Endometrial cancer is the most common gynecologic malignancy in developed countries, with incidence rising steadily over the past two decades. While early-stage disease is often curable with surgery, advanced or recurrent cases carry a poor prognosis, making new treatment strategies urgently needed.
Immunotherapy -- particularly immune checkpoint inhibitors -- has transformed the treatment of several cancers and is now showing promise in endometrial cancer. Understanding the global research landscape helps identify where progress has been made and where critical gaps remain.
This study used bibliometric analysis to systematically map the entire body of published research on endometrial cancer immunotherapy from 2012 to 2024, covering 861 articles across 58 countries and thousands of researchers worldwide.
Bibliometrics is the quantitative study of scientific publications. Researchers searched the Web of Science database for all articles related to endometrial cancer and immunotherapy published between 2012 and 2024, retrieving 861 qualifying papers.
Specialized software tools -- CiteSpace and VOSviewer -- were used to visualize connections between authors, institutions, countries, journals, and keywords. These tools reveal collaboration networks and identify which topics cluster together in the literature.
Keyword co-occurrence analysis identifies themes that appear together frequently across publications, pointing to active research hotspots. Citation burst analysis flags topics that suddenly attracted intense research attention during specific time periods.
Annual publications in this field grew dramatically, from fewer than 20 papers per year in 2012 to over 150 by 2024. This exponential growth reflects both increasing clinical interest and the approval of checkpoint inhibitors for endometrial cancer in recent years.
China led in total publication volume, contributing approximately 40% of all papers in the dataset. However, the United States led in citation impact, meaning American research was more frequently referenced by other scientists -- a distinction between quantity and influence.
The most productive journals were Frontiers in Oncology, Cancers, and Gynecologic Oncology. The most prolific authors were concentrated at major academic cancer centers in China, the US, and Europe.
The single most prominent research theme was the tumor immune microenvironment -- the complex ecosystem of immune cells, signaling molecules, and structural components that surround a tumor. Understanding this environment is essential to predicting which patients will respond to immunotherapy.
Immune checkpoint inhibitors, particularly drugs targeting the PD-1/PD-L1 pathway, formed the second major cluster. These drugs release the brakes on the immune system, enabling T cells to attack cancer. Pembrolizumab, an anti-PD-1 antibody, received FDA approval for endometrial cancer during this period.
Mismatch repair deficiency (dMMR) and microsatellite instability (MSI) emerged as critical biomarkers for predicting immunotherapy response. Patients with dMMR/MSI-H tumors respond far better to checkpoint inhibitors, making molecular profiling a central research focus.
Targeted therapy combining immunotherapy with agents like lenvatinib (a kinase inhibitor) represented a third major cluster. The FDA-approved combination of pembrolizumab plus lenvatinib for advanced endometrial cancer generated substantial research activity.
Keyword burst analysis revealed that nanotechnology-based drug delivery was one of the fastest-growing recent topics. Nanoparticles can carry immunotherapy drugs directly to tumors, potentially improving efficacy while reducing side effects.
The integration of artificial intelligence and machine learning into immunotherapy research appeared as a newly emerging cluster, reflecting growing interest in using computational tools to predict treatment response and identify new therapeutic targets.
CAR-T cell therapy and tumor vaccines -- two forms of adoptive immunotherapy -- were also identified as rising topics, suggesting researchers are beginning to look beyond checkpoint inhibitors toward next-generation approaches for endometrial cancer.
Despite high publication volumes, international collaboration in this field remains limited. Most research clusters within national borders, and cross-country co-authorship is less common than might be expected for a field of this global importance.
The analysis identified underexplored areas including the role of the gut microbiome in immunotherapy response, combination strategies with radiation therapy, and immunotherapy approaches for the rare but aggressive Type II endometrial cancers such as uterine serous carcinoma.
The authors recommend that future research prioritize biomarker discovery beyond dMMR/MSI -- since many patients lack these markers yet might still benefit from immunotherapy -- and foster greater international data-sharing to accelerate clinical translation.
Bibliometric analysis offers a bird's-eye view of a scientific field that individual paper reviews cannot provide. This study confirms that endometrial cancer immunotherapy research has grown explosively and is converging on a set of well-defined themes centered on the immune microenvironment and checkpoint inhibition.
The data suggest that the field is maturing -- moving from foundational discoveries toward clinical optimization, combination strategies, and biomarker-guided treatment selection. The next decade of research will likely focus on expanding immunotherapy access to the majority of patients who currently do not respond to existing approaches.
For clinicians and researchers, this bibliometric map provides a strategic guide to where resources and attention are concentrated, helping identify both where to build on existing momentum and where important questions remain unanswered.