Ilsandong gu, South Korea
Ilsandong gu, South Korea

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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.


Todo Y.,National Hospital Organization | Choi H.-J.,University of Ulsan | Kang S.,Center for Uterine Cancer | Kim J.-W.,Seoul National University | And 4 more authors.
Gynecologic Oncology | Year: 2013

Objective The aim of this study was to elucidate the significance of tumor volume as a risk factor for predicting lymph node metastasis. Methods We applied the tumor volume index to the data that were collected for 327 Korean patients with endometrial cancer who underwent preoperative assessment including magnetic resonance imaging (MRI) and subsequent surgery including systematic lymphadenectomy. The volume index, which we previously reported in the literature, was defined as the product of maximum longitudinal diameter along the uterine axis, maximum anteroposterior diameter in a sagittal section image, and maximum horizontal diameter in a horizontal section image according to MRI data, from 425 Japanese women with endometrial cancer. Relationships between lymph node metastasis and results of preoperative examinations including volume index were analyzed by logistic regression analysis. Results The prevalence of affected lymph nodes was 14.2%. Multivariate analysis showed that high-grade histology assessed by endometrial biopsy [odds ratio (OR); 2.9, 95% confidence interval (CI): 1.4-6.4], volume index (OR; 2.4, 95% CI: 1.1-5.3), node enlargement assessed by MRI (OR; 4.2, 95% CI: 1.4-13.2), and high serum cancer antigen (CA)125 level (OR; 3.6, 95% CI: 1.6-8.1) were significantly and independently related to lymph node metastasis. When volume index was excluded from the analysis, myoinvasion assessed by MRI was an independent risk factor for lymph node metastasis as well as high-grade histology, node enlargement, and high serum CA125 level. Conclusion Volume index is compatible with myometrial invasion as a factor for predicting lymph node metastasis in endometrial cancer. © 2013 Elsevier Inc.


Oh H.Y.,National Cancer Center | Kim B.-S.,Seoul National University | Kim B.-S.,Hallym University | Seo S.-S.,Center for Uterine Cancer | And 6 more authors.
Clinical Microbiology and Infection | Year: 2015

Recent studies have suggested potential roles of the microbiome in cervicovaginal diseases. However, there has been no report on the cervical microbiome in cervical intraepithelial neoplasia (CIN). We aimed to identify the cervical microbiota of Korean women and assess the association between the cervical microbiota and CIN, and to determine the combined effect of the microbiota and human papillomavirus (HPV) on the risk of CIN. The cervical microbiota of 70 women with CIN and 50 control women was analysed using pyrosequencing based on the 16S rRNA gene. The associations between specific microbial patterns or abundance of specific microbiota and CIN risk were assessed using multivariate logistic regression, and the relative excess risk due to interaction (RERI) and the synergy index (S) were calculated. The phyla Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, Tenericutes, Fusobacteria and TM7 were predominant in the microbiota and four distinct community types were observed in all women. A high score of the pattern characterized by predominance of Atopobium vaginae, Gardnerella vaginalis and Lactobacillus iners with a minority of Lactobacillus crispatus had a higher CIN risk (OR 5.80, 95% CI 1.73-19.4) and abundance of A. vaginae had a higher CIN risk (OR 6.63, 95% CI 1.61-27.2). The synergistic effect of a high score of this microbial pattern and oncogenic HPV was observed (OR 34.1, 95% CI 4.95-284.5; RERI/S, 15.9/1.93). A predominance of A. vaginae, G. vaginalis and L. iners with a concomitant paucity of L. crispatus in the cervical microbiota was associated with CIN risk, suggesting that bacterial dysbiosis and its combination with oncogenic HPV may be a risk factor for cervical neoplasia. © 2015 European Society of Clinical Microbiology and Infectious Diseases.


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.


Lee J.-Y.,Seoul National University | Youm J.,Seoul National University | Kim T.H.,Seoul National University | Cho J.Y.,Seoul National University | And 6 more authors.
Gynecologic Oncology | Year: 2014

Objective The aim of this study is to identify a patient group with a low-risk of parametrial involvement (PMI) in Stage IB1 cervical cancer using preoperative magnetic resonance imaging (MRI) parameters. Methods In total, 190 Stage IB1 cervical cancer patients with clinically visible lesions who had undergone Type C2 radical hysterectomy and preoperative MRI were included in this study. Clinical records, pathology reports, and preoperative MRI findings were reviewed retrospectively. Results Of the 190 patients, 19 (10%) had pathologic PMI. The largest tumor diameter identified by MRI ranged from zero (no definite mass on the cervix) to 60 mm, with a median of 21 mm. Patients were identified as being either low-risk (tumor size ≤ 25 mm and no evidence of PMI, n = 127) or high-risk (tumor size > 25 mm and/or findings indicating PMI, n = 63) based on MRI parameters. The rate of pathologic PMI in low- and high-risk patients was 0.0% and 30.2%, respectively (P < 0.001). Five-year progression-free survival in low-risk patients was 95.9%, which is significantly better than the rate of 85.6% for patients in the high-risk group (P = 0.039). Conclusions Preoperative MRI parameters can help identify patients with a low-risk of PMI and, therefore, possible candidates for trials on less radical surgery. © 2014 Elsevier Inc. All rights reserved.


Todo Y.,National Hospital Organization | 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.


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.


Kang S.,Center for Uterine Cancer | Park S.-Y.,Center for Uterine Cancer
Annals of Oncology | Year: 2011

Although maximal cytoreduction is the cornerstone of current treatment for patients with advanced ovarian cancer, optimal cytoreduction is not always achievable in the clinic. Therefore, using clinical characteristics, diagnostic imaging, serum biomarkers or laparoscopic findings, many studies have attemptesd to find models for predicting surgical resectability. However, most of these prediction models showed limited effectiveness and have not been properly validated. To establish a reliable prediction model, several requirements should be met. First, the goal of surgical cytoreduction should be adequately defined. Second, the desired accuracy for making the model clinically useful should be defined. Third, the model should test all relevant predictors, including clinical, radiological and biochemical predictors, and be developed using a large dataset that provides a sufficient number of events. Fourth, any prediction model should be validated with a relevant external dataset. Lastly, the prediction model should be able to aid decision making and, thereby, improve the outcome of patients. Therefore, randomized clinical trials with decision making based on prediction models are urgently required. ©The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Kang S.,Center for Uterine Cancer | Yoo H.J.,Center for Uterine Cancer | Hwang J.H.,Center for Uterine Cancer | Lim M.-C.,Center for Uterine Cancer | And 2 more authors.
Gynecologic Oncology | Year: 2011

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. © 2011 Elsevier Inc. All rights reserved.


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.

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