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Yanggu, South Korea

Kang S.,Center for Uterine Cancer | Todo Y.,Hokkaido Cancer Center | Watari H.,Hokkaido University
Journal of Obstetrics and Gynaecology Research | Year: 2014

Due to advances of radiological imaging and tumor biomarkers, the extent of information provided by preoperative assessment is rapidly growing. The Korean Gynecologic Oncology Group (KGOG) recently proposed new preoperative criteria to identify patients at low risk for lymph node metastasis in endometrial cancer. In the multicenter study, serum carbohydrate antigen 125 levels and three magnetic resonance imaging parameters were found to be independent risk factors for nodal metastasis, and classified 53% of patients as part of a low-risk group. The false-negative predictive value (NPV)was 1.7%, andwas 1.4% in the validation set. Furthermore, the KGOG low-risk criteria were validated in 319 Japanese patients with endometrial cancer. The criteria identified 181 of 319 patients as a low-risk group (51%), and three false-negative cases were found (1.9%). These results indicate that we are able to identify low-risk patients with a negligible NPV before surgery. In addition, the low false NPV implies that there is great difficulty in performing a randomized trial to determine the efficacy of routine lymphadenectomy in patients at low risk of lymph node metastasis. Based on these data, the challenges and possible solutions for developing a consensus on the optimized management of low-risk endometrial cancer will be discussed in this review. © 2014 Japan Society of Obstetrics and Gynecology. Source

Todo Y.,Hokkaido Cancer Center | Watari H.,Hokkaido University | Kang S.,Center for Uterine Cancer | Sakuragi N.,Hokkaido University
Journal of Obstetrics and Gynaecology Research | Year: 2014

It has been strongly suggested that patients with endometrial cancer with low risk of lymph node metastasis do not benefit from lymphadenectomy and that intermediate-risk/high-risk endometrial cancer patients benefit from complete pelvic and para-aortic lymphadenectomy. This hypothesis needs to be validated by prospective studies. For randomized controlled trials (RCT), heterogeneity of intervention compromises internal validity and non-participation of experienced doctors compromises external validity. As these situations easily occur in randomized surgical trials (RST) intended for high-risk patients, the effects of complicated surgery, such as full lymphadenectomy, might be underestimated in RST. In a famous RST, data for all eligible patients implied that survival outcome for the non-randomized group was significantly better than that for the randomized group. One plausible explanation is that physicians' judgment and experience produce better treatment decisions than do random choices. Although two RCT from European countries showed negative results of lymphadenectomy on prognosis, valuing the care of individual patients may be more important than uncritically adopting the results of RCT. In endometrial cancer, lymphadenectomy must be tailored to maximize the therapeutic effect of surgery and minimize its invasiveness and adverse effects. Two strategies are: (i) to remove lymph nodes most likely to harbor disease while sparing lymph nodes that are unlikely to be affected; and (ii) to perform full lymphadenectomies only on patients who can potentially benefit from them. Here, we focus on the second strategy. Preoperative risk assessments used in Japan and Korea to select low-risk patients who would not benefit from lymphadenectomy are discussed. © 2014 Japan Society of Obstetrics and Gynecology. Source

Kang S.,Center for Uterine Cancer | Todo Y.,Hokkaido Cancer Center | Odagiri T.,Hokkaido University | Mitamura T.,Hokkaido University | And 4 more authors.
Gynecologic Oncology | Year: 2013

Objective The Korean Gynecologic Oncology Group (KGOG) recently proposed new pre-operative criteria to identify a low-risk group for lymph node metastasis in endometrial cancer. The aim of this study was to test whether the good performance of the criteria can be reproducible in diverse clinical settings. Methods From two Japanese hospitals, 319 patients with endometrial cancer who underwent systemic lymphadenectomy were retrospectively reviewed. In one hospital, para-aortic lymphadenectomy was routinely performed, but it was selectively performed in the other hospital. The performance of the criteria was determined by adjusting the false-negative rate (FNR) at the given prevalence of nodal metastasis of 10% using Bayes' theorem. Results Nodal metastasis rate of the study population was 12.9%. The KGOG low-risk criteria identified 181 of 319 patients as a low-risk group (51%), and three false-negative cases were found (1.9%). Despite a significant difference in the nodal metastasis rate (18.2% and 8.8%, P =.012) and the surgical policy for para-aortic lymphadenectomy (100% and 48.9%, P <.001) between the two hospitals, KGOG criteria consistently showed a very low adjusted FNR at the prevalence of 10% in both hospitals (1.8% vs. 1.1%, respectively). Among the entire study population, the adjusted FNR was 1.4% (95% confidence interval,.5% to 4.3%), which was similar to the FNR of 1.3% in our previous study. Conclusion The KGOG low-risk criteria accurately identified a low-risk group for lymph node metastasis with acceptable false negativity regardless of diverse clinical settings. © 2013 Elsevier Inc. Source

Lim M.C.,Center for Uterine Cancer | Park S.-Y.,Center for Uterine Cancer
Journal of the Korean Medical Association | Year: 2016

The standard treatment for epithelial ovarian cancer is maximal cytoreductive surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy can be considered as an alternative treatment strategy when unacceptable primary surgery, in terms of gross residual tumor remaining at the end of cytoreduction, is expected or in cases where poor general condition renders extensive cytoreductive surgery unsuitable. Intraperitoneal chemotherapy is ideal for epithelial ovarian cancer because its spread is mainly limited to the peritoneal cavity. Several randomized controlled trials have reported a survival gain with intraperitoneal chemotherapy. However, disadvantages such as port-related complications, abdominal pain, and neurotoxicity hinder its wide use. Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been suggested as an alternative treatment strategy for intraperitoneal chemotherapy. Ongoing clinical trials of hyperthermic intraperitoneal chemotherapy will quantify clinical outcomes in the future, such as the survival benefit in epithelial ovarian cancer. © Korean Medical Association. Source

Jeong N.-H.,Kyung Hee University | Lee J.-M.,Kyung Hee University | Lee J.-K.,Korea University | Kim J.W.,Seoul National University | And 6 more authors.
Gynecologic Oncology | Year: 2010

Objective: We aimed to evaluate the role of body mass index (BMI) as a risk and prognostic factor of endometrioid uterine cancer in Korean women. Methods: The records of 937 patients with endometrioid uterine cancer treated between 2000 and 2006 in Korea were reviewed. To determine the disease risk by BMI, four age-matched controls were recruited from healthy women (1-year age group). Results: The obese (BMI ≥ 25 kg/m2) and overweight (23 kg/m2≤ BMI < 25 kg/m2) women had an increased risk for endometrioid uterine cancer (OR = 3.161, 95% CI = 2.655-3.763 and OR = 1.536, 95% CI = 1.260-1.873, respectively) compared to the non-obese (BMI < 23 kg/m2) women. That is, an increment of 1 kg/m2 caused an 18% increase in the endometrioid uterine cancer risk (OR = 1.181, 95% CI = 1.155-1.207). However, there was no difference in overall survival according to the BMI-based subgroups (log-rank = 0.366, p = 0.8328). The crude Cox model showed that obesity was not associated with the patients' overall survival when the obese and non-obese women were compared (crude HR = 0.82, 95% CI = 0.40-1.66). Furthermore, there was a significant trend toward a better prognosis at increased increments of BMI (p for trend < 0.001), but this was not found in the multivariate analysis. Conclusions: A high BMI was a significant risk factor for endometrioid uterine cancer in an Asian population. However, it was not associated with overall survival, in spite of the earlier tumor stage of the obese women. © 2010 Elsevier Inc. All rights reserved. Source

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