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Endometrial cancer remains one of the most common malignancies in women, and its incidence is particularly increasing in developed countries. Despite the well-known promotive role of excessive exposure to estrogen, many other details of the pathogenesis of endometrial cancer remain unknown. Recent studies have elucidated the emerging role of the resident microbiota in the progression of various diseases, including cancer. Next-generation sequencing demonstrated that the uterine cavity, previously considered sterile, contains a composition-rich microbiota. In this work, we determined the differences in the composition of the intrauterine microbiota between patients with endometrial cancer and its precursor—endometrial hyperplasia.

Endometrial cancer (EC) is the most common malignancy of the female reproductive system in Sweden. Patients with EC generally have a good prognosis, though some face recurrence and have a lower survival rate despite treatment. Current prognostic factors for EC are still not able to accurately reflect disease prognosis.Therefore, the overall aim of the present project was to evaluate the impact of different, patient-specific factors on the prognosis of women with EC, with a special focus on the LRIG family of proteins, cadmium, dietary factors, daily routines, and the endometrial microbiome. Identifying these factors could pave the way for better determination of EC prognosis.Study I analysed the role of LRIG1, LRIG2, and LRIG3 proteins on survival rates in women with EC. The analysis demonstrated that most patients had >50% positive cells for all three LRIG proteins. The LRIG1 protein score was high in most patients (97.3%). The percentage of LRIG3-positive cells was positively associated with better overall survival (P=0.019). There was no LRIG3 cell membrane staining in 30.4% of women who died, compared to 7.7% of EC survivors (P=0.01). Consequently, the results reveal a potential prognostic role of LRIG3, not LRIG1 and LRIG2, in EC.Study II assessed the role of cadmium intake on the survival of 416 women with EC residing in Sweden. Median dietary cadmium intake was 13.1 μg/day. High dietary cadmium intake was associated with lower overall survival (P=0.05), but not with progression-free survival (P=0.348). Accordingly, high dietary cadmium intake seems to be an adverse prognostic factor in EC.Study III evaluated the prognostic role of modifiable factors, such as dietary habits and daily routines, in EC using machine learning models. Among the 186 variables considered, consumption of sugar-sweetened beverages and fried potatoes increased the risk of EC recurrence and death, while physical activity decreased the risk of death. As a consequence, modification of specific dietary habits and daily routines might favourably impact EC prognosis.Study IV investigated the role of endometrial microbiota in women with EC and compared it to the bacterial profile of women with benign conditions of the gynaecological tract (endometrial hyperplasia, EH or endometrial polyp, EP). Most women in the EC and EH/EP groups were postmenopausal and had a BMI above the normal range. The median age in the EC group was 10 years higher than that in the EH/EP group. The preliminary analysis showed that patients with EC have endometrial microbiota distinct from that of patients with EH/EP: Atopobium and Porphyromonas were present in patients with EC, while Lactobacillus was present in those with EH/EP. Thereby, endometrial microbiota might play a role in EC prognosis.To conclude, this thesis provides additional knowledge on certain molecular and nonmolecular factors that might play a role in EC, including its prognosis. Moreover, it emphasises the importance of continued investigation of other potential prognostic factors in EC.

Introduction/BackgroundIn 2022, over 8.2 million refugees were recorded across Europe after the Russian invasion in Ukraine. As every human crisis, the war is associated with changes in access to medical care. Due to the cervical cancer pathogenesis, results of compromised prevention may become visible after years since the beginning of war. The aim of the study was to evaluate experience of European centres in cervical cancer prevention among Ukrainian refugees.MethodologyThis was a cross-sectional questionnaire based study. Questionnaires were distributed among clinicians from the European Network of Young Gynae Oncologists (ENYGO) network until August 2022. Our survey included questions about managing patients who voluntary reported exclusively for the purpose of cervical cancer screening or treatment of preinvasive cervical lesions.ResultsOur analysis included data obtained from 38 respondents practicing in Germany, Hungary, Italy, Norway, Poland, Romania, Slovenia, Spain, Turkey, and the UK. More than one third of these centres were accredited by the European Society of Gynaecological Oncology (ESGO).Seven (17%) centres reported participation in Ukrainian refugees gynaecological cancer prevention measures. Seven (17%) respondent sites collected Pap smear or human papillomavirus (HPV) test. Three (7%) centres reported demand for HPV vaccination from the Ukrainian refugees.Seven (17%) clinical centres managed Ukrainian refugees with precancerous cervical lesions. More than half of these patients (54%) required primary invasive treatment. 15% were admitted for continuation of treatment. 7% required follow-up after treatment. 23% underwent further diagnostic regimen without indication for invasive treatment.ConclusionPrevention and treatment of cervical lesions in terms of war in Ukraine pose significant challenge both for European healthcare providers and Ukrainian refugees. The results obtained in present study show that even in specialized oncologic centres, which are mostly dedicated to treat invasive disease, Ukrainian refugees report and require both preventive and curative services of cervical lesions.DisclosuresNothing to disclose

Introduction/BackgroundThe increased life expectancy and westernization of the lifestyle are considered the major contributors to a sustainable rise in endometrial cancer (EC) rates. The factors predicting EC recurrence include patient age and tumour characteristics, such as type, differentiation, and depth of invasion. At the same time, recent studies testify the impact of meal and exercises on the course of various diseases. What are the food preferences and activities that could influence the ultimate risk of EC relapse and death?MethodologyThe study included 481 women who previously underwent a hysterectomy due to EC at Karolinska University Hospital. The participants filled an extensive questionnaire on their dietary habits and everyday routines. Related clinical data was obtained through the National e-health system. It resulted in a large dataset with more than 180 variables, which was processed using the Random Survival Forest (RSF) approach. The latter is applied to a right-censored data and uses a collection of decision trees to rank the variables by their importance for the occurrence of an event. The top-ranked variables were further investigated with the Cox proportional hazards model. Analyzes were performed using the RandomForestSRC package for Python.ResultsThe consumption of the fried potatoes significantly increased the risk of EC relapse and death [HR=8.62 (2.22–33.56), p=0.002; HR=6.00 (1.06–34.01), p=0.043, respectively), the latter persisted after adjustment for body mass index, age and smoking status. Besides, each additional serving of sweetened soda drinks increased the risk of death [3.262 (1.834–5.800), p=0.0001]. In contrast, physical activity was beneficial with each additional Metabolic Equivalent per day decreasing the risk of death by 7.3% [HR=0.927 (0.892–0.964), p< 0.0001).ConclusionWe hypothesise that the fried potatoes’ detrimental effect may be related to the acrylamide, which is formed in starch-rich foods under high-temperature conditions. It acts as a carcinogen and endocrine disruptor, causing the endometrial hyperplasia and EC in animal studies. Sweetened beverages cause a rise in insulin, which in turn inhibits sex-hormone binding protein. This results in higher levels of circulating free oestrogens. Also, insulin has mitogenic and anti-apoptotic properties, further inducing the endometrium proliferation. The favorable influence of regular physical activity on EC relapse and death is in accordance with previous studies, including recent meta-analysis.Therefore, we encourage women treated for EC to consider reducing sweetened beverages and fried potatoes consumption and increasing physical activity.DisclosuresThe authors have nothing to disclose.

Introduction/BackgroundExposure to platinum and taxane-based chemotherapy is associated with the risk of developing hypersensitivity reactions (HSRs), which may necessitate the use of less effective treatments to avoid anaphylaxis. Desensitisation to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen; therefore, this study investigated the current management of HSRs to platinum and/or taxane chemotherapy in patients with gynaecological cancers.MethodologyWe conducted a cross-sectional survey among gynaecological and medical oncologist consisting of 33 questions. SurveyMonkey software was used to create and distribute the questionnaire. The survey was posted online on the ENYGO and Oncoalert social media channels and data were collected from 1) members of ENYGO and ESGO and 2)ESGO/ENYGO followers.ResultsA total of 144 respondents completed the survey and 133 respondents were included in the final analysis. The gender of the participants was balanced with 54.9% female and 45.1% male with an average age of 38 years. The majority of participants were gynaecological oncologists (43.6%) and medical oncologists (33.8%) working mainly in a university hospital (57.1%) and 77.4%(n=103) were involved in chemotherapy treatment. Of these, 79 participants administered platinum and 67 participants taxane-based chemotherapy. The majority of participants experienced more than 5 HSRs to platinum and taxane per year (73.4% and 73.1%, respectively). Pre-medication with antihistamines/steroids and a new attempt at standard infusion with platinum or taxane chemotherapy were used in 84.8% and 92.5% of Grade 1–2 HSRs to platinum and taxane, respectively. In contrast, tolerance induction was used in 49.4% and 41.8% of Grade 3–4 HSRs to platinum and taxane, respectively. Tolerance induction was mainly performed by medical oncologists,allergists and gynaecological oncologists.ConclusionThe majority of participants strongly emphasised the need to standardise the management of platinum and taxane HSR in gynaecological cancer and to develop international guidelines, regardless of their involvement in chemotherapy treatment.DisclosuresAll of the authors have no conflicts of interest to disclose.

This is a report from the European Society of Gynaecological Oncology State-of-the-Art Virtual Meeting held December 14–16, 2020. The unique 3-day conference offered comprehensive state-of-the-art summaries on the major advances in the treatment of different types of gynecological cancers. Sessions opened with a case presentation followed by a keynote lecture and interactive debates with opinion leaders in the field. The speakers also presented scientific reviews on the clinical trial landscape in collaboration with the European Network of Gynecological Oncological Trial (ENGOT) groups. In addition, the new ESGO-ESRTO-ESP endometrial cancer guidelines were officially presented in public. This paper describes the key information and latest studies that were presented for the first time at the conference.

This is a report from the 22nd Meeting of the European Society of Gynaecological Oncology, held October 23–25, 2021. The 3-day event offered an educational experience covering the major scientific and clinical advances in gynecological oncology. The Congress program included different session formats, including guidelines updates and state-of-the-art lectures. This article provides an overview of the main Congress activities as well as of the most important studies that were presented at the event for the first time.