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To provide evidence-based guidance on the role of metabolic and bariatric surgery (MBS) and other weight loss interventions in the management of obesity among women with endometrial intraepithelial neoplasia (EIN) and endometrial cancer (EC). This clinical practice statement, developed collaboratively by the Society of Gynecologic Oncology (SGO) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), synthesizes current literature on obesity, EC outcomes, and weight loss interventions, including lifestyle modification, anti-obesity medications, endoscopic bariatric therapies, and MBS. Obesity is a major modifiable risk factor for EC and is associated with worse oncologic and overall outcomes, with cardiovascular disease representing the leading cause of mortality in this population. Lifestyle and pharmacologic interventions can achieve modest weight loss but are often limited by sustainability. In contrast, MBS produces substantial and durable weight loss, improves obesity-related comorbidities, and is associated with reduced risk of hormone-related cancers, including EC. Emerging evidence supports the feasibility of incorporating MBS at various time points in cancer care, including as a bridge to definitive surgery or as an adjunct to conservative management, with early weight loss contributing to improved surgical candidacy and metabolic health. MBS represents the most effective and durable treatment for obesity in women with EIN and EC and may reduce cancer risk and improve overall health outcomes. Early multidisciplinary evaluation and integration of obesity treatment into oncologic care are essential to optimize patient outcomes.
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Clinical trials are essential for advancing treatment, yet inefficiencies across the trial lifecycle may hinder progress. We evaluated trial-level characteristics associated with non-completion among gynecologic cancer clinical trials. We conducted an analysis of interventional cervical, ovarian, and uterine cancer trials registered on ClinicalTrials.gov. Trials with at least one U.S. site initiated between 2008 and 2021 and classified as completed or not completed were included (n = 1033). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with non-completion. Reasons for premature trial termination were categorized into predefined groups. The majority of trials included ovarian cancer (68.3%), followed by uterine (25.8%), and cervical (24.7%) cancers. Overall, 30.3% of trials did not complete. In multivariable analyses, intervention type, year of initiation, and U.S. region were significantly associated with non-completion. Compared with drug/biologic trials, those evaluating multiple (OR 0.62, 95% CI 0.42-0.93) or other interventions (OR 0.49, 95% CI 0.25-0.98) had lower odds of non-completion. Trials initiated between 2018 and 2021 had substantially higher odds of non-completion compared with trials initiated 2008-2012 (OR 2.30, 95% CI 1.58-3.36). There was also heterogeneity of non-completion across region; however, no region was significantly different from the reference category of Northeast. Insufficient patient accrual was the most common reason for non-completion (28.8%). Thirty percent of gynecologic cancer trials fail to complete, with temporal trends playing a role. Findings highlight the need for improved trial design and feasibility planning to enhance efficiency in gynecologic oncology.
To evaluate feasibility, adherence, and participant experience of home-based cognitive training for gynecologic cancer survivors with cancer-related cognitive impairment (CRCI). This was an open-label pilot randomized mixed-methods trial at a tertiary academic cancer center. Eligible participants were gynecologic cancer survivors with screen-positive cognitive concerns after chemotherapy. Participants were randomized 2:1 to 10 weeks of home-based BrainHQ cognitive training or usual care. Feasibility was completion of baseline and week 10 assessments. Adherence was completion of at least 1200 adjusted BrainHQ minutes, corresponding to 80% of the prescribed dose. Post-intervention mixed-methods interviews were analyzed using inductive thematic text analysis. Among 155 patients screened for subjective CRCI, 88 (57%) screened positive, 64 consented, and 60 were randomized to BrainHQ (n = 40) or usual care (n = 20). Overall, 59 of 60 randomized participants (98%) completed baseline and week 10 assessments, exceeding the prespecified 65% feasibility threshold (p < 0.001). Among participants randomized to BrainHQ, median use was 1442 min (IQR 747-1831), and 22 of 40 (55%) met the prespecified adherence threshold. Ten BrainHQ participants completed interviews. Qualitative themes showed that participants were motivated by cognitive concerns, perceived cognitive and functional value, used routine and accountability to support engagement, and were often interested in continued cognitive training. Barriers included time burden, competing health or life demands, and platform frustration. Trial procedures were feasible, and adherence to the full prescribed BrainHQ dose was variable. Qualitative findings support refinement of intervention dose, adherence support, and participant-facing materials before a larger efficacy trial. GOV: NCT06662435.
The most common sites of breast cancer metastasis include the bone, lung, liver, and brain. Metastasis to the uterine cervix and endometrium is uncommon and can mimic primary gynecologic malignancies, leading to substantial diagnostic challenges. The authors have reported a 56-year-old postmenopausal woman with metastatic invasive mammary carcinoma of the left breast, including biopsy-confirmed liver metastasis, who presented after a syncopal event following an episode of heavy vaginal bleeding. Following her presentation, she underwent cervical and endometrial biopsies. Cervical biopsy revealed scattered discohesive tumor cells positive for GATA3, mammoglobin, TRPS1, AE1/3, and CAM5.2 and negative for PAX8, which were consistent with metastatic breast carcinoma. Endometrial biopsy showed cohesive nests of atypical carcinoma with diffuse p16, p63, and CK5/6 positivity and negative staining for mammoglobin, TRPS1, SOX10, and PAX8, initially raising concern for a human papillomavirus-associated squamous cell carcinoma. Following multidisciplinary evaluation, it was established that these features represented metastatic breast human papillomavirus-associated squamous cell carcinoma to the endometrium rather than a new primary gynecologic malignancy. This case highlighted the importance of considering metastatic disease in patients with breast cancer presenting with abnormal uterine bleeding and demonstrated the value of multidisciplinary evaluation in determining an accurate diagnosis.
Chronic pain significantly affects a person's quality of life, interferes with treatment adherence, and substantially increases healthcare costs. There are limited data on the prevalence, risk factors, and impacts of chronic pain in Northern Ethiopia. Following ethical approval, a multicenter cross-sectional study was conducted in Northern Ethiopia. The impact of chronic cancer pain was assessed using the Brief Pain Inventory Short Form. Binary logistic regression was employed to determine associations with chronic cancer pain. A P-value of <0.05 was considered statistically significant. Among 397 participants, 237 (59.7%) reported chronic cancer pain, and 46.4% reported moderate to severe pain. Chronic cancer pain was significantly associated with female gender [adjusted odds ratio (AOR) = 2.3], primary education (AOR = 2.4), and secondary education (AOR = 2.7), respectively. Breast cancer (AOR = 3.0), gynecologic cancer (AOR = 2.3), lung cancer (AOR = 2.5), genitourinary cancer (AOR = 4.0), and head or neck cancers (AOR = 2.6) also showed positive associations. Additionally, stage IV cancers increased the risk (AOR = 2.2). Patients with chronic cancer pain reported impaired physical activity, increased anxiety and depression, poorer sleep quality, and reduced enjoyment of life compared to those without chronic pain. Chronic cancer pain is prevalent in Northern Ethiopia, disproportionately affecting women, patients with lower education, and those with specific or advanced cancers. It substantially impairs physical, mental, and overall quality of life. These findings highlight the urgent need for targeted pain management and supportive care strategies to improve outcomes for high-risk cancer patients.
To evaluate the clinical impact of incorporating patient specific 3-dimensional (3D) printed anatomical models into gynecological practice for improving surgical planning and patient outcomes in patients with deep endometriosis. A pilot prospective randomized control study using a repeated measure, questionnaire-based design included patients consented for surgical excision of endometriosis. Patients were randomized to have a 3D printed model or not (control). 3D models were rendered from T2 weighted magnetic resonance images. Gynecologic surgeons completed questionnaires on surgical planning, surgical outcomes and surgeon experience before and after viewing the 3D printed models and post-operatively and comparisons were made using paired t tests. There were 5 patients included in the 3D printing group and 8 patients in the control group. In the 3D printing group, there was a change in 5/10(50%) surgeon responses for perception of surgical level of difficulty, 5/10(50%) surgeon responses for allotted surgical time, and 3/10(30%) surgeon responses for estimated blood loss after viewing the 3D model. Eight of 10(80%) of surgeon responses reported referencing the model intraoperatively. Allotted surgical time was significantly greater post viewing compared to pre-viewing the model (256.4±60.5 vs. 246.4±56.6 minutes; d = -0.19, P = 0.044) and estimated blood loss significantly lower post-viewing compared to pre-viewing the model (177.3±114.8 vs. 204.6±154.1 ml; d = 0.293, P = 0.003). Compared to control cases, mean surgical time was significantly lower in the 3D model cases (271.7±94.6 vs. 460±225.2mins; P = 0.006). 3D printed models may help to optimize surgical planning and improve surgical performance, bettering the overall surgical outcomes in gynecologic surgery for deep endometriosis.
Introduction/ObjectiveOpportunistic salpingectomy (OS) has been shown to reduce high-grade serous ovarian cancer (HGSOC) by 42-80%, yet awareness of this strategy outside of obstetrics and gynecology remains limited. The objective of this study was to assess awareness and counseling practices regarding OS for HGSOC prevention among primary care providers (PCPs).MethodsWe conducted a cross-sectional survey study using a 6-item electronic survey evaluating PCP knowledge and counseling practices related to HGSOC prevention through OS. The study was conducted at a single tertiary care center with gynecologic oncology services. Survey items assessed awareness of HGSOC origin, awareness of OS as a preventative strategy, counseling frequency in the setting of abdominal or pelvic surgery, counseling comfort, and resources needed to increase confidence in recommending OS. Response formats included Likert scales and Yes/No/Unsure options. The survey was distributed by email to attending physicians and advanced practice providers (APPs) in the Department of Family Medicine (FM) and Internal Medicine (IM).ResultsOf 398 providers surveyed, 136 responded (34% overall response rate; FM 44%, IM 28%), including 96 attending physicians and 40 APPs. Most PCPs were unaware that HGSOC originates in the fallopian tubes (60%) and were unaware of OS as a preventive strategy (71%). Counseling was uncommon: 11% had ever counseled on OS, while 74% had not and 15% reported it was outside their scope. Most respondents (63%) reported being not at all comfortable counseling patients about OS. Providers identified clinical guidelines (60%), CME or training modules (50%), eligibility criteria (48%), gynecology collaboration pathways (48%), and patient-friendly materials (44%) as key supports to improve counseling confidence.ConclusionPCP awareness and counseling regarding OS are limited. Given that guideline support for OS has solidified only in recent years, these gaps are not surprising-and they represent a clear, actionable opportunity. PCPs are well-positioned to lead the expansion of ovarian cancer prevention beyond specialty care with the right tools and support.
Endometrial cancer is the most common gynecologic malignancy in developed countries, with rising incidence worldwide. While early stage disease generally carries a favorable prognosis, recurrence remains a significant clinical concern. Among the histopathological features, lymphovascular space invasion (LVSI) has emerged as a critical prognostic factor, reflecting tumor aggressiveness and potential for metastatic spread. LVSI is associated with increased risk of recurrence, distant metastasis, and reduced survival, even in patients with otherwise low risk disease. Understanding the role of LVSI in endometrial cancer is essential for refining risk stratification, guiding adjuvant therapy decisions, and improving patient outcomes. Our study to evaluate the impact of lymphovascular space invasion (LVSI) on treatment outcomes, recurrence, and survival in patients with stage I endometrioid endometrial cancer. A retrospective cohort study was conducted at the Hospital Canselor Tuanku Muhriz (HCTM) Gynecologic Oncology Clinic, with ethical approval from Universiti Kebangsaan Malaysia. Patients with stage I endometrial carcinoma, classified according to the International Federation of Gynecology and Obstetrics (FIGO) 2018, and confirmed on hysterectomy specimens were included. Demographic clinicopathological, and treatment data were collected. LVSI was defined as the presence of tumor cells within endothelial lined spaces. Overall survival (OS) was the primary endpoint. Statistical analyses were performed using SPSS version 26, employing chi square, t tests, and Kaplan-Meier estimates, with significance set at p < 0.05. Of 180 patients, 163 had endometrioid carcinoma; 114 were included in the final analysis (mean age 58 years; 79.8% postmenopausal). LVSI was present in 14.2% of cases and was associated with higher grade and deeper myometrial invasion. Recurrence occurred in 8.5% overall, with 18.8% in LVSI positive and 4.1% in LVSI negative patients. The 2 year disease free survival (DFS) rate was 93.4% (80.8% LVSI positive vs 99% LVSI negative). The 5 year DFS rate was 91.1% (73.4% LVSI positive vs 94% LVSI negative). The OS rate was 97.3% (87.5% LVSI positive vs 99% LVSI negative). Distant metastasis predicted 2 year DFS, whereas LVSI positivity independently predicted reduced 5 year OS. At 5 years, the DFS rate was 91.1% (SE = 0.031), while the OS rate was 97.3% (SE = 0.013). The similarity between DFS and OS reflects the low number of recurrence and death events, indicating favorable prognosis and effective disease control. Median survival was not reached. LVSI was associated with higher recurrence and poorer survival in patients with Stage I endometrioid endometrial carcinoma, independently predicting 5-year survival, supporting its role in risk stratification and treatment planning.
To evaluate the feasibility and perioperative safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with sentinel lymph node biopsy (SLNB) for surgical staging of endometrial neoplasia. We conducted a retrospective consecutive case series at a tertiary gynecologic oncology center between May 2024 and December 2025. All patients undergoing hysterectomy and SLNB for staging of suspected or confirmed early-stage endometrial neoplasia using the vNOTES approach were included. Demographic characteristics, operative parameters, conversions, and intra- and postoperative complications were recorded. Primary outcomes were feasibility-defined as completion of the procedure without conversion-, detection rate and perioperative safety. Secondary outcomes included operative time, blood loss, hospital stay, and factors influencing operative performance. Thirty-six patients were included. Median age was 63 years (IQR 57-69) and median BMI was 30 kg/m² (IQR 27-36). The procedure was completed by vNOTES in 33 patients (89%), with 1 conversion to laparoscopy (3%) and 2 conversions to laparotomy (6%) for specimen extraction. Median operative time was 125 minutes (IQR 115-150). Median hospital stay was 1 day (IQR 1-2; range 1-21). Estimated blood loss was <100 mL in 69% of procedures. Intraoperative complications occurred in 4 patients (11%), all bladder injuries recognized and repaired intraoperatively. Bilateral detection rate was 89% and unilateral detection rate was 100%. Operative time did not differ significantly between the first 10 cases and the subsequent procedures (median 125 vs 120 minutes, p=0.86). No variable was significantly associated with the occurrence of complications, and BMI was not associated with operative duration. vNOTES hysterectomy with SLNB for endometrial cancer staging is feasible and demonstrates acceptable perioperative morbidity in a consecutive series. Further studies are required to assess long-term oncologic outcomes.
Hysterectomy is one of most performed gynecological procedures worldwide. Recent decades have witnessed a significant uptake of laparoscopic approaches. While technical proficiency is increasingly recognized as being closely linked to patient outcomes in different surgical specialties, standardization of assessment in minimally invasive gynecological surgery remains challenging. This study aimed to develop and validate a comprehensive assessment tool for robotic-assisted and laparoscopic hysterectomy and investigate associations between surgical performance and perioperative outcomes. An international multi-center mixed-method study was conducted. Literature review was performed, and statements were proposed by a steering group of seven expert gynecologists, followed by a Delphi consensus to identify essential procedural phases, potential technical errors or near misses. The resulting assessment tool was validated using 40 unedited minimally invasive hysterectomy videos assessed by multiple raters under a national prospective multi-center observational cohort study. Inter-rater and intra-rater reliability were calculated using Cronbach's alpha and intraclass correlation. Concurrent validity was assessed through correlation with a validated error assessment tool (OCHRA), while predictive validity was established by correlating scores with clinical outcomes including operative time, blood loss, and postoperative complications according to the Clavien-Dindo classification. Consensus was achieved amongst 17 international experts from 6 countries on the composition of an objective assessment tool, composed of seven phases and four quality measures. Inter-rater and intra-rater reliability and internal consistency were considered excellent: ICC = 0.969 (CI: 0.922-0.986, p < 0.001), ICC 0.810 (CI: 0.800-0.842, p = 0.002), and Cronbach's α per phase was 0.743-0.834. When controlling potential confounders a higher STELLAR score was associated with shorter operating time, less blood loss and fewer post operative complications. Increased tool score was associated with significant lower chance of post-operative complications: rs = -0.438, (CI: -0.173 to -0.657, p = 0.004). Operative performance during laparoscopic and robotic-assisted hysterectomy can be objectively measured and correlated with clinical outcomes. This newly developed objective assessment tool can be used for surgical quality assurance of surgical techniques during education and training sessions or surgical trials.
Food insecurity is an underrecognized determinant of nutritional vulnerability among women with cancer. Although oncology nutrition guidelines increasingly emphasize early screening, dietitian referral, body-composition preservation, and survivorship-oriented dietary patterns, many women experience financial toxicity after diagnosis through out-of-pocket medical costs, income loss, transportation expenses, caregiving disruption, and competing household needs. These economic pressures can restrict access to adequate, safe, and nutrient-dense foods, thereby worsening malnutrition risk, diet quality, sarcopenia, obesity-related metabolic dysfunction, fatigue, and treatment intolerance. The problem is especially relevant in breast, gynecologic, and other women's cancers, where endocrine therapy, menopausal transition, long-term survivorship care, and gendered caregiving roles may amplify nutritional and economic strain. This Mini Review synthesizes the health-economic pathway linking financial toxicity, food insecurity, and nutritional vulnerability in women with cancer. It discusses clinical mechanisms, evidence connecting food insecurity with care disruption and mortality, and implementation priorities for equitable nutrition care. A practical framework is proposed in which food insecurity screening, malnutrition assessment, financial navigation, dietitian referral, social support, and outcome monitoring are integrated into survivorship care. Equity should be evaluated not by service volume alone, but by whether women at greatest nutritional and financial risk receive timely, effective, and sustainable support.
Ovarian cancer (OC) is the most lethal gynecological malignancy. A deeper insight into tumor microenvironment (TME) interactions is essential for developing novel therapeutic approaches. leukocyte immunoglobulin-like receptor B4 (LILRB4) is a receptor involved in multiple biological and pathological processes in hematological malignancies; however, its role in the progression of solid tumors remains largely unexplored. In particular, the function within the OC is still unclear. We systematically investigated the expression profile of LILRB4 in OC, along with its regulatory effects on OC cells, its role in immune cell modulation, and its potential as an immunotherapeutic target, using bioinformatics analyses, in vitro functional assays, and an in vivo orthotopic tumor model. We found that LILRB4 is the most highly expressed member of the LILRB family in OC, with significantly higher expression in tumor tissues than in normal ovarian tissues, and its elevated expression was associated with poor patient survival. In vitro functional assays demonstrated that LILRB4 knockdown significantly inhibited OC cell proliferation, migration, and invasion, whereas overexpression of LILRB4 promoted these malignant phenotypes. Further analyses revealed that LILRB4 expression was positively correlated with the infiltration of tumor-associated macrophages in the TME and promoted macrophage polarization toward the immunosuppressive M2c phenotype. Mechanistically, in vitro experiments showed that LILRB4 promoted tumor cell secretion of CCL5, activated the NF-κB p65 signaling pathway, and enhanced M2c macrophage polarization, thereby promoting tumor progression and immune suppression. Finally, we demonstrated that downregulation of LILRB4 could enhance the sensitivity of OC to immunotherapy. These findings identify LILRB4 as a key regulator of tumor progression and immune evasion in OC. High LILRB4 expression is associated with an immunosuppressive TME and poor response to immunotherapy, highlighting its potential as both a prognostic biomarker and a therapeutic target.
To assess concordance of tumor BRCA1/BRCA2 variant detection across four sequencing workflows benchmarked against the Myriad myChoice companion diagnostic in newly diagnosed ovarian cancer. Within the MITO16A/MaNGO-OV2 trial, 100 formalin-fixed paraffin-embedded ovarian cancer samples were analyzed across four workflows in the Italian network: one academic modular workflow (Agilent OneSeq/VarDict) and three commercial platforms (Oncomine Comprehensive Assay Plus/Ion Reporter, SOPHiA DDM, and TruSight Oncology 500/DRAGEN). BRCA1/BRCA2 calls were compared with myChoice as the reference. Variant classification, quality metrics, and copy number findings were centrally curated. Concordance was assessed at the sample level, and discordant cases underwent manual review to identify technical or interpretive drivers. Two samples failed myChoice testing and were excluded, leaving 98 evaluable cases. Complete agreement across all workflows and the reference assay was observed in 86 of 98 samples (87.8%). The 12 discordant cases (12.2%) fell into four recurrent categories: limited detection of exon-level copy number alterations, low-frequency variants in formalin-fixed paraffin-embedded specimens, differences in reporting of variants of uncertain significance, and transcript or nomenclature inconsistencies. An illustrative sample with dual BRCA1/BRCA2 pathogenic variants highlighted the impact of local coverage and filtering thresholds. No workflow showed systematic over-calling or under-calling. Tumor BRCA1/BRCA2 results showed moderate cross-platform concordance, with clinically relevant discordances driven mainly by technical and interpretive factors. Greater standardization of tumor BRCA1/BRCA2 testing is needed to support consistent reporting, treatment decisions, and referral for hereditary cancer assessment. EudraCT 2012-003043-29; NCT01706120.
To evaluate the efficacy and safety of intracavitary brachytherapy for high-grade vaginal squamous intraepithelial lesions (HSIL/VaIN2-3) and clarify its role and dose-fractionation within the therapeutic algorithm. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review registered in International Prospective Register of Systematic Reviews (CRD420261292798). MEDLINE, Embase, and CENTRAL were searched from inception to February 2026 for clinical trials, analytical observational studies, and case series that included at least 5 women with biopsy-proven HSIL/VaIN2-3 treated with any brachytherapy modality. Two reviewers independently screened records, selected studies, and extracted data on local control, persistence, recurrence, progression to invasive cancer, and acute and late toxicity; methodological quality was appraised with the Joanna Briggs Institute case-series checklist. Ten retrospective series comprising 225 women with vaginal intraepithelial neoplasia (214 HSIL/VaIN2-3) treated with low-, medium-, or high-dose-rate intracavitary brachytherapy were included. Median age ranged from 56 to 63 years, and follow-up duration from 26 to 127 months; most patients had prior cervical intraepithelial neoplasia, cervical or endometrial cancer, hysterectomy, or previous local treatments. Across studies, actuarial or crude local control ranged from 85% to 95%; 6 of 225 patients (2.7%) had persistent disease, 3 of 176 patients with vaginal intraepithelial neoplasia-specific data (1.7%) recurred, and 5 of 225 (2.2%) progressed to invasive or microinvasive vaginal carcinoma, usually within 2 to 3 years. Acute toxicity was predominantly grade 1 or 2 urinary, gynecologic, or anorectal and self-limited, whereas relevant late morbidity was mainly vaginal; severe rectal or bladder events were uncommon, but late grade ≥3 vaginal stenosis or ulceration increased at higher equivalent doses. Intracavitary brachytherapy achieves high local control with low persistence, recurrence, and progression rates in women with HSIL/VaIN2-3, particularly with contemporary high-dose-rate regimens around 45 to 55 Gy Equivalent dose in 2Gy fractions (EQD2) at 3 to 5 mm depth. Given the small, noncomparative, methodologically heterogeneous series and the apparent rise in late vaginal toxicity beyond EQD2 ≈70 Gy, brachytherapy should be reserved for carefully selected extensive, multifocal, recurrent, post-hysterectomy, or surgically high-risk cases, and future prospective multicenter studies comparing brachytherapy with surgery, laser, and topical treatments and incorporating standardized dosimetry and patient-reported outcomes are warranted.
Evidence to guide (neo)adjuvant chemotherapy choices in carriers of germline BRCA1/BRCA2 pathogenic variants (BRCA carriers) with early breast cancer (BC) is limited. We evaluated the association of different chemotherapy regimens with survival outcomes in this population. The BRCA BCY Collaboration (NCT03673306) is an international, multicenter, retrospective cohort study of BRCA carriers diagnosed with stage I-III BC at age ≤ 40 years, between 2000 and 2020. Disease-free survival (DFS) and overall survival (OS) were assessed among patients with HER2-negative disease treated with anthracycline-taxane, anthracycline-no-taxane, or non-anthracycline (neo)adjuvant chemotherapy. The association of platinum use with outcomes was evaluated in triple-negative breast cancer (TNBC). Among 4200 young BRCA carriers from 109 centres who received (neo)adjuvant chemotherapy for HER2-negative BC, 58.7% had TNBC. Median follow-up was 8.1 years (IQR, 4.7-12.6 years). Anthracycline-taxane, anthracycline-no-taxane, and non-anthracycline regimens were used in 74.4%, 19.3%, and 6.3% of patients, respectively. Platinum agents were administered in 19.8% of TNBC cases. After multivariable adjustment, no significant differences in DFS or OS were observed between anthracycline-no-taxane and anthracycline-taxane regimens (DFS adjusted hazard ratio [aHR] 0.88, 95% CI 0.73-1.05; OS aHR 1.20, 95% CI 0.87-1.67) or non-anthracycline regimens (DFS aHR 1.07, 95% CI 0.82-1.38; OS aHR 1.16, 95% CI 0.68-2.0). In TNBC, platinum use was not associated with improved outcomes. In young BRCA carriers with HER2-negative early BC, no statistically significant differences in survival outcomes were detected across different chemotherapy regimens. Our findings may inform future prospective studies evaluating chemotherapy de-escalation strategies in this genetically defined population.
Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder. Irisin is an exercise-related myokine involved in energy homeostasis; however, prior studies have reported inconsistent associations between irisin and PCOS. To compare serum irisin levels between women with PCOS and non-PCOS controls and to assess the discriminatory performance of irisin for PCOS. Cross-sectional, case-control study conducted at a tertiary referral center. We enrolled 144 women, 72 with PCOS and 72 non-PCOS as controls. Serum irisin levels were measured using an enzyme-linked immunosorbent assay. Adjusted comparisons were performed using a general linear model, and the association between irisin and PCOS was further evaluated using multivariable binary logistic regression. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of irisin. Serum irisin levels in the PCOS group were significantly lower than those in the control group (p = 0.006). In the age and body mass index (BMI) adjusted ANCOVA model, PCOS status remained significantly associated with lower log-transformed irisin (p = 0.002). In a multivariable logistic regression analysis adjusted for age and BMI, log-transformed irisin levels remained independently associated with PCOS (p = 0.006). In ROC analysis, the area under the ROC curve for irisin was 0.632; an irisin cut-off of ≤ 16.2 ng/mL resulted in 87.5% sensitivity and 38.89% specificity. Women with PCOS had lower circulating irisin levels than controls, and this association persisted after adjusting for age and BMI. Discriminatory performance was modest, and specificity was low at the selected cutoff. Larger studies are warranted to validate these findings.
Adult cervical embryonal rhabdomyosarcoma (ERMS) is an exceptionally rare malignant mesenchymal tumor, and evidence regarding its clinicopathologic characteristics, optimal management, and prognostic factors remains limited. We report an aggressive case of adult cervical ERMS and provide a contemporary review of the literature. A 50-year-old woman presented with abnormal vaginal bleeding and was diagnosed with cervical ERMS following histopathologic and immunohistochemical evaluation. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant vincristine, actinomycin D, and cyclophosphamide (VAC) chemotherapy. Despite multimodal treatment, she developed rapid pelvic recurrence, progressive disease, and recurrent vaginal bleeding requiring palliative radiotherapy and died 13 months after diagnosis. To better characterize adult cervical ERMS, we reviewed English-language reports published between 2015 and 2026. Forty-one previously reported adult cases with sufficient clinical information were identified. The median age at diagnosis was 38 years, and the median tumor size was 5 cm. Most patients presented with stage I disease and were treated with surgery combined with chemotherapy, most commonly VAC-based regimens. Overall outcomes were generally favorable. Uncommon clinical presentations and associated conditions included uterine inversion, pregnancy-associated disease, cerebral venous sinus thrombosis, melanoma, and DICER1-associated alterations. Adult cervical ERMS demonstrates substantial clinical heterogeneity. Although most reported patients achieve favorable outcomes with multimodal treatment, a subset may experience aggressive disease characterized by rapid recurrence and poor prognosis. Greater molecular characterization, particularly regarding DICER1-associated alterations, may improve risk stratification and support more individualized treatment strategies.