Annals of Medicine

Clinical value of preoperative serum calcium level in predicting deep infiltrative endometriosis among ovarian endometrioma

To evaluate preoperative serum calcium levels and their association with deep infiltrating endometriosis (DIE) in ovarian endometrioma. A retrospective, observational cohort study. A total of 2,557 women who underwent surgery for benign ovarian tumors were initially enrolled. Of these, 987 were pathologically confirmed to have endometriosis, while the remaining 1570 did not. Endometriosis (EM) group had significantly lower albumin-adjusted calcium levels than the non-EMs group ( Albumin-adjusted calcium level was lower in patients diagnosed with EM compared to those with other benign ovarian tumors. The combined use of albumin-adjusted calcium and CA125 may potentially offer enhanced diagnostic utility for EM, though further validation is required. Moreover, a lower serum level of albumin-adjusted calcium was associated with the presence of DIE among EM patients.

Research progress of ferroptosis in cervical cancer treatment

Clinical and nutritional-inflammatory biomarkers-based nomogram predicts survival in recurrent or metastatic cervical cancer treated with immune checkpoint inhibitors

Immunotherapy offers potential benefits for recurrent or metastatic cervical cancer (R/M CC), yet personalized predictive tools are essential for optimizing treatment. This study aims to develop a nomogram integrating nutritional-inflammatory biomarkers and clinical features to predict survival in R/M CC patients undergoing immune checkpoint inhibitor (ICI) therapy. We retrospectively analyzed 98 R/M CC patients treated with ICIs. Overall survival (OS) was the primary endpoint. Demographic characteristics and peripheral blood biomarkers before and after ICI treatment were collected. Univariate analysis screened potential variables, followed by LASSO regression to select key biomarkers and compute the Risk-Score. Prediction models combining clinical features and the Risk-Score were evaluated using ROC curves and decision curve analysis (DCA). The optimal nomogram model was developed and validated with ROC curves, calibration plots, and DCA. Three models were established: (i) a clinical model based on age and squamous cell carcinoma antigen (SCC-Ag), (ii) a Risk-Score model, and (iii) a combined model integrating age, SCC-Ag, and Risk-Score.  The combined model showed superior predictive performance. A nomogram incorporating age, stage, SCC-Ag, and Risk-Score predicted 6-month, 1-year, and 2-year survival probability, with respective AUC values of 0.892, 0.868, and 0.846. Calibration curves and DCA affirmed high predictive accuracy and clinical utility. The nomogram integrating nutritional-inflammatory biomarkers and clinical parameters may serve as a promising tool for predicting survival in R/M CC patients undergoing ICI therapyand may help guide individualized treatment strategies following further validation.

Examined lymph node counts affected the staging and survival in cervical cancer: a retrospective study using the SEER and Chinese cohort

The impact of examined lymph node (LN) count on survival in cervical cancer remains understudied, with no consensus on the optimal number required. We aimed to investigate the role of LN count in postoperative pathological evaluation for cervical cancer patients undergoing surgery. Data from the US SEER database and a retrospective Chinese cohort were analyzed. Multivariable logistic and Cox regression models assessed LN positivity detection and overall survival (OS), respectively. Smoothing spline curves and Chow tests identified structural change points in hazard ratios and LN-positive ratios. Among 14,133 SEER and 2,811 Chinese cases, higher LN counts correlated with increased detection of positive LNs (OR: 1.040, 95% CI: 1.019-1.062) and improved OS (HR: 0.990, 95% CI: 0.984-0.996). Structural change points occurred at 20 LNs for LN-negative patients and 13 LNs for LN-positive patients (both P < 0.001). An elevated LN-positive ratio (positive/examined LNs) strongly predicted worse OS (HR: 4.208; 95% CI: 1.454-12.181). An increased number of examined LNs significantly contributes to the detection of positive LNs and improved patient survival. For patients with claimed LN-negative and LN-positive disease, a minimum examination of 20 and 13 LNs, respectively, is recommended to ensure adequate LN evaluation. The LN positive ratio is a strong prognostic indicator in patients with LN-positive disease.

Comparison of two platinum-containing chemotherapy regimens in the treatment of advanced cervical cancer with concurrent chemoradiotherapy

The present study aims to compare the efficacy and side effects of a platinum-containing combination regimen and platinum single-drug concurrent chemoradiotherapy (CCRT) in patients with advanced cervical cancer (CC) and to understand the prognostic factors in patients with CC. A total of 108 cases of CC treated in Wenzhou Central Hospital were retrospectively selected. Patients in the monotherapy (single-drug) group received external pelvic radiotherapy (RT) and platinum-based single-drug chemotherapy (CT). Patients in the combined group received external pelvic RT and platinum-containing CT. The efficacy, CCRT time, 3-year survival rate after treatment and side effects were compared between the two groups, and the prognostic factors were analysed. The total effective rate was 74.07% in the monotherapy group and 72.22% in the combined group ( The efficacy of the two regimens in the treatment of advanced CC was similar. However, the side effects increased significantly during combined treatment. A higher patient age, having an AC and stage of IIIa and a high SCC-Ag value before treatment resulted in a relatively low survival rate.

Perception about benefits and risks related to combined hormonal contraceptives use in women with Lynch syndrome

Lynch syndrome (LS) is a hereditary condition associated with an increased risk of colorectal and endometrial cancer. This study aimed to assess the knowledge, attitudes, and beliefs of women with LS regarding combined hormonal contraceptive (CHC) use compared to a control group of healthy women. Pre-menopausal women with LS ( Women with LS were less likely to use CHCs compared to the control group ( This study highlights contrasting perceptions of CHCs and their implications in oncology between women with LS and healthy women. Tailored counselling and support strategies are crucial for empowering women with LS to make informed decisions about their gynaecologic health.

Effect of neoadjuvant chemotherapy on the immune microenvironment of gynaecological tumours

Genomic profiling of ovarian clear cell carcinoma in Chinese patients reveals potential prognostic biomarkers for survival

Ovarian clear cell carcinoma (OCCC) has distinct clinical and molecular features and heterogeneous prognosis. Insights into the somatic genomic abnormalities of OCCC provide the basis for deeper understanding and potential therapeutic avenues. Herein, we performed extensive genomic profiling in Chinese patients to illustrate the mutation landscape and genetic prognostic biomarkers of OCCC. We used targeted DNA sequencing on 61 OCCC cases with a panel of 520 cancer-related genes. Correlations between clinicopathological features and survival were evaluated. Nomogram-based models were constructed to predict progress-free survival (PFS). We detected 763 somatic mutations spanning 286 genes. The most frequent genetic alterations, ARID1A (49%) and PIK3CA (48%), were concurrently mutated. Comprehensive copy number alterations (CNAs) were identified in chromosomes 20q13.2 and 8q. Most (73.7%) patients harboured potentially targetable driver mutations. The mean and median tumour mutational burden were 7.0 and 3.0 mutations/Mb, respectively. Microsatellite instability (high) was identified in 8.2% of patients. Mutation of the base-excision repair pathway was significantly higher in patients of stage II/III/IV. ATM mutation was associated with platinum sensitivity ( We described somatic genomic alterations in Chinese OCCC patients and observed different genomic alterations between stage I and stage II/III/IV tumours. Genetic factors may supplement clinical factors in nomogram modelling for PFS prediction.Key MessagesWe performed extensive genomic profiling in a well-annotated cohort of 61 Chinese ovarian clear cell carcinoma (OCCC) patients.PIK3CA mutations were associated with worse overall survival (OS) in stage I OCCC, and SWI/SNF gene mutations were associated with improved OS in stage II/III/IV disease.We propose an easy-to-use nomogram using clinical factors (tumour stage and residual disease) and genetic alterations (SWI/SNF complex mutations, ATM mutations and chr8q CNAs) to predict the progress-free survival (PFS) of OCCC.

Effect of bladder filling status on positioning errors in post-hysterectomy cervical cancer radiotherapy

Comprehensive clinical analysis of gastric-type endocervical adenocarcinoma: a real-world multicenter study

Gastric-type endocervical adenocarcinoma (G-EAC) is a rare malignancy, and its clinicopathological characteristics remain poorly defined. This study aimed to evaluate the real-world features, treatment patterns, and outcomes of patients with G-EAC. Clinical data from 124 patients diagnosed with G-EAC between 2012 and 2024 across four tertiary hospitals in China were retrospectively analyzed. Clinicopathological features, therapeutic approaches, and survival outcomes were assessed. Overall survival (OS) was the primary endpoint. Kaplan-Meier and Cox regression analyses were performed to identify prognostic factors. The median diagnostic age was 55 years (range, 33-82). At presentation, 62.1% of patients had invasion or metastasis, most commonly lymphovascular (47.6%). Surgery was performed in 81.5% of cases, and 84.7% received chemotherapy, primarily platinum-based (81.5%). Radiotherapy was administered to 69.4%. The 1-, 3-, and 5-year OS rates were 78.6%, 54.8%, and 46.1%, respectively. Older age (≥65 years; HR, 4.71; 95% CI, 1.52-14.58; G-EAC exhibits aggressive behavior and unfavorable prognosis, with a 5-year OS of 46.1%. Multimodal treatment, particularly surgery combined with chemotherapy, remains the cornerstone of management and may improve survival. Prospective multicenter studies are warranted to further define optimal therapeutic strategies for this rare entity.

Diagnosis, treatment and clinical outcomes of extrauterine sites of leiomyomatosis: a systematic review

This review aims to provide a comprehensive description of the clinical presentation, treatment, and histopathological features of extrauterine sites of leiomyomatosis (ESL), such as disseminated peritoneal leiomyomatosis (DPL), parasitic myoma (PM), benign metastatic leiomyoma (BML), and intravascular leiomyoma (IVL). The impact of previous surgery (hysterectomy or myomectomy) on development of intra-abdominal extrauterine leiomyomas (IAELs) and extra-abdominal extrauterine leiomyomas (EAELs) has been evaluated. According to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science databases. Relevant articles were retrieved in full-text format and screened based on predefined inclusion and exclusion criteria. 358 studies (372 cases) are included. Among IAELs, the most common symptom is abdominopelvic pain (63.9% of DPL, and 69.2% of PMs cases, respectively). In contrast, EAELs exhibit heterogeneous clinical presentations; dyspnea is the most common symptom (29.7% of BML, and 29.9% of IVL cases, respectively). 68.8% of DPL, 60% of PM, 89.7% of BML, and 56.4% of IVL patients underwent previous uterine surgery. A significant association ( DPL, PM, BML, and IVL exhibit overlapping characteristics, requiring a multimodal approach that includes imaging, histopathology, and surgical or medical management. Greater awareness among clinicians is needed regarding surgical procedures involving ligation and/or cutting of major uterine vessels, which appear to contribute to the development of EAELs, and morcellation, which tends to promote intraperitoneal metastatic spread.

Factors affecting cervical cancer screening and human papilloma virus vaccination among Middle Eastern refugee women in Türkiye: indicators for social workers and nurses

This study aimed to generate knowledge regarding factors affecting cervical cancer screening and human papillomavirus vaccination that can be used practically by social workers and nurses while working with Middle Eastern refugee women living in Türkiye. This study involved the administration of a self-reported questionnaire to 227 female migrants. It identified sociodemographic variables, such as age, marital status, and education level, that influenced the participation of these women in preventive practices against cervical cancer. Despite their cultural beliefs, financial constraints, and language hurdles, the findings indicated that the likelihood of involvement in screening and vaccination for cervical cancer was greater among refugee women if they were well-informed and assisted. The results of this study suggest the necessity for specific training programs and improved initiatives for healthcare access to prevent cervical cancer among vulnerable groups. Healthcare providers can support preventive measures more effectively if these concerns are addressed with consideration of the sociocultural elements and language issues among Middle Eastern refugee women. Although some limitations associated with self-reported data collection methods may have introduced response bias, this study showed how social workers and nurses can act as facilitators to prevent cervical cancer.

Emerging trends in cervical cancer incidence among younger Taiwanese generations: an urban–rural comparison

Despite global declines in cervical cancer incidence, certain regions observe unexpected rising trends among younger generations. This study uses the age-period-cohort model to examine long-term incidence trends of invasive cervical cancer in Taiwan. Data were sourced from the Taiwan Cancer Registry. From 2000 to 2019, both urban and rural areas of Taiwan saw a marked decrease in incidence rates, a trend largely attributed to the cytology-based screening program introduced in 1995. Yet, rising incidence rates emerged in younger Taiwanese generations, specifically those born post-1975 in urban and post-1980 in rural settings. The 1990-born urban cohort faced a risk 1.9 times higher than their 1975-born counterparts, while the risk for the 1990-born rural cohort was 1.4 times greater than those born in 1980. In addition, post-1980 urban cohorts exhibited greater risks than their rural counterparts. The rising trends in cervical cancer incidence among younger Taiwanese generations may be influenced by factors such as increased sexual permissiveness and urbanization. Although current prevention efforts, such as human papillomavirus vaccination, are noteworthy, there is a need for ongoing surveillance and improved strategies that specifically target recent cohorts.

Prognostic factors for pure ovarian immature teratoma and the role of adjuvant chemotherapy in stage I diseases

The prognostic factors for patients with pure ovarian immature teratoma (POIT) and the role of adjuvant chemotherapy in stage IA G2-G3 and IB-IC POIT remains controversial. We conducted a retrospective study of 155 POIT patients treated in our hospital between 2000 and 2022. The recurrence-free survival (RFS), disease-specific survival (DSS), and potential prognostic factors of POIT patients were evaluated. Subgroup analysis was conducted in stage I other than stage IA G1 POIT. The median age at diagnosis was 23.0 years (range: 4.0 - 39.0), and 126 (81.3%), 2 (1.3%), 26 (16.8%), and 1 (0.6%) patients had FIGO stage I, stage II, stage III, and stage IV disease, respectively. Twenty-three patients relapsed and five died of the diseases after a median follow-up of 7.6 years, with a 5-year RFS and DSS rate of 86.0% and 97.0%, respectively. Multivariate analysis showed that positive postoperative tumour markers (TM) were the risk factor for recurrence in the overall cohort (hazard ratio [HR] 4.058, 95% CI 1.175 - 14.019, Positive postoperative TM and FIGO stage II-IV were the prognostic factors for POIT. Active surveillance in stage I POIT of any grade may be practical for those with negative postoperative TM.

TCGA molecular subtypes in endometriosis-associated ovarian cancer: a systematic review and meta-analysis

Endometriosis-associated ovarian cancer (EAOC) mainly includes endometrioid ovarian cancer (ENOC) and clear cell ovarian cancer (CCOC). The Cancer Genome Atlas (TCGA) revealed four molecular subtypes of endometrial cancer (EC) in 2013, which have been proven pivotal in the diagnostic, prognostic and therapeutic domains of EC. Existing evidence indicates that EC and EAOC molecular analysis have similar significance. This review aims to investigate the distribution, staging and prognostic characteristics of molecular subtypes in EAOC. PubMed, Embase and Web of Science were systematically searched from January 2013 to December 2023 using predefined keywords. Patient characteristics, including stage and prognostic characteristics, were extracted from the selected studies. Data analysis was carried out using Stata 14MP. A total of 6 studies involving 1,133 patients with ENOC and 4 studies comprising 377 patients with CCOC were included. ENOC had a higher frequency of the POLE mutation (POLEmut) subtype (odds ratio (OR) = 2.29, 95% CI: 1.03-5.11, The TCGA subtypes of EC may exhibit similarities in prognosis between ENOC and CCOC.

Gynecological surgery using the Kangduo robotic system

Robotic surgery represents a notable advancement in the field of minimally invasive gynecological surgery. Although the Kangduo Robot® SR1000 (KD-SR-01) surgical system has shown improved stability and high efficiency, studies describing its use for gynecological surgery are limited. We aimed to review the safety and effectiveness of the KD-SR-01 system in gynecologic surgery and compare it with conventional laparoscopic operation. We compared patient characteristics and short-term outcomes in cases of gynecological surgery conducted using the KD-SR-01 system and laparoscopic minimally invasive procedures between March 2024 and October 2024. The short-term clinical efficacies of both surgical modalities were compared by performing statistical analyses. The KD-SR-01 system was used for total hysterectomy due to benign uterine tumors in 144 cases, ovarian cyst removal surgery due to benign ovarian tumors in 25 cases, unilateral adnexectomy due to benign ovarian tumors or borderline tumors in 25 cases, staging of early endometrial cancer in 24 cases, and radical cervical cancer resection for early cervical cancer in 24 cases. None of the patients showed serious complications (Clavien-Dindo grade ≥ 3). In comparison with traditional laparoscopic surgery, Kangduo robotic surgery resulted in a lower duration of hospitalization, operation time, blood loss, and drainage volume, but the two surgical modalities showed no differences in the complication rate. The Kangduo robotic system was safe and feasible for gynecological surgery. Evidence from additional studies and more surgical experience are required to determine the long-term outcomes and indications for gynecological surgery using this robotic system.

Advances in the application of assisted reproductive technology in fertility preservation for female patients with malignant tumours of the reproductive systems

Rising female reproductive system malignant tumours and gonadotoxic treatments increase infertility risks in reproductive-age women, many of whom lack sufficient fertility preservation (FP) information. To review advances, status, challenges and ethical/legal aspects of assisted reproductive technology (ART) for FP in these patients. This narrative review synthesized literature from PubMed, Embase, Web of Science and Cochrane Library (keywords included ART, FP, reproductive system malignancies; literature deadline: January 2022), incorporating original studies, reviews, meta-analyses and guidelines from ASRM, ESHRE, ASCO. ART has advanced significantly in FP but faces gaps in protocol standardization, accessibility, clinical translation and psychosocial impacts, due to tumour/treatment heterogeneity and psychological factors. Multidisciplinary collaboration, provider training and evidence-based guidelines are needed; future research should focus on ovarian tissue transplantation safety, low-cost technologies, clinical translation of novel approaches, global protocols and ethical frameworks. ART facilitates FP, but standardized guidelines, multidisciplinary collaboration and long-term outcome research are essential to optimize care and patient autonomy.

Patient acceptance of HPV self-sampling approach for cervical cancer screening: evidence from a pilot study in Kazakhstan

Cervical cancer remains a major global health burden, particularly in low- and middle-income countries. In Kazakhstan, cervical cancer incidence is rising, despite an established cytology-based screening program. Self-sampling for human papillomavirus (HPV) genotyping is suggested as a promising strategy to improve screening participation, yet it has not been evaluated in Kazakhstan. Thus, this study aims to perform a preliminary assessment of self-sampling approach acceptance among Kazakhstani women. A cross-sectional study was conducted among women attending outpatient clinics in large cities in Kazakhstan between August 2024 and June 2025. Participants used both the Evalyn Brush and BGI Sentis self-sampling kits and completed structured questionnaires assessing knowledge, perceptions, ease of use, discomfort, confidence and willingness to recommend. Descriptive and bivariate statistics were performed to evaluate associations with acceptance and usability. A total of 124 women were included in this pilot study, with a median age of 34.5 years (IQR: 27.5-44.0). Only 28.2% of respondents preferred self-sampling for their next screening, whereas 62.1% preferred gynaecologist-collected samples. The Evalyn Brush demonstrated higher ease of use (93.5%) compared to the BGI kit (45.2%). Confidence in correct self-collection was also higher for the Evalyn Brush (85.4% vs. 67.7%). Women who believed that home-based self-sampling is easier than Pap-smear were significantly more likely to prefer self-sampling for future screening ( Self-sampling is acceptable for a proportion of Kazakhstani women, with the Evalyn Brush showing greater comfort, ease and confidence, indicating that device selection is critical for successful implementation. The findings support further large-scale evaluation that will guide improvements to Kazakhstan's cervical cancer screening programme. A nationwide study is required for a more precise assessment of the self-sampling approach acceptance and the strategy's feasibility.

Gut microbiota and endometrial cancer: research progress on the pathogenesis and application

As one of the three major malignant tumors in women, the morbidity of endometrial cancer is second only to that of cervical cancer and is increasing yearly. Its etiological mechanism is not clear, and the risk factors are numerous and common and are closely related to obesity, hypertension, diabetes, etc. The gut microbiota has many strains, which play a considerable part in normal digestion and absorption in the human body and the regulation of the immune response. In the last few years, research on the gut microbiota has been unprecedentedly popular, and it has been confirmed that the gut microbiota closely correlates with the occurrence and development of all kinds of benign and malignant diseases. In this article, the effects of the gut microbiota and its metabolites on the occurrence and development of endometrial cancer is reviewed, and its application in the prevention, diagnosis and treatment of endometrial cancer is explored.

Prevalence of human papillomavirus and cervical lesions among elderly women: an unignored challenge to cervical cancer prevention

The prevalence of human papillomavirus (HPV) genotype and cervical neoplasia in women older than 64 years, who are outside the age demographic of cervical cancer screening in China, has been under-researched. This study conducts a retrospective analysis of women from a tertiary hospital in Guangzhou, with the aim to offer valuable insights for cervical cancer prevention and control in elderly women. The study incorporated 876 women, all aged 64 and above. In this age bracket, the prevalence rate of any HPV genotype was found to be 19.27%. The top six HR HPV genotypes were HPV 16, HPV 52, HPV 58, HPV 31, HPV 33, and HPV 18. The persistence rate of any HPV type over a 24-month period in this age group was as high as 33.33%. Among women over 64, around 16.47% of HPV-positive patients were diagnosed with cervical cancer. HPV 58 infection was the most substantial risk factor for histological CIN2+ (OR 3.556; 95% CI, 1.107-11.415;

The distribution of colposcopy directed ectocervical biopsy and endocervical curettage results: a retrospective study of 47,134 cases

To investigate the distribution of colposcopy directed ectocervical biopsy and endocervical curettage (ECC) results, and to identify patients who may benefit from ECC. This retrospective study analyzed the clinical data of 47,134 patients who underwent colposcopy directed ectocervical biopsy and ECC between January 2021 and December 2023. Risk factors were identified by univariate and multivariate logistic analyses. The positive rate of the final histopathological diagnosis was 37.1% (17,503/47,134), with 22.8% (10,724/47,134) for low-grade squamous intraepithelial lesion (LSIL) and 14.4% (6,779/47,134) for high-grade squamous intraepithelial lesion (HSIL) or worse lesions (≥HSIL). At final diagnosis of LSIL, HSIL, adenocarcinoma ECC is a useful procedure for detecting additional endocervical lesions, and is recommended for patients aged ≥ 45, with high-risk HPV infection, ASC-H + or AGC cytology, and TZ3, as it will help reduce the rate of missed diagnosis of cervical lesions.

Predicting BRCA mutation and stratifying targeted therapy response using multimodal learning: a multicenter study

The status of We included 1695 slides from 1417 patients with ovarian, breast, prostate, and pancreatic cancers across three independent cohorts. Using a self-attention mechanism, we constructed a multi-instance attention model (MIAM) to detect Across the four cancer types, MIAM-C outperformed the deep learning-based MIAM in identifying the The MIAM-C model accurately detected

Neuroendocrine carcinoma of the cervix: the value of postoperative radiation in early-stage disease

The current treatment for early-stage neuroendocrine carcinoma of the cervix (NECC) mainly relies on operation and chemotherapy. We want to evaluate values of postoperative radiation in early-stage NECC. Retrospective cohort study. Early-stage NECC patients from 2006 to 2022 in our hospital were included and divided into Postoperative non-radiation group (Group A) and Postoperative radiation group (Group B). We use Kaplan-Meier method to analyze the progression-free survival (PFS), overall survival (OS), recurrence and OS rate. Sixty-six cases were included, 32 (48.5%) in Group A and 34 (51.5%) in Group B. After 35 (range 12-116) months follow-up, 26 (39.4%) had recurrence. Compared with Group A, Group B had lower pelvic recurrence rate (12.5% vs 2.9%, Retrospective study and relative small sample size. Postoperative radiation seems to prolong PFS and OS in patients with cervical stromal invasion ≥1/2. LVSI was a high-risk factor for tumour recurrence, but radiation after surgery in patients with LVSI seems have no survival benefits.

Risk-based triage strategy by extended HPV genotyping for women with ASC-US cytology

We attempted to evaluate the immediate high-grade squamous intraepithelial lesion-cervical intraepithelial neoplasia grade 2/3 or worse (HSIL-CIN2+/3+, hereafter referred to as CIN2+/3+) risk of specific human papillomavirus (HPV) genotype and form the precise risk-based triage strategy for atypical squamous cells of undetermined significance (ASC-US) women. The clinical data of ASC-US women who underwent HPV genotyping testing and colposcopy were retrospectively reviewed. The distribution and CIN2+/3+ risks of specific HPV genotype were assessed by three approaches. The risk-based triage strategy was further established, and its efficacy in detecting CIN2+/3+ was estimated. Totally, 5553 ASC-US women including 3648 HPV-positive and 1905 HPV-negative were analysed. CIN2+/3+ were 662/319 cases, including 639/306 HPV-positive and 23/13 HPV-negative women. HPV16, HPV52, HPV58 and HPV18 were always among the top 5 ranking genotypes, no matter in HPV-positive women or in HPV-positive CIN2+/3+ cases. HPV16 and HPV33 carried the highest risk, while HPV73 and 26 carried the least risk for CIN2+/3+. Based on the immediate CIN2+/3+ risk of specific HPV genotype, 18 HPVs were divided into three risk-stratified groups. Only women infected with HPVs included in group A were necessary for immediate colposcopy. Compared with conventional strategy, this new risk-based strategy not only had higher specificity (CIN2+: A new triage strategy for ASC-US women was successfully constructed based on CIN2+/3+ risks of 14 high-risk and 4 intermediate-risk HPVs, which could significantly reduce unnecessary colposcopies.

circDENND4C, a novel serum marker for epithelial ovarian cancer, acts as a tumor suppressor by downregulating miR-200b/c

To explore the diagnostic value of circ-DENN domain containing 4 C (circDENND4C) in epithelial ovarian cancer (EOC) and the corresponding mechanism. We determined the expression of circDENND4C and miR-200b/c in tissues and serum specimens as well as EOC cell lines using qRT-PCR. Basic clinical data, and serum HE4 and CAl25 levels were acquired from patients' clinical records. Expression-related correlations and the diagnostic value of serum circDENND4C in EOC were also estimated. CCK-8 and flow cytometry were performed to detect the effect of circDENND4C on cell proliferation and apoptosis. circDENND4C level was lowest while miR-200b/c was highest in EOC tissues, followed by benign and normal tissues. Similarly, serum circDENND4C was lowest while miR-200b/c was highest in EOC patients. Moreover, serum circDENND4C was lower in patients with benign ovarian tumors than in healthy women, while miR-200b/c expression was higher. circDENND4C was negatively associated with miR-200b/c in EOC tissues and serum specimens, and serum circDENND4C was also negatively correlated with serum HE4 and CAl25 in EOC patients. circDENND4C expression in both tissue and serum was negatively related to FIGO and TNM stage, and tumor size in EOC. Serum circDENND4C could distinguish healthy persons from patients with benign ovarian tumors and EOC, and they showed a higher specificity and accuracy than serum CA125 or HE4 in EOC diagnosis. circDENND4C upregulation significantly suppressed EOC cell proliferation and facilitated apoptosis by downregulating miR-200b/c Summarily, circDENND4C acts as a tumor inhibitor by downregulating miR-200b/c in EOC and could be a possible tumor marker for EOC diagnosis.KEY MESSAGEScircDENND4C expression was lowest while miR-200b/c was highest in EOC tissues or serums, followed by benign and normal tissues or serums.circDENND4C was involved in malignant progression of EOC, concretely, overexpression of circDENND4C suppressed EOC cell proliferation and stimulated apoptosis via downregulating miR-200b/c, and circDENND4C expression in both tissue and serum was closely related to FIGO and TNM stages and tumor size in EOC.Serum circDENND4C showed a higher specificity and accuracy than serum CA125 or HE4 in EOC diagnosis.HIGHLIGHTScircDENND4C expression was lowest while miR-200b/c was highest in EOC tissues, followed by benign and normal tissues.Serum circDENND4C was lowest while miR-200b/c was highest in EOC patients, followed by benign patients and healthy women.Overexpression of circDENND4C suppresses EOC cell proliferation and stimulates apoptosis via downregulating miR-200b/c.circDENND4C expression in both tissue and serum was closely related to FIGO and TNM stage and tumor size in EOC.Serum circDENND4C showed a higher specificity and accuracy than serum CA125 or HE4 in EOC diagnosis.

Prevalence of precancerous gynecological lesions and gynecological cancer in patients undergoing vaginal hysterectomy for pelvic organ prolapse

This retrospective cohort study aimed to determine the prevalence of precancerous or malignant lesions of the cervix and/or endometrium among patients who underwent vaginal hysterectomy. Medical record of patients who had been diagnosed with pelvic organ prolapse (POP) and undergone vaginal hysterectomy from January 2009 to September 2018 in tertiary hospital was reviewed. The exclusion criteria included individuals who had previously received a diagnosis of gynecologic precancerous lesions or cancer, had abnormal preoperative findings, presented abnormal cervical cancer screening test results or abnormal results from preoperative endometrial biopsy, and had incomplete operative notes or pathological results. The electronic medical records of 530 patients were reviewed and included in the analysis. Nine of the 530 patients (1.7%) had precancerous or malignant lesions of the cervix and/or endometrium. The prevalence of atypical endometrial hyperplasia and endometrial carcinoma were 0.19% and 0.57%, respectively. All of the patients with endometrial cancer subsequently underwent complete surgical staging. Precancerous cervical lesions were found in five patients (0.95%): CIN II 0.38% and CIN III 0.57%. No cases of cervical cancer were identified. It is possible to detect a minor prevalence of precancerous and malignant lesions following post-operative procedures in POP. The assessment of the elderly through the use of risk-based evaluation merits attention for the purpose of early identification. This study offers valuable insights that can be utilized in preoperative counseling and enhancing the preoperative evaluation process.

Diagnostic performance of PAX1 methylation as a biomarker for cervical lesions: a clinical study and meta-analysis

To evaluate the diagnostic performance of PAX1 gene methylation in the detection of cervical lesions and assess its potential clinical application in cervical cancer screening through both a single-centre study and a meta-analysis. A retrospective analysis was conducted on 329 patients who underwent concurrent ThinPrep cytologic test (TCT), high-risk HPV testing and PAX1 methylation analysis at the Affiliated Hospital of Jining Medical University. The diagnostic accuracy of PAX1 methylation for detecting high-grade squamous intraepithelial lesions (HSIL) and cervical squamous cell carcinoma (CSCC) was assessed. Additionally, we performed a systematic review and meta-analysis, which included seven eligible studies from Asian populations. Pooled diagnostic metrics were calculated using a bivariate mixed-effects model. Heterogeneity and publication bias were evaluated using Cochran's Q test, I PAX1 methylation values declined with increasing severity of cervical lesions. In clinical samples, the sensitivity and specificity for detecting CSCC were 81.3% and 94.2%, respectively. Meta-analysis yielded a pooled sensitivity of 0.87 (95% CI: 0.79-0.92), specificity of 0.75 (95% CI: 0.52-0.89) and an area under the curve (AUC) of 0.89. The diagnostic odds ratio was 20, indicating strong discriminatory performance. PAX1 methylation demonstrates high diagnostic accuracy for cervical cancer and is a promising noninvasive biomarker for screening and triage. Further studies are needed to validate its clinical utility in diverse populations and to explore its potential role in monitoring lesion progression or regression, particularly in women managed with conservative approaches.

The expression and clinical significance of serum exosomal-long non-coding RNA DLEU1 in patients with cervical cancer

Accumulating evidence has demonstrated that the long non-coding RNA (lncRNA) lymphocytic leukaemia deletion gene 1 (DLEU1) is abnormally overexpressed in many cancer types, including cervical cancer (CC). However, the potential clinical significance of DLEU1 in serum exosomes of patients with CC remains unclear. The expression of serum exosomal DLEU1 was detected by quantitative real-time polymerase chain reaction (qRT-PCR). A receiver operating characteristic (ROC) curve was plotted to evaluate the clinical diagnostic efficacy of DLEU1. The Kaplan-Meier survival curve and Cox proportional hazards model were used to assess the effect of DLEU1 on postoperative recurrence, metastasis and prognosis among patients with CC. Our research showed that DLEU1 expression in the serum exosomes of patients with CC was significantly upregulated compared to that in patients with cervical intraepithelial neoplasia (CIN) and healthy controls (HCs) (both Our findings suggest that serum exosome DLEU1 has certain clinical value for diagnosing, monitoring recurrence and metastasis, and evaluating CC prognosis.

Prognostic and clinicopathological effect of the prognostic nutritional index (PNI) in patients with cervical cancer: a meta-analysis

Numerous studies have explored whether the prognostic nutritional index (PNI) can predict the prognosis of cervical cancer (CC); however, their findings remain controversial. This meta-analysis focused on evaluating the relationship between the PNI and the prognosis of patients with CC. Relevant articles were collected from specific databases up to March 16, 2023. The relationship between the PNI and survival outcomes in patients with CC was estimated using combined hazard ratios (HRs) and associated 95% confidence intervals (CIs). The association of the PNI with clinicopathological features in patients with CC was assessed by combining odds ratios (ORs) and associated 95% CIs. Nine articles with 2508 cases were included in the meta-analysis. According to our pooled findings, a decreased PNI showed a significant association with worse overall survival (OS) (HR = 2.98, 95% CI = 2.22-3.99, In this study, a low PNI predicted dismal OS and PFS in patients with CC, who also tend to suffer from LN metastasis and larger tumor size. PNI is a promising biomarker for predicting the prognosis of patients with CC in clinical practice.

Qualitative analysis of out-of-hospital self-management capabilities and ongoing care needs in patients with gynecological malignancies and venous thromboembolism

Postoperative patients with gynecological malignant tumors are prone to venous thromboembolism (VTE) due to hypercoagulability and limited mobility, and lack of professional guidance after discharge, further increasing the risk of VTE occurrence. Therefore, this study focuses on the current status of self-management ability and continuity of care needs of patients after discharge, aiming to clarify the practical difficulties of prevention activities such as limb activity and symptom recognition in the home environment, in order to improve the implementation and compliance of VTE prevention measures for patients outside the hospital. Utilizing a phenomenological approach within qualitative research, interview outlines were developed through a comprehensive literature review and expert consultations. The interviewees were selected from 10 patients with gynecological malignant tumors who underwent chemotherapy in our department within 3 months after surgery. The interview method is semi-structured and in-depth qualitative interviews. Data were transcribed, coded, refined, and analyzed utilizing the Colaizzi phenomenological 7-step analysis method. The self-management abilities for out-of-hospital VTE prevention among patients with gynecological malignancies were categorized into five themes: inadequate VTE risk perception, low self-efficacy in VTE prevention, limited interest in VTE-related information, insufficient VTE prevention education and awareness efforts by healthcare providers, and restricted access to VTE prevention resources. Ongoing care needs were identified into two primary areas: a desire for diverse VTE prevention educational materials and support from families and relatives. Significant challenges persist in the out-of-hospital self-management and ongoing care of VTE among patients with gynecological malignancies. To address these issues, healthcare providers must develop effective strategies to enhance self-management, optimize continuous care services, and provide comprehensive information resources and social support. These interventions aim to improve patient adherence to VTE prevention measures and enhance their efficacy.

Screening differentially expressed genes between endometriosis and ovarian cancer to find new biomarkers for endometriosis

Endometriosis is one of the most common reproductive system diseases, but the mechanisms of disease progression are still unclear. Due to its high recurrence rate, searching for potential therapeutic biomarkers involved in the pathogenesis of endometriosis is an urgent issue. Due to the similarities between endometriosis and ovarian cancer, four endometriosis datasets and one ovarian cancer dataset were downloaded from Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified, followed by gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and protein-protein interaction (PPI) analyses. Then, we validated gene expression and performed survival analysis with ovarian serous cystadenocarcinoma (OV) datasets in TCGA/GTEx database, and searched for potential drugs in the Drug-Gene Interaction Database. Finally, we explored the miRNAs of key genes to find biomarkers associated with the recurrence of endometriosis. In total, 104 DEGs were identified in the endometriosis datasets, and the main enriched GO functions included cell adhesion, extracellular exosome and actin binding. Fifty DEGs were identified between endometriosis and ovarian cancer datasets including 11 consistently regulated genes, and nine DEGs with significant expression in TCGA/GTEx. Only

Molecular targeted therapy in combination with chemotherapy for the treatment of platinum-resistant/refractory ovarian cancer (PROC): a systematic review and network meta-analysis

Although single-agent chemotherapy is the most common approach for treating platinum-resistant or refractory ovarian cancer (PROC), there is growing evidence that combining molecular targeted agents with chemotherapy is beneficial, especially for certain patient groups. However, the most effective combination regimen remains elusive. This Bayesian network meta-analysis (NMA) aims to identify the best combination therapy for PROC. Relevant studies were searched in PubMed, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials from their inception until October 2024. The primary outcomes were overall survival (OS), progression-free survival (PFS) and adverse events (AEs). Statistical analyses were performed using the GEMTC package (1.0-2) and R 4.2.0. This review was registered in PROSPERO (CRD42023428414). Our analysis of 22 randomized controlled trials (RCTs) ( Bevacizumab-based combinations demonstrate consistent benefits across multiple regimens for PROC. Paclitaxel + bevacizumab emerges as the optimal balance of efficacy and safety. Topotecan + sorafenib could be an alternative for patients who are ineligible for anti-angiogenic therapy.

Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda

The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda. This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided Most participants (97%; Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.

Prevalence of high-risk human papillomavirus infection and genotype distribution among Kazakhstani women with abnormal cervical cytology

This study aimed to identify the prevalence and distribution of high-risk human papillomavirus (HR-HPV) types among Kazakhstani women with abnormal cervical cytology. A cross-sectional study was performed from May 2019 to June 2020. Cervical samples were collected from women in the different regions of Kazakhstan. A total of 316 patients' samples were analysed for HR-HPV using real-time multiplex PCR. Cervical cytology abnormalities were reported according to the Bethesda classification. HPV detection by cytology showed a statistically significant association with HPV status and the number of HPV infection types ( There is a high prevalence of HR-HPV types among Kazakhstani women with abnormal cervical cytology. The most identified types were HPV16, 18, 31, 33 and 52. There is an emergency need to implement an HPV vaccination program to prevent cervical lesion development.

Attitudes of women towards products containing hormones (hormonal contraceptives or hormone therapy): what changes from pre to postmenopause?

To evaluate the actual perceptions of hormonal contraceptives (HC) in women of reproductive age in comparison with similar concerns of postmenopausal women in relation to hormone therapy (HT). A questionnaire-based study was conducted in a population of 370 women, 198 (53.5%) premenopausal and 172 (46.5%) postmenopausal. Perceptions were evaluated using specific questions and Likert scales (-5 to +5).Multivariate regression analyses were adjusted for categories of HC/HT use (never, past and current). The most reported adverse effect associated with hormonal treatments was venous thrombosis (1.4 ± 0.1), especially for HC use in premenopausal women ( Our data suggest that our patients are primarily concerned about the effects of hormonal treatments on venous thrombosis, mood, breast cancer and cervical cancer risk, and, later in life, about their impact on weight gain, breast and ovarian cancer risk.KEY MESSAGESYoung patients are primarily concerned about the effects of hormonal treatments on venous thrombosis, mood, breast cancer and cervical cancer risk.Older patients are primarily concerned about the effects of hormonal treatments on weight gain, breast and ovarian cancer risk.The greatest oncological concern throughout life was about breast cancer.

The pattern of human papillomavirus infection and genotypes among Nigerian women from 1999 to 2019: a systematic review

There are no robust national prevalence of Human Papillomavirus (HPV) genotypes in Nigerian women despite the high burden of cervical cancer morbidity and mortality. This study aims to determine the pooled prevalence and risk factors of genital HPV infection in Nigeria through a systemic review protocol. Databases including PubMed, Scopus, Google Scholar and AJOL were searched between 10 April to 28 July 2020. HPV studies on Nigerian females and published from April 1999 to March 2019 were included. GRADE was used to assess the quality of evidence. The pooled prevalence of cervical HPV was 20.65% (95%CI: 19.7-21.7). Genotypes 31 (70.8%), 35 (69.9%) and 16 (52.9%) were the most predominant HPV in circulation. Of the six geopolitical zones in Nigeria, northeast had the highest pooled prevalence of HPV infection (48.1%), while the least was in the north-west (6.8%). After multivariate logistic regression, duration (years) of sexual exposure (OR = 3.24, 95%CI: 1.78-9.23]), history of other malignancies (OR = 1.93, 95%CI: 1.03-2.97]), history of sexually transmitted infection (OR = 2.45, 95% CI: 1.31-3.55]), coital frequency per week (OR = 5.11, 95%CI: 3.86-14.29), the status of circumcision of the sexual partner (OR = 2.71, 95%CI: 1.62-9.05), and marital status (OR = 1.72, 95%CI: 1.16-4.72), were significant risk factors of HPV infection ( HPV prevalence is high in Nigeria and was significantly associated with several associated risk factors. Rapid screening for high-risk HPV genotypes is recommended and multivalent HPV vaccines should be considered for women.

The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.