Int J Gynecol Cancer
· 2026 May · PMID 41965225
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OBJECTIVE: To determine whether pre-treatment pelvic bone T1-weighted magnetic resonance imaging provides additional prognostic information beyond traditional clinical variables in patients with cervical cancer undergoin...OBJECTIVE: To determine whether pre-treatment pelvic bone T1-weighted magnetic resonance imaging provides additional prognostic information beyond traditional clinical variables in patients with cervical cancer undergoing definitive concurrent chemoradiotherapy. METHODS: We retrospectively analyzed 494 treatment-naive patients with cervical cancer who underwent pre-treatment magnetic resonance imaging prior to chemoradiotherapy. Pelvic bone-masked images were processed using a vision transformer framework. A stability-driven feature selection process across repeated Monte Carlo splits and pre-processing configurations identified 2 highly reproducible imaging biomarkers. Survival models were developed using overall survival as the primary endpoint. External validation was performed in 38 patients from The Cancer Genome Atlas without refitting imaging features. The feature-extraction architecture with the highest mean external concordance index was selected, and a representative model was used for clinically interpretable survival analyses. Model-derived 60-month predicted mortality risk was analyzed as a continuous variable in multi-variable Cox proportional hazards models and used for Kaplan-Meier risk stratification. RESULTS: In the discovery cohort, the image-only model achieved a mean concordance index of 0.84 (95% confidence interval 0.82 to 0.85) for overall survival, exceeding that of the clinical-only model (0.52). Imaging-derived risk significantly stratified overall survival in Kaplan-Meier analyses. Five-year overall survival was lower in the high imaging risk group compared with the low imaging risk group within both IB to IIIC1 (69.8% vs 95.4%) and IIIC2 to IVB (47.2% vs 93.7%) stage categories (p <.001 for both). In multi-variable Cox analyses adjusted for age, stage, and histology, imaging-derived risk remained independently associated with overall survival (hazard ratio 1.72 per 10% increase, 95% confidence interval 1.60 to 1.85, p <.001). External validation demonstrated consistent overall survival discrimination (mean concordance index = 0.74). CONCLUSIONS: Pre-treatment pelvic bone magnetic resonance imaging captures reproducible host-related imaging signatures derived from marrow-containing pelvic bone regions that are associated with overall survival and refine conventional stage-based risk stratification in patients with cervical cancer undergoing chemoradiotherapy.
Barretina-Ginesta MP, Madariaga A, Gil-Martín M
… +21 more, Ramchandani A, Pardo M, Sanchez-Heras AB, Churruca C, Guerra-Alia EM, Madroñal C, Fernandez-Plana J, Herrero A, Dotor E, Esteban C, Quindós-Varela M, Romeo M, Gost E, Bermejo MJ, Fernandez-Chacón C, Ferrer N, Gomez-Raposo C, Tort SC, Eichbaum M, Sehouli J, Woopen H
Int J Gynecol Cancer
· 2026 Apr · PMID 41951282
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OBJECTIVE: Ovarian cancer remains a significant global health concern. Contemporary therapeutics have led to an increased number of long-term survivors. This research investigates the unmet needs of long-term ovarian can...OBJECTIVE: Ovarian cancer remains a significant global health concern. Contemporary therapeutics have led to an increased number of long-term survivors. This research investigates the unmet needs of long-term ovarian cancer survivors in Spain, focusing on persistent side effects, patient concerns, lifestyle changes, and ongoing challenges. METHODS: This is a multi-center, cross-sectional, observational study, assessing the results from the international North-Eastern German Society of Gynecological Oncology survey, Expression VI - Long-term survival with ovarian cancer in Spain. Participants were identified during follow-up visits at oncology departments. A structured questionnaire of 68 items, including demographic, clinical, psychosocial, and lifestyle domains, was completed anonymously in printed format, with implied consent through survey completion. RESULTS: A total of 250 long-term ovarian cancer survivors from Spain, defined as patients diagnosed of malignant ovarian cancer with a survival ≥8 years since diagnosis (median age at diagnosis 52 years; median survival time 11 years), completed the survey. A substantial number of participants continued to experience long-term side effects, including gastrointestinal (90%), dermatologic (91.6%), and neurologic symptoms, such as memory problems (15.1%) and concentration difficulties (10.8%). Nearly half of the survivors (47.3%) expressed concerns about nervousness, 43.6% reported ongoing pain, and 40% struggled with sleep disturbances. Lifestyle changes after cancer diagnostic were significant, with 56.5% of smoker participants quitting or reducing smoking and 41.6% adopting healthier diets. Finally, our results indicate that most participants received some form of follow-up, primarily through blood biomarker monitoring (87.0%) and imaging tests (73.0%). CONCLUSIONS: This study highlights the persistent challenges among long-term ovarian cancer survivors in Spain, stressing the need for more comprehensive, tailored aftercare. These findings may be generalized to other regions, emphasizing the importance of addressing ongoing side effects and unmet care needs to improve survivors' long-term quality of life. Enhanced follow-up care, patient support, and effective communication are essential components of this effort.
Pareja R, Agustí N, Vieira S
… +13 more, Mora-Soto N, Sanchez E, Fernandes A, Aristizábal B, Heredia F, Levin G, Varon ML, Pontremoli Salcedo M, Krause KJ, Abu-Rustum NR, Huh W, Rauh-Hain JA, Viveros-Carreño D
Int J Gynecol Cancer
· 2026 Apr · PMID 41951281
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OBJECTIVE: This study aimed to systematically review the literature regarding topical therapies for reducing the risk of cervical intra-epithelial neoplasia (CIN) grade 2 or higher (CIN II+) lesions among women with high...OBJECTIVE: This study aimed to systematically review the literature regarding topical therapies for reducing the risk of cervical intra-epithelial neoplasia (CIN) grade 2 or higher (CIN II+) lesions among women with high-risk human papillomavirus (HPV) infection and histologically confirmed CIN I or either no cervical lesions. METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered the protocol in PROSPERO (CRD42024629608). We searched Ovid MEDLINE, Ovid EMBASE, Cochrane Central, and ClinicalTrials.gov from inception through December 16, 2024 for randomized controlled trials evaluating any cervical topical treatment in women with high-risk HPV and, at most, CIN I. The primary outcome was progression to histologically confirmed CIN II+. Secondary outcomes were treatment-related adverse events. RESULTS: Of 305 records, 19 full-text articles were reviewed. Finally, 16 trials were assessed. None met all our eligibility criteria, with some trials being excluded for multiple reasons. Twelve were excluded due to an inadequate study population (included women with CIN II+, lacked histologic confirmation of lesion grade, or lacked confirmatory high-risk HPV testing), 4 used inappropriate interventions, and 2 did not include a placebo or watchful waiting comparator. Although many studies reported HPV clearance or cytologic regression, none were powered or designed to assess progression to CIN II+. CONCLUSIONS: The current evidence from randomized trials is insufficient to determine whether topical cervical therapies reduce the risk of progression to CIN II+ in women with high-risk HPV infection. Future trials should prioritize histologic outcomes and adhere to current management protocols to establish the clinical utility of such therapies.
Russo G, Apostol AI, Ruscito I
… +9 more, Sassu CM, Diella C, Salvati F, Capomacchia FM, Boccia SM, Vertechy L, Marth C, Fagotti A, Marchetti C
Int J Gynecol Cancer
· 2026 Mar · PMID 41946649
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OBJECTIVE: In BRCA-mutated (BRCAmut) patients, while sensitivity to platinum has been assessed, the efficacy of other chemotherapy drugs, such as paclitaxel, in the recurrent setting is less defined. To this purpose, a s...OBJECTIVE: In BRCA-mutated (BRCAmut) patients, while sensitivity to platinum has been assessed, the efficacy of other chemotherapy drugs, such as paclitaxel, in the recurrent setting is less defined. To this purpose, a single-center retrospective study was designed to evaluate the effects of paclitaxel monotherapy in patients with platinum-resistant ovarian cancer based on BRCA status. METHODS: We collected data on patients with recurrent high-grade epithelial ovarian cancer treated with paclitaxel monotherapy between November 2017 and October 2024. Only patients who received 2 to 4 previous lines of chemotherapy before paclitaxel were selected. BRCAmut patients were compared with BRCA wild-type (BRCAwt) patients. The primary outcome was the impact of paclitaxel monotherapy on overall survival in both groups separately. The secondary outcomes were progression-free survival, response rate, and toxicity profile. RESULTS: Of 175 patients who received paclitaxel, 155 met the inclusion criteria: 50 (32.3%) BRCAmut and 105 (67.7%) BRCAwt patients. Median progression-free survival was 5 months (95% confidence interval [CI] 3.58 to 6.42) in the BRCAwt group compared with 4 months (95% CI 2.29 to 5.71) in the BRCAmut group (p = .013). In BRCAmut patients, median overall survival was 11 months (95% CI 8.28 to 13.72) compared with 18 months for the BRCAwt group (95% CI 16.04 to 19.96) (p < .001). In the 93 patients who had previously received poly (ADP-ribose) polymerase (PARP) inhibitors, overall survival remained significantly longer in BRCAwt patients (p = .004), but not progression-free survival (p > .05). CONCLUSIONS: Treatment with paclitaxel monotherapy seems to be less effective in patients with recurrent platinum-resistant BRCAmut ovarian cancer compared with the BRCAwt population. Further clinical studies are needed to confirm these data and investigate potential mechanisms of paclitaxel resistance in BRCAmut carriers.
Wright JD, Pankratz DG, Liu G
… +11 more, Wu S, Payne DS, Pattee PM, Wong MG, Cao M, Milton AK, Monzon FA, Hopkins MR, Kennedy GC, Ramirez PT, Mariani A
Int J Gynecol Cancer
· 2026 Apr · PMID 41945089
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OBJECTIVE: Current tissue-based methods for ruling out endometrial cancer in symptomatic women are highly invasive. We explored whether non-invasive vaginal samples could be used to detect endometrial cancer. METHODS: Wo...OBJECTIVE: Current tissue-based methods for ruling out endometrial cancer in symptomatic women are highly invasive. We explored whether non-invasive vaginal samples could be used to detect endometrial cancer. METHODS: Women undergoing hysterectomy were enrolled in an exploratory study, PNK001, wherein vaginal swabs, ectocervical swabs, endocervical cytobrushes, and endometrial tissue were obtained. Additionally, we secured RNA sequencing data from The Cancer Genome Atlas and endometrial tissues from the Cooperative Human Tissue Network. We generated sequencing data from swab, cytobrush, and tissue samples representing 27 PNK001 participants and 46 Cooperative Human Tissue Network samples. We analyzed differential expression, cell type signatures, and expressed somatic variants. We performed machine learning analyses on tissue samples and data from 20 PNK001 participants using expressed features and surgical pathology as reference labels. RESULTS: Machine learning classifiers trained on and applied to tissue samples achieved receiver operating characteristic area under the curve values of 0.97 and 0.98 on an independent test set. Significant differential gene expression and elevated somatic variant counts were present in endocervical cytobrush samples, ectocervical swabs, and vaginal swabs from women with endometrial cancer. Classifiers trained using expressed genes and variant counts distinguished 5 benign from 15 malignant cases in cytobrush, ectocervical, and vaginal swab samples, with average receiver operating characteristic area under the curve values of 0.6 to 0.96 in cross-validation. CONCLUSIONS: Vaginal swabs provided sufficient signal to detect endometrial cancer using RNA-based machine learning. We therefore selected the vaginal swab as the primary sample type for a second study (PNK002) to develop and validate a test for endometrial cancer. A non-invasive vaginal swab test with high sensitivity and negative predictive value could potentially rule out cancer in symptomatic women instead of invasive workup.
Int J Gynecol Cancer
· 2026 May · PMID 41936273
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OBJECTIVE: Retractions in scientific publishing have increased sharply in the past 2 decades, with more than 10,000 articles withdrawn globally in 2023. Despite this growth, the scope, causes, and temporal patterns of re...OBJECTIVE: Retractions in scientific publishing have increased sharply in the past 2 decades, with more than 10,000 articles withdrawn globally in 2023. Despite this growth, the scope, causes, and temporal patterns of retractions within gynecologic oncology have not been systematically characterized. Understanding these patterns is essential to safeguard research integrity and maintain confidence in the oncologic evidence base. METHODS: We conducted a descriptive observational analysis of retracted gynecologic oncology publications using the Retraction Watch Database from its inception and publication outputs indexed in Web of Science between 1989 and 2024. Retracted articles were identified across all gynecologic oncology disease sites, and bibliometric characteristics, study type, country of origin, publisher, citation impact, time to retraction, and stated reasons for retraction were analyzed. RESULTS: We identified 220 retracted gynecologic-oncology articles published across 83 journals in all specialties. These retracted publications were cited 4955 times, with median citations per retraction of 6 (range; 0-1855). Ovarian (101, 45.9%), cervical (76, 34.5%), and endometrial cancer (34, 15.5%) were the most represented disease sites, and 126 (57.3%) of retracted articles were basic-science studies. Median time to retraction was 1 year (range; 0-14). Data concerns accounted for the majority of withdrawals (118, 53.6%), followed by compromised peer review (35, 15.9%), image duplication (15, 6.8%), and authorship or ethics issues (15, 6.8%). China accounted for the largest proportion of identified retractions (80.9%), followed distantly by the United States (4.1%) and Japan (2.7%). Two publishers accounted for 47.0% (n = 104) of retractions. When adjusted for overall publication volume (n = 265,102 gynecologic oncology articles), the global rate of retractions rose markedly from 0.7 per 1000 publications in 2000 to 10.1 per 1000 publications in 2024. CONCLUSIONS: These findings suggest opportunities to strengthen editorial and institutional safeguards, robust research-integrity training, and systematic implementation of fraud-detection tools to protect the quality of gynecologic-oncology literature.
Bouchard-Fortier G, Ante Z, Liu N
… +6 more, Covens A, Eiriksson L, Osborne R, Pulman K, Swift BE, Gien LT
Int J Gynecol Cancer
· 2026 May · PMID 41936272
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OBJECTIVES: Gestational trophoblastic disease (GTD) is a rare condition that affects reproductive-age women with excellent clinical outcomes if treated appropriately. The study aims to describe patterns of care of GTD in...OBJECTIVES: Gestational trophoblastic disease (GTD) is a rare condition that affects reproductive-age women with excellent clinical outcomes if treated appropriately. The study aims to describe patterns of care of GTD in Ontario, Canada between 2005-2022. METHODS: Using province-wide administrative databases, individuals with molar pregnancies and gestational trophoblastic neoplasia (GTN) were identified between 2005-2022. Patient characteristics included age, socioeconomic status, comorbidities, type of treatment, type of provider and type of chemotherapy. Descriptive statistics were used to analyze baseline characteristics. Characteristics of low-risk GTN were compared to those of high-risk GTN to determine differences. Overall survival is reported with Kaplan-Meier curves. RESULTS: Between 2005-2022, there were 2,334,219 hospital births recorded in Ontario, among which 1,660 molar pregnancies were identified (0.7 per 1,000 births). Suction evacuation was the most common management (91.0%), while 9.0% underwent hysterectomy. Patients treated with hysterectomy were significantly older (mean 36 vs. 31 years, p<0.01). Procedures were performed by general gynecologists (83.0%) and gynecologic oncologists (16.0%, p<0.01). Among 385 patients treated with GTN-chemotherapy, 87.3% had low-risk and 12.7% high-risk GTN. High-risk patients were older (mean 37 vs. 33 years, p=0.01) and more likely to have undergone hysterectomy (24.5% vs. 10.1%, p<0.01). Low-risk and high-risk GTN were mostly treated with a single line of chemotherapy (77.7%). Gynecologic oncologists provided most first-line chemotherapy (77.4%) compared to medical oncologists (19.5%). At least 1 subsequent hospital birth was noted in 28.0% of GTN patients and 17.4% had 2 or more. Eight deaths occurred (2.1%), primarily within the first 2 years of diagnosis, yielding a 5-year overall survival of 97.9%. CONCLUSIONS: While survival for GTN in Ontario appears excellent for a cohort including mostly low-risk GTN, under-ascertainment may mask variability in treatment and outcomes. Our findings support mandatory reporting, centralized referral, and a provincial registry to reliably define care and drive improvements.
Li L, You J, Yuan Y
… +5 more, Gu X, Wu D, Yao K, Li X, Wang W
Int J Gynecol Cancer
· 2026 May · PMID 41935414
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OBJECTIVE: The study aimed to evaluate the efficacy of prophylactic para-aortic extended-field radiotherapy in participants with locally advanced cervical cancer undergoing concurrent chemoradiotherapy. METHODS: This ret...OBJECTIVE: The study aimed to evaluate the efficacy of prophylactic para-aortic extended-field radiotherapy in participants with locally advanced cervical cancer undergoing concurrent chemoradiotherapy. METHODS: This retrospective study included eligible participants with cervical cancer diagnosed with 2009 International Federation of Gynecology and Obstetrics stage IB to ⅣA and negative common iliac and para-aortic lymph nodes. All patients received concurrent chemotherapy with either pelvic or extended-field radiotherapy from March 2007 to December 2022. Propensity-score matching was used to balance key variables. RESULTS: Of the 1547 participants included, 1265 received pelvic radiotherapy and 282 received extended-field radiotherapy. Participants who received extended-field radiotherapy were more likely to have advanced disease, large tumor size, or pelvic lymph node involvement. Propensity-score matching resulted in 2 well-matched cohorts of 247 participants each, with balanced key variables. With a median follow-up of 69.0 months, extended-field radiotherapy was associated with a reduced risk of 5-year para-aortic lymph node failure relative to pelvic radiotherapy (2.5% vs 8.4%, p = .005). However, this local control benefit did not translate into significant improvements in survival outcomes. Five-year disease-free survival (71.4% vs 73.6%, p = .701) and overall survival (85.4% vs 80.8%, p = .183) remained comparable between extended-field radiotherapy and pelvic radiotherapy, as did the distant failure rate (22.0% vs 17.1%, p = .154). Multi-variate analysis revealed that extended-field radiotherapy was associated with better para-aortic lymph node control (hazard ratio 0.32, 95% confidence interval 0.15 to 0.70, p = .005). The incidence of grade 3 to 4 hematologic toxicities was higher in the extended-field radiotherapy group, whereas acute and chronic gastrointestinal and genitourinary toxicities were comparable. CONCLUSIONS: The largest retrospective study demonstrated that prophylactic extended-field radiotherapy was well tolerated and improved para-aortic lymph node control, though it did not confer a significant survival benefit. Further prospective trials are warranted to establish the role of risk-adapted strategies.
Kobayashi M, Nakagawa S, Matsuzaki S
… +4 more, Ouzounian AJ, Lee MW, Roman LD, Matsuo K
Int J Gynecol Cancer
· 2026 May · PMID 41932141
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In this retrospective cohort study examining 197 patients with T1b3, T2a2, and T2b small cell neuroendocrine carcinoma of the uterine cervix identified in the Commission-on-Cancer's National Cancer Database from 2006 to...In this retrospective cohort study examining 197 patients with T1b3, T2a2, and T2b small cell neuroendocrine carcinoma of the uterine cervix identified in the Commission-on-Cancer's National Cancer Database from 2006 to 2022, the majority received non-hysterectomy treatment with a combination of external beam radiotherapy and chemotherapy (63.5%), followed by primary hysterectomy and post-operative external beam radiotherapy and chemotherapy (17.8%), primary hysterectomy and postoperative chemotherapy without external beam radiotherapy (9.6%), and hysterectomy after a combination of external beam radiotherapy and chemotherapy (9.1%). The median tumor size was 6 cm. Among the hysterectomy cases, nearly one-quarter had surgical margins with tumor involvement (23.2%). The median follow-up was 7.6 years. When compared to a combination of external beam radiotherapy and chemotherapy without hysterectomy, primary hysterectomy followed by postoperative combination external beam radiotherapy and chemotherapy was associated with improved overall survival in multivariable analysis (5-year overall survival rate, 68.9% vs 46.9%; adjusted-hazard ratio, 0.42; 95% confidence interval, 0.24 to 0.74). This association was similar for node-positive cases in exploratory analysis. In conclusion, the results of these hypothesis-generating analyses may propose a possible role of hysterectomy in conjunction with radiotherapy and chemotherapy in select patients with early bulky locally advanced small cell neuroendocrine carcinoma of the uterine cervix, particularly when access to high-quality radiotherapy is not available.
Bretova P, Ndukwe MI, Romanova M
… +12 more, Kabele P, Koblizkova M, Gobel J, Muzykiewicz K, Reslova T, Kummel J, Pohankova D, Weinberger V, Habes D, Nowak-Jastrząb M, Sirak I, Zikan M
Int J Gynecol Cancer
· 2026 May · PMID 41932140
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OBJECTIVE: To determine how often lymph node assessment alters post-operative risk classification or adjuvant therapy in p53-abnormal endometrial carcinoma and to calculate the number needed to stage to obtain 1 manageme...OBJECTIVE: To determine how often lymph node assessment alters post-operative risk classification or adjuvant therapy in p53-abnormal endometrial carcinoma and to calculate the number needed to stage to obtain 1 management-changing result. METHODS: This multicenter retrospective study included patients with biopsy-confirmed p53-abnormal endometrial carcinoma who underwent pre-operative expert ultrasound, molecular classification, and definitive surgery. Pre-operative risk groups were based on ultrasound-assessed invasion and molecular subtype; post-operative groups incorporated final pathology and lymph node status. The number needed to stage was defined as the number of patients staged divided by the number with management-changing results. RESULTS: Among 120 patients, lymph node status was evaluable in 107, with metastases identified in 19 (17.8%) cases. Concordance between pre-operative and post-operative risk groups was 84.2%. Reclassification occurred in 15.8% of patients and was driven entirely by uterine pathological findings. Lymph node findings altered guideline-based post-operative management in only 2 of 107 patients (1.9%; 95% confidence interval 0.2% to 6.6%), both through treatment de-escalation based on negative nodal status. No escalation of adjuvant therapy was triggered by nodal metastases. The number needed to stage was 53.5. CONCLUSIONS: In this multicenter cohort of p53-abnormal endometrial carcinoma, lymph node assessment had a limited impact on guideline-based post-operative management, with treatment decisions largely driven by molecular subtype and uterine pathological factors. Prospective, molecularly stratified studies are needed to clarify the optimal role of nodal staging in this patient population.
Laios A, Plakou G, Quaranta M
… +4 more, Kaufmann A, Theophilou G, Kalampokis E, Fotopoulou C
Int J Gynecol Cancer
· 2026 May · PMID 41911632
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OBJECTIVE: To determine whether large language models (LLMs) can automatically extract organ-level disease involvement to populate the Surgical Findings section of the European Society of Gynaecological Oncology (ESGO) O...OBJECTIVE: To determine whether large language models (LLMs) can automatically extract organ-level disease involvement to populate the Surgical Findings section of the European Society of Gynaecological Oncology (ESGO) Operative Report for advanced ovarian cancer. METHODS: We retrospectively collected 300 operative notes from cytoreductive surgeries performed at a tertiary ESGO-accredited center. Each note was interrogated to identify disease involvement across 35 pre-defined ESGO anatomical sites. For each site, LLMs were tasked with classifying whether disease was present. Their accuracy was compared with expert annotations using F1 scores. Four modern models were selected based on their state-of-the-art performance and suitability for clinical text interpretation. Operative notes were converted into sets of binary (yes/no) questions corresponding to each anatomical site. Models were tested both in their basic form and after targeted enhancement strategies to reduce common errors. These enhancements included adding a clinical terminology list, providing clearer task instructions, and showing a small number of examples. RESULTS: The models showed good baseline accuracy, with the two top-performing systems achieving F1 scores of 0.851 (95% confidence interval [CI] 0.841 to 0.861) and 0.864 (95% CI 0.854 to 0.873). Following optimization strategies, accuracy increased further, reaching 0.897 (95% CI 0.888 to 0.906) and 0.875 (95% CI 0.866 to 0.884). Performance was highest for key clinical sites, including the omentum, right diaphragm (95%), and ovaries (92%). Lower accuracy was observed for complex anatomical sites such as bowel (small bowel 73%, large bowel 61%) and peritoneal sites (pouch of Douglas 82%, abdominal wall 68%). Frequent errors involved laterality, overlapping anatomical regions, and ambiguous abbreviations. Optimization strategies improved distinction between closely related sites (rectosigmoid vs large bowel/mesentery) and reduced left/right errors. CONCLUSIONS: With enhancement strategies, LLMs demonstrated near-human performance in extracting ESGO-compliant operative information. Integrating model-assisted extraction into surgical workflows may reduce reporting time, improve completeness, and help standardize operative documentation.