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Background Recurrent endometrial cancer is still associated with poor survival rates. Daily life factors and comorbidities influence adherence to oncologic treatment. This study provides multicenter real-world data on patients life conditions and tumor’s characteristics, which might contribute to treatment decision-making. Materials and methods The study was performed retrospectively in five centers for gynecologic oncology. All patients treated for recurrent endometrial cancer between 2005 and 2022 were included, regardless of whether they received curative or palliative, surgical or medical treatment. Data collection was performed using the RedCap ® software (Research Electronic Data Capture). Results In total, 277 patients with recurrent endometrial cancer were included in the study. The median age at time of recurrence was 70 years. 68.3 % of the patients had distant metastases, most of them (41 %) had pulmonary metastases. 63.9% of the patients had pelvic recurrences. 30.7 % of the patients had a second recurrence and 49.6 % of all patients died during the follow-up. 86.3 % of patients died due to endometrial cancer. Polypharmacy as an indicator of frailty was analyzed revealing that 34.2 % of the patients took more than five different drugs per day. Conclusion The findings of this study indicate that the majority of patients with recurrent endometrial cancer undergo tumor-specific treatment rather than best supportive care. However, in cases of recurrence, the carcinoma itself remains a very frequent cause of death. Considering that a significant number of patients are living independently at the time of diagnosis, this study may contribute to treatment plans that prioritize strategies that enable patients to stay at home and maintain their autonomy. Key message The present study suggests that most patients with recurrent endometrial cancer are in relatively good overall health, allowing them to undergo anti-tumor treatment. In general, they live independently and prefer active treatment over best supportive care.

Background Accurate preoperative molecular and histological risk stratification is essential for effective treatment planning in endometrial cancer. However, inconsistencies between pre- and postoperative tumor histology have been reported in previous studies. To address this issue and identify risk factors related to inaccurate histologic diagnosis after preoperative endometrial evaluation, we conducted this retrospective analysis. Methods We conducted a retrospective analysis involving 375 patients treated for primary endometrial cancer in five different gynaecological departments in Germany. Histological assessments of curettage and hysterectomy specimens were collected and evaluated. Results Preoperative histologic subtype was confirmed in 89.5% of cases and preoperative tumor grading in 75.2% of cases. Higher rates of histologic subtype variations (36.84%) were observed for non-endometrioid carcinomas. Non-endometrioid (OR 4.41) histology and high-grade (OR 8.37) carcinomas were identified as predictors of diverging histologic subtypes, while intermediate (OR 5.04) and high grading (OR 3.94) predicted diverging tumor grading. Conclusion When planning therapy for endometrial cancer, the limited accuracy of endometrial sampling, especially in case of non-endometrioid histology or high tumor grading, should be carefully considered.

Background The integration of immune checkpoint inhibitors (ICIs) into routine gynecologic cancer treatment requires a thorough understanding of how to manage immune-related adverse events (irAEs) to ensure patient safety. However, reports on real-world clinical experience in the management of ICIs in gynecologic oncology are very limited. The aim of this survey was to provide a real-world overview of the experiences and the current state of irAE management of ICIs in Germany, Switzerland, and Austria. Methods We designed a questionnaire consisting of 34 items focused on physicans’ clinical experiences with ICIs and their management of irAEs. The survey was distributed between October 2022 and May 2023 to medical professionals with experience in the field of gynecologic oncology. Results A total of 221 gynecologists participated in the study. Most respondents ( n  = 130, 59.1%) were primarily engaged in gynecologic oncology at the time of the survey, with an average of ten years of clinical experience. Individual experiences with regard to irAEs varied significantly. When asked which irAEs they had observed “frequently” or “very frequently”, respondents most commonly reported thyroiditis (37.2%), followed by skin reactions (23.6%), and pneumonitis (10.6%). A total of n  = 16 (7.4%) reported at least one death of a patient due to irAEs. Feeling “unconfident” or “very unconfident” about managing irAEs was reported by 35.6% ( n  = 78). With regard to clinical management of adverse events after discontinuation of treatment, 32.4% ( n  = 68) ceased to inquire about irAEs after six months. Conclusion The results of this survey provide valuable insights into physicians’ real-world experiences with irAEs associated with ICI treatment. Dealing with serious immune-related and potentially life-threatening side effects has become a routine aspect of clinical practice. Many physicians, however, express a lack of sufficient familiarity with irAEs and their management. Therefore, it is essential to improve medical education, specialized oncological training, and close interdisciplinary collaboration to improve patient care.

Background Patients undergoing extended multivisceral, non-cardiac surgery require a high demand for intravenous fluid administration, leading to substantial positive fluid balances. This study aimed to perioperatively characterize extravasation as a correlate of capillary leakage and micro-arterial regulation, as well as venous return characteristics, as possible causes for the positive fluid balances. Methods In this single center, observational trial we included patients undergoing abdominal debulking surgery due to ovarian cancer. The measurements were performed by a venous congestion plethysmography (VCP) protocol to determine extravasation, micro-arterial reagibility, and after deflation of congestion venous outflow characteristics at timepoints before and during surgery, and repeatedly during the postoperative course. Results Thirty patients with primary ovarian cancer undergoing cytoreductive surgery treated within a goal-directed hemodynamic algorithm (GDA) based on the esophageal Doppler were included in the analysis. Stroke volume index did not change throughout the procedure with an increase in heart rate and consequently an increase in cardiac index. The norepinephrine requirements to maintain mean arterial pressure increased during surgery. Patients received a median 1750[25-quartile 1075;75-quartile 2100]ml crystalloids and 1000[1000;1500]ml starches, transfusions of 0[0;1040]ml red-packed cells, and 360[0;2880]ml fresh-frozen plasma. The intraoperative fluid and blood loss of 1020[508;1695]ml resulted in a positive fluid balance (2820[1338;6075]ml). Extravasation did not increase during surgery, even in the presence of substantially positive fluid balances. On the third and fifth postoperative days, extravasation increased relative to the preoperative baseline value. The micro-arterial function deteriorated throughout the course of the surgery, recovering to baseline values within 4 h after surgery. The venous outflow characteristics of the limb after releasing the venous congestion deteriorated over the course of surgery. Conclusions There was no increase in extravasation measured by VCP during surgery despite a substantial intraoperative positive fluid balance, showing that they were not associated with each other. The micro-arterial function and venous backflow characteristics deteriorated during surgery, indicating that vascular dilation rather than capillary leakage may contribute to the high fluid demands. Trial registration : ClinicalTrials.gov identifier: NCT01311297.

Background: Chromosomal instability, a hallmark of cancer, results in changes in the copy number state. These deviant copy number states can be detected in the cell-free DNA (cfDNA) and provide a quantitative measure of the ctDNA levels by converting cfDNA next-generation sequencing results into a genome-wide copy number instability score (CNI-Score). Our aim was to determine the role of the CNI-Score in detecting epithelial ovarian cancer (EOC) and its role as a marker to monitor the response to treatment. Methods: Blood samples were prospectively collected from 109 patients with high-grade EOC. cfDNA was extracted and analyzed using a clinical-grade assay designed to calculate a genome-wide CNI-Score from low-coverage sequencing data. Stored data from 241 apparently healthy controls were used as a reference set. Results: Comparison of the CNI-Scores of primary EOC patients versus controls yielded sensitivities of 91% at a specificity of 95% to detect OC, respectively. Significantly elevated CNI-Scores were detected in primary (median: 87, IQR: 351) and recurrent (median: 346, IQR: 1891) blood samples. Substantially reduced CNI-Scores were detected after primary debulking surgery. Using a cut-off of 24, a diagnostic sensitivity of 87% for primary and recurrent EOC was determined at a specificity of 95%. CNI-Scores above this threshold were detected in 21/23 primary tumor (91%), 36/42 of platinum-eligible recurrent (85.7%), and 19/22 of non-platinum-eligible recurrent (86.3%) samples, respectively. Conclusion: ctDNA-quantification based on genomic instability determined by the CNI-Score was a biomarker with high diagnostic accuracy in high-grade EOC. The applied assay might be a promising tool for diagnostics and therapy monitoring, as it requires no a priori information about the tumor.

BackgroundPatients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry.MethodsIn a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien–Dindo classification were used as a grouping criterion.ResultsThe relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median – 19 [25-quartile − 26%; 75-quartile − 10%]%, p < 0.0001), stroke volume index (SVI, − 9.5 [− 15.3; 3.2]%, p = 0.0038), cardiac index (CI, − 24.5 [− 32; − 13]%, p < 0.0001) and index of contractility (− 17.5 [− 35.3; − 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery.ConclusionsSubstantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.

OBJECTIVEOvarian cancer (OC) recurrence constitutes a therapeutic dilemma with various novel targeted agents emerging that offer alternative treatment options. The aim of the present study was to evaluate and compare epithelial cell adhesion molecule (EpCAM) expression profiles in paired tumor samples of patients with OC relapse. METHODSEpCAM expression was analyzed by immunohistochemistry using the avidin-biotin-complex method on paraffin-embedded OC tissues obtained at primary surgery as well as on corresponding tumor samples of the same patients at relapse. The EpCAM overexpression was defined as 76% to 100% of tumor cells positively stained for EpCAM. Clinical data were collected within the Tumorbank Ovarian Cancer Network. RESULTSNineteen patients with serous OC histology were included in the study (median age at primary diagnosis, 50 years; range, 40–74 years). The majority of the patients (95%) presented with International Federation of Gynecology and Obstetrics stage III/IV, and 68.4% of the tumors were poorly differentiated. A complete macroscopic tumor resection could be achieved in 15 patients (78.9%) at diagnosis. Epithelial cell adhesion molecule overexpression was detected in 17 (89%) of the primary and 16 (84%) of the recurrent tumors (P = 1.0); hence, no significant change of the EpCAM expression profile could be identified over time. CONCLUSIONSEpithelial cell adhesion molecule expression profile appears to remain stable during the course from the primary throughout the relapse of serous OC. The results indicate that EpCAM might be an interesting therapeutic target structure in serous OC.

OBJECTIVESarcomas of the female genital tract are rare tumors. They are described to be associated with a poor prognosis when compared with gynecogical carcinoma. The aim of this study was to report incidence patterns and survival rates for gynecological sarcoma (GS) in Germany. METHODS/MATERIALSClinical data and survival rates for patients with GS diagnosed in Germany between 2009 and 2013 were extracted from the German national center for population-based cancer registry data. Incidence patterns and 5-year relative survival rates were calculated. RESULTSA total of 1066 GSs were included in our analysis during a 5-year time span. The uterus was the most common site, with 87.9% of all cases. The annual age-standardized incidence rate (old European standard) was 8.7 per 1 million women for all GSs. The median age at diagnosis was 59 years. The prognosis ranged according to site, stage, and subtype, for example, from a 5-year relative survival of 53.0% (uterine leiomyosarcoma) if confined to the pelvis, to a very good 5-year relative survival of 97.2% (endometrial stromal sarcoma). CONCLUSIONSDespite the rareness of GS, the size of the data set allows for a differentiation of subtypes according to morphology and site of origin. Clinically relevant differences in incidence and prognosis between subgroups were observed.