Gynecologic Oncology Research Research Articles

From the Beginning of the Korean Gynecologic Oncology Group to the Present and Next Steps.

The Korean Gynecologic Oncology Group (KGOG) was established in 2002 and is the only organization in Korea conducting multi-center clinical trials for gynecologic cancers. Since its re-establishment as a non-profit organization in 2021, KGOG has grown significantly, now including 207 gynecologic oncology specialists from 76 hospitals. This growth is a testament to the dedication and hard work of all those involved in the organization. KGOG is committed to maximizing the activation of multi-center clinical research through policies that support patients with rare diseases and gynecologic cancer research, focusing on strengthening institutional capacity, equalizing participation opportunities, and enhancing information sharing. A significant milestone for KGOG was becoming a member of the US Gynecologic Oncology Group (GOG) in 2005, allowing participation in GOG clinical trials. KGOG later joined the Gynecologic Cancer InterGroup (GCIG) and strengthened its capabilities by hosting the first Endometrial Cancer Consensus Conference-Clinical Research (ECCC-CR) in 2023. KGOG holds biannual meetings and symposia, as well as 224 operating committee meetings annually to review the discussions of the Tumor Site Committee. KGOG has conducted 156 investigator-initiated trial (IIT) or sponsor-initiated trial (SIT) studies as KGOG-led or participated in research. Currently, 18 studies are registered, and 10 are in preparation. To date, 68 papers have been published. KGOG conducts six national projects and collaborates with external organizations such as the NRG Oncology Foundation, Gynecologic Oncology Group Partners (GOG-P), GCIG, East Asian Gynecologic Oncology Trial group (EAGOT), and the Japanese Gynecologic Oncology Group (JGOG). Through collaboration with renowned international research institutions, KGOG has significantly expanded the scope of its research, achieving noteworthy clinical outcomes. This report not only introduces the history and recent status of KGOG but also presents the exciting future direction of the organization, filled with potential breakthroughs and advancements in gynecologic oncology research.

The value of multicenter collaboration in Gynecologic Oncology research.

Canadian gynecological oncology (GYNONC) is constantly evolving. We aim to study the patterns in Canadian GYNONC research using a systematic search approach and bibliometric analysis. We used Web of Science to identify all relevant publications in the field of GYNONC by Canadian. We analyzed bibliometric data obtained from the iCite database. Publications were evaluated for specific characteristics including the province of all co-authors. We compared bibliometric metrics among provinces. Overall, 1511 publications, published in 138 different journals during 1973-2022 were analyzed. Of those, 23.5% (N.=355) were of interprovincial origin. Interprovincial publications were constantly increasing, now reaching 34.1%. Publications of interprovincial setting had higher RCR, CPY, FCR and NIH percentile scores when compared to any single province (P=0.009, P>0.001, P<0.001, and P<0.001, respectively). The proportion of publications in high impact factor journals were higher in the interprovincial setting: 35 (9.9%) vs. 48 (4.2%), P<0.001. Excluding the interprovincial publications there were 1156 publications. Half of the publications were authored by authors from Ontario (N.=587, 50.6%), 278 (24.1%) by authors from Quebec, and 161 (14.0%) by authors from British Columbia. The mean FCR was higher in British Columbia as compared to Ontario, Quebec and Manitoba (6.0±2.1 vs. 5.3±2.1, 5.3±1.5, and 4.1±3.0 respectively; P=0.006, P=0.034, and 0.037, respectively). Only Ontario, Quebec, British Columbia and Alberta had publications in high impact factor journals, with similar rate (P=0.806). Interprovincial publications have the highest citation metrics in all domains. This underscores the importance of collaboration for the purpose of impactful research.

Lymphadenectomy in clinically early epithelial ovarian cancer and survival analysis (LILAC): a Gynecologic Oncology Research Investigators Collaboration (GORILLA-3002) retrospective study.

This study aimed to evaluate the therapeutic role of lymphadenectomy in patients surgically treated for clinically early-stage epithelial ovarian cancer (EOC). This retrospective, multicenter study included patients with clinically early-stage EOC based on preoperative abdominal-pelvic computed tomography or magnetic resonance imaging findings between 2007 and 2021. Oncologic outcomes and perioperative complications were compared between the lymphadenectomy and non-lymphadenectomy groups. Independent prognostic factors were determined using Cox regression analysis. Disease-free survival (DFS) was the primary outcome. Overall survival (OS) and perioperative outcomes were the secondary outcomes. In total, 586 patients (lymphadenectomy group, n=453 [77.3%]; non-lymphadenectomy groups, n=133 [22.7%]) were eligible. After surgical staging, upstaging was identified based on the presence of lymph node metastasis in 14 (3.1%) of 453 patients. No significant difference was found in the 5-year DFS (88.9% vs. 83.4%, p=0.203) and 5-year OS (97.2% vs. 97.7%, p=0.895) between the two groups. Using multivariable analysis, lymphadenectomy was not significantly associated with DFS or OS. However, using subgroup analysis, the lymphadenectomy group with serous histology had higher 5-year DFS rates than did the non-lymphadenectomy group (86.5% vs. 74.4%, p=0.048; adjusted hazard ratio=0.281; 95% confidence interval=0.107-0.735; p=0.010). The lymphadenectomy group had longer operating time (p<0.001), higher estimated blood loss (p<0.001), and higher perioperative complication rate (p=0.004) than did the non-lymphadenectomy group. In patients with clinically early-stage EOC with serous histology, lymphadenectomy was associated with survival benefits. Considering its potential harm, lymphadenectomy should be performed according to histologic subtype and subsequent chemotherapy in patients with clinically early-stage EOC. Clinical Research Information Service Identifier: KCT0007309.

Risk factors for the failure of first-line PARP inhibitor maintenance therapy in patients with advanced ovarian cancer: Gynecologic Oncology Research Investigators Collaboration Study (GORILLA-3004).

To identify the risk factors for failure of first-line poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance therapy in patients with advanced ovarian cancer. Patients with stage III-IV epithelial ovarian cancer who received first-line PARPi maintenance therapy were retrospectively reviewed. Clinicopathologic factors were compared between two groups-recur/progression of disease (PD) and non-recur/PD. In total, 191 patients were included. Median follow-up was 9.9 months, and recurrence rate was 20.9%. BRCA mutations were found in 63.4% patients. Postoperative residual tumor (60.5% vs. 37.8%), non-high grade serous carcinoma (HGSC) (15.0% vs. 6.0%), neoadjuvant chemotherapy (NAC) (55.0% vs. 35.8%), and pre-PARPi serum CA-125 levels ≥23.5 U/mL (35.9% vs. 15.2%) were more frequently observed in the recur/PD group. Multivariate Cox-regression analysis revealed pre-PARPi serum CA-125 levels ≥23.5 U/mL (HR, 2.17; 95%CI, 1.03-4.57; p = 0.042), non-HGSC (3.28; 1.20-8.97; p = 0.021), NAC (2.11; 1.04-4.26; p = 0.037), and no BRCA mutation (2.23; 1.12-4.44; p = 0.023) as independent risk factors associated with poor progression-free survival (PFS). A subgroup analysis according to BRCA mutation status showed that pre-PARPi serum CA-125 levels ≥26.4 U/mL were the only independent risk factor for poor PFS in women with BRCA mutations (2.75; 1.03-7.39; p = 0.044). Non-HGSC (5.05; 1.80-14.18; p = 0.002) and NAC (3.36; 1.25-9.04; p = 0.016) were independent risk factors in women without BRCA mutations. High pre-PARPi serum CA-125 levels, non-HGSC histology, NAC, and no BRCA mutation might be risk factors for early failure of first-line PARPi maintenance therapy. In women with BRCA mutations, high pre-PARPi serum CA-125 levels, which represent a large tumor burden before PARPi, were the only independent risk factor for poor PFS.

Comparison of Survival of Radical hysterectomy and chemoradiation for cervical cancer with an absence of Parametrial involvement and suspicious lymph node metastasis (SURPRISE): Gynecologic Oncology Research Investigators coLLborAtion study (GORILLA-1002) (1199)

Comparison of Survival of Radical hysterectomy and chemoradiation for cervical cancer with an absence of Parametrial involvement and suspicious lymph node metastasis (SURPRISE): Gynecologic Oncology Research Investigators coLLborAtion study (GORILLA-1002) (1199)

Risk factor for the failure of first-line PARP inhibitor maintenance therapy in patients with advanced ovarian cancer: Gynecologic oncology research investigators coLLborAtion study (GORILLA-3004) (1152)

Risk factor for the failure of first-line PARP inhibitor maintenance therapy in patients with advanced ovarian cancer: Gynecologic oncology research investigators coLLborAtion study (GORILLA-3004) (1152)

Is minimally invasive radical surgery safe for patients with cervical cancer ≤2 cm in size? (MISAFE): Gynecologic Oncology Research Investigators coLLborAtion study (GORILLA-1003)

ObjectiveTo identify clinicopathological factors associated with disease recurrence for patients with 2018 FIGO stage IA with lymphovascular invasion to IB1 cervical cancer treated with minimally invasive surgery (MIS). MethodsA total of 722 patients with cervical cancer between January 2010 and February 2021 were identified. Clinicopathological factors related to disease recurrence were analyzed. Disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. To determine prognostic factors for DFS, a Cox proportional hazard regression model was used. ResultsOf 722 patients, 49 (6.8%) experienced disease recurrence (37 pelvis, 1 para-aortic lymph node, and 11 peritoneum). Five-year DFS and OS rates were 90.7% and 98.1%, respectively. In multivariate analysis, risk factors associated with disease recurrence were residual disease in the remaining cervix (OR, 3.122; 95% CI, 1.152–8.461; p = 0.025), intracorporeal colpotomy (OR, 3.252; 95% CI, 1.507–7.017; p = 0.003), and positive resection margin (OR, 3.078; 95% CI, 1.031–9.193; p = 0.044). The non-conization group had a higher percentage of stage IB1 (77.4% vs. 64.6%; p = 0.004) and larger tumor (10 mm vs. 7 mm; p < 0.001) than the conization group. Intracorporeal colpotomy and residual disease in the remaining cervix were independent variables associated with disease recurrence in patients undergoing MIS following conization. ConclusionDuring MIS, patients with cervical cancer ≤2 cm in size can be vulnerable to peritoneal recurrences. Patients diagnosed with invasive cancer through conization often have low-risk pathological features, which may affect their survival outcomes.

Fertility-sparing hormonal treatment in patients with stage I endometrial cancer of grade 2 without myometrial invasion and grade 1–2 with superficial myometrial invasion: Gynecologic Oncology Research Investigators coLLaborAtion study (GORILLA-2001)

ObjectivesTo evaluate oncologic and pregnancy outcomes of fertility-sparing treatment (FST) using progestin in patients with stage I grade 2 endometrioid endometrial cancer (EC) without myometrial invasion (MI) or grade 1–2 with superficial MI. MethodsMulticenter data of patients with stage I grade 2 EC without MI or grade 1–2 EC with superficial MI, who received FST between 2005 and 2021, were analyzed. Cox regression analysis identified independent factors for progressive disease (PD) during the FST. ResultsAltogether, 54 patients received FST [medroxyprogesterone acetate (500–1000 mg) in 44, megestrol acetate (40–800 mg) in 10] with concurrent levonorgestrel-releasing intrauterine devices use in 31. With median time to achieve a complete response (CR) of 10 (3–24) months, 39 patients (72.2%) achieved CR. Of the 15 patients who attempted to conceive after achieving CR, 7 (46.7%) became pregnant (2 abortions, 5 live births). During a median FST duration of 6 (3–12) months, nine patients (16.6%) were diagnosed with PD. Fifteen (38.5%) experienced recurrence with a median recurrence-free survival of 23 (3–101) months. In the multivariable analysis, tumor size before FST ≥2 cm (HR 5.456, 95% CI 1.34 to 22.14; p = 0.018) was significantly associated with a high PD rate during FST. ConclusionThe overall response rate to FST was promising, however, the PD rate was significant during the first 12 months of FST. Therefore, performing thorough endometrial biopsy and imaging studies is essential to strictly evaluate the extent of the disease every 3 months from FST initiation.

Optimum selection criteria for secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer: A multicenter study from the Gynecologic Oncology Research Investigators coLLaborAtion group (GORILLA-3001).

To identify those most likely to benefit from secondary cytoreductive surgery (SCS), we evaluated the survival outcomes and factors predictive of prognosis in patients with recurrent ovarian cancer. We retrospectively reviewed the medical records of patients with recurrent ovarian cancer treated at five high-volume Korean hospitals between 2010 and 2021. Recurrence characteristics, treatment methods, and potential predictors of survival were compared between the chemotherapy and surgery groups. Among all 670 patients, 88.1% had initial stage III/IV disease, and 215 (32.1%) underwent SCS. Among patients who underwent SCS, only those who achieved complete resection exhibited improved survival. Even in patients with residual disease < 1 cm after SCS, we observed no significant survival benefit (p = 0.942). In the multivariate Cox analysis, residual disease at primary surgery, progression-free interval, recurrence sites (≤3 regions or limited carcinomatosis), ascites, and SCS were significant predictors of survival. Meanwhile, the only factor predictive of complete resection after SCS was recurrence sites (p < 0.001). The benefits of SCS appear to be exclusive to cases of complete resection. We propose limited regional platinum-sensitive recurrence (≤3 regions or limited carcinomatosis) without ascites as the optimum selection criteria for SCS.

Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials.

Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access-related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11-0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12-0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.

Oncological big data platforms for promoting digital competencies and professionalism in Chinese medical students: a cross-sectional study

ObjectivesAdvancements in big data technology are reshaping the healthcare system in China. This study aims to explore the role of medical big data in promoting digital competencies and professionalism among...

Penetrating complications of bevacizumab-containing chemotherapy in previously-irradiated recurrent cervical cancer: a Korean multicenter retrospective study of the Gynecologic Oncology Research Investigators coLLaborAtion (GORILLA) group (GORILLA1001) (036)

<b>Objectives:</b> Gynecologic Oncology Group 240 study showed that incorporating bevacizumab in the treatment of recurrent, persistent, or metastatic cervical cancer conferred overall survival (OS) benefit. However, fistula occurred significantly higher in the bevacizumab (+) group than the chemotherapy alone group. Moreover, all fistulas in the bevacizumab (+) group were developed in patients who were previously irradiated. This study aimed to evaluate the incidence and to identify risk factors for penetrating complications, including gastrointestinal (GI) and genitourinary (GU) fistula/perforation, of bevacizumab plus chemotherapy in recurrent cervical cancer patients who underwent pelvic radiation therapy (RT). <b>Methods:</b> Medical records of the patients with recurrent cervical cancer who previously underwent pelvic radiation at five university hospitals in Korea from 2007 to 2020 were retrospectively reviewed. Women who received chemotherapy immediately after RT were excluded. Clinical-pathologic factors were compared between groups of the following two settings: <i>1)</i> fistula/perforation (+) and (-); <i>2)</i> bevacizumab plus chemotherapy and chemotherapy alone. Univariate and multivariate regression analyses were performed to identify risk factors for penetrating complications. OS was also compared between groups of the two comparisons. <b>Results:</b> Of 219 women with recurrent cervical cancer who previously underwent pelvic RT, 144 (65.8%) received bevacizumab-containing chemotherapy, and 75 (34.2%) received chemotherapy alone. Fistula/perforation of any grade occurred in 36 (16.4%): fistulas alone in 27 (11 GI, 8 GU, and 8 both) and perforations in nine patients. Women receiving bevacizumab experienced fistula/perforation more frequently than those who used chemotherapy alone (20.8% [30/144] vs 8.0% [6/75]; p=0.015) (Table 1). Multivariate regression analysis showed that bevacizumab administration was the only independent risk factor for the occurrence of fistula/perforation. Age, diabetes, hypertension, tumor histology (squamous vs non-squamous), cumulative dose of RT, primary treatment (operation vs. RT vs both), use of intensity-modulated RT, and the time interval between RT and bevacizumab failed to show association with fistula/perforation. During median follow-up of 33.7 months (1.2-185.6 months), significant OS difference was shown neither between bevacizumab (+) versus bevacizumab (-) (HR: 1.03; median 119.8 months [95% CI: 97.3-142.3months] vs 115.7 months [96.0-135.4 months]; p=0.928) nor between fistula/perforation (+) versus fistula/perforation (-) (HR: 1.78; median 84.2 months [59.3-109.0 months] vs 129.5 months [114.1-144.9 months]; p=0.065). <b>Conclusions:</b> The study results suggest that incorporating bevacizumab in the chemotherapy regimen to treat recurrent cervical cancer with a previous history of pelvic RT incurs a considerable risk of GI and/or GU penetrating complications, which might damage the survival outcome as well as the quality of life. The risk and benefit of incorporating bevacizumab in the treatment of previously irradiated recurrent cervical cancer patients are needed to be carefully weighed, considering that effective prevention of the penetrating complications is difficult because of the lack of knowledge regarding other risk factors.

Topic Modeling to Identify Research Themes over Thirty Years of Original Research in Gynecologic Oncology (082)

<b>Objectives:</b> Identifying thematic trends in published research can allow investigators to understand what questions or topics have been prioritized for dissemination over time and identify trends and directions for future studies. We aimed to define the most common research topics published in <i>Gynecologic Oncology</i> over a thirty-year period using an unsupervised machine-learning approach of topic modeling and subsequently discuss the trends of these topics over time. <b>Methods:</b> We retrieved the abstracts of all original research published in <i>Gynecologic Oncology</i> from 1990 to 2020 using PubMed. The abstract text was pre-processed into root words called tokens. The corpus of text was then run through the most popular topic modeling algorithm, Latent Dirichlet Allocation, to cluster the text into unnamed topical themes. Topics were then manually named by three independent reviewers. Named topics were subsequently investigated for temporal trends. <b>Results:</b> We retrieved 12,586 original research articles, of which 11,217 were evaluable for subsequent analysis. Twenty-three research topics were identified at the completion of topic modeling. The topics of basic science genetics, epidemiologic methods, and chemotherapy experienced the greatest increase over the time period, while surgical outcomes, reproductive age cancer management, and cervical dysplasia experienced the greatest decline. Interest in basic science research remained relatively constant.Fig. 1 <b>Conclusions:</b> The use of topic modeling, generated through an unsupervised machine learning approach, can allow investigators to identify trends in research themes and can be used to provide insight into the evolution of the field of gynecologic oncology research over time.

Optimum selection criteria for secondary cytoreductive surgery in patients with recurrent ovarian cancer: A multicenter study from the Gynecologic Oncology Research Investigators coLLaborAtion (GORILLA) group (GORILLA 3001) (546)

Objectives: Optimum selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer is often dependent on multiple confounding factors. This study aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigate the factors identifying patients who most likely benefit from the SCS. Methods: We retrospectively reviewed medical records of recurrent ovarian cancer patients from five referral hospitals in Korea from 2010 to 2020. Recurrent characteristics, following treatment methods and potential factors for survivals were evaluated between the chemotherapy and surgery groups. Results: A total of 670 patients with recurrent ovarian cancer were identified. The patient’s median age was 55 years (24-83), and 88.1% of patients had initial stage III/IV disease. Of all patients, 215 (32.1%) received SCS for the disease recurrence. The median survival was 85 months (95% CI: 65.0-105.0) in the chemotherapy group, whereas the median survival time was not reached in the SCS group. Patients who received the SCS were more likely to be young and had no residual disease at primary surgery, platinum-sensitive recurrence, limited regional recurrence (LRR, ≤3 lesions or regional carcinomatosis) with a low rate of ascites (p<0.001, 0.001, 0.001, 0.001, 0.006, respectively). In multivariate cox analysis, residual disease at primary surgery, PFI, recurrent sites, ascites, and SCS were significant prognostic factors for survival. Meanwhile, predicting factor for complete resection after SCS was only recurrent sites (LRR, p<0.001). Conclusions: SCS resulted in significantly favorable survival outcomes in well-selected patients. Platinum-sensitive recurrence with limited regional diseases (< 3 regions or limited carcinomatosis without ascites) can be considered as optimum criteria for SCS in recurrent ovarian cancer. Objectives: Optimum selection criteria for secondary cytoreductive surgery (SCS) in recurrent ovarian cancer is often dependent on multiple confounding factors. This study aimed to evaluate the treatment outcomes of recurrent ovarian cancer and investigate the factors identifying patients who most likely benefit from the SCS. Methods: We retrospectively reviewed medical records of recurrent ovarian cancer patients from five referral hospitals in Korea from 2010 to 2020. Recurrent characteristics, following treatment methods and potential factors for survivals were evaluated between the chemotherapy and surgery groups. Results: A total of 670 patients with recurrent ovarian cancer were identified. The patient’s median age was 55 years (24-83), and 88.1% of patients had initial stage III/IV disease. Of all patients, 215 (32.1%) received SCS for the disease recurrence. The median survival was 85 months (95% CI: 65.0-105.0) in the chemotherapy group, whereas the median survival time was not reached in the SCS group. Patients who received the SCS were more likely to be young and had no residual disease at primary surgery, platinum-sensitive recurrence, limited regional recurrence (LRR, ≤3 lesions or regional carcinomatosis) with a low rate of ascites (p<0.001, 0.001, 0.001, 0.001, 0.006, respectively). In multivariate cox analysis, residual disease at primary surgery, PFI, recurrent sites, ascites, and SCS were significant prognostic factors for survival. Meanwhile, predicting factor for complete resection after SCS was only recurrent sites (LRR, p<0.001). Conclusions: SCS resulted in significantly favorable survival outcomes in well-selected patients. Platinum-sensitive recurrence with limited regional diseases (< 3 regions or limited carcinomatosis without ascites) can be considered as optimum criteria for SCS in recurrent ovarian cancer.

Gastrointestinal/genitourinary perforation and fistula formation with or without bevacizumab in patients with previously irradiated recurrent cervical cancer: a Korean multicenter retrospective study of the Gynecologic Oncology Research Investigators Collaboration (GORILLA) group (GORILLA-1001)

BackgroundThis study aims to evaluate the incidence of and identify risk factors for gastrointestinal (GI) and genitourinary (GU) fistula or perforation formation with or without bevacizumab in patients with recurrent cervical cancer who underwent pelvic radiation therapy (RT).MethodsMedical records of patients with recurrent cervical cancer who previously underwent pelvic RT between 2007 and 2020 were retrospectively reviewed. Clinicopathological factors were compared between groups that are stratified according to: 1) fistula/perforation (+) versus (-); and 2) bevacizumab plus conventional chemotherapy (BC) versus chemotherapy alone (C). Univariate and multivariate regression analyses were performed to identify risk factors for fistula/perforation. Overall survival (OS) was compared between the different groups.ResultsOf 219 participants, fistula/perforation of any grade occurred in 36 patients (16.4%); 27 fistulas and 9 perforations. Bevacizumab was more frequently used in Bevacizumab was more frequently used ( +) group than fistula/perforation (-) group (p = 0.015). Multivariate analysis showed that bevacizumab administration was the only independent risk factor for fistula or perforation (HR, 3.27; 95% CI, 1.18–9.10; P = 0.023). F/P was observed more frequently in women receiving BC (n = 144) than those receiving C (n = 75) (20.8% vs. 8.0%; P = 0.019). During median follow-up of 33.7 months (1.2–185.6 months), no significant OS difference was observed between fistula/perforation ( +) vs. (-) (hazards ratio [HR], 1.78; median 84.2 months [95% CI, 59.3–109.0] vs. 129.5 months [95% CI, 114.1–144.9]; P = 0.065) or BC vs. C (HR, 1.03; median 119.8 months [95% CI, 97.3–142.3] vs. 115.7 months [95% CI, 96.0–135.4]; P = 0.928).ConclusionsThis study suggests that incorporation of bevacizumab in chemotherapy regimens for treating recurrent cervical cancer in patients who underwent pelvic RT incurs considerable risk for GI/GU fistula or perforation. There were no other independent risk factors for developing GI/GU fistula or perforation in this study population.

Editorial introductions.

Editorial introductions.

Discrepancies between author- and industry-reported disclosures of financial relationships at an annual gynecologic oncology research meeting

ObjectiveTrillions of dollars pass to physicians from industry-related businesses annually, leading to many opportunities for financial conflicts of interest. The Open Payments Database (OPD) was created to ensure transparency. We describe the industry relationships as reported in the OPD for presenters at the 2019 Society of Gynecologic Oncology (SGO) Annual Meeting and evaluate concordance between author disclosures of their financial interests and information provided by the OPD. MethodsThis is an observational, cross-sectional study. Disclosure data were collected from authors with oral and featured abstract presentations in the 2019 SGO annual conference. These disclosures were compared to data available for each author in the 2018 OPD, which included the amount and nature of industry payments. ResultsWe examined the disclosures of 301 authors who met inclusion criteria. Of 161 authors who had disclosure statements on their presentations,147 reported “no disclosures,” and 14 disclosed industry relationships. The remaining 140 did not list any disclosure information. Sixty percent (184/301) of authors had industry relationships in the 2018 OPD, including 173 of 287 (60.3%) of authors who either reported no disclosures or did not have disclosure data available in their presentations. These transactions totaled over 43 million USD from 122 different companies, with most payments (46%) categorized as “Research or Associated Research.” Accurate disclosure reporting was associated with receiving higher payments or research payments, and being a presenting author. ConclusionsMost authors at the SGO annual conference did not correctly disclose their industry relationships when compared with their entries in the OPD.

Race and Ethnicity Representation in Gynecologic Oncology Research

Objectives: Social determinants of health play significant roles in cancer outcomes. Increasing efforts have been made to improve how health disparity research is conducted with the ultimate goal to improve access for all patients to cancer research benefits. Significant racial disparities, including mortality differences, have been demonstrated within the field of gynecologic oncology. Despite known racial disparities in outcomes, there are few studies that specifically evaluate these issues. The objective of this study is to evaluate racial and ethnic representation within recent NRG Oncology/GOG publications.

Participation of Women with Low English Proficiency in Gynecologic Oncology Clinical Research

OBJECTIVES: Clinical trials are critical for advancing medical care, but enrollment of patients who are representative of the general population is an ongoing challenge. In gynecologic oncology, the fact that elderly, Black, Hispanic and uninsured populations are under-represented in clinical trials is well documented, but underlying mechanism are not well understood. Low English Proficiency (LEP) is a known barrier in healthcare that may drive other disparities in trial enrollment. Individuals with LEP comprise 8% of the US population and represent the full spectrum of race categories, yet their representation in clinical research is not well characterized. We sought to determine participation rates in gynecologic oncology research among women with LEP.

Gynecologic Oncology in the Department of Defense.

Gynecologic oncology existed within the Department of Defense (DOD) prior to its recognition as a separate subspecialty of obstetrics and gynecology. Military gynecologic oncologists were among the founders of the specialty and continue a tradition of leadership and engagement within the field at the national and international level. The full range of gynecologic oncology services is located at the military's largest medical centers, acknowledging the team approach with multiple subspecialties necessary to provide the highest standard of modern gynecologic cancer care. Gynecologic oncologists within the military receive training on par or exceeding that of their civilian counterparts, and their education extends beyond traditional training to prepare them for the unique challenges within military medicine as well. The clinical offerings from these practitioners and their facilities are state of the art, and each offers the full spectrum of care inclusive of surgery and chemotherapy. Closely coupled with expert clinical care is medical education and comprehensive cancer research. The gynecologic oncology research conducted by the DOD spans the scientific spectrum from basic laboratory investigations, to translational and molecular analyses, to all phases of clinical trials. This discussion will examine gynecologic oncology services in the DOD inclusive of infrastructure, personnel and training, clinical care and outcomes, as well as research contributions.