1
|
Lee SU, Kim JY, Kim MK, Kim YS, Kim YJ, Eom KY, Wee CW. Pattern of practice for postoperative management of endometrial cancer in Korea: a survey by the Korean Gynecologic Oncology Group and the Korean Radiation Oncology Group (KGOG 2028-KROG 2104). J Gynecol Oncol 2023:34.e54. [PMID: 36998224 DOI: 10.3802/jgo.2023.34.e54] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/19/2023] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the current status of postoperative management of uterine endometrial cancer (EC) in Korea. METHODS A mail survey was administered to members of the Korean Gynecologic Oncology Group and Korean Radiation Oncology Group. A total of 38 gynecologic cancer surgeons (GYNs) and 31 radiation oncologists (RO) in 43 institutions was responded. The questionnaire consisted of general questions for clinical decision and clinical case questions. The GYN and RO responses were compared using chi-square statistics. RESULTS The 2 expert groups had similar responses for clinical decision based on the results of the Gynecologic Oncology Group (GOG)-249 and Postoperative Radiation Therapy for Endometrial Carcinoma-III trials in the early-stage EC. In contrast, the responses based on GOG-258 results differed, as GYNs most frequently opted for sequential chemotherapy (CTx) and radiotherapy (RT), while ROs preferred concurrent chemoradiotherapy in locally advanced stage (p<0.05). Based on the GOG-258, GYNs preferred CTx alone for adjuvant treatment of serous or clear cell adenocarcinoma histology, whereas ROs advocated for combined CTx and RT (sequential or concurrent). Among the clinical case questions, GYNs were more likely than ROs to choose CTx alone rather than the combination of CTx and RT (sequential or concurrent) as the answers to case questions representing patients with locally advanced stage or unfavorable histology (all p<0.05). CONCLUSION The present study showed several different opinions of GYNs and ROs regarding adjuvant treatment for EC, particularly for adjuvant RT in advanced stage or unfavorable histology.
Collapse
Affiliation(s)
- Sung Uk Lee
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea.
| | - Min Kyu Kim
- Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
2
|
Yoshida H, Machida H, Matsuo K, Terai Y, Fujii T, Mandai M, Kawana K, Kobayashi H, Mikami M, Nagase S. Trend and characteristics of minimally invasive surgery for patients with endometrial cancer in Japan. J Gynecol Oncol 2023; 34:e56. [PMID: 36929580 PMCID: PMC10157347 DOI: 10.3802/jgo.2023.34.e56] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/25/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan. METHODS This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015-2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined. RESULTS A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44-4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%. CONCLUSION MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.
Collapse
Affiliation(s)
- Hiroshi Yoshida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University School of Medicine, Hyogo, Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Aichi, Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University School of Medicine, Yamagata, Japan
| |
Collapse
|
3
|
Akada K, Koyama N, Miura T, Fukunaga E, Miura Y, Aoshima K, Fujiwara K. Real-world database analysis of the characteristics and treatment patterns of patients with endometrial cancer in Japan. Curr Med Res Opin 2021; 37:1171-1178. [PMID: 33792449 DOI: 10.1080/03007995.2021.1903847] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to identify the characteristics and treatment patterns of early and advanced stage endometrial cancer patients using real-world data. METHODS Patients' data extracted from a Japanese health insurance claims database were analyzed. RESULTS Of the 12,449 endometrial cancer patients, 74.4% were in stage I, 5.1% in stage II, 12.0% in stage III, and 8.4% in stage IV. Their median age was 60.5 years, higher in advanced stages (III/IV) than in early stages (I/II). Overall, 11,055 patients (88.8%) underwent surgery, and 4977 patients (40.0%) received post-surgery treatment, including chemotherapy (4441: 35.7%), chemoradiation therapy (379: 3.0%), and radiation therapy (157 patients: 1.3%); 1394 patients (11.2%) were not treated by surgery, and 742 patients (6.0%) received other treatment, with chemotherapy (548: 4.4%), radiation therapy (105: 0.8%), and chemoradiation therapy (89: 0.7%). The rate of patients undergoing surgery decreased, and that receiving chemotherapy increased significantly as cancer stage progressed. Paclitaxel/carboplatin was the most frequent first-line regimen (85.4% of patients), whereas various combination and monotherapy regimens were used as second- and third-line regimens. The most frequent second-line monotherapy was paclitaxel. The rate of monotherapy increased as the treatment line progressed (first-line 3.5%, second-line 22.0%, and third-line 36.4%). CONCLUSIONS The characteristics and treatment patterns of endometrial cancer patients differed between early and advanced stages, as did the chemotherapy regimens among first-, second-, and third-lines. Since various regimens were used for second- and third-line chemotherapies, development of appropriate second- and third-line chemotherapy regimens is warranted. A real-world analysis of cancer patients using a nationwide claims database may be a valuable approach to identifying unmet medical needs.
Collapse
Affiliation(s)
- Keishi Akada
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | | | - Takuma Miura
- Japan Asia Clinical Department, Oncology Business Unit, Eisai Co. Ltd, Tokyo, Japan
| | - Eiji Fukunaga
- Japan Medical Department, Eisai Co. Ltd, Tokyo, Japan
| | - Yuji Miura
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Ken Aoshima
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
4
|
Chen JLY, Huang CY, Huang YS, Hsu CY, Lan KH, Shih IL, Cheng WF, Chen CA, Sheu BC, Kuo SH. Real-World Evaluation of Modern Adjuvant Radiotherapy in Women with Stage IB Endometrial Cancer. Cancers (Basel) 2021; 13:1386. [PMID: 33803915 PMCID: PMC8003240 DOI: 10.3390/cancers13061386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
The optimal adjuvant treatment for stage IB endometrial cancer remains undefined. We investigated the benefit of modern adjuvant radiotherapy for women with stage IB endometrial cancer. We retrospectively reviewed patients with surgically staged, pure stage IB endometrioid adenocarcinoma (2010 to 2018). Adjuvant modern radiotherapy consists of external-beam radiotherapy (EBRT) by intensity, volumetric-modulated arc radiotherapy, or image-guided vaginal brachytherapy (VBT). The study included 180 stage IB patients. Patients with grade 3 diseases had frequent aggressive histology patterns (lymphovascular space invasion (LVSI); low uterine segment involvement) and experienced significantly shorter recurrence-free survival (RFS) and overall survival (OS) than patients with grade 1/2 diseases. Adjuvant modern radiotherapy decreased the incidence of acute/chronic grade ≥2 gastrointestinal toxicity. In IB grade 1/2 patients, EBRT significantly lengthened survival (RFS/OS); patients with age >60 years, myometrial invasion beyond the outer third, or LVSI benefited the most from EBRT. EBRT also significantly improved survival (RFS/OS) in IB grade 3 patients, where patients with bulky tumors or LVSI benefited the most from EBRT. Therefore, EBRT may be beneficial for all stage IB patients.
Collapse
Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Cancer Center, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chao-Yuan Huang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu 300, Taiwan
| | - Yu-Sen Huang
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Che-Yu Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
| | - Keng-Hsueh Lan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
| | - I-Lun Shih
- Department of Radiology, National Taiwan University College of Medicine, Taipei 100, Taiwan; (J.L.-Y.C.); (Y.-S.H.); (I.-L.S.)
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan; (W.-F.C.); (C.-A.C.); (B.-C.S.)
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-Y.H.); (K.-H.L.); (S.-H.K.)
- Cancer Center, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| |
Collapse
|
5
|
Yang D, Ma X, Xu J, Jia K, Liu X, Zhang P. Zfx-induced upregulation of UBE2J1 facilitates endometrial cancer progression via PI3K/AKT pathway. Cancer Biol Ther 2021; 22:238-247. [PMID: 33632059 DOI: 10.1080/15384047.2021.1883186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Emerging documents revealed that E2 enzyme family has been implicated in regulating the progression of numerous human cancers. Ubiquitin-conjugating enzyme E2 J1 (UBE2J1), a member of E2 enzyme family, has been reported to participate in the biological process of medulloblastoma, while little is known about its functionality in endometrial cancer (EC). Gene expression at the mRNA and protein levels were identified using RT-qPCR and western blot analysis, separately. The alteration on cell proliferation, adhesion, migration, invasion, and epithelial-mesenchymal transition (EMT) process was determined through 5-Ethynyl-2'-deoxyuridine, cell adhesion, wound healing and transwell assays as well as western blot analysis. The role of UBE2J1 in xenograft tumor in mice was determined. Luciferase reporter and chromatin immunoprecipitation assays were conducted to reveal the undering mechanism of UBE2J1. Our results indicated that UBE2J1 displayed high level in EC tissues and cells and predicted poor prognosis of EC patients. In addition, UBE2J1 depletion inhibited cell proliferation, adhesion, motion, EMT process invitro, and repressed tumor growth invivo. Rescue assays manifested that ethyl 2-amino-6-chloro-4-(1-cyano-2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate treatment reversed the effects of UBE2J1 on PI3K/AKT pathway activation and malignant phenotypes of EC cells. Finally, zinc finger X-chromosomal protein (zfx), with high expression in EC tissues, was verified to activate UBE2J1 transcription by binding to UBE2J1 promoter. In conclusion, all facts signified that zfx-induced upregulation of UBE2J1 accelerated the progression of EC via regulating the PI3K/AKT signaling pathway, which suggested that UBE2J1 might be of great significance in probing into the underlying therapeutic strategies of EC.
Collapse
Affiliation(s)
- Dexin Yang
- Institute of Science and Technology for Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, China
| | - Xin Ma
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Jie Xu
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Ke Jia
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Xiaoli Liu
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| | - Ping Zhang
- Department of Gynaecology and Obstetrics, Zhangjiagang First People's Hospital, Zhangjiagang, China
| |
Collapse
|
6
|
Mandai M. AOFOG survey for the status of minimally invasive gynecologic surgery in the Asia/Oceania region. J Obstet Gynaecol Res 2019; 45:1091-1095. [PMID: 30977214 DOI: 10.1111/jog.13954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
AIM To clarify the status of minimally invasive gynecologic surgery (MIGS) in the Asia/Oceania region. METHODS Survey questionnaires were sent out to the representative of AOFOG countries. They consisted of questions on the general status of MIGS, the clinical indication of MIGS, cost coverage, company support, training and certification for MIGS, patient preference for MIGS and requirements for the AOFOG. RESULTS Developmental stage of MIGS in this region was roughly divided into three categories: fully developed countries, countries in the developmental stage and countries in the rudimentary stage. Clinical indication of MIGS and training opportunity of young doctors were correlated with the developmental stage. CONCLUSION Support by AOFOG should be considered according to the developmental stage of each country. Collecting updated information on MIGS in each member country is important to provide adequate support.
Collapse
Affiliation(s)
- Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
7
|
LINC01016 promotes the malignant phenotype of endometrial cancer cells by regulating the miR-302a-3p/miR-3130-3p/NFYA/SATB1 axis. Cell Death Dis 2018; 9:303. [PMID: 29467441 PMCID: PMC5833433 DOI: 10.1038/s41419-018-0291-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/09/2017] [Accepted: 01/04/2018] [Indexed: 12/24/2022]
Abstract
Long noncoding RNAs (lncRNAs) have been implicated in tumorigenesis and cancer progression and are tightly associated with the phenotypes of numerous cancers. However, the functional roles underlying these effects are unknown. The expression levels of LINC01016, miR-302a-3p, miR-3130-3p, NFYA, and SATB1 were evaluated by quantitative real-time polymerase chain reaction (qRT-PCR) in 33 endometrial cancer tissues and 20 normal tissues. Bioinformatics analyses, luciferase reporter analyses, chromatin immunoprecipitation (ChIP) assays, and qRT-PCR assays were performed to verify potential binding sites. The qRT-PCR and western blot were used to identify the regulatory mechanisms of LINC01016 in cell biological behavior, which were also examined by cell counting kit -8 (CCK-8), 5-ethynyl-2′-deoxyuridine (EdU) assays, flow cytometry, wound healing assays, and transwell assays. LINC01016 was substantially upregulated in endometrial cancer tissues, and LINC01016 silencing abolished the malignant behavior of endometrial cancer cells. LINC01016 positively rescued the downstream gene nuclear factor YA (NFYA) by competitively “sponging” miR-302a-3p and miR-3130-3p. In turn, these two miRNAs could inhibit LINC01016 transcription, thus forming two reciprocal repression cycles, which influenced the biological behavior of endometrial cancer cells. MiR-302a-3p and miR-3130-3p could specifically bind with the 3′-UTR regions of NFYA, and NFYA could upregulate the expression of special AT-rich sequence-binding protein 1 (SATB1) as a transcriptional factor. This study was the first to show that the LINC01016–miR-302a-3p/miR-3130-3p/NFYA/SATB1 axis played a crucial role in the occurrence of endometrial cancer. These findings may provide relevant insights into the diagnosis and therapy of endometrial cancer.
Collapse
|