Search

The Korean Society of Gynecologic Oncology (KSGO) had been making an effort to standardize and enhance the quality of domestic uterine corpus cancer treatment by developing updated clinical practice guidelines in 2021. The KSGO revised the guidelines based on a literature search using 4 key elements: Population, Intervention, Comparison, and Outcome framework. These elements include the evaluation of the efficacy and safety of immune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patients who have failed platinum-based chemotherapy, as well as the effect of combined treatment with trastuzumab in patients with HER2/neu-positive endometrial cancer. Additionally, the guideline assessed the efficacy and safety of omitting lymph node dissection in low-risk endometrial cancer patients, investigated the effect of sentinel lymph node mapping in early-stage endometrial cancer surgery, addressed the outcome of chemoradiation therapy as a postoperative treatment in patients with advanced (stage III-IVA) endometrial cancer, and explored the impact of initial treatment with immune checkpoint inhibitors on survival in patients with advanced or recurrent endometrial cancer patients. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate long-term oncologic outcomes and prognostic factors in early-stage cervical cancer patients who underwent radical trachelectomy. Methods: We identified early-stage cervical cancer patients from eight institutions who underwent radical trachelectomy between 2004 and 2022. Excluding cases with prior neoadjuvant chemotherapy or intraoperative converted radical hysterectomy, 314 patients were included. Clinicopathological variables were retrospectively reviewed from electronic medical records. Results: The median follow-up period was 59.5 months (range, 1-199). The mean tumor size was 16.28 mm (range, 0.1-7), respectively. International Federation of Gynecology and Obstetrics stage (2018) IB1 disease was most common (42.6%). Of the patients, 8.6% underwent open surgery. Lymph node metastasis was occurred in 3.2%, and 9.6% received adjuvant treatment. The overall survival (OS) rate was 95.9%, and the disease-free survival (DFS) rate was 89.2%. A preoperative history of loop electrosurgical excision procedure or conization was an independent risk factor for recurrence (p=0.041; hazard ratio [HR]=0.446; 95% confidence interval [CI]=0.206-0.969). Depth of invasion was an independent risk factor for death (p=0.014; HR=7.336; 95% CI=1.502-35.824). Minimally invasive surgery was not a risk factor for recurrence and death. Moreover, in tumors below 2 cm with no risk factors, DFS was 92.2%, and OS was 99.3%. Among these patients, tumor size was risk factor for recurrence. (p=0.038; HR=1.109; 95% CI=1.006-1.224). Conclusion: Radical trachelectomy is feasible, but the recurrence rate, even in tumors below 2 cm with no risk factors, is high. Consideration of further adjuvant treatment strategies in these patients may be warranted, though additional studies are necessary. [ABSTRACT FROM AUTHOR]

Objective: We investigate a real-world feasibility of whether clinical trial participation impacts overall survival in women with advanced recurrent cervical cancer. Methods: This study was a retrospective study conducted at a single institution, and was conducted on patients with advanced or recurrent cervical cancer from August 2018 to November 2023. A total of 75 patients were included in three types of phase 2 trials and five phase 3 clinical trials. Survival analysis was conducted in three types of phase 3 trials that allowed comparative analysis. Results: Among the 75 patients enrolled in the clinical trial and available for analysis, 51 patients were enrolled in the phase 3 trial. Survival analysis was conducted on 37 patients in three phase 3 clinical trials in which comparative analysis was possible. In the three phase 3 trial data available for comparative analysis, there were no significant differences between the study group and the control group in age, (mean 55 vs. 48 years, p=0.125), histological classification (p=0.564), stage (p=0.286), and previous treatments (surgery: p=0.286, radiation: p=0.478, chemotherapy: p=0.513, respectively). On univariate analysis, the study group was associated with significantly improved OS from the control group (median survival 27.1 vs. 8.7 months, hazard ratio=0.347; 95% confidence interval=0.138-0.877; p=0.007). Conclusion: This study shows that patients with advanced or recurrent cervical cancer improve their survival rate when they participate in clinical trials, which is considered to be good evidence for patients to actively participate in clinical. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node (SLN) mapping has been suggested as an alternative surgical technique to full lymphadenectomy for early-stage endometrial cancer. However, the survival outcomes of SLN mapping compared with lymphadenectomy have not been established via a prospective study. Methods: A multi-center, single-blind, randomized controlled trial has been designed to determine the prognostic value of SLN mapping alone compared with conventional lymphadenectomy for patients with clinical stage I-II endometrial cancer. Eligible participants will be randomly assigned in a 1:1 ratio between the group to undergo SLN mapping using indocyanine green and the conventional lymph node dissection group. A high-risk group will undergo a 2-step SLN mapping procedure. The primary endpoint is the 3-year disease-free survival (DFS). The secondary endpoints are 3-year overall survival (OS), 5-year DFS, 5-year OS after surgery, pattern of recurrence, immediate surgical outcomes, success rate of SLN mapping, postoperative lymph-related complications, postoperative quality of life, and postoperative cost effectiveness. The role of pathologic ultrastaging of SLNs will also be assessed. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop a new prognostic classification for epithelial ovarian cancer (EOC) patients using gradient boosting (GB) and to compare the accuracy of the prognostic model with the conventional statistical method. Methods: Information of EOC patients from Samsung Medical Center (training cohort, n=1,128) was analyzed to optimize the prognostic model using GB. The performance of the final model was externally validated with patient information from Asan Medical Center (validation cohort, n=229). The area under the curve (AUC) by the GB model was compared to that of the conventional Cox proportional hazard regression analysis (CoxPHR) model. Results: In the training cohort, the AUC of the GB model for predicting second year overall survival (OS), with the highest target value, was 0.830 (95% confidence interval [CI]=0.802-0.853). In the validation cohort, the GB model also showed high AUC of 0.843 (95% CI=0.833-0.853). In comparison, the conventional CoxPHR method showed lower AUC (0.668 (95% CI=0.617-0.719) for the training cohort and 0.597 (95% CI=0.474-0.719) for the validation cohort) compared to GB. New classification according to survival probability scores of the GB model identified four distinct prognostic subgroups that showed more discriminately classified prediction than the International Federation of Gynecology and Obstetrics staging system. Conclusion: Our novel GB-guided classification accurately identified the prognostic subgroups of patients with EOC and showed higher accuracy than the conventional method. This approach would be useful for accurate estimation of individual outcomes of EOC patients. [ABSTRACT FROM AUTHOR]