Gynecologic Cancer Research Articles

Pelvic radiotherapy (RT) causes tissue injury which could lead to vaginal problems including dryness, shortening, and tightening of the vagina, causing discomfort, and affect sexual activity. In this longitudinal, prospective study, the association between pelvic RT and sexual function were studied in primary cervical cancer and in primary uterine tumor patients. This prospective longitudinal cohort study comprised patients with primary cervical cancer and primary uterine tumors with pelvic radiotherapy (RT). Seventy-nine cervical cancer and 43 uterine tumor patients were included from May 2014 to February 2019. Patients completed questionnaires for global health status and sexual functioning before RT start and at 3 and 12months after RT. In primary cervical cancer patients, the sexual activity was significantly higher in patients with pelvic RT alone compared to patients with pelvic RT + cervical brachytherapy/boost at 3months (P = 0.007, 34.6% vs. 73.3%) and12 months after RT (P = 0.054, 45.7% vs. 76.9%). No significant relationship was found in primary uterine tumor patients. At 12months after RT, 52.5% of the cervix and 42.3% of the primary uterine tumor patients were sexually active. Of the cervical cancer patients, 81.8% reported symptoms as dry vagina 12months after RT. Local estrogens did not improve the sexual activity in cervical cancer or uterine tumor patients after RT. In cervical cancer patients, the sexual activity was significantly higher with pelvic RT alone compared to pelvic RT + cervical brachytherapy/boost. Better medical interventions are needed to reduce the sexual symptoms. Reduced sexual activity in gynecological cancer survivors with curative pelvic RT. For the future, improved medical interventions are needed to decrease the sexual symptoms.

Onconephrology represents a burgeoning subspecialty within nephrology, dedicated to ensuring optimal oncological management for cancer patients with pre-existing or cancer-therapy-induced renal impairment. Epidemiological data regarding the early impact of renal function alterations in Italian oncology patients are currently lacking. This study presents a three-year single-center experience from an onconephrology clinic, evaluating patients with solid tumors and renal abnormalities, specifically acute kidney injury (AKI) or proteinuria. A total of 254 patients with solid malignancies were included. Among these, 153 (60.2%) were referred due to AKI, predominantly AKIN stages I-II, with 71 cases (46.4%) attributed to oncological treatment. Notably, antineoplastic therapy was permanently discontinued in only 27 patients (13.1%). The most frequent tumor types were pulmonary (17.5%) and gynecological (17.9%) cancers. Checkpoint inhibitors were the therapies most commonly associated with AKI. During the follow-up period, 83 of the 254 patients (34.5%) died, with 46 (55%) of these having experienced concurrent AKI, suggesting a potential risk for chronic kidney disease development. Among the surviving patients, 71% exhibited a decline in estimated glomerular filtration rate of <30 ml/min. This experience underscores the intricate relationship between cancer therapies and renal function, highlighting the critical need for early and continuous onconephrological assessment in this patient population.

STEEL MAGNOLIAS (shared telehealth for multidisciplinary gynecologic cancer survivorship) is a novel gynecologic cancer surveillance care-delivery program in which rural patients see a close-by gynecologist in person with simultaneous virtual gynecologic oncology consultation. This study assesses feasibility of STEEL MAGNOLIAS by examining travel burden reduction, cancer outcomes, visit activities, guideline adherence, and patient satisfaction. We retrospectively reviewed charts of patients with gynecologic cancer in remission under the STEEL MAGNOLIAS program in rural south Louisiana (March 2020-September 2023). Travel metrics, patient satisfaction, cancer outcomes, survival status, reasons for visit, and adherence to follow-up as per National Comprehensive Cancer Network (NCCN) guidelines were recorded. A small subset of patients prospectively completed questionnaires, such as the COST-FACIT (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) for financial toxicity and the PSQ-18 (Patient Satisfaction Questionnaire Short Form), and responded to questions about existing barriers to care. Descriptive statistics and Wilcoxon rank sum tests for continuous data were used. We assessed feasibility by assessing continued patient compliance without erosion of satisfaction. Sixty-three patients attended 178 STEEL MAGNOLIAS appointments, and most of the patients had a history of endometrial cancer. The majority, 82.5%, were alive with no evidence of disease. Our patients traveled a median of 16.9 miles for STEEL MAGNOLIAS, compared with 137 miles for in-person visits. We identified prevalent transportation and technology barriers to in-person and conventional virtual visits. Patients demonstrated high satisfaction with appointments. Genitourinary and cancer therapy symptoms and reviews of laboratory test results and imaging often were discussed. Laboratory tests, imaging, and referrals were ordered and completed at high rates, with 76.9% of appointments adhering to NCCN follow-up guidelines. The STEEL MAGNOLIAS program is a feasible, innovative hybrid telehealth model for rural gynecologic cancer surveillance that reduces travel burdens and ensures high guideline adherence and patient satisfaction. This scalable model has potential to improve outcomes and compliance, meeting patients where they are and transforming cancer survivorship.

Despite advances in cancer treatments, epithelial ovarian cancer (EOC) remains the leading cause of death among gynecologic cancers. EOC is stratified into five main histopathological subtypes: high-grade serous carcinoma (HGSC), low-grade serous carcinoma (LGSC), endometrioid carcinoma (EC), clear cell carcinoma (CCC), and mucinous carcinoma (MC). However, personalized treatment strategies and reliable biomarkers for all histotypes remain elusive. Building on our previous work with early-stage EOC, we aim to explore diagnostic and prognostic biomarkers in advanced-stage EOC, updated to the latest World Health Organization classification guidelines from 2020, using comprehensive transcriptomic profiling from total RNA sequencing of 146 EOCs. Differential expression analysis identified top 9 histotype-specific gene panels for HGSC, CCC, MC, and EC, including S100A1 (HGSC), ARID3A (CCC), LGALS4 (MC), and PAX9 (EC). We also identified gene candidates associated with overall survival and disease-specific survival, reflecting both favorable (e.g., OTOF, EEF1E1-BLOC1S5, and STAC3) and unfavorable (e.g., SMOC1, GDPGP1, EPRS1) clinical outcome. Additionally, enrichment analysis revealed tumor progression-related pathways unique to each histotype, offering insights into the molecular mechanisms underlying disease progression and potential therapeutic targets. These findings provide valuable insights into the molecular landscape of advanced-stage EOC, paving the way for more effective diagnostic and prognostic tools across diverse histotypes.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24938-0.

To evaluate whether geospatial or sociodemographic characteristics are associated with live birth after fertility-sparing treatment for early-stage gynecologic cancer and stages I-III breast cancer. Retrospective matched case-control study using linked data from the California Cancer Registry, the California Office of Statewide Health Planning and Development (now known as the California Department of Health Care Access and Information), and Society for Assisted Reproductive Technology. We included patients aged 18-45 years who were diagnosed with stages I-III of breast cancer or stage I cervical, endometrial, or ovarian cancer between 2000 and 2012 and underwent fertility-sparing treatment. Patients in the case group had live births after treatment; patients in the control group did not. Propensity score matching was performed in a 1:2 ratio. Generalized linear mixed models were used to estimate associations between odds of live birth and geospatial and sociodemographic exposures such as the California Healthy Places Index, clinic proximity, race and ethnicity, marital status, insurance, and socioeconomic status. Our study included 254 individuals in the case group and 455 individuals in the matched control group. On multivariable analysis, no significant associations were observed between geospatial factors and live birth. Compared with individuals living in ZIP codes within the lowest California Healthy Places Index quartile (Q, 0-25%), those in higher quartiles had similar odds of live birth (Q2: odds ratio [OR] 1.16; 95% CI, 0.45-2.96, P=.76; Q3: OR 1.29; 95% CI, 0.46-3.59, P=.62; Q4 or unknown: OR 1.19; 95% CI, 0.39-3.62, P=.75). Neither the number of nor the distance to the nearest gynecologic oncology or in vitro fertilization clinic was associated with outcome. Sociodemographic characteristics also were not significantly associated with odds of live birth. Subanalyses by treatment type and cancer type also demonstrated no significant associations variables of interest and odds of live birth. Among patients who accessed fertility-sparing treatment, geospatial and sociodemographic factors were not associated with live-birth outcomes. These findings provide reassurance that once patients access fertility-sparing care, birth outcomes are not influenced by sociodemographic or geographic disadvantage.

Ovarian cancer (OVCA) is third most lethal gynecologic cancers and acquired chemoresistance is the key link in the high mortality rate of OVCA patients. Currently, there are no reliable methods to predict chemoresistance in OVCA. In our study, we identify genes, pathways and networks altered by DNA methylation in high-grade serous ovarian carcinoma(HGSC) cells that are associated with chemoresistance and prognosis of HGSC patients. We performed methylome-wide profiling using Illumina Infinium MethylationEPIC BeadChip (HM850K) methylation array on a set of HGSC chemoresistant and chemosensitive cell lines. Differentially Methylated CpG Probes (DMPs) were identified between the resistant and sensitive groups in HGSC. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) over-representation analyses were conducted to identify both common and unique pathways between resistant and sensitive cells. While the HM850K array was used for the discovery phase to identify differentially methylated probes and regions in HGSC cell lines, the publicly available The Cancer Genome Atlas ovarian cancer (TCGA-OV) dataset generated using the Illumina Infinium HumanMethylation27 BeadChip (27K array) methylation array served as an independent validation cohort for downstream survival and drug sensitivity analyses. Machine learning methods were applied to our dataset to predict drug sensitivity in the TCGA-OV cohort and to investigate associations with overall survival and progression-free survival. Kaplan-Meier analysis was performed to assess the relationship between differentially methylated genes and patient survival outcomes. The overlapping CpG probes shared between the two Illumina platforms were used for machine learning and survival analyses. Data visualization was performed using various R/Bioconductor packages. Our analysis identified a total of 3,641 DMPs spanning 1,617 differentially methylated genes between chemoresistant and sensitive HGSC cells, whereas 80% of them were hypermethylated CpG sites associated with HGSC resistant cells. Approximately half of the DMPs were distributed on chromosomes 1-3, 6, 11-12 and 17 and top identified hypermethylated CpGs were cg21226224 (SOX17, ∆β = 79%, adj.P = 7.73E-03), cg02538901 (ATP1A1, ∆β = 75%, adj.P = 7.6E-03), and cg17032184 (CD58, ∆β = 64%, adj.P = 4.39E-02). Machine learning analysis identified significant association of global hypermethylation in the HGSC chemoresistant cells with poor overall and progression-free survival of HGSC patients. Further analysis identified four differentially methylated genes (CD58, SOX17, FOXA1, ETV1) that were also positively associated with poor prognosis of HGSC OC patients. Functional enrichment analysis showed enrichment of several cancer-related pathways, including phosphatidylinositol signaling, homologous recombination and ECM-receptor interaction pathways. This study supplements the current knowledge of the underlying mechanism behind acquired chemoresistance in OVCA. Four differentially methylated genes identified in this study may have the potential to serve as promising epigenetic clinical biomarkers for HGSC chemotherapy resistance.

ObjectivesMonitoring of Cancer Antigen 125 (CA125) during ovarian cancer (OC) maintenance treatment with poly(ADP-ribose) polymerase inhibitors (PARPis) may be insufficient when using Gynecologic Cancer Intergroup (GCIG) biochemical progression criteria. This study aimed to evaluate the usefulness of CA125 monitoring in detecting OC recurrence during PARPis maintenance treatment.MethodsThis multicenter retrospective cohort study included patients with primary OC who achieved complete or partial response after first-line platinum-based chemotherapy followed by PARPis maintenance treatment. Progression was defined using Response Evaluation Criteria in Solid Tumors (RECIST) and GCIG biochemical criteria. New biochemical progression definitions, based on CA125 nadir determined using receiver operating characteristic (ROC) curve analysis, were proposed. Concordance between radiological and biochemical progression was assessed.ResultsOf 142 patients, progression was detected in 54 (38.03%) and 29 (20.42%) using RECIST and GCIG criteria, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GCIG criteria were 53.70% [95% confidence interval (CI): 39.61%–67.38%], 100.00% [95% CI:95.91%–100.00%], 100.00% [95%CI: 88.10%–100.00%] and 77.88% [95% CI: 72.54%–82.43%], respectively. A cut-off of 1.59× nadir achieved 88.90% sensitivity and 87.20% specificity [Area Under Curve (AUC): 91.10%, 95% CI: 84.70%–97.40%] with a false positive rate (FPR) of 12.67%. Defining biochemical progression as an increase in CA125 of ≥3× nadir achieved sensitivity, specificity, PPV, NPV, and FPR of 79.63% [95% CI: 66.47%–89.37%], 98.86% [95% CI: 93.83%–99.97%], 97.73% [95% CI: 85.91%–99.67%], 88.78% [95% CI: 82.35%–93.06%], and 1.14%, respectively. Diagnostic accuracy was higher using the ≥3× nadir criterion compared with GCIG definition (91.55% vs. 82.39%).ConclusionGCIG biochemical progression criteria during PARPis maintenance treatment after first-line chemotherapy missed 46.3% of progressing patients. A new criterion—CA125 ≥3× nadir—improves sensitivity and NPV, while maintaining high specificity, offering a simple and practical approach for clinical implementation.

Background/Objectives: Endometrial cancer (EC), a malignancy arising from the uterine lining, is a leading gynecological cancer in developed countries. Syringic acid (SA), a naturally occurring phenolic compound, possesses various bioactivities including antioxidant, anti-inflammatory, chemoprotective, and anti-angiogenic properties. This study aimed to investigate the effects of SA on the proliferation and migration of RL95-2 EC cells, its protective role in normal endometrial stromal cells (HESCs), and the underlying molecular mechanisms. Furthermore, the potential synergistic anticancer effects of SA in combination with chemotherapeutic agents against EC were evaluated. Methods: Cell viability was assessed using nuclear fluorescence staining, the MTT assay, and clonogenic survival assay. Cell migration was evaluated through wound closure and Transwell migration assays. Gene expression levels were analyzed by the RT-PCR method. Results: SA significantly inhibited the proliferation of RL95-2 EC cells, with an IC50 value of 27.22 μM. Co-treatment with SA and the chemotherapeutic agent doxorubicin (Dox) demonstrated an additive inhibitory effect. Mechanistically, both SA and the SA-Dox combination induced apoptosis by upregulating the expression of caspases-3, -8, and -9, increasing the expression of pro-apoptotic genes (Bax and Bad), and downregulating anti-apoptotic genes (Bcl-XL and Bcl-2). Cell cycle analysis revealed the downregulation of cyclin D and the upregulation of tumor suppressors p21 and p27, contributing to growth arrest. In addition, both SA and the combination treatment effectively suppressed cell migration by downregulating matrix metalloproteinases (MMPs) and β-catenin. SA treatment also induced the expression of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) and activated NF-κB signaling, leading to an elevated expression of inflammatory mediators such as COX-2 and iNOS. Furthermore, SA promoted oxidative stress in RL95-2 cells by inhibiting the Nrf2 pathway and reducing the expression and activities of antioxidant enzymes including catalase, glutathione peroxidase, and superoxide dismutase, thereby enhancing reactive oxygen species (ROS) accumulation. In contrast, in lipopolysaccharide-stimulated HESC cells, SA attenuated inflammation and ROS generation, indicating its selective cytoprotective role in normal endometrial cells. Conclusions: SA may serve as a promising adjuvant candidate to enhance chemotherapeutic efficacy while protecting normal cells by mitigating inflammation and oxidative stress.

BackgroundWomen with breast or gynecological cancer and their intimate partners often face sexual problems in their relationships. Accessing care for sexual health problems is challenging for several reasons (eg, limited trained health care providers and privacy concerns), making self-management approaches highly promising.ObjectiveThis study assessed the feasibility of the Psychosexual Educational Partners Program (PEPP), a 6-week sexual health self-management intervention for women treated for breast or gynecological cancer and their intimate partners.MethodsA mixed methods single-arm, repeated measures design was used for this study. An attrition rate of ≤25% was considered feasible. Intervention experiences were assessed via interviews, and preliminary effects on the Dyadic Sexual Communication Scale, relationship quality measured by the Revised Dyadic Adjustment Scale, and sexual health measured by PROMIS Sexual Function and Satisfaction version 2.0 were explored quantitatively.ResultsIn total, 7 (77%) of the 9 couples completed the study through week 6 and provided both pre- and poststudy data, resulting in an attrition rate of 22% (2/9), which met the feasibility benchmark for attrition of 25% or less. The following two themes emerged: (1) PEPP helped us start difficult conversations and impacted emotional and physical intimacy. The intervention adherence was 85%. Dyadic Sexual Communication Scale scores improved with a mean change score of 6.64 (SD 9.65) and a Cohen d of 0.69. Revised Dyadic Adjustment Scale scores declined slightly, with a mean change score of –0.93 (SD 3.41) and a Cohen d of 0.27. PROMIS Sexual Function and Satisfaction version 2.0 scores showed small improvements for women on desire, with a mean change score of 2.36 (SD 6.24) and a Cohen d of 0.38. Similarly, for women, the satisfaction mean change score was 2.20 (SD 8.22) and a Cohen d of 0.27. For intimate partners, a small effect was found for desire, but in this instance, desire decreased with a mean change score of –1.57 (SD 6.09) and a Cohen d of 0.26.ConclusionsThe findings support PEPP as a feasible intervention for improving sexual communication. If proven effective in a randomized controlled trial, it has the potential to address the critical gap in supportive care among female cancer survivors.Trial RegistrationClinicalTrials.gov NCT05070299; https://clinicaltrials.gov/study/NCT05070299

This study aimed to explore the joint effect of sitting time on anemia status and its association with mortality among cancer patients aged 55years and older in the United States. This cross-sectional study utilized two databases: the Global Burden of Disease (GBD) 2021 and National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. The burden of cancer attributable to low physical activity was assessed globally and in the United States using data from the GBD database. To evaluate the effects of sitting time in conjunction with anemia on mortality outcomes in cancer patients, we employed multivariate logistic regression, Cox regression analysis, and restricted cubic spline (RCS) analyses. From 1990 to 2021, the number of cancer deaths associated with low physical activity increased both globally and in the United States. However, during the same period, the age-standardized death rate (ASDR) showed a slight downward trend. The study included a total of 2,581 adult cancer patients (aged ≥55years) from the NHANES database. Compared to patients with shorter sitting durations, those with longer sitting durations exhibited a significantly higher incidence of anemia (OR=1.98; 95% CI: 1.29-3.04). Additionally, a trend of increasing mortality was observed with longer sitting times (HR=1.66; 95% CI: 1.24-2.21). In the joint analysis, prolonged sitting was associated with an elevated risk of mortality among cancer survivors with anemia (HR=2.65; 95% CI: 1.60-4.38). Further analysis revealed that prolonged sitting has a more detrimental impact on gynecological cancers. This study reveals that from 1990 to 2021, global cancer mortality related to low physical activity has declined. Furthermore, the prolonged sedentary time in cancer patients is significantly associated with anemia, and their synergistic effect increases mortality risk. Sedentary behavior particularly increases the mortality risk of gynecological cancers. These findings suggest that clinical strategies should prioritize interventions tailored to different tumor types, particularly those managing sedentary behavior and anemia.

Effects of Yoga Interventions on Health Outcomes in Women With Gynecological Cancers: A Systematic Review of Randomised Controlled Trials

BackgroundBreast and gynecological cancer have a high prevalence and a significant impact on public health. It is important to note that the time intervals until diagnosis and treatment influence the prognosis. The objective was to describe the delay in the diagnosis of breast and gynecological cancer and to identify the variables related to the patient, healthcare and the disease that intervene in the time interval until diagnosis and treatment.MethodsWe conducted a retrospective study (2014–2023) following a cohort of women with breast and gynecological cancer, from the onset of symptoms to the start of treatment. The study included 722 women from 30 general practice clinics in Albacete, Spain, and data were obtained from both primary care and hospital settings.ResultsAmong breast cancer patients, 150 (25.7%) had been diagnosed through screening, and among those diagnosed with cervical cancer, 14 (37.8%), it was not possible to calculate some time intervals. In breast cancer the variables associated with a total time interval (from first symptoms to start of treatment) of more than 90 days were: age over 50 and symptoms other than a breast lump. In gynecological cancer, the related variables were: no family history and having attended the health center for the first consultation. In the diagnostic interval (from first consultation to diagnosis), the variables associated with a duration of more than 30 days were: presenting with fewer than two risk factors in breast cancer and first consultation at the health center in gynecological cancer.ConclusionMost patients with breast and/or gynecological cancer are diagnosed in the early stages of the disease, except in the case of ovarian cancer. Most breast and cervical tumors are not diagnosed through screening. The time interval that most influences the total interval is the diagnostic interval, which includes the primary care interval. The treatment interval is high in most tumors, exceeding the recommended time. The results provide useful information for proposing improvements in access to diagnostic and therapeutic resources, as well as preferential referral circuits to improve early detection and prognosis of the disease.

Background:Cancer-related fatigue (CRF) is a persistent, distressing, subjective sense of physical, emotional, or cognitive tiredness or exhaustion disproportionate to recent activity and interferes with normal functioning. Jing Si herbal tea (JSHT) has shown several pharmacological actions in preclinical and clinical models. We aimed to investigate the effect of JSHT on alleviating CRF in patients with gynecological cancer.Methods:A randomized controlled trial was conducted at our hospital from March 1, 2021 to December 31, 2023. Participants aged 20 to 80 years with gynecologic cancer and moderate-to-severe CRF were randomly categorized into 2 groups. The intervention group was given JSHT twice daily for 6 weeks, while the control group was given a placebo for 3 weeks and JSHT for the following 3 weeks. The primary outcomes were fatigue and quality of life, which were evaluated using the brief fatigue inventory-total (BFI-T) and functional assessment of cancer therapy-general 7 scale. The secondary outcomes included white blood cells and differential counts.Results:Among the 19 participants, there was no significant difference in CRF (BFI-T) and quality of life (functional assessment of cancer therapy-general 7) improvement between the intervention group (n = 9) and the control group (n = 10). However, both groups showed significant improvements in BFI-T: global fatigue score, BFI-T: fatigue intensity, and BFI-T: fatigue interference after treatment (P < .05). The difference in monocyte count was statistically significant after treatment in both groups (P < .001), with the intervention group showing a significant decrease in monocyte count compared to the control group at the beginning of cycle 2 (P < .05).Conclusion:Both intervention and control groups improved fatigue and decreased monocyte counts. Further research is needed to explore these findings and their clinical relevance.

Background:Ovarian cancer is a leading cause of gynecologic cancer mortality, with Black women experiencing 5-year survival rates of only 41%. Disproportionate air pollution exposure may impact survival. We evaluated associations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) exposure with survival among Black women with epithelial ovarian cancer using data from the California Cancer Registry (CCR, n = 540) and the multi-state African American Cancer Epidemiology Study (AACES, n = 766).Methods:Annual PM2.5 and NO2 levels were estimated at a 1 km resolution using well-validated ensemble-based prediction models derived from the Socioeconomic Data and Application Center and assigned to the participants’ residential addresses per their year of diagnosis (2004−2016). Weibull accelerated failure time models with participant-level frailty were used to assess air pollutant exposure associations with overall survival.Results:Average PM2.5 and NO2 exposures were 11.3 μg/m³ and 25.8 ppb in CCR and 9.7 μg/m³ and 17.5 ppb in AACES. There was little evidence of an association between air pollution exposures and survival, with event time ratios (> 1 indicate longer survival) in CCR of 1.08 (95% CI = 0.97, 1.20) per 1 μg/m³ PM2.5 and 1.07 (95% CI = 0.99, 1.15) per 10 ppb NO2, and in AACES of 1.00 (95% CI = 0.93, 1.07) per 1 μg/m³ PM2.5 and 1.04 (95% CI = 0.91, 1.19) per 10 ppb NO2.Conclusions:Findings were modest and consistent across both cohorts and sensitivity analyses, supported by the use of advanced exposure modeling. Future research should use time-varying, long-term exposure data and examine interactions with occupation, physical activity, and neighborhood stressors.

Ovarian cancer (OV) is one of the most malignant gynecological cancers. Poly(ADP-ribose) polymerase inhibitors (PARPi) represent the first-line maintenance therapy, effectively prolonging patient survival; however, the development of PARPi resistance poses a significant challenge for OV maintenance therapy. Previous studies have indicated that HNF4G functions as an oncogene in various tumors, but its role in OV development and Olaparib resistance remains unexplored. We established an Olaparib-resistant OV cell line, SKOV3-PARPi, from the parental SKOV3 cell line. The impact of HNF4G on SKOV3 cell resistance to Olaparib was investigated using qRT-PCR, CCK-8 assay, Transwell assay, colony formation assay, scratch assay, Western blot, flow cytometry, as well as a nude mouse xenograft tumor model and immuno-histochemistry. The function of HNF4G in SKOV3-Olaparib resistant cells was elucidated and subsequently validated through the animal tumor model. Prolonged Olaparib exposure induced acquired resistance in SKOV3 cells. Compared to parental OV cells, HNF4G expression was upregulated in Olaparib-resistant cells. Overexpression of HNF4G enhanced Olaparib resistance in OV cells, whereas HNF4G knockdown diminished it. Furthermore, increased protein levels of components within the PI3K-AKT signaling pathway were observed in Olaparib-resistant cells. Knocking down HNF4G expression in resistant cells significantly slowed tumor growth under Olaparib treatment. Changes in the protein levels of HNF4G and PI3K-AKT pathway components in the in vivo xenograft tumor tissues were consistent with the cellular observations. Overexpression of HNF4G plays a crucial role in conferring Olaparib resistance in OV by activating the PI3K-AKT signaling pathway. HNF4G may serve as a potential therapeutic target for patients with Olaparib-resistant OV.

This study aimed to examine the level of spiritual experience and the impact of socio-demographic and clinical features, anxiety and depression, and spiritual well-being on the spiritual experiences of hospitalized patients with gynecological cancer. This cross-sectional study was conducted with 192 patients in a university-affiliated hospital in the west of Turkey. The participants completed self-assessment tools, including the Daily Spiritual Experience Scale, the Functional Assessment of Chronic Illness Therapy--Spiritual Well-Being Scale, and the Hospital Anxiety and Depression Scale. According to the results of the hierarchical linear regression analysis, the statistically significant factors affecting spiritual experience among patients with gynecologic cancer were age (β = -.219), anxiety (β = .208), depression (β = .172), and faith (β = -.312). Meaning and peace subdimensions of spiritual well-being were not found to be a significant predictor of spiritual experience. This indicates that when the subdimensions contaminating the construct of spiritual well-being are removed, the faith subdimension predicts spiritual experience more strongly. Gynecological cancer patients may have spiritual issues, so health professionals should provide spiritual support.

To compare the survival difference between 2018 International Federation of Gynecology and Obsterics (FIGO) stage IIB cervical cancer (CC) patients with Unilateral parametrial invasion (UL) and Bilateral parametrial invasion (BL) disease and explore the significant role of parametrial invasion (PI) in prognosis prediction. A total of 506 stage IIB CC patients were identified from the multi-center study and patients were divided into UL and BL groups according to gynecological and radiological examination. Survival outcomes were estimated and compared between two groups before and after Propensity Scoring Matching (PSM). The role of upper 2/3 vaginal invasion (VI) in impacting survival probability was also assessed. The random forest (RF) model was constructed and validated to select important features related to survival outcomes and predict prognosis for these patients. The SHapley Additive exPlanation (SHAP) was further introduced to provide better understanding towards the findings from RF model. Significant better 5-year overall survival (OS) was observed among patients with UL disease whether before [BL : 61.7% (95%CI : 57.0%-66.4%); UL : 84.8% (95%CI : 82.4%-87.2%); HR = 2.83, 95%CI : 1.90-4.20, P < 0.001] or after PSM [BL : 61.3% (95%CI : 56.6%-66.0%); UL : 81.2% (95%CI : 77.3%-85.1%); HR = 2.51, 95%CI : 1.56-4.04, P < 0.001]. Similar findings could also be observed in terms of progression free survival (PFS). The presence of VI didn't significantly impair the survival probability whether in UL or BL group (All P > 0.05). RF model was constructed, which possessed decent predictive ability both in the training (AUC = 0.893; 95%CI : 0.874-0.912) and validation cohort (AUC = 0.879; 95%CI : 0.801-0.957). PI was identified to be the paramount feature in affecting the survival outcomes for stage IIB CC patients through the Beeswarm summary plot and bar chart in SHAP analysis. Our findings demonstrated that 2018 FIGO stage IIB CC patients with BL disease had worse prognosis than those with UL disease and PI was the most significant feature in prognosis prediction for these patients.

Combined operative and radiotherapeutic treatment for locally recurrent gynaecologic cancer with pelvic wall invasion: A monocentric retrospective study.

Anemia is common among patients with gynecologic cancers receiving systemic treatment and is associated with adverse outcomes. We describe a quality-improvement initiative designed to improve screening and treatment for nutritional causes of anemia in this population, and we assess the effect of this intervention on hemoglobin levels and blood transfusions. We implemented a quality-improvement intervention that automatized regular laboratory evaluation for nutritional causes of anemia in patients with gynecologic malignancies receiving systemic treatment who had hemoglobin levels below 12 g/dL. Patients with nutritional deficiencies were treated with intravenous iron or oral vitamin B12. We evaluated the association of the intervention and change in hemoglobin levels over three cycles of treatment (delta hemoglobin), along with the rate of blood transfusion. Thirty patients with hemoglobin levels below 12 g/dL were administered a survey regarding anemia, fatigue, and the acceptability of the intervention. The overall rates of iron and vitamin B12 deficiency were 54.2% and 8.1%, respectively. The control period included 117 patients, and the intervention period included 101 patients. Our quality-improvement process increased the rate of evaluation for iron and vitamin B12 deficiency in patients with anemia from 23.1% and 20.5%, respectively, to more than 90%. When controlling for relevant demographic and cancer-related characteristics, the delta hemoglobin was 0.45 g/dL higher in patients treated after the intervention when compared with patients treated before the intervention. In patients with hemoglobin levels below 11 g/dL, the delta hemoglobin was 0.91 g/dL higher after the intervention. There was no significant difference in the rate of blood transfusion. Patients with anemia who were surveyed were concerned about fatigue and overall accepting of the intervention. Using medical record treatment plans to send reflex anemia evaluation tests was effective at increasing rates of screening for nutritional deficiencies. Proactively addressing nutritional causes of anemia was associated with maintenance of higher hemoglobin levels in patients with gynecologic cancer receiving systemic treatment.

BackgroundHigh body-mass index (BMI) is a major modifiable risk factor for gynecological cancers, yet its contribution to the global cancer burden remains incompletely characterized. This study provides a comprehensive analysis of the current burden of gynecological cancers attributable to high BMI and projects future trends through 2050.MethodsWe analyzed data from the Global Burden of Disease (GBD) 2021 study, examining uterine and ovarian cancers attributable to high BMI across 204 countries and territories. Burden was quantified using deaths and disability-adjusted life years (DALYs). Temporal trends were identified using joinpoint regression analysis, while future burden was projected using Bayesian Age-Period-Cohort (BAPC) models. We evaluated relationships between socio-demographic index (SDI) and cancer burden to identify development-associated patterns.ResultsBetween 1990 and 2021, global deaths from gynecological cancers attributable to high BMI increased by 143.4% (from 20,743–50,479), with corresponding DALYs rising by 141.7% (from 561,515–1,357,395). Rising age-standardized rates indicated increasing individual-level risk. While burden was highest in high-SDI regions, the most rapid increases occurred in low- and middle-SDI settings. Cancer-specific patterns varied, with uterine cancer showing consistent increases across all SDI quintiles, while ovarian cancer exhibited decreasing trends in high-SDI regions after 2003. Projections indicate a 2.6-fold increase in deaths by 2050, with differential growth by cancer type: a 3.2-fold increase for ovarian cancer versus 2.3-fold for uterine cancer.ConclusionsThe global burden of gynecological cancers attributable to high BMI has increased substantially and is projected to accelerate through 2050, particularly in developing regions. These findings underscore the urgent need for targeted obesity prevention strategies within comprehensive cancer control programs to avert a substantial proportion of future gynecological cancer cases.