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Kim JH, Lee Y, Kim DY, Kim S, Seo SS, Kang S, Park SY, Lim MC. Adherence of PARP inhibitor for frontline maintenance therapy in primary epithelial ovarian cancer: a cross-sectional survey. J Gynecol Oncol 2024; 35:e3. [PMID: 37681357 PMCID: PMC10792206 DOI: 10.3802/jgo.2024.35.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 08/13/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To identify the adherence rate to poly (ADP-ribose) polymerase (PARP) inhibitors and identify factors contributing to the deterioration of adherence at our institution. METHODS The adherence rate to PARP inhibitors was calculated using self-reported Adherence to Refills and Medications Scale questionnaires from a cross-sectional survey. Multivariable logistic regression analysis was performed to identify the factors that affected adherence. RESULTS Of the 131 respondents, 32 (24.4%) showed non-adherence to PARP inhibitors. In the multivariable logistic regression analysis, unemployed or retired status (odds ratio [OR]=4.878; 95% confidence interval [CI]=1.528-15.572; p=0.008), patients receiving niraparib (OR=3.387; 95% CI=1.283-8.940; p=0.014), and a lower score on the quality-of-life assessment (EORTC-QLQ-OV28), which reflects a better quality of life (QOC) with a lower symptom burden (OR=1.056; 95% CI=1.027-1.086; p<0.001) were associated with high adherence to PARP inhibitors. CONCLUSION Approximately one-fourth of patients with ovarian cancer are non-adherent to PARP inhibitors as maintenance treatment for newly diagnosed advanced ovarian cancer. The occupational status, type of PARP inhibitor, and QOC may affect adherence to PARP inhibitors.
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Affiliation(s)
- Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Yumi Lee
- Department of Nursing, Pukyong National University, Busan, Korea
| | - Da-Young Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sinae Kim
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
- Rare & Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, Korea
- Center for Clinical Trial, Hospital, National Cancer Center, Goyang, Korea.
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Kim SH, Kim KH, Hyun JW, Kim JH, Seo SS, Kim HJ, Park SY, Lim MC. Corrigendum: Blood neurofilament light chain as a biomarker for monitoring and predicting paclitaxel-induced peripheral neuropathy in patients with gynecological cancers. Front Oncol 2023; 13:1279558. [PMID: 37746278 PMCID: PMC10513489 DOI: 10.3389/fonc.2023.1279558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2022.942960.].
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Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
- Center for Clinical Trial, Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
- Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Control and Policy, National Cancer Center, Goyang, Republic of Korea
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Kim JH, Han WH, Lee DE, Kim SY, You K, Park SS, Lee DW, Seo SS, Kang S, Park SY, Lim MC. Anastomotic leakage after resection of the rectosigmoid colon in primary ovarian cancer. J Ovarian Res 2023; 16:85. [PMID: 37120533 PMCID: PMC10148549 DOI: 10.1186/s13048-023-01153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/02/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND The aim of the study is to evaluate the risk factors of anastomotic leakage (AL) and develop a nomogram to predict the risk of AL in surgical management of primary ovarian cancer. METHODS We retrospectively reviewed 770 patients with primary ovarian cancer who underwent surgical resection of the rectosigmoid colon as part of cytoreductive surgery between January 2000 to December 2020. AL was defined based on radiologic studies or sigmoidoscopy with relevant clinical findings. Logistic regression analyses were performed to identify the risk factor of AL, and a nomogram was developed based on the multivariable analysis. The bootstrapped-concordance index was used for internal validation of the nomogram, and calibration plots were constructed. RESULTS The incidence of AL after resection of the rectosigmoid colon was 4.2% (32/770). Diabetes (OR 3.79; 95% CI, 1.31-12.69; p = 0.031), co-operation with distal pancreatectomy (OR, 4.8150; 95% CI, 1.35-17.10; p = 0.015), macroscopic residual tumor (OR, 7.43; 95% CI, 3.24-17.07; p = 0<001) and anastomotic level from the anal verge shorter than 10 cm (OR, 6.28; 95% CI, 2.29-21.43; p = 0.001) were significant prognostic factors for AL on multivariable analysis. Using four variables, the nomogram has been developed to predict anastomotic leakage: https://ALnomogram.github.io/ . CONCLUSION Four risk factors for AL after resection of the rectosigmoid colon are identified from the largest ovarian cancer study cohort. The nomogram from this information provides a numerical risk probability of AL, which could be used in preoperative counseling with patients and intraoperative decision for accompanying surgical procedures and prophylactic use of ileostomy or colostomy to minimize the risk of postoperative leakage. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Ji Hyun Kim
- Center for Gynecologic Cancer, Hospital, Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Won Ho Han
- Department of Critical Care Medicine, Hospital, National Cancer Center, Goyang, South Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Republic of Korea
| | - Sun Young Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kiho You
- Center for Colorectal Cancer, Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Sil Park
- Center for Colorectal Cancer, Hospital, National Cancer Center, Goyang, South Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Hospital, National Cancer Center, Goyang, South Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Hospital, Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Hospital, Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
- Department of Cancer Control & Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
- Division of Clinical Research, Research Institute, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Hospital, Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Hospital, Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Research Institute, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
- Department of Cancer Control & Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.
- Division of Clinical Research, Research Institute, National Cancer Center, Goyang, Republic of Korea.
- Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, Republic of Korea.
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Yoon M, Lee HK, Park EY, Kim JH, Lee JH, Kim YS, Kim HJ, Kim H, Yoo CW, Lee S, Hong EK, Kim TH, Kim TS, Seo SS, Kang S, Chang SJ, Shin HJ, Uong TNT, Lee S, Kim JY. Randomized multicenter phase II trial of prophylactic irradiation of para-aortic lymph nodes in advanced cervical cancer according to tumor hypoxia: Korean Radiation Oncology Group (KROG 07-01) study. Int J Cancer 2022; 151:2182-2194. [PMID: 35751421 DOI: 10.1002/ijc.34190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
We conducted a prospective phase II study on whether extended-field irradiation (EFI) confers survival benefits depending on hypoxic markers in locally advanced uterine cervical cancer (LAUCC). RNA-seq was performed to identify immune and hypoxic gene signatures. A total of 288 patients were randomized to either EFI or pelvic radiotherapy (PRT). All patients completed chemoradiotherapy. Overall, significantly higher 5-year para-aortic recurrence free survival (PARFS) rate occurred in EFI (97.6%) than in PRT group (87.2%), with marginal tendency to improve disease-free survival (DFS; 78% vs 70%, P = .066). Subgroup analyses were performed based on carbonic anhydrase 9 (CA9)-only positive, CA9/hypoxia-inducible factor (HIF) double positive and CA9 negative. In the CA9-only positive, EFI successfully increased 5-year PARFS (100% vs 76.4%, P = .010), resulting in significantly improved long-term DFS (85.7% vs 54.7%, P = .023) compared to the PRT, while there was no such benefit of EFI in the CA9/HIFs double positive. RNA-seq analysis identified distinct immunehigh subgroup with negative correlation with hypoxia gene signatures (R = -.37, P < .01), which showed a higher 5-year DFS than the immunelow (P = .032). Hypoxia-related genes were upregulated in the CA9/HIFs double positive compared to CA9 negative (P < .05). Only 17.4% of patients in CA9-negative group showed immunelow signatures, while 40.0% of patients in the double-positive group exhibited immunelow signatures. In conclusion, EFI improved PARFS significantly in all patients, but therapeutic efficacy of EFI in terms of improved DFS was solely observed in CA9-only positive LAUCC, and not in CA9/HIFs double-positive subgroup. RNA-seq analysis suggested that hypoxia-induced immunosuppression may be related to treatment resistance in LAUCC.
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Affiliation(s)
- Meesun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyo Kyung Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Eun Young Park
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, South Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University, College of Medicine, Seoul, South Korea
| | - Hunjung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University, School of Medicine, Incheon, South Korea
| | - Chong Woo Yoo
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sun Lee
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eun Kyung Hong
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Tae Hyun Kim
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Tae-Sung Kim
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sang-Soo Seo
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sokbom Kang
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Suk-Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, South Korea
| | - Hye Jin Shin
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Tung Nguyen Thanh Uong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Semin Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Joo-Young Kim
- Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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Kim JH, Lee DE, Ha HI, Jung JY, Kim SH, Lee HH, Seo HK, Seo SS, Kang S, Park SY, Lim MC. Surgical outcomes of ureteral reconstruction during cytoreductive surgery for ovarian cancer: a retrospective cohort study. BMC Cancer 2022; 22:1163. [PMID: 36357914 PMCID: PMC9650832 DOI: 10.1186/s12885-022-10288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Ureteral reconstruction is required after surgical resection of the tumor invading the urinary tract in ovarian cancer with low incidence. There are no currently reported surgical outcomes of ureteral reconstruction during cytoreductive surgery. The aim of the study is to investigate the clinical features and surgical outcomes of ureteral reconstruction during primary, interval and secondary cytoreductive surgery for ovarian cancer. Methods A total of 3226 patients who underwent primary, interval or secondary cytoreductive surgery for ovarian cancer between January 2000 and May 2021 were reviewed. Fifty-six patients who underwent ureteral reconstruction during cytoreductive surgery were included in the analysis. Results Ureteral reconstruction was required in 1.7% (56/3226) of ovarian cancer patients. Of the 56 patients who underwent ureteral reconstruction during cytoreductive surgery, 35 (62.5%) had primary ovarian cancer, and 21 (37.5%) had recurrent ovarian cancer. The median tumor size invading the lower urinary tract was 2.0 cm (range, 0.4–9.5 cm). Ureteroneocystostomy with direct implantation (51.8%) and psoas hitch (8.9%), transureteroureterostomy (7.1%), and ureteroureterostomy (32.1%) were required as part of cytoreductive surgery. Complete cytoreduction with ureteral reconstruction was achieved in 83.9% (47/56) and the rest of the patient population (16.1%) achieved a gross residual tumor size of less than 1 cm. All complications, including hydronephrosis (33.9%), were managed, none resulting in long-term sequelae. In primary ovarian cancer, the 5-year disease-free survival and overall survival were 50.0% and 89.5%, respectively. In patients with recurrent ovarian cancer, the 5-year disease-free survival and overall survival were 23.6% and 64.0%, respectively. Conclusions Ureteral reconstruction as a part of cytoreductive surgery for ovarian cancer could be performed with acceptable morbidities. Complete cytoreduction by a multidisciplinary surgical team, including urologic oncologists, should be pursued for the surgical management of ovarian cancer. Trial registration Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10288-x.
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Shin W, Yang SJ, Park SY, Kang S, Lee DO, Lim MC, Seo SS. A predictive model based on site-specific risk factors of recurrence regions in endometrial cancer patients. BMC Cancer 2022; 22:1111. [PMID: 36316771 PMCID: PMC9620664 DOI: 10.1186/s12885-022-10193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study investigated site-specific differences in clinical factors for recurrence in patients who were newly diagnosed and treated for endometrial cancer. A model for predicting recurrence sites was generated. Methods Electronic medical records’ data were retrieved from January 2006 to December 2018 for patients who were diagnosed with endometrial cancer at the National cancer center in Korea. Recurrence sites were classified as local, regional, or distant. We used multinomial logistic regression models that modeled the log-odds for the three recurrence sites relative to non-recurrence as a linear combination of possible risk factors for the recurrence of endometrial cancer. Results The data of 611 patients were selected for analysis; there were 20, 12, and 25 cases of local, regional, and distant recurrence, respectively, and 554 patients had no recurrence. High-grade disease was associated with local recurrence; non-endometrioid histology and parametrial invasion were risk factors for regional recurrence; additionally, parametrial invasion and no lymphadenectomy were associated with distant metastasis. Conclusion We identified different risk factors specific for each type of recurrence site. Using these risk factors, we suggest that individually tailored adjuvant treatments be introduced for patients.
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Affiliation(s)
- Wonkyo Shin
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea ,grid.254230.20000 0001 0722 6377Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Seong J. Yang
- grid.411545.00000 0004 0470 4320Department of Statistics (Institute of Applied Statistics), Jeonbuk National University, Jeonju, Republic of Korea
| | - Sang-Yoon Park
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dong Ock Lee
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea ,grid.410914.90000 0004 0628 9810National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, 10408 Goyang-si Gyeonggi-do, Republic of Korea
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Kim SH, Kim KH, Hyun JW, Kim JH, Seo SS, Kim HJ, Park SY, Lim MC. Blood neurofilament light chain as a biomarker for monitoring and predicting paclitaxel-induced peripheral neuropathy in patients with gynecological cancers. Front Oncol 2022; 12:942960. [PMID: 36059704 PMCID: PMC9428708 DOI: 10.3389/fonc.2022.942960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Objective We aimed to evaluate the potential of serum neurofilament light chain (sNfL) and serum brain-derived neurotrophic factor (sBDNF) as reliable biomarkers for paclitaxel-induced peripheral neuropathy (PIPN). Methods Forty-eight patients with gynecologic cancer scheduled to undergo six cycles of paclitaxel-based chemotherapy at the National Cancer Center of Korea between September 2020 and January 2022 were prospectively assessed during and after chemotherapy. Results At the end of the chemotherapy, 12 (25%) patients were classified as having grade 3 PIPN according to the National Cancer Institute-Common Toxicity Criteria. The sNfL levels increased during paclitaxel treatment in all patients. After two, four, and six cycles, patients with grade 3 PIPN exhibited higher mean sNfL levels than those in the 0-2 grade range (p = 0.004, p = 001, and p < 0.001, respectively). For sNfL levels ≥ 124 pg/mL, after two cycles of chemotherapy, the sensitivity and specificity for predicting grade 3 PIPN at the end of treatment were 80% and 79%, respectively. Over the course of paclitaxel-based treatment, sBDNF levels continued to decrease regardless of the severity of PIPN. At the end of treatment and six months after chemotherapy, patients with grade 3 PIPN had lower sBDNF levels than those within the 0-2 grade range (p =0.037 and 0.02, respectively), and the patients in the latter group had better clinical symptoms six months after the end of treatment. Conclusions The sNfL levels during paclitaxel-based chemotherapy reflect ongoing neuroaxonal injury and serve as reliable biomarkers of PIPN severity. The sNfL levels during early treatment with paclitaxel might be prognostic indicators for PIPN progression. Low sBDNF levels 6 months after chemotherapy might adversely affect PIPN recovery.
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Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, South Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, Goyang, South Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, South Korea
- Center for Clinical Trial, Hospital, National Cancer Center, Goyang, South Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
- Rare and Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, South Korea
- Department of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
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Ha HI, Park EY, Eoh KJ, Lee YJ, Seo SS, Kang S, Park SY, Lim MC. Clinical outcomes of BRCA1/2 pathogenic variants in ovarian cancer cluster region in patients with primary peritoneal, epithelial ovarian, and fallopian tube cancer. Gynecol Oncol 2021; 164:415-420. [PMID: 34924242 DOI: 10.1016/j.ygyno.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE An "ovarian cancer cluster region" (OCCR) has been reported in both BRCA1 and BRCA2. However, the clinical significance of the OCCR of BRCA1/2 has not yet been investigated. METHODS The medical records of 991 patients with epithelial ovarian, primary peritoneal, and fallopian tube cancer who underwent genetic testing for BRCA1 and/or BRCA2 from January 1, 2006, to August 31, 2019, were retrospectively reviewed. Sanger and next-generation sequencing analyses were used to test the BRCA1 and BRCA2 mutation status. Progression-free survival (PFS) and overall survival (OS) were compared according to the mutation location (OCCR vs. non-OCCR region). Survival outcomes were determined using Kaplan-Meier survival analysis. RESULTS A total of 162 patients had BRCA1 pathogenic variants (PVs), and 76 had BRCA2 PVs. Patients with BRCA1 PV that in the OCCR region showed shorter PFS than those with BRCA1 PV outside the OCCR (22.6 months vs. 27.6 months, P = 0.038). In the platinum-sensitive subgroup of BRCA1, patients with BRCA1 PV in the OCCR region showed shorter PFS than those in the non-OCCR group (P = 0.0197). On the other hand, BRCA2 variants did not exhibit any particular trend (32.8 months vs. 27.9 months, P = 0.468). However, no significant differences were detected in OS between patients with BRCA1/2 PVs, regardless of the location of the variants. CONCLUSIONS Patients with BRCA1 PV in the OCCR had shorter PFS than those outside the OCCR. This tendency was more pronounced in the platinum-sensitive subgroup. To our knowledge, this is the first study of BRCA1/2 mutations based on the OCCR.
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Affiliation(s)
- Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan National School of Medicine, Yangsan, Republic of Korea
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Republic of Korea; Department of Statistics and Data Science, Yonsei University, Republic of Korea
| | - Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Yeon Jee Lee
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea; Division of Tumor Immunology and Center for Gynecologic Cancer, Research Institute and Hospital, Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
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Shin W, Park SY, Seo SS, Lim MC, Kim JY, Kang S. Predicting the risk of the distant recurrence of cervical cancer after concurrent chemoradiation: A validation study of the Korean Gynecologic Oncologic Group (KGOG)-1024 model. Gynecol Oncol 2021; 164:62-67. [PMID: 34696893 DOI: 10.1016/j.ygyno.2021.10.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to validate the performance of the Korean Gynecologic Oncologic Group (KGOG)-1024 risk model in predicting the risk of distant failure after chemoradiation in patients with locally advanced cervical cancer (LACC). METHODS In a retrospective cohort of 297 patients who received concurrent chemoradiation for advanced cervical cancer, individual risk was calculated using the KGOG-1024 risk model. The cohort was categorized into three risk groups (low-, intermediate-, and high-risk groups) according to the calculated risk. The means of the calculated and observed risks were compared within each group. RESULTS The study population was classified into low-, intermediate-, and high-risk groups according to the KGOG-1024 risk model (27.2%, 49.3%, and 23.5% of patients, respectively). The calculated and observed 5-year cumulative incidence rates were 12.4% vs. 16.4% in the low-risk group, 23.2% vs. 25.9% in the intermediate-risk group, and 50.7% vs. 36.3% in the high-risk group. Overall, the calculated and observed risk was 26.7% vs. 25.6%. CONCLUSIONS The KGOG-1024 risk assessment model accurately predicted distant recurrence after chemoradiation in patients with LACC, especially in the low- and intermediate-risk groups. The model may be helpful for identifying patients for future trials assessing the possible benefit of adjuvant systemic treatment after chemoradiation.
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Affiliation(s)
- Wonkyo Shin
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea; Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sokbom Kang
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea; Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea.
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10
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Abstract
Backgrounds We aimed to evaluate the prognosis in patients with synchronous endometrial and ovarian cancer (SEOC) by comparing the differences between double primary cancer (DPC) and metastatic cancer (MC). Methods The medical records of 47 patients diagnosed synchronously with endometrial and ovarian cancer between January 2006 and December 2018 were retrospectively reviewed. Twenty-eight and 19 patients were diagnosed with DPC and MC, respectively. Demographics, recurrence-free survival (RFS), and 5-year overall survival (OS) were compared. The clinical factors affecting survival were evaluated using univariate and multivariate analyses. Results The demographics were not different between both groups. Endometrioid histology and the International Federation of Gynecology and Obstetrics grade were higher in the MC group than in the DPC group (42.1% vs. 10.7%; P = 0.018, P = 0.002, respectively). The ratio of post-operative adjuvant therapy was not different in both groups. Recurrence occurred in five patients with DPC and seven with MC. The difference in RFS was not significantly different (P = 0.131) but the OS was different between both groups (P = 0.020). Histology and para-aortic lymph node metastasis were associated wtih RFS in univariate analysis, but no difference was found in multivariate analysis. Conclusions Although DPC patients had longer OS, multivariate analysis did not identify any influential factors. Focus should be placed on defining the appropriate adjuvant treatment for high-risk patients, which will improve prognosis, rather than on discriminating between DPC and MC. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08220-w.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Department of Obstetrics & Gynecology, Chungnam national university sejong hospital, Sejong, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Common Cancer Branch, Research Institute Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Precision Medicine Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Center for Clinical Trials, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Cancer Healthcare Research Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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11
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Shin W, Jeong G, Son Y, Seo SS, Kang S, Park SY, Lim MC. The Knowledge and Attitude of Patients Diagnosed with Epithelial Ovarian Cancer towards Genetic Testing. Int J Environ Res Public Health 2021; 18:ijerph18052312. [PMID: 33652933 PMCID: PMC7956717 DOI: 10.3390/ijerph18052312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the knowledge and attitude of patients with ovarian cancer (OC) toward OC and next generation sequencing (NGS). The data, including characteristics of patients, their knowledge about OC and their knowledge and attitude of NGS, were collected from June to October 2018. Of the 103 participants, 70.9% (n = 73) had cancer within the second-degree relatives, and 18.4% (n = 19) had BRCA pathogenic mutations. The percentage of right answer for the knowledge about OC and NGS was 64.7% (11/17) and 50% (6/12), respectively. The median number of patients who had positive expectations for the genetic test was 34 (range, 22-44). Based on a first-degree familial history, patients had a different degree of knowledge about OC (11 vs. 8.5, p = 0.026) and NGS (6.5 vs. 5, p = 0.011), but patients with a BRCA pathogenic mutation did not have a different degree of knowledge about OC and NGS panel testing. High-income families had a more positive attitude towards the genetic test than low-income families (p = 0.005). Women with OC do not have enough knowledge about OC (11/17, 64.7%) and NGS (6/12, 50%) but they showed a positive attitude toward the NGS test. These women need OC and NGS educational intervention.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Gowoon Jeong
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Yedong Son
- College of Nursing, Woosuk University, Wanju 55338, Korea;
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Sokbom Kang
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Division of Precision Medicine, Research Institute, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea; (W.S.); (G.J.); (S.-S.S.); (S.K.); (S.-Y.P.)
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
- Center for Clinical Trials, Hospital, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Division of Tumor Immunology, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea
- Correspondence: ; Tel.: +82-31-920-1763
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12
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Nam M, Seo SS, Jung S, Jang SY, Lee J, Kwon M, Khan I, Ryu DH, Kim MK, Hwang GS. Comparable Plasma Lipid Changes in Patients with High-Grade Cervical Intraepithelial Neoplasia and Patients with Cervical Cancer. J Proteome Res 2020; 20:740-750. [PMID: 33241689 DOI: 10.1021/acs.jproteome.0c00640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cervical cancer is the fourth most prevalent cancer among women worldwide and usually develops from cervical intraepithelial neoplasia (CIN). In the present study, we compared alterations in lipids associated with high-grade CIN and cervical cancer with those associated with a normal status and low-grade CIN by performing global lipid profiling on plasma (66 healthy controls and 55 patients with CIN1, 44 with CIN2/3, and 60 with cervical cancer) using ultraperformance liquid chromatography/quadrupole time-of-flight mass spectrometry. We identified 246 lipids and found 31 lipids with similar alterations in both high-grade CIN and cervical cancer. Among these 31 lipids, four lipid classes (phosphatidylcholine, phosphatidylethanolamine, diglyceride, and free fatty acids) were identified as the major lipid classes with significant differences in the patients with CIN2/3 and cervical cancer compared to the healthy controls and the patients with CIN1. Lipid metabolites belonging to the same classes were positively correlated with each other. High-grade CIN and cervical cancer induce comparable changes in lipid levels, which are closely related to the development of cervical tumors. These results suggest that lipid profiling is a useful method for monitoring progression to cervical cancer.
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Affiliation(s)
- Miso Nam
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, 150 Bugahyeon-ro, Seodaemun-gu, Seoul 03759, Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea
| | - Sunhee Jung
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, 150 Bugahyeon-ro, Seodaemun-gu, Seoul 03759, Korea.,Department of Chemistry, Sungkyunkwan University, Suwon 16419, Korea
| | - Seo Young Jang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, 150 Bugahyeon-ro, Seodaemun-gu, Seoul 03759, Korea.,Department of Chemistry and Nano Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Jueun Lee
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, 150 Bugahyeon-ro, Seodaemun-gu, Seoul 03759, Korea
| | - Minji Kwon
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea
| | - Imran Khan
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.,Department of Food Science and Technology, The University of Haripur, Haripur 22620, Pakistan
| | - Do Hyun Ryu
- Department of Chemistry, Sungkyunkwan University, Suwon 16419, Korea
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea
| | - Geum-Sook Hwang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, 150 Bugahyeon-ro, Seodaemun-gu, Seoul 03759, Korea.,Department of Chemistry and Nano Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
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13
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Shin W, Park SY, Kang S, Lim MC, Seo SS. The survival effect of ovary preservation in early stage endometrial cancer: a single institution retrospective analysis. J Ovarian Res 2020; 13:97. [PMID: 32828125 PMCID: PMC7443286 DOI: 10.1186/s13048-020-00698-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE We investigated the effect of ovary preserving surgery in early International Federation of Obstetrics and Gynecology (FIGO) stage endometrial cancer patients. METHODS Medical records were retrospectively reviewed for 539 patients who were diagnosed with early stage endometrial cancer between Jan 2006 and Dec 2017. Patients were categorized into ovary preservation and ovary removal groups. Demographics, recurrence free survival (RFS), and five-year overall survival (OS) rate were compared, and the clinical factors affecting survival were evaluated by univariate and multivariate analysis. RESULTS The median follow-up period was 85 months (range, 6-142 months), and the median age was 52.7 years. The mean age was higher in the ovary removal group than in the ovary preservation group (54.4 vs 40.94 years; P < 0.001). The ovary preservation group showed an earlier FIGO stage than the ovary removal group (P = 0.0264). There was a greater incidence of adjuvant chemotherapy administration in the removal group. There were no statistical differences in other baseline characteristics. When comparing the RFS and OS rates, there were no statistical differences between the preservation and removal groups. (recurrence free rate 98.5% vs 92.7%, p = 0.4360, and 5-year survival rate 98.6% vs 93.0%, p = 0.0892, respectively). Endometrioid histology (p = 0.006) and post-operative adjuvant chemotherapy (p = 0.0062) were related to OS, and adjuvant chemotherapy (p < 0.001) and radiotherapy (p = 0.005) were related to RFS. CONCLUSIONS Ovary preservation in early stage endometrial cancer is worth considering, as it does not affect survival in early stage endometrial cancer patients.
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Affiliation(s)
- Wonkyo Shin
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Common Cancer Branch, Research Institute Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Precision Medicine Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Center for Clinical Trials, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.,Cancer Healthcare Research Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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14
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Jeong GW, Shin W, Lee DO, Seo SS, Kang S, Park SY, Lim MC. Uptake of Family-Specific Mutation Genetic Testing Among Relatives of Patients with Ovarian Cancer with BRCA1 or BRCA2 Mutation. Cancer Res Treat 2020; 53:207-211. [PMID: 32777875 PMCID: PMC7812001 DOI: 10.4143/crt.2020.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The BRCA1 or BRCA2 gene is transmitted in an autosomal dominant fashion, and genetic testing of first-degree relatives of patients with family-specific mutation (FSM) is recommended. This study examined factors affecting the uptake of FSM testing among relatives of patients with peritoneal, ovarian, or fallopian tube (POFT) cancer with confirmed BRCA1 or BRCA2 germline mutation. Materials and Methods Data from medical charts of 392 eligible patients and their relatives who had undergone outpatient genetic counseling/testing were retrospectively reviewed. Clinical factors were compared between family members who had and had not undergone genetic counseling/testing. Results The uptake of FSM testing was 30.5% (129/423) among first-degree living relatives and 53.5% (69/129) within the overall family unit. The average time from genetic testing of the proband to the first FSM test within a family was 168 days (range, 23 to 681 days). Having a living father (33.8% vs. 13.3%, p=0.007) and daughter (79.4% vs. 60.3%, p=0.019) increased the uptake of FSM testing. FSM testing was more likely among female than among male relatives of cancer patients (40.9% vs. 17.6%, p < 0.001). Conclusion Approximately one-third of first-degree relatives of patients with a POFT cancer with BRCA1 or BRCA2 mutation underwent FSM testing. Having a living father or daughter was a factor affecting the uptake of FSM testing, which was higher among female than among male relatives of the proband. This discrepancy might be due to a misconception that the BRCA gene is associated with women rather than with men.
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Affiliation(s)
- Go Woon Jeong
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Wonkyo Shin
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea.,Divison of Precision Medicine, Research Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute, National Cancer Center, Goyang, Korea.,Center for Clinical Trials, Hospital, Research Institute, National Cancer Center, Goyang, Korea.,Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Korea
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15
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Youn SH, Kim YJ, Seo SS, Kang S, Lim MC, Chang HK, Park SY, Kim JY. Effect of addition of bevacizumab to chemoradiotherapy in newly diagnosed stage IVB cervical cancer: a single institution experience in Korea. Int J Gynecol Cancer 2020; 30:764-771. [PMID: 32276937 DOI: 10.1136/ijgc-2020-001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the clinical outcomes of chemoradiotherapy with or without bevacizumab in patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer. METHODS 41 patients with stage IVB cervical cancer who underwent chemoradiotherapy between August 2015 and December 2017 were retrospectively analyzed. This study included 11 patients who received bevacizumab before or after radiotherapy (group A) and 30 patients who received conventional chemoradiotherapy without bevacizumab (group B). We excluded the following patients: those with dual primary cancers; those whose pathologic diagnosis was neither squamous cell carcinoma nor adenocarcinoma; those who did not undergo radiotherapy; or those from whom follow-up data could not be collected. We analyzed the treatment responses, toxicities, progression-free survival, and overall survival rates. RESULTS A total of 41 patients were included in the analysis. The median follow-up was 19 months (range 3-108). The response rates at 3 months after treatment were 90.9% in group A and 83.3% in group B (p=0.54). After completing all treatments, the complete response rates were 81.8% in group A and 47% in group B (p=0.04). Grade ≥3 gastrointestinal toxicities, including bleeding, fistula, perforation, and obstruction, were more frequent in group A (54.5%) than in group B (6.7%) (p=0.003). The 12 month progression-free survival and overall survival rates were similar in both arms (12 month progression-free survival: 45.5% vs 46.7%, respectively, p=0.22; 12 month overall survival: 81.8% vs 72.9%, respectively, p=0.57). Patients with node-only metastasis had better 12 month progression-free survival in group B than in group A (59.1% vs 42.9%, respectively, p=0.04). However, the responses to both treatments did not differ in patients with organ metastasis. CONCLUSIONS Bevacizumab for stage IVB cervical cancer is associated with higher complete response rates. However, patients treated with bevacizumab experienced more bowel toxicities. Bevacizumab did not improve progression-free survival among patients with node-only metastasis.
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Affiliation(s)
- Sang Hee Youn
- Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Yeon-Joo Kim
- Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Sokbom Kang
- Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Ha Kyun Chang
- Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea
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16
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Yoo HJ, Lim MC, Seo SS, Kang S, Joo J, Park SY. Phase I/II clinical trial of modulated electro-hyperthermia treatment in patients with relapsed, refractory or progressive heavily treated ovarian cancer. Jpn J Clin Oncol 2019; 49:832-838. [PMID: 31070763 DOI: 10.1093/jjco/hyz071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To determine the maximal tolerated dose (MTD) of modulated electro-hyperthermia (mEHT) treatment and to reveal whether mEHT treatment is feasible and effective as second-line therapy in recurrent and progressive ovarian cancer. METHODS Patients were treated with mEHT with dose escalation during the first cycle (two sessions each week for three weeks) to determine the MTD. Additional cycles were carried out with the determined dose. Dose limiting toxicity (DLT) was defined grade ≥ 2: skin burns and inability to endure the hyperthermic state of the study. The Fact-O quality of life scale was used to assess health-related well-being. RESULTS Nineteen patients with recurrent and progressive ovarian cancer were enrolled. In the first cycle of mEHT treatment, no patient developed DLT with applied power up to 110 W, 130 W, and 150 W/day; the 150 W was the maximal applied power. Stable disease was observed in only one patient (12.5%). With median progression of 4.0 months (range, 2-17 months), 18 patients (95%) demonstrated disease progression. With median overall survival of 8.0 months (range, 2-32 months), 18 patients (95%) had died. Physical well-being scores were significantly decreased over the study period, although social, emotional, and functional well-being scores did not significantly change. CONCLUSIONS The mEHT treatment was feasible in patients with recurrent or progressive ovarian cancer without any complication and optimal dose of mEHT treatment was up to 150 W for 1 hour/day.
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Affiliation(s)
- Heon Jong Yoo
- Department of Obstetrics and Gynecology, Chungnam National University College of Medicine, Daejon, South Korea.,Department of Obstetrics and Gynecology, Chungnam National University hospital, Daejon, South Korea
| | - Myong Cheol Lim
- Gynecologic Cancer Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital and Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Gynecologic Cancer Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital and Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Gynecologic Cancer Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital and Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Cancer Biostatistics Branch, Research Institute and Hospital, National Cancer Center
| | - Sang-Yoon Park
- Gynecologic Cancer Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital and Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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17
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Khan I, Nam M, Kwon M, Seo SS, Jung S, Han JS, Hwang GS, Kim MK. LC/MS-Based Polar Metabolite Profiling Identified Unique Biomarker Signatures for Cervical Cancer and Cervical Intraepithelial Neoplasia Using Global and Targeted Metabolomics. Cancers (Basel) 2019; 11:cancers11040511. [PMID: 30974861 PMCID: PMC6521312 DOI: 10.3390/cancers11040511] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer remains one of the most prevalent cancers among females worldwide. Therefore, it is important to discover new biomarkers for early diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer, preferably non-invasive ones. In the present study, we aimed to identify unique metabolic signatures for CINs and cervical cancers using global and targeted metabolomic profiling. Plasma samples (69 normal, 55 CIN1, 42 CIN2/3, and 60 cervical cancer) were examined by ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-QTOF-MS) coupled with multivariate statistical analysis. Metabolic pathways were analyzed using the integrated web-based tool MetaboAnalyst. A multivariate logistic regression analysis was conducted to evaluate the combined association of metabolites and human papillomavirus (HPV) status with the risk of cervical carcinogenesis. A total of 28 metabolites exhibiting discriminating levels among normal, CIN, and cervical cancer patients (Kruskal–Wallis test p < 0.05) were identified in the global profiling analysis. The pathway analysis showed significantly altered alanine, aspartate, and glutamate metabolic pathways (FDR p-value < 0.05) in both the discovery and validation phases. Seven metabolites (AMP, aspartate, glutamate, hypoxanthine, lactate, proline, and pyroglutamate) were discriminated between CINs and cervical cancer versus normal (area under the curve (AUC) value > 0.8). The levels of these metabolites were significantly high in patients versus normal (p < 0.0001) and were associated with increased risk of developing CIN2/3 and cervical cancer. Additionally, elevated levels of the seven metabolites combined with positive HPV status were correlated with substantial risk of cancer progression. These results demonstrated that metabolomics profiling is capable of distinguishing CINs and cervical cancers from normal and highlighted potential biomarkers for the early detection of cervical carcinogenesis.
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Affiliation(s)
- Imran Khan
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
| | - Miso Nam
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul 03759, Korea.
| | - Minji Kwon
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
| | - Sunhee Jung
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul 03759, Korea.
| | - Ji Soo Han
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul 03759, Korea.
| | - Geum-Sook Hwang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul 03759, Korea.
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Madu-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
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Kwon M, Seo SS, Kim MK, Lee DO, Lim MC. Compositional and Functional Differences between Microbiota and Cervical Carcinogenesis as Identified by Shotgun Metagenomic Sequencing. Cancers (Basel) 2019; 11:cancers11030309. [PMID: 30841606 PMCID: PMC6468638 DOI: 10.3390/cancers11030309] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
Recent studies have reported the potential role of microbiomes in cervical disease. However, little is known about the microbiome composition and function in cervical carcinogenesis. We aimed to identify the compositional and functional alterations of cervical microbiomes in cases of cervical carcinogenesis of Korean women using shotgun metagenomic sequencing. In this study, using shotgun sequencing, we sequenced the cervical metagenomes of cervical intraneoplasia 2/3 (n = 17), cervical cancer (n = 12), and normal controls (n = 18) to identify the microbial abundances and enriched metabolic functions in cervical metagenomes. At the genus level, the microbiota of cervical cancer were differentially enriched with genera Alkaliphilus, Pseudothermotoga, and Wolbachia. Cervical intraepithelial neoplasia (CIN) 2/3 were enriched with Lactobacillus, Staphylococcus, and Candidatus Endolissoclinum. The normal group was enriched with Pseudoalteromonas and Psychrobacter. Further characterization of the functionalities of the metagenomes may suggest that six Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) that are involved in 10 pathways are associated with an increased risk of CIN2/3 and cervical cancer. Specifically, cervical metagenomes were enriched in the course of peptidoglycan synthesis and depleted by dioxin degradation and 4-oxalocrotonate tautomerase. The Cluster of Orthologous Groups (COG) category ‘Defense mechanisms’ was depleted in cervical cancer patients. Our findings based on shotgun metagenomic sequencing suggest that cervical microbiome community compositions and their metagenomics profiles differed between cervical lesions and normal subjects. Future studies should have larger sample sizes and/or aggregate their results to have sufficient power to detect reproducible and significant associations.
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Affiliation(s)
- Minji Kwon
- Division of Cancer Epidemiology and Prevention, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Korea.
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Korea.
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Korea.
| | - Dong Ock Lee
- Center for Uterine Cancer, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Korea.
| | - Myoung Cheol Lim
- Center for Uterine Cancer, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Korea.
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Chang HK, Seo SS, Myong JP, Koo JW, Jeong J. Factors Associated with Cervical Cancer Screening among Married Female Immigrants with Korean Husbands in South Korea. Int J Environ Res Public Health 2018; 15:ijerph15112528. [PMID: 30424504 PMCID: PMC6266390 DOI: 10.3390/ijerph15112528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022]
Abstract
Background. The purpose of this study was to identify factors associated with the national cervical cancer screening behaviors of married female immigrants living in South Korea. Methods. The present study dataset was collected by the National Health Insurance Services in 2014–2015. A final study population of 15,935 was considered eligible for inclusion in this study if they met the criteria for participation in the national cervical cancer screening program in 2014–2015. Results. Of the 15,935 subjects, 7837 (49%) participated in cervical cancer screening. Based on the results of the logistic regression analysis of the association between cervical cancer screening behaviors and related factors, the odds ratio (OR) for participation in cervical cancer screening among individuals older than 50 years was the highest (OR: 2.13; 95% confidence interval (CI): 1.82–2.51), and the OR increased as their duration of stay in South Korea decreased. The OR of Chinese women for cervical cancer screening participation was higher than that of non-Chinese women (OR: 1.83; 95% CI: 1.69–1.99). The OR value was 29.4 (95% CI: 25.9–33.3) among those who participated in the general health screening compared with those who did not participate. Conclusions. To improve awareness about cervical cancer screening and reduce disparities in access to healthcare, appropriate programs should be developed to promote cervical cancer screening participation to socially vulnerable classes. Continuous social attention is needed to address these issues and encourage participation in general health screening to improve the rate of cervical cancer screening.
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Affiliation(s)
- Ha Kyun Chang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10408, Korea.
| | - Jun-Pyo Myong
- Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Jung-Wan Koo
- Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Jinhee Jeong
- Department of medical benefit, National Health Insurance Company, 32, Geongang-ro, Wonju-si, Gangwon-do 26464, Korea.
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Lim MC, Won YJ, Lim J, Seo SS, Kang S, Yoo CW, Kim JY, Oh JH, Bristow RE, Park SY. Second primary colorectal cancer among endometrial cancer survivor: shared etiology and treatment sequelae. J Cancer Res Clin Oncol 2018; 144:845-854. [PMID: 29445866 PMCID: PMC5916981 DOI: 10.1007/s00432-018-2599-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the incidence of colon cancer as a second primary cancer (CCSPC) and the survival outcomes of women with and without CCSPC after the diagnosis of endometrial cancer (EC). Methods The standardized incidence ratio (SIR) of CCSPC and survival outcomes of EC survivors with and without CCSPC were analyzed using data from January 1 1993 to December 31 2011, obtained from the Korea Central Cancer Registry. Results Of 14,797 EC survivors, 147 (0.99%) developed CCSPC after an average interval of 5.5 years. The SIR of CCSPC among EC survivors was 2.56, higher than that of colon cancer in the general population. The SIR of CCSPC was highest for the ascending (3.77), followed by the transverse (3.45), descending colon (2.06), and rectum (1.99). The risk of a proximal site of CCSPC was high, especially within 5 years after the diagnosis of EC in the ascending (SIR, 4.37) and transverse (4.91) colon, and in young survivors (< 60 years) in the ascending (5.19) and transverse (3.82) colon. The 5- and 10-year overall survival rates were 84.8 and 80.4% among survivors with EC only and 89.2 and 76.3% for survivors with CCSPC, respectively. Conclusions The risk of CCSPC among EC survivors increases especially in the proximal colon in young survivors. These results could be used for surveillance and counseling of EC survivors.
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Affiliation(s)
- Myong Cheol Lim
- Cancer Healthcare Research Branch, Research Institute, National Cancer Center, Goyang, Republic of Korea
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
- Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, California, USA
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
| | - Jiwon Lim
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- Precision Medicine Branch, Research Institute, National Cancer Center, Goyang, Republic of Korea
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Chong Woo Yoo
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Joo-Young Kim
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jae Hwan Oh
- Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Republic of Korea
- Center for Colorectal Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Robert E Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, California, USA
| | - Sang-Yoon Park
- Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Republic of Korea
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang, Republic of Korea
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Bae HS, Kim YJ, Lim MC, Seo SS, Park SY, Kang S, Kim SH, Kim JY. Predictors of Radiation Field Failure After Definitive Chemoradiation in Patients With Locally Advanced Cervical Cancer. Int J Gynecol Cancer 2017; 26:737-42. [PMID: 26937749 DOI: 10.1097/igc.0000000000000662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We identified the predictive factors for locoregional failure after definitive chemoradiation in patients with locally advanced cervical cancer. METHODS Altogether, 397 patients with locally advanced cervical cancer (stage IB2-IVA) were treated with definitive chemoradiation between June 2001 and February 2010. Platinum-based concurrent chemotherapy was given to all patients with median radiation dose of external beam radiotherapy 50.4 Gy in 28 fractions and intracavitary radiotherapy 30 Gy in 6 fractions. Competing risk regression analysis was used to reveal the predictive factors for locoregional failure. RESULTS During the median follow-up of 7.2 years, locoregional failure occurred in 51 (12.9%) patients. The estimated 3-year rate of locoregional control was 89%, whereas the overall survival rate was 82%. After univariate and multivariate analyses, large tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage (III-IV) were identified as risk factors for locoregional failure (P = 0.003, P = 0.075, P = 0.005, P = 0.055, and P < 0.001, respectively). After risk grouping according to the coefficients from the multivariate model, we identified a high-risk group for locoregional failure after treatment with definitive chemoradiation as follows: (1) tumor size larger than 5 cm, and at least 1 other risk factor or (2) tumor size 5 cm or less, and at least 3 other risk factors. The cumulated estimated 3-year rate of locoregional failure of the high-risk group was 26%, which was significantly higher than that of the low-risk group (7%, P < 0.001). The 3-year overall survival rates of the 2 groups were also significantly different (57% vs 86%, P < 0.001). CONCLUSIONS Large tumor size (>5 cm), young age (≤40 years), nonsquamous histology, positive lymph node on magnetic resonance imaging, and advanced stage are all risk factors for locoregional failure after definitive platinum-based chemoradiation in patients with locally advanced cervical cancer. In the high-risk group, further clinical trials are warranted to improve the locoregional control rate.
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Affiliation(s)
- Hyo Sook Bae
- *Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do; †Department of Gynecologic Oncology and Minimally Invasive Surgery, CHA Gangnam Medical Center, CHA University, Seoul; and ‡Gynecologic Cancer Branch, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
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Seo SS, Oh HY, Lee JK, Kong JS, Lee DO, Kim MK. Combined effect of diet and cervical microbiome on the risk of cervical intraepithelial neoplasia. Clin Nutr 2016; 35:1434-1441. [DOI: 10.1016/j.clnu.2016.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 01/13/2023]
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Kim Y, Kim YJ, Kim JY, Lim YK, Jeong C, Jeong J, Kim M, Lim MC, Seo SS, Park SY. Toxicities and dose-volume histogram parameters of MRI-based brachytherapy for cervical cancer. Brachytherapy 2016; 16:116-125. [PMID: 27876378 DOI: 10.1016/j.brachy.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/11/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the toxicities and dose-volume histogram parameters of external-beam and magnetic resonance imaging-based intracavitary brachytherapy in cervical cancer patients. METHODS AND MATERIALS Acute and late toxicities were assessed in 135 patients divided into four groups: group 1, grade 0; group 2, grades 1-4; group 3, grades 0-1; and group 4, grades 2-4. The doses at the International Commission on Radiation Units and Measurements (DICRU) and minimum doses to the most exposed 0.1, 1, 2, and 5 cc (D0.1cc, D1cc, D2cc, and D5cc) of normal organs were calculated as equivalent doses in 2 Gy (α/β = 3). RESULTS The median follow-up was 35.2 months. For rectum, DICRU, D0.1cc, D1cc, and D2cc were significantly different between groups 1 and 2 and DICRU, D0.1cc, and D1cc between groups 3 and 4. For bladder, D0.1cc, D1cc, and D2cc were significantly different between groups 1 and 2 and DICRU, D1cc, D2cc, and D5cc between groups 3 and 4. Grade 2-4 bladder toxicity occurred in fewer patients with D2cc ≤ 95 Gy than those with D2cc > 95 Gy (7% vs. 22%, p = 0.014). CONCLUSIONS DICRU, D0.1cc, D1cc, and D2cc are relevant for predicting late rectal toxicities. The patients with bladder D2cc > 95 Gy are required to be in close observation for severe late toxicities.
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Affiliation(s)
- Youngkyong Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Yeon-Joo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea; Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea.
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea; Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Chiyoung Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Jonghwi Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Meyoung Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
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Park B, Kim SI, Seo SS, Kang S, Park SY, Lim MC. Health Behaviors and Associated Sociodemographic Factors in Cervical Cancer Survivors Compared with Matched Non-Cancer Controls. PLoS One 2016; 11:e0160682. [PMID: 27529704 PMCID: PMC4986960 DOI: 10.1371/journal.pone.0160682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/24/2016] [Indexed: 11/18/2022] Open
Abstract
We explored the prevalence of smoking, alcohol consumption, physical activity, and obesity in cervical cancer survivors and examined associations between sociodemographic factors and each health behavior. We studied 448 cervical cancer survivors ≥2 years after their initial diagnosis who had completed treatment. The total sample consisted of these survivors, and 4,480 cancer-free controls who were grouped into 5-year age cohorts and matched to the survivors in terms of both education and monthly household income. The prevalence of current smoking, current alcohol consumption, physical inactivity, and obesity in cervical cancer survivors (2.68, 23.88, 62.02, and 32.81%, respectively) did not differ significantly from those of matched non-cancer controls. Age (younger), marital status (married), and education (≥college) were associated with lower probabilities of current alcohol consumption (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.88–0.95; OR = 0.42, 95% CI = 0.23–0.78; OR = 0.49, 95% CI = 0.25–0.97, respectively). A monthly household income ≥$2,000, being employed, and self–rated health status (less healthy) were associated with physical inactivity (OR = 0.61, 95% CI = 0.37–0.99; OR = 2.16, 95% CI = 1.36–3.42; OR = 1.94, 95% CI = 1.23–3.05, respectively). Both age and number of years since diagnosis were associated with obesity (OR = 1.04, 95% CI = 1.01–1.08; OR = 0.38; 95% CI = 0.20–0.72, respectively). The health behaviors of cervical cancer survivors did not differ from those of matched cancer-free controls. As health behaviors are modifiable, identification of cervical cancer survivors who are at risk of an unhealthy lifestyle would allow individual- and population-based intervention programs to more effectively use their limited resources.
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Affiliation(s)
- Boyoung Park
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Korea
- Cancer Early Detection Branch, National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang-si, Korea
| | - Sokbom Kang
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Korea
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang-si, Korea
- Gynecologic Cancer Branch, Research Institute, National Cancer Center, Goyang-si, Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang-si, Korea
- Gynecologic Cancer Branch, Research Institute, National Cancer Center, Goyang-si, Korea
| | - Myong Cheol Lim
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Korea
- Center for Uterine Cancer, Hospital, National Cancer Center, Goyang-si, Korea
- Gynecologic Cancer Branch, Research Institute, National Cancer Center, Goyang-si, Korea
- * E-mail:
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Kim TH, Lim MC, Kim SI, Seo SS, Kim SH, Park SY. Preoperative Prediction of Cardiophrenic Lymph Node Metastasis in Advanced Ovarian Cancer Using Computed Tomography. Ann Surg Oncol 2015; 23:1302-8. [PMID: 26714941 DOI: 10.1245/s10434-015-5015-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether the preoperative diameter of cardiophrenic lymph nodes (CPLNs) along the short and long axes, determined via computed tomography (CT), predicts CPLN metastasis in patients with advanced epithelial ovarian cancer. METHODS A total of 31 patients with primary advanced ovarian cancer who had CPLN dissection underwent preoperative CT that was reviewed twice by a radiologist blinded to the final pathology. An array of CT features and clinical factors [age, cancer antigen 125 (CA 125)] were compared between metastasis-positive and metastasis-negative CPLNs using the t test and Fisher's exact test. The optimal CPLN dimensions that best predicted metastasis were calculated using a receiver operating characteristic (ROC) curve, and were applied to find the correlation with other CT findings. Results were validated in an independent test set of nine patients by using the best cutoff value to predict metastasis. RESULTS Pathological evaluation revealed metastasis-positive CPLNs in 19 patients and metastasis-negative CPLNs in 12 patients. Metastasis-positive CPLNs had significantly reduced short axes than those of negative CPLNs (5.6 ± 1.7 and 7.8 ± 2.2, respectively; p < 0.001). ROC curve analysis showed that a cutoff value of 7 mm for the short axis demonstrated the largest area under the curve (0.789; p < 0.0007), with 63.16 % sensitivity and 83.33 % specificity. The presence of peritoneal metastasis and abdominopelvic adenopathy strongly related with CPLN adenopathy. Accuracies were 66.7 % (six of nine patients) based on the cutoff value in the independent test set. CONCLUSIONS The probability of detecting CPLN metastasis in patients with advanced ovarian cancer was approximately 85 % when the short axis of the CPLN was >7 mm in preoperative CT scans. Patients with CPLNs of this size may be candidates for CPLN dissection in order to confirm the pathological diagnosis.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. .,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Seoul, Republic of Korea.
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Sun Ho Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
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Oh HY, Kim MK, Seo SS, Lee JK. Association of Combined Tobacco Smoking and Oral Contraceptive Use With Cervical Intraepithelial Neoplasia 2 or 3 in Korean Women. J Epidemiol 2015; 26:22-9. [PMID: 26441210 PMCID: PMC4690737 DOI: 10.2188/jea.je20150047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Cigarette smoking and oral contraceptive (OC) use have been associated with cervical neoplasia, and the combination of smoking and OC use could influence cervical carcinogenesis. We aimed to assess the joint effect of smoking and OC use on the risk of cervical intraepithelial neoplasia (CIN). Methods From a cohort of human papillomavirus-positive subjects recruited from 6 hospitals in Korea from March 2006 to November 2012, a total of 678 subjects (411 control, 133 CIN 1, and 134 CIN 2 or 3 cases) were selected for this study (mean age, 43 years). The risk of CIN associated with smoking and OC use on additive and multiplicative scales was estimated via multinomial logistic regression after adjustment for potential confounding factors. The relative excess risk due to interaction (RERI) and the synergy index (S) were used to evaluate the additive interaction. Results OC users (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.07–3.69) and long-term OC use (≥20 months; OR 2.71; 95% CI, 1.11–6.59) had a higher risk of CIN 2/3, but had no association with CIN 1, compared to non-OC users. Smokers and heavy smoking (≥8 cigarettes/day) were not associated with any CIN grade. Combined smoking and OC use (OR 4.91; 95% CI, 1.68–14.4; RERI/S, 3.77/27.4; P for multiplicative interaction = 0.003) and combined heavy smoking and long-term OC use (OR 11.5; 95% CI, 1.88–70.4; RERI/S, 9.93/18.8; P for multiplicative interaction = 0.009) had a higher risk of CIN 2/3 but had no association with CIN 1 compared to combined non-smoking and non-OC use. Conclusions OC use and smoking acted synergistically to increase the risk of CIN 2 or 3 in Korean women.
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Affiliation(s)
- Hea Young Oh
- Division of Cancer Epidemiology and Prevention, National Cancer Center
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Ham Y, Oh HY, Seo SS, Kim MK. Association between Health Behaviors and a Family History of Cancer among Korean Women. Cancer Res Treat 2015; 48:806-14. [PMID: 26511810 PMCID: PMC4843757 DOI: 10.4143/crt.2015.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/05/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to examine the health-related behaviors related to a family history of cancer (FHCA) among Korean women underwent cancer screening. Materials and Methods A total of 8,956 women who underwent cancer screenings during 2001-2011 at the National Cancer Center, Korea, were analyzed. The association between health-related behaviors and a FHCA were assessed using multivariate logistic regression. Results Compared to women with no FHCA, women with FHCA were more likely to smoke (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.06 to 1.65), to be exposed to passive smoking (aOR, 1.21; 95% CI, 1.15 to 1.65), and less likely to engage in regular exercise (aOR, 1.20; 95% CI, 1.01 to 1.41). Combined effects of selected health behaviors for FHCA were significant, although no statistically significant interactions were observed between selected health behaviors. Compared to women with no FHCA, women with FHCA were more likely to simultaneously smoke and be exposed to passive smoking (aOR, 1.65; 95% CI, 1.17 to 2.31) and to simultaneously smoke and be physically inactive (aOR, 1.62; 95% CI, 1.00 to 2.64). Conclusion The study found that women with a FHCA exhibited unhealthy behaviors compared to women without FHCA. Higher emphasis on lifestyle modifications using a new standardized tool is strongly recommended for those with a FHCA, as well as individuals who are at high risk, together with their family members.
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Affiliation(s)
- Youngsun Ham
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hea Young Oh
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Korea
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Kim SI, Lim MC, Lee JS, Lee Y, Park K, Joo J, Seo SS, Kang S, Chung SH, Park SY. Impact of lower limb lymphedema on quality of life in gynecologic cancer survivors after pelvic lymph node dissection. Eur J Obstet Gynecol Reprod Biol 2015; 192:31-6. [DOI: 10.1016/j.ejogrb.2015.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
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Kim SI, Lim MC, Lee JS, Kim YJ, Seo SS, Kang S, Yoo CW, Nam BH, Kim JY, Chung SH, Park SY. Comparison of Lower Extremity Edema in Locally Advanced Cervical Cancer: Pretreatment Laparoscopic Surgical Staging with Tailored Radiotherapy Versus Primary Radiotherapy. Ann Surg Oncol 2015; 23:203-10. [PMID: 26059654 DOI: 10.1245/s10434-015-4653-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study investigated the clinical manifestations of lower extremity edema (LEE) in locally advanced cervical cancer patients treated with two different strategies. METHODS In total, 79 cervical cancer survivors with International Federation of Gynecology and Obstetrics stage IB2-IIB were included. Six survivors with stage IB1 and who had been suspicious for lymph node metastasis on pretreatment image also were included. Forty-two patients received radiotherapy after pretreatment laparoscopic surgical staging (Group 1), and 43 patients received primary radiotherapy (Group 2). The patients' medical records and survey results of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) were analyzed. RESULTS The incidence of LEE was higher in Group 1 than in Group 2 (69.0 vs. 11.6 %; P < 0.001). The duration of LEE was longer in Group 1 (mean 77.3 vs. 9.4 months). At the time of survey, 47.6 % of the patients in Group 1 were clinically diagnosed with lymphedema compared with no patients in Group 2. In GCLQ-K, the mean symptom cluster scores for general swelling (0.74 vs. 0.09; P < 0.001), limb swelling (0.22 vs. 0.00; P = 0.006), and heaviness (0.45 vs. 0.23; P = 0.033) were significantly higher in Group 1. One patient in Group 1 developed lymphedema-related angiosarcoma that was diagnosed at 7.8 years after surgery. CONCLUSIONS Patients with cervical cancer who underwent radiotherapy after laparoscopic surgical staging more commonly experienced LEE and related symptoms than patients who underwent primary radiotherapy. As LEE decreases patients' quality of life, it should be considered during patient consultation and surveillance.
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Affiliation(s)
- Se Ik Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. .,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
| | - Jeong Seon Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Joo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sokbom Kang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Chong Woo Yoo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Biostatistics Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Joo-Young Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Seung Hyun Chung
- Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Sang-Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
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Bae HS, Kim YJ, Lim MC, Seo SS, Park SY, Kang S, Kim SH, Kim JY. Predictors of radiation field failure after definitive chemoradiation in patients with locally advanced cervical cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-Si, South Korea
| | | | - Sun Ho Kim
- National Cancer Center, Seoul, South Korea
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Bae HS, Lim MC, Lee JS, Lee Y, Nam BH, Seo SS, Kang S, Chung SH, Kim JY, Park SY. Postoperative Lower Extremity Edema in Patients with Primary Endometrial Cancer. Ann Surg Oncol 2015; 23:186-95. [DOI: 10.1245/s10434-015-4613-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Indexed: 11/18/2022]
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Oh HY, Seo SS, Kim MK, Lee DO, Chung YK, Lim MC, Kim JY, Lee CW, Park SY. Correction: Synergistic effect of viral load and alcohol consumption on the risk of persistent high-risk human papillomavirus infection. PLoS One 2015; 10:e0124991. [PMID: 25867214 PMCID: PMC4395081 DOI: 10.1371/journal.pone.0124991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lim MC, Lee JS, Nam BH, Seo SS, Kang S, Park SY. Lower extremity edema in patients with early ovarian cancer. J Ovarian Res 2014; 7:28. [PMID: 24602386 PMCID: PMC3975336 DOI: 10.1186/1757-2215-7-28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/03/2014] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study was to investigate clinical manifestations of lower extremity edema (LEE) in early ovarian cancer. Methods Patients with early ovarian cancer who underwent staging surgery between January 2001 and December 2010. Medical records for LEE and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were evaluated. Results Patients had a median age of 46 years. Twenty-nine patients (40.8%) had past (13 patients, 44.8%) and/or current patient-reported LEE (16 patients, 55.2%). Symptoms reported on the GCLQ in over 20% of respondents were numbness, firmness/tightness, swelling, heaviness, limited movement of knee, and aching. GCLQ total symptoms score was significantly higher in patients with current LEE. Most of the LEE (25/29, 86.2%) developed within 12 months after surgery and LEE lasted more than 6 months in approximately two-thirds of the patients (18/29, 62.1%). Only half of the patients (52.1%) indicated knowledge of lymphedema: 86.2% of LEE patients and 28.6% of patients with no LEE. Conclusions Although a significant proportion of patients with ovarian cancer have LEE after surgery, most are not aware of lymphedema until they develop. Education and analyses for LEE and lymphedema are needed in patients with ovarian cancer.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 410-769, Gyeonggi-do, Republic of Korea.
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Lim MC, Lee JS, Joo J, Park K, Yoo HJ, Seo SS, Kang S, Chung SH, Park SY. Development and evaluation of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire in gynecologic cancer survivors. Gynecol Oncol 2014; 133:111-6. [PMID: 24522267 DOI: 10.1016/j.ygyno.2014.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was two-fold: first, to develop a Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) and evaluate its reliability and reproducibility and second, to examine the diagnostic efficacy of GCLQ-K in predicting lymphedema in gynecologic cancer survivors. METHODS We designed a case-control study, and the GCLQ-K was completed by 33 gynecologic cancer survivors with lymphedema and 34 gynecologic cancer survivors without lymphedema. A follow-up GCLQ-K was completed 3weeks after the baseline questionnaire. RESULTS The GCLQ-K showed high reliability with a Cronbach's α of 0.83 and high reproducibility with an intraclass correlation of 0.96. Of the 7 symptom clusters, 6 identified patients with lymphedema with statistical significance; identification of lymphedema using the physical functioning and infection-related symptom clusters did not reach significance. The area under the receiver operating characteristic curve (AUC) to distinguish patients with and without lymphedema was 0.868 (95% confidence interval [CI], 0.779-0.956). Following the exclusion of the physical functioning and infection-related symptom clusters, which showed poor prediction value for lymphedema, the AUC of the GCLQ-K total score further improved to 0.922 (95% CI, 0.864-0.981). CONCLUSION The GCLQ-K was successfully developed with minimal modifications to adapt the original GCLQ to the Korean culture and showed high internal consistency and reproducibility. Moreover, gynecologic cancer survivors with and without lymphedema could be satisfactorily distinguished using the GCLQ-K. Thus, GCLQ-K was proven to be a reliable tool, capable of identifying lymphedema in Korean gynecological cancer survivors.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
| | - Jeong Seon Lee
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
| | - Kibyung Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Heon Jong Yoo
- Department of Obstetrics & Gynecology, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Sokbom Kang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Seung Hyun Chung
- Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
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Lim MC, Seo SS, Kang S, Kim SK, Kim SH, Yoo CW, Park SY. Intraoperative image-guided surgery for ovarian cancer. Quant Imaging Med Surg 2012; 2:114-7. [PMID: 23256068 DOI: 10.3978/j.issn.2223-4292.2012.06.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/05/2012] [Indexed: 11/14/2022]
Abstract
Approximately two thirds of the ovarian cancer is diagnosed at late stage with peritoneal seeding. The most important prognostic factor is the residual tumor size after surgery. The better survival outcome from minimizing tumor has been established well from several institutional reports, clinical trials for chemotherapy, and meta-analyses. The current standard treatment for such advanced ovarian cancer is to resect all visible and palpable ovarian cancer as much as possible and postoperative chemotherapy. But, even after complete resection of all visible and palpable tumors, a significant percentage of the patients have recurrence usually in the peritoneal cavity in advanced ovarian cancer. Recurrence likely stems from microscopic residual tumor not resected at time of the initial surgery. Currently, advanced technology for intraoperative tumor detection has been reported. Although the current clinical outcome is at an early stage definitively, clinical benefit could be expected from the future in-depth basic research and clinical trials in this area. If all residual microscopic disease, especially chemotherapy-resistant cancer cells, could be removed or treated using new technology, groundbreaking advance for treating ovarian cancer will be realized.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769 Republic of Korea
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Yoo HJ, Lim MC, Seo SS, Kang S, Yoo CW, Kim JY, Park SY. Pelvic exenteration for recurrent cervical cancer: ten-year experience at National Cancer Center in Korea. J Gynecol Oncol 2012; 23:242-50. [PMID: 23094127 PMCID: PMC3469859 DOI: 10.3802/jgo.2012.23.4.242] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/02/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate survival and morbidity after pelvic exenteration (PE) for the curative management of recurrent cervical cancer. Methods We retrospectively evaluated patients with recurrent cervical cancer who underwent PE from January 2001 to April 2011. Patients were identified from the registry of our institution. The clinical status and demographic information was obtained by reviewing the medical records. Results Sixty-one recurrent cervical cancer patients underwent PE. Patients who received radiotherapy, operation, chemotherapy before PE were 98%, 41%, and 23%, respectively. The total morbidity rate was 44%; 10 (16%) patients had early complications (30 days or less after PE), whereas 22 (36%) patients had late complications. Wound problems were common early complications (7/18), and bowel fistulas were common late complications (9/30). The five-year overall survival and five-year disease-free survival were 56% and 49%, respectively. Median follow-up was 22 months (range, 1.8 to 60 months). Affecting factors for overall survival were resection margin status, pelvic wall and rectal involvement. Conclusion Our overall 5-year survival is encouraging. Although the morbidity rate is still high, PE is a potentially curative opportunity in gynecological malignancies with no other treatment options. The most important factors for overall survival after PE are the resection margin status, pelvic wall involvement and rectal involvement.
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Affiliation(s)
- Heon Jong Yoo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Kim YJ, Kim JY, Yoo SH, Min BJ, Chung KZ, Seo SS, Kang SB, Lim MC, Hwang JH, Yoo HJ, Park SY. High control rate for lymph nodes in cervical cancer treated with high-dose radiotherapy using helical tomotherapy. Technol Cancer Res Treat 2012; 12:45-51. [PMID: 22905806 DOI: 10.7785/tcrt.2012.500252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate whether bulky lymphadenopathy located in the abdominopelvic cavity in cervical cancer can be controlled without severe toxicity by increasing radiation dose using helical tomotherapy. From January 2007 to December 2010, 26 patients with cervical cancer with metastatic lymph nodes (LNs) having at least one short diameter > 1.5 cm were treated with helical tomotherapy. A total of 58 LN sites were treated and the largest LN of each site was evaluated for response. Median follow-up time was 28 months (4-50 months). Median short diameter of the LNs was 1.7 cm (0.7-4.2 cm) with median radiation dose of 62.6 Gy(10) in 2 Gy equivalent dose (53.3-77.9 Gy(10)). Initial LN response was evaluated on imaging obtained within 4 months after radiotherapy. Initial complete response (CR), partial response (PR), and stable disease (SD) were observed in 54, 2 and 2 lesions, respectively. Recurrence occurred in two with CR and progression in one with PR. Therefore, final CR, PR, SD, and progression of disease were observed in 52, 1, 2, and 3, respectively. Actuarial 3-year LN progression-free survival and overall survival (OS) were 63% and 65%, respectively. Multivariate analysis revealed final LN response (CR vs. non-CR) as a strong prognostic factor for OS (p = 0.016). Radiation Therapy Oncology Group grade 2 or more acute and late toxicity was observed in 8 and 1 patients, respectively. The treatment of bulky lymphadenopathy using helical tomotherapy in advanced cervical cancer is highly effective and has acceptable toxicity.
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Affiliation(s)
- Y J Kim
- Research Institute and Hospital, _National Cancer Center, Goyang-si, Gyeonggi-do, South Korea.
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Yoo HJ, Lim MC, Lim S, Park JY, Kang S, Park SY, Seo SS. Phase II study of paclitaxel in combination with carboplatin for patients with recurrent or persistent uterine sarcoma. Arch Gynecol Obstet 2012; 286:1529-35. [DOI: 10.1007/s00404-012-2466-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 07/09/2012] [Indexed: 11/30/2022]
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Kang S, Nam BH, Park JY, Seo SS, Ryu SY, Kim JW, Kim SC, Park SY, Nam JH. Risk Assessment Tool for Distant Recurrence After Platinum-Based Concurrent Chemoradiation in Patients With Locally Advanced Cervical Cancer: A Korean Gynecologic Oncology Group Study. J Clin Oncol 2012; 30:2369-74. [PMID: 22614984 DOI: 10.1200/jco.2011.37.5923] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose 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. Patients and Methods 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 [18F]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. Results 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. Conclusion 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.
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Affiliation(s)
- Sokbom Kang
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Byung-Ho Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jeong-Yeol Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Young Ryu
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Jae Weon Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Seung-Cheol Kim
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Sang-Yoon Park
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Sokbom Kang, Byung-Ho Nam, Sang-Soo Seo, Sang-Yoon Park, National Cancer Center, Goyang; Jeong-Yeol Park, Joo-Hyun Nam, Asan Medical Center; Sang-Young Ryu, Korea Cancer Center; Jae Weon Kim, Seoul National University Hospital; Seung-Cheol Kim, Ewha Woman's University Medical Center, Seoul, Republic of Korea
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Abstract
AIM The purpose of this study was to describe the features of patients with brain metastasis from cervical cancer. MATERIAL AND METHODS The medical records of patients with cervical cancer between February 2001 and June 2011 were reviewed retrospectively. Clinical characteristics, symptoms, treatment and survival in patients with brain metastasis were analyzed. RESULTS Eleven patients with brain metastasis from cervical cancer were identified, representing an incidence of brain metastasis in the study population of 0.45%. Median patient age at initial diagnosis of cervical cancer was 50 years (range 33-75 years). Non-squamous cell carcinoma was diagnosed in six (54.5%) of the 11 patients, with small cell carcinoma diagnosed in two patients. Ten of the 11 patients had lung-related metastasis at presentation; eight patients had lung metastasis, one had mediastinal lymph node metastasis, and one had pleural metastasis. The median interval from diagnosis of cervical cancer to identification of brain metastasis was 15.4 months (range 3.4-83.3 months). Nine patients presented with neurologic symptoms, such as headache, nausea, vomiting, seizure and extremity weakness. Initially, six patients received whole brain radiotherapy: three patients received chemotherapy; one underwent surgery; and one patient refused treatment. The median survival time after diagnosis of the brain metastases was 5.9 months (range 0.7-19 months). CONCLUSION The prognosis after diagnosis of the brain metastasis in patients with uterine cervical cancer is poor. The small cell type and lung metastasis seem to be related with brain metastasis and may be regarded as risk factors.
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Affiliation(s)
- Jong Ha Hwang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Hwang JH, Lim MC, Joung JY, Seo SS, Kang S, Seo HK, Chung J, Park SY. Urologic complications of laparoscopic radical hysterectomy and lymphadenectomy. Int Urogynecol J 2012; 23:1605-11. [PMID: 22531954 DOI: 10.1007/s00192-012-1767-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 03/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate the intra- and postoperative urologic complications and management in patients with cervical or endometrial cancer treated with laparoscopic radical hysterectomy and lymphadenectomy. METHODS We retrospectively reviewed the medical records of 146 patients with cervical or endometrial cancer who underwent total laparoscopic radical hysterectomy with lymphadenectomy between August 2002 and April 2011. The intra- and postoperative urologic complications were analyzed. RESULTS Double ureteral stents were inserted prophylactically in 13 patients (8.9 %), 2 of whom had postoperative urologic complications. Nine patients (6.2 %) had postoperative urologic complications. Of four patients with ureterovaginal fistulas, two were treated conservatively with cystoscopic placement of ureteral stents and two underwent ureteroneocystostomies. Vesicovaginal fistulas occurred in two patients, both of whom underwent vesicovaginal fistula repairs. One patient noted to have a bladder injury intraoperatively had a laparoscopic repair, and one patient noted to have a ureteral injury postoperatively was treated conservatively with cystoscopic placement of ureteral stents. CONCLUSIONS Iatrogenic lower urinary tract injuries during laparoscopic radical hysterectomy are relatively common complications. Intraoperative prophylactic ureteral stent insertion and the early detection of urologic complications postoperatively is advised for patients who undergo laparoscopic radical hysterectomies.
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Affiliation(s)
- Jong Ha Hwang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323 Illsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea
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Hwang JH, Yoo HJ, Park SH, Lim MC, Seo SS, Kang S, Kim JY, Park SY. Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy. Fertil Steril 2012; 97:1387-93.e1-2. [PMID: 22464082 DOI: 10.1016/j.fertnstert.2012.02.052] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/09/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of ovarian transposition procedures in preserving ovarian function in relation to the location of the transposed ovaries in patients who underwent surgery with or without pelvic radiotherapy. DESIGN Retrospective. SETTING Uterine cancer center. PATIENT(S) A total of 53 patients with cervical cancer who underwent ovarian transposition between November 2002 and November 2010. INTERVENTION(S) Ovarian transposition to the paracolic gutters with or without radical hysterectomy and lymph node dissection. MAIN OUTCOME MEASURE(S) Preservation of ovarian function, which was assessed by patient's symptoms and serum FSH level. RESULT(S) Lateral ovarian transposition was performed in 53 patients. Based on receiver operator characteristic curve analysis, optimum cutoff value of location more than 1.5 cm above the iliac crest was significantly associated with preservation of ovarian function after treatment (area under receiver operator characteristic curve: 0.757, 95% confidence interval [CI]: 0.572-0.943). In univariate analysis, higher location of transposed ovary more than 1.5 cm from the iliac crest was the only independent factor for intact ovarian function (odds ratio 9.91, 95% CI: 1.75-56.3). Multivariate analysis confirmed that the location of transposed ovary (odds ratio 11.72, 95% CI 1.64-83.39) was the most important factor for intact ovarian function. CONCLUSION(S) Location of transposed ovary higher than 1.5 cm above the iliac crest is recommended to avoid ovarian failure after lateral ovarian transposition after primary or adjuvant pelvic radiotherapy in cervical cancer.
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Affiliation(s)
- Jong Ha Hwang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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Kang S, Kang WD, Chung HH, Jeong DH, Seo SS, Lee JM, Lee JK, Kim JW, Kim SM, Park SY, Kim KT. Preoperative identification of a low-risk group for lymph node metastasis in endometrial cancer: a Korean gynecologic oncology group study. J Clin Oncol 2012; 30:1329-34. [PMID: 22412131 DOI: 10.1200/jco.2011.38.2416] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Sokbom Kang
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
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Hwang JH, Lim MC, Seo SS, Kang S, Park SY, Kim JY. Outcomes and toxicities for the treatment of stage IVB cervical cancer. Arch Gynecol Obstet 2011; 285:1685-93. [DOI: 10.1007/s00404-011-2173-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/05/2011] [Indexed: 11/24/2022]
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Kang S, Kim TJ, Seo SS, Kim BG, Bae DS, Park SY. Prediction of a high-risk group based on postoperative nadir CA-125 levels in patients with advanced epithelial ovarian cancer. J Gynecol Oncol 2011; 22:269-74. [PMID: 22247804 PMCID: PMC3254846 DOI: 10.3802/jgo.2011.22.4.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/08/2011] [Accepted: 06/14/2011] [Indexed: 11/30/2022] Open
Abstract
Objective We aimed to determine the ideal cut-off of nadir serum CA-125 level for prediction of progression free survival. Methods Among 267 patients who achieved complete remission after chemotherapy, the correlation between nadir CA-125 and progression free survival were compared among the subgroups classified according to the distribution of CA-125. The diagnostic odds ratio and area under the receiver operator characteristics curve were compared at various cut-off points. Results The nadir CA-125 levels did not have prognostic value under 12 U/mL (to 75 percentile). In contrast, they were significantly correlated with progression free survival only when the CA-125 level was greater than 12, which was 75 percentile (p=0.034). In predicting progression free survival <6 and 12 months, the cut-off value of 18 (90 percentile) showed superior diagnostic performance over 10 or 12 U/mL. Compared with patients who showed nadir levels between 0 and 12 U/mL (0 to 75 percentile), those with nadir >18 U/mL showed a hazard ratio of 2.85 (95% confidence interval, 1.70 to 4.76; p<0.001); patients with nadir levels between 18 and 12 U/mL showed a the hazard ratio of 1.68 (95% confidence interval, 1.11 to 2.56; p=0.015) compared with those whose nadir levels were under 12 U/mL. Conclusion The predictive power of the traditional cut-off of 10 U/mL to classify a risk group or to identify high risk patients was unsatisfactory. The optimal diagnostic performance was observed at the cut-off of 18 U/mL and this can be proposed to dichotomize cut-off values to predict outcomes among individual patients.
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Affiliation(s)
- Sokbom Kang
- Branch of Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol 2011; 123:522-7. [PMID: 21945553 DOI: 10.1016/j.ygyno.2011.08.034] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/29/2011] [Accepted: 08/29/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The validity of the sentinel lymph node (SLN) procedure for the assessment of nodal status in patients with endometrial cancer is unclear. We aimed to assess the diagnostic performance of this procedure. METHODS We searched the PubMed and Embase databases for studies published before June 1, 2011. Eligible studies had a sample size of at least 10 patients, and reported the detection rate and/or sensitivity of the SLN biopsy. RESULTS We identified 26 eligible studies, which included 1101 SLN procedures. The overall weighted-mean number of harvested SLNs was 2.6. The detection rate and the sensitivity were 78% (95% confidence interval [CI]=73%-84%) and 93% (95% CI=87%-100%), respectively. Significant between-study heterogeneity was observed in the analysis of the detection rate (I-squared statistic, 80%). The use of pericervical injection was correlated with the increase of the detection rate (P=0.031). The hysteroscopic injection technique was associated with the decrease of the detection rate (P=0.045) and the subserosal injection technique was associated with the decrease of the sensitivity (P=0.049), if they were not combined with other injection techniques. For the detection rate, significant small-study effects were noted (P<0.001). CONCLUSIONS Although SLN biopsy has shown good diagnostic performance in endometrial cancer, such performance should be interpreted with caution because of significant small study effects. Current evidence is not yet sufficient to establish the true performance of SLN biopsy in endometrial cancer.
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Affiliation(s)
- Sokbom Kang
- Center for Uterine Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea.
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Lee ES, Kim TS, Yoo CW, Seo SS, Kim SK. A Case of Meigs' Syndrome: The (18)F-FDG PET/CT Findings. Nucl Med Mol Imaging 2011; 45:229-32. [PMID: 24900010 DOI: 10.1007/s13139-011-0093-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022] Open
Abstract
The findings of an ovarian mass with marked ascites and pleural effusion are highly suggestive of malignancy, especially in a postmenopausal female with an elevated level of CA-125. However, benign conditions such as Meigs' syndrome should be considered in the differential diagnosis if the primary mass shows benign features. (18)F-FDG is known to be useful to differentiate between malignant and benign diseases, and this utility is also promising in the case of ovarian tumor. We present here a case of Meigs' syndrome that was evaluated by (18)F-FDG PET/CT, and this helped the preoperative diagnosis be made. (18)F-FDG PET/CT is a promising modality to diagnose the pathological character of an ovarian tumor preoperatively, which can lead to a proper therapeutic plan.
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Affiliation(s)
- Eun Seong Lee
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
| | - Chong Woo Yoo
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
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Kong SY, Han MH, Yoo HJ, Hwang JH, Lim MC, Seo SS, Yoo CW, Kim JH, Park SY, Kang S. Serum HE4 Level is an Independent Prognostic Factor in Epithelial Ovarian Cancer. Ann Surg Oncol 2011; 19:1707-12. [DOI: 10.1245/s10434-011-1943-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Indexed: 01/20/2023]
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Kang S, Jong YH, Hwang JH, Lim MC, Seo SS, Yoo CW, Park SY. Is neo-adjuvant chemotherapy a "waiver" of extensive upper abdominal surgery in advanced epithelial ovarian cancer? Ann Surg Oncol 2011; 18:3824-7. [PMID: 21691879 DOI: 10.1245/s10434-011-1830-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The goal of this study was to explore the necessity of extensive surgical procedures in patients who received neoadjuvant chemotherapy (NAC). METHODS We analyzed the surgical outcomes and frequency of extensive procedures required for maximal cytoreductive surgery after NAC and primary debulking surgery (PDS) in 256 women with advanced epithelial ovarian cancer. RESULTS NAC was performed in 116 of 256 women (45.3%). In NAC group, complete cytoreduction rate and optimal cytoreduction rate were 60.3 and 92.2%, respectively. Although the NAC group comprised patients with higher risk of suboptimal cytoreduction, complete cytoreduction rate was similar to that of PDS group (57.9%, P = .69). Moreover, blood loss and surgical complexity significantly reduced in NAC group (P = .011 and .017). Extensive upper abdominal surgery (EUAS) was performed in 70 of 116 patients (60.3%) in the NAC group. The frequency of EUAS was similar between NAC and PDS group (P = .60). Among NAC group, gross upper abdominal metastasis requiring EUAS was found in 51 patients (44%, 95% confidence interval = 35.3-53.1%). CONCLUSIONS A significant proportion of patients who received NAC still have gross metastatic tumors requiring EUAS. Gynecologic oncologists should be familiar with EUAS and be ready to perform any required procedures together with multidisciplinary teams, even in the patients who have received NAC.
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Affiliation(s)
- Sokbom Kang
- Gynecologic Oncology Research Division, Uterine Cancer Center, National Cancer Center, Goyang, Republic of Korea.
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Kang S, Kim TJ, Seo SS, Kim BG, Bae DS, Park SY. Role of extended chemotherapy in advanced ovarian cancer patients with high posttreatment serum CA-125 levels. Gynecol Obstet Invest 2011; 72:50-4. [PMID: 21372548 DOI: 10.1159/000322438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to determine whether the inclusion of additional cycles of carboplatin-paclitaxel is beneficial to patients with high posttreatment serum CA-125 levels. METHODS Among patients who achieved remission after six cycles of carboplatin-paclitaxel chemotherapy, those with CA-125 of 10-35 U/ml at the time of remission were divided into two groups (group A: six cycles of standard chemotherapy vs. group B: two or more additional cycles) and were analyzed. RESULTS Among the 436 patients with advanced epithelial ovarian cancer, 154 patients (46.8%) had CA-125 of 10-35 U/ml at the time of remission. Fifty-six patients (36.4%) received two or more cycles after the first six cycles of chemotherapy (group B). The addition of two or more cycles of chemotherapy did not improve the progression-free survival (p = 0.660). There was no statistical difference in the rates of CA-125 falling to <10 U/ml between the two groups (p = 0.256). Moreover, the degree of CA-125 decrease after six cycles of chemotherapy was similar regardless of the additional cycles (p = 0.656). CONCLUSION The addition of two or more cycles of standard chemotherapy based on posttreatment CA-125 levels was not beneficial.
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Affiliation(s)
- Sokbom Kang
- Branch of Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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