPV infections.

Objective: This study aimed to retrospectively evaluate and compare the recurrence-free survival (RFS) between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) while avoiding the use of a uterine manipulator, vaginal washing and clamping before colpotomy, and removal of the uterus with a retrieval bag.

Methods: This study included patients with cervical cancer, classified by the International Federation of Obstetrics and Gynecologists (2018) as preoperative stages IB1, IB2, and IIA1, who underwent radical hysterectomy at our institution between October 2009 and August 2023.

Results: Overall, 103 patients with cervical cancer who underwent radical hysterectomy were included in this study. ARH was performed in 71 patients and LRH in 32. The median follow-up periods were 60 and 50 months for patients who underwent ARH and LRH, respectively. No significant difference was observed in the RFS between the ARH and LRH groups. Furthermore, after adjusting for inverse probability weighting, there was no significant difference in the RFS between the ARH and LRH groups. Similarly, no significant difference in overall survival was observed between the 2 groups.

Conclusion: The RFS after LRH in patients with early-stage cervical cancer did not differ significantly from that in patients who underwent ARH when avoiding the uterine manipulator and tumor isolation method.

Recent advances in gynecologic oncology have driven a paradigm shift toward less invasive, more personalized surgical approaches. This narrative review critically examines key ongoing international trials investigating innovative surgical strategies across vulvar, cervical, ovarian, and endometrial cancers, with a focus on improving oncologic outcomes while minimizing morbidity. In vulvar cancer, trials are exploring the use of neoadjuvant chemotherapy and the replacement of inguinofemoral lymphadenectomy with chemoradiation in selected patients. For cervical cancer, large multicenter randomized trials are evaluating the oncologic safety of minimally invasive hysterectomy, surgical staging for para-aortic disease, and robotic-assisted surgery. In the contest of ovarian cancer, randomized trials are assessing the role of lymphadenectomy in early-stage disease, the optimal timing of cytoreductive surgery (primary versus interval), and the potential benefits of hyperthermic intraperitoneal chemotherapy, even in cases of platinum-resistant recurrence. For endometrial cancer, both observational and interventional studies are investigating sentinel lymph nodes mapping and robotic-assisted hysterectomy as alternatives to traditional staging procedures. Collectively, these trials underscore the growing importance of individualized treatment strategies guided by disease stage, histologic subtype, response to neoadjuvant therapy, and patient-specific factors. While minimally invasive techniques and surgical de-escalation appear promising for selected patient populations, critical questions remain regarding long-term oncologic safety, cost-effectiveness, and the consistency of practice across institutions. This narrative review synthesizes current evidence and outlines how the outcomes of these pivotal studies are expected to influence future guidelines in gynecologic cancer surgery.

Objective: This study evaluated the cost-effectiveness of expanding the current routine human papillomavirus (HPV) vaccination program to women aged 13-24 years in Thailand.

Methods: A Markov model of HPV infection and cervical cancer was adapted. We compared catch-up cohorts of 13- to 24-year-old women vaccinated with (1) bivalent HPV vaccine (Cervarix^®), (2) 2vHPV (Cecolin^®), (3) quadrivalent HPV vaccine (Gardasil^®), (4) nonavalent HPV vaccine (Gardasil9^®), and (5) no vaccination. The outcomes included the number of new cancer cases, cancer-related deaths, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) of each strategy from a healthcare perspective. Extensive sensitivity analyses were performed to ensure the robustness of the findings.

Results: Compared to no vaccination, the catch-up vaccination programs decreased the incidence of cervical cancer cases and cancer-related deaths 44.8%-63.4% over a lifetime. Vaccinating with 2vHPV (Cervarix^®), 2vHPV (Cecolin^®), 4vHPV (Gardasil^®), and 9vHPV (Gardasil9^®) resulted in decremental costs of 3,093.53, 3,377.94, 3,117.78 and 2,846.59 Thai baht (THB) (88.03, 96.11, 88.72, 81.01 USD) per capita and incremental benefits of 0.29, 0.30, 0.32 and 0.45 QALYs per capita, compared to no vaccination, respectively. Based on the incremental analysis, after excluding extended dominated comparators, 9vHPV was the most cost-effective intervention with the ICER of 3,661.38 THB (104.19 USD) per QALY, given the current willingness-to-pay threshold of 160,000 THB (4,552.50 USD) per QALY (1 USD=33.67 THB).

Conclusion: All catch-up vaccination programs for women aged 13 to 24 years produce additional health benefits and reduce healthcare costs. Vaccination with 9vHPV was considered the most cost-effective option.

Objective: This study aimed to assess the impact of comprehensive staging on survival outcomes in this population.

Methods: Patients who underwent surgery for epithelial ovarian cancer in one of the 14 Francogyn cancer centers between 2000 and 2020 were included in the study. The primary analysis evaluated the impact of lymphadenectomy on overall survival and recurrence-free survival. Lymph node count was analyzed as a continuous variable, and its association with survival, considered as a continuous outcome was assessed using linear regression (secondary analysis). Survival was compared using the log-rank test, and multivariate analysis was performed using a Cox model.

Results: A total of 467 patients with presumed early-stage epithelial ovarian cancer were included, of which 198 underwent complete lymphadenectomy and 266 did not. No significant association was found between lymph node staging and survival in the primary analysis, possibly due to limited statistical power and a selection bias, as patients without lymphadenectomy had more favorable disease profiles (p=0.600 and p=0.700, respectively). Complete lymphadenectomy was associated with a significantly higher risk of complications (34.5% vs. 14%, p<0.001). In secondary analysis, the number of para-aortic lymph nodes harvested was identified as an independent predictor of both overall survival and recurrence-free survival (p=0.007 and p=0.002, respectively). Histological characteristics and adjuvant chemotherapy also showed a significant correlation with improved survival outcomes.

Conclusion: Extensive para-aortic lymphadenectomy in early-stage epithelial ovarian cancer is associated with better overall and recurrence-free survival but comes with an increased risk of complications.

Objective: Our previous study demonstrated that training oncologists to provide genetic counselling for ovarian cancer patients in Malaysia, an upper-middle-income Asian country, increased uptake of genetic testing to 80% when the test was free under research. However, in practice, genetic tests are unlikely to be provided for free in low-and-middle-income countries. In this study, we explored the willingness to pay (WTP) for genetic testing among ovarian cancer patients in Malaysia.

Methods: In this multi-center study, ovarian patients without prior genetic counselling were administered questionnaires on WTP (a contingent valuation exercise), facilitators and barriers to genetic counselling, and followed up for at least 6 months. We estimated the WTP value and explored factors associated with being willing to pay using logistic regression.

Results: Of 100 sequential patients recruited, 58% stated WTP for genetic testing at median of MYR1,000 (interquartile range=MYR1,125). Older participants were less likely to be willing to pay (odds ratio=0.95; 95% confidence interval=0.91-0.99). Reasons for being unwilling to pay included affordability (71%), belief that it should be paid by government or insurance (19%) and preference not to know their genetic status (14%). At the end of follow-up (mean 5±17 months), 17% took the test at full price.

Conclusion: In this exploratory study, stated WTP for genetic testing was high but only at a reduced price. At follow-up, only a minority of patients paid the full price. A co-payment framework or subsidy scheme may be needed to reduce the significant cost barriers to genetic testing in Malaysia.

Objective: This study aimed to estimate the medical costs among patients with ovarian cancer across distinct phases of care and surgical years.

Methods: This population-based retrospective cohort study identified newly diagnosed ovarian cancer patients who underwent surgery based on nationwide claims data from Korea (2012-2019). Medical costs were categorized into 5 phases: neoadjuvant chemotherapy, surgery, frontline chemotherapy, monitoring, and recurrence. Total and cancer-related costs were analyzed by surgical year on a per patient and per patient per month (PPPM) basis. Per patient costs were estimated for each phase, with up to one year of follow-up per phase, for patients identified between 2013 and 2016. Generalized linear models (GLMs) examined associations between surgical year and cancer-related costs.

Results: Among 10,594 patients, median cancer-related costs per patient were highest in the recurrent phase ($20,548), followed by the frontline chemotherapy ($7,005), neoadjuvant chemotherapy ($5,870), surgery ($4,965), and monitoring phases ($1,906). The median surgery phase costs per patient increased from $4,254 in 2013 to $5,676 in 2016; recurrent phase costs increased from $17,289 to $26,750. GLM analysis revealed that per patient and PPPM costs significantly increased over time, particularly in the surgery and recurrent phases. Compared with the cost per patient in 2013, the cost per patient in 2016 was 27% higher for the surgery phase and 49% higher for the recurrent phase.

Conclusion: Ovarian cancer-related costs have significantly increased over time, especially in the surgery and recurrent phases, thus highlighting the growing economic burden and the need for cost-effective care strategies.

Objective: This multi-center retrospective study aimed to clarify the characteristics, diagnostic accuracy, treatment outcomes, and prognostic factors of uterine serous carcinoma (USC) in Japanese women.

Methods: The medical records of 193 patients who were treated between 2006 and 2008 at 24 participating institutions in the Japanese Clinical Oncology Group were examined, and pathological slides of 188 patients were re-checked through central pathology review (CPR), hematoxylin-eosin staining, and immunohistochemistry.

Results: USC was confirmed in 144 of the 188 (76.6%) patients using CPR, and only 50% were correctly diagnosed preoperatively. Forty-three patients were diagnosed with non-serous carcinoma, whereas one patient had metastasis from another organ. The average age was 65.7 years, and 19% of patients had a history of other cancers. The incidence of stage III-IV disease was 52.8%, and lymph node metastasis was found in 28.5% of patients. Extrauterine spread and distant metastasis occurred in 39% and 14% of patients, respectively. The 2-year overall survival and progression-free survival (PFS) rates were 56% and 42%, respectively. The PFS of patients with stage I and II who underwent complete staging surgery was 92.3%, and that of those without lymph node dissection or omentectomy was 33.3%. Patients with USC had a significantly worse prognosis than 43 patients with non-serous carcinoma.

Conclusion: USC in Japanese women has characteristics different from those of endometrioid carcinoma, worse prognosis, and is difficult to diagnose preoperatively. Complete surgical staging is necessary even for early-stage disease. Additionally, new adjuvant treatment strategies, including molecular targeted therapy, should be explored.