Introduction:Adult-type granulosa cell tumors (AGCTs) are rare ovarian neoplasms with a low overall incidence of recurrence, and also data on secondary recurrence and survival after relapse remain limited. This study aimed to identify factors associated with secondary recurrence and survival after recurrence in patients with recurrent AGCTs. Methods:This multicenter retrospective study included 52 patients with recurrent AGCTs identified among 484 patients treated between 2000 and 2023. Clinical characteristics, treatment modalities, and outcomes were analyzed, with a particular focus on factors associated with secondary recurrence and survival after first recurrence. Recurrence-free survival and overall survival after first recurrence (OS-FR) were evaluated using Kaplan-Meier analysis. Results:The mean follow-up duration was 99.2 ± 61.5 months. Secondary recurrence occurred in 17 patients (32.7%). A serum CA-125 level >35 U/mL at the time of first recurrence was significantly associated with an increased risk of secondary recurrence (p=0.01). Factors significantly associated with improved OS-FR included a CA-125 level ≤35 U/mL at initial diagnosis and at first recurrence, absence of residual disease following surgery for the first recurrence, and administration of salvage chemotherapy (all p<0.05). In subgroup analysis, salvage chemotherapy was associated with improved OS-FR in patients with residual disease or those who did not undergo surgery (p < 0.01), but not in patients who achieved complete cytoreduction (p = 0.67). Conclusions:Secondary recurrence remains a significant clinical challenge in AGCTs. Serum CA-125 levels, surgical outcomes at first recurrence, and the use of salvage chemotherapy may help management strategies in recurrent disease.

Presence of peritoneal metastasis in ovarian cancer is one of the most important factors affecting the prognosis of the disease. In this study we aimed to investigate the additive value of dedicated abdomen 18F-FDG PET/MR imaging to whole body18F-FDG PET/CT in the detection of peritoneal recurrence in ovarian cancer patients with elevated serum Ca-125 levels. This prospective study included 45 ovarian cancer patients with elevated serum Ca-125 levels during postoperative follow-up, all of whom underwent whole-body 18F-FDG PET/CT followed by dedicated abdominal PET/MRI. With the addition of PET/MR imaging to PET/CT, peritoneal recurrence was detected in 35 patients (78

PURPOSE:Peritoneal metastases significantly affect prognosis in ovarian cancer. We aimed to compare the prognostic value of 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) and 18F-FDG PET/MRI performed for restaging in patients with suspected recurrence and elevated CA-125. MATERIALS AND METHODS:Forty-five recurrent ovarian cancer patients who underwent same-session 18F-FDG PET/CT followed by whole-abdomen 18F-FDG PET/MRI for restaging were included from a previously published prospective cohort; patients were followed for overall survival (OS; median follow-up: 61.9 months). Kaplan-Meier and Cox regression analyses were performed. RESULTS:18F-FDG PET/MRI detected peritoneal involvement more frequently than 18F-FDG PET/CT (78% vs. 58%, P = 0.012) and yielded higher peritoneal cancer index (PCI) scores (P < 0.001). During follow-up, 35 patients (77.8%) died, and the median OS was 27.7 months. On 18F-FDG PET/CT, the number of peritoneal lesions (P = 0.002), PCI score (P = 0.004), and distant organ metastases (P = 0.017) were significantly associated with OS. Peritoneal involvement showed clearer survival separation on 18F-FDG PET/CT than on 18F-FDG PET/MRI (P = 0.046 vs. P = 0.222). For 18F-FDG PET/MRI, the number of peritoneal lesions (P = 0.038) and PCI score (P = 0.005) were significantly associated with OS, whereas peritoneal involvement on 18F-FDG PET/MRI was not associated with OS. Thus, binary PET/MRI positivity and quantitative PET/MRI-derived disease burden showed different prognostic associations. In addition, among 18F-FDG PET/MRI-positive patients, OS did not differ significantly between those positive only on 18F-FDG PET/MRI and those positive on both 18F-FDG PET/MRI and 18F-FDG PET/CT (P = 0.246). In the multivariable Cox model including age and both imaging modalities simultaneously, only 18F-FDG PET/CT-defined peritoneal lesion burden (>5 vs. ≤5 lesions) remained independently associated with OS [hazard ratio = 3.80, 95% confidence interval (CI) = 1.35-10.68, P = 0.012], whereas 18F-FDG PET/MRI-defined lesion burden (>5 vs. ≤5 lesions) did not retain statistical significance (hazard ratio = 1.31, 95% CI = 0.53-3.25, P = 0.555). CONCLUSION:Although 18F-FDG PET/MRI detected peritoneal metastases more frequently and yielded higher PCI scores, 18F-FDG PET/CT-derived peritoneal lesion burden demonstrated stronger independent prognostic value. 18F-FDG PET/CT appears sufficient for baseline prognostic stratification, whereas 18F-FDG PET/MRI may still provide complementary value for anatomical localization, detection of small-volume disease, and treatment planning.

Objective The updated European Society of Gynaecological Oncology guidelines recommend routine molecular classification to refine risk assessment and guide adjuvant treatment. However, the prognostic impact of sentinel lymph node involvement and molecular classification in apparent early-stage endometrial cancer remains incompletely defined. Methods PROMISE-EC is a multi-center retrospective study including patients with apparently uterine-confined endometrial cancer who underwent surgical staging with sentinel lymph node biopsy at 16 European institutions (January 2014-February 2024). Clinicopathologic characteristics, sentinel lymph node status, and Cancer Genome Atlas-based molecular classification were collected and analyzed. The primary endpoint was progression-free survival. Results Among 2732 records, 2003 patients met inclusion criteria. International Federation of Gynecology and Obstetrics 2009 stage I was observed in 1585 patients (79.4%). Sentinel lymph node involvement was present in 282 patients (14.1%). p53-abnormal tumors were associated with poorer progression-free survival (p <.0001), whereas patients with POLE-mutated tumors showed excellent outcomes, with no significant difference compared with non-specific molecular profile (p =.103). Patients with deficient mismatch repair tumors showed intermediate outcomes (p =.484). In unadjusted Kaplan-Meier analysis, progression-free survival worsened with increasing sentinel lymph node tumor burden (p =.047). In multi-variable analysis, high-grade disease (p =.003) and p53 abnormal status (p <.001) remained independent predictors of recurrence. The association between sentinel lymph node tumor burden and recurrence was attenuated, with only macrometastatic involvement retaining independent prognostic significance. In multi-variable logistic regression, lymphovascular space invasion was the strongest predictor of sentinel lymph node metastases (p <.00001), while patients with POLE-mutated tumors were less likely to harbor clinically relevant nodal involvement (p =.032). Conclusions Our study supports the prognostic relevance of both sentinel lymph node assessment and molecular classification in early-stage endometrial cancer, with potential implications for post-operative risk stratification and management.

Abstract Background We aimed to assess current practices, perceptions, and perceived effectiveness of ChatGPT among gynecologic oncology professionals in academic and clinical settings. Methods A 23-item, international online survey was conducted between July and September 2025. Gynecologic oncology professionals were recruited via social media and snowball sampling. We evaluated demographics, awareness, utilization, and perceptions of ChatGPT-3.5 across different domains. Results Our respondents(n = 111) were predominantly aged 36–45 years(55.0%), from Türkiye (90.1%), and affiliated with academic institutions(87.4%). Nearly all respondents(99.1%) were aware of ChatGPT, and 66.7% reported professional use, primarily for literature summarization(52.3%), teaching(42.3%), and academic writing(36.9%). Direct clinical use remained somewhat limited(17.1%), with minimal engagement in patient communication(7.2%). Misinformation was the most commonly reported concern(66.7%). Perceived effectiveness was highest in academic writing, literature summarization, and teaching, whereas patient communication, clinical decision support, and exam preparation were rated somewhat low. Overall, 60.3% indicated that ChatGPT contributed meaningfully to their work, 45.9% supported its integration into gynecologic oncology education, and 58.5% would recommend it to colleagues. Participants < 45 years and those with < 5 years of clinical experience reported significantly more frequent ChatGPT use in their professional activities(p-value = 0.026). Those with greater clinical experience were more likely to use ChatGPT for writing purposes(p-value = 0.039), whereas those < 45 years used it more often for clinical decision-making(p-value = 0.015). Conclusions ChatGPT is widely recognized and used for academic and educational tasks in gynecologic oncology, yet its clinical applications remain limited. Future research should optimize large language models for clinical use, evaluate comparative outcomes across diverse models, and investigate their integration into multidisciplinary care.

BackgroundSentinel lymph node (SLN) mapping has increasingly replaced systematic lymphadenectomy in apparent uterine-confined endometrial cancer (EC). However, concerns persist regarding the risk of recurrence following nodal surgical de-escalation, particularly in patients with aggressive histologic subtypes. We aimed to evaluate the oncologic safety of SLN-based nodal de-escalation by analyzing recurrence patterns and recurrence-free survival in patients with apparent early-stage EC.MethodsWe conducted a retrospective multi-institutional study including women with apparent uterine-confined EC who underwent primary surgery including SLN mapping, with or without pelvic and/or para-aortic lymphadenectomy. Patients were grouped according to nodal staging strategy: SLN-only, SLN plus pelvic lymphadenectomy (PLND), and SLN plus PLND plus para-aortic lymphadenectomy (PALND). The primary endpoints were progression-free survival (PFS) and patterns of recurrence.ResultsWe included 2123 patients from 15 centers in six countries. SLN-only staging was performed in 1,341 patients (63.2%), SLN+PLND in 483 (22.8%), and SLN+PLND+PALND in 299 (14.1%). With a median follow-up of 44.9 months (IQR 19.1–73.4), 121 recurrences were observed (5.6%). No statistically significant differences in PFS were observed among nodal staging groups. On multivariable Cox analysis, SLN-only staging was not associated with inferior PFS compared with SLN+PLND (HR 1.12, p=0.61), and the addition of PALND did not confer a significant benefit. Endometrioid high-grade histology, non-endometrioid high-risk histotypes, deep myometrial invasion, and lymphovascular space invasion were independently associated with recurrence. Isolated nodal relapse was uncommon (14.9%) and similarly distributed across groups. Exploratory molecular analysis did not show statistically significant differences in PFS across molecular subgroups, although expected survival trends were observed.ConclusionsIn apparent uterine-confined EC, no significant differences in recurrence or nodal relapse were observed across nodal staging strategies. These findings support the use of SLN mapping as an adequate staging approach within a biology-driven framework, although they should be interpreted in light of the retrospective design.

OBJECTIVE:To evaluate the association between sentinel lymph node status and survival outcomes in cases of endometrial cancer and to identify prognostic factors. METHODS:Our multicenter retrospective study included 1473 cases of clinically early-stage endometrial cancer evaluated by sentinel lymph node mapping between 2014 and 2023. After excluding 89 cases due to missing data, 1384 cases were analyzed, including 1282 patients found to have negative sentinel lymph nodes and 102 with positive sentinel lymph nodes. Propensity score matching (1:1) was performed using histological subtypes, tumor grades, myometrial invasion depths, and lymphovascular space and cervical stromal invasion statuses. Of the 102 patients found to have sentinel lymph node positivity, 73 were successfully matched to 73 patients from the negative group. RESULTS:After a median follow-up duration of 52 months, no statistical difference was noted between patients with positive and negative sentinel lymph nodes for 5-year disease-free survival (60.3% and 78.6%, respectively; p = 0.162) or 5-year overall survival (71.1% and 86.7%; p = 0.255). Multivariable analysis indicated that tumor grade 3 could independently predict decreased disease-free survival (HR: 3.04; 95% CI: 1.37-6.74; p = 0.006). However, no independent prognostic factors were determined for overall survival. CONCLUSION:After adjustment for uterine risk factors, sentinel lymph node status was no statistically significant independent association detected with survival outcomes. Prognosis was found to be shaped by an integrated set of uterine risk factors that included sentinel lymph node status, highlighting the need to individualize adjuvant treatment according to the complete tumor risk profile.

AIM:This study evaluated the feasibility and surgical outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for retroperitoneal sentinel lymph node biopsy (SLNB), specifically targeting obese and morbidly obese patients diagnosed with endometrial cancer (EC). METHODS:Pathohistological evaluation confirmed the diagnosis of either Grade I or II endometrioid EC in all participants. RESULTS:In total, 31 patients participated in this study. The median age was 56 [43-75] years and the median BMI was 34 [30-54] kg/m2. Near-infrared fluorescence imaging utilizing ICG was implemented in 17 cases (54.8%), while methylene blue dye was used in 14 cases (45.2%). A median, 4 sentinel lymph nodes (SLNs) were excised per patient, with numbers ranging from 1 to 7. The overall SLN detection rate was 90.3%, with unilateral detection in 9.7% of patients and bilateral detection in 80.6%. During the surgery, two complications occurred, and an additional two developed afterward. In 3.2% of cases, it was required to switch to a conventional laparoscopic procedure. Lymphatic metastases were identified in 3 patients (9.7%). The median hospital stay was 2 days. CONCLUSION:vNOTES can be a viable alternative to retroperitoneal SLNB, providing distinct benefits, especially for obese and morbidly obese patients with EC.

Objective: We aimed to compare the oncological outcomes of patients with bilateral sentinel lymph nodes (SLNs) detection and removed with those who underwent pelvic lymphadenectomy (PLA) in addition to bilateral SLNs removal. Methods: This multicenter, retrospective study included cases of endometrioid type, grade I-II endometrial cancer, in which bilateral SLNs were detected and removed. Patients who had only bilateral SLNs detected and removed (group I) and patients who had bilateral SLNs detected and removed and subsequent additional bilateral PLA (group II) were included in the evaluation. Results: In group I (n=216), SLN metastasis rate was 5.5% and in group II (n=251), it was 10.3%. The low-volume disease detection rate was 4.6% in group Iand 4.8% in group II. In group II, in patients with SLN macrometastasis had also 28.6% non-SLN macrometastasis. No false-negative results occurred in group II. Recurrence was detected 1.8% in group Iand 5% in group II; however, there was no significant difference (p=0.083). Disease-free survival and overall survival, were almost same between the groups (hazard ratio [HR]=2.11; 95% confidence interval [CI]=0.681-6.588; p=0.187) and (HR=1.531; 95% CI=0.392-5.975; p=0.537), respectively. Conclusion: SLN mapping, ultrastaging, and immunohistochemical staining can identify low-volume metastases that may not be identified with classic lymphadenectomy and hematoxylin & eosin staining. It has been observed that adding PLA beyond SLN mapping did not provide an additional positive contribution to survival. For endometriod type grade I-II patients, detection of bilateral SLNs in both hemipelvis only, if detectable, is an adequate approach.

Background and Objectives: Investigate whether there is an oncological benefit of performing back up systematic lymphadenectomy in addition to bilateral sentinel node biopsy. Methods: This multicentre retrospective study included patients with high-risk endometrial cancer treated at four gynaecological oncology clinics in Turkey between 2014 and 2023. Patients were stratified according to both conventional and ESGO risk criteria, and within each category were divided into two groups respectively "Sentinel Lymph Node Biopsy Group (SLN-only)" and "Back-up Lymphadenectomy Group (Back-up LND)". Disease-free survival (DFS) and overall survival (OS) were compared using univariate and multivariable Cox regression analyses. Results: 56 patients in the SLN-only group and 158 patients in the Back-up LND group comprised of the Conventional High-Risk Group (CONV-HR) in the analysis. There was no significant difference statistically in terms of DFS (Log-Rank P = 0.29) and OS (Log-Rank P = 0.99). The European Society of Gynaecologic Oncology (ESGO) High-Risk Group (ESGO-HR) consisted of 44 patients in the SLN-only group and 133 patients in the Backup LND group were included. The median follow-up periods were 27 months (IQR = 15-38) and 28 (IQR = 16-38) months, respectively. Recurrence rate was 14.1 % and mortality rate was 9.6 %. There was no significant difference statistically in terms of DFS (Log-Rank P = 0.342) and OS (Log Rank P = 0.488). Conclusion: Sentinel lymph node biopsy is a safe and effective method for lymph node assessment in high-risk and clinical early-stage endometrial cancer. The addition of systematic lymphadenectomy did not provide any oncological benefit in terms of survival outcomes.

AIM:This study evaluated predictors and treatment of isolated vulvar recurrence (IVR) in patients with stage I-II tumors locally confined to the vulva. METHODS:We retrospectively collected data from patients with stage I-II vulvar squamous cell carcinoma (VSCC) who underwent surgery for vulvar cancer between 2005 and 2021. The IVR group comprised patients with stage I-II tumors at the time of initial diagnosis who developed recurrence confined to the vulvar region after initial treatment. RESULTS:This study included 416 patients with early-stage (stage I-II) VSCC. IVR was developed in 67 (16.1%) patients; the remaining 349 patients were included in the control group. Independent predictors of IVR were depth of invasion, perineural invasion, and positive surgical margins. Among patients with tumors confined to the vulva at the time of initial diagnosis, the 5-year overall survival rates were 59.0% and 87.0% in the IVR and control groups, respectively (P < 0.001). In the IVR group, the cumulative rates of local relapse were 38.8% in the first year, 58.2% in the second year, and 74.6% in the third year. CONCLUSION:Independent predictors of IVR in early-stage VSCC were depth of invasion, perineural invasion, and positive surgical margins. Approximately two-thirds of local recurrences occurred in the first 3 years after treatment.

Background: The aim of this study was to compare survival outcomes, short-term postoperative morbidity and mortality in patients undergoing primary debulking surgery (PDS) and receiving neoadjuvant chemotherapy (NACT). Methods: This study is a single center retrospective clinical study. We evaluated 196 patients with advanced stage epithelial ovarian cancer (EOC). The treatment approach was based on the patient's performance status (PS), preoperative radiological evaluation and diagnostic laparoscopic evaluation. Overall survival (OS) and progression-free survival (PFS) were compared for stage III-IV and IIIC alone according to the amount of residual tumor which determines the prognosis. Kaplan-Meier method was used for survival curves and Long-Rank test was used for survival comparisons. Pearson Chi-square test was used to compare categorical variables. Results: Out of 196 patients, 127 (64.7%) underwent PDS and 69 (35.2%) received NACT due to the comorbities, poor PS and unresectable tumor burden. In both groups most of the patients had stage IIIC and serous histology. NACT group had significantly older age, poorer PS, higher rates of recurrence and mortality. Complete and optimal cytoreduction were similar in both groups (PDS: 43.3% and 40.2% versus NACT: 33.3% and 50.7%, respectively). Complete resection was observed to prolong PFS and OS in PDS. In patients with stage IIIC, the effect of PDS on OS is superior. Because of the low number of patients in stage IVA-B, OS and PFS were found insignificant in both groups. The 30-day post-operative complication rate was higher in the NACT group (p < 0.001). Conclusions: PDS should be preferred initial treatment for patients with III-IV EOC. NACT should be considered for patients who are not medically fit for surgery and/or for whom complete cytoreduction is not feasible.

Objective:The aim of this study was to investigate the timing of recurrence in patients with early-stage endometrial cancer and to determine the optimal postoperative follow-up protocol for the detection of recurrence. Material and Methods:Patients with stage 1 and 2, grade 1-3 endometrioid type endometrial cancer who underwent follow-up for at least two years were included. The diagnostic method for recurrence was analyzed for each patient. Analysis of risk factors for recurrence were done using SPSS. Sensitivity analyzes were performed comparing the diagnostic methods. Results:A total of 303 patients were included and recurrence was diagnosed in 17 (5.61%). Cumulative risk of recurrence was 3.06% in the first 23 months, rising to 7.52% in the first 33 months. Sensitivity of physical examination (PE) was 50.00%, specificity 99.52%, positive predictive value 88.89%, negative predictive value 96.30% and accuracy rate 96.00% respectively. It was found that each step increase of grade increased recurrence odds by 2.549 times [95% confidence interval (CI): 1.078-6.027; p=0.033] while each step increase of stage increased recurrence odds by 2.943 times (95% CI: 1.270-6.820; p=0.012). Conclusion:It is notable that recurrence rate increased after 25 months and the risk of recurrence increased as the tumor stage and grade worsened. Symptoms in patients with high-grade and deep myometrial invasion, especially after the first two years, should be considered risky and patients should be informed about seeking medical care when symptoms occur. PE and symptoms of patients are key factors in detecting reccurence while other diagnostic methods can be used according to clinical findings.

BACKGROUND:Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is gaining increasing popularity among gynaecological surgeons worldwide due to its minimally invasive nature and associated benefits. However, despite its growing adoption, it remains a relatively novel surgical technique that continues to be evaluated and refined in clinical practice. The primary objective of this study is to share and analyse our initial experiences with the implementation of vNOTES hysterectomy across six specialised gynaecological centres in Turkey. METHODS:This retrospective analysis included all women who underwent vNOTES hysterectomy, with or without salpingo-oophorectomy, for benign or malignant conditions. All procedures adhered to the standardised protocol described by Baekelandt et al. Data on baseline patient characteristics, intraoperative details, and postoperative outcomes were collected and analysed. RESULTS:A total of 685 patients underwent vNOTES procedures. Among them, 64 women (9.3%) had a history of one caesarean delivery, 38 (5.5%) had two prior caesareans, and 11 (1.6%) had three or more. Myoma, with or without accompanying metrorrhagia, was the most common surgical indication (53.0%). The mean operative time was 72.4 ± 40.2 min, and the average haemoglobin decrease was 1.3 ± 1.0 g/dL. The mean uterine weight was 204 ± 145 g. Intraoperative complications occurred in 1.7% of cases (n = 12), while postoperative complications were observed in 1.4% (n = 10). Conversion to conventional laparoscopy occurred in six cases (0.9%), primarily due to an obliterated pouch of Douglas or intraoperative complications. The average hospital stay was 2.3 ± 1.4 days. CONCLUSIONS:These findings support vNOTES as a safe and effective surgical approach, offering a viable alternative to traditional laparoscopic or vaginal techniques in select patient populations.

Background: The purpose of this research was to determine the key factors that can predict the outcomes of secondary cytoreductive surgery and the criteria for selecting patients that would result in improved survival rates. Methods: The retrospective study analyzed a cohort of 97 individuals who were diagnosed with platinum-sensitive epithelial ovarian cancer at the Gynecologic Oncology Unit from 1990 to 2012, and who had undergone surgery for recurrence following initial treatment, which included primary surgery and adjuvant chemotherapy. Surgical intervention was recommended for patients who had a median disease-free interval (DFI) of at least 6 months from their initial treatment to the recurrence, and who exhibited an Eastern Cooperative Gynecologic Oncology Group performance status of 2 or lower. All patients were treated with platinum-based chemotherapy or other chemotherapy regimens in the postoperative period. Results: The DFI was 24.5 months (95% confidence interval (CI): 18.2-30.7). Optimal secondary cytoreduction was achieved in 63 (64.9%) patients, with a significant increase in survival compared to patient groups with suboptimal cytoreduction (142.9 months vs. 42.2 months and 33.7 months) (p < 0.001). Survival was significantly increased in patients with a DFI >14 months (p = 0.002). Multivariate analysis revealed that disease-free interval (DFI) and the presence of residual disease following secondary surgery emerged as pivotal independent predictors of survival. Conclusions: Secondary cytoreductive surgery stands out as a secure and efficient therapeutic approach for recurrent epithelial ovarian cancer, leading to a decrease in complication rates. Employing maximal surgical interventions notably extends patients' survival times.