Objectives This study aimed to investigate the changes in the incidence and mortality trends of ovarian cancer (OC), cervical cancer (CC) and uterine cancer (UC) in the Fujian Province, southeastern China. Design Provincial, population-based, retrospective observational study. Setting Fujian province, southeastern China between 2011-2020. Participants From 2011 to 2020, 6178 new cases and 2037 deaths caused by 3 gynaecological cancers were eligible for analysis. Primary and secondary outcome measures The primary outcome measures were the incidence and mortality rates, including the age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), of three gynaecological cancers. The secondary outcome measure was the prevalence (average annual per cent changes (AAPC)). Results The incidence of all three gynaecological cancers increased from 2011 to 2020. CC had the slowest upward trend, with an AAPC of 2.54% over the period. However, it had the highest ASIR among the 3 cancers in 2020 (10.41/100 000). UC showed a rapid increase, with an AAPC of 15.15% from 2016 to 2020. While the mortality rate of UC remained stable, both CC and OC also exhibited rising trends, with the CC having the highest ASMR (3.05/100 000) in 2020. The ASMR for CC increased rapidly, with the highest AAPC of 5.51%. Conversely, changes in the ASMR for UC were not statistically significant (p=0.601). Moreover, high incidence rates were more common among perimenopausal women and older participants in the respective cancer groups where the increased mortality was observed. Conclusions Gynaecological cancer burden remains a public health issue in Fujian Province, with an increasing incidence. Improving the healthcare system and promoting a healthy lifestyle should be highlighted to reduce the cancer burden.

Aims:This study aimed to identify the prognostic value of tumor invasion distance (TID) based on MRI findings in cervical-cancer (CC) patients treated with radiotherapy (RT). Methods: A total of 218 CC patients diagnosed at Fujian Cancer Hospital from December 2018 to December 2019 were included in the study. Cox regression analyses were conducted to identify independent prognostic factors for overall survival (OS), including low 1/3 vaginal involvement, a longer TID, and RT without chemotherapy. These factors were subsequently used to construct a nomogram for individualized risk prediction. Kaplan–Meier survival analysis was employed to evaluate survival outcomes and establish a risk stratification system. The performance of the new stratification was assessed using the linear trend χ² test, Akaike information criterion, and Harrell’s concordance index. Results: A longer TID was associated with worse 3-year OS (p < 0.001, HR: 3.42, 95% CI: 1.67–7.00). A longer TID, lower 1/3 vaginal involvement, and concurrent chemotherapy were independent prognostic survival factors for CC patients. Compared with the 2018 FIGO staging system, the new risk stratification system provided better monotonicity with a higher linear trend χ² value (28.03 vs. 9.35), better discriminatory ability with smaller Akaike information criterion (312 vs. 331), and a greater Harrell C statistic (0.74 vs. 0.65) for predicting 3-year OS. Conclusions: This was the first study to demonstrate the prognostic value of TID in CC patients who received RT. The new risk stratification system based on TID could complement the 2018 FIGO staging system in identifying high-risk patients for more intense treatment and care. Further prospective research with larger samples is warranted to confirm the significance of TID for CC patients treated with RT.

Objectives: To develop and externally validate MRI-based radiomics and clinicoradiomics models for predicting pathological lymph node metastasis (LNM) in neuroendocrine carcinoma of the cervix (NECC). Methods: This retrospective two-center study included 133 patients who underwent pretreatment pelvic MRI and pathological nodal assessment: 93 for development and 40 for external validation. Intratumoral and peritumoral features were extracted from T2-weighted, diffusion-weighted, and contrast-enhanced T1-weighted images. Stratified nested fivefold cross-validation evaluated the complete revised selection process. Locked models were assessed for discrimination, calibration, and exploratory net benefit, with conventional MRI nodal assessment as a comparator. Results: Pathological LNM was present in 54/133 patients (40.6%). The selected radiomics-only k-nearest neighbors (KNN) model had an external AUC of 0.783 (95% CI, 0.630 to 0.935), accuracy of 0.800, sensitivity of 0.813, and specificity of 0.792. The complete selection procedure yielded an out-of-fold AUC of 0.731. External AUCs were 0.727 for the clinical/MRI model and 0.767 for the clinicoradiomics model; neither fusion model differed significantly from the clinical/MRI comparator. Conventional MRI sensitivity was 0.563, with no significant paired difference from the selected model (p = 0.125). External calibration was imperfect (Brier score, 0.186; slope, 0.672). Conclusions: MRI radiomics showed moderate external discrimination of pathological LNM in NECC. Adding clinical variables did not demonstrate further benefit. Multicenter validation, recalibration, and clinical-impact assessment are needed before clinical application.