Background/Objectives: The present study evaluates predictive implications of the pretherapeutic Fibrinogen–Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. Methods: This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, who underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Associations between the FARI and complete tumor resection status were described by receiver operating characteristics, and binary logistic regression models were fitted. Results: Higher preoperative FARI values correlated with higher ascites volumes (r = 0.371, p < 0.001), and higher CA125 levels (r = 0.271, p = 0.001). A high FARI cut at its median (≥11.06) was associated with lower rates of complete tumor resection (OR 3.13, 95% CI [1.63–6.05], p = 0.001), and retrained its predictive value in a multivariable model independent of ascites volumes, CA125 levels, FIGO stage, and Charlson Comorbidity Index (CCI). Conclusions: The FARI appears to act as a surrogate for higher intra-abdominal tumor load. After clinical validation, FARI could serve as a readily available serologic biomarker to complement preoperative patient assessment, helping to identify patients who are likely to achieve complete tumor resection during primary cytoreductive surgery.

Radical trachelectomy allows for fertility preservation in patients with early cervical cancer not qualifying as “low-risk” as defined by ConCerv. This study reports on the 10-year surgical, oncological, and obstetrical experience of patients treated by radical abdominal trachelectomy at an Austrian tertiary care center. A retrospective chart analysis and telephone survey of all patients with FIGO stage IA2-IB2 (2018) cervical cancer treated by radical abdominal trachelectomy and pelvic lymphadenectomy between 2013 and 2022 were performed. Radical abdominal trachelectomy was attempted in 29 patients, of whom 3 patients underwent neoadjuvant chemotherapy. Three cases, including one after neoadjuvant therapy, required conversion to radical hysterectomy due to positive margins; four cases had positive lymph nodes following surgical staging and were referred to primary chemo-radiotherapy. Twenty-two (75.9%) successful abdominal radical trachelectomies preserving fertility were performed. According to final histopathology, 79.3% of tumors would not have met the “low-risk”-criteria. At a median follow-up of 64.5 (25.5–104.0) months, no recurrence was observed. Eight (36.4%) patients attempted to conceive, with a live birth rate of 62.5%. Radical abdominal trachelectomy appears oncologically safe in early-stage cervical cancers that do not fulfill the “low-risk”-criteria. Strict preoperative selection of patients who might qualify for more conservative surgical approaches is strongly recommended.

In recent years, several randomized controlled trials have been published regarding cervical cancer therapy and significantly changed the treatment landscape. Recent advances have improved the treatment options and allow personalized treatment concepts with escalation of treatment in high-risk disease and de-escalation with reduction in morbidity in selected low-risk patients. This review aims to provide a comprehensive analysis of the latest landmark studies that are poised to significantly influence clinical practice. Personalized treatment concepts with careful patient selection allow de-escalation in the surgical treatment of cervical cancer. In low-risk cervical cancer patients (lesions of ≤2 cm with limited stromal invasion), simple hysterectomy (SH) was non-inferior to radical hysterectomy in terms of 3-year incidence of pelvic recurrence and was associated with a lower risk of urinary incontinence or retention and improved sexual health and quality of life. Furthermore, sentinel lymphadenectomy is constantly replacing systematic pelvic lymphadenectomy in patients with low-risk cervical cancer. In addition, further studies are necessary to clarify the role of postoperative therapy for patients with intermediate-risk cervical cancer. Starting in 2008, the EMBRACE studies assess the role of Image guided adaptive brachytherapy (IGABT) in LACC in addition to modern external beam radiotherapy concurrent to chemotherapy. The publication of the results of the EMBRACE I prospective study established MRI guided IGABT as state-of-the-art brachytherapy for LACC. EMBRACE II and additional prospective studies emerging from this consortium will address important questions in modern radiotherapy for LACC. Immune checkpoint inhibitors (CPIs) have been evaluated across various clinical settings and are expected to be utilized in numerous scenarios due to several positive randomized trials. Particularly, the combination of platinum-based chemotherapy and pembrolizumab, with or without bevacizumab, has been established as the new standard treatment for primary metastatic or recurrent PD-L1 positive high-risk cervical cancer. In locally advanced cervical cancer, two new treatment escalation regimens—neoadjuvant chemotherapy and adjuvant CPI therapy—have been evaluated in addition to chemoradiation. Furthermore, antibody-drug conjugates, such as tisotumab-vedotin, represent a promising future therapeutic option for recurrent cervical cancer.

Background/Objectives: Recent evidence suggests open radical hysterectomy is safer than radical hysterectomy by minimally invasive surgery (MIS) in early-stage cervical cancer. This study evaluated the oncological safety of laparoscopic lymph node assessment followed by open radical hysterectomy and the rate of unnecessary laparotomies avoided compared with a completely open approach. Methods: This two-center retrospective study included patients with cervical cancer FIGO stage ≤ Ib3 treated at two Austrian centers between 2015 and 2023. Patients undergoing laparoscopic lymph node assessment followed by open radical hysterectomy were compared with a matched historical cohort treated with primary open surgery between 2012 and 2017. Recurrence rates and progression-free survival (PFS) were compared using univariate and multivariate analyses. Results: In total, 130 patients were included: 79 (60.8%) underwent the combined approach and 51 (39.2%) the completely open approach. Recurrence rates (10.1% vs. 5.9%, p = 0.53) and median PFS (p = 0.36; median 26.0 vs. 71.3 months) did not differ between the two approaches. All patients underwent thorough preoperative radiologic and clinical assessment without suspected nodal metastases and were scheduled for radical hysterectomy with prior nodal assessment by MIS or open surgery. Intraoperative lymph node metastases were incidentally detected in 21/130 (16.2%) patients (combined approach n = 12 [15.2%] vs. open approach n = 9 [17.6%]). In cases of positive lymph nodes, surgery was abandoned without performing open radical hysterectomy and patients were referred to chemoradiotherapy. The needed to treat number to prevent one unnecessary open surgery was 6.25. Conclusions: Laparoscopic lymph node assessment before open radical hysterectomy appears oncologically safe, with comparable recurrence rates and PFS, and could spare one unnecessary laparotomy in every 7th patient with early-stage cervical cancer undergoing the combined approach.

Einleitung Explorative Studien zeigten für nicht-gynäkologische Tumore eine potenzielle prognostische Relevanz der Serumverläufe von Immunglobulin G (IgG) - einem zentralen Bestandteil des humoralen Immunsystems - unter zytotoxischen Systemtherapien. Präliminäre Daten einer eigenen Patientinnenkohorte mit gynäkologischen Malignomen deuteten auf eine Assoziation zwischen einem kontinuierlichen IgG-Abfall und Therapieansprechen auf Checkpoint-Inhibitortherapien (CPI). Ziel der vorliegenden Studie war eine Validierung dieser Beobachtung in größerer Kohorte und eine Analyse des Zusammenhangs zwischen IgG-Serumverläufen und progressionsfreiem Überleben (PFS). Material und Methode Insgesamt wurden 69 Patientinnen mit Endometrium-, Cervix-, Vulva- oder Vaginalkarzinom, die zwischen 2022 und 2024 CPI+/- Chemotherapie erhielten und bei denen keine G-CSF-Prophylaxe durchgeführt wurde, in die Analyse eingeschlossen. IgG-Serumspiegel wurden vor jeder Therapiegabe prospektiv bestimmt. Durch die einzelnen Messzeitpunkte wurde ein lineares Modell erstellt, und die sich ergebende Steigung der IgG-Kinetik (Regressionskoeffizent) errechnet. Anhand der Steigung der IgG-Kinetik wurde mittels ROC–AUC mit dem Endpunkt „Therapieansprechen“ (partielles/komplettes Ansprechen) und Youden–Index ein optimaler Cut-Off ermittelt und univariate und multivariate Überlebensanalysen für das PFS berechnet. Ergebnisse Patientinnen mit Therapieansprechen zeigen einen medianen Regressionskoeffizent von -0,009 und in 82.2% ein Absinken der IgG-Spiegel zwischen dem ersten und zweiten Messzeitpunkt; Patientinnen ohne Ansprechen einen medianen Regressionskoeffizent von+0,04 und in 37.5% ein Absinken (jeweils p<0,001). Die ROC ergab für den Regressionskoeffizenten und den Endpunkt „Therapieansprechen“ eine AUC von 0,831(0,725-0,931). Der Youden-Index bestimmte den Nullpunkt als optimalen Cut-Off: Somit ist bei negativem Regressionskoeffizienten ein Therapieansprechen wahrscheinlicher. Dementsprechend zeigten Patientinnen mit sinkender IgG-Kinetik ein signifikant niedrigeres Rezidivrisiko (OR 0,04 95%KI [0,011-0,015], p<0,001) und längeres PFS (HR 0,41 95%KI [0,20-0,84], p=0,015). Diese Beobachtung wurde im multivariablen Modell bestätigt (p=0,028). Schlussfolgerung Patientinnen, die nach vier Zyklen auf CPI-Therapien ansprechen, zeigen charakteristisch sinkende IgG-Kinetiken. Eine klinische Validierung serieller IgG-Serumspiegel als Prädiktor für das Therapieansprechen erscheint vielversprechend und könnte somit bereits ab den zweiten Zyklus ein Abschätzen des Ansprechens auf Checkpointinhibitoren erlauben. Article published online: 16 April 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany