Jure Knez

Improvement of Cancer Care—Analysis of ESGO Quality Indicators for the Surgical Treatment of Endometrial Cancer in Slovenian and Croatian Gynaecologic Oncology Departments

Background and Objectives: This study aims to analyze ESGO quality indicators for the surgical treatment of endometrial cancer patients at two gynecologic oncology departments in Slovenia and Croatia, providing insights for improving cancer care. Materials and Methods: We conducted a retrospective analysis of clinical data to evaluate ESGO quality indicators for surgical treatment of endometrial cancer patients from 2020 to 2022. ESGO quality indicators were calculated, and the results were discussed to formulate suggestions for enhancing cancer care. Institutional review board approval was obtained for the analysis. Results: The analysis reveals that the Slovenian Department for Gynecology and Breast Oncology in Maribor achieved compliance with 24 out of 26 quality indicators, while the Department of Obstetrics and Gynecology in Rijeka met 18 out of 26. The disparity may be partly attributed to Maribor’s status as an ESGO-accredited center in training since 2014, which facilitates more rapid updates in care practices. Conclusions: Based on our findings and epidemiological data, we recommend several actions to enhance cancer care in both countries: (a) advance initiatives for the centralization of care (2 to 3 centers in Slovenia and 5 to 6 in Croatia), (b) implement a national system for the prospective measurement of quality indicators, and (c) pursue center accreditation and gynecologist certification in subspecialty care by international societies such as ESGO, given the small size of both countries. Our results confirm that the analysis of ESGO quality indicators is a viable method for all stakeholders involved in enhancing cancer care.

Evaluation of Patient-Reported Symptoms and Functioning after Treatment for Endometrial Cancer

The overall survival of women with endometrial cancer is excellent after management. Different management strategies are associated with variable patient-reported outcomes (PROs). Evaluating PROs in the follow-up period can aid in better counseling and intervention for PRO improvement. This study aimed to evaluate the properties of the Slovenian translation of the EORTC QLQ-EN24 assessment scale. Women treated at the University Medical Centre Maribor, Slovenia, between January 2016 and December 2019 were invited to report their symptoms using the EORTC QLQ-EN24 questionnaire. Data were correlated with treatment modalities and clinical characteristics. The median age of participants in our study was 61 years old. PROs were not specific to therapy or clinical characteristics. Overall, women who more frequently reported gastrointestinal symptoms, muscular pain, or back pain also had statistically more frequently decreased levels of PROs in other assessed areas. Women who reported sexual or vaginal problems more often reported significantly poorer body images. Sexual activity within 4 weeks prior to completing the scale was reported by 39% of women. Sexual functioning assessments also showed important correlations between sexual interest, enjoyment, and activity. Individualized follow-ups addressing PROs should be offered to better address concerns and improve long-term outcomes in women with endometrial cancer.

The Role of CTNNB1 in Endometrial Cancer

Endometrial cancer (EC) is the most common gynaecologic malignancy in the developed countries. Recent evidence suggests that histopathological subtyping together with molecular subgrouping can lead to more accurate assessment of the risk profile for the patient. Clinical studies suggest the currently used molecular classification improves the risk assessment of women with endometrial cancer but does not explain the differences in recurrence profiles clearly. This could be improved by novel markers. One of such are mutations in the β-catenin (CTNNB1) gene, a frequently mutated gene in endometrial cancer. This shows mutations mostly at phosphorylation sites of the β-catenin and almost exclusively in the endometrial subgroup of no specific molecular profile. CTNNB1 mutations lead to alterations in the Wnt/β-catenin signalling pathway, involved in the carcinogenesis and progression of EC by inducing transcription of target genes, whose function is to regulate the cell cycle. Although tumours with mutations in CTNNB1 tend to have low-risk characteristics, they are related to worse outcomes with significantly increased rate of disease recurrence and lower overall survival.

Ultra-High-Risk Gestational Choriocarcinoma of the Ovary Associated with Ectopic Pregnancy

Gestational choriocarcinoma of the ovary is an exceptionally rare and highly aggressive tumor. Preoperative diagnosis of extrauterine choriocarcinoma is difficult due to nonspecific clinical presentation and its resemblance to ectopic pregnancy. Without molecular genetic analysis, it is not possible to reliably differentiate gestational from non-gestational choriocarcinoma. Here, we present a case of a 44-year-old woman who presented to our emergency department with complaints of pelvic pain, vaginal bleeding, and amenorrhea. Because of a recent history of conservatively managed ectopic pregnancy, the patient underwent emergency laparoscopy. Right-sided salpingo-oophorectomy was performed due to intraoperatively suspected ovarian ectopic pregnancy. Histopathology results revealed the diagnosis of ovarian choriocarcinoma of possible gestational origin. It was classified as FIGO stage IV and WHO ultra-high-risk, and she underwent multi-agent chemotherapy without major complications. She has remained in complete remission after a 12-month follow-up. Considering the rarity of this diagnosis, we conducted a literature review including all published cases of suspected gestational choriocarcinomas of the ovary. We conclude that due to the rarity of this entity, preoperative differentiating between ovarian ectopic pregnancy and ovarian choriocarcinoma is extremely challenging, and without molecular genetic analysis, it is not possible to identify the genetic origin of the tumor.