Background: Cervical cancer is a major global health concern, particularly in low-resource settings where access to advanced diagnostics is limited. The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory marker, has shown prognostic significance in various malignancies. However, its role in predicting cervical cancer in patients undergoing conization remains unclear. Objectives: This study evaluated NLR’s diagnostic and predictive value in identifying malignancy in conization outcomes. Methods: This retrospective study analyzed 374 patients from the SCOPE study. Preoperative NLR levels were assessed with conization histopathology outcomes using the Kruskal–Wallis test, Mann–Whitney U test, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: NLR levels were significantly higher in patients with malignant conization outcomes (χ² = 15.988, p = 0.001). A cut-off NLR ≥ 2.86 significantly predicted cervical cancer presence (p = 0.045). Logistic regression showed that each unit increase in the NLR increased cancer likelihood by 37.2% (p = 0.008). ROC analysis demonstrated moderate diagnostic accuracy (AUC = 0.734), with an optimal NLR cut-off of ≥1.865 yielding 87.0% sensitivity and 53.8% specificity. Conclusions: Our findings suggest that the NLR may serve as a promising, easily accessible, non-invasive biomarker with modest predictive value for cervical cancer in patients undergoing conization. Future studies should focus on validating the NLR in combination with other biomarkers, such as HPV genotyping and molecular markers, to improve diagnostic accuracy, particularly in low-resource settings.

Background: Cervical cancer continues to pose a significant global health challenge, particularly in low-resource regions with limited access to advanced diagnostics. Cervical conization can occasionally uncover invasive carcinoma in patients initially suspected of having only pre-invasive lesions. This study assessed the platelet-to-lymphocyte ratio (PLR) as a potential predictive biomarker for identifying invasive disease in patients undergoing a loop electrosurgical excision procedure (LEEP). Methods: A retrospective study was conducted on 371 patients who underwent LEEP conization for cervical dysplasia. Preoperative PLR values were collected and compared across final histopathological categories (negative, low-grade, high-grade, invasive carcinoma) using the Kruskal–Wallis test, followed by Mann–Whitney U tests for pairwise comparisons. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic accuracy. Results: PLR values above 7.7 were significantly associated with HPV positivity, increasing with histopathological severity. There were significant PLR differences across the outcome groups (p = 0.005), with notably higher values in cases of invasive carcinoma (p < 0.01). ROC analysis showed moderate diagnostic utility (AUC ≈ 0.72); at a PLR cutoff of ~11.9, sensitivity was 65% and specificity 81%. Conclusions: The PLR cutoff of 7.7 was associated with HPV positivity, while a higher cutoff of 11.93 was identified for predicting invasive cervical cancer. These findings support that preoperative PLR is a non-invasive, clinically relevant marker correlated with lesion severity, offering potential for preoperative risk stratification, particularly where advanced diagnostics are limited.

Background: Endometrial cancer (EC) is the most common gynecological malignancy, increasingly affecting premenopausal women. While hysterectomy is the standard treatment, it eliminates reproductive potential, highlighting the need for effective fertility-sparing alternatives. Current ESHRE/ESGO/ESGE guidelines recommend progestin-based therapies, often with hysteroscopic resection. However, these are based on limited pharmacological options and moderate to low-quality evidence. Novel and combination therapies have shown promise but remain absent from current clinical guidelines. This review aims to evaluate the efficacy and safety of fertility-preserving treatments for early-stage EC, emphasizing the need to update current strategies based on emerging data. Methods: A systematic review and meta-analysis will follow PRISMA guidelines and the Cochrane Handbook. Eligible studies, including randomized and non-randomized designs, will assess fertility-preserving treatments for early-stage EC. Data will be extracted on complete response, recurrence, and long-term fertility outcomes. The GRADE system will assess evidence certainty. Risk of bias will be evaluated using RoB 2 for RCTs and ROBINS-I for non-randomized studies. Meta-analysis will be performed if sufficient data are available. Conclusions: This review will provide a comprehensive analysis of fertility-sparing treatments for early-stage EC, support personalized strategies, identify evidence gaps, and guide future research. Trial registration—Prospero: CRD420251032161.

Background: Atypical endometrial hyperplasia is a precursor of endometrial carcinoma, increasingly diagnosed in reproductive-aged women. Standard hysterectomy may constitute overtreatment. Fertility-sparing approaches, oral or local progestins, hysteroscopic resection, and combined regimens are widely used, though evidence largely derives from early-stage carcinoma. Methods: CENTRAL, EMBASE, Scopus, Web of Science, and PubMed were searched from inception to 13 April 2025. Eligible studies included premenopausal women with AEH treated with oral progestins, levonorgestrel intrauterine devices (LNG-IUDs), hysteroscopic resection, or combination regimens (e.g., oral progestins + metformin, LNG-IUD + GnRH analogues). Random-effects meta-analyses with multilevel modeling were applied. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence was graded with GRADE-PRO. Results: Forty-nine studies (2313 women) were included. The pooled complete response (CR) rate was 85% (95% CI 80–89%). LNG-IUDs resulted in 88% CR and oral progestins in 80%. Combination therapies achieved up to 95% CR, though data were limited. Hysteroscopic resection combined with hormonal therapy reported high CR rates (96–97%) but relied on small, heterogeneous cohorts with uncertain reproducibility. The pooled recurrence rate was 19% (95% CI, 13–25%), lower with LNG-IUDs (14%) compared with oral progestins (22%). No response occurred in 14% overall and was lower with LNG-IUDs (13%) than oral progestins (19%). Among women attempting conception, the pooled pregnancy rate was 41%, and the live birth rate was 30%. The mean time to achieve CR was 5.6 months, whereas the mean time to recurrence was approximately 33 months. Conclusions: LNG-IUDs provide the most effective and well-supported fertility-sparing treatment for AEH, ensuring high remission with low recurrence. Despite favorable numerical outcomes, the evidence for hysteroscopic resection is limited and inconsistent, not supporting its routine use. Combination regimens may improve response but require confirmation in larger studies.

Endometrial carcinoma (EC) is the leading gynecologic malignancy in high-income countries, with a consistent upward trend in incidence observed among younger women, particularly in those younger than 50 years

Endometrial cancer is the sixth most common malignancy in women worldwide, and surgery remains the cornerstone of its treatment. Minimally invasive approaches, including conventional laparoscopy and robotic-assisted surgery are widely used; however, their relative oncologic effectiveness remains debated. This systematic review and meta-analysis compared oncologic and perioperative outcomes of robotic-assisted hysterectomy and conventional laparoscopic hysterectomy in patients with endometrial cancer. A systematic literature search was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane and Web of Science according to PRISMA 2020 guidelines. Comparative studies evaluating robotic assisted versus laparoscopic surgery for endometrial cancer were included. Outcomes assessed included lymph node yield, recurrence, progression-free survival (PFS), overall survival (OS), and perioperative variables, including estimated blood loss (EBL), conversion to open surgery, operative time, and intraoperative complications. Random-effects meta-analyses with heterogeneity and sensitivity analyses were conducted. Forty-two studies, including 91,151 patients, were analyzed. Robotic-assisted and laparoscopic surgery demonstrated equivalent oncologic outcomes, with no significant differences in recurrence, PFS, or OS. Lymph node yields were similar between approaches. Robotic surgery was associated with reduced EBL and lower conversion to open surgery, while other perioperative outcomes were comparable. Intraoperative complications were slightly more frequent in the robotic group. Robotic-assisted and conventional laparoscopic hysterectomy provide equivalent oncologic and survival outcomes. Perioperative differences are modest and mainly reflect technical characteristics. Surgical platform choice may therefore be guided by institutional resources, surgeon expertise, and patient-specific factors. CRD420251274986 (registered on December 29, 2025).