Int J Gynecol Cancer
· 2026 Jun · PMID 42102629
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OBJECTIVE: Advances in cancer survival have made fertility preservation an essential clinical need for young female patients. While traditional chemotherapy's gonadotoxicity is well established, the effects of newer syst...OBJECTIVE: Advances in cancer survival have made fertility preservation an essential clinical need for young female patients. While traditional chemotherapy's gonadotoxicity is well established, the effects of newer systemic therapies (immune checkpoint inhibitors, poly [adenosine diphosphate-ribose] polymerase inhibitors, and cyclin-dependent kinase 4/6 inhibitors) on female fertility remain unclear. This systematic review aims to compare the impact of these agents on ovarian function and fertility outcomes. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed/MEDLINE and Cochrane Library for studies published between January 2020 and December 2025. We included clinical and pre-clinical original research articles examining the effects of immune checkpoint inhibitors or targeted therapies on fertility in women of reproductive age or suitable pre-clinical models. Clinical studies were assessed using the Newcastle-Ottawa Scale and pre-clinical studies using Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool. RESULTS: Eleven studies met the inclusion criteria, including 6 pre-clinical studies and 5 clinical investigations. Pre-clinical studies evaluating poly (adenosine diphosphate-ribose) polymerase inhibitors consistently reported reductions in primordial follicle counts and increased markers of DNA damage in ovarian tissue, suggesting potential impairment of ovarian reserve. Clinical and pharmacovigilance data on immune checkpoint inhibitors indicate possible immune-mediated ovarian dysfunction, including menstrual irregularities and cases of ovarian insufficiency reported in small observational cohorts. In contrast, available clinical data on cyclin-dependent kinase 4/6 inhibitors did not demonstrate clear additional gonadotoxic effects beyond those associated with prior systemic therapies. Most available evidence is derived from pre-clinical studies and small observational clinical cohorts, which limits the strength of conclusions regarding fertility outcomes. CONCLUSIONS: Current evidence suggests potential gonadotoxic effects of poly (adenosine diphosphate-ribose) polymerase inhibitors, primarily based on pre-clinical findings. In contrast, available clinical data do not demonstrate clear additional gonadotoxicity associated with immune checkpoint inhibitors or cyclin-dependent kinase 4/6 inhibitors, although evidence remains limited. As most data derive from pre-clinical models and small observational cohorts, findings should be interpreted cautiously, highlighting the need for prospective studies with standardized fertility end points.
Wang XS, Pond GR, Piedimonte S
… +14 more, Nelson G, Aubrey C, Plante M, Lau S, Kwon J, Chai J, Altman AD, Willows K, Feigenberg T, Sabourin J, Samouelian V, Vicus D, Helpman L, Canadian Cervical Cancer Collaborative (4C) Group
Int J Gynecol Cancer
· 2026 Jun · PMID 42097082
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OBJECTIVE: Pre-operative imaging has the potential to improve selection of surgical candidates in early-stage cervical cancer, but limited evidence exists on its association with post-operative adjuvant treatment. This s...OBJECTIVE: Pre-operative imaging has the potential to improve selection of surgical candidates in early-stage cervical cancer, but limited evidence exists on its association with post-operative adjuvant treatment. This study investigated the role of imaging in candidate selection for radical surgery and its association with the need for adjuvant treatment in early-stage cervical cancer. METHODS: Retrospective analysis was performed using the Canadian Cervical Cancer Collaborative (4C) database of surgical cases from 11 tertiary centers between 2007 and 2017. All patients with squamous, adenocarcinoma, or adenosquamous histology, staged IAI to IIIC per the International Federation of Gynecology and Obstetrics 2018 system, who underwent primary surgical treatment with radical hysterectomy or trachelectomy were included. Groups were defined as no pre-operative imaging, computed tomography (CT) only, magnetic resonance imaging (MRI) with or without CT ("MRI"), or positron emission tomography (PET) with or without MRI or CT ("PET"). Regression analyses estimated associations of pre-operative imaging with adjuvant treatment, recurrence, and death. RESULTS: A total of 1103 patients were analyzed. PET use increased over the study period. Imaging modality was not associated with odds of lymph node spread (p =.16). Pre-operative PET was associated with decreased odds of adjuvant therapy compared with CT only (adjusted odds ratio 0.35; 95% confidence interval 0.18 to 0.66, p <.001) after controlling for other factors including site and year of surgery, age, surgical approach, and histology. No associations between imaging modality and recurrence-free survival or overall survival were observed. CONCLUSIONS: PET use before radical surgery for early-stage cervical cancer was associated with decreased odds of adjuvant treatment but no significant difference in oncologic outcomes. Future studies may refine our understanding of the predictive performance of multi-modal imaging for adjuvant treatment and prognosis.
Coopmans LTA, van Trommel NE, Balduzzi S
… +8 more, Aguiar X, Charfare F, Ghorani E, Caldwell R, Kaur B, Sarwar N, Lok CAR, Seckl MJ
Int J Gynecol Cancer
· 2026 Jun · PMID 42092285
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OBJECTIVE: Low-risk gestational trophoblastic neoplasia is treated with single-agent chemotherapy. Methotrexate is often used as a first-line therapy but is switched to dactinomycin in the event of resistance or toxicity...OBJECTIVE: Low-risk gestational trophoblastic neoplasia is treated with single-agent chemotherapy. Methotrexate is often used as a first-line therapy but is switched to dactinomycin in the event of resistance or toxicity. However, it is unclear whether the currently favored single-pulse 1-day dactinomycin is equally effective as when given daily for 5 days (5-day dactinomycin), both repeated every 2 weeks. The aim of this study was to assess the differences in remission, resistance, recurrence, and chemotoxicity rates between the 5-day and 1-day dactinomycin regimens. METHODS: A retrospective study using the database of the Charing Cross Centre for Gestational Trophoblastic Disease. Patients who were treated with dactinomycin as second-line treatment for low-risk gestational trophoblastic neoplasia between 2005 and 2020 were selected. Multi-variable analysis was used to identify factors associated with resistance and recurrence. RESULTS: A total of 324 patients were included, of whom 180 received 5-day dactinomycin and 144 1-day dactinomycin. Remission was achieved in 93.3% (168/180) and 91.7% (132/144) of patients in the 5-day and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Resistance to treatment developed in 6.7% (12/180) and 8.3% (12/144) of patients in the 5-day dactinomycin and 1-day dactinomycin groups (p =.914; odds ratio 0.95, 95% confidence interval 0.35 to 2.54), respectively. Overall, recurrences occurred in 5.6% (18/324) of patients, including 4.8% (8/168) after the 5-day dactinomycin regimen and 7.6% (10/132) following the 1-day dactinomycin (p =.24; odds ratio 1.80, 95% confidence interval 0.68 to 4.72). Though the incidence of overall chemotoxicity was similar in both groups, mucositis was significantly higher in patients receiving the 5-day dactinomycin group (95% confidence interval in this test, p <.001). Moreover, patients receiving the 5-day dactinomycin regimen required more dose reductions due to chemotoxicity, and this regimen was more costly to deliver. CONCLUSIONS: There is no significant difference in remission or subsequent recurrence rates between the 5-day and 1-day dactinomycin regimens. The 1-day dactinomycin regimen is associated with increased patient convenience, with less toxicity and hospital visits, and is therefore more cost-effective.
Hanna K, Levin G, Al Nasir M
… +20 more, Lacouline-Boulanger R, Shahbazian L, Diwan SS, Li J, Hamidi D, Stephan L, Hmimas M, Zhang N, Nathalie Nguyen PN, Richer L, Jacob K, Gomez A, Ribeiro R, Mandilaras V, Bernard L, Zeng X, Soslow RA, Gilbert L, Annie Leung SO, Tessier-Cloutier B
Int J Gynecol Cancer
· 2026 Apr · PMID 42091345
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OBJECTIVE: Access to homologous recombination testing remains limited in many centers. We aim to correlate the morphology and immunophenotype of high-grade serous ovarian carcinoma with homologous recombination statuses....OBJECTIVE: Access to homologous recombination testing remains limited in many centers. We aim to correlate the morphology and immunophenotype of high-grade serous ovarian carcinoma with homologous recombination statuses. METHODS: A retrospective analysis of a high-grade serous ovarian carcinoma tumors with known homologous recombination status. A pathological review of morphology was performed for each tumor, along with immunohistochemical profiling. Tumor morphology was classified as (1) solid, pseudo-endometrioid, or transitional (2) micropapillary or nested. RESULTS: Overall, 81 tumors were included. The median age was 62 (interquartile range; 52-71). Of those, 27 (33.3%) tumors were BRCA1mut, 19 (23.5%) were BRCA2mut, 15 (18.5%) tumors had no BRCA1 or BRCA2 mutations but exhibited a genomic instability score ≥42 and were classified as BRCA1/2-wild-type with homologous recombinant deficient. The remainder 20 (24.7%) cases were homologous recombinant proficient. The proportion of tumors with solid transitional-like morphology was higher in BRCA1 (12/21, 57%) and BRCA2 (12/18, 67%) compared to the tumors with homologous recombinant proficient (3/17, 18%), p =.019. When stratified by genomic instability score, tumors with low score (genomic instability score <26) exhibited 0% solid transitional-like morphology versus 43% solid transitional-like morphology in high-score (genomic instability score >26), p =.03. PAX8 diffuse expression was detected in 71% of BRCA1, 65% of BRCA2, 92% of BRCA-wild-type homologous recombinant deficient tumors, and 100% of homologous recombinant proficient tumors, p =.071. The proportion of diffuse expression was higher in homologous recombinant proficient (100%) versus BRCA2 (65%) (Bonferroni-adjusted pairwise comparisons). CONCLUSIONS: Homologous recombinant deficient tumors are associated with the solid transitional-like morphology, with the BRCA1/2-mutated homologous recombinant deficient cases showing the strongest correlation. Genomic instability score alone may not fully capture the spectrum of homologous recombinant deficient-related phenotypes. The variation in solid transitional-like morphology features among BRCA1- or BRCA2-mutated, BRCA1/2- wild-type with homologous recombinant deficient, and homologous recombinant proficient cases may reflect the diverse biological spectrum of different homologous recombination alterations.
Andres S, Dagher C, Henderson R
… +12 more, Ward J, Broach V, Sonoda Y, Gardner GJ, Long KC, Ellenson LH, Chiang S, Jewell E, Chi DS, Mueller JJ, Abu-Rustum NR, Leitao MM
Int J Gynecol Cancer
· 2026 Mar · PMID 42070912
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OBJECTIVE: To determine factors impacting successful bilateral sentinel lymph node mapping and empty nodal packet rate using indocyanine green for uterine cancer staging. METHODS: All women with clinical early-stage uter...OBJECTIVE: To determine factors impacting successful bilateral sentinel lymph node mapping and empty nodal packet rate using indocyanine green for uterine cancer staging. METHODS: All women with clinical early-stage uterine cancer who underwent hysterectomy with sentinel lymph node mapping between January 1, 2014, and December 31, 2022, were included. The primary endpoint was the successful bilateral sentinel lymph node mapping rate. Secondarily, we assessed the empty nodal packet rate and identified factors impacting successful sentinel lymph node mapping and empty nodal packet rates. Appropriate statistical tests were used. RESULTS: A total of 2690 patients were included, with a median body mass index of 30.9 kg/m (range; 14.0-70.2). Of these, 1893 (70%) had low-grade endometrioid histology, 260 (10%) had high-grade endometrioid histology, and 537 (20%) had non-endometrioid histology. A total of 2499 (93%) cases were completed with minimally invasive surgery, and 191 (7%) via laparotomy. Bilateral sentinel lymph node mapping was successful in 2340 of 2690 patients (87%). The rate of bilateral mapping by body mass index group was 89% for body mass index <30 kg/m, 86% for body mass index 30 to 39.9 kg/m, 85% for body mass index 40 to 49.9 kg/m, 83% for body mass index 50 to 59.9 kg/m, 69% for body mass index ≥60 kg/m (p =.04). A total of 2196 (88%) minimally invasive surgery cases had bilateral mapping compared with 144 (75%) laparotomy cases (p <.001). On multi-variate analysis, age, body mass index, and surgical approach were independently associated with successful sentinel lymph node mapping. Empty nodal packets occurred in 98 of 2633 patients (3.7%). Increasing age and body mass index were associated with a higher empty nodal packet rate. Bilateral mapping increased from 82.5% in 2014 to 91.3% in 2022 (p =.03), whereas the empty nodal packet rate did not change (p =.2). CONCLUSIONS: High rates of successful sentinel lymph node mapping can be achieved across body mass index categories using indocyanine green. A decreased rate was noted in patients with body mass index ≥60 kg/m and in cases completed via laparotomy. Sentinel lymph node mapping success rates improved with continued experience.
Erfani H, Martynova A, Matsuzaki S
… +5 more, Matsuo K, Roman LD, Sood AK, Kurnit KC, Westin SN
Int J Gynecol Cancer
· 2026 Jun · PMID 42070324
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Endometrial cancer continues to be the most common gynecologic malignancy in the United States. Endometrial tumors frequently express hormonal receptors, making this pathway targeting an attractive anti-cancer treatment....Endometrial cancer continues to be the most common gynecologic malignancy in the United States. Endometrial tumors frequently express hormonal receptors, making this pathway targeting an attractive anti-cancer treatment. Recent advances have broadened our understanding of the androgen receptor's role in solid tumors beyond prostate cancer. Understanding the significance of androgen receptor signaling and its effects on tumor behavior and therapeutic outcomes in endometrial cancer is important for further clinical development. This review presents inter-connected pathways involving sex hormone-binding globulin, androgens, and androgen receptor signaling in cellular processes related to tumor pathogenesis. Sex hormone-binding globulin regulates androgen levels, influencing aromatase activity and estrogen production, which in turn activates estrogen receptors involved in gene expression promoting cell growth. Concurrently, notch pathway transcription factor forkhead box A1 modulates androgen receptor activity, impacting androgen receptor target gene expression and cell proliferation. Lysin-specific histone demethylases lysine demethylase 4A and lysine demethylase 4B modify chromatin at c-Myc and p27 promoter regions, respectively, affecting gene expression critical for cell-cycle regulation and tumor progression, demonstrating complex regulation of cellular mechanisms by hormone signaling pathways. lysine demethylase 4A interacts with androgen receptor signaling through chromatin remodeling, influencing transcriptional regulation of key cell-cycle genes. The complexity of androgen receptor signaling in endometrial cancer, marked by its varied expression and influence, necessitates a deeper investigation to harness its full therapeutic potential. The exploration of androgen receptor-targeted therapies offers promising avenues for refining treatments and improving outcomes of patients with endometrial cancer. This narrative review synthesizes current evidence on androgen receptor signaling and its therapeutic implications in endometrial cancer. Several potential androgen receptor-targeted approaches are also discussed in the context of future therapeutic development. These possible candidates to call for further development include (1) triple hormonal targeting with androgen receptor inhibitor, aromatase inhibitor, gonadotropin-releasing hormone and agonism, (2) targeting androgen receptor and lysine-specific demethylase 1-dependent forkhead box A1 demethylation, (3) targeting lysine demethylase 4B, (4) gamma secretase inhibitor combination therapy, and (5) combined androgen receptor and immune checkpoint inhibition.
Watson GA, Murtas F, Chawla T
… +9 more, Zhang L, Rouzbahman M, Pulenzas N, Toor H, Donnelly C, Han K, Croke J, Mackay H, Kim SR
Int J Gynecol Cancer
· 2026 Jun · PMID 42068680
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Uterine sarcomas are rare heterogeneous neoplasms, comprising only a small percentage of uterine malignancies. There is a diverse array of uterine sarcoma sub-types, each with distinct molecular, clinical, and behavioral...Uterine sarcomas are rare heterogeneous neoplasms, comprising only a small percentage of uterine malignancies. There is a diverse array of uterine sarcoma sub-types, each with distinct molecular, clinical, and behavioral features. In recent years, there has been significant advancement in all facets of the multi-disciplinary management of uterine sarcomas. Despite this, several challenges regarding optimization of treatment remain. Pre-operative diagnosis can be difficult, as imaging and biopsy may not reproducibly distinguish uterine sarcomas from benign entities. Early-stage uterine sarcomas are potentially curable with surgery; however, there remains a high risk of recurrence, and the use of adjuvant treatment is controversial. There is also a lack of high-quality data to guide best practices for fertility-sparing surgery in younger patients. Optimal management requires multi-disciplinary discussion by clinicians experienced in sarcoma management at specialized sarcoma centers, as initial management may have a profound impact on patient outcomes. In this review, we summarize and address many of these challenges facing patients with early-stage uterine sarcoma, and provide a comprehensive update on the clinical features, the molecular and genomic pathogenesis, and the current diagnostic and treatment landscape for these patients.
Vallés E, Bebia V, García-Pineda V
… +28 more, Gracia M, Hardisson D, Díaz-Feijoo B, Carreras N, Fernández-González S, Padilla-Iserte P, Carballas E, López de la Manzanara C, Oliver-Pérez R, Sanchis J, Pantoja M, Mancebo G, Agababyan C, Escayola C, Torrent A, Gómez Del Valle M, Fidalgo S, Gómez T, Roldán F, Alonso P, Quesada A, Chacón E, Muruzabal JC, García-Cano DG, Calvo A, Gil-Moreno A, Cabrera S, Spain-GOG and the MULTISENT Study Group
Int J Gynecol Cancer
· 2026 Jun · PMID 42066415
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OBJECTIVE: This study aimed to compare one-step nucleic acid amplification with conventional histopathological ultrastaging for sentinel lymph node assessment in patients with uterine-confined endometrial cancer. The pri...OBJECTIVE: This study aimed to compare one-step nucleic acid amplification with conventional histopathological ultrastaging for sentinel lymph node assessment in patients with uterine-confined endometrial cancer. The primary endpoint was to evaluate differences in diagnostic performance in routine clinical practice. The secondary endpoint was to evaluate differences in oncological outcomes. METHODS: We conducted a multi-center retrospective study including patients with pre-operatively uterine-confined endometrial cancer who underwent sentinel lymph node biopsy. Two independent cohorts were analyzed: one in which conventional ultrastaging (serial hematoxylin and eosin staining and immunohistochemistry) was performed, and another assessed using one-step nucleic acid amplification. Only patients with a minimum follow-up of 2 years were included in the analysis. RESULTS: A total of 945 patients were included (immunohistochemistry = 653; one-step nucleic acid amplification = 292). Overall, 11.6% (n = 109) of cases were positive, predominantly with low-volume disease-isolated tumor cells 3.0% (n = 28), micrometastases 4.0% (n = 38), macrometastases 4.6% (n = 43). Both methods demonstrated high diagnostic accuracy with low false-negative rates (overall 1.9%; immunohistochemistry = 1.6%, one-step nucleic acid amplification = 2.8%). Median follow-up was 3.6 years. Three-year overall survival was 92.2% (95% confidence interval 90.0% to 93.9%), with comparable survival rates between immunohistochemistry (92.8%, 95% confidence interval 90.2% to 94.7%) and one-step nucleic acid amplification (90.9%, 95% confidence interval 86.2% to 94.0%, p =.929). The ultrastaging method was not associated with overall survival in the Cox multi-variate analysis. CONCLUSIONS: Sentinel lymph node assessment using one-step nucleic acid amplification and conventional immunohistochemistry ultrastaging did not show significant differences in accuracy for detecting nodal metastases and yielded comparable oncological outcomes, both in overall and disease -free survival. These findings reflect real-world clinical practice, supporting the reliability of both techniques for endometrial cancer staging and suggesting that the choice of sentinel lymph node evaluation method does not affect long-term patient outcomes.
Momi M, Salviato E, Ravaggi A
… +8 more, Mazza C, Tognon G, Bergamaschi C, Zanotti L, Gozzini E, Zizioli V, Odicino F, Bignotti E
Int J Gynecol Cancer
· 2026 Jun · PMID 42061278
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OBJECTIVE: Pathogenic mutations in BRCA1/2 are associated with improved survival in high-grade serous ovarian carcinoma, but the prognostic impact of specific mutations remains unclear. The primary aim of this study was...OBJECTIVE: Pathogenic mutations in BRCA1/2 are associated with improved survival in high-grade serous ovarian carcinoma, but the prognostic impact of specific mutations remains unclear. The primary aim of this study was to evaluate the role of different locations, types, and functions of BRCA1/2 mutations on survival in patients with high-grade serous ovarian carcinoma. METHODS: This study included a total of 174 patients with advanced-stage high-grade serous ovarian cancer, 74 women with BRCA1/2 mutations, and 100 wild-type controls. Mutations were categorized based on gene (BRCA1 vs BRCA2), location (inside exon 11 vs outside; functional domains), type (frameshift, nonsense, missense), and function (truncated protein vs amino acid change). Poly (adenosine diphosphate-ribose) polymerase inhibitor exposure was defined as receipt of maintenance therapy in first or subsequent lines. Survival outcomes were analyzed using univariate and multi-variate models. RESULTS: In multi-variate analysis, adjusted for residual tumor and International Federation of Gynecology and Obstetrics stage, mutations in BRCA2 RAD51-BD (hazard ratio 0.03, P=.001) and in BRCA1 DNA-binding domain (hazard ratio 0.23, p =.008) were associated with the most favorable prognosis compared to wild type. In contrast, BRCA1 BRCT or RING domain mutations showed survival outcomes similar to wild type. Frameshift (hazard ratio 0.17, p <.001) and nonsense mutations (hazard ratio 0.4, p =.016) were associated with improved survival compared to wild type, whereas missense variants were not. In patients not receiving poly (adenosine diphosphate-ribose) polymerase inhibitors, the presence of a BRCA2 or BRCA1 mutation was an independent marker of improved overall survival (hazard ratio 0.09, p <.001 and hazard ratio 0.37, p =.006, respectively), while the presence of residual tumor (>0) and International Federation of Gynecology and Obstetrics stage IV were associated with worse prognosis (hazard ratio 3.07, p =.001; hazard ratio 1.93, p =.031, respectively). In the poly (adenosine diphosphate-ribose) polymerase inhibitor-treated group, only BRCA2 mutations remained significantly associated with improved overall survival (hazard ratio 0.12, p =.043). CONCLUSIONS: The prognostic value of BRCA1/2 mutations in high-grade serous ovarian carcinoma may depend on their specific location and type. If validated in larger cohorts, our findings could influence patient stratification and should be considered in future clinical trial design.
Viveros-Carreño D, Beshar I, Agustí N
… +7 more, Murthy A, Mora-Soto N, Iniesta MD, Barajas K, Melamed A, Rauh-Hain JA, Wilke RN
Int J Gynecol Cancer
· 2026 Jun · PMID 42056783
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Tubo-ovarian cancer represents the most lethal gynecologic malignancy, and its burden is compounded by the absence of effective screening and the substantial lifetime risk carried by women with germline BRCA1 or BRCA2 pa...Tubo-ovarian cancer represents the most lethal gynecologic malignancy, and its burden is compounded by the absence of effective screening and the substantial lifetime risk carried by women with germline BRCA1 or BRCA2 pathogenic variants. While risk-reducing salpingo-oophorectomy remains the standard for prevention, conferring reduction in tubo-ovarian cancer risk and improved overall survival, it also induces premature menopause with significant effects on quality of life and bone, cardiovascular, and sexual health. These consequences have driven the exploration of alternative preventive strategies, and a paradigm shift toward individualized risk assessment. Emerging data highlight that tubo-ovarian cancer risk among BRCA pathogenic variant carriers is not uniform but influenced by gene type, variant position, family history, and modifiable factors such as parity, breastfeeding, and oral contraceptive use. Modern risk models integrate genetic, familial, and lifestyle data to refine personalized estimates and guide the timing of intervention. Concurrently, the understanding that many high-grade serous carcinomas originate in the fallopian tube has prompted evaluation of risk-reducing salpingectomy with delayed oophorectomy as a staged surgical strategy that may balance oncologic safety with preservation of hormonal function. Ultimately, management of BRCA pathogenic variant carriers must combine genomic precision, reproductive planning, and patient-centered counseling to align cancer prevention with quality of life, supporting truly individualized care in hereditary tubo-ovarian cancer risk reduction. Despite several reviews on hereditary tubo-ovarian cancer prevention, a clinically relevant gap remains in translating contemporary evidence into a practical counseling framework for women with BRCA1/2 pathogenic variants. This narrative review aims to synthesize current evidence on tubo-ovarian cancer risk assessment and risk-reducing strategies in this population, with a focus on individualized counseling and shared decision-making.
Int J Gynecol Cancer
· 2026 Jun · PMID 42034020
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OBJECTIVE: We aimed to compare oncologic and peri-operative outcomes after minimally invasive surgery versus open surgery among women with clinical stage I uterine leiomyosarcoma. METHODS: We performed a retrospective co...OBJECTIVE: We aimed to compare oncologic and peri-operative outcomes after minimally invasive surgery versus open surgery among women with clinical stage I uterine leiomyosarcoma. METHODS: We performed a retrospective cohort study using the National Cancer Database (2010-2021). Eligible cases were clinical stage I leiomyosarcoma (cT1a/cT1b) treated with hysterectomy and bilateral salpingo-oophorectomy. Patients were grouped by surgical approach (minimally invasive surgery [laparoscopy/robotic] vs open); conversions were analyzed descriptively and excluded from outcome models. Primary outcome was overall survival; secondary outcomes were length of stay and 30-day readmission. Survival was assessed with Kaplan-Meier and log-rank tests; multi-variable Cox models adjusted for age, adjuvant therapy, margin status, and pathologic stage. RESULTS: Among 683 patients, 208 (30.5%) underwent minimally invasive surgery, 447 (65.4%) open surgery, and 28 (4.1%) had conversions. Minimally invasive surgery patients more often were White (85.1% vs 70.0%) and privately insured (66.8% vs 54.4%), had higher neighborhood income, more clinical stage IA disease (30.3% vs 15.2%), and smaller tumors (median 7.2 cm vs 9.9 cm, all p <.001). Adjuvant chemotherapy and radiotherapy rates were similar between groups. Minimally invasive surgery was associated with a shorter hospital stay (median 1 vs 3 days, p <.001) and comparable 30-day readmission (both 3.8%). In clinical stage IA, unadjusted overall survival favored minimally invasive surgery (68.0% alive at 94 months vs 51.5% open, log-rank p =.028), whereas stage IB showed no difference (median overall survival 79 vs 79 months, p =.72). In multi-variable analysis, surgical approach was not independently associated with overall survival (adjusted hazard ratio 1.16, 95% confidence interval 0.91 to 1.49). Worse overall survival was associated with increasing age, higher stage, and positive margins. CONCLUSIONS: The surgical approach was not independently associated with survival. Future prospective cohorts should capture specimen extraction and tumor disruption to better define which patients can safely undergo minimally invasive approaches.
Kong Y, Gao X, Che Y
… +5 more, Li X, Gong X, Luan X, Cui Z, Tian T
Int J Gynecol Cancer
· 2026 Jun · PMID 42019142
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OBJECTIVE: The objective of this study was to develop and validate a metabolic-lipid nomogram that refines the International Federation of Gynecology and Obstetrics (FIGO) 2000 scoring system, thereby enhancing the predi...OBJECTIVE: The objective of this study was to develop and validate a metabolic-lipid nomogram that refines the International Federation of Gynecology and Obstetrics (FIGO) 2000 scoring system, thereby enhancing the predictive capacity for primary chemoresistance and informing therapeutic decision-making in patients with low-risk gestational trophoblastic neoplasia. METHODS: A cohort of 83 consecutive patients with gestational trophoblastic neoplasia receiving first-line single-agent chemotherapy was retrospectively enrolled. Measurements of fasting blood glucose, full lipid profile, and serum beta-human chorionic gonadotropin (β-hCG) were obtained prior to the first cycle and before every subsequent cycle. A logistic nomogram, designated as the novel model, was constructed using 4 baseline variables: total cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, and β-hCG. Its predictive performance was compared to that of the FIGO score alone and a model combining both. RESULTS: Compared to responders, patients with chemoresistance presented with elevated baseline β-hCG (p =.023) and fasting blood glucose (p =.004), reduced total cholesterol and low-density lipoprotein cholesterol (p =.009), and higher FIGO scores (3-6; p =.004). Multi-variate analysis confirmed low-density lipoprotein cholesterol (odds ratio [OR] 0.085, 95% confidence interval [CI] 0.012 to 0.621), fasting blood glucose (OR 3.793, 95% CI 1.359 to 10.588), and β-hCG >5000 IU/L (OR 7.229, 95% CI 1.484 to 35.209) as independent resistance predictors. The resulting nomogram showed superior predictive performance (area under the curve [AUC] 0.81, 95% CI 0.697 to 0.922), which was further enhanced upon integration with the FIGO score (AUC 0.833, 95% CI 0.738 to 0.929), markedly surpassing the FIGO score alone (AUC 0.704, 95% CI 0.55 to 0.858). CONCLUSIONS: Our findings indicate that elevated fasting blood glucose, low-density lipoprotein cholesterol, and β-hCG > 5000 IU/L are key risk factors for chemoresistance in patients with gestational trophoblastic neoplasia. The integration of low-density lipoprotein cholesterol and fasting blood glucose into the FIGO framework significantly enhances the pre-therapeutic prediction of treatment failure, representing a readily translatable, cost-effective strategy for personalizing primary chemotherapy. External validation in diverse, multi-center populations should be encouraged.