OBJECTIVE:To assess the diagnostic accuracy of the Chronic Kidney Disease Epidemiology Collaboration 2021 and Janowitz equations for identifying renal dysfunction, defined using the pre-specified absolute glomerular filtration rate threshold of <60 mL/min, a treatment-relevant boundary for cisplatin eligibility assessment, using 99mTc-DTPA (Technetium-99m Diethylenetriaminepentaacetic acid) isotopic quantification as the reference standard in women with locally advanced cervical cancer. METHODS:Retrospective diagnostic accuracy study including women with International Federation of Gynecology and Obstetrics 2018 stage IB3-IVA cervical cancer evaluated at the Instituto Nacional de Cancerología in Bogotá, Colombia, between June 2018 and September 2023 and selected as candidates for primary concurrent chemoradiation. All glomerular filtration rate values were standardized to absolute mL/min before analysis. 99mTc-DTPA values reported as mL/min/1.73 m2 were de-indexed by multiplying by body surface area/1.73. Chronic Kidney Disease Epidemiology Collaboration 2021 was calculated as an indexed creatinine-based estimate and converted to absolute mL/min using the same body surface area adjustment. Janowitz estimates were analyzed as absolute mL/min. RESULTS:A total of 210 of 237 consecutively included women had complete data and were included in the analysis; 27 (12.9%) had a 99mTc-DTPA glomerular filtration rate <60 mL/min. Correlation with measured glomerular filtration rate was moderate for Chronic Kidney Disease Epidemiology Collaboration 2021 (rho = 0.53, 95% confidence interval 0.43 to 0.62) and Janowitz (rho = 0.51, 95% confidence interval, 0.41 to 0.61). Mean bias (estimated minus measured glomerular filtration rate) was 5.0 mL/min for Chronic Kidney Disease Epidemiology Collaboration 2021 and 0.2 mL/min for Janowitz, with wide limits of agreement. Chronic Kidney Disease Epidemiology Collaboration 2021 detected 12/27 cases and missed 15 (10 false positives; sensitivity 44%, 95% confidence interval 25% to 65%; specificity 95%, 95% confidence interval 90% to 97%; negative likelihood ratio 0.59). Janowitz detected 10 of 27 and missed 17 (7 false positives, sensitivity 37%, 95% confidence interval 19% to 58%; specificity 96%, 95% confidence interval 92% to 98%; negative likelihood ratio 0.65). CONCLUSION:Chronic Kidney Disease Epidemiology Collaboration 2021 and Janowitz were insufficiently sensitive to replace measured glomerular filtration rate when cisplatin eligibility depends on threshold-based glomerular filtration rate classification. These findings support measured glomerular filtration rate when accurate threshold classification would alter cisplatin eligibility; any estimate-based triage strategy requires prospective validation.
Objective The aim of this study was to assess the rate of microscopic omental metastasis in patients with clinical stage I serous, carcinosarcoma, clear cell, and undifferentiated endometrial carcinoma. Methods We retrospectively identified all cases of newly diagnosed clinical stage I serous, carcinosarcoma, clear cell, and undifferentiated endometrial carcinoma undergoing primary surgery between 1/1/2018 and 12/31/2022 at our institution. We obtained the method of omental sampling from operative reports and reviewed final pathology reports to evaluate omental and peritoneal involvement. To report findings, we used descriptive statistics. Results We identified a total of 248 cases: 145 (58.5%) serous, 71 (28.6%) carcinosarcoma, 23 (9.3%) clear cell, and 9 (3.6%) undifferentiated/dedifferentiated. All but 9 (3.6%) cases had preoperative imaging. The surgical approach was robotic-assisted laparoscopy in 184 (74.2%) cases, laparoscopy in 47 (19.0%), and open in 17 (6.9%). An omental biopsy was performed in 214 (86.3%) patients, an infracolic omentectomy in 32 (12.9%), and a total omentectomy in 2 (0.8%). Microscopic omental disease was found in 1 (0.4%) case: a carcinosarcoma that also had metastatic disease in both sentinel lymph nodes on final pathology. Peritoneal biopsies of normal-appearing peritoneum were taken in 30 (12.1%) cases, and 1 (3.3%) of these had microscopic disease for a patient with serous carcinoma who also had a positive sentinel lymph node on final pathology. One intraoperative complication was reported when performing an infracolic omentectomy robotically, and it was a thermal injury to the transverse colon, which was oversewn with multiple layers including an omental patch. Conclusion Microscopic omental disease in high-grade non-endometrioid endometrial carcinomas clinically confined to the uterus is rare and unlikely to impact treatment decisions. These data suggest that routine omental biopsies may not be necessary in this cohort of patients.
The European Society for Medical Oncology (ESMO) Gynaecological Cancers Congress 2026, held in Copenhagen, Denmark, from June 17 to 19, 2026, brought together more than 1,270 participants from over 70 countries and featured more than 40 international speakers, 171 scientific abstracts, six Proffered Papers, and ten Rapid Oral presentations. The scientific program reflected the continued evolution of gynecologic oncology, with particular emphasis on immunotherapy, antibody–drug conjugates, and biomarker-guided treatment strategies.Selected oral presentations evaluated novel antibody–drug conjugates targeting FRα, HER2, B7-H4, and nectin-4, as well as emerging immunotherapy approaches in endometrial and cervical cancers. Additional studies explored biomarkers and treatment-selection tools, including KELIM and circulating immune signatures, with the aim of refining patient selection and informing therapeutic decision-making.This meeting summary reviews the principal findings from selected oral presentations, placing them within their clinical context and discussing their potential implications for future research and the management of gynecologic malignancies.
Objective Non–high-grade epithelial cancers originating in the ovary, fallopian tube, or peritoneum are rare, and the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with these cancers is undefined. We evaluated whether HIPEC is associated with improved overall survival and, secondarily, in which histologic subgroup the association was strongest. Methods Adults with stage III–IV non–high-grade epithelial ovarian, fallopian tube, or primary peritoneal carcinoma undergoing primary or interval cytoreductive surgery in the National Cancer Database (2004–2022) were classified by HIPEC receipt. Overall survival was administratively censored at 10 years. The entire eligible cohort was analyzed with era-balanced 1:4 propensity-score matching, full-cohort inverse-probability and overlap weighting, multiple imputation, and E-values. Results Among 15,654 patients, 72 (0.5%) received HIPEC and were matched to 288 controls. In the matched cohort, 5- and 10-year overall survival were 64.5% and 48.4% with HIPEC versus 50.0% and 29.0% without. HIPEC was associated with improved 10-year overall survival across estimators (overlap-weighted HR 0.66, 95% CI 0.46–0.95, p=0.024; inverse-probability-weighted HR 0.66, 95% CI 0.47–0.95, p=0.024; matched-set HR 0.52, 95% CI 0.33–0.81, p=0.004; multiply-imputed HR 0.66, 95% CI 0.46–0.94, p=0.023), with a directionally consistent multivariable estimate (HR 0.72, 95% CI 0.49–1.04, p=0.079). In exploratory analyses, the association was strongest in the 17 HIPEC-treated patients with mucinous carcinoma (multivariable HR 0.39, 95% CI 0.17–0.88, p=0.024) and was near-null in non-mucinous histologies (HR 0.93, 95% CI 0.56–1.54); these estimates rest on small numbers. Conclusions In this national cohort, HIPEC was associated with improved 10-year overall survival after adjustment for measured confounders, although unmeasured factors such as completeness of cytoreduction and tumor burden cannot be excluded. The association was strongest among patients with mucinous carcinoma. Pending prospective, histology-specific evaluation, these data may inform individualized discussion of HIPEC with selected patients at experienced centers, with counseling that high-level evidence is lacking.
Cervical cancer is caused by persistent high-risk human papillomavirus (HR-HPV) infection and remains a major global health burden despite available preventive strategies. Most HR-HPV infections and associated low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, yet increasing commercial promotion of topical therapies targeting HPV clearance has emerged in clinical practice. This FIGO/International Gynecologic Cancer Society (IGCS) Position Statement critically appraises the available evidence on topical treatments for HR-HPV infection and LSIL, and provides evidence-based recommendations for clinical practice and future research. No randomized controlled trial has been adequately designed or powered to evaluate the effect of topical therapies on the prevention of histologically confirmed high-grade squamous intraepithelial lesions (HSIL/CIN3+). Available studies are characterized by small sample sizes, short follow-up periods, heterogeneous populations, inadequate comparators, and reliance on surrogate endpoints of uncertain clinical relevance, including cytological regression, HPV nondetection, and immunohistochemical markers such as p16/Ki-67. Published meta-analyses reporting statistically significant improvements in virological and cytological surrogates are limited by substantial heterogeneity, publication bias, and follow-up periods under 1 year. Product-specific appraisal of Coriolus versicolor-based and silicon dioxide/selenite-based vaginal gels reveal additional methodological concerns, including retrospective trial registration, industry funding, and misinterpretation of findings consistent with the spin phenomenon. In the absence of high-quality evidence demonstrating clinically meaningful benefit, FIGO and IGCS do not endorse the routine clinical use of any currently available topical agent for HR-HPV infection or LSIL. Evidence-based surveillance remains the standard of care. Future research should prioritize rigorous trial design with histologically confirmed HSIL/CIN3+ as the primary endpoint, adequate follow-up of at least 3 years, and appropriate comparators. Clinical management should center on informed shared decision-making and evidence-based counseling, rather than on interventions lacking proven clinical benefit.
Human papillomavirus is the most common sexually transmitted infection and the necessary cause of cervical cancer, as well as a proportion of other anogenital and oropharyngeal cancers. Although most infections clear spontaneously, persistent oncogenic human papillomavirus infection may lead to precancer and cancer. There is therefore a need for effective and globally accessible therapies that either promote sustained clearance of human papillomavirus infection or safely treat human papillomavirus-related lesions, particularly in settings where ablative or excisional procedures are not readily available. However, no therapy has demonstrated proven and durable efficacy in eradicating human papillomavirus infection itself, although some non-ablative interventions have shown efficacy in treating specific human papillomavirus-related lesions.We conducted a narrative review of currently available and emerging interventions promoted for the treatment of human papillomavirus infection or human papillomavirus-related lesions, including approved topical agents, oral formulations, immunotherapies, therapeutic vaccines, molecular inhibitors, and widely marketed commercial products. Evidence was synthesized from clinical trials, systematic reviews, clinical guidelines, health technology assessments, and policy recommendations, and assessed using a structured evidence-evaluation framework. Some agents, including immune modulators and sinecatechins, are approved for external anogenital warts but do not reliably eliminate underlying human papillomavirus infection. Selected topical therapies, particularly 5-fluorouracil, have demonstrated efficacy in randomized trials for regression of cervical intraepithelial neoplasia in specific clinical contexts, but do not represent validated antiviral eradication therapies. Photodynamic therapy, intralesional immunotherapy, therapeutic vaccines, and molecular inhibitors remain investigational, with insufficient evidence for routine clinical use. Probiotics, nutritional supplements, vaginal gels, and other commercially promoted products also lack robust evidence. In the absence of proven therapies that eradicate human papillomavirus infection, current management relies on surveillance, evidence-based treatment of precancerous lesions, vaccination, and screening. The proposed framework may support professional societies in evaluating emerging interventions and providing clear, evidence-based guidance to health care professionals, policymakers, patients, and the public.
Objective Adult-type granulosa cell tumors account for 5% of ovarian malignancies. Several issues on management remain controversial due to limited evidence. The aim of this project was to assess the feasibility of pooling existing retrospective data within the European Network of Gynecological Oncological Trial Groups (ENGOT) and analyse prognostic factors. Methods This retrospective study included patients diagnosed with adult-type granulosa cell tumors, registered within Groupe d'Investigateurs Nationaux pour l'Étude des Cancers de l'Ovaire et du sein (GINECO) / Tumeurs malignes rares gynecologiques (TMRG) and Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO), after anonymized data pooling. Peritoneal staging was considered done if peritoneal biopsies, omentectomy or peritonectomy were performed. Conservative surgery comprised cystectomy or unilateral salpingo-oophorectomy. Clinicopathological variables were evaluated for association with relapse and death. Survival curves were calculated using Kaplan-Meier method and compared with log-rank test. Results Overall, 585 patients with median age 51 (range 18-90) were included; 336 (57.4%) and 249 (42.6%) were treated within GINECO/TMRG and MITO, respectively. 220 patients (37.6%) received surgery within a reference centre. 528 patients (90.3%) had stage I disease. Surgery was laparoscopic for 229 patients (39.1%) and conservative for 255 (43.6%). Peritoneal staging was done in 345 cases (59%); 5-year disease-free survival and overall survival were 78% and 98%, respectively. At multivariable analysis early stage, optimal cytoreduction, non-fertility sparing surgery and management in a reference centre were independent prognostic factors for disease-free survival, early stage for overall survival. Surgical approach, peritoneal staging and adjuvant chemotherapy were not associated with survival in stage I disease. Conclusions Anonymized data pooling from existing registries was feasible. Reference centre, stage, non-fertility sparing surgery and residual tumor were prognostic factors for disease-free survival, early stage for overall survival only. This experience paves the way for further investigations within the ENGOT network.
Objective This study aimed to develop and internally validate a preoperative biochemical model for stratifying sarcoma risk and supporting clinical decision-making in women with uterine masses. Methods This retrospective diagnostic accuracy study included 2453 women surgically treated for uterine masses between 2004 and 2016 at two tertiary gynecologic centers. Histopathological examination confirmed 2404 benign lesions and 49 sarcomas. Preoperative serum levels of lactate dehydrogenase isoenzymes and total lactate dehydrogenase were used to construct a three-tier risk stratification model. Diagnostic performance was assessed by calculating sensitivity, specificity, and negative predictive value, and by performing receiver operating characteristic analysis. Results The model correctly classified all 49 malignant cases as high-risk, yielding a sensitivity and a negative predictive value of 100%. Among the 2404 benign cases, 2216 (92.2%) were classified as no-risk, 184 (7.6%) as low-risk, and 4 (0.2%) as high-risk. These classifications yielded a specificity of 92.2% and an overall accuracy of 92.3%. Furthermore, the model reclassified a subset of patients initially considered high-risk into lower-risk categories, potentially reducing the need for unnecessary radical surgeries. Conclusions This biochemical model provides a simple, clinically applicable approach to preoperatively stratify uterine masses. By reliably identifying patients with a negligible sarcoma risk, the model supports more conservative, fertility-preserving management while maintaining oncologic safety. However, because the observed diagnostic performance may reflect cohort-specific characteristics, prospective multicenter validation is required before routine clinical use.
