Introduction
Gynecological oncology deals with the 360-degree management of the woman suffering
from a neoplasm of the female genital tract. Its research field is oriented towards
an improvement of diagnostic, therapeutic and prognostic techniques aimed at improving
the survival and quality of life of women affected by gynecological cancers.
The correct staging and prognostic stratification of cancer patients is the basis
for tracing an adequate treatment strategy at the same time radical enough to guarantee
the cancer safety and minimally invasive to minimize the negative effects on the quality
of life of cancer survivors.
This Research Topic aimed at widening the knowledges on the methods used for scientific
advancement in the gynecological oncology field. The issue currently includes 9 papers
on the diagnosis, prognostic stratification, treatment strategy of gynecological cancers
patients. All contributions to this Research Topic focus on one or more of the research
areas highlighted above, evidenced below by reference to the designated areas’ letters.
The gynecological tumors affect female population with different incidences and features.
Data from the National Cancer Institute Surveillance, Epidemiology and End Results
Program (NCI SEER) reported that the more frequent gynecological malignancy is represented
by uterine cancer with 65950 new cases in 2022 and a 5-year relative survival of 81.3%,
followed by ovarian cancer with 19880 new cases in 2022 and a 5-year relative survival
of 49.7%, cervical cancer with 14100 new cases in 2022 and a 5-year relative survival
of 66.7%, vulvar cancer with 6330 new cases in 2022 and a 5-year relative survival
of 70.3% (1). Primary vaginal cancer is very rare, showing a prevalence of approximately
1 in 100,000 women (typically of squamous cell histology) (2).
Ovarian tumors show the worst prognosis between gynecological cancers and they can
be divided into epithelial, germ cell or sex cord-stromal tumors based on the type
of cell from which they originate. Epithelial ovarian cancer (EOC) can be categorized
according to their invasiveness and biological features into borderline or malignant.
Gynecological neuroendocrine tumors are rare, there are no clear guidelines for their
clinical management and they can originate from cervical, endometrial and ovarian
tissue. Ovarian neuroendocrine tumors account for about 2% of all gynecological tumors
and they are divided into carcinoid, small cell neuroendocrine tumor (SCNET), and
large cell neuroendocrine tumor (LCNET) (3).
Diagnostic methodology in gynecological oncology
This thematic issue aims to show current advances in diagnosis and screening of gynecologic
malignancies.
Xu et al. proposed a radiomics nomogram to distinguish borderline ovarian cancer from
malignant epithelial ovarian cancer (EOC). In classifying early-stage type I and type
II EOC, the radiomics signature exhibited superior diagnostic performance over the
clinical model, based on patient age, menopausal status, CA-125 level, bilaterality,
MR-reported pelvic fluid, tumor configuration, and peritoneal involvement. Radiomics
has recently emerged as a powerful approach for non-invasively capturing the inter-lesion
heterogeneity that can be used to build an objective and accurate decision support
systems for cancer patients. The diagnostic efficacy of the nomogram was the same
as that of the radiomics model. Xu et al. used imaging features to characterize the
properties of adnexal masses with the aim of improving the diagnostic characterization
of EOC and providing to tailor specialized treatment plans on different patients.
The authors concluded that the radiomics model and combined model had higher benefits
than the clinical model to distinguish borderline from EOC.
Concerning diagnostic improvement to better characterize a pelvic mass suspected for
malignancy Yang et al. reported a model based on the combination between the marker’s
value HE4 and the already proposed ADNEX (Assessment of Different NEoplasias in the
adneXa) model proposed by Timmerman et al. in the research conducted by the IOTA (International
Ovarian Tumor Analysis) (4–6). The authors concluded that the ADNEX model performs
excellently to determine the benignity or malignancy of a ovarian tumor, with higher
specificity when combined with HE4. This combination can improve the differential
diagnosis ability and the sensitivity of an ovarian borderline tumor and a Stage II–IV
OC.
Wang et al. reported a case of superficial myofibroblastoma (SMF) of the lower female
genital tract, a relatively rare benign mesenchymal tumor, arose in a 71-year-old
Chinese female patient with postmenopausal vaginal bleeding. The authors described
a diagnostic path based on gynecological examination and colposcopic evaluation, color
Doppler flow imaging, magnetic resonance and the final diagnosis by histopathological
analysis. For the first time, colposcopy was used for auxiliary diagnosis and evaluation
before surgery for SMF and revealed a lesion covered with normal squamous epithelium
with a wide pedicle and a mushroom-like appearance.
Prognostic stratification in gynecological oncology
This section aims to underline the importance of prognostic classification of gynecological
cancer patients in order to tailor them the more appropriate therapeutic and surveillance
programme.
Xu et al. with their radiomics nomogram aimed at differentiate borderline ovarian
cancer from malignant EOC identified a tool for imaging-based prognostic stratification
of patients affected by ovarian malignancies.
Jiang et al. presented a nomogram based on clinical and non-clinical features that
affect the prognosis of patients with cervical cancer to develop an accurate prognostic
model that correlate with overall survival and cancer-specific survival. The authors
constructed nomograms including the following factors: insurance status, grade, histology,
chemotherapy, metastasis number, tumor size, regional node examination, LVSI, and
radiation.
Pang et al. conducted a retrospective analysis of data from 469 patients affected
by gynecologic LCNET to describe prevalence, survival outcomes, and associated factors
with this rare neoplasm. Their analysis revealed that American Joint Committee on
Cancer stage, lymph node metastasis, and chemotherapy were independent prognostic
factors for overall survival and cancer-specific survival in patients with cervical
LCNEC. Lymph node metastasis, surgery, and chemotherapy were independent prognostic
factors for overall survival and cancer-specific survival in the ovarian group and
for overall survival in the endometrial group. Lymph node metastasis and surgery were
also independent prognostic factors for cancer-specific survival in the endometrial
group.
Li and Cao developed nomograms to predict progression-free survival and overall survival
in patients with ovarian clear cell carcinoma after primary treatment. Their analysis
included several features studied on 358 Chinese patients. The most predictive nomogram
for progression-free survival considered the following variables: thrombosis, the
FIGO staging, residual of the tumor and distant metastasis. The most predictive nomogram
for overall survival considered the following variables: thrombosis, lymph node metastasis,
residual of the tumor, malignant ascites/washing, and platinum resistance.
Innovative therapeutic strategies in gynecological oncology
This thematic issue aims to propose new treatment strategies for women affected by
a neoplasm of the female genital tract.
Pang et al. thanks to their retrospective analysis of data from 469 patients affected
by gynecologic LCNET found that surgery alone may help to improve overall survival
and cancer-specific survival in patients with early-stage cervical LCNET. In contrast,
surgery+chemotherapy and surgery+radiotherapy may help to improve survival in those
with early-stage ovarian and endometrial LCNET, respectively. Regardless of subtype,
comprehensive treatment involving surgery, chemotherapy, and radiotherapy should be
considered to improve prognosis in patients with advanced-stage gynecologic LCNET.
Restaino et al. reported a brilliant and innovative treatment using human amniotic
membrane for myocutaneous dehyscence after a radical surgical treatment for vulvar
cancer. The authors described the first case of using human amniotic membrane to promote
healing of a surgical wound in a patient with gynecological oncology. The implantation
of amniotic membranes on surgical wounds appears to be safe, moreover, the psychological
impact of the treatment on the patient was acceptable, with an improvement also in
terms of pain.
Wang et al. showed the success of the surgical resection treatment of a patient affected
by vaginal SMF.
Li et al. compared the survival outcomes among 590 stage IB3 cervical cancer patients
who undergo abdominal radical hysterectomy+pelvic lymphadenectomy ± para-aortic lymph
node dissection versus radiochemotherapy. The authors concluded that for FIGO 2018
stage IB3 cervical cancer patients, surgery based on abdominal radical hysterectomy
and lymphadenectomy resulted in better overall survival and disease-free survival
than radiochemotherapy.
Li et al. reported the successful surgical treatment of an ovarian SCNET patients,
alive after two years from surgery who underwent laparoscopic total uterine double
attachment resection, bilateral ovarian arteriovenous high ligation, abdominal catheterization
and postoperative adjuvant chemotherapy.
Conclusion
In conclusion, this Research Topic provided several investigations focusing on relevant
oncological aspects as diagnosis, prognostic stratification and therapeutic strategy
of gynecological cancer patients.
Advances in oncological research provide the development of tools for conducting the
patient counseling, her postoperative management, and her follow-up to tailor diagnostic,
prognostic and therapeutic pathway on each different patient by multidisciplinary
approach.
Some other aspects about methods in gynecological oncology should be addressed and
deepened in future Research Topic, as the development of minimally invasive surgery
techniques, the use of new radio and chemotherapy schemes, the fertility sparing surgical
therapeutic pathways in young patients with gynecological cancer.
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution
to the work and approved it for publication.