OBJECTIVE:To evaluate the correlation in temporal trends in obesity and endometrioid endometrial cancer incidence in the United States using two comprehensive national databases. METHODS:This is a cohort study in which data on endometrioid endometrial cancer were obtained from the U.S. Cancer Statistics from 2001 to 2018 and corrected for hysterectomy and pregnancy. Data on obesity were collected from the NHANES (National Health and Nutrition Examination Survey) database from 1988 to 2018. Average annual percentage changes (AAPCs) were used to describe trends. Pearson correlation coefficients ( r ) were calculated to examine the relationship between trends. SEER*Stat 8.3.9.2 and joinpoint regression program 5.2.0 were used for statistical analysis. RESULTS:From U.S. Cancer Statistics data, 586,742 cases of endometrioid cancer were identified from 2001 to 2018. The average annual increase in endometrioid cancer was as follows: Hispanic 1.37% (95% CI, 1.14-1.60, P <.001), Black 1.30% (95% CI, 1.04-1.57, P <.001), and White -0.17 (95% CI, -0.91 to 0.58, P =.656). Women aged 20-29 years had a 4.48% annual increase (95% CI, 3.72-5.25, P <.001) and women aged 30-39 years had a 3.00% annual increase in rates (95% CI, 2.65-3.36, P <.001). According to the NHANES data, the prevalence of obesity in 2018 in adult women was as follows: Black 56.80%, Hispanic 44.10%, and White 40.90%. An examination of trends by age showed that women aged 20-29 years had the highest annual rise in obesity compared with other age groups (AAPC 7.36%, 95% CI, 4.0-10.8, P <.05). Strong and statistically significant correlations between endometrioid cancer and obesity trends were noted for Black ( r =0.78, P =.01) and Hispanic ( r =0.91, P <.001) women, as well as women aged 20-29 years ( r =0.72, P =.03) and 30-39 years ( r =0.88, P =.001). CONCLUSION:The current data demonstrate a temporal association between the increasing incidence of obesity and endometrioid endometrial cancer, and this effect disproportionately affects younger women and Black and Hispanic women.

This article addresses the role of surgery in the management of gynecologic cancers with liver metastases. The authors review the short-term and long-term outcomes of aggressive resection through retrospective and randomized studies. Although the data supporting aggressive resection of liver metastasis are largely retrospective and case based, the randomized control data to address neoadjuvant versus chemotherapy have been widely criticized. Residual disease remains an important predictor for survival in ovarian cancer. If a patient cannot achieve near optimal cytoreduction, radical cytoreductive procedures, such as hepatic resection, should be considered for palliation only.

OBJECTIVE:Timeliness of cancer care has been recognized as an indicator of quality of care for numerous cancer sites. Differences in endometrial cancer type may contribute to racial/ethnic disparities in treatment outcomes. This study examines racial/ethnic disparities in time to surgical treatment among type I and type II endometrial cancers. METHODS:We used data from 33,626 women with endometrial cancer in the California Cancer Registry between 2000 and 2019. Descriptive statistics, bivariate analyses, univariate logistic regression models, and multivariate logistic regression models stratified by endometrial cancer type (type I or type II) were performed. RESULTS:Surgical treatment delays were apparent in 35.3 % (n = 22,487) of type I and 34.6 % (n = 11,139) of type II endometrial cancers; treatment delays varied across racial/ethnic group. Among type I endometrial cancers, multivariable models indicate that American Indian/Alaska Native (odds ratio [OR] 1.47, 95 % CI 1.10-1.97, p < 0.05), Black (OR 1.41, 95 % CI 1.23-1.62, p < 0.001), Hispanic/Latina (OR 1.23, 95 % CI 1.15-1.33, p < 0.001), and Asian or Pacific Islander (OR 1.12, 95 % CI 1.02-1.22, p < 0.01) women had higher odds of experiencing treatment delays compared with White women. Among type II endometrial cancers, multivariable models indicate that Black (OR 1.36, 95 % CI 1.18-1.56, p < 0.001) and Hispanic/Latina (OR 1.15, 95 % CI 1.03-1.28, p < 0.05) women had higher odds of experiencing treatment delays compared with White women. CONCLUSIONS:Targeted interventions are needed to address racial/ethnic disparities in time to surgical treatment for endometrial cancer to ensure equitable access to timely and appropriate cancer care.

•Growing teratoma syndrome occurs when mature teratomas are discovered in patients who have previously received adjuvant chemotherapy for immature teratoma.•Gliomatosis peritonei is a rare condition often found alongside immature teratoma.•Synchronous identification of growing teratoma syndrome and gliomatosis peritonei has rarely been reported.•Comprehensive abdominopelvic imaging is critical to the surveillance protocol after treatment of immature teratoma to assess and appropriately treat this phenomenon.

Endometrial cancer is one of few cancers that has continued to rise in incidence over the past decade, with disproportionate increases in adults younger than 50 years old. We used data from the Surveillance, Epidemiology, and End Results Registry (2000-2019) to examine endometrial cancer incidence trends by race/ethnicity and age of onset among women in the United States. Case counts and proportions, age-adjusted incidence rates (per 100 000), and average annual percent changes were calculated by race/ethnicity, overall and stratified by age of onset (early vs late). We found a disproportionate increase in endometrial cancer incidence among women of color, for both early and late onset endometrial cancer. The highest increases in early onset endometrial cancer (<50 years old) were observed among American Indian/Alaska Native women (4.8), followed by Black (3.3), Hispanic/Latina (3.1), and Asian and Pacific Islander women (2.4), whereas White women (0.9) had the lowest increase. Late onset (>= 50 years old) endometrial cancer incidence followed a similar pattern, with the greatest increases for women of color. The increasing burden of endometrial cancer among women of color, particularly those younger than 50 years old, is a major public health problem necessitating further research and clinical efforts focused on health equity.

e17593 Background: Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. The lack of reliable diagnostic tests for early detection has led to the majority of EOC patients being diagnosed with advanced stage disease. Despite advances, most patients continue to suffer recurrence within 5 years following surgery and platinum (CDDP)-based chemotherapy. As malignant transformation is associated with metabolic re-programming, plasma-based biochemical signatures may offer biomarkers for the earlier detection of EOC. We previously reported the application of quantitative Mass Spectrometry (MS/MS) for the identification of CDDP resistance in EOC (D’Amora et al., Gynecol Oncol, 2021). Here we report the application of plasma MS/MS signatures for the detection of EOC. Methods: Following informed consent, EOC patients and controls provided EDTA blood samples with plasma was stored at -80 C. Quantitative MS/MS was performed using the Absolute IDQ p180 on a Sciex 6500 triple Quad MS. Amino acid (AA), lipid, acyl-carnitine, and hexose concentrations were compared with internal and external standards (NIST). Data analyses used MetaboAnalyst 3.0 to develop training sets in the original 13 EOC and 31 controls that were then validated in 34 EOC and 100 controls confirming diagnostic accuracy. Results: Plasma lipidomic profiles comparing EOC with controls provided highly significant differences that included micro-molar concentrations of Palmitic acid (C16) (p-1.07E-06), Oleic acid (C18:1) (p=1.37E-17) and the ratio of acyl-carnitine/carnitine (AcylC/C0) (p=1.07E-10). AA concentrations including Tryptophan (p=3.79E-22), branch chain amino acids (BCAA) (p=2.90E-07) and the Tryptophan/ Kynurenine ratio (TRP/KYN) (p=1.77E-11) were also significantly different for EOC versus controls. A composite equation comprised of AA and lipids (Valine/Phenylalanine)/(lysophophatidyl cholinePCaC16:0)/Trp} was found to predict disease free survival (DFS)(p =0.024). Conclusions: Malignant transformation in EOC reflects metabolic re-programming that can be identified and quantified in the plasma using targeted MS/MS. Changes in the concentrations of bioenergetic and structural lipids and AA’s reflect altered nutrient dependencies in transformed cells, while the ratio of TRP/KYN may reflect dysregulated immune response and surveillance. Plasma metabolite concentrations and select ratios provide insights into EOC pathogenesis that could be applied for diagnosis and prognosis. These MS/MS signatures have the potential to provide a new platform the earlier diagnosis of EOC.

OBJECTIVE:Secondary cytoreductive surgery is considered for selected patients with recurrent ovarian cancer. Although evidence supports its impact on progression-free survival, its effect on overall survival remains controversial. This study aims to identify patient sub-groups that benefit most from secondary cytoreductive surgery. METHODS:A systematic review and trial-level meta-analysis of randomized controlled trials published through March 2025 was conducted. The primary end points were pooled hazard ratio (HR) for overall survival and progression-free survival comparing secondary cytoreductive surgery plus chemotherapy versus chemotherapy alone. Sub-group analyses were performed based on histology, platinum-free interval, number of recurrent lesions, individualized model or Arbeitsgemeinschaft Gynäkologische Onkologie score, and residual disease status. RESULTS:Three randomized controlled trials involving 1249 patients were included in this meta-analysis. Patients with favorable validated selection scores (positive Arbeitsgemeinschaft Gynäkologische Onkologie or individualized model ≤4.7) showed significantly improved overall survival (HR 0.79, 95% confidence interval [CI] 0.66 to 0.96). Complete resection was associated with significantly better overall survival (HR 0.53, 95% CI 0.43 to 0.64) and progression-free survival (HR 0.51, 95% CI 0.42 to 0.61) than patients who had residual disease. A progression-free survival benefit was also observed in the non-high-grade serous histology (HR 0.52, 95% CI 0.38 to 0.72). In patients with a platinum-free interval of 6 to 12 months (SOC-1, 6-16 months), there was a significant trend toward improved overall survival (HR 0.70, 95% CI 0.55 to 0.91). CONCLUSIONS:Secondary cytoreductive surgery significantly improves progression-free survival and provides an overall survival benefit in carefully selected patients, particularly, those with a high likelihood of complete resection, favorable surgical selection scores, and a shorter platinum-free interval (<16 months). These findings highlight the critical role of patient selection and surgical completeness in optimizing outcomes for recurrent ovarian cancer.

OBJECTIVE:To quantify the impact on short-term ovarian cancer survival associated with treatment at high-performing hospitals using the observed-to-expected ratio (O/E) for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care. METHODS:This was a retrospective population-based study of stage I-IV invasive epithelial ovarian cancer reported to California Cancer Registry 1996-2017. A fit logistic regression model, risk-adjusted for patient and disease characteristics, was used to calculate O/E for each hospital stratified by hospital annual case volume. Cox proportional hazards model was used for survival analyses at 3, 6, 12, 24 months and stratified according to sociodemographic characteristics. RESULTS:The study population included 35,725 subjects treated at 443 hospitals: Low-O/E - 26.4% of cases; Intermediate-O/E - 55.5% of cases; and High-O/E - 18.1% of cases. Overall median survival by hospital category was: High-O/E = 72.5 months (95% CI = 68.6-78.6 months), Intermediate-O/E = 68.6 months (95% CI = 65.9-71.6 months), Low-O/E = 47.0 months (95% CI = 44.2-49.2 months). Initial treatment at a High-O/E hospital (HR = 1.00) was a statistically significant and independent predictor of improved short-term survival compared to Low-O/E hospitals at 3 months (HR = 1.46, 95% CI = 1.29-1.65), 6 months (HR = 1.35, 95% CI = 1.22-1.50), 12 months (HR = 1.27, 95% CI = 1.17-1.38), and 24 months (HR = 1.19, 95% CI = 1.11-1.27). Significant and independent associations between improved sort-term survival and High/O/E care were observed for Whites, Hispanics, Asian/Pacific Islanders (A/PI), across SES strata, and among all payer categories. CONCLUSION:Ovarian cancer care at a High-O/E hospital is an independent predictor of improved outcome and the survival advantage is disproportionately weighted toward the short-term time horizon following diagnosis.

OBJECTIVES:This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of secondary CRS and chemotherapy in comparison to chemotherapy alone for women with platinum-sensitive recurrent epithelial ovarian cancer.

Background:Most pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for emergency cesarean section (ECS) during the index hospitalization for pregnant trauma patients (PTPs) are unknown. We sought to investigate the national rate of ECS in PTPs presenting after MVC, hypothesizing a higher risk of ECS among those with severe injuries or elevated shock index (SI). Methods:The 2020-2021 TQIP was queried for PTPs presenting after MVC. PTPs that underwent ECS were compared to patients that did not undergo ECS. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale grade ≥3. Bivariate and multivariable logistic regression analyses were performed. Results:From 1183 PTPs, 95 (8.0 %) underwent ECS. The median time to ECS was 115 min. The ECS group had higher rates of lung (27.4 % vs. 12.2 %, p < 0.001) injury, spleen (18.9 % vs. 5.5 %, p < 0.001) injury, and elevated SI (22.1 % vs. 9.8 %, p < 0.001). ECS patients had higher rates of complication (9.5 % vs. 2.1 %, p < 0.001) and death (4.2 % vs. 1.1 %, p = 0.012). Independently associated risk factors for ECS included severe head (OR 2.65, CI 1.14-6.17, p = 0.023) or abdominal (OR 2.07, CI 1.08-3.97, p = 0.028) injuries and elevated SI (OR 2.17 CI 1.25-3.79, p = 0.006). Conclusion:The national rate of ECS among PTPs presenting after MVC is 8 % with most occurring within the first 2 hours of arrival. Severe head and abdominal injuries as well as elevated SI are risk factors for ECS.

OBJECTIVE:The aim of this study was to examine disparities in 20-year incidence trends and mutations in advanced-stage uterine cancer in the United States, given poor survival rates. METHODS:Data were obtained from the United States Cancer Statistics for patients from 2001 to 2019 with International Federation of Gynecology and Obstetrics 2009 stage IVA and IVB uterine cancer. SEER∗Stat 8.3.9.2 and Joinpoint Regression Program 4.9.0.0 were used to calculate cancer incidence per 100,000 women, annual percentages, and average annual percent change (AAPC). The mutational landscape of advanced uterine cancer was explored using data from the Genomic Data Commons. RESULTS:In United States Cancer Statistics, 75,450 patients with advanced uterine cancer were identified with an annual percentage increase of 2.63% between 2001 and 2019 and significantly higher rates in Black, Hispanic, and Asian patients compared with White patients (AAPC Black: 3.56%, AAPC Hispanic: 3.12%, and AAPC Asian 3.06% vs AAPC White: 2.07%, each p < .001). AAPC in patients with serous carcinomas increased by 6.32% in Black vs 3.91% in White patients (p < .001). Furthermore, AAPC was 3.0% for Black patients vs 0.7% for White patients with leiomyosarcoma (p < .001). In the Genomic Data Commons, TP53 mutations were more common, and PTEN was less common in Black vs White patients, older vs younger patients, advanced vs early stage, or high- vs low-risk histologic subtypes (p < .05). Mutations in BRCA1, BRCA2, POLE, and PMS2 were less common in high- vs low-risk histologic subtypes (p < .05). CONCLUSION:Advanced-stage uterine cancer rates are rising in the United States, particularly affecting Black and Hispanic women. Molecular differences exist by age, race, stage, and histology.

Surgical decision making is complex and involves a combination of analytic, intuitive, and cognitive processes. Medicolegal, infrastructural, and financial factors may influence these processes depending on the context and setting, but to what extent can they influence surgical decision making in gynecologic oncology? This scoping review evaluates existing literature related to medicolegal, infrastructural, and financial aspects of gynecologic cancer surgery and their implications in surgical decision making. Our objective was to summarize the findings and limitations of published research, identify gaps in the literature, and make recommendations for future research to inform policy.