Ovarian cancer has the highest mortality rate among gynecological tumors. This is based on late diagnosis and the lack of early symptoms. To improve early detection, it is essential to find reliable biomarkers. The metalloprotease ADAM17 could be a potential marker, as it is highly expressed in many solid tumors, including ovarian and breast cancer. The aim of this work is to evaluate the relevance of ADAM17 as a potential diagnostic blood-based biomarker in ovarian cancer. Ovarian cancer cell lines IGROV-1 and A2780, as well as primary patient-derived tumor cells obtained from tumor tissue and ascitic fluid, were cultured to analyze ADAM17 abundance in the culture supernatant. In a translational approach, a cohort of 117 well-characterized ovarian cancer patients was assembled and ADAM17 levels in serum and corresponding ascitic fluid were determined at primary diagnosis. ADAM17 was quantified by enzyme-linked immunosorbent assay (ELISA). In the present study, ADAM17 was detected in the culture supernatant of ovarian cancer cell lines and primary cells. In addition, ADAM17 was found in serum and ascites of ovarian cancer patients. ADAM17 level was significantly increased in ovarian cancer patients compared to an age-matched control group (p < 0.0001). Importantly early FIGO I/II stages, which would not have been detected by CA-125, were associated with higher ADAM17 concentrations (p = 0.007). This is the first study proposing ADAM17 as a serum tumor marker in the setting of a gynecological tumor disease. Usage of ADAM17 in combination with CA-125 and other markers could help detect early stages of ovarian cancer.

Recent trials such as INSEMA and SOUND have demonstrated the oncological safety of omitting sentinel lymph node biopsy in selected patients with hormone receptor-positive, HER2-negative early breast cancer. However, the implications for adjuvant treatment decisions in routine clinical practice remain unclear. We conducted a retrospective multicenter cohort study from university breast cancer centers, analyzing 867 patients diagnosed between 2020 and 2024 who met INSEMA criteria: cT1, G1-2, age ≥50 years, clinically node-negative, undergoing breast-conserving surgery. We evaluated the incidence of pathologically positive lymph nodes, frequency of postoperative upgrades in tumor stage or grading, and potential impact on adjuvant therapy decisions, including indications for CDK4/6 inhibitors, secondary axillary surgery or radiation. Sentinel lymph node biopsy revealed occult lymph node metastases in 14.3 % (n = 124) of patients, with a false-negative rate of 10.5 % when micrometastases and isolated tumor cells were excluded. In 11.6 % of cases, nodal positivity led to relevant therapeutic changes, including chemotherapy, axillary radiation, or potential adjuvant CDK4/6 inhibitor therapy. Moreover, 18.8 % of patients would have required secondary axillary surgery due to postoperative upgrades in tumor characteristics. The number needed to operate to prevent one invasive recurrence with CDK4/6 inhibitors varies significantly based on age and clinical tumor size, ranging from 1:333 (maximum) to 1:111 (minimum). While omission of sentinel lymph node biopsy appears safe in selected patients, our real-world data suggest that axillary staging retains clinical relevance for guiding personalized treatment, unless other prognostic tests like gene expression profiles are used.

Objective: To investigate changes in surgical procedures and patient outcomes of patients diagnosed with endometrial cancer (EC) at a German university hospital between 1998 and 2014. Methods: A monocentric, retrospective review was conducted to identify patients diagnosed and treated with EC during the aforementioned period at the Department of Gynecology and Obstetrics at the University Hospital Kiel, Germany. Results: 303 patients were identified. Patient demographics, risk factors, histological subtypes and stages of EC remained consistent over time. The most common surgical procedure was total abdominal hysterectomy (TAH) (81.9%). In 2011, the institution carried out its first total laparoscopic hysterectomy (TLH) for EC, resulting in a significant increase in laparoscopic surgical procedures (2011–2014: N = 70; TAH 44.2%; TLH 51.4%). Although the total number of lymph node stagings remained consistent over time, there was a significant increase in the performance of simultaneous pelvic and para-aortic lymphonodectomy (LNE) compared to pelvic LNE alone (2.6 in 2001–2005 vs. 18.0% in 2011–2014, p ≤ 0.001). The duration of hospital stays significantly decreased over time, with a mean of 20.9 days in the first and 8.5 days in the last period. When comparing surgical procedures, TLHs resulted in significantly shorter postoperative stays with an average of 6.58 vs. 13.92 days for TAH. The surgical procedure performed did not affect 5-year overall survival rates in this study (84.9% for TAH and 85.3% for TLH, p = 0.85). Conclusions: Our retrospective single-center study demonstrates that laparoscopic surgery for endometrial cancer is oncologically safe and shortens hospital stays.