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Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

Background Sexual dysfunction is common following a cancer diagnosis in young adulthood (18–39 years) and problems related to sex life are ranked among the core concerns in this age group. Yet, few studies have investigated to what extent adults younger than 40, receive information from healthcare providers about the potential impact of cancer and its treatment on their sex life. Methods A population‐based cross‐sectional survey study was conducted with 1010 young adults 1.5 years after being diagnosed with cancer (response rate 67%). Patients with breast, cervical, ovarian and testicular cancer, lymphoma, and brain tumors were identified in national quality registries. Sociodemographic and clinical factors associated with receiving information were examined using multivariable binary logistic regression. Results Men to a higher extent than women reported having received information about potential cancer‐related impact on their sex life (68% vs. 54%, p < 0.001). Receipt of information varied across diagnoses; in separate regression models, using lymphoma as reference, both women and men with brain tumors were less likely to receive information (women: OR 0.10, CI = 0.03–0.30; men: OR 0.37, CI = 0.16–0.85). More intensive treatment was associated with higher odds of receiving information in both women (OR 1.89; CI = 1.28–2.79) and men (OR 2.08; CI = 1.09–3.94). None of the sociodemographic factors were associated with receipt of information. Conclusions To improve sexual health communication to young adults with cancer, we recommend diagnosis‐specific routines that clarify when in the disease trajectory to discuss these issues with patients and what to address in these conversations. Young women with cancer report having received information about potential treatment‐related impact on sex life to a lesser extent than men, and there is also a variation across cancer types. The majority of recipents recalled being informed that there was \"some risk\" of sex life being affected, see figure below. Routines clarifying when to discuss these issues are recommended to improve sexual health communication with young patients in cancer care.

Primary vaginal carcinoma (PVC) is a rare malignancy. Established prognostic factors include tumour stage and age at diagnosis. The leucine-rich repeats and immunoglobuline-like domains (LRIG)-1 protein functions as a tumour suppressor, but less is known about the functions of LRIG2 and LRIG3. The present study aimed to evaluate the expression of LRIG proteins and analyse their possible associations with clinical characteristics and survival in a cohort of PVC patients. We used immunohistochemistry to investigate LRIG1, LRIG2, and LRIG3 expression in tumour samples from a consecutive cohort of 70 PVC patients. The association between LRIG protein expression and clinical characteristics and cancer-specific survival was investigated using univariate and multivariate analyses. The majority of PVC patients (72%) had >50% LRIG1- and LRIG2-positive cells, and no or low LRIG3-positive cells. HPV status was significantly correlated with LRIG1 expression (p = 0.0047). Having high LRIG1 expression was significantly correlated with superior cancer-specific survival in univariate and multivariate analyses. LRIG2 and LRIG3 expression did not significantly correlate with clinical characteristics or survival. LRIG1 expression might be of interest as a prognostic marker in PVC patients, whereas the role of LRIG2 and LRIG3 expression remains to be clarified.

P34 and P37 are two previously identified RNA binding proteins in the flagellate protozoan Trypanosoma brucei. RNA interference studies have determined that the proteins are involved in and essential for ribosome biogenesis. The proteins interact with the 5S rRNA with nearly identical binding characteristics. We have shown that this interaction is achieved mainly through the LoopA region of the RNA, but P34 and P37 also protect the L5 binding site located on LoopC. We now provide evidence to show that these factors form a novel pre-ribosomal particle through interactions with both 5S rRNA and the L5 ribosomal protein. Further in silico and in vitro analysis of T. brucei L5 indicates a lower affinity for 5S rRNA than expected, based on other eukaryotic L5 proteins. We hypothesize that P34 and P37 complement L5 and bridge the interaction with 5S rRNA, stabilizing it and aiding in the early steps of ribosome biogenesis.

The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10–GEICO 68-C–JGOG1084–GOG-3030), we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone. In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing. Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3–16·6) with atezolizumab and 10·4 months (9·7–11·7) with standard therapy (hazard ratio [HR]=0·62 [95% CI 0·49–0·78]; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3–36·8) versus 22·8 months (20·3–28·0), respectively (HR 0·68 [95% CI 0·52–0·88]; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1–2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab. Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. F Hoffmann-La Roche.

Background As the choice of treatment in patients with cervical carcinoma depends on cancer stage at diagnosis, accurate staging is essential. Purpose To compare three different combinations of magnetic resonance (MR) sequences for preoperative staging. Material and Methods Fifty-seven consecutive patients with biopsy proven cervical carcinoma underwent MR imaging (MRI) staging followed by primary surgical treatment. Thirty-two of 57 patients had had a cone biopsy prior to MRI. Three MR pulse sequence combinations were retrospectively reviewed by two experienced radiologists. The first imaging protocol consisted of pre-contrast sagittal and transverse images (protocol A), the second protocol included additionally oblique high-resolution T2-weighted (T2W) MR images of the cervix (protocol A+B), and the third included also contrast-enhanced sequences (protocol A+B+C). The imaging findings in the three steps (A, A+B, A+B+C) were recorded. The TNM stage was used for comparison between preoperative imaging and histopathology. Histopathology, together with surgical findings, served as gold standard. Results In 4/57 (7%) patients, the MR assessment of tumor stage (mrT) was altered when oblique sequences were added to the standard two plane imaging protocol (A+B). The mrT stage was altered in 1/57 (2%) patient when contrast-enhanced sequences were added to standard and oblique sequences (protocol A+B+C). The correlation between visible tumor on MRI and presence of tumor in the resected specimen did not change by adding oblique or contrast-enhanced images. Conclusion It is not necessary to perform oblique and contrast-enhanced sequences in small cervical carcinomas, i.e. without parametrial invasion. To avoid erroneous interpretation, information on previous cone biopsy is essential.

Purpose To examine health-related quality of life (HRQoL) and supportive care needs among young adult (YA) cancer survivors up to 3 years post-diagnosis. Methods A national cohort of individuals diagnosed at 18–39 years with breast, cervical, ovarian, or testicular cancer, lymphoma or brain tumor was approached with surveys at 1.5 ( n  = 1010, response rate 67%) and 3 ( n  = 722) years post-diagnosis. HRQoL was measured using the EORTC QLQ-C30. Scores were dichotomized using cut-off scores to predict supportive care needs in the Supportive Care Needs Survey-Long Form 59 (SCNS-LF59). Swedish cancer quality registers provided clinical data. Factors predicting need of support at 1.5 and 3 years post-diagnosis were identified using logistic regression. Results HRQoL improvements over time were trivial to small. At both time points, a majority of respondents rated HRQoL levels indicating supportive care needs. At 1.5 years post-diagnosis, the risk of having support needs was lower among survivors with testicular cancer (compared to lymphoma) or university-level education, and higher among those on treatment (predominantly endocrine therapy). At 3 years post-diagnosis, when controlling for previous HRQoL scores, most correlations persisted, and poor self-rated household economy and chronic health conditions were additionally associated with supportive care needs. Conclusion A majority of YAs diagnosed with cancer rate HRQoL at levels indicating support needs up to 3 years post-diagnosis. Testicular cancer survivors are at lower risk of having support needs. Concurrent health conditions and poor finances are linked to lower HRQoL. More efforts are needed to provide adequate, age-appropriate support to YA cancer survivors.

Introduction/BackgroundNon-epithelial ovarian cancer (NEOC) accounts for 6% of all ovarian cancer in Sweden and are divided into germ cell tumours (GCTs), sex cord-stromal tumours (SCSTs) and other more uncommon subtypes. Only a few population-based studies of NEOC have been published. The aim of this study was to provide additional knowledge about these rare tumours by analysing population-based high-validity Swedish register data.MethodologyAll women with NEOC registered in the Swedish Quality Registry for Gynecological Cancer between 2008 and 2022 were included. Cox proportional hazard was used in survival analyses.Results718 patients were diagnosed with NEOC; 187 with GCTs, 459 with SCSTs, and 72 with other subtypes. Median age at diagnosis was 32 years for GCTs (range 18–83) and 57 years (range 18–93) for SCSTs. Although most patients were diagnosed at FIGO stage I (GCTs: 73.2%; SCSTs: 85.8%), the primary tumour was often ≥10 cm (GCTs: 74.0%; SCSTs: 55.0%).The majority of patients underwent primary surgery. Macroscopic radicality was achieved in 96.5% and 97.6% of the GCT and SCST patients, respectively. Most young GCT patients had fertility sparing surgery.After a median follow-up of 5.6 years (GCT; range 0.1–15.2 years) and 6.6 years (SCST; range 0.1–15.4 years), 89.6% of GCT and 91.8% of SCST patients were cancer free. Overall survival was 89.8% for GCT and 88.2% for SCST patients.Age ≥35 years at diagnosis was associated with worse survival in GCTs [HR 24.3, 95%CI 3.25–182.2]. Higher age at diagnosis was also associated with worse survival in SCSTs [per year: HR 1.08, 95%CI 1.06–1.11]. Advanced stage was associated with worse prognosis in both GCTs and SCSTs [e.g. SCSTs stage III versus stage I: HR 11.32, 95%CI 5.26–24.33].ConclusionThe overall survival was high in this population-based study of NEOC in Sweden. Higher age at diagnosis and advanced stage were adverse prognostic factors.DisclosuresNothing to disclose.Abstract 1043 Figure 1

Introduction/BackgroundTo investigate time to chemotherapy (TTC) from primary debulking surgery (PDS) and relative survival (RS) in advanced epithelial ovarian cancer (EOC) in a nationwide population-based cohort.MethodologyAll women diagnosed with EOC, stage IIIC-IV and registered in the Swedish Quality Register for Gynecologic Cancer between 2008–2018 with PDS performed followed by chemotherapy were included. Patient and tumor characteristics including no (R0) or residual disease (RD), were retrieved. The TTC was categorized into five groups. The 2- and 5-year RS (95%CI) were calculated and uni- and multivariable Poisson regression of excess mortality rate ratios (EMRRs) analyzed with covariates; TTC, age, FIGO stage, serous and non-serous histology and residual disease.ResultsIn total, 1710 women were included. The mean age was 64.3 years. R0 was achieved in 47.7%; 39.0% of 292 women with TTC <21 days, 46.9% of 360 with 22–28 days, 48.5% of 392 (29–35 days), 52.1% of 303 with 36–42 days and 51.0% of 363 women with TTC >42 days, respectively. In the total cohort, age <70 years, stage IIIC, serous histology and R0 were found significant prognostic factors for 5-year RS but not TTC. Two-year RS for FIGO stage IV and R0 was 92.9% (82.8–1.00) for TTC <21 days compared with 66.3% (50.8–81.8) for TTC >42 days. The corresponding figures for stage IIIC and R0 were 91.0% (84.7–97.4) and 82.4% (75.8–89.0), respectively. Five-year RS for FIGO stage IV and R0 was 67.2% (48.0–86.3) for TTC <21 days and 42.6% (25.2–59.9) for TTC > 42 days. The corresponding 5-year RS for stage IIIC and R0 were 56.4% (45.2–67.6) and 51.6% (42.8–60.5), respectively.ConclusionOur data indicate that TTC after PDS may be associated with short-term survival among stage IV disease without residual disease. Updated results with EMRR data for subgroups will be presented.DisclosuresThe authors declare no conflicts of interest.

Primary vaginal cancer (PVC) is a rare gynaecological malignancy, which, at present, lacks appropriate biomarkers for prognosis. The proteins dyskerin and WD repeat containing antisense to TP53 (WRAP53[beta]), both of which exert their functions in the telomerase holoenzyme complex, have been shown to be upregulated in different cancer types. These proteins have also been proposed as prognostic markers in some types of cancer. The aim of the present study was to examine the expression patterns of dyskerin and WRAP53[beta] in patients with PVC. Moreover, as part of a search for effective biomarkers to evaluate prognosis in PVC, the expression of these two proteins and their potential association with clinical variables and survival were also evaluated. The expression of dyskerin and WRAP53[beta] was assessed in PVC tumour samples from 68 patients using immunohistochemistry. The majority of tumour samples showed low and moderate expression levels of dyskerin. Upregulation of dyskerin in tumour samples was significantly associated with a shorter survival time and a poorer cancer-specific survival rate. WRAP53[beta] was also expressed in most of the cells but was not significantly associated with clinical variables or survival. This study demonstrates that upregulation of dyskerin is significantly associated with poor prognosis. Thus, dyskerin may serve as a promising prognostic marker and a potential putative therapeutic target in PVC.