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Jae Kwan Lee,
Jin Hwa Hong,
Sokbom Kang,
Dae-Yeon Kim,
Byoung-Gie Kim,
Sung-Hoon Kim,
Yong-Man Kim, Jae-Weon Kim,
Jae-Hoon Kim,
Tae-Jin Kim, [......],
Jeong-Won Lee,
Taek Sang Lee,
Myong Cheol Lim,
Suk-Joon Chang,
Hyun Hoon Chung,
Woong Ju,
Hee Jae Joo,
Soo-Young Hur,
Sung-Ran Hong,
Joo-Hyun Nam
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ABSTRACT: The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.
Journal of Gynecologic Oncology 04/2013; 24(2):186-203. · 1.49 Impact Factor
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ABSTRACT: The purpose of this study is to evaluate the efficacy and toxicity of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX-4) chemotherapy in heavily pretreated patients with recurrent epithelial ovarian cancer (EOC).
Clinical data were reviewed in 28 patients who received FOLFOX-4 as more than the second-line chemotherapy, consisting of 85 mg/m(2) of oxaliplatin as a 2-hour infusion, 200 mg/m(2) of leucovorin as a 2-hour infusion, and bolus 400 mg/m(2) on day 1, followed by a 22-hour infusion of 600 mg/m(2) of 5-fluorouracil for two consecutive days every three weeks. In addition, its efficacy and toxicity were compared with those reported in in three previous relevant studies.
A total of 128 cycles of FOLFOX-4 were administered with the median number of five cycles (range, 1 to 10 cycles). In nine patients with measurable disease, complete response (CR) and partial response (PR) were observed in 0 (0%) and two (22.2%) patients, whereas in 19 patients with non-measurable disease, CR and PR were observed in 0 (0%) and five (26.3%) patients. Among all patients, grade 3 anemia, neutropenia, and thrombocytopenia were observed in two (7.1%), three (10.7%), and one (3.6%) patient, and grade 3 fatigue, nausea and vomiting, and peripheral neuropathy were observed in one (3.6%), two (7.1%), and three (10.7%) patients. In addition, median values of time to progressive disease and chemotherapy-specific survival were three months (range, 0 to 10 months) and nine months (range, 4 to 24 months).
FOLFOX-4 is feasible as salvage chemotherapy with acceptable toxicity for heavily pretreated patients with recurrent EOC.
Cancer Research and Treatment 03/2013; 45(1):40-7.
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ABSTRACT: OBJECTIVE: The objective of this study was to evaluate the epidemiologic association between diabetes and risk of ovarian cancer. METHODS: We searched PubMed, EMBASE, and The Cochrane Library for observational studies on the association between diabetes and ovarian cancer. Cohort studies that reported relative risks (RRs) and case-control studies that showed odds ratios were included in the analysis. Summary RRs with 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS: A total of 19 studies from 18 articles (7 case-control studies and 11 cohort studies) met the inclusion criteria. Combining data from all studies, diabetes was associated with an increased risk of ovarian cancer, compared with no diabetes (summary RR of ovarian cancer incidence, 1.17; 95% CI, 1.02-1.33). In cohort and nested case-control studies, patients with diabetes had statistically significant increased risk of ovarian cancer (RR, 1.16; 95% CI, 1.01-1.33), without significant heterogeneity (I = 27; P = 0.172). Among studies that control for age, body mass index, smoking, and alcohol, a prominent association between diabetes and ovarian cancer was found (RR, 1.55; 95% CI, 1.11-2.19). CONCLUSIONS: This study suggests that women with diabetes have a moderately increased risk of ovarian cancer.
International Journal of Gynecological Cancer 01/2013; · 1.65 Impact Factor
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ABSTRACT: OBJECTIVE: The Korean Gynecologic Oncology Group (KGOG) recently proposed new pre-operative criteria to identify a low-risk group for lymph node metastasis in endometrial cancer. The aim of this study was to test whether the good performance of the criteria can be reproducible in diverse clinical settings. METHODS: From two Japanese hospitals, 319 patients with endometrial cancer who underwent systemic lymphadenectomy were retrospectively reviewed. In one hospital, para-aortic lymphadenectomy was routinely performed, but it was selectively performed in the other hospital. The performance of the criteria was determined by adjusting the false-negative rate (FNR) at the given prevalence of nodal metastasis of 10% using Bayes' theorem. RESULTS: Nodal metastasis rate of the study population was 12.9%. The KGOG low-risk criteria identified 181 of 319 patients as a low-risk group (51%), and three false-negative cases were found (1.9%). Despite a significant difference in the nodal metastasis rate (18.2% and 8.8%, P=.012) and the surgical policy for para-aortic lymphadenectomy (100% and 48.9%, P<.001) between the two hospitals, KGOG criteria consistently showed a very low adjusted FNR at the prevalence of 10% in both hospitals (1.8% vs. 1.1%, respectively). Among the entire study population, the adjusted FNR was 1.4% (95% confidence interval, .5% to 4.3%), which was similar to the FNR of 1.3% in our previous study. CONCLUSION: The KGOG low-risk criteria accurately identified a low-risk group for lymph node metastasis with acceptable false negativity regardless of diverse clinical settings.
Gynecologic Oncology 01/2013; · 3.89 Impact Factor
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ABSTRACT: : To analyze pregnancy outcomes in young women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus after successful fertility-sparing management using progestin.
: We reviewed the medical records of 141 women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus who had complete remission after progestin treatment. Statistical analysis was performed using Student's t test or Mann-Whitney U test for continuous variables, using χ or Fisher's exact test for categorical variables, and using log-rank test for survival comparison.
: Fifty-four (38.3%) women in the study cohort had a history of infertility. Seventy (49.6%) of the 141 patients tried to conceive with 44 (62.9%) receiving fertility drugs. The median interval to attempted pregnancy after treatment was 5 months (range 1-31 months). The median age at the time of the pregnancy trial was 32.4 years (range 23-40 years). Fifty-one (73%) of 70 women who tried to conceive were successful and 46 (66%) gave birth to 58 live neonates. The spontaneous abortion rate, ectopic pregnancy rate, and preterm delivery rates in our cohort were 24%, 2.8%, and 11.5%, respectively. The 5-year disease-free survival was similar between patients who received fertility drugs (n=44) or who did not (n=97) (73% compared with 62%, P=.335), and this rate was significantly higher in patients who achieved at least one pregnancy (n=51) than those who did not (n=90) (76% compared with 62%, P=.028).
: Although the proportion of patients with a history of subfertility or infertility was high in our cohort, the pregnancy outcomes were very promising using assisted reproductive technology. The use of fertility drugs was not associated with a higher incidence of cancer recurrence after successful fertility-sparing management in this study population.
: II.
Obstetrics and Gynecology 01/2013; 121(1):136-42. · 4.73 Impact Factor
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ABSTRACT: Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized.
Journal of Gynecologic Oncology 01/2013; 24(1):66-82. · 1.49 Impact Factor
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Jeong-Yeol Park,
Sang-Hun Lee,
Seok Ju Seong,
Dae-Yeon Kim,
Tae-Jin Kim, Jae Weon Kim,
Jong-Hyeok Kim,
Yong-Man Kim,
Young-Tak Kim,
Duk-Soo Bae,
Joo-Hyun Nam
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ABSTRACT: OBJECTIVE: To analyze the outcomes of second round of fertility-sparing management using progestin in patients with recurrent endometrial cancer after successful fertility-sparing management using progestin. METHODS: We reviewed 45 patients who had recurrence after achieving complete remission by fertility-sparing management using progestin for presumed stage IA, grade 1, endometrioid adenocarcinoma of the uterus. Of 45 patients, 33 tried progestin re-treatment at recurrence and were included in this study. RESULTS: Recurrent disease was atypical hyperplasia in 13 patients (39%) and grade 1 endometrioid adenocarcinoma in 20 patients (61%) which were confined to the endometrium. Thirty patients (91%) received medroxyprogesterone acetate (dose range, 80-500 mg/day) and three patients (9%) received megestrol acetate (dose range, 80-160 mg/day), with 29 patients receiving a dose of 500 mg/day of medroxyprogesterone acetate. The median duration of treatment was 6 months (range, 3-19 months). Five patients failed to respond to progestin re-treatment and underwent definitive surgical treatment including hysterectomy. Twenty eight patients (85%) showed complete response to progestin re-treatment. The median follow-up time after progestin re-treatment in 28 patients who achieved complete remission was 51 months (range, 24-160 months). During follow-up, five patients had second recurrence after median time interval of 14 months (range, 4-82 months). All patients who tried progestin re-treatment are alive without evidence of disease. CONCLUSION: Progestin re-treatment in patients with recurrent endometrial cancer was effective and safe. Therefore, this can be recommended for young women who still want to preserve fertility at recurrence after complete response to progestin.
Gynecologic Oncology 12/2012; · 3.89 Impact Factor
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ABSTRACT: A prospective multicenter trial has been started in Korea to investigate the treatment efficacy of a levonorgestrel-releasing intrauterine system plus medroxyprogesterone acetate in young women with early-stage endometrial cancer. A number of studies have reported the effectiveness of hormonal therapy using systemic progestin in women clinically diagnosed with early endometrial adenocarcinoma at Stage IA, Grade 1, who want to maintain reproductive potential. In addition, several recent studies reported the use of a levonorgestrel-releasing intrauterine system to treat patients at a high risk of perioperative complications who cannot tolerate systemic progesterone because of its adverse effects. However, there has been no prospective multicenter trial that investigated the effectiveness of treatment with systemic progesterone in combination with intrauterine progesterone in young women with endometrial cancer. Young patients with histologically confirmed Grade 1 endometrioid adenocarcinoma that is presumably confined to the endometrium, who desired to preserve their fertility potential, undergo levonorgestrel-releasing intrauterine system insertion and are administered medroxyprogesterone acetate at a dosage of 500 mg/day concurrently. The follow-up and treatment response assessment were implemented at a 3-month interval with office endometrial aspiration biopsy with the levonorgestrel-releasing intrauterine system in place, and dilatation and curettage after removal of the levonorgestrel-releasing intrauterine system. The primary endpoint is the complete response rate. The secondary endpoint is to estimate the consistency of the results of the office endometrial aspiration biopsy with the levonorgestrel-releasing intrauterine system in the uterus and a dilatation and curettage after removal of the levonorgestrel-releasing intrauterine system.
Japanese Journal of Clinical Oncology 10/2012; · 1.78 Impact Factor
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Jeong-Yeol Park,
Dae-Yeon Kim,
Jong-Hyeok Kim,
Yong-Man Kim,
Kyu-Rae Kim,
Young-Tak Kim,
Seok Ju Seong,
Tae-Jin Kim, Jae Weon Kim,
Seok Mo Kim,
Duk-Soo Bae,
Joo-Hyun Nam
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ABSTRACT: OBJECTIVE: To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer. METHODS: We analysed 148 patients (age⩽40years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA). RESULTS: 115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ⩾25kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI⩾25kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence. CONCLUSION: Fertility-sparing management was highly effective and safe. BMI<25kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success.
European journal of cancer (Oxford, England: 1990) 10/2012; · 4.12 Impact Factor
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ABSTRACT: The aim of this study was to identify a standard for the evaluation of future models for prediction of lymph node metastasis in endometrial cancer through estimation of performance of well-known surgicopathological models.
Using the medical records of 947 patients with endometrial cancer who underwent surgical management with lymphadenectomy, we retrospectively assessed the predictive performances of nodal metastasis of currently available models.
WE EVALUATED THREE MODELS INCLUDED: 1) a model modified from the Gynecologic Oncology Group (GOG) pilot study; 2) one from the GOG-33 data; and 3) one from Mayo Clinic data. The three models showed similar negative predictive values ranging from 97.1% to 97.4%. Using Bayes' theorem, this can be translated into 2% of negative post-test probability when 10% of prevalence of lymph node metastasis was assumed. In addition, although the negative predictive value was similar among these models, the proportion that was classified as low-risk was significantly different between the studies (56.4%, 44.8%, and 30.5%, respectively; p<0.001).
The current study suggests that a false negativity of 2% or less should be a goal for determining clinical usefulness of preoperative or intraoperative prediction models for low-risk of nodal metastasis.
Journal of Gynecologic Oncology 10/2012; 23(4):251-6. · 1.49 Impact Factor
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ABSTRACT: To define a subset of patients with early-stage cervical cancer at low risk for parametrial invasion through pathologic parameters of loop electrosurgical excision procedure (LEEP).
A retrospective analysis of data from 131 patients who underwent LEEP before radical hysterectomy or radical trachelectomy for stage IA2 to IB1 cervical cancer was performed. Subgroup analysis was performed to define a group of patients at the lowest risk for parametrial invasion based on LEEP findings.
Overall, 7 (5.3%) of 131 patients showed parametrial involvement, all of whom had residual tumors in hysterectomy specimens. Risk factors for residual disease included a tumor width greater than 30 mm and a positive endocervical or deep resection margin. A subgroup analysis demonstrated that LEEP parameters, including a depth of invasion of 5 mm or less and a negative endocervical resection margin, were able to define the subgroup of patients at low risk for parametrial invasion. In 24 patients (18.3%) who met these criteria, there was no evidence of parametrial spread as well as nodal metastasis.
A subgroup of patients with early-stage cervical cancer selected by the 2 LEEP variables, depth of invasion of 5 mm or less and a negative endocervical resection margin, demonstrated no risk for parametrial invasion.
International Journal of Gynecological Cancer 07/2012; 22(7):1214-9. · 1.65 Impact Factor
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ABSTRACT: This study investigated the efficacy and toxicity associated with consolidation chemotherapy using paclitaxel and carboplatin after concurrent chemoradiation (CCR) in cervical cancer patients.
From a total of 37 patients, 19 with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA cervical cancer (group 1) underwent surgery followed by consolidation chemotherapy after CCR, and 18 with stage IIB-IVA disease (group 2) received consolidation chemotherapy after primary CCR. Three cycles of chemotherapy using paclitaxel (135 mg/m(2)) and carboplatin (AUC 5.0) were administered every 3 weeks for CCR therapy, and three cycles of consolidation chemotherapy using paclitaxel (175 mg/m(2)) and carboplatin (AUC 5.0) were used every 3 weeks after CCR.
The complete and partial response rates were 77.8% and 22.2% in group 2. Moreover, the 3-year progression-free and overall survival rates were 62.7% and 90.9% in group 1, and 51.9% and 60% in group 2, respectively. The most common grade 3 or 4 hematologic toxicities observed were leukopenia (group 1, 10.5%; group 2, 13.0%) and neutropenia (group 1, 7.0%; group 2, 14.8%), and grade 3 or 4 diarrhea (group 1, 1.8%) and febrile illness (group 2, 1.9%) were the most frequently observed non-hematologic toxicities. When we compared these results with previous reports, consolidation chemotherapy after CCR using paclitaxel and carboplatin revealed a relatively lower complete response rate (77.8% vs. 87-100%, respectively) and shorter progression-free survival (51.9-62.7% vs. 81-86%, respectively) and overall survival (60-90.9% vs. 81-95%, respectively) in spite of similar toxicity findings.
Due to low efficacy results, consolidation chemotherapy using paclitaxel and carboplatin after CCR is not a feasible treatment regimen for high-risk early-stage or locally advanced cervical cancer.
Cancer Research and Treatment 06/2012; 44(2):97-103.
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ABSTRACT: Our study aimed to develop a model to predict distant recurrence in locally advanced cervical cancer, which can be used to select high-risk patients in enriched clinical trials.
Our study was a retrospective analysis of a multi-institutional cohort of patients treated between 2001 and 2009. According to the order of data submission, data from three institutions were allocated to a model development cohort (n = 434), and data from the remaining two institutions were allocated to an external validation cohort (n = 115). Patient information including [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) data and clinical outcome was modeled using competing risk regression analysis to predict 5-year cumulative incidence of distant recurrence.
The competing risk analysis revealed that the following four parameters were significantly associated with distant recurrence: pelvic and para-aortic nodal positivity on FDG-PET, nonsquamous cell histology, and pretreatment serum squamous cell carcinoma antigen levels. This four-parameter model showed good discrimination and calibration, with a bootstrap-adjusted concordance index of 0.70. Also, the validation set showed good discrimination with a bootstrap-adjusted concordance index of 0.73. A user-friendly Web-based nomogram predicting 5-year probability of distant recurrence was developed.
We have developed a robust model to predict the risk of distant recurrence in patients with locally advanced cervical cancer. Further, we discussed how the selective enrichment of the patient population could facilitate clinical trials of systemic chemotherapy in locally advanced cervical cancer.
Journal of Clinical Oncology 05/2012; 30(19):2369-74. · 18.37 Impact Factor
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ABSTRACT: To evaluate the efficacy of post-treatment positron emission tomography (PET)/computed tomography (CT) for identification of tumor recurrence, and to determine whether [(18)F]fluorodeoxyglucose (FDG) uptake measured as the maximum standardized uptake value (SUV(max)) has predictive role regarding survival in patients with uterine cervical cancer.
Medical records from 276 women with uterine cervical cancer who had post-treatment [(18)F]FDG PET/CT performed were retrospectively reviewed. Results of PET/CT scans were compared with histological or clinical examination.
Ninety-five (34.4%) of the 276 patients had documented recurrence by either surgical biopsy or clinical and imaging follow-up. Median duration from treatment to PET/CT scan was 24 months (range, 6-307). The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of post-treatment PET/CT were 94.7%, 87.8%, 80.4%, 97%, and 90.2%, respectively. The PET/CT scan modified both the diagnostic or treatment plan in 67 patients (24.3%). Patients were divided into two groups according to cut-off SUV(max) established on the basis of ROC analysis (<5.25 vs. ≥5.25), and there was a significant difference in OS between groups (p=0.001). In addition, the 5-year progression-free survival (PFS) and OS rates of patients with a negative PET/CT scan for recurrence were significantly better than those with a positive PET/CT (98.62% vs. 17.83%, p<0.0001 for PFS, 99.31% vs. 85.38%, p=0.0015 for OS).
Post-treatment PET/CT scan is a sensitive and accurate surveillance modality, and provides prognostic information in uterine cervical cancer. Furthermore, it may allow individualization of patient care.
European journal of radiology 05/2012; 81(8):e817-22. · 2.65 Impact Factor
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ABSTRACT: PurposeWe sought to investigate the efficacy of in vitro extreme drug resistance (EDR) assay for the prediction of drug response,
platinum-resistance (progression-free survival, PFS <6months) and survival in patients with epithelial ovarian cancer (EOC)
who received taxane- and platinum-based chemotherapy after surgery.
MethodsBetween December 2005 and August 2007, 43 patients were enrolled prospectively. They underwent staging laparotomy followed
by six or nine cycles of taxane- and platinum-based chemotherapy, and their tumors were submitted for in vitro EDR assay to
taxanes (paclitaxel or docetaxel) and platinum compounds (carboplatin or cisplatin).
ResultsThe rates of EDR to taxanes and platinum compounds were 20.9% (9/43) and 23.3% (10/43). Patients with EDR to platinum compounds
showed a lower rate of overall response (60 vs. 100%), a higher rate of platinum-resistance (50 vs. 18.2%) and poor overall
survival (OS) (median OS; 29.2 vs. 33.7months) than those without EDR to platinum compounds (P<0.05), whereas patients with EDR to taxanes showed poor PFS than those without EDR to taxanes (12.5 vs. 19months, P<0.01). Moreover, suboptimal debulking surgery and EDR to taxanes were poor prognostic factors for PFS (adjusted hazard
ratio 3.215 and 3.984; 95% confidence interval 1.845–7.895 and 3.814–11.674, respectively) although there was no independent
risk factor for poor OS by the multivariate Cox’s proportional hazard analysis.
ConclusionsIn vitro EDR assay to taxanes and platinum compounds may be helpful for predicting drug response, platinum-resistance and
survival in patients with EOC who received taxane- and platinum-based chemotherapy after staging laparotomy.
Journal of Cancer Research and Clinical Oncology 04/2012; 135(11):1513-1520. · 2.56 Impact Factor
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ABSTRACT: We sought to compare the efficacy and toxicity between surgery followed by concurrent chemoradiation and primary concurrent
chemoradiation in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib1–IIa squamous cell carcinoma
of cervix and suspicious para-aortic lymph node metastasis by preoperative computed tomographic and magnetic resonance imaging.
From January 2000 to December 2007, 48 patients treated with radical hysterectomy with pelvic and para-aortic lymphadenectomy
followed by concurrent chemoradiation (group 1) were matched to 16 patients treated with primary concurrent chemoradiation
(group 2) from medical records. Primary end points were progression-free survival (PFS) and overall survival, and secondary
end points were late complications by concurrent chemoradiation and pattern of disease recurrence. Among 48 patients in group
1, 39 (81.3%) and 35 (72.9%) had histologic pelvic and para-aortic lymph node metastases, respectively. Distant metastasis
was more frequent in group 2 than in group 1 (37.6% vs. 12.5%, p=0.027), although there was no difference in locoregional recurrence between the two groups. Surgery followed by concurrent
chemoradiation and FIGO stage Ib1 were only statistically significant factors for improved PFS (adjusted hazard ratio, 0.231
and 0.244; 95% confidence interval, 0.072–0.821 and 0.086–0.697), although there was no prognostic factor for overall survival.
Furthermore, there was no difference in grade 3 or 4 late complications between groups 1 and 2 (25.0% vs. 31.3%, p=0.745). Surgery followed by concurrent chemoradiation may improve PFS and reduce distant metastasis without difference
in late complications compared with primary concurrent chemoradiation in patients with FIGO stage Ib1–IIa squamous cell carcinoma
of cervix and suspicious para-aortic lymph node metastasis.
Annals of Surgical Oncology 04/2012; 16(1):133-139. · 4.17 Impact Factor
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ABSTRACT: To evaluate the correlation of pre-operative systemic inflammatory response (SIR) markers with lymph node (LN) metastasis compared with serum CA-125 in endometrioid endometrial adenocarcinoma.
Retrospective review of 319 patients who were pathologically proven to have endometrioid endometrial adenocarcinoma after staging operations. Serum CA-125 and pre-operative SIR markers [neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein (CRP), albumin, platelets and fibrinogen] were assessed. Receiver operating characteristic (ROC) curves were plotted for each SIR marker and serum CA-125.
NLR, PLR and serum CA-125 were higher in the LN-positive group compared with the LN-negative group (p=0.003, 0.012 and 0.025, respectively). Serum albumin was significantly lower in the LN-positive group compared with the LN-negative group (p<0.001). ROC curves demonstrated the best cut-off values for NLR (≥1.97), PLR (≥9.14), albumin (≤4.15 g/dl) and serum CA-125 (≥32.50 U/ml) for pre-operative diagnosis of LN metastasis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of serum CA-125 were 63.3%, 87.6%, 37.3%, 95.4% and 85.1%, respectively. No pre-operative SIR markers were superior to serum CA-125 in terms of sensitivity, specificity, PPV, NPV or accuracy, with the exception of the slightly higher sensitivity of PLR (64.5%).
Pre-operative SIR markers do not appear to be more effective in predicting LN metastasis than serum CA-125 in endometrioid endometrial adenocarcinoma.
European journal of obstetrics, gynecology, and reproductive biology 03/2012; 162(2):206-10. · 1.97 Impact Factor
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Sokbom Kang,
Woo Dae Kang,
Hyun Hoon Chung,
Dae Hoon Jeong,
Sang-Soo Seo,
Jong-Min Lee,
Jae-Kwan Lee, Jae Weon Kim,
Seok-Mo Kim,
Sang-Yoon Park,
Ki Tae Kim
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ABSTRACT: The aim of this study was to develop a preoperative risk prediction model for lymph node metastasis in patients with endometrial cancer and to identify a low-risk group before surgery.
The medical records of 360 patients with endometrial cancer who underwent surgical staging were collected from four institutions and were retrospectively reviewed. By using serum CA-125 levels, preoperative biopsy data, and magnetic resonance imaging (MRI) data, a multivariate logistic model was created. Patients whose predicted probability was less than 4% were defined as low risk. The developed model was externally validated in 180 patients from two independent institutions.
Serum CA-125 levels and three MRI parameters (deep myometrial invasion, lymph node enlargement, and extension beyond uterine corpus) were found to be independent risk factors for nodal metastasis. The model classified 53% of patients as part of a low-risk group, and the false negative rate was 1.7%. In the validation cohort, the model classified 43% of patients as low-risk, and the false negative rate was 1.4%. The model showed good discrimination (area under the receiver operator characteristic curve = 0.85) and was calibrated well. The negative likelihood ratio of our low-risk criteria was 0.11 (95% CI, 0.04 to 0.29), which was equivalent to the false-negative rate of 1.3% (95% CI, 0.5% to 3.3%) at the assumed prevalence of nodal metastasis of 10%.
Using serum CA-125 and MRI as criteria resulted in the accurate identification of a low-risk group for lymph node metastasis among patients with endometrial cancer.
Journal of Clinical Oncology 03/2012; 30(12):1329-34. · 18.37 Impact Factor
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ABSTRACT: This study was performed to evaluate treatment outcomes and define prognostic factors for primary vaginal cancer treated with definitive radiotherapy.
We retrospectively analyzed 38 patients with primary vaginal cancer who received radiotherapy with curative intent between January 1981 and August 2008. Of these 38 patients, 6 were excluded from this analysis because of other uncontrolled malignancy (n = 1), uncommon histology (n = 4), or insufficient medical records (n = 1). Twenty-three patients (72%) presented with early-stage disease (International Federation of Gynecology and Obstetrics stages 0, I, or II). Eleven patients (34%) were treated with external beam radiotherapy (EBRT) alone and 21 patients (66%) with EBRT plus brachytherapy (BT). Low-dose rate cesium-137 was used with intracavitary technique for most of the patients who received BT. Five patients received chemotherapy. The median total dose in patients who received EBRT and EBRT+BT was 50.4 Gy (range, 39.6-70.4 Gy) and 78.9 Gy (range, 72.0-87.0 Gy), respectively.
The median duration of follow-up was 38 months. Five-year overall survival, cause-specific survival, disease-free survival, local control, and regional control rates for the analyzed patients were 75%, 88%, 58%, 62% and 90%, respectively. Thirteen patients had treatment failure as follows: local (n = 7), distant (n = 1), local plus regional (n = 1), local plus distant (n = 2), and local plus regional plus distant (n = 2). Primary tumor size was a significant prognostic factor for disease-free survival (P = 0.039).
Definitive radiotherapy is an effective treatment modality for primary vaginal cancer. Local failure was the major failure pattern, and achievement of local control is important for disease control and survival.
International Journal of Gynecological Cancer 03/2012; 22(3):521-7. · 1.65 Impact Factor
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ABSTRACT: Aim: Various DNA alterations by environmental or endogenous carcinogens, if not repaired, can cause genetic mutagenesis, resulting in carcinogenesis. A polymorphic variant of excision repair cross-complementation group 1 (ERCC1) (the DNA repair gene) may be associated with carcinogenesis due to reduced DNA repair capacity. The aim of this study was to investigate whether the ERCC1 C19007T polymorphism might be associated with the increased risk and invasiveness of cervical cancer in Korean women. Methods: Peripheral blood samples from 229 patients with invasive cervical cancer and 204 non-cancer controls were used to detect the ERCC1 C19007T polymorphism by performing a polymerase chain reaction restriction fragment length polymorphism assay. Allelic frequencies and genotype distributions in the patients' group were compared with those in the control group. The relationship between this polymorphism and cancer invasiveness was also evaluated by analyzing clinicopathological parameters including International Federation of Gynecology and Obstetrics stage, lymph node status, histological type and parametrial invasion. The analytic methods used were the χ(2) test and logistic regression analysis. Results: The allelic frequencies of patients (A, 0.758; C, 0.242) were not significantly different from that of controls (A, 0.755; C, 0.245) (P = 0.925). The C/C genotype had no increased risk for cervical cancer susceptibility compared with the TT genotype (P = 0.932). A subgroup analysis of the clinicopathological parameters in the cancer group also showed that there is no significant association between the ERCC1 C19007T polymorphism and cervical cancer invasiveness. Conclusion: This study shows that the ERCC1 C19007T polymorphism might not be associated with the risk and invasiveness of cervical cancer in Korean women.
Asia-Pacific Journal of Clinical Oncology 02/2012; · 0.58 Impact Factor
