OBJECTIVE:This study investigates treatment quality and survival outcomes in elderly patients (≥75 years) with early-stage (International Federation of Gynecology and Obstetrics stage I/II) epithelial ovarian cancer documented in the German national quality-assurance program. It examines associations between surgical and systemic treatment quality and disease-free and overall survival. METHODS:Patients with a first diagnosis of ovarian cancer during the third quarter of 2012, 2016, and 2021 were documented. Surgical quality was defined as optimal when no more than one required staging procedure was omitted and sub-optimal when two or more procedures were missing. Chemotherapy quality was considered optimal when aligned with national guidelines. Overall treatment quality was classified as optimal, mixed, or sub-optimal according to surgical and chemotherapy quality. RESULTS:A total of 228 elderly patients with presumed early-stage epithelial ovarian cancer were included. Among them, 24.6% received both optimal surgery and optimal chemotherapy, 10.1% received optimal surgery with sub-optimal chemotherapy, 25.4% received sub-optimal surgery with optimal chemotherapy, and 39.9% received sub-optimal treatment in both modalities, with marked differences in age, Eastern Cooperative Oncology Group performance status, and comorbidity burden across treatment groups. At 24 months, 64% (95% confidence interval, 58% to 71%) of elderly patients remained disease-free. Within the elderly cohort, 24-month disease-free and overall survival were 90% (95% confidence interval, 82% to 99%) and 98% (95% confidence interval, 94% to 100%) with optimal surgery and chemotherapy, 68% (95% confidence interval, 56% to 81%) and 79% (95% confidence interval, 68% to 90%) with sub-optimal surgery and optimal chemotherapy, and 49% (95% confidence interval, 32% to 76%) and 62% (95% confidence interval, 45% to 87%) with optimal surgery and sub-optimal chemotherapy. CONCLUSIONS:In elderly patients with assumed early-stage ovarian cancer, guideline-concordant surgery and chemotherapy showed deficits that were associated with unfavorable outcomes. Chemotherapy quality showed a strong association with outcome, underscoring the need to optimize evidence-based treatment in elderly patients. Nonetheless, these findings are associative only, given possible selection of fitter patients and treatment of occult advanced disease in surgically under-staged patients.

PURPOSE:Ductal carcinoma in situ (DCIS) is a non-invasive precursor of invasive breast cancer and is primarily treated surgically. Re-excision is commonly performed to achieve clear margins; however, its impact on local recurrence remains controversial. This study evaluated whether re-excision influences the risk of ipsilateral breast tumor recurrence in patients with DCIS. METHODS:In this retrospective single-center cohort study, all patients treated for DCIS at the University Hospital Münster between 2003 and 2015 were included. Clinical and pathological parameters, including age, menopausal status, tumor size, nuclear grade, re-excision, and adjuvant radiotherapy were analyzed. Follow-up data were obtained from the German cancer registry. The association between re-excision and local recurrence was analyzed using log-rank testing, and multivariate Cox regression was performed to identify independent risk factors. RESULTS:A total of 425 patients were treated for DCIS between 2003 and 2015, with follow-up data available for 247 patients (mean follow-up: 4.4 years). Re-excision was performed in 119 patients (48.2%). Local recurrence occurred in 8 patients (6.7%) with re-excision and in 9 patients (7.1%) without. The 5-year local recurrence rate was 2.9% with re-excision versus 6.0% without (P = .33). Multivariate analysis identified younger age (P = .03) and premenopausal status (P = .02) as significant risk factors, while adjuvant radiotherapy showed a protective effect (P = .01). CONCLUSION:Re-excision was not associated with a significantly different risk of local recurrence. Younger age and premenopausal status were associated with increased recurrence risk, whereas adjuvant radiotherapy was associated with improved local control.

Introduction: Hormone receptor negative breast cancer lacking HER2 overexpression is associated with poor prognosis and limited treatment options. Recent efficacy of anti HER2 antibody drug conjugates in HER2-low (HER2 1+ and HER2 2+/ISH-negative) disease suggests that this subgroup represents a biologically and clinically distinct entity. Analyses of cohorts treated before the availability of HER2 targeted therapies are needed to define the natural disease course and prognostic relevance of HER2 low status. Methods: We retrospectively analyzed data of HR-negative and either HER2-zero or HER2-low breast cancer patients treated in a single clinical center between 2014 and 2024. Primary endpoints included overall survival (OS) and event-free survival (EFS), secondary endpoints included pathological complete response (pCR) after neoadjuvant chemotherapy and clinicopathological characteristics. Results: Among 277 patients, 160 (57.8 %) had HER2-zero, 75 (27.1 %) had HER2 1+ and 42 (15.2 %) HER2 2+/ISH-negative tumors. Higher tumor stages (p = 0.053) and lower Ki-67 indices (p = 0.038) were more prevalent in HER2 2+/ISH-negative patients. OS was significantly worse in HER2 2+/ISH-negative patients (HR 8.12, 95 % CI 1.98–33.37, p = 0.004), whereas EFS and pCR rates did not differ significantly. Patients with pCR after neoadjuvant chemotherapy had significantly better OS (p = 0.007) and EFS (p = 0.003) than those with non-pCR, with no differences among the HER2 subgroups. Conclusion: HER2 2+/ISH-negative status was associated with poorer OS. Distinct clinicopathological features associated with lower pCR rates may have contributed to the inferior survival in this group.

Background: Long-term survivors (LTS) after gynecological cancer may be cured but still face physical and psychological challenges. This multicenter study aimed to assess the long-term side effects, the received follow-up care, and the personal perspectives of survivors. Methods: Between 2019 and 2025, LTS from four European countries within the ENGOT (European Network of Gynecological Oncological Trial Groups) and GCIG (Gynecologic Cancer InterGroup) networks were recruited. Long-term survival was defined as surviving at least five years after the first diagnosis. LTS completed a questionnaire with 81 questions (patient's characteristics, oncological history, current health status, lifestyle factors). Analyses were mainly descriptive. Results: A total of 677 LTS were enrolled, with a median age of 64.0 years (range: 26-92) and a median survival time of 7 years (range: 5-38). A total of 46.6% were diagnosed with cervical cancer, 32.9% with endometrial cancer, 4.4% with ovarian cancer, and 16.1% with other types of gynecological cancer. Moreover, 36.9% still suffer from physical and psychological symptoms, most frequently being lymphedema (36.2%), hot flashes (22.4%), difficulties with concentration (21.1%), fatigue (20.9%), vaginal dryness (20.1%), and urinary incontinence (18.9%). Median overall health status was ranked (scale 1-5; 1 = very good, 5 = very poor) as 2, while 13.5% rated their health as poor/very poor. Current symptoms were associated with poorer health status (p < 0.001) and a history of recurrent disease (p = 0.001). In addition, 13.6% reported not receiving follow-up care. CA-125 was determined in 80.8% of ovarian LTS, as well as in 30.7% of cervical and 28.9% of endometrial LTS. Pap smear follow-up was reported by 50.5% of endometrial LTS. A total of 33.7% did not exercise at all or exercised less than an hour per week, 13.4% smoke tobacco, and 51.2% drink alcohol more often than once a month. Conclusions: Our findings highlight the need for patient-centered follow-up care, addressing both long-term side effects and education on lifestyle and prevention. Follow-up procedures that do not follow guidelines should be avoided.

Kaplan–Meier estimates of PFS stratified on Giscar HRD status among inconclusive status of MGMC (n = 43).

Objectives The German quality assurance program (QS-Ovar) representatively documents treatment and survival for patients with the initial diagnosis of primary ovarian cancer in the third quarters of 2004, 2008, 2012, 2016, and 2021. We evaluate lymphadenectomy (LNE) rates in dependence on histologic subtype and outcome for early ovarian cancer FIGO I. Methods Therapy quality was defined according to national guidelines. Surgical quality was categorized as “optimal“ (SUR+: maximum 1 surgical item missing), versus “suboptimal“ (SUR-); analogous categorization “optimal“ systemic treatment (CT+) and “suboptimal“ (CT-). Results Overall, 832 pts. (19.3 %) were diagnosed with FIGO I, of them 47.6 % with FIGO IC, 35.7 % had a high-grade serous subtype, 5.0 % low-grade serous, 6.9 % low-grade endometrioid, 18 % high-grade endometrioid, 11 % clear cell, and 18 % mucinous tumors. The optimal surgical standard increased from 21.1 % (2004) to 53.0 % (2012). Surgical quality has remained unchanged in 2021 with 53.8 % and SUR + -subgroup with 74.2 %. The rate of pelvic and para-aortic lymphadenectomy increased over time for high-grade serous and clear cell carcinoma and decreased for mucinous carcinoma. In 2021, 67.6 % had ≥25 resected lymph-nodes in high-grade serous, 46.2 % in low-grade serous, 52.2 % in high-grade endometrioid, 35.3 % in low-grade endometrioid, 74.1 % in clear cell and 35.7 % in mucinous tumors. In 2021, the SUR+/CT + -subgroup decreased to 62.9 % versus 69.2 % in 2016. Four-year-disease-free-survival was 86 % for SUR+/CT+, 78 % for SUR-/CT+, 68 % for SUR+/CT- and 57 % for SUR-/CT- (p < 0.001). Conclusions One therapy modality cannot replace another one. Although urgently required, quality of therapy has not improved in 2021.

List of BRCA variants detected by both GIScar tests and MGMC tests

PFS in patients according to GIScar (left panel) and MGMC scores (right panel).

MGMC and GIScar scores among concordant and discordant HRD classification on the clinical collection (n = 469)

Panel of gene used for the GIScar calculation (n =127)

Kaplan–Meier estimates of PFS stratified on treatment arm (n = 469).

PD1/PD-L1 inhibition (ICi) has recently become a new standard of care for patients with advanced MMR-deficient (MMRd) endometrial cancers. Nevertheless, response to immunotherapy is more complex than the presence of a single biomarker and therefore it remains challenging to predict patients response to ICi beyond MMRd tumors. Elevated PD-L1 expression (CPS ≥ 1) is often used as a prognostic marker as well as a predictive biomarker of response to ICi in different tumor types. In a retrospective, patient derived study, we analyzed PD1- and PD-L1 staining and correlated the results of different scores to clinical data to evaluate the prognostic impact of these scores. Immunohistochemical analysis of the receptor PD1 and the receptor ligand PD-L1 were performed on TMAs of primary paraffin‑embedded tumor samples. All patients were treated for primary endometrial cancer in the Department of Gynecology and Obstetrics, University Medical Center Schleswig–Holstein, Campus-Lübeck, Germany between the years 2006–2018. The evaluation and determination of the tumor proportion scoring (TPS), the combined positive score (CPS) and the immune cell scoring (IC) was automatically assessed semi-quantitatively, and results were correlated with clinicopathological characteristics and survival. 130 samples were evaluable and 64

The need for contralateral full groin dissection after bilateral sentinel node biopsy (SNB) with only unilateral detection of a macrometastasis is still a matter of debate. GROINSS-VI/II subanalysis has shown an absolute risk <3 % for contralateral groin recurrence or contralateral non-sentinel metastases, however, the individual risk varied widely dependent on the primary tumor characteristics. METHODS:The AGO VOP.2 QS vulva study is a retrospective, multicenter study. Data from 306 patients diagnosed with primary groin node positive VSCC (vulvar squamous cell carcinoma) between 2017 and 2019 at 33 gynecologic cancer centers in Germany were collected. In the current subgroup analysis, only patients with bilateral SNB and unilateral positive SNL were included. RESULTS:Of 306 documented groin node positive patients, 137 received bilateral SNB. Of these, 98 had a unilaterally positive SNL. The consecutive contralateral groin procedure was at the surgeons' discretion. 58/98 (59.2 %) received a bilateral inguinofemoral lymphadenectomy (if-LAE). 30/98 (30.6 %) underwent ipsilateral if-LAE only and 10/98 (10.2 %) had no further surgical treatment of the groins. 3/98 (3.1 %) patients either showed contralateral non-SN metastasis after bilateral if-LAE (n = 2) or developed isolated contralateral groin recurrence after unilateral if-LAE dissection (n = 1). CONCLUSION:In this large multicenter retrospective study the risk of contralateral groin recurrence was low (3,1 %). Therefore, morbidity should be carefully balanced against oncologic safety and omission of contralateral LAE should be considered.

Clinical collection used to validate GIScar (n = 469)