Jyoti Meena

Prognostic significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting response to neoadjuvant chemotherapy in advanced high-grade serous ovarian cancer: a prospective study

To evaluate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can predict pathological and clinical responses to neoadjuvant chemotherapy (NACT) in patients with advanced-stage high-grade serous ovarian carcinoma (HGSOC). In this prospective cohort study, 80 patients with FIGO stage III-IV HGSOC received three cycles of platinum-based neoadjuvant chemotherapy. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were measured before and after the neoadjuvant treatment. Treatment response was evaluated using RECIST 1.1, chemotherapy response score (CRS), and the Completeness of cytoreduction score (CC score). The associations between these inflammatory markers and outcomes were analyzed using appropriate statistical tests. Following neoadjuvant chemotherapy, patients who achieved a good histopathological response (CRS 3) showed significantly lower baseline and post-NACT NLR and PLR values compared to those with CRS 1-2 (p  5.5 (Sensitivity: 94.7 %, Specificity: 86.9 %), PLR > 177 (Sensitivity: 94.7 %, Specificity: 88.5 %) predicted poor histopathological response (CRS1). Pre- and post-NACT NLR and PLR may serve as valuable, non-invasive biomarkers for predicting histopathologic response to chemotherapy in advanced serous ovarian carcinoma. Incorporating these inflammatory markers into preoperative assessment may improve patient stratification and surgical planning.

Post-hysterectomy presentation of low-grade endometrial stromal sarcoma (LGESS): a clinical challenge in uterine malignancies

Endometrial stromal sarcoma (ESS) is a rare uterine malignancy originating from endometrial connective tissue. It is classified into benign and malignant subtypes. While it primarily affects perimenopausal women aged 45–55 years, younger patients may also be affected. ESS often presents with symptoms such as abnormal uterine bleeding, pelvic pain or pelvic mass, mimicking benign conditions like fibroids. Definitive treatment includes total hysterectomy with bilateral salpingo-oophorectomy, complemented by hormonal therapy for advanced cases. Despite its indolent nature, low-grade ESS (LGESS) requires long-term follow-up due to significant recurrence risk. We present a case of a woman in her late 20s, who underwent hysterectomy for severe bleeding and anaemia, with LGESS diagnosed later during a growing abdominal wall mass evaluation. Imaging and biopsy confirmed her diagnosis. She underwent extensive debulking surgery. Histological analysis revealed oval to spindle cells, low mitotic activity, no necrosis or atypical mitotic figures; Estrogen Receptor (ER), Progesterone Receptor (PR) and CD10 positivity, which were consistent with LGESS.

Patterns of care for vulvar cancer and insights from revised FIGO staging: a retrospective study

The objective of this study was to evaluate the clinicopathological characteristics and patterns of care among women diagnosed with vulvar malignancy at a tertiary care teaching institute. Additionally, the study aimed to analyse the implications of revised FIGO staging system on stage shift and patient outcomes. A retrospective observational study was conducted, wherein hospital records of biopsy-proven cases of vulvar cancers managed over a period of 10 years were comprehensively reviewed. The assignment of FIGO staging was performed utilizing both 2009 and 2021 FIGO staging systems for comparative analysis. Statistical analysis was performed using STATA version 17. Survival curves were constructed using the Kaplan-Meier method, with differences assessed using the log-rank test. Additionally, multivariable analysis was conducted using the Cox proportional hazard model. A total of 82 cases meeting the inclusion criteria were enrolled in the study. Management patterns varied widely, with the majority undergoing surgery (73.2%), followed by definitive radiotherapy with or without chemotherapy (10.9%), neoadjuvant radiotherapy and subsequent surgery (4.9%), and palliative care (10.9%). Post-operative radiotherapy was administered in 31.7% of cases. The disease-specific recurrence rate was found to be 32.9%, and the mortality rate was 30.5%. The median Disease-Free Survival (DFS) was 17 months (interquartile range [IQR]: 1-36 months), while the Overall Survival (OS) was 27 months (IQR: 9-52 months). Upon application of the 2021 staging system, a stage shift was observed in 18% of cases of advanced vulvar cancer. The 3-year DFS and OS were reduced for stage IIIA and stage IVA, while showing improvement for stage IIIB. The revised FIGO 2021 staging system offers enhanced simplicity in its application within clinical practice and demonstrates improved correlation with prognosis. Approximately 18% cases experienced restaging under the updated system. Not applicable.

Adjuvant treatment in cervical, vaginal and vulvar cancer

Primary surgical management is successful as the sole therapeutic modality in the majority of women with early-stage cervical, vaginal and vulvar cancer, but the presence of certain risk factors in the surgico-pathological specimen indicates a poorer prognosis. Adjuvant treatment can improve overall survival in such cases. Important risk factors in cervical cancer include intermediate-risk factors (large tumor size, deep cervical stromal invasion, lymph-vascular space invasion) and high-risk factors (positive or close margins, lymph nodes, or parametrial involvement). In vulvar cancer, positive margins and lymph nodes are the two most important factors for adjuvant therapy. Radiation therapy has been the mainstay of adjuvant therapy in these cancers, supplemented by chemotherapy. Recent advances have witnessed the inclusion of newer therapeutic modalities such as immunotherapy. This review addresses the current status of various adjuvant therapeutic modalities for these gynecological cancers.

Current status and challenges in training the next generation of gynecologic cancer care providers in Asia

Gynecologic oncology is undergoing rapid development with continuous advances in treatment strategies, surgical techniques, and clinical research. Training programs must keep pace by providing future specialists with the necessary surgical skills and a solid understanding of evolving practices. This study aimed to examine the current state of gynecologic oncology training in Asia and to identify key challenges and opportunities for improvement. A descriptive survey was conducted in October 2023 under the leadership of the Education Committee of the Asian Society of Gynecologic Oncology (ASGO). Key stakeholders involved in clinical training and policy-making from eight countries and regions (China, Hong Kong SAR, India, Japan, the Philippines, South Korea, Taiwan, and Thailand) responded to an online questionnaire assessing the structure and quality of their national training programs. Six of the eight countries/regions have official gynecologic oncology societies. Training duration was three years or more in five regions and two years in the remaining three. Seven reported conducting formal assessments of surgical skills. While five programs offered adequate exposure to minimally invasive surgery, three noted limitations. Satisfaction with research opportunities and overall training quality also varied. The most frequently cited concern was the lack of standardized curricula. This regional overview reveals notable differences in training approaches across Asia. Standardizing educational frameworks and expanding collaborative initiatives - such as virtual tumor boards, elective rotations, and skills-based workshops - may help address current gaps and strengthen gynecologic oncology training in the region.