The objective of the present study was to examine how intermediate-risk factors affect the oncological outcomes of patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer who do not undergo any adjuvant treatment. A multicentric retrospective study that involved 612 patients who were diagnosed with stage IA-IB2 cervical cancer at seven tertiary gynaecological oncology centres between 1993 and 2023 was conducted. A total of 232 patients were classified as FIGO 2018 stage IB2. Patients who had received neoadjuvant chemotherapy, parametrial or surgical border involvement, received adjuvant therapy and synchronous tumours were excluded from the present cohort. Therefore, the present study cohort consisted of 120 patients who had undergone radical hysterectomy and lymphadenectomy. Among the 120 patients, 89 (74.2%) had squamous cell cancer, 18 (15%) had adenocarcinoma, 2 (1.7%) had a mixed type tumour consisting of squamous cell cancer and adenocarcinoma and 11 (9.1%) had other types of tumours (adenosquamous cancer and glassy cell cancer). Deep cervical stromal invasion was found in 68 (56.7%) patients. The duration of patient follow-up varied from 1 to 246 months, with a median of 36 months. Overall, 6 patients (5%) experienced recurrence and 1 patient (0.8%) succumbed to the disease. The 3-year disease-free survival (DFS) rate was 94%, whereas the 3-year overall survival rate was 99%. The presence of deep cervical stromal invasion had a statistically significant impact on DFS (P=0.038). Deep cervical stromal invasion was found to be associated with recurrence in patients with stage IB2 cervical cancer. Hence, the present study demonstrated that the presence of deep cervical stromal invasion may be considered a key parameter in determining whether adjuvant treatment should be applied in patients with stage IB2 cervical cancer.

Objective. Endocervical adenocarcinoma (ECA) with a micropapillary component is considered to be associated with aggressive behavior and poor prognosis. So far, only limited studies investigated this histological subtype of ECA in the literature. In this study, we present a clinicopathological analysis of 10 such tumors. Methods. We retrieved ten ECAs with a micropapillary component between January 2014 and July 2023 and analyzed their clinicopathologic features. Results. At diagnosis, nine tumors (90%) were of advanced clinical stage (FIGO stage ≥ IIA), nine tumors (90%) exhibited deep stromal invasion (≥2/3 of the cervix), and three tumors (30%) showed parametrial involvement. Lymphovascular invasion was evident in all tumors (100%), and lymph node metastasis was found in eight tumors (80%). Among the 10 patients, six were alive without disease (60%), one had a recurrent/later metastatic tumor (10%), and three died from the disease (30%). Furthermore, eight tumors were positive for PD-L1 expression (80%), while only one tumor showed HER2 overexpression (10%), and one tumor exhibited p53 mutant-type staining (10%). Conclusion. Endocervical adenocarcinomas with micropapillary components are associated with aggressive clinical behavior and a poor prognosis, which can be found in various conventional histological types of ECAs regardless of the HPV status. The high prevalence of PD-L1 expression suggests that patients with micropapillary ECAs may be good candidates for PD-L1 inhibitor treatment.

This review aims to summarize the current applications of quantitative MRI biomarkers in the staging, treatment response evaluation, and prognostication of endometrial (EC) and cervical cancer (CC). By focusing on functional imaging techniques, we explore how these biomarkers enhance personalized cancer management beyond traditional morphological assessments.

A structured search of the PubMed database from January to May 2024 was conducted to identify relevant studies on quantitative MRI in uterine cancers. We included studies examining MRI biomarkers like Dynamic Contrast-Enhanced MRI (DCE-MRI), Diffusion-Weighted Imaging (DWI), and Magnetic Resonance Spectroscopy (MRS), emphasizing their roles in assessing tumor physiology, microstructure, and metabolic changes.

DCE-MRI provides valuable quantitative biomarkers such as Ktrans and Ve, which reflect microvascular characteristics and tumor aggressiveness, outperforming T2-weighted imaging in detecting critical factors like myometrial and cervical invasion. DWI, including advanced models like Intravoxel Incoherent Motion (IVIM), distinguishes between normal and cancerous tissue and correlates with tumor grade and treatment response. MRS identifies metabolic alterations, such as elevated choline and lipid signals, which serve as prognostic markers in uterine cancers.

Quantitative MRI offers a noninvasive method to assess key biomarkers that inform prognosis and guide treatment decisions in uterine cancers. By providing insights into tumor biology, these imaging techniques represent a significant step forward in the precision medicine era, allowing for a more tailored therapeutic approach based on the unique pathological and molecular characteristics of each tumor.

Biomarkers obtained from MRI can provide useful quantitative information about the nature of uterine cancers and their prognosis, both at diagnosis and response assessment, allowing better therapeutic strategies to be prepared.

Quantitative MRI improves diagnosis and management of uterine cancers through advanced imaging biomarkers. Quantitative MRI biomarkers enhance staging, prognosis, and treatment response assessment in uterine cancers. Quantitative MRI biomarkers support personalized treatment strategies and improve patient management in uterine cancers.

Current staging systems classify distant lymph node metastasis (DLM) in cervical cancer as stage IVB, typically treated with systemic therapy. We aim to assess if patients with DLM have different survival rates than those with other stage IVB cervical cancer forms.

This study included patients diagnosed with metastatic cervical cancer from 2000 to 2021, divided into three groups: para-aortic lymph node metastasis (PaLM), DLM, and distant organ metastasis (DM). Kaplan-Meier analyses estimated cervical cancer-specific (CCSS) and overall survival (OS). A 1:1 propensity-score match between DLM and PaLM patients used logistic regression. Univariate and multivariate Cox analyses identified prognostic risk factors.

Of the included 6241 patients, 2079 (33.3 %) were diagnosed with PaLM only, 631 (10.1 %) with DLM only, and 3531 (56.6 %) had DM. Multivariate Cox regression analysis indicated that patients with DLM exhibited comparable CCSS (HR, 0.91; P = 0.28) and OS (HR, 0.93; P = 0.34) to those with PaLM. In contrast, compared to patients with DM, the DLM cohort demonstrated significantly improved CCSS (HR, 0.54; P < 0.001) and OS (HR, 0.58; P < 0.001). Following matching, the CCSS (HR, 0.96; P = 0.70) and OS (HR, 0.95; P = 0.61) of patients with DLM remained comparable to those with PaLM. Among the 632 patients with DLM, locoregional treatments such as total hysterectomy (HR, 0.46; P = 0.039) and radiotherapy (HR, 0.34; P = 0.046) were independently associated with improved OS.

In cervical cancer, metastasis confined to distant lymph nodes indicates a locoregionally advanced stage, distinct from other stage IVB forms, and can be treated curatively with intensive locoregional therapy.

Primary cervical sarcomatoid squamous cell carcinoma (SSCC), a rare biphasic malignancy with 29 documented cases, is characterized by co-existing malignant squamous epithelium and sarcomatoid spindle cells. Immunohistochemical co-expression of epithelial (PCK) and mesenchymal (vimentin) markers remains diagnostic. We analyzed 8 institutional cases (2006-2024) alongside literature reports. Patients (median age 46, range 28-72) predominantly presented with vaginal bleeding (7/8 cases), while one exhibited abdominal pain with discharge. HPV16 was detected in 2 cases. All tumors showed variable immunoreactivity for PCK, vimentin, p16, and ≥ 1 squamous marker (p63/p40/CK5/6). Treatment included chemotherapy (6/8) and radiotherapy (3/8). Follow-up (median 57.4 months, n = 7) revealed aggressive behavior: two stage IIIC patients developed supraclavicular/visceral metastases (alive with disease at 10-31 months), one stage IIIA patient died at 24 months, while others remained disease-free. Combined analysis with 29 published cases confirms SSCC's dual histologic presentation (biphasic/monophasic) and consistent epithelial-mesenchymal marker co-expression. These findings underscore SSCC's clinicopathologic heterogeneity and metastatic potential despite multimodal therapy.

Purpose This study aimed to assess patterns and risks of distant metastasis (DM) in cervical cancer patients treated with chemoradiotherapy and MR-image-guided adaptive brachytherapy (IGABT) and to explore a potential dose-effect relationship of concomitant cisplatin. Materials and Methods Data were derived from EMBRACE-I, an international, prospective, multicenter cohort study conducted at 24 centers across Europe, Asia, and North America from July 30, 2008, to December 29, 2015. The study included 1416 patients with biopsy-confirmed cervical cancer (FIGO2009 stage IB-IVA or stage IVB limited to paraaortic lymph nodes). Treatment involved external beam radiotherapy (45-50.4 Gy), weekly cisplatin (40 mg/m², 30 mg/m², or paused), and IGABT. DM was defined as extra-pelvic recurrence excluding paraaortic nodes. Results The analysis included 1318 patients with a median age of 49 years and a median follow-up of 52 months. The 5-year cumulative incidence of DM was 14%, with the lungs (26%), mediastinal lymph nodes (15%), and bones (10%) identified as the most common metastatic sites. Key risk factors for DM included non-squamous histology (HR: 1.89, 95% CI: 1.30-2.75), nodal involvement at diagnosis (pelvic-only nodes: HR: 1.56, 95% CI: 1.07-2.26; paraaortic nodes: HR: 3.15, 95% CI: 1.93-5.16), and large target volume at brachytherapy (HR: 1.93, 95% CI: 1.21-3.08). Patients receiving fewer than 4 cycles of chemotherapy demonstrated a significantly higher risk of DM (HR: 1.52, 95% CI: 1.08-2.13). Conclusion DM is a substantial burden in patients with locally advanced cervical cancer, with the lungs, distant lymph nodes, and bones being the most frequent sites. Risk factors such as non-squamous histology, nodal involvement, and large target volumes at brachytherapy are critical considerations for identifying high-risk patients in future studies. These findings highlight the need for tailored strategies to mitigate DM in this patient population.

Background: Cervical cancer is a leading cause of morbidity and mortality among women globally. Currently, treatment is primarily based on tumor staging; however, discrepancies between preoperative and postoperative tumor staging remain a significant challenge and may impact treatment decisions and outcomes. This study aims to investigate the disparity between preoperative and postoperative risk factors in early-stage cervical cancer, with a particular focus on the histopathological parameters and the correlation with preclinical risk factors. Methods: Patients who underwent surgical treatment for an initial diagnosis of primary cervical carcinoma at the University Hospital Cologne in the Department of Gynecology and Obstetrics between 2015 and 2021 were included. A retrospective analysis was conducted to examine variations in histological parameters and their relationships with preclinical risk factors, such as age, BMI, smoking status, and HPV status, along with pretherapeutic diagnostic results. Results: In 85.7% of cases, preoperative grading showed concordance with postoperative grading. Postoperative upgrading was observed in 14.3% of cases with no instances of downgrading. Inconsistent findings were noted for venous invasion (3.6% of cases) and lymphovascular space invasion (6.7% of cases). No significant correlations were found between pre- and postoperative discrepancies and preclinical risk factors or pretherapeutic diagnostics. Kaplan-Meier analyses revealed no impact of discordance in grading (p = 0.559) or lymphatic vessel invasion (p = 0.752) on recurrence-free survival. Conclusions: The analyzed discrepancies were not influenced by preclinical risk factors or pretherapeutic interventions and showed no significant prognostic relevance for the patients' recurrence-free survival. More robust conclusions would require further studies with larger sample sizes.

Chemo-immunotherapy (IO) is the preferred first-line treatment for stage IVB or recurrent cervical cancer. However, limited data exist on the efficacy and safety of using IO-alone as a de-escalation strategy. We report outcomes from a case series of selected patients treated with IO-alone and review the feasibility of de-escalating first-line treatment.

The authors conducted a literature review using Google Scholar and PubMed to identify reports using IO-alone as a de-escalation strategy across malignancies published between 1999 and December 2024 and also reviewed a cervical cancer database from a tertiary academic to identify patients with stage IVB or recurrent disease treated with IO-alone. The authors used the Kaplan-Meier method to estimate progression-free survival (PFS) and overall survival (OS).

Among 582 patients treated between 2015 and 2021, 18 met the inclusion criteria. The median age was 43 years (range 28-84); 67% had squamous cell carcinoma, 11% adenocarcinoma, and 80% expressed PD-L1. CPS scores were <1 in 20%, 1--10 in 33%, and >10 in 47%. Most patients had oligo-metastatic disease (83%). Treatment with IO-alone began a median of 7 months after platinum-based chemotherapy. Indications included prior adjuvant (44%) or neoadjuvant (22%) chemotherapy, clinical trial participation (11%), or patient preference (22%). Median PFS and OS were 27 months and 82 months, respectively.

These findings support the need for clinical trials evaluating IO-alone as a first-line treatment option for de-escalation in stage IVB or recurrent cervical cancer. Biomarker development is needed to better identify candidates for personalized therapy.

Despite advances in screening and prevention, cervical cancer (CC) remains an unresolved public health issue and poses a significant global challenge, particularly for women in low-income regions. Human papillomavirus (HPV) infection, especially with the high-risk strains, is a primary driver of cervical carcinogenesis. Emerging evidence indicates that integrating HPV testing with existing approaches, such as cervical cytology and visual inspection, offers enhanced sensitivity and specificity in CC screening. HPV infection-associated biomarkers, including HPV E6/E7 oncogenes, p16^INK4a, DNA methylation signatures, and non-coding RNAs, offer valuable insights into disease progression and the development of personalized interventions. Preventive and therapeutic vaccination against HPV, along with tertiary prevention strategies such as the use of antiviral and immune-modulating drugs for HPV-related lesions, show great clinical potential. At the mechanistic level, single-cell RNA sequencing analysis and the development of organoid models for HPV infection provide new cellular and molecular insights into HPV-related CC pathogenesis. This review focuses on the crucial roles of HPV in the prevention, diagnosis, and treatment of CC, with particular emphasis on the latest advancements in screening and disease intervention.

Our study aimed to investigate the clinicopathologic and molecular features of endocervical adenocarcinoma with a micropapillary component (EAC-MP) in the setting of current classification schema. We investigated 26 EAC-MP from consecutive 511 adenocarcinomas. HER2 status was analyzed by immunohistochemistry and fluorescence in situ hybridization. Four cases were performed with targeted next-generation sequencing (NGS). We found that HPV-associated adenocarcinomas (HPVA) with a micropapillary component (HPVA-MP) (n = 12) had a higher frequency of large tumor size (> 2 cm), Silva pattern C (12/12, 100%), invasion of the deep cervical wall (> 2/3) (8/12, 66.7%), lymphovascular space invasion (LVSI) (11/12, 91.7%), lymph node metastasis (4/11, 36.4%), FIGO stage III/IV (4/12, 33.3%), and HER2 amplification (3/12, 25%, P = 0.015), compared to those without (HPVA-NMP (all P < 0.05). HPV-independent adenocarcinomas (HPVI) with a micropapillary component (HPVI-MP) (n = 14) had LVSI more commonly than those without (HPVI-NMP) (P = 0.033). Survival analysis indicated that HPVA-MP was associated with worse overall survival and recurrence-free survival than HPVA-NMP (P < 0.01). Particularly, in patients with Silva pattern C, HPVA-MP appeared to have more adverse clinical outcomes (P < 0.01). No survival differences were found in HPVI-MP versus HPVI-NMP (P > 0.05). NGS identified significant mutations in STK11, TERT, ERBB2, TP53, PIK3CA, ARID1A, and NTRK2. We conclude that the micropapillary structure is an indicator for unfavorable clinical outcomes in HPVA, and can aid in the prognostic stratification of Silva pattern C EAC. The presence of HER2 amplification and specific gene mutations raise the possibility for targeted therapy in the future.

Our study aimed to further confirm the clinical significance of the tumour budding activity and cell nest size-based (TBNS) grading scheme in cervical squamous cell carcinomas (SCC).

We applied the TBNS system to assess the prognostic value in an institutional cohort of well-annotated cervical SCC consisting of 312 consecutive cases with surgical resection, no neoadjuvant chemotherapy and higher than stage pT1a. We found that high budding activity, single cell and TBNS grade 3 were more frequently associated with a decreased overall survival (OS) time and disease-free survival (DFS) time (P < 0.001) and several other clinicopathological factors, including lymphovascular space invasion, lymph node metastasis, advanced Federation of Gynecology and Obstetrics (FIGO) stage and deep invasion of the cervical wall (> 2/3) (P < 0.05). On multivariate analysis, TBNS grade 3 was an adverse indicator for OS and DFS independently of age, invasion of the cervical wall and FIGO stage (P < 0.05). By comparison, the conventional three-tiered grading system was not associated with OS and DFS in cervical SCC (P > 0.05).

Our study further confirms that the TBNS grading scheme is robust in prognostic assessment in cervical SCC that outperforms the conventional three-tiered grading system. It is applicable to add TBNS grade into routine diagnostic practice.

Gastric-type adenocarcinoma (GAS) is the most common subtype of human papillomavirus (HPV)-independent cervical adenocarcinomas and is associated with a poor prognosis. We used a gross morphologic classification system and imaging analysis to compare the clinicopathological features of GAS and HPV-associated adenocarcinoma (HPVA) and identify factors contributing to the poor prognosis of GAS. This retrospective 2-center study analyzed 33 patients with GAS and 70 with HPVA (stages IB-IVB) who underwent surgery between 1997 and 2023. GAS had a higher rate of positive surgical margins (21.2% vs. 0%, respectively, P <0.001) and unclear tumor boundaries on gross morphologic findings (47.8% vs. 8.8%, respectively, P <0.001). Discrepancies between clinical and pathologic T classifications were more common in GAS, leading to frequent upstaging (51.5% vs. 28.6%, respectively, P =0.029). Imaging analysis revealed that GAS was associated with a smaller median tumor cell area (19.8% vs. 55.7%, respectively, P <0.001), which was significantly correlated with unclear tumor boundaries. Perineural invasion (PNI) was significantly more frequent in GAS (69.7% vs. 10.0%, respectively, P <0.001). A Kaplan-Meier analysis showed that patients with PNI had significantly poorer overall survival ( P <0.001). A Cox multivariate analysis identified an advanced pathologic stage, positive peritoneal cytology, and positive surgical margins as independent risk factors. The present results indicate that GAS has a unique "stealth" invasion pattern, possibly caused by low tumor density, leading to undetectable tumor boundaries and positive surgical margins. This suggests a greater risk of incomplete resection than HPVA, leading to a poorer prognosis.

The purposes of the study are to assess the diagnostic performance of preoperative imaging for staging factors in gastric-type endocervical adenocarcinoma (GEA) and to compare the performance for GEA with that of usual-type endocervical adenocarcinoma (UEA) among patients preoperatively deemed locally early stage (DLES) (< T2b without distant metastasis).

For this multi-center retrospective study, 58 patients were enrolled. All had undergone MRI with or without CT and FDG PET-CT preoperatively and had been pathologically diagnosed with GEA at five institutions. Based on the medical charts and radiological reports, the diagnostic performances of preoperative imaging for the International Federation of Gynecology and Obstetrics staging factors were assessed retrospectively. Next, the imaging performance was assessed in preoperatively DLES-GEA (n = 36) and DLES-UEA (n = 136, with the same inclusion criteria). The proportions of underestimation of GEA and UEA were compared using Fisher's exact test.

Imaging diagnostic performance for GEA was limited, especially for sensitivity: parametrial invasion, 0.49; vaginal invasion, 0.54; pelvic lymph node metastasis (PELNM), 0.48; para-aortic lymph node metastasis, 0.00; and peritoneal dissemination, 0.25. Among preoperatively DLES patients, the proportions of underestimation were significantly higher in GEA than in UEA; parametrial invasion, 35% vs. 5% (p < 0.01); vaginal invasion, 28% vs. 6% (p < 0.01); PELNM, 24% vs. 6% (p < 0.05); peritoneal dissemination, 6% vs. 0% (p < 0.05).

At present, preoperative imaging diagnostic performance for staging factors in GEA does not meet clinical expectations, especially for sensitivity. Among patients preoperatively DLES, the proportions of underestimation in GEA were significantly higher than in UEA. Future incorporation of approaches specifically emphasizing GEA is desirable to improve imaging performance.

To compare the long-term survival outcomes, recurrence patterns and morbidity of type B and type C radical hysterectomy (RH) for stage IB2 cervical cancer (FIGO 2018).

Based on FOUR-C database, patients who underwent type B or C RH in 47 hospitals from 2004 to 2018 were reviewed. Univariate and multivariate analyses were performed to compare 5-year overall survival (OS) and recurrence-free survival (RFS), recurrence patterns and morbidity between the two groups after propensity score matching (PSM).

A total of 1308 patients were enrolled in this study, 840 and 468 patients underwent type B and type C. There was no difference in 5-year survival outcomes between groups type B and type C, either before or after matching (OS: unmatched 95.6% vs. 93.3%, matched 95.6 vs. 93.0%, P>0.05; RFS: unmatched: 90.5% vs. 90.1%, matched: 91.2% vs. 89.7%, P>0.05). Type B group had a shorter operative time, less blood loss, earlier recovery of intestinal function, eariler removal of catheter and shorter hospitalization (P<0.01). Intraoperative complications were similar (0.1% vs. 0.2%, P>0.05), but postoperative complications occurred more frequently in the type C group (8.3% vs. 12.1%, P < 0.05), especially lymphocysts and urinary retention. The surgical dissection does not appear to influence tumor recurrences significantly (P>0.05).

For cervical cancer patients with stage IB2, type B RH demonstrated comparable long-term oncological outcomes and recurrence patterns to type C RH, while being associated with fewer intra-and postoperative complications. Type B RH is a feasible and appropriate surgical option, but the conclusions need to be confirmed by prospective studies.

In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer.

This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB-IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan-Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve.

Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters.

In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.

This study aimed to improve the accuracy of the diagnosis of lymph node metastasis (LNM) and prediction of patient prognosis in cervical cancer patients using a hybrid model based on MRI and clinical aspects. We retrospectively analyzed routine MR data from 485 patients with pathologically confirmed cervical cancer from January 2014 to June 2021. The data were divided into a training cohort (N = 261), internal cohort (N = 113), and external validation cohort (n = 111). A total of 2194 features were extracted from each ROI from T2WI and CE-T1WI. The clinical model (M1) was built with clinicopathological features including squamous cell carcinoma antigen, MRI-reported LNM, maximal tumor diameter (MTD). The radiomics model (M2) was built with four radiomics features. The hybrid model (M3) was constructed with squamous cell carcinoma antigen, MRI-reported LNM, MTD which consists of M1 and four radiomics features which consist of M2. GBDT algorithms were used to create the scores of M1 (clinical-score, C-score), M2 (radiomic score, R-score), and M3 (hybrid-score, H-score). M3 showed good performance in the training cohort (AUCs, M3 vs. M1 vs. M2, 0.917 vs. 0.830 vs. 0.788), internal validation cohorts (AUCs, M3 vs. M1 vs. M2, 0.872 vs. 0.750 vs. 0.739), and external validation cohort (AUCs, M3 vs. M1 vs. M2, 0.907 vs. 0.811 vs. 0.785). In addition, higher scores were significantly associated with worse disease-free survival (DFS) in the training cohort and the internal validation cohort (C-score, P = 0.001; R-score, P = 0.002; H-score, P = 0.006). Radiomics models can accurately predict LNM status in patients with cervical cancer. The hybrid model, which incorporates clinical and radiomics features, is a novel way to enhance diagnostic performance and predict the prognosis of cervical cancer.

Cervical cancer constitutes a formidable health challenge imperiling the well-being and lives of women globally, particularly in underdeveloped nations. The survival rates among patients diagnosed with cervical cancer manifest considerable heterogeneity, shaped by a myriad of variables. Within the scope of this inquiry, a predictive model for projecting overall survival (OS) in cervical cancer patients was formulated and subsequently validated.

Clinicopathological and follow-up information of patients diagnosed with cervical cancer were prospectively collected from May 1, 2015, to December 12, 2019, as part of an ongoing longitudinal cohort study conducted at Chongqing University Cancer Hospital. Subsequent to the acquisition of follow-up data, the sample was randomly divided into two cohorts: a training cohort (n = 2788) and a testing cohort (n = 1194). The predictors for the model were selected through least absolute shrinkage and selection operator (LASSO) regression analysis. Cox stepwise regression analysis was then employed to identify independent predictive indicators. The study results were subsequently presented in the form of static and web-based dynamic nomograms. To elucidate the objective validation of the prognosis and anticipated survival, the concordance index (C-index) was computed. The model's discriminatory ability across various variables and its predictive performance were assessed through calibration plots. Additionally, the predictive model's capacity for outcome prediction and its net benefit were evaluated using the Net Reclassification Index (NRI) and Decision Curve Analysis (DCA) curves.

The final model regarded the following variables from the training cohort as independent risk factors for cervical cancer patients: age, medical insurance, pathology, HPV infection status, chemotherapy, β2-microglobulin, neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR). The C-indices of OS for the training group were 0.769 (95% CI, 0.748-0.789) and for the testing cohort were 0.779 (95% CI, 0.751-0.808). In both the training and testing cohorts, the calibration curve for estimating the chance of survival exhibited a significant agreement between prediction by nomogram and actual observation. In the training cohort, the areas under the curve (AUC) of the receiver operating characteristic (ROC) curves for 1-year, 3-year, and 5-year OS were 0.811, 0.760, and 0.782, respectively, while in the testing cohort, they were 0.818, 0.780, and 0.778, respectively. The Net Reclassification Index (NRI) and Decision Curve Analysis (DCA) provided evidence of the model's superior predictive ability and net benefit when compared to the FIGO Staging system.

The prediction methods effectively forecasted the outcomes of cervical cancer patients. Due to the model's excellent calibration and discrimination, it provided a reliable approach for predicting patient survival, potentially supporting the implementation of individualized treatment strategies.

Lymph node metastasis (LNM) critically impacts the prognosis and treatment decisions of cervical cancer patients. The accuracy and sensitivity of current imaging techniques, such as CT and MRI, are limited in assessing lymph node status. This study aims to develop a more accurate and efficient method for predicting LNM.

Three independent cohorts were merged and divided into training and internal validation groups, with our cohort and those from other centers serving as external validation. A predictive model for LNM in cervical cancer was established using the LASSO regression and multivariate logistic regression. The diagnostic performance of the predictive model was compared with that of CT/MRI in terms of accuracy, sensitivity, specificity, and AUC.

Using RNA-seq data, four independent predictive genes (MAPT, EPB41L1, ACSL5, and PRPF4B) were identified through LASSO regression and multivariate logistic regression, and a predictive model was constructed to calculate the LNM risk score. Compared with CT/MRI, the model demonstrated higher diagnostic efficiency, with an accuracy of 0.840 and sensitivity of 0.804, compared to CT/MRI's accuracy of 0.713 and sensitivity of 0.587. The predictive model corrected 81% of misdiagnoses by CT/MRI, demonstrating significant improvements in accuracy and sensitivity.

The predictive model developed in this study, based on gene expression data, significantly improves the preoperative assessment accuracy of LNM in cervical cancer. Compared to traditional imaging techniques, this model shows superior sensitivity and accuracy. This study provides a robust foundation for developing precise diagnostic tools, paving the way for future clinical applications in individualized treatment planning.

A conventional endpoint for locally advanced cervical cancer (LACC) clinical trials is overall survival (OS) with five years of follow-up. The primary hypothesis was that progression-free survival (PFS) with three years of follow-up (PFS36) would be an appropriate primary surrogate endpoint.

The primary hypothesis, which was developed from our data, was further investigated using phase III randomized controlled trials and then externally validated using retrospective studies up to 2023. Correlation analysis at the treatment-arm level was performed between 2-, 3-, 4-, and 5-year PFS rates and 5-year OS.

A total of 613 patients with histologically confirmed cervical cancer who underwent radiotherapy or chemoradiation at our institute between January 2010 and December 2013 were eligible. The recurrence rates for years 1 through 5 were 12.9%, 7.3%, 3%, 2.3%, and 1.8%, respectively. Patients who did not achieve PFS36 had a 5-year OS rate of 30.3%. However, patients who achieved PFS36 had a 5-year OS rate of 98.2%. Further data were extracted from 26 randomized phase III trials on LACC. The trials included 55 arms, with a pooled sample size of 7,281 patients. Trial-level surrogacy results revealed that PFS36 (r2, 0.732) was associated with 5-year OS. The correlation between PFS36 and OS was externally validated using independent retrospective data.

A significant positive correlation was found between PFS36 and OS at 5 years of follow-up both within patients and across trials. These results suggest that PFS36 is an appropriate endpoint for LACC clinical trials of radiotherapy-based regimens.

To characterize and estimate rates of fragmented care, to investigate its association with the receipt of guideline-concordant treatment, and to evaluate treatment components at risk with fragmented care.

This is a single-institution retrospective study of patients with locally advanced cervical cancer (stage IB3-IVA) from January 2003 to September 2023. We stratified patients into fragmented and nonfragmented care groups based on receipt of all care at our institution or if they received any component of care outside of our institution. The primary outcome, receipt of guideline-concordant treatment , was defined as a composite of 1) completion of treatment within 56 days, 2) completion of brachytherapy, and 3) receipt of concurrent chemotherapy. Demographic and treatment data were collected, including the Social Vulnerability Index (SVI), a census tract-based measure of disadvantage. Univariate and multivariate analyses were performed.

Two hundred eighty-six patients were identified; 75.5% received fragmented care. Those receiving nonfragmented care were significantly more likely to receive guideline-concordant treatment than those receiving fragmented care (71.4% vs 50.9%, P =.003). This was driven primarily by rates of timely completion (81.4% vs 60.6%, P =.001). Univariate analysis indicated that fragmented care (odds ratio [OR] 0.42, 95% CI, 0.23-0.74) and Medicaid insurance (OR 0.40, 95% CI, 0.20-0.78) were significantly associated with lower odds of guideline-concordant treatment. Multivariate analyses controlling for a priori confounders of insurance type and SVI showed that fragmented care (OR 0.45, 95% CI, 0.23-0.90) and Medicaid insurance (OR 0.42, 95% CI, 0.19-0.89) were independently associated with lower odds of guideline-concordant treatment. Multivariate analysis controlling for demographic covariates found even lower odds of receiving guideline-concordant treatment in those who received fragmented care (OR 0.39, 95% CI, 0.18-0.84) and who had Medicaid insurance (OR 0.35, 95% CI, 0.16-0.78).

More than 75% of patients received fragmented care, which had a significant clinical effect and was associated with significantly lower rates of guideline-concordant treatment.

Neuroendocrine tumors (NEC) were first described by Albores-Saavedra in 1972 and these tumors account for only 0.9% to 1.5% of all invasive cervical cancers.1,2 The most common type is small cell neuroendocrine carcinoma (SCNEC) of the cervix, which accounts for 80% of cases.2 The poor prognosis despite advances in treatment remains still a huge problem, so the aim of our review is to cover all current therapeutic options.

We searched for all available interventional studies, reviews, case reports and meta-analyses published from 1995 to 2023.

In 2017 Castle et al.9 published a systematic review and meta-analysis and concluded that SCNC and large cell neuroendocrine carcinoma (LCNC) are, in most cases, caused by HPV, primarily HPV18 and HPV16. Comparative genomics data suggest that cervical NEC may be genetically more similar to common cervical cancer subtypes than to extra-cervical SCNEC of the lung and bladder.13 Surgery is recommended as the primary treatment in early stages of disease, with radical hysterectomy and nodal assessment followed by adjuvant pelvic radiotherapy and/or chemotherapy. However, simple hysterectomy may be adequate when followed by adjuvant radiotherapy with concurrent cisplatin and etoposide as additional chemotherapy.15 Considering that pathologic and clinical behavior is similar to small cell lung cancer, patients usually receive platinum and etoposide as part of their primary therapy.16 The recurrent disease remains a major clinical problem, because there is no standard treatment modality for these patients, and individualized therapy is recommeded.

Current therapeutic modalities are mainly based on experience in the treatment of SCNEC of the lung. Certainly, a multidisciplinary approach is very important inorder to design a personalized management plan.

Cervical cancer is a prevalent form of cancer affecting women worldwide and it is the second most common cancer among women in Indonesia, accounting for 8.5% of all cancer-related deaths. Cervical cancer progression can be evaluated through laboratory tests to detect anaemia, an increased platelet count, and elevated inflammatory markers, therefore, effective laboratory examination is crucial for early detection and treatment of cervical cancer.

To evaluate the association between laboratory findings (haematology, haematology index, and inflammatory index) and the clinical stage of cervical cancer.

This cross-sectional study analyzed adult cervical cancer patients' data from medical records and laboratory results including sociodemographic status, histopathological finding, clinical stage, and complete haematology examination. Numerical data was analyzed by the one-way ANOVA (normal data distribution), while the Kruskal-Wallis test was used for non-parametric data (abnormal distribution), followed by appropriate post-hoc analysis. The categorical data was analyzed by the Chi-square or Fisher Exact tests. The significance level was established at a P value < 0.05.

This study involved the data of 208 adult cervical cancer patients and found no association between age, marital history, parity history, hormonal contraceptive use and cervical cancer stages. There were significant differences in the clinical laboratory test results based on the clinical stage of cervical cancer, including haemoglobin levels (P < 0.001), leucocytes (P < 0.001), neutrophils (P < 0.001), monocytes (P = 0.002), lymphocytes (P = 0.006), platelets (P < 0.001), neutrophil-lymphocyte ratio/NLR (P < 0.001), lymphocyte-monocyte ratio/LMR (P < 0.001), and platelet-lymphocyte ratio/PLR (P < 0.001). There were also significant differences in the systemic inflammatory index (SII) and systematic inflammatory response index (SIRI) between stage III + IV cervical cancer and stage II (SII P < 0.001; SIRI P = 0.001) and stage I (SII P < 0.001; SIRI P = 0.016), associated with the shifts in previously mentioned complete haematological values with cancer advancement.

The haematological parameters, inflammatory haematological ratios, and inflammatory indices exhibited significant differences between cervical cancer stages, therefore these tests can be utilized to evaluate cervical cancer progression.

OBJECTIVE: This study was conducted to evaluate the prognosis of cervical cancer in pregnancy (CCIP) and analyze the clinicopathological factors affecting the prognosis of this cancer.

The studies published through July 2024 were systematically retrieved from PubMed, Embase, Web of Science, and Cochrane Library.

The cohort studies, case-control studies, randomized controlled trials, and non-randomized controlled trials involving CCIP patients with data on 5-year overall survival (OS) were included in this study.

The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). A meta-analysis was performed using Stata 15.0, focusing on the 5-year OS and relevant clinicopathological factors.

The results demonstrated that the 5-year OS of patients with CCIP was similar to that of non-pregnant patients with cervical cancer (RR = 1.00, 95% CI: 0.94-1.06, P = 0.978). The subgroup analysis results revealed that tumor size (≥ 4 cm), International Federation of Gynecology and Obstetrics (FIGO) stage (≥ IB2), and timing of diagnosis (postpartum) were prognostic factors with statistical significance (P < 0.05). However, such factors as pregnancy termination and timing of delivery did not significantly affect the 5-year OS (P > 0.05). The delivery mode required further validation despite its borderline significance (P = 0.05).

The results of this study suggest that pregnancy does not exert a significant adverse effect on the long-term survival of patients with cervical cancer. Tumor size (≥ 4 cm), FIGO stage (≥ IB2), and time of diagnosis (postpartum) are identified as unfavorable prognostic factors for CCIP patients, while delivery mode requires further investigation. These findings provide strong evidence to support the optimization of personalized treatment strategies for CCIP patients.

To compare the 5-year oncological outcomes of different adjuvant treatment modalities in patients with FIGO 2018 stage IA-IIA cervical adenocarcinoma who underwent open radical hysterectomy and one intermediate-risk pathological factor.

Based on the Four C database (between 2004 and 2018,n=63,926), patients with FIGO 2018 stage IA-IIA cervical adenocarcinoma and only one intermediate-risk pathological factor underwent open extensive hysterectomy. All patients were divided into three groups, namely, the simple surgery group (radical hysterectomy, RH), postoperative adjuvant chemotherapy group (radical hysterectomy and chemotherapy, RH + CT), and postoperative adjuvant chemoradiotherapy group (radical hysterectomy and radiotherapy/concurrent chemoradiotherapy, RH + RT/CCRT). The 5-year OS and DFS rates were compared among the three groups.

Of the 219 cervical adenocarcinoma patients with only one intermediate-risk pathological factor, 50 patients had RH; 54 patients had RH + CT; and 115 patients had RH + RT/CCRT. There were no significant differences in 5-year OS and 5-year DFS rates among the three groups (RH vs. RH + CT: 92.7% vs. 90.3%, P = 0.749; 88.5% vs. 85.1%, P = 0.680, RH vs. RH + RT/CCRT: 90.7% vs. 82.3%, P = 0.484; 84.4% vs. 90.1%, P = 0.494, RH + CT vs. RH + RT/CCRT: 89.9% vs. 90.6%, P = 0.815; 90.5% vs. 90.8%, P = 0.905).

Postoperative adjuvant chemotherapy or chemoradiotherapy did not significantly improve the outcomes of FIGO 2018 IA-IIA cervical adenocarcinoma patients with only one intermediate risk factor.

Cervical adenocarcinoma (ADC) is more aggressive compared to other types of cervical cancer (CC), such as squamous cell carcinoma (SCC). The tumor immune microenvironment (TIME) and tumor heterogeneity are recognized as pivotal factors in cancer progression and therapy. However, the disparities in TIME and heterogeneity between ADC and SCC are poorly understood.

We performed single-cell RNA sequencing on 11 samples of ADC tumor tissues, with other 4 SCC samples served as controls. The immunochemistry and multiplexed immunofluorescence were conducted to validate our findings.

Compared to SCC, ADC exhibited unique enrichments in several sub-clusters of epithelial cells with elevated stemness and hyper-malignant features, including the Epi_10_CYSTM1 cluster. ADC displayed a highly immunosuppressive environment characterized by the enrichment of regulatory T cells (Tregs) and tumor-promoting neutrophils. The Epi_10_CYSTM1 cluster recruits Tregs via ALCAM-CD6 signaling, while Tregs reciprocally induce stemness in the Epi_10_CYSTM1 cluster through TGFβ signaling. Importantly, our study revealed that the Epi_10_CYSTM1 cluster could serve as a valuable predictor of lymph node metastasis for CC patients.

This study highlights the significance of ADC-specific cell clusters in establishing a highly immunosuppressive microenvironment, ultimately contributing to the heightened aggressiveness and poorer prognosis of ADC compared to SCC.

Funded by the National Natural Science Foundation of China (82002753; 82072882; 81500475) and the Natural Science Foundation of Hunan Province (2021JJ40324; 2022JJ70103).

Burkitt's lymphoma (BL) affecting the female genital tract is rare.

The aim of this paper is to report BL of the cervix in an HIV-positive patient to discuss the fatality of the condition and ways to mitigate it through advocacy for improved health care delivery in resource limited settings.

The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.

This case suggests that women living with HIV who have BL should be fast-tracked for treatment as HIV viremia may worsen the prognosis of the malignancy. Following the encounter with the index patient an advocacy action plan has been made by the oncology multidisciplinary team to prioritize the treatment of women with aggressive histological types of cervical cancer.

A long waiting list for chemoradiation in low resource settings may delay management of advanced BL of the cervix. Inadequate cervical cancer screening and delays in diagnosis are other barriers to the care of women with aggressive cervical cancers in low resource settings. Systemic changes in healthcare delivery are therefore required in many low resource settings. Advocacy for patients particularly those with aggressive diseases using the index case as a point of reference is ideal and should be promoted in resource-limited settings to improve health care delivery.

The purpose of this article is to review the staging systems for common malignant genitourinary and gynecological tumors, including renal cell carcinoma, urinary bladder carcinoma, as well as cervical, endometrial, and ovarian carcinoma, and to highlight the key imaging findings ("tipping points") that may alter patient management algorithms based on radiological staging.

There are identifiable imaging features for the common genitourinary and gynecological malignancies, including the size of the primary tumor, tumor extension, invasion of adjacent structures, lymph node involvement, and distant metastasis, which provide important prognostic information and determine patient management. Radiologists must be aware of these imaging findings ("tipping points") when interpreting staging examinations.

Cervical cancer is preventable with screening and vaccination approaches; however, access to these preventative measures is limited both nationally and globally and thus many women will still develop cervical cancer. Novel treatments and practice-changing research have improved cervical cancer outcomes over the past few decades. In this Review, we discuss clinical trials that have refined or redefined the treatment of cervical cancers across the early stage, locally advanced, persistent, recurrent and/or metastatic disease settings. Advances for patients with early stage disease have been achieved through trials evaluating less extensive and fertility-preserving surgeries, different surgical approaches (open versus minimally invasive), and sentinel versus full pelvic lymph node dissection. We also discuss results from trials testing the use of neoadjuvant, induction and adjuvant chemotherapy as well as immune-checkpoint inhibitors in patients with locally advanced disease. Finally, we review the progress made with systemic chemotherapy and novel therapeutics, including anti-angiogenic agents, immune-checkpoint inhibitors and antibody-drug conjugates, in the setting of metastatic and/or recurrent cervical cancer. The advances highlighted in this manuscript have reduced morbidity and improved overall survival for patients with this challenging-to-treat disease, while also inspiring additional research and trials in the field.

To compare the clinical outcomes of two different schedules of modern image-guided adaptive brachytherapy (IGABT) in patients underwent chemoradiotherapy (CCRT) and high-dose rate (HDR) brachytherapy (BT) for locally advanced cervical cancer treated (LACC) METHODS AND MATERIALS: Data from medical records of all consecutive patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA) treated by HDR-BT after CCRT at our institution between 2016 and 2021 were reviewed.

Two hundred and 8 patients with LACC FIGO 2018 stages (IB 20.7%; II 26.5%, III 51%, IVA 1.9%) underwent brachytherapy at our institution. Depending on initial clinical features of disease and the clinical response to CCRT, HDR-BT was delivered with one implant (BT1i) or two implants (BT2i) in 39% and 61% of patients respectively. FIGO stages (≥IIB) were 63% vs. 78% for BT1i and BT2i patient group respectively. Combined brachytherapy technique [endocavitary/interstitial (IC/IS)] was required in 14.8% vs. 68.5% for BT1i and BT2i respectively. With a median follow-up of 32.5 months (95% confidence interval, [29.7-35.8]), local relapse was observed in sixteen patients: 8 patients (3.8%) had local (exclusive) relapse and 8 patients (3.8%) had locally persistent and progressive disease, without significant difference for each BT modality group (p = 0.27), even if BT2i group had more aggressive initial disease. The estimated 3-year disease free survival and overall survival for the entire population was 69% (95% confidence interval, [62-75%]) and 88% (95% confidence interval, [82-92%]) respectively. There was a significant difference in the incidence of global toxicity grade G≥2 in favour to the BT2i group (p = 0.026).

HDR brachytherapy delivered with a long time interval between fractions, two implants, and combined IC/IS brachytherapy is the best way to ensure local control and to perform IGABT with low toxicity, even in advanced stages of disease.

Fertility-sparing treatment (FST) has become a key aspect of managing gynecologic cancers in reproductive-age patients who wish to preserve fertility. Several leading clinical societies, including the European Society of Gynecological Oncology, the European Society for Radiotherapy and Oncology, the European Society of Pathology, and the European Society of Human Reproduction and Embryology, have published evidence-based guidelines on fertility-sparing strategies and post-treatment surveillance of patients with early-stage gynecologic cancers, in particular endometrial and cervical cancers. These guidelines highlight MRI as essential to initial patient selection and follow-up. Properly tailored pelvic MRI protocols and clear MRI reports are key to performing accurate staging, assessing eligibility, and confirming the initial and ongoing feasibility of FST. Accordingly, radiologists, particularly those specializing in gynecologic imaging, play a critical role in the multidisciplinary approach to FST. They should be well-versed in FST eligibility criteria and key MRI findings before and after FST, ensuring these details are comprehensively communicated in structured MRI reports.

Despite the importance of T2-weighted image in clinical practice, artifacts can significantly degrade image quality and affect diagnosis. This study quantitatively analyzed uterine displacement and surveyed the relationship between the image quality of fast-spin-echo-T2-weighted image of the female pelvis and quantitative value of uterine displacement. Overall, 147 women (mean age, 46.0 ± 12.8 years; age range, 22-84 years) who had undergone pelvic magnetic resonance imaging examination using a 3 T- magnetic resonance imaging scanner were included. Two radiologists performed a visual assessment of the fast-spin-echo-T2-weighted image in the sagittal plane in terms of ghosts and motion blur, and classified the image quality into the following three groups: poor, moderate, and excellent. Uterine displacement on half-Fourier acquisition single-shot turbo spin-echo-cine images was calculated, and the maximum amplitude of uterine displacement and summation of uterine displacement were calculated from the displacement map images. The Kruskal-Wallis and Steel-Dwass tests were performed to compare the maximum amplitude of uterine displacement and summation of uterine displacement among the three groups. Poor, moderate, and excellent image qualities were observed in 48, 71, and 28 patients, respectively. The quality of fast-spin-echo-T2-weighted images degraded statistically significantly with P < 0.01 as the maximum amplitude of uterine displacement increased. The summation of uterine displacement in the poor and moderate groups had greater statistical significance with P < 0.01 than that in the excellent group.

To evaluate risk factors for survival, recurrence and metastasis in patients with FIGO stage IA-IVA cervical cancer who underwent radical radiotherapy (RT) or concurrent chemoradiotherapy (CCRT).

We performed a retrospective analysis of 1288 cervical cancer patients. Kaplan-Meier curves, Cox regression models, and log-rank tests were used for statistical analysis.

The 5-year overall survival rate for patients with stage I-II and stage III-IVA are 81.1% and 70.4%. In multivariable analysis, pathological type, 2009 FIGO stage, pre-treatment SCC-Ag level, pre-brachytherapy tumor size, and CCRT are independent influencing factors for patient OS. Patients with non-squamous cell carcinoma are more likely to occur distant metastasis compared to those with squamous cell carcinoma. No significant correlation was observed between histological types among patients with local recurrence. In patients with squamous cell carcinoma, multivariable analysis showed that SCC value > 11.75 at diagnosis was an independent predictor of distant metastasis and local recurrence (P = 0.001 and P = 0.038, respectively). Lymph node metastasis was an independent risk factor for distant metastasis. Age, treatment time of RT, CCRT, and pre-treatment Hb classification showed no significant correlation with cervical cancer distant metastasis and local recurrence.

Non-squamous cell carcinoma patients may have a worse prognosis than squamous cell carcinoma patients. In patients with squamous cell carcinoma, SCC value at diagnosis, and lymph node metastasis are independent influencing factors for distant metastasis, while SCC value at diagnosis is an independent influencing factor for local recurrence.

The landscape of medical education is rapidly evolving, driven by advancements in technology. This evolution has ushered in a new era characterized by digitization, connectivity, and intelligence. In this era, traditional teaching methods are being augmented with innovative technologies such as virtual learning, artificial intelligence platforms, and access to cloud-based health platforms. One notable advancement is the integration of three-dimensional (3D) reconstructed models into medical education, particularly in fields like gynecological oncology.

This study introduces 3D reconstructed models based on real cervical cancer cases as a teaching tool for undergraduate gynecological oncology education. Participants were fourth-year Clinical Medicine students of Wuhan University, China. Using student identity document numbers for grouping, half were assigned to the control group (odd numbers) and the other half to the 3D reconstructed model teaching group (even numbers). All the students completed the pre-tests before receiving traditional teaching on cervical intraepithelial lesions and cervical cancer. The control group completed the post-tests after traditional teaching alone, while the 3D reconstructed model teaching group completed the post-tests after receiving the additional 3D reconstructed model teaching. Feedback on this innovative teaching tool was collected. The pre-tests and post-tests covered cervical intraepithelial lesions, cervical cancer and staging system, and female pelvic anatomy.

This study includes 267 students, with 134 in the control group and 133 in the 3D reconstructed model teaching group. The pre-test scores of the three tests between the control group and the 3D reconstructed model teaching group showed no statistical difference (p > 0.05). Compared to the control group, the post-test scores of the 3D reconstructed model teaching group in theoretical knowledge of cervical intraepithelial lesions and cervical cancer, female pelvic anatomy and 2018 International Federation of Gynecology and Obstetrics staging system for cervical cancer increased significantly (p < 0.05). Feedback from students underscored the visual benefits and engaging nature of the models, with many expressing that the 3D models provided a clearer representation of cervical cancer and enhanced their learning experience.

The integration of 3D reconstructed models into medical education represents a promising approach to address the complexities of teaching intricate subjects in anatomy such as gynecological oncology. These models offer a more intuitive and thorough visualization of anatomical structures and pathological processes, fostering a hands-on and exploratory learning experience for students.

Identifying metastatic lymph nodes (LNs) in patients with cervical cancer treated with definitive radiotherapy may inform treatment strategy and determine prognosis, but available methods have limitations, especially in developing regions. Herein, we aimed to evaluate the performance of quantitative parameters in spectral computed tomography (CT) scanning in this context, focusing on its complementary role alongside conventional diagnostic approaches like 18-fluorine-fuorodeoxyglucose positron emission tomography computed tomography (18 F FDG-PET/CT). Patients with cervical cancer, who underwent pretreatment spectral CT simulation scanning and planned radiotherapy, were enrolled in this prospective study. The LNs were categorized as "metastatic" and "non-metastatic", based on a procedure that included 18 F FDG-PET/CT as well as CT, magnetic resonance imaging, Node Reporting and Data System and follow-up results. Iodine concentrations (IC), normalized IC (NIC), effective atom number (effZ), and spectral curve slope (λHU) in the arterial (AP) and venous (VP) phases, were compared between metastatic and non-metastatic LNs. IC were derived from iodine-based material decomposition through manual delineation and normalized to the iodine concentration in the adjacent artery (NIC). effZ and λHU were calculated based on the effective atom number image and virtual monochromatic images. Univariate and multivariate logistic regression analyses were used to determine spectral CT factors independently associated with LNs metastasis, and their diagnostic efficacies were assessed using the area under the curve (AUC) analysis. The diagnostic efficiency of 18 F FDG-PET/CT and spectral CT was compared. A total of 115 metastatic and 97 non-metastatic LNs were detected, and spectral CT parameters (IC, NIC, effZ, λHU) significantly differed between the two groups. In univariate and multivariable logistic regression analysis, λHU in the AP and NIC in the VP were independent predictors for metastatic LNs and their combination improved AUC to 0.923, with a sensitivity of 84.4%, and a specificity of 85.6%. Spectral CT could achieve similar sensitivity as 18 FFDG-PET/CT in total LNs, and, more importantly, a higher sensitivity (95.5% vs. 59.1%) and diagnostic accuracy (92.9% vs. 67.9%) for para-aortic LNs. Quantitative spectral CT parameters can help distinguish metastatic from non-metastatic LNs in patients with cervical cancer treated with definitive radiotherapy. Combination of λHU in AP and NIC in VP further improves diagnostic performance. Spectral CT, while promising, complements rather than replaces PET/CT, especially for diagnosing para-aortic LNs, where PET/CT may have limitations. It could be a valuable adjunct to conventional imaging, particularly in settings with limited access to advanced tools.

Background: Cervical cancer (CC) is the most prevalent gynecological tumor among women. Cyclin-dependent kinase 8 (CDK8), which plays a crucial role in cellular transcriptional processes and various signaling pathways, has been identified as a key oncogenic factor in numerous cancers. However, limited data exists on the correlation between CDK8 and CC. The objective of our study was to investigate whether there is an association between CDK8 gene polymorphisms and the development of CC in Han women from Southwest China. Materials and methods: A total of 300 unrelated CC patients and 335 healthy controls from Southwest China were included in the study. The polymerase chain reaction-restriction fragment length polymorphism analysis was used to genotype the two tag single nucleotide polymorphisms (SNPs) of CDK8 gene (rs17083838 and rs7992670), and the relationship between the two tag SNPs and CC incidence was analyzed by SNPstats software. Multifactor dimensionality reduction (MDR) was used to analyze the interaction of multiple polymorphisms of the CDK8 gene. The false-positive report probability (FPRP) was used to verify the effective correlation. Results: The frequency of the A allele of CDK8 rs17083838 in the CC group was significantly higher than that in the control group (25% vs. 12%, p < 0.0001, odds ratio (OR): 0.42, 95% confidence intervals [CI]: 0.31-0.58). The frequency of the A allele at rs7992670 was higher in the CC group than that in the control group (52% vs. 45%, p = 0.026, OR: 0.78, 95% CI: 0.63-0.97). MDR analysis showed that rs17083838 and rs7992670 as the overall model was the best model, the detection accuracy was 0.6157, and the cross-validation consistency was 10/10 (p < 0.0001). In addition, 22 valid FRPR values were verified by using the FPRP detection method. Conclusion: The two SNPs of the CDK8 gene may be associated with the increased risk of CC in the Han population in Southwest China.