Antigen-Presentation Competence in Gynecologic Cancers: Mechanisms, Evidence and Translational Priorities.

Immune-checkpoint biomarkers in gynecologic cancers primarily estimate antigenic potential or characterize an inhibited immune response. However, they do not establish whether malignant cells are visible to antigen-specific lymphocytes. We define antigen-presentation competence as the capacity of the tumor-immune ecosystem to generate antigenic peptides, display them through functional human leukocyte antigen molecules, prime cognate T cells through professional antigen-presenting cells, and permit recognition of malignant cells by effector lymphocytes. Recurrent defects have been reported at each step in cervical, endometrial, and ovarian cancers, but the evidence is not equally mature across these diseases. Cervical studies emphasize human papillomavirus-associated immune selection and antigen-processing machinery abnormalities; endometrial cancer provides relatively direct treatment-linked evidence for major histocompatibility complex class I and interferon-pathway defects; and ovarian cancer offers direct immunopeptidomic and multiregion evidence that antigen availability, presentation, and immune recognition can diverge. Taken together, the literature makes antigen-presentation competence a testable functional framework. It does not yet justify a biomarker or clinical score. Prospective work will need spatial and longitudinal measurements of tumor presentation, dendritic-cell priming, and T-cell recognition. A key test is whether these measurements improve prediction beyond mismatch repair, polymerase epsilon, programmed death-ligand 1, and tumor mutational burden.