Department Of Gynecologic Oncology Research Articles

Clinico-Pathological Characteristics of Endometrial Carcinoma with Mismatch Repair Deficiency

Background: Endometrial carcinoma (EC) is a common gynecologic malignancy with significant implications for women's health. Mismatch repair deficiency (MMRd) has emerged as a critical factor influencing the pathogenesis and prognosis of EC. This study aims to investigate the clinicopathologic characteristics of MMRd EC in a Bangladeshi cohort. Methods: This cross-sectional observational study was conducted at the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2022 to February 2023. A total of 49 patients with histologically confirmed EC were included. Data were collected through a semi-structured questionnaire and patient records. Results: Among the 49 patients, 67.35% (n=33) were MMR proficient, while 32.65% (n=16) were MMR deficient. The mean age was 55 years for MMR proficient and 55.6 years for MMR deficient patients. Hypertension was present in 69.70% of MMR proficient and 75% of MMR deficient patients, while diabetes mellitus affected 54.55% of MMR proficient and 62.50% of MMR deficient patients. MMRd patients showed higher rates of adnexal involvement (37.50% vs. 6.06%, p=0.010) and metastasis (37.50% vs. 9.09%, p=0.024). Multivariate logistic regression identified advanced FIGO stage (III & IV) as a significant predictor of MMR deficiency (adjusted OR 4.274, 95% CI: 1.691-15.515, p=0.025). Conclusion: MMRd in endometrial carcinoma is associated with more aggressive tumor features and poorer prognostic indicators. Routine evaluation of MMR status is crucial for effective prognosis and treatment planning. Addressing socioeconomic disparities and integrating targeted therapeutic strategies can improve management and outcomes for patients with MMRd endometrial carcinoma in diverse populations.

Impact of postsurgical vaginal microbiome on high-risk HPV infection and recurrence risk in patients with cervical cancer and intraepithelial neoplasia: A retrospective study

PurposeThis study aimed to determine the effect of postsurgical vaginal microbiome (VM) on high-risk human papillomavirus (hrHPV) infection and the risk of disease recurrence in patients surgically treated for cervical cancer (CC) or intraepithelial neoplasia (CIN). Methods207 women who underwent surgical treatment for CC or CIN at the Department of Gynecologic Oncology of the First Affiliated Hospital of University of Science and Technology of China from November 2016 to October 2023 were included. The patients’ clinical data, including age, surgical modality, and diagnosis at time of index surgery, were collected retrospectively and analyzed. Associations between postsurgical VM indices, hrHPV infection, cervical cytology, and recurrence were also evaluated. ResultsPatient age, surgical modality (whether complete excision of the cervix was performed), and diagnosis at time of index surgery (cervical dysplasia vs. cervical carcinoma) showed no significant association with postsurgical hrHPV infection, cervical cytology, or disease recurrence. However, postsurgical VM imbalance was significantly associated with hrHPV infection status (OR = 4.640, 95 % CI = 2.085–10.460, P < 0.001), abnormal cervical cytology (OR = 3.994, 95 % CI = 1.154–13.826, P = 0.020), and disease recurrence (OR = 3.789, 95 % CI = 1.091–13.154, P = 0.026). Among the specific VM indices, a vaginal pH above 4.5 (OR = 4.570, 95 % CI = 1.640–12.690, P = 0.002), a lactobacilli proportion below 50 % (OR = 3.938, 95 % CI = 1.299–11.934, P = 0.010), and the presence of aerobic vaginitis (AV, OR = 2.425, 95 % CI = 0.996–5.901, P = 0.046) were risk factors for postsurgical recurrence. ConclusionPostsurgical VM imbalance, especially abnormal indices, such as a pH above 4.5, a lactobacilli proportion below 50 %, and the presence of AV, was associated with an increased risk of postsurgical recurrence in patients who underwent surgical treatment for CIN and CC. Monitoring and potentially intervening in the VM may improve the prognosis of these patients.

Single-center experience of laparoscopic hysterectomy: analysis of one thousand five hundred and fifteen patients

Laparoscopic hysterectomy has become an increasingly used surgery in recent years. The aim of this study was to evaluate the clinical features and perioperative outcomes of patients who underwent laparoscopic hysterectomy for benign or malignant indications in a single center during a period of eight years. Data of patients who underwent laparoscopic hysterectomy in the gynecological oncology department of a university hospital over a period of eight years was analyzed retrospectively. Two groups were formed based on being operated for benign or malignant indications. Demographic characteristics and perioperative data of these groups were evaluated. A total of 1,515 patients underwent laparoscopic hysterectomy. The mean age of the patients was 52.0±9.8 years and mean body mass index (BMI) was 31.3±8.5 kg/m2. Of these, 1,219 had benign and 296 had malignant histopathology results. In the whole cohort, intraoperative complications were seen in 1.6% and postoperative complications in 3.5%. The patients in the malignant group were older, had a higher BMI and a higher comorbidity rate. The duration of operation and length of hospital stay were significantly longer in this group (p=0.0001 for all parameters). However, intraoperative and postoperative complication rates, rate of blood transfusion and amount of transfusion were similar between the two groups (p>0.05). Laparoscopic hysterectomy can be performed with low complication rates in benign and malignant indications, regardless of the patient’s contributing factors. However, since experience is important, financial resources and personnel training processes should be supported.

Post-Operative Complications Following Vulval Cancer Surgery: A Retrospective Study from a Gynaecologic Oncology Department

Post-Operative Complications Following Vulval Cancer Surgery: A Retrospective Study from a Gynaecologic Oncology Department

Using heart rate variability to evaluate the association between the autonomic nervous system and coagulation function in patients with endometrial cancer.

The incidence of endometrial cancer (EC) is increasing worldwide, but the specific mechanism of coagulation dysfunction in EC is not fully understood. The objective of the present study was to explore the relationship between autonomic nervous system function and coagulation function in patients with EC using heart rate variability (HRV) analysis. The study included 100 patients with EC who were treated at the Department of Gynecological Oncology of The First Affiliated Hospital of Bengbu Medical University (Bengbu, China) from December 2021 to March 2023. A 5-min resting electrocardiogram was collected from each patient to analyze HRV parameters, including the time domain parameters standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD), and the frequency domain parameters low-frequency power and high-frequency power (HF). Blood samples were submitted to biochemistry tests to measure coagulation markers, namely prothrombin time (PT), international normalized ratio of PT (PT-INR), prothrombin activity (PTA), activated partial thromboplastin time (APTT) and fibrinogen. Bivariate Spearman correlation analyses revealed that PT, PT-INR and APTT were significantly positively correlated with SDNN, RMSSD and HF, while PTA was significantly negatively correlated with RMSSD. Following adjustments for confounding factors, namely age, body mass index, menopause, ligation of the fallopian tubes, diabetes, hypertension, adjuvant chemotherapy and mean heart rate, linear regression analysis demonstrated that SDNN, RMSSD and HF were independent factors influencing PT and PT-INR in patients with EC. The findings of the present study indicate that certain HRV parameters correlate with coagulation markers in EC and provide new insight into the occurrence of cancer-associated coagulation dysfunction.

TP53 mutation as predictive factor of platinum response in BRCA-mutated ovarian cancer: A prospective case-series analysis.

128 Background: Platinum sensitivity (PS) is a prerequisite for first-line PARP inhibitors (PARPi) in locally advanced and relapsed high grade serous ovarian cancer (HGS-OC). BRCA mutations are predictive of PS and of response to PARPi. Notably, platinum and PARPi cytotoxic action is mainly related to p53-mediated inducted apoptosis. Therefore, the integrity of p53 machinery is crucial for platinum-related activity whereas the presence of p53 mutation is a fairly frequent event in ovarian cancer, especially in HGS-OC and in BRCA mutated. Methods: We prospectively analyzed 208 women with primary ovarian cancer undergoing surgery at the Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy, between 2019 and 2023. Somatic NGS analysis was performed to detect BRCA and HRD mutations. TP53 mutations were classified according to according to hotspot, structural (missense/nonsense) and functional classification as “gain of function” (GOF) or “loss of function” (LOF), based on IARC TP53 database. Comparative testing with Fisher's exact test was used to examine TP53 mutation distribution and associations with clinicopathologic factors and PS. BRCA mutation status was further used to stratify the analysis. Results: Globally, we included 127 adult HGS-OC patients (pts). 84.2% had stage III-IV disease. TP53 mutation was found in 83.4% of pts. Somatic BRCA mutations were found in 28.3%. HGS-OC with somatic BRCA mutations had higher TP53 mutation frequency (88.8%) than BRCA WT (81.3%, p=0.1510). Employing the structural classification scheme, most harbored a missense TP53 mutation (76.5%). LOF TP53 mutations were found in 59.4% while GOF in 31.2%. No significant disparity was observed in the distribution of specific TP53 mutations within each classification scheme between cases with BRCA mutations and those without. As for BRCA mutated pts, TP53 WT were all PS. Among those p53 mutated, GOF mutations were associated with PS in 7 pts and platinum resistance in 3 pts; LOF mutations were associated with PS in 7 pts and platinum resistance in 12 pts. The difference in distribution of PS between functional categories of p53 mutations was significant (p=0.0291). As for BRCA WT pts, TP53 WT were all PS. Among TP53 mutated, GOF mutations were associated with PS in 14 pts and platinum resistance in 10 pts, whereas LOF mutations were associated with PS in 19 pts and platinum resistance in 25 pts, even if these findings were not statistically significant (p=0.2357). Of relevance, in 5 cases where LOF mutations of p53 was associated with null HIC p53 expression, pts were refractory to platinum-based chemotherapy. Conclusions: Even if preliminary, our data show that HGS-OC harboring TP53 null mutations are the poorest prognostic subgroup, especially in terms of PS. Further studies are needed to confirm our findings and the role of TP53 mutation as a biomarker of inherent or acquired platinum resistance.

Impact of the Treatment-Free Interval on Health-Related Quality of Life in Patients with Early-Stage Serous Epithelial Ovarian Cancer

Background: Although the incidence of ovarian cancer is less than that of other female cancers, the morbidity and mortality associated with the disease course is high. Because treatment involves radical surgery and intense courses of chemotherapy, health-related quality of life (HRQOL) is often compromised. Most patients recur post-first-line therapy and undergo multiple rounds of chemotherapy. Thus, HRQOL is further disrupted. Objective: The aim of this study is to assess impact of the treatment-free interval on health-related quality of life in patients with early-stage serous epithelial ovarian cancer. Methods: The cross-sectional observational study was conducted in the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total 38 women with histopathologically confirmed serous epithelial ovarian cancer were included in the study. Participants were divided into two groups according to their mutation status; patients with BRCA mutation were Exposed Group and those without BRCA mutation as Unexposed Group. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, maximum study subjects 26 (68.4%) were in &gt;45 years age group and 12 (31.6%) were in ≤45 years age group. Mean age of the study subjects was 52.43±4.22 years and majority of the patients 29 (76.3%) were literate and 9 (23.7%) were illiterate. About 25 (65.8%) respondents had family history of breast / ovarian cancer and 11 (28.9%) had no family history of breast / ovarian cancer. Majority 20 (52.6%) respondents underwent Primary Debulking Surgery as primary treatment modality, whereas 18 (47.4%) did not receive Primary Debulking Surgery and majority respondents 21 (55.3%) received neoadjuvant chemotherapy and interval debulking surgery, whereas 19 (44.7%) ..........

ESGO Quality Indicators for Surgical Management of Cervical Cancer: An Audit of Compliance of a Tertiary Care Center

Objective This article assesses the compliance of surgical management of carcinoma cervix, to the quality indicators for treatment put forth by the European Society of Gynaeacological Oncology (ESGO), at a tertiary care center. Methods This is a retrospective analysis and audit of data collected from electronic medical records of patients with carcinoma cervix who underwent surgical management in the department of gynecologic oncology from June 1, 2017 to May 31, 2020. Results Compliance to all 15 quality indicators under 5 categories was assessed. The first two structural indicators were met. The mean number of parametrectomies was 24 and all were operated by a specialist. With regard to targets addressing overall management, only 46% cases were preoperatively planned in multidisciplinary team meetings and 74% met the target of required preop investigations. There was deficiency in recording pertinent intraoperative details and postoperative pathological information. On assessing the quality of surgical care, there were no postoperative urological fistula, but 18% had involved surgical margins, 16% were upstaged postsurgery, and 15% had recurrence within 2 years. All were counseled about fertility-sparing technique when relevant but only 7% had undergone lymph node staging as per recommendations and 51% had received adjuvant chemoradiation. Conclusion This audit revealed that the department did not meet the ESGO quality standards published in 2020. The department has implemented structural and procedural changes to meet these standards and a plan to continuously assess compliance to the same.

Assessing The Safety of Laparoscopic Surgery in Treating of Adenocarcinoma Endometrial Cancer

In recent years, there has been a growing preference for laparoscopic surgery. Insufficient data exists on the safety of laparoscopy in endometrial cancer. The objective of this study was to assess and compare the perioperative and oncologic results of laparoscopic and laparotomic. staging surgery in patients diagnosed with adenocarcinoma endometrial cancer. The study aimed to evaluate the safety and effectiveness of laparoscopic surgery in this specific patient group. A retrospective analysis was conducted on the data of 250 patients who had surgical staging for adenocarcinoma endometrial cancer at the gynecologic oncology department of a government hospital from 2018 to 2023. A comparison was made between the laparoscopy and laparotomy groups in terms of demographic, histopathologic, perioperative, and oncologic parameters. An additional assessment was conducted on a subset of individuals who had a body mass index greater than 30. The demographic and histopathologic parameters of the two groups were comparable, however laparoscopic surgery demonstrated a much higher level of effectiveness in terms of perioperative outcomes. The laparotomy group had a much greater number of excised and metastatic lymph nodes. However, this difference did not have an impact on the oncologic outcomes, such as recurrence and survival rates. Both groups had similar results in this regard. The results of the subgroup with a BMI more than 30 were consistent with those of the entire population. The intraoperative problems encountered during the laparoscopic procedure were effectively resolved. Laparoscopic surgery is considered superior to laparotomy and, depending on the surgeon's expertise, it can be safely used for surgical staging of adenocarcinoma endometrial cancer.

Comparing the Accuracy, Sensitivity, Specificity, and Predictive Values of Two Biomarkers in Detecting Malignant Ovarian Tumors

Introduction: Ovarian cancer presents a significant challenge in oncology due to its high mortality rates primarily stemming from late-stage diagnoses. Early detection through reliable biomarkers such as CA-125 and IL-6 is crucial for improving patient outcomes. Aim of the study: This study aimed to compare the accuracy, sensitivity, specificity, and predictive values of CA-125 and IL-6 in detecting malignant ovarian tumors. Methods: A cross-sectional analytical study was conducted at the Department of Gynecological Oncology, BSMMU, and NICRH, Dhaka, Bangladesh. A total of 94 women with suspected ovarian tumors underwent preoperative assessment of CA-125 and IL-6 levels. Receiver-operator characteristic (ROC) curves were utilized to determine optimal cut-off values. Result: In this study of 94 women with ovarian tumors, we evaluated the diagnostic performance of CA-125 and IL-6 biomarkers. CA-125 showed a sensitivity of 83.0% and specificity of 51.2% at a cut-off of ≥89.0 u/ml, while IL-6 exhibited 84.9% sensitivity and 80.5% specificity at ≥9.5 pg/ml. Combining CA-125 and IL-6 improved specificity to 95.1%, maintaining a sensitivity of 77.4%. These findings underscore the potential of biomarker combinations in enhancing diagnostic accuracy for detecting malignant ovarian tumors. Conclusion: IL-6 exhibited higher sensitivity and specificity compared to CA-125 in detecting malignant ovarian tumors. The combined use of both biomarkers improved specificity while maintaining reasonable sensitivity, suggesting their potential utility in clinical practice for early detection and management of ovarian malignancies.

Abstract A020: TP53 mutation and prediction of platinum response in BRCA-mutated ovarian cancer: A prospective case-series analysis

Abstract Background and aim of the study: Currently, platinum sensitivity (PS) is a prerequisite for first-line PARP inhibitors (PARPi) in locally advanced and relapsed high grade serous ovarian cancer (HGS-OC). BRCA mutations are recognized as predictive of PS and, therefore, of response to PARPi . Notably, platinum and PARPi cytotoxic action is mainly related by their ability of inducing p53-mediated apoptosis. Therefore, the integrity of p53 machinery is crucial for platinum-related activity whereas the presence of p53 mutation is a fairly frequent event in ovarian cancer, particularly in HGS-OC and in BRCA mutated ones. Patients and methods: We prospectively analyzed 208 women with primary ovarian cancer undergoing surgery at the Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy, between 2019 and 2023. Somatic NGS analysis was performed to detect BRCA and HRD mutations. TP53 mutations were classified according to according to hotspot, structural (missense or nonsense) and functional classification as “gain of function” (GOF) or “loss of function” (LOF), based on the IARC TP53 database. Comparative testing with Fisher's exact test was used to examine TP53 mutation distribution and associations with clinicopathologic factors and PS. The BRCA mutation status was further used to stratify the analysis. Results: Globally, we included 127 adult HGS-OC pts. 84.2% had stage III-IV disease. TP53 mutation was found in 83.4 % of the entire cohort. Somatic BRCA mutations were found in 28.3% pts. Overall, HGS-OC with somatic BRCA mutations had higher TP53 mutation frequency (88.8%) when compared to BRCA WT (81.3%, p=0.1510). Employing the structural classification scheme, most cancers harbored a missense TP53 mutation (76.5%). LOF TP53 mutations were found in 59.4% while GOF in 31.2%. No significant disparity was observed in the distribution of specific TP53 mutations within each classification scheme between cases with BRCA mutations and those without. As for BRCA mutated pts, TP53 WT were all PS. Among those p53 mutated, GOF mutations were associated with PS in 7 pts and platinum resistance in 3 pts; LOF mutations were associated with PS in 7 pts and platinum resistance in 12 pts. The difference in distribution of PS between functional categories of p53 mutations was significant (p=0.0291). As for BRCA WT pts, TP53 WT were all PS. Among TP53 mutated, GOF mutations were associated with PS in 14 pts and platinum resistance in 10 pts; viceversa, LOF mutations were associated with PS in 19 pts and platinum resistance in 25 pts, even if these findings were not statistically significant (p=0.2357). Of relevance, in 5 cases where LOF mutations of p53 was associated with null expression of HIC p53, patients were refractory to platinum-based chemotherapy. Conclusions: Even if preliminary, our data show that HGS-OC harboring p53 null mutations are the poorest prognostic subgroup, especially in terms of PS. Further studies are needed to confirm our findings and the role of TP53 mutation as a biomarker of inherent or acquired platinum resistance. Citation Format: Eleonora Lai, Manuela Neri, Elisabetta Sanna, Sonia Nemolato, Fabio Bardanzellu, Mario Scartozzi, Sabrina Giglio, Antonio Macciò, Clelia Madeddu. TP53 mutation and prediction of platinum response in BRCA-mutated ovarian cancer: A prospective case-series analysis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Expanding and Translating Cancer Synthetic Vulnerabilities; 2024 Jun 10-13; Montreal, Quebec, Canada. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(6 Suppl):Abstract nr A020.

Metronidazole and cefazolin vs cefazolin alone for surgical site infection prophylaxis in gynecologic surgery at a comprehensive cancer center

BackgroundSurgical site infection (SSI) is one of the most common complications of gynecologic cancer surgery. Current guidelines recommend the administration of cefazolin pre-operatively to reduce SSI rates for patients undergoing clean-contaminated surgeries such as hysterectomy. ObjectiveTo evaluate the impact of a quality improvement project adding metronidazole to cefazolin for antibiotic prophylaxis on SSI rate for women undergoing gynecologic surgery at a comprehensive cancer center. Study DesignThis retrospective, single-center, cohort study included patients who underwent surgery in the Gynecologic Oncology department from 5/2017 to 6/2023. Patients with penicillin allergies and those undergoing concomitant bowel resection(s) and/or joint cases were excluded. The pre-intervention group patients had surgery from 5/2017 to 4/2022, and the post-intervention group patients had surgery from 4/2022 to 6/2023. The primary outcome was 30-day SSI rate. Sensitivity analyses were performed to compare SSI rates based on actual antibiotic(s) received and for those who had a hysterectomy. Factors independently associated with SSI were identified using a multivariable logistic regression model adjusting for confounding variables. ResultsOf 3343 patients, 2572 (76.9%) and 771 (23.1%) were in the pre- and post-intervention groups, respectively. Most patients (74.7%) had a hysterectomy performed. Thirty four percent of cases were for non-oncologic (benign) indications. Pre-intervention patients were more likely to receive appropriate pre-operative antibiotics (95.6% vs 90.7%; p<0.001). The overall SSI rate prior to the intervention was 4.7% compared to 2.6% after the intervention (p=0.010). The SSI rate for all patients who underwent hysterectomy was 4.9% (pre-intervention) vs. 2.8% (post-intervention) (p=0.036); a similar trend was seen for benign cases (4.4% vs 2.4%; p=0.159). On multivariable analysis, the odds ratio for SSI was 0.49 (95% CI 0.38-0.63) for the post- compared to pre-intervention group (p<0.001). In a sensitivity analysis (n=3087), SSI rate was 4.5% for those who received cefazolin alone compared to 2.3% for those who received cefazolin plus metronidazole, with significant decreased odds of SSI for the cefazolin plus metronidazole group (adjusted OR 0.40, 95% CI 0.30-0.53; p<0.001). Among only those who had a hysterectomy performed, the odds of SSI was significantly reduced for those in the post-intervention group (adjusted OR 0.63, 95% CI 0.47-0.86; p=0.003). ConclusionThe addition of metronidazole to cefazolin before gynecologic surgery decreased the SSI rate by half, even after accounting for other known predictors of SSI and differences in practice patterns over time. Providers should consider this combination regimen in women undergoing gynecologic surgery, especially for cases involving hysterectomy.

The Role of HPV Genotype among Colposcopy Diagnosed Cervical Precancerous Lesions

Background: Cancer is the leading cause of death and a major contributor to reduced life expectancy in every country on Earth [1]. Cervical cancer (CC) is a serious global health concern that is more common in developing countries, especially those on the Indian subcontinent. More and more women are suffering from CC. Cervical cancer is mostly caused by the Human Papillomavirus (HPV), a sexually transmitted virus that is one of the most common illnesses of the reproductive system. Objective: The aim of this study is to evaluate the role of HPV genotype among colposcopy diagnosed cervical precancerous lesions. Methods: The cross-sectional observational study was conducted in the Department of Gynecological Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2021 to June 2022. A total of 132 subjects were included in the study. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, the mean age was found to be 36.7±6.3 years, with a range from 31 to 60 years, the majority 53 (40.2%) of patients completed SSC and 118 (89.4%) were housewives and 125(94.7%) were Muslims. In this study most of the patients 101 (76.5%) came from middle-income families. About 45 (34.1%) patients were married between the ages of 15-17 years, 45 (34.1%) were between 16-18 years during their first delivery and 56 (42.4%) had 3-4 children. Most of the patients 92(69.7%) had history of received OCP. About 10(7.0%) patients were found HPV 16 positive followed by 1(0.7%) HPV 18, 3(2.1%) other HR-HPV, 3(2.1%) HPV 16 &amp; other HR-HPV and 1(0.7%) HPV 16-HPV 18 &amp; other HR-HPV. Most of the 95 (72.0%) patients had CIN I, 30 (22.7%) had CIN II and 7 (5.3%) had CIN III identification by colposcopy reports. In this study 59 (44.7%) patients had CIN I followed by 13 (9.8%) had CIN II, 9 (6.8%) had CIN III, 5 (3.8%) had CIS and 46 (34.8%) ..

Acellular Dermal Matrices as an New Alternative for Treatment in Reproductive Organ Static Disorders: A Pilot Study.

Background: The study aimed to evaluate the clinical effects of utilizing acellular dermal matrix (ADM) for treating pelvic organ prolapse. The motivation behind exploring a new treatment method stems from the limited efficacy of current surgical options, which are often associated with side effects. Methods: Ten patients with reproductive organ prolapse underwent surgery at the Chair and Department of Gynecology, Obstetrics, and Gynecological Oncology in Katowice. ADM was used as a support material, with eight patients receiving double TOT and two undergoing a six-point fixation mesh procedure. Pelvic organ prolapse was evaluated pre-operatively and one month post-surgery using the Pelvic Organ Prolapse Quantification (POP-Q) System. General medical history and complaints were assessed using the short form (PFDIQ-SF20). The study included ten patients aged 39 to 71 (mean: 63.6 years), all with a history of at least one vaginal delivery (mean of two). None had undergone a cesarean section. Four patients exhibited POP-Q 3, and five had POP-Q 2. Results: The mean PFDIQ-SF20 score before surgery was 70.6 points. No major complications occurred during or after surgery. One patient experienced a vaginal fungal infection and an allergic reaction to sutures. Post-operation, ailments reduced by an average of 60.76 points, with five patients reporting no complaints. Conclusions: ADM emerges as a material of interest for gynecological surgery, with initial reports highlighting its effectiveness and optimistic safety profile. Further research is warranted to explore its potential as a promising option in pelvic organ prolapse treatment.

Prediction models for lymph node metastasis in cervical cancer based on preoperative heart rate variability.

The occurrence of lymph node metastasis (LNM) is one of the critical factors in determining the staging, treatment and prognosis of cervical cancer (CC). Heart rate variability (HRV) is associated with LNM in patients with CC. The purpose of this study was to validate the feasibility of machine learning (ML) models constructed with preoperative HRV as a feature of CC patients in predicting CC LNM. A total of 292 patients with pathologically confirmed CC admitted to the Department of Gynecological Oncology of the First Affiliated Hospital of Bengbu Medical University from November 2020 to September 2023 were included in the study. The patient' preoperative 5-min electrocardiogram data were collected, and HRV time-domain, frequency-domain and non-linear analyses were subsequently performed, and six ML models were constructed based on 32 parameters. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. Among the 6 ML models, the random forest (RF) model showed the best predictive performance, as specified by the following metrics on the test set: AUC (0.852), accuracy (0.744), sensitivity (0.783), and specificity (0.785). The RF model built with preoperative HRV parameters showed superior performance in CC LNM prediction, but multicenter studies with larger datasets are needed to validate our findings, and the physiopathological mechanisms between HRV and CC LNM need to be further explored.

Assessing the learning curve for transumbilical single-site laparoscopy for endometrial cancer.

Applying transumbilical laparoendoscopic single-site surgery to endometrial cancers is worldwide, and the depiction of the learning curve is rarely described, which leads to the vagueness of young clinical practitioners. We accumulated the data to identify the completion of the learning curve by analyzing the operative and postoperative outcomes of the patients with endometrial cancer for transumbilical laparoendoscopic single-site surgery (TU-LESS). This was a retrospective, consecutive single-center study of patients with endometrial cancer undergoing standard endometrial cancer comprehensive staging surgery (extrafascial hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy) through TU-LESS by an experienced surgeon from December, 2017 to June, 2021 in the Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, 42 patients were included in the study. The learning curve for this study was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Applying CUSUM and RA-CUSUM has grouped 42 cases into three phases. The prior five cases represented the learning period. The following six cases were needed to lay a technical foundation (cases 6-11). The third phase was regarded as achieving proficiency (cases 12-42). The operative time decreased drastically with the learning curve. There were no significant differences in terms of postoperative complications and lymph node retrieval among the three phases. More difficult patients were confronted in the third phase. In our study, the learning curve was composed of three phases. According to the results of our study, 11 cases were required for experienced surgeons to achieve a technical foundation.

Methylation of the Selected TP53 Introns in Advanced-Stage Ovarian Carcinomas.

Objective: Advanced-stage ovarian cancer (OC) is among the most fatal female genital tract neoplasms worldwide. Although different genetic mechanisms have been shown to be involved in ovarian carcinogenesis, the role of TP53 introns methylation is still unresolved. We performed methylation analysis of introns 1, 3, and 4 of the TP53 to identify patterns in primary stage III OCs, corresponding metastases, and healthy tissues. Methods: The study involved samples of paraffin-embedded tissues obtained from 80 patients with stage III OCs, who underwent surgery at the Department of Gynecology and Gynecologic Oncology of the Military Institute of Medicine in Warsaw, Poland. Altogether, 40 serous-type G2/3 OCs and 40 endometrioid-type G2/3 OCs were included. From the same patient, metastatic and normal tissues were simultaneously analyzed. As a control group, 80 tissue samples were collected from patients after bariatric operations. Human ovarian cancer A2780 cell line was also investigated. Total genomic DNA was isolated from paraffin-embedded tissue blocks and the methylation analysis was performed by bisulfite DNA conversion, DNA amplification with specific primers, cloning, and DNA sequencing. Results: All of the samples of intron 1 of TP53 were un-methylated in OCs, metastatic tissues, and in healthy tissues from the same patient. Also, no methylation of TP53 intron 1 was detected in cells from the human A2780 ovarian cancer cell line and in all samples from control group. In all samples, introns 3 and 4 of the TP53 were methylated in primary tumors, metastatic tissue, and in healthy tissue from the same patient, in human A2780 ovarian cell line, and in DNA samples from healthy patients. None of the clinicopatholocal features was related to the TP53 introns methylation status. Conclusions: Our data on TP53 introns methylation sheds new light on the mechanism of p53 activity for a better understanding of cancer biology. The study suggests the existence of an additional regulation rule of TP53 activity that involves demethylation-methylation mechanisms. Methylation at introns 3 and 4 may also overall help in protecting TP53 against damage by viral restrictases or viral DNA integration.

Diagnostic value of ICG for sentinel lymph node mapping in patients with stage I endometrial cancer

Background. Lymphatic spread is the main route of metastasis in early stage endometrial cancer. Considering its significance, three risk factors of lymph node metastasis were identified. At a high risk of lymph node metastasis in patients with stage I endometrial cancer, pelvic and lumbar lymph node dissection is recommended. In low-risk patients, lymph node dissection is not performed. Lymph node dissection in medium-risk patients is considered as a staging procedure. However, in patients with aggravating factors that prevent extended hysterectomy, lymph node biopsy with ICG mapping and subsequent microstaging may be an alternative to lymph node dissection. Purpose of the study: to analyze the effectiveness of surgical approaches for staging endometrial cancer at different risk factors for lymphatic metastasis.Material and Methods. The treatment outcomes were retrospectively analyzed in 565 patients with stage I endometrial cancer treated at the gynecological oncology department of Botkin City Clinical Hospital and at the gynecological oncology department of Kaluga Regional Clinical Oncology Center from 2021 to 2023. All women were divided into three groups according to the risk factors of lymph node metastasis. Patients underwent hysterectomy, hysterectomy combined with pelvic or pelvic and lumbar lymphadenectomy, as well as hysterectomy with ICG mapping and sentinel lymph node biopsy.Results. A total of 334 endometrial cancer patients underwent surgery at Botkin City Clinical Hospital. In the medium-risk group patients (n=94), who underwent hysterectomy with pelvic (n=36) and pelvic + lumbar lymphadenectomy (n=31), lymph node metastases were detected in 4 (11.1 %) and 6 (19.4 %) patients, respectively. In the high-risk group (n=50) with similar surgeries, metastatic lymph nodes were identified in 2 (10.5 %, n=19) and 6 (26.1 %, n=23) patients, respectively. At Kaluga Regional Oncology Center, 231 patients underwent hysterectomy with sentinel lymph node biopsy. The low-risk group, the medium-risk group, and the high-risk group showed lymph node metastases in 7 (5.47 %), 6 (10.2 %), and 6 (13.6 %) patients, respectively.Conclusion. In stage I endometrial cancer patients with a low risk of lymph node metastasis, hysterectomy with sentinel lymph node biopsy is recommended. For medium-and high-risk groups, hysterectomy with systemic lymphadenectomy is recommended. If it is not possible to remove the pelvic and lumbar lymph nodes, their biopsy with ICG mapping and microstaging can be recommended. A combination of systemic lymphadenectomy with sentinel lymph node biopsy is a promising technique that could hypothetically demonstrate better results in terms of disease staging.

Hematological indicator-based machine learning models for preoperative prediction of lymph node metastasis in cervical cancer.

Lymph node metastasis (LNM) is an important prognostic factor for cervical cancer (CC) and determines the treatment strategy. Hematological indicators have been reported as being useful biomarkers for the prognosis of a variety of cancers. This study aimed to evaluate the feasibility of machine learning models characterized by preoperative hematological indicators to predict the LNM status of CC patients before surgery. The clinical data of 236 patients with pathologically confirmed CC were retrospectively analyzed at the Gynecology Oncology Department of the First Affiliated Hospital of Bengbu Medical University from November 2020 to August 2022. The least absolute shrinkage and selection operator (LASSO) was used to select 21 features from 35 hematological indicators and for the construction of 6 machine learning predictive models, including Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GNB), and Logistic Regression (LR), as well as Random Forest (RF), Support Vector Machines (SVM), and Extreme Gradient Boosting (XGBoost). Evaluation metrics of predictive models included the area under the receiver operating characteristic curve (AUC), accuracy, specificity, sensitivity, and F1-score. RF has the best overall predictive performance for ten-fold cross-validation in the training set. The specific performance indicators of RF were AUC (0.910, 95% confidence interval [CI]: 0.820-1.000), accuracy (0.831, 95% CI: 0.702-0.960), specificity (0.835, 95% CI: 0.708-0.962), sensitivity (0.831, 95% CI: 0.702-0.960), and F1-score (0.829, 95% CI: 0.696-0.962). RF had the highest AUC in the testing set (AUC = 0.854). RF based on preoperative hematological indicators that are easily available in clinical practice showed superior performance in the preoperative prediction of CC LNM. However, investigations on larger external cohorts of patients are required for further validation of our findings.

Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia.

This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria. Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann-Whitney two-sample test. Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point. PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.