Chi-Hau Chen

Background: Genitourinary syndrome of menopause (GSM) is common, and non-hormonal treatment options are needed for women unsuitable for or reluctant to use estrogen therapy. Objective: To prospectively evaluate clinical outcomes and clinical improvement rates of photobiomodulation (PBM) for GSM. Methods: Twenty-seven postmenopausal women with GSM were enrolled in a prospective study conducted from January 2024 to July 2025. Participants received eight weekly 30-minute sessions of pulsed 660-nm PBM delivered through a stationary silicone vaginal light-guide probe. With the probe attached, target irradiance was 32.38mW/cm² at the probe tip and 13.38mW/cm² at the probe side, corresponding to per-session radiant exposures of 29.14J/cm² at the vaginal fornix and 12.04J/cm² at the vaginal wall. Assessments occurred at baseline (V1), pre-4th session (V2), pre-8th session (V3), and three months post-treatment (V4). The primary outcome was the Vaginal Health Index (VHI). Secondary outcomes included validated questionnaires for lower urinary tract symptoms (LUTS) and sexual function (FSFI). Clinical improvement was defined using established minimal clinically important differences (MCID), minimal detectable change (MDC), and cutoff scores as thresholds. Results: The mean age of participants was 62.9 ± 9.7 years. Total VHI scores were significantly higher at all follow-up time points compared to baseline ( p < 0.05), with all participants reaching the non-atrophic VHI threshold at V4. UDI-6, IIQ-7, OABSS, and several KHQ domains improved significantly ( p < 0.05) and persisted through the 3-month follow-up. Total FSFI scores improved significantly (p < 0.05), but only 13.3% reached the clinical cutoff (≥26.5) at V4 for functional recovery. No adverse events were observed during the study period. Conclusions: Intravaginal 660-nm PBM is a well-tolerated, non-hormonal modality that may improve objective vaginal health and subjective symptoms in GSM. As an integrated therapeutic option, PBM may also improve GSM-related LUTS, suggesting potential relevance for geriatric patients with polypharmacy concerns. Trial registration: ClinicalTrials.gov NCT06074120

Introduction: Fertility‐sparing treatments using oral progestins have demonstrated promising oncologic outcomes for endometrial intraepithelial neoplasia and early‐stage endometrial cancer. However, the high recurrence rate remains a major concern, and the literature on long‐term follow‐up outcomes is limited. This study aimed to identify recurrence risk factors by analyzing clinicopathological and molecular profiles in a cohort with a median follow‐up of 9 years.Material and Methods: This retrospective study included patients under 45 years of age who were diagnosed with endometrial intraepithelial neoplasia or endometrial cancer and received fertility‐sparing treatments at our center between 2010 and 2021. Patients who achieved complete responses were categorized according to recurrence status. Demographic, clinical, and molecular data were compared between groups. The primary endpoint was to identify risk factors for recurrence; secondary endpoints assessed obstetric and oncologic outcomes in patients with relapse.Results: Out of 40 patients, 8 underwent hysterectomy within 1.5 years, while 32 responded to treatment and continued follow‐up. The recurrence and non‐recurrence groups contained 20 and 12 patients, respectively, with a median follow‐up of 107.5 months (range, 35–175 months). Multivariate analysis showed that a family history of cancer (HR = 2.597, p = 0.039) and treatment with megestrol acetate as the initial therapy (HR = 3.130, p = 0.021) were independent risk factors for shorter time to recurrence. Although mismatch repair deficiency was positively correlated with recurrence, the association did not reach statistical significance (p = 0.057). Four out of 24 patients were upstaged after hysterectomy, and all were in the recurrence group. Nine patients (22.5%) achieved pregnancy, with three successfully conceiving after achieving complete response following retreatment.Conclusions: In patients with long‐term follow‐up after fertility‐sparing treatment, a family history of cancer and initial treatment with megestrol acetate were significantly associated with recurrence.

Proteinuria is a common adverse event arising from treatment with bevacizumab, requiring diagnostic testing via 24-h urine collection. However, this method is cumbersome. We assessed urine screenings in gynecologic cancer patients from February 2021 to May 2022. Along with a simple urine dipstick (UD), the urine microalbumin, total protein, and creatinine were measured and calculated as the urine albumin to creatinine ratio (UACR) and the urine protein to creatinine ratio (UPCR), which were further adjusted through the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations to be estimated and correlated with 24-h urine total protein content. The incremental cost-effectiveness ratio was used for cost analysis. There were 129 urine samples from 36 patients. The sensitivity and specificity for the UACR were 0.56 and 0.97, and for the UPCR, 0.71 and 0.88, respectively. The 24-h TP correlated strongly with the UACR (r = 0.75; p < 0.001) and UPCR (r = 0.79; p < 0.001) and fair for the simple UD (r = 0.35; p < 0.001). The UPCR saves one unnecessary 24-h urine test for less than a dollar compared to a simple UD. The results indicate that using the UPCR could enhance diagnostic accuracy, lower costs, and reduce unnecessary 24-h urine sampling.

Endometrial cancer in Lynch syndrome is characterized by a higher incidence, younger age at onset, and increased recurrence rates compared to sporadic cases, while the safety and efficacy of fertility-sparing treatments remain uncertain. This case report presents the oncology outcome of fertility-preserving treatment in a 39-year-old woman diagnosed with Lynch syndrome and atypical endometrial hyperplasia. Initially, she responded favorably to fertility-preserving treatment but subsequently experienced disease relapse and rapid progression during retreatment. Final pathology revealed endometrial cancer with metastasis to the right ovary, categorized as FIGO 2023 stage IIIA1. This population’s unique molecular mechanisms and genetic mutations warrant special consideration when opting for fertility-sparing treatment. We have reviewed and summarized the oncology and pregnancy outcomes among Lynch syndrome and MMR-deficient patients through previous literature. However, no studies have investigated retreatment after recurrence in Lynch syndrome. Our case highlights the potential risks associated with retreatment following relapse. Vigilant monitoring and prompt consideration of surgical intervention are recommended upon disease relapse.

Ovarian cancer is the most lethal gynecological malignancy and is characterized by peritoneal disseminated metastasis. Although O-mannosyltransferase TMTC1 is highly expressed by ovarian cancer, its pathophysiological role in ovarian cancer remains unclear. Here, immunohistochemistry showed that TMTC1 was overexpressed in ovarian cancer tissues compared with adjacent normal ovarian tissues, and high TMTC1 expression was associated with poor prognosis in patients with ovarian cancer. Silencing TMTC1 reduced ovarian cancer cell viability, migration, and invasion in vitro, as well as suppressed peritoneal tumor growth and metastasis in vivo. Moreover, TMTC1 knockdown reduced cell-laminin adhesion, which was associated with the decreased phosphorylation of FAK at pY397. Conversely, TMTC1 overexpression promoted these malignant properties in ovarian cancer cells. Glycoproteomic analysis and Concanavalin A (ConA) pull-down assays showed that integrins β1 and β4 were novel O-mannosylated protein substrates of TMTC1. Furthermore, TMTC1-mediated cell migration and invasion were significantly reversed by siRNA-mediated knockdown of integrin β1 or β4. Collectively, these results suggest that TMTC1-mediated invasive behaviors are primarily through integrins β1 and β4 and that TMTC1 is a potential therapeutic target for ovarian cancer.