Nitric oxide is generated by the NO synthases, a family of isoenzymes expressed in a wide range of mammalian cells. In the vascular and nervous systems distinct isoforms generate NO to act as a signal transduction mechanism. The isoform induced by cytokines, on the other hand, provides a sustained release of NO which mediates some cytotoxic and cytostatic effects of the immune system. Solid tumors are a heterogeneous population of cell types, including tumor, vascular, and infiltrating immune cells. Studies in vitro show that NO synthase can be present in many of these cells. However, its presence in situ in solid human tumors has not been reported. In this study, we have investigated NO synthase activity and its cellular localization in malignant and nonmalignant human gynecological tissue. Nitric oxide synthase activity was observed in malignant tissue, was highest (> or = 250 pmol/min/g tissue) in poorly differentiated tumors, and was below detectable levels in normal gynecological tissue. Furthermore, investigations with a polyclonal NO synthase antibody revealed immunoreactivity only in malignant tissue. This was associated with NO synthase activity and localized to tumor cells. Thus NO synthase is present in human gynecological tumors, and its presence seems to correlate inversely with the differentiation of the tumor.
Ovarian cancer remains the most lethal gynecological malignancy worldwide, with late-stage diagnosis, high recurrence rates, and chemoresistance posing persistent clinical challenges. Adoptive cell therapy (ACT), a rapidly advancing immunotherapeutic strategy, offers promising efficacy with low systemic toxicity and has emerged as a compelling option to address these limitations. This review provides a comprehensive overview of ACT modalities-including tumor-infiltrating lymphocytes (TILs), chimeric antigen receptor T cells (CAR-T), natural killer (NK) cells, and other emerging cellular therapies such as TCR-T, cytokine-induced killer (CIK) cells, and γδ T cells-in the context of ovarian cancer. We highlight the mechanistic underpinnings of ACT, the immunosuppressive features of the ovarian tumor microenvironment, and cutting-edge advances in combinatorial regimens, genetic engineering, and cell design aimed at overcoming therapeutic resistance. In particular, we discuss antigen specificity, tumor immune evasion, and stromal barriers, and summarize current clinical trial progress, efficacy outcomes, and translational barriers. Together, these insights underscore the transformative potential of ACT in ovarian cancer and outline future directions for personalized and scalable immunotherapies.
Ovarian cancer, one of the most lethal gynecological cancers, metastasizes into skin in 0.9%-5.8% of cases. Cutaneous metastases severely affect the quality of life of ovarian cancer patients. Although cutaneous metastases are rare, a therapeutic option for affected patients is needed. Herein, we present a combination therapy comprising radiation and mild hyperthermia with parallel chemotherapy as a treatment modality. A woman with extensive skin metastases of a high-grade, serous ovarian carcinoma on the thigh was treated with a combination of mild hyperthermia (39-43 °C) immediately followed by low-dose hypofractionated radiotherapy and parallel systemic treatment with carboplatin/gemcitabine. Mild hyperthermia, a strong radiosensitizer, was induced through water-filtered infrared A radiation (wIRA). The patient responded well and remained tumor free in the treatment area for more than 1 year. Radiotherapy combined with mild hyperthermia in addition to systemic treatment allows for tumor control in the treated area, even with a reduced total radiation dose. To the best of our knowledge, this is the first report of a long-term tumor-free situation in the treatment area of skin metastases of ovarian cancer. This novel treatment might also be beneficial for skin metastases from other malignancies.
Endometriosis is a complex gynecological condition affecting nearly 10% of reproductive-aged women. This report updates a 2017 MSMR report of gynecological conditions, including endometriosis, from 2012 through 2016 among U.S. active component service women. The current report utilized medical encounter data from 2017 through 2024 to assess the incidence of endometriosis and its health care burden among U.S. active component service women. Factors related to co-occurring gynecological conditions, deployment, parity, and contraceptive use were also examined. Crude incidence rates and incidence rate ratios with 95% confidence intervals were calculated. The overall crude rate of endometriosis was 32.8 cases per 10,000 person-years and increased approximately 42.0% from 2017 to 2024. Incidence rates increased with age and were higher among nulliparous and never-deployed service women. Additionally, obese and underweight service women had higher incidence rates. Menorrhagia was the most common co-occurring condition, with oral birth control the most common form of contraceptive among incident cases. Identification of at-risk service women may help formulate targeted policies for earlier diagnosis to improve both quality of life and military readiness. Incidence of endometriosis increased during the surveillance period, from 28.7 cases per 10,000 person-years in 2017 to 40.7 cases per 10,000 person-years in 2024, coincident with a general increase of medical encounters for endometriosis, from 2,740 medical encounters in 2017 to 3,864 medical encounters in 2024. Service women who were older, obese or underweight, nulliparous, and never deployed had higher incidence rates.
Endometrial cancer has been regarded as one of the most common gynecological malignancies in high-income nations. A wide range of genetic, environmental, and lifestyle-related factors has been identified in the causation of endometrial cancers among women. Acknowledging the rising incidence, associated mortality, and the presence of multiple lifestyle-related factors in the causation of endometrial cancer, we must adopt targeted public health interventions to minimize the impact of these attributes. In conclusion, multiple lifestyle-related factors interact synergistically and significantly contribute to the incidence of endometrial cancer. The need of the hour is to adopt a multisectoral approach to effectively mitigate the consequences of lifestyle-related factors.
Eclampsia is a severe complication of preeclampsia involving blood-brain barrier (BBB) disruption. While small extracellular vesicles (sEVs) contribute to endothelial dysfunction in preeclampsia, their role in eclampsia remains unclear. We examined the effects of plasma and plasma-derived sEVs from women with eclampsia on BBB integrity. Plasma and plasma-sEVs were isolated from women with normotensive pregnancies (n=18), preeclampsia (n=19), preeclampsia with organ complications (n=17), and eclampsia (n=20). An in vitro BBB model based on the culture of human brain endothelial cells was used to evaluate electrical resistance (TEER) and Dextran 70 kDa permeability in the presence of women's plasmas or plasma-sEVs. sEVs cargo of relevant proteins involved in BBB regulation, eNOS, and TNF-α, were analyzed. Plasma from women with eclampsia disrupted the BBB, with marked reductions in TEER and increased permeability compared to normotensive controls, preeclampsia, and preeclampsia with organ complications. Moreover, plasma-sEVs of women with eclampsia caused a drop in TEERs but less BBB permeability than plasma-sEVs from normotensive controls or preeclampsia. Lower levels of eNOS and TNF-α in eclampsia-derived sEVs compared to normotensive controls were found. We report the critical role of circulating plasma factors in the disruption of the BBB during eclampsia. Although plasma-derived sEVs induce some alterations in barrier properties, our findings suggest they are not the main drivers of the BBB impairment observed in eclampsia, likely due to altered cargo composition.
Paraneoplastic pemphigus (PNP) or paraneoplastic autoimmune multiorgan syndrome (PAMS) is a rare, mucocutaneous blistering condition associated with high morbidity and mortality. Most reported cases occur in the setting of lymphoproliferative malignancies, with limited data describing associations with solid tumors. Additionally, standardized diagnostic criteria and management guidelines remain lacking. We describe the first, to our knowledge, case of PNP/PAMS associated with primary peritoneal clear cell carcinoma. A 47-year-old woman with recurrent, platinum-resistant primary peritoneal clear cell carcinoma presented with painful oral mucosal erosions, intermittent epistaxis, and a pruritic cutaneous eruption involving the trunk, groin, and lower extremities approximately four weeks after her fourth cycle of gemcitabine, cisplatin, and bevacizumab. Skin punch biopsy, serologies, and clinical findings were consistent with PNP/PAMS. She was treated with high-dose intravenous corticosteroids, followed by multiple adjunctive systemic and supportive therapies through a multidisciplinary approach; however, her recalcitrant and aggressive mucocutaneous disease progressed, contributing to significant clinical decline. She ultimately transitioned to comfort-focused care and died from complications of her underlying malignancy. This case highlights the diagnostic and therapeutic challenges of PNP/PAMS in patients with solid tumors and underscores the importance of multidisciplinary management in the absence of standardized treatment guidelines.
Robot-assisted hysterectomy (RAH) has been progressively introduced in gynecologic surgery, yet nationwide data describing its uptake and early efficiency outcomes remain limited. We described trends in surgical route for hysterectomy within France and evaluate the length of hospital stay (LoS) according to surgical route and center expertise in robot-assisted surgery (RAS). All total hysterectomies (excluding vaginal) performed in France between January 2020 and December 2024 were identified from the national Programme de Médicalisation des Systèmes d'Informations (PMSI) registry. Procedures were categorized as open, laparoscopic hysterectomy (LH), or RAH and stratified by indication (endometriosis, other benign conditions, malignancy) and by center expertise in RAS, including multidisciplinary RAS centers. Primary outcomes were surgical volumes by approach and LoS. Among 196,050 hysterectomies, LH remained the predominant approach; nevertheless, the proportion of RAH increased steadily across all indications over time, mainly at the expense of open surgery. This increase was more pronounced in high-volume and multidisciplinary RAS centers. Across indications, LoS was consistently shorter after minimally invasive surgery than after open hysterectomy. LoS following RAH was comparable to LH and decreased progressively over time. In experienced and multidisciplinary RAS centers, RAH was associated with the lowest LoS for benign indications. These nationwide, real-world findings show that RAH is increasingly being integrated into minimally invasive hysterectomy pathways within France, with LoS comparable to laparoscopy and shorter than open surgery. Our results support the role of RAS expertise and multidisciplinary organization in optimizing early clinical and operational outcomes during the adoption of gynecologic RAS.
Low-dose aspirin is recommended to pregnant individuals at increased risk of preeclampsia to improve outcomes. We recently showed that low-dose aspirin improves uterine artery function in a rat model of excessive hypercholesterolemia (eHC) in pregnancy, a known risk factor for preeclampsia. However, its effects on placentas from male and female offspring remain unclear. Here, we examined how low-dose aspirin affects various placental inflammatory and angiogenic markers, as well as the maternal soluble fms-like tyrosine kinase receptor-1 (sFlt-1)/placental growth factor (PlGF) ratio, in eHC pregnancies. We hypothesized that low-dose aspirin reduces placental inflammation, leading to angiogenic balance in these pregnancies. Sprague Dawley rats were fed a control diet or a high cholesterol diet (to model eHC) from gestational day (GD)6 to 20, with placebo or low-dose aspirin administered from GD10 to 20. On GD20, placentas were collected and separated based on the fetal sex. eHC in pregnancy elevated maternal plasma sFlt-1 without altering PlGF, resulting in an increased sFlt-1/PlGF ratio; that did not occur with low-dose aspirin treatment. Moreover, placental sFlt-1 was increased in male, but not female, fetuses; and was reduced by low-dose aspirin. Placental PlGF was reduced in males, but increased in females, of eHC pregnancies; low-dose aspirin restored placental PlGF in only the female placentas. NLRP3 (a major placental inflammatory pathway) levels were increased in only eHC male placentas, and normalized by low-dose aspirin. These findings reveal that low-dose aspirin restores the maternal plasma sFlt-1/PlGF ratio and suppresses placental inflammation through sex-specific mechanisms in eHC pregnancies.
To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy. This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve > 0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise. While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
The aim of the study was to follow the impact of cystectomy and compare bipolar and laser electrocoagulation on prooxidative stress biomarkers and antioxidative capacity. A total of 60 women with diagnosed endometriosis were included in the study and divided in two groups according to laparoscopy treatment with different energy sources for electrocoagulation. Prooxidative parameters (superoxide anion radical (O2-), nitrites (NO2-), hydrogen peroxide (H2O2), index of lipid peroxidation measured as thiobarbituric acid reactive substances) and antioxidative defence system parameters (reduced glutathione (GSH), activity of superoxide dismutase (SOD), and activity of catalase (CAT)) were determined spectrophotometrically before and after the surgery. The value of H2O2 was decreased in group treated with biporal electrocoagulation, while the value of GSH was increased in both groups. The value of O2- was significantly decreased in the group treated with laser, while SOD activity was increased in the same group. Both methods had a similar effect on index of lipid peroxidase and reduced glutathione, but when it comes to the decreasing of harmful superoxide anion radical and increasing of SOD activity, laser electrocoagulation showed better outcome. The role of oxidative stress in both understanding the pathogenesis of this disease and as a potential therapeutic target is certainly of great importance.
In 2022, Colombia reported 13.7 cases of cervical cancer per 100,000 females. Given the persistently low coverage of human papillomavirus (HPV) vaccination among girls (51%), alternative interventions are being considered. We assessed the population-level impact of switching from a quadrivalent to a nonavalent vaccine, as well as increasing vaccination coverage to the World Health Organization's target of 90% (≥1 dose). We developed a dynamic model of carcinogenic HPV transmission and vaccination in the population of Colombia aged 15+ years, stratified by health state, sex, age, sexual activity, and HPV vaccination status, accounting for latency. The model was calibrated to HPV prevalence data from Colombia and all Latin America. We evaluated gender-neutral and girl-only routine one-dose vaccination (<15 years) under current Colombian coverage levels and 90% coverage. We estimated age-standardised HPV prevalence, and the relative reduction in HPV prevalence and cervical cancer incidence over 2013-2100. Both vaccines reduced age-standardised HPV prevalence, with greater reductions observed at 90% coverage, under a gender-neutral scenario, and with a nonavalent vaccine. Switching to a nonavalent vaccine at current levels could reduce HPV prevalence by 39% (range: 33%-46%) in females by 2100, compared to 8% (range: 1%-17%) when only increasing quadrivalent vaccine coverage to 90% in a gender-neutral vaccination strategy. Only a nonavalent vaccine strategy reduced projected age-standardised cervical cancer incidence rates to below 4 cases per 100,000 females as early as 2058. Switching to a nonavalent vaccine will accelerate the reduction of HPV infections, thereby expediting progress toward cervical cancer elimination. Fonds de recherche du Québec-Santé and the Division of Cancer Epidemiology at McGill University.
Mid-life women are increasingly recognized as a vulnerable population for endocrine disruption due to chronic environmental exposures. Among emerging contaminants, per- and polyfluoroalkyl substances (PFAS) and microplastics have been implicated in reproductive health risks, yet focused evaluations in mid-life populations remain limited. The to systematically review human studies assessing the association between chronic exposure to PFAS and microplastics with reproductive health outcomes in mid-life women. We conducted a systematic review adhering to PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Web of Science, and EMBASE up to April 2025. Inclusion criteria were original human studies evaluating PFAS or microplastics in association with at least one reproductive health outcome (e.g., menopause, hormone levels, fertility metrics, and gynecologic conditions) in mid-life women. Study quality was appraised using the Newcastle-Ottawa Scale. Publication bias was qualitatively assessed. PROSPERO Registration ID: CRD42025446217. Eighteen human studies were included (16 PFAS-related, 2 microplastic-related). PFAS exposure was consistently linked with earlier menopause, elevated FSH, reduced fertility, and higher odds of endometriosis and polycystic ovarian syndrome. Limited studies on microplastics demonstrated their presence in human ovarian follicular fluid and placental tissues, with preliminary evidence of altered ovarian reserve. However, no large-scale epidemiological outcomes for microplastics were available. PFAS are significantly associated with adverse reproductive outcomes in mid-life women. Although microplastics have been detected in reproductive tissues, outcome-based evidence is insufficient. Further longitudinal studies are warranted to clarify these emerging environmental risks.
In utero stenting of the atrial septum has been introduced for fetuses with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) to prevent secondary pulmonary vascular damage caused by left atrial hypertension. Previous reports revealed a high risk of significant or complete in-stent obstruction after successful intervention due to endothelial proliferation. We report a fetus with HLHS and IAS complicated by nutmeg lung who underwent successful fetal atrial septal stenting using an everolimus-eluting stent (Xience Sierra; Abbott). The procedure resulted in immediate left atrial decompression and maintained an unrestrictive interatrial communication until delivery. The use of a drug-eluting stent resulted in sustained stent patency without evidence of endothelial overgrowth and without detectable systemic adverse effects in the fetus. In utero use of an everolimus-eluting stent appears safe and may reduce the risk of in-stent obstruction in fetuses with HLHS and IAS.
This study explored the association between the composite dietary antioxidant index (CDAI) and cardiovascular-kidney-metabolic (CKM) progression in an older population. Using data from NHANES 2001-2020, we analyzed 4974 adults aged ≥ 60 years with CKM syndrome. The CDAI was calculated from the intake of six dietary antioxidants. Associations between the CDAI and its components and advanced CKM syndrome (Stages 3-4) were assessed using multivariable logistic regression, restricted cubic splines, piecewise logistic regression, and weighted quantile sum (WQS) regression. Participants in the highest CDAI quartile had lower odds of advanced CKM syndrome than those in the lowest quartile (OR = 0.728, 95% CI: 0.594-0.893). Restricted cubic spline analysis showed an L-shaped association between CDAI and odds of advanced CKM syndrome, with an inflection point at 5.857; the inverse association was evident below this threshold and plateaued above it. Furthermore, the WQS regression model identified a protective combined effect of the six dietary antioxidants against advanced CKM syndrome, with vitamin A and vitamin C contributing the largest weights. Higher CDAI levels were associated with a lower risk of advanced CKM syndrome in older adults, with vitamins A and C emerging as the most influential components.
Respiratory viruses pose a persistent threat to human health, demanding effective strategies to block airborne transmission at the individual protection level. Traditional personal protective materials often lack intrinsic virucidal activity or suffer from cytotoxicity, failing to address the risk of secondary transmission. Herein, we highlight an H-type zeolite (H-Zeo) as a cost-effective, biocompatible, and inorganic antibody-mimetic inhibitor that efficiently inactivates SARS-CoV-2. The core antiviral mechanism relies on E340-targeted zeolite-protein biorecognition (ZPB): surface-localized H+ ions of H-Zeo form stable coordination bonds with the E340 residue of the SARS-CoV-2 spike protein receptor-binding domain (RBD), with an interaction energy (-1080.2 ± 66.7 kJ·mol-1) far exceeding that of the RBD-angiotensin-converting enzyme 2 (ACE2) interaction (-570.7 ± 69.4 kJ·mol-1). This strong competitive binding potently blocks the RBD-ACE2 protein-protein interaction, the initial step of viral entry into host cells. Based on this mechanism, we developed an H-Zeo-based antiviral gauze (H-ZG) for personal protection, which achieves >99.99% inactivation of authentic SARS-CoV-2. Notably, H-Zeo maintains >90% cell viability across all tested concentrations, overcoming the cytotoxicity limitations of metal-exchanged zeolites (e.g., Cu-zeolite). As a low-cost, scalable, and biocompatible material, H-Zeo provides a practical solution for mitigating airborne SARS-CoV-2 transmission, with broad potential for application in personal protective equipment and public health interventions.
As a significant threat to women's health worldwide, the incidence of endometrial cancer is rising annually, and current treatment options have limited effectiveness for advanced-stage patients. The use of antibody-drug conjugates (ADCs) in the treatment of endometrial cancer shows great potential. ADCs achieve selective killing of tumor cells through the combination of monoclonal antibodies, linkers, and cytotoxic drugs, while reducing damage to normal tissues. ADCs targeting Trop-2, HER2, and FRα have demonstrated notable efficacy in clinical trials, such as Sacituzumab Govitecan (SG) and Trastuzumab Deruxtecan (T-DXd), which have shown high objective response rates in Trop-2 and HER2-positive patients, respectively. Furthermore, the combination of ADCs with other treatment modalities (such as chemotherapy and immunotherapy) further enhances efficacy. However, ADCs still face challenges regarding resistance and safety, and future efforts must focus on optimizing designs and exploring more emerging targets to achieve the goals of precision medicine. This article provides a focused narrative overview of recent advances in ADCs for the treatment of endometrial cancer, with a primary focus on key targets including Trop-2, HER2, FRα, and Nectin-4.
Cancer of endometrium is among the most common female malignancies in developed nations. Usually, because of awareness related to complaints of postmenopausal bleeding and availability of various diagnostic modalities, endometrial cancer has a favorable prognosis. The aim of this study is to determine how accurate the contrast-enhanced magnetic resonance imaging (MRI) is for preoperative staging of uterine cancer considering final histopathological report as gold standard. In this retrospective study done in a tertiary care center, 50 patients with histopathological diagnosis of endometrial carcinoma were included, operated at our center between January 2024 and December 2024. Various prognostic factors such as invasion of myometrium and cervical stroma, metastasis to the lymph nodes (LNs), and extrauterine spread (EUS) were analyzed preoperatively with contrast-enhanced MRI reported by a single radiologist and then compared with final histopathology report. Statistical parameters such as accuracy (Ac), sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of MRI were assessed for each factor. The Sn, Sp, Ac, PPV, and NPV of myometrial invasion (MI) diagnosed with MRI were 62.5%, 80.77%, 72%, 75%, and 70%, and these values for cervical invasion were 40%, 100%, 94%, 100%, and 93.75%, respectively. Similar values for LN metastasis were 33.3%, 95.5%, 88%, 50%, and 91.3% and for EUS were 25%, 97.83%, 92%, 50%, and 93.75%, respectively. MRI is a sensitive tool for MI with good Ac and Sp for the diagnosis of cervical stromal invasion and LN metastasis before surgery and helps the clinician to plan the surgery accordingly.
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Prehabilitation is a proactive strategy aimed at optimizing physical, nutritional, and psychological reserves before initiating cancer treatment. While emerging evidence supports its effectiveness in improving perioperative outcomes in oncology, data specific to gynecologic cancers and low- and middle-income country (LMIC) settings remain limited. A prospective analytical cohort study was conducted at a tertiary care center in North India from July 2023 to April 2025. A total of 183 women with newly diagnosed or suspected gynecological malignancies were assessed prior to treatment. Parameters included performance status (Eastern Cooperative Oncology Group [ECOG]), frailty (Modified Frailty Index-11), nutritional markers (body mass index [BMI], hemoglobin, and albumin), and psychological well-being (Patient Health Questionnaire-9 depression scale). Time taken from presentation to diagnosis was also recorded and analyzed. Among 183 women with gynecologic cancers, cervical (45.9%) and ovarian (33.3%) malignancies predominated. Baseline vulnerabilities were highly prevalent: anemia (76.0%), low BMI (40.4%), hypoalbuminemia (31.1%), high frailty (52.5%), and moderate-severe depression (67.2%). The mean hemoglobin was 10.9 g/dL, BMI 22.2 kg/m2, and albumin 3.73 g/dL. The mean diagnostic delay was 30.2 ± 7.4 days (range: 12-41). On multivariable regression, higher ECOG status (β =4.44 days per point, P < 0.0001), lower albumin (β = -3.75 days per g/dL, P < 0.0001), and higher frailty (β =0.38 days per unit, P < 0.0001) independently predicted longer delays (R 2 = 0.62). Subgroup analysis confirmed significantly prolonged delays among frail patients (P < 0.0001). A high prevalence of frailty, nutritional risk, and psychological distress was identified among gynecologic oncology patients in this LMIC setting. These domains are interrelated and represent modifiable targets for structured prehabilitation. Future research and policy efforts should prioritize the implementation of cost-effective, multidisciplinary prehabilitation models tailored to resource-constrained environments.