Obstetrics & Gynecology Science

Impact of time elapsed since diagnosis on neuropathic symptoms, sexual function, lymphedema, and overall quality of life in ovarian cancer survivors (KGOG 3068)

ObjectiveTo assess the impact of time since treatment on the quality of life (QOL), neurotoxicity, sexual function, lymphedema, and utility in ovarian cancer survivors.MethodsThis secondary analysis of a cross-sectional study examined the QOL, neurotoxicity, sexual function, lymphedema, and utility in 172 epithelial ovarian cancer survivors treated with first-line platinum-based chemotherapy without recurrence. Associations between time since treatment and overall QOL (National Comprehensive Cancer Network/functional assessment of cancer therapy ovarian symptom index-18 [NFOSI-18]), neurotoxicity (neurotoxicity subscale, version-4 [NTX-4]), sexual function (female sexual function index, 6-item Korean version [FSFI-6K]), lymphedema (gynecologic cancer lymphedema questionnaire [GCLQ]), and utility (EuroQol 5-dimension [EQ-5D]) were visualized using jittered box plots.ResultsOverall QOL (NFOSI-18) improved up to 3 years post-treatment (scores: 29.3 at 1 year, 28.6 at 2 years, and 26.6 at 3 years), followed by minor fluctuations over time. NTX-4 scores improved until 5 years (8.2, 7.7, 6.2, and 5.8), but remained above normal (score 0). Sexual function (FSFI-6K) increased until 3 years of age (4.6, 6.9, and 10.4 years), stabilizing at a level indicative of dysfunction (score <21). The lymphedema (GCLQ) scores fluctuated over time (4.9, 5.6, 3.3, 4.3, 5.2, and 3.8). Utility (EQ-5D index) improved up to 3 years (0.8250, 0.885, and 0.925), whereas the EQ-5D visual analog scale score increased gradually up to 5 years (71.5, 72, 73, 76, and 74), indicating ongoing recovery.ConclusionIn ovarian cancer survivors, QOL, symptom burden, and utility gradually improved over time post-treatment but did not fully return to pre-treatment levels.

Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours

Objective To assess the utility of ultrasound and color Doppler and the Accuracy of International Ovarian Tumor Analysis (IOTA) group classification in the preoperative evaluation of ovarian neoplasms to assess benign or malignant histopathology in the diagnosis of ovarian tumors.Methods This observational longitudinal prospective analysis of 60 patients was performed over a period of 2 years (2017- 2019). The mean age of the patients was 43.75 years. Ultrasonography of ovarian masses were evaluated, and cancer antigen-125 (CA-125) levels were evaluated. Based on the IOTA classification, the B and M features of adnexal masses were studied. Color Doppler imaging was performed to evaluate the patterns of vascularity and indices.Results Sixty patients with 35 benign, 23 malignant, and two borderline lesions were included in the study. In malignant lesions, 17 women (73.9%) were above the age of 45. The CA-125 cut off was ≥35 internatioal units/mL. Based on the IOTA classification, 27/35 (77.1%) benign cases, were correctly identified as benign, 6/35 (17.1%) benign cases were incorrectly identified as malignant, and two (5.7%) were found to be inconclusive. In the malignant group, 17 of the 23 patients were identified as having malignancy. Color Doppler showed three (18.8%) benign tumors had a pulsatality index (PI) of <0.8 and 21 malignant tumors had a PI of <0.8. Four benign tumors had an resistive index (RI) of <0.6 and 100% of malignant tumors had an RI <0.6.Conclusion The IOTA classification is a reliable scoring system for adnexal masses, and color Doppler can help to minimize interobserver variation.

Incidence and survival of gynecologic cancer including cervical, uterine, ovarian, vaginal, vulvar cancer and gestational trophoblastic neoplasia in Korea, 1999-2019: Korea Central Cancer Registry

Objective To investigate the incidence, trends, and survival rates of all gynecologic cancers using the Korea Central Cancer Registry (KCCR) database from 1999-2019.Methods Gynecologic cancer data were obtained from the KCCR database between 1999 and 2019. Age-standardized incidence rates (ASRs), annual percentage changes, and average annual percentage changes (AAPCs) were calculated. The relative survival rate (RSR) was reported by age group, stage, and 6-year period (I: 1999-2005, II: 2006-2012, III: 2013- 2019).Results The gynecologic cancer ASRs were 26.2 and 24.9 per 100,000 individuals in 1999 and 2019, respectively. Trends of incidence in gynecologic cancer revealed a decrease in cervical cancer and gestational trophoblastic neoplasia (GTN) with AAPCs of -3.4 and -4.3, respectively. Conversely, the incidence of uterine, ovarian, and vulvar cancers increased with AAPCs of 4.7, 2.3, and 2.1, respectively. AAPC for vaginal cancer showed no change. The 5-year survival rate was highest for GTN (90.5%) and lowest for vaginal cancer (56.6%). An increase in age was correlated with poorer survival rates across all gynecologic cancers, excluding vaginal cancer. For all gynecologic cancer types, the prognosis deteriorates with advancing cancer stages. The RSR of uterine cancer improved consistently across all periods. The ovarian cancer RSR improved more in period III than in periods I or II. Additionally, the vulvar cancer RSR improved more in periods II and III than in period I.Conclusion In Korea, the incidence of cervical cancer and GTN decreased, whereas the incidence of uterine, ovarian, and vulvar cancer increased from 1999 to 2019. The RSR for uterine, ovarian, and vulvar cancers showed consistent improvements over different periods. Effective screening programs and the adoption of advanced treatments may be necessary to further reduce the burden of gynecologic cancer.