ObjectivesTo explore hypermethylated gene markers in cervical scraped cells that may be associated with endometrial cancer and validate their diagnostic role in endometrial cancer.MethodsIn an exploratory cohort consisting of 40 paired endometrial tissue and cervical scraping samples, high-performance methylation-targeted genes associated with endometrial cancer were identified. In training and validation sets with 347 and 149 participants, respectively, methylated markers from cervical cytology together with other epidemiological and clinical parameters were assessed to determine their accuracy in detecting endometrial cancer. A decision tree was constructed using methylation markers, bleeding symptoms and endometrial thickness on transvaginal ultrasound (TVS).ResultsIn this exploratory study, eleven genes highly related to endometrial cancer were evaluated using a methylation array. In the training cohort, the highest AUC values for detecting endometrial cancer were 0.93, 0.91, and 0.89 for hypermethylated CDO1, NEFM, and CELF4, respectively. In the validation set, combining methylated CDO1, CELF4, and NEFM achieved a sensitivity of 94.6% (95% confidence interval 85.1-98.9) and a specificity of 92.8% (89.3-95.5) for detecting endometrial cancer. Integration of the endometrial thickness of TVS slightly improved the diagnostic specificity with very low sensitivity.ConclusionsCervical cytological DNA methylation assays of CDO1, CELF4 and NEFM provide a reliable and safe strategy for detecting endometrial cancer and are superior to other noninvasive evaluation methods or parameters.

Cervical cancer (CC) remains a major health challenge worldwide. Early detection methods and screening strategies are important for reducing both incidence and mortality rates. This study evaluates the clinical performance of the real-time optoelectronic device, TruScreen (TS), in detecting high-grade cervical precancers compared to standard methods [high-risk human papillomavirus (hrHPV) testing, cytology, and colposcopy) in a Chinese hospital-based opportunistic screening cohort. In addition, assess the clinical effectiveness of the TS strategies alongside current guidelines and methodologies in cervical cancer screening. A multicenter, cross-sectional study was conducted across 64 hospitals between September 2018 and June 2021 in China. Participants (n = 14,982 women aged ≥ 20 years) underwent TS test, hrHPV test, liquid-based cytology (LBC), and colposcopy with biopsy confirmation. Diagnostic performance [sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV)] were calculated using histopathology as the gold standard. Strategies incorporating TS test were compared to WHO-recommended guidelines. For cervical intraepithelial neoplasia grade 2 and servier lesions (CIN2+), TS test demonstrated comparable sensitivity (87.0

Type I to III cervical transformation zones (TZ-1 to TZ-3) may have various effects on cervical cancer screening and diagnostic outcomes. This study aims to evaluate the clinical utility of the cytological PAX1/JAM3 methylation (CISCER) assay in cervical cancer screening, especially in TZ-3 women. Between November 2020 and October 2022, 1782 women referred for colposcopy underwent liquid-based cytology (LBC), high-risk human papillomavirus (hrHPV) genotyping, and CISCER testing. After applying inclusion criteria, 1398 women were analyzed, including 1190 with documented TZ classification. Diagnostic performance for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3+) was compared across TZ subgroups. For CIN3+ detection, CISCER showed sensitivities of 67.4%, 72.0%, 48.3%, and 81.5% and specificities of 91.0%, 94.2%, 91.3%, and 89.8% in all women, TZ-1, TZ-2, and TZ-3, respectively. Compared with LBC ≥ ASC-US, hrHPV positivity, or HPV16/18 positivity, CISCER achieved the highest diagnostic accuracy, with AUC values of 0.792, 0.831, 0.698, and 0.856 across the respective groups. In both the overall cohort and TZ-3 subgroup, CISCER positivity was associated with the highest CIN3+ risk (34.6% and 31.4%) and required the fewest colposcopy referrals per CIN3+ detected (2.9 and 3.2). Combining hrHPV testing with CISCER further improved risk stratification. CISCER demonstrated superior diagnostic performance across TZ types, particularly in TZ-3, enabling improved CIN3+ risk discrimination while substantially reducing unnecessary colposcopy referrals compared with conventional cytology and HPV genotyping.

Background High-intensity focused ultrasound (HIFU), a noninvasive treatment method, has attracted increasing attention in recent years for the management of gynaecological diseases. This review summarizes current literature on the application of HIFU in gynaecological diseases and discusses the advantages of HIFU compared with traditional surgery and other treatment strategies.Methods A comprehensive literature search was conducted in PubMed, Embase and Web of Science from their inception to Dec 2025. Titles and abstracts were screened, and relevant data were extracted, followed by full-text quality assessment of the potentially relevant articles.Results This studies have enrolled the application of HIFU in 135 studies in uterine fibroids, 42 studies in adenomyosis, 22 studies in caesarean scar pregnancy, 12 studies in endometriosis, 3 studies in cervicitis, 13 studies in vulvar diseases and 10 studies in placenta diseases. With accumulating clinical experience and ongoing technological advancements, HIFU has achieved improved efficacy and reduced rates of severe adverse events. In particular, HIFU may represent a well-tolerated option for patients seeking fertility preservation and does not appear to increase obstetric risk.Conclusion HIFU is effective and recognized as a treatment for uterine fibroids, adenomyosis, and other benign gynaecological diseases. However, lack of high-quality long-term follow-up data remains. Patients can be more precisely selected and treated with appropriate therapy, minimizing adverse effects and decreasing the re-intervention rates. Noninvasive treatments such as HIFU are expected to become increasingly important in the next decade.

Ovarian immature teratoma is a relatively rare malignant ovarian tumor that predominantly occurs in children, adolescents, and young adults. In clinical diagnosis and treatment, tumor marker detection and imaging examinations serve as crucial bases for differentiating mature and immature terotomas. A comprehensive preoperative evaluation followed by the selection of an appropriate surgical approach and extent is key to improving prognosis. Some studies have indicated that for stage Ⅰ ovarian immature teratoma, avoiding adjuvant chemotherapy under close follow-up does not increase the risk of recurrence or affect long-term survival of patients; however, for advanced-stage ovarian immature teratoma, standardized postoperative chemotherapy is still recommended. Some patients may experience benign-malignant transformation of malignant germ cell components after surgery, such as growing teratoma syndrome or squamous cell carcinoma transformation. Due to the rarity of ovarian immature teratoma, current understanding of its pathogenesis and clinical management remains limited. This paper provides a review focusing on key clinical issues related to ovarian immature teratoma and proposes corresponding diagnostic and therapeutic recommendations, aiming to offer references for promoting multidisciplinary collaboration and individualized treatment.

BACKGROUND:We aimed to explore the volume reduction rate (VRR) and its influencing factors in solitary uterine fibroids classified as Funaki type I and II after ultrasonography-guided high-intensity focused ultrasound (USgHIFU) ablation. METHODS:We enrolled 191 patients with uterine fibroids who underwent USgHIFU ablation. To calculate the VRR, fibroid dimensions were measured using ultrasonography at 3, 6 and 12 post-treatment months. The primary endpoint was the VRR at 12 post-treatment months. The secondary endpoints included the non-perfused volume ratio (NPVR) and VRR at three and six months. RESULTS:The mean VRR for all 191 patients was 29.9%, 39.6% and 44.0% at 3, 6 and 12 post-treatment months, respectively. Subgroup analysis demonstrated a significant volume reduction across groups stratified by maximum fibroid diameter, Funaki type and NPVR. Univariable logistic analysis identified the following factors significantly associated with a higher VRR at 12 months: age ≥35 years (odds ratio [OR] 3.960, 95% confidence interval [CI] 1.405-11.159), presence of menstrual abnormalities (OR 1.936, 95% CI 1.075-3.485), moderate enhancement (OR 2.340, 95% CI 1.193-4.591), anteverted uterus (OR 2.020, 95% CI 1.034-4.025) and lymphocyte count <1.8 × 109/L (OR 2.963, 95% CI 1.265-5.993). Multivariable logistic analysis revealed that age ≥35 years (OR 3.436, 95% CI 1.188-9.947) and lymphocyte count <1.8 × 109/L (OR 2.113, 95% CI 1.142-3.908) were significantly associated with high VRR. CONCLUSION:The uterine fibroid volume progressively decreased after USgHIFU ablation. Age ≥35 years and lymphocyte count <1.8 × 109/L were significantly associated with high VRR.

OBJECTIVE:To compare the long-term survival outcomes, recurrence patterns and morbidity of type B and type C radical hysterectomy (RH) for stage IB2 cervical cancer (FIGO 2018). METHODS:Based on FOUR-C database, patients who underwent type B or C RH in 47 hospitals from 2004 to 2018 were reviewed. Univariate and multivariate analyses were performed to compare 5-year overall survival (OS) and recurrence-free survival (RFS), recurrence patterns and morbidity between the two groups after propensity score matching (PSM). RESULTS:A total of 1308 patients were enrolled in this study, 840 and 468 patients underwent type B and type C. There was no difference in 5-year survival outcomes between groups type B and type C, either before or after matching (OS: unmatched 95.6% vs. 93.3%, matched 95.6 vs. 93.0%, P>0.05; RFS: unmatched: 90.5% vs. 90.1%, matched: 91.2% vs. 89.7%, P>0.05). Type B group had a shorter operative time, less blood loss, earlier recovery of intestinal function, eariler removal of catheter and shorter hospitalization (P<0.01). Intraoperative complications were similar (0.1% vs. 0.2%, P>0.05), but postoperative complications occurred more frequently in the type C group (8.3% vs. 12.1%, P < 0.05), especially lymphocysts and urinary retention. The surgical dissection does not appear to influence tumor recurrences significantly (P>0.05). CONCLUSIONS:For cervical cancer patients with stage IB2, type B RH demonstrated comparable long-term oncological outcomes and recurrence patterns to type C RH, while being associated with fewer intra-and postoperative complications. Type B RH is a feasible and appropriate surgical option, but the conclusions need to be confirmed by prospective studies.

OBJECTIVE:DNA methylation is a promising biomarker for cervical cancer screening. This study aimed to validate the triage performance of cytological DNA methylation for detecting cervical intraepithelial neoplasia of grade 3 or worse (CIN3+) in women with high-risk human papillomavirus (hrHPV) infection from a large prospective cohort undergoing opportunistic screening in China (METHY3). METHODS:The triage performance for detecting CIN3+ lesions was compared between HPV16/18 genotyping, a liquid-based cytology (LBC) test, and the PAX1 and JAM3 methylation (PAX1m/JAM3m) test according to cervical pathologic outcomes. Among the 4394 women infected with hrHPV, 1105 had definitive cervical histological findings that were analyzed. RESULTS:For detecting CIN3+, the specificity of HPV16/18(+), the LBC result of ≥atypical squamous cells of undetermined significance (ASCUS), and PAX1m/JAM3m(+) was 66.4%, 23.9%, and 89.6%, respectively, with odds ratios of 4.24 (95% confidence interval [CI], 2.85-6.40), 4.44 (2.27-10.1), and 18.5 (12.1-28.7) (P < .001), respectively. PAX1m/JAM3m(+) had the highest area under the receiver operating characteristic curve (0.790, 95% CI, 0.747-0.832) in the whole cohort and in women of various ages. PAX1m/JAM3m (+) was detected in all patients with cancer (n = 28). Compared with HPV16/18 genotyping and the LBC test, PAX1m/JAM3m testing reduced referrals to colposcopy by 20.64 percentage points and 61.18 percentage points, respectively. CONCLUSIONS:PAX1 m /JAM3 m testing is highly specific for detecting CIN3+. As a triage biomarker, it is superior to HPV 16/18 genotyping and LBC testing for women with hrHPV infection.

STUDY OBJECTIVE:To explore the associations between adenomyosis patterns on transvaginal sonography (TVS) and surgical outcomes. DESIGN:A retrospective cohort study. SETTING:Peking Union Medical College Hospital, Beijing, China. PATIENTS:The medical records of 322 patients diagnosed with adenomyosis who underwent open or laparoscopic fertility-sparing surgeries from March 1 to December 31, 2018, were reviewed. Patients were divided into localized (221 patients) and diffuse (101 patients) adenomyosis groups on the basis of TVS findings. INTERVENTIONS:Detailed epidemiological information, imaging evaluations, surgical reports, and pathological findings were retrospectively collected. MEASUREMENTS AND MAIN RESULTS:The median postsurgical follow-up period was 52.8 months (range 6-88 months), with 24 patients (7.4%) lost to follow-up by July 1, 2019. The localized and diffuse adenomyosis groups had similar symptom relief and recurrent uterine lesions. Among the 104 patients who attempted pregnancy, 75 patients (72.1%) conceived, with 35 miscarriages (46.7%) and 59 live births (78.7%). For the whole cohort and the localized adenomyosis and diffuse adenomyosis groups, the cumulative 5-year conception rates were 75%, 83% and 60%, respectively; the cumulative 5-year live birth rates were 63%, 79% and 37%, respectively. The adenomyosis patterns found during sonography were the only independent risk factors related to clinical pregnancy and live birth in the Cox regression model. Patients with diffuse adenomyosis had significantly lower rates of conception (HR 0.5, 95% CI 0.3-1.0) and live birth (HR 0.4, 95% CI 0.2-0.8). CONCLUSION:Adenomyosis patterns (localized versus diffuse) in pretreatment TVS could predict obstetrical outcomes, irrespective of surgical type and uterine size. CLINICAL REGISTRY:The clinical trial registry name is the Cooperative Adenomyosis Network (CAN); the registration number is NCT03230994 (https://clinicaltrials.gov). This study started on June 30, 2017, and was completed on December 30, 2020.

Background Ovarian cancer (OC) is a heterogeneous malignancy with multiple histological subtypes, showing global variability in incidence. Temporal changes in diagnostic criteria and risk factors might influence the incidence and distribution of OC and its subtypes. Methods This study analyzed incidence patterns (2013-2017) and trends (1988-1992 to 2013-2017) of OC and its subtypes across 65 and 40 countries, respectively. Data were extracted from the Cancer Incidence in Five Continents (CI5 XII) and CI5plus databases (accessed in June 2024). Annual percent changes were computed to describe trends in age-standardized rates (ASRs) of OC and its subtypes. Proportions of ASR for each subtype relative to the ASR of OC for individual countries were calculated. Findings The incidence of OC displayed marked disparities across regions and Human Development Index (HDI), with the highest ASRs in Eastern and Central Europe and very high HDI regions, and the lowest in Africa, Asia, and medium HDI regions. Despite stable trend in ASRs of OC globally, notable declines were observed in Europe, America, and Oceania, in contrast to increases in Asian countries like Japan and South Korea. Globally, serous carcinomas remained the most prevalent subtype. European countries exhibited a higher proportion of serous carcinomas, while Asian countries had a higher proportion of endometrioid and clear cell carcinomas. Although trends in subtypes also remained stable, ASRs increased over time for serous carcinomas and germ cell tumor in most countries, while mucinous carcinomas and adenocarcinoma NOS showed a decline. Interpretation Variations in global patterns and trends in OC incidence and its subtypes might be influenced by genetic and reproductive factors. Consequently, region-specific prevention strategies and ongoing surveillance are essential to mitigate the burden of OC.

Endometriosis is a chronic condition with limited therapeutic options. The molecular aberrations promoting ectopic attachment and interactions with the local microenvironment sustaining lesion growth have been unclear, prohibiting development of targeted therapies. Here, we performed single-cell and spatial transcriptomic profiling of ectopic lesions and eutopic endometrium in endometriosis. We found that ectopic endometrial stromal (EnS) cells retained cyclical gene expression patterns of their eutopic counterparts while exhibiting unique gene expression that contributes to the pathogenesis of endometriosis. We identified two distinct ovarian stromal cells (OSCs) localized at different zones of the lesion, showing differential gene expression profiles associated with fibrosis and inflammation, respectively. We also identified WNT5A upregulation and aberrant activation of non-canonical WNT signaling in endometrial stromal cells that may contribute to the lesion establishment, offering novel targets for therapeutic intervention. These data will enhance our understanding of the molecular mechanisms underlying endometriosis and paves the way for developing non-hormonal treatments.

OBJECTIVE:This study aimed to evaluate the diagnostic performance of the novel Optoelectronic Imaging Tracing System as a triage or adjunct tool for women with high-risk human papillomavirus (hrHPV) infections. METHODS:Between June 2024 and August 2024, 581 women aged 18 to 65 years undergoing colposcopy were enrolled. The performance of hrHPV testing, cytology, the Optoelectronic Imaging Tracing System, and their combinations in detecting cervical intra-epithelial neoplasia grade 2 or worse and cervical intra-epithelial neoplasia grade 3 or worse was compared by assessing sensitivity, specificity, odds ratios, and area under the receiver operating characteristic curve (AUC). RESULTS:The Optoelectronic Imaging Tracing System demonstrated high sensitivity for detecting cervical intra-epithelial neoplasia grade 2 or higher (96.0%, 95% CI 93.5% to 98.6%) and grade 3 or higher (95.5%, 91.1% to 99.8%), and showed the highest odds ratios for detecting grade 2 or higher (26.0, 13.6 to 56.3) and grade 3 or higher (10.2, 3.72 to 43.3), respectively. In contrast, HPV16/18 genotyping had the highest specificity (65.9% [61.0% to 70.8%] and 63.7% [59.4% to 67.9%], respectively). In detecting cervical intra-epithelial neoplasia grade 2 or higher, the best AUC was achieved by the Optoelectronic Imaging Tracing System alone (0.742, 0.713 to 0.771), whereas the combination of the Optoelectronic Imaging Tracing System and HPV16/18 genotyping had the best AUC in detecting cervical intra-epithelial neoplasia grade 3 or higher (0.699, 0.645 to 0.753). No complaints or adverse events were reported by the participants. CONCLUSIONS:This exploratory study demonstrated the potential of the Optoelectronic Imaging Tracing System as a safe and effective triage or adjunct tool for detecting high-grade cervical lesions in women with hrHPV infections.

Objective To compare the 5-year oncological outcomes of different adjuvant treatment modalities in patients with FIGO 2018 stage IA-IIA cervical adenocarcinoma who underwent open radical hysterectomy and one intermediate-risk pathological factor. Methods Based on the Four C database (between 2004 and 2018, n =63,926), patients with FIGO 2018 stage IA-IIA cervical adenocarcinoma and only one intermediate-risk pathological factor underwent open extensive hysterectomy. All patients were divided into three groups, namely, the simple surgery group (radical hysterectomy, RH), postoperative adjuvant chemotherapy group (radical hysterectomy and chemotherapy, RH + CT), and postoperative adjuvant chemoradiotherapy group (radical hysterectomy and radiotherapy/concurrent chemoradiotherapy, RH + RT/CCRT). The 5-year OS and DFS rates were compared among the three groups. Results Of the 219 cervical adenocarcinoma patients with only one intermediate-risk pathological factor, 50 patients had RH; 54 patients had RH + CT; and 115 patients had RH + RT/CCRT. There were no significant differences in 5-year OS and 5-year DFS rates among the three groups (RH vs. RH + CT: 92.7% vs. 90.3%, P = 0.749; 88.5% vs. 85.1%, P = 0.680, RH vs. RH + RT/CCRT: 90.7% vs. 82.3%, P = 0.484; 84.4% vs. 90.1%, P = 0.494, RH + CT vs. RH + RT/CCRT: 89.9% vs. 90.6%, P = 0.815; 90.5% vs. 90.8%, P = 0.905). Conclusion Postoperative adjuvant chemotherapy or chemoradiotherapy did not significantly improve the outcomes of FIGO 2018 IA-IIA cervical adenocarcinoma patients with only one intermediate risk factor.

This study investigated BRCA1/2 and homologous recombination repair (HR) pathway gene variants in Chinese epithelial ovarian cancer (EOC) patients. Germline and somatic variants in 21 HR-related genes were analyzed in 229 patients using a 21-gene ovarian panel and in 141 patients using a 508-gene pan-cancer panel. BRCA1, BRCA2, and HR-related gene mutation rates were 17.9%, 3.5%, and 23.1%, respectively, with TP53 as the most frequent somatic mutation (66.4%). Combined germline and somatic BRCA1/2 mutation rates rose to 23.6 and 6.1%. Survival analysis (n = 200) demonstrated longer overall survival (OS) in patients carrying BRCA1/2 or HR mutations. Notably, strategies including likely pathogenic (LP) and variants of uncertain significance (VUS) showed improved OS, especially in BRCA2 and BRCA1/2 somatic carriers. These findings suggest that integrating germline, somatic, and VUS data enhances survival prediction and guides treatment decisions in Chinese EOC patients.

OBJECTIVES:To explore the role of a DNA methylation assay for managing minimally abnormal cervical cancer screening results in a prospective cohort undergoing opportunistic cervical cancer screening. METHODS:In the cohort of the METHY2 and METHY3 screening studies of women undergoing opportunistic cervical cancer screening, cervical cytology samples were sent for high-risk human papillomavirus (hrHPV) DNA assays, cytologic pathology and methylation assays of PAX1/JAM3 (CISCER). This study evaluated the discriminative power of CISCER in managing women with minimally abnormal cervical cancer screening results for CIN3+. Absolute CIN3+ risks and colposcopy referrals within one screening round were calculated. RESULTS:A total of 1857 women with minimally abnormal cervical cancer findings had cervical histologic outcomes and were included in the analysis. In women with a minimally abnormal cervical cancer result, the sensitivity and specificity of CISCER was 74.9% (95% confidence interval [CI], 68.3%-81.4%) and 89.1% (95% CI 87.6%-90.6%) for detecting CIN3+. CISCER analysis discriminated well for minimally abnormal cervical cancer results, yielding a CIN3+ risk of 40.5% (95% CI 34.9%-46.2%) after a positive result and a CIN3+ risk of 2.7% (95% CI 2.0%-3.6%) after a negative result. CONCLUSIONS:In women with a minimally abnormal cervical cancer screening result, the CISCER provides excellent detection of CIN3+. The use of CISCER in women with a minimally abnormal cervical cancer screening result can lead to a substantial reduction in the number of direct colposcopy referrals.

BACKGROUND:Ablative/excisional surgery is the recommended therapy for cervical high-grade squamous intraepithelial lesions (HSILs) but is associated with cervical damage and elevated risk of complications upon subsequent pregnancies. METHODS:This multicenter, randomized, controlled trial compared APL-1702 (2-g ointment containing 5% hexaminolevulinate; photoactivated at 125 J/cm2) versus placebo in adult women with cervical HSILs (randomization ratio: 2:1). Upon completion of 6-month treatment, patients in the APL-1702 group entered into a 6-month extension phase with observation only. The primary efficacy endpoint was treatment response, as defined by normal histology or low-grade squamous intraepithelial lesion (LSIL) histology plus human papillomavirus (HPV) clearance, at 6 months in a modified intent-to-treat (mITT) population. FINDINGS:A total of 402 women were enrolled. The 6-month response rate was 41.1% (104/253) in the APL-1702 group versus 21.7% (28/129) in the placebo group (p < 0.001). The HPV16/18 clearance rates were 31.4% (49/156) and 15.4% (12/78) in the APL-1702 and placebo groups, respectively (p = 0.011). The rates of treatment-emergent adverse events were 56.8% (151/266) and 56.0% (75/134) in the APL-1702 and placebo groups, respectively. At the end of the 6-month extension period, 54.9% (56/102) of the patients who responded at the end of the 6-month treatment period maintained a response. CONCLUSIONS:APL-1702 significantly increased the 6-month response rate in patients with cervical HSILs versus placebo control, with a favorable safety profile. FUNDING:This trial was sponsored by Asieris Pharmaceuticals (Shanghai, China).

OBJECTIVE:To analyse the risk factors for post-operative recurrence or progression of intravenous leiomyomatosis and explore the impact of different treatment strategies on patient prognosis. METHODS:Patients with intravenous leiomyomatosis who underwent surgery from January 2011 to December 2020 and who were followed for ≥3 months were included. The primary endpoint was recurrence (for patients with complete resection) or progression (for patients with incomplete resection). Kaplan-Meier survival analysis was used to analyse the factors affecting recurrence. RESULTS:A total of 114 patients were included. The median age was 45 years old (range 24-58). The tumors were confined to the uterus and para-uterine vessels in 48 cases (42.1%), while in 66 cases (57.9%) it involved large vessels (iliac vein or genital vein and/or proximal large veins). The median follow-up time was 24 months (range 3-132). Twenty-nine patients (25.4%) had recurrence or progression. The median recurrence or progression time was 16 months (range 3-60). Incomplete tumor resection (p=0.019), involvement of the iliac vein or genital vein (p=0.042), involvement of the inferior vena cava (p=0.025), and size of the pelvic tumor ≥15 cm (p=0.034) were risk factors for recurrence and progression. For intravenous leiomyomatosis confined to the uterus or para-uterine vessels, no post-operative recurrence after hysterectomy and bilateral oophorectomy occurred in this cohort. Compared with hysterectomy and bilateral oophorectomy, the risk of recurrence after tumorectomy (with the uterus and ovaries retained) was significantly greater (p=0.009), while the risk of recurrence after hysterectomy was not significantly increased (p=0.058). For intravenous leiomyomatosis involving the iliac vein/genital vein and the proximal veins, post-operative aromatase inhibitor treatment (p=0.89) and two-stage surgery (p=0.86) were not related to recurrence in patients with complete tumor resection. CONCLUSION:Incomplete tumor resection, extent of tumor lesions and size of the pelvic tumor were risk factors for post-operative recurrence and progression of intravenous leiomyomatosis.

OBJECTIVE:This multicenter study aimed to investigate the disparity in clinical features and prognosis among different histopathologic subtypes of endocervical adenocarcinoma (EA) based on the 2014 World Health Organization (WHO) classification. METHODS:We retrieved and analyzed data from the Chinese Four C Database between 2004 and 2018. 672EA patients with radical hysterectomies from 32 institutions were retrospectively reviewed. Clinicopathologic characteristics, five-year overall survival (OS), and disease-free survival (DFS) were compared based on histological subtypes. RESULTS:The 5-year DFS and OS rates for usual, endometrioid, mucinous, gastric, villoglandular, clear cell/serous/mesonephric EAs were as follows: 81.3 %, 89.1 %, 63.0 %, 35.6 %, 88.6 %, 79.9 %, respectively (P < 0.0001); 87.4 %, 96.6 %, 74.7 %, 34.0 %, 96.7 %, 86.3 %, respectively (P < 0.0001). Gastric- and mucinous-type exhibited a higher frequency of lymph node metastasis, deep stromal invasion, uterine corpus invasion, and recurrence than the usual -type (recurrence rate:50.00 % vs 29.90 % vs 15.50 %, P < 0.0001). Multivariate analysis revealed gastric-type was significantly associated with inferior DFS (HR,3.018; 95 % CI, 1.688-5.397; P < 0.0001) and OS(HR, 4.114; 95 % CI, 2.002-8.453; P < 0.0001). Furthermore, compared to the usual -type, mucinous-type demonstrated significantly worse DFS (HR, 1.773; 95 % CI,1.123-2.8; P = 0.014) and OS (HR, 2.168; 95 % CI,1.214-3.873; P = 0.009) whereas endometrioid-type was an identified as independent factor for better DFS (HR, 0.365; 95 % CI,0.143-0.928; P = 0.034). Villoglandular subtype displayed similar features and favorable prognosis as the usual type. CONCLUSIONS:Relevant clinical features and prognosis varied significantly among histological subtypes of EA, thus offering valuable guidance for the development of subtype-specific treatment strategies to optimize EA management.

Objective: To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies. Methods: A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed. Results: A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common. Conclusions: Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.