Joo Hyun Nam

Quality of life and sexual problems in disease‐free survivors of cervical cancer compared with the general population

The purpose of this study was to identify problems related to long‐term quality of life (QOL) and sexual function in cervical cancer survivors.

The Impact of Tumor Morcellation During Surgery on the Outcomes of Patients with Apparently Early Low-Grade Endometrial Stromal Sarcoma of the Uterus

The purpose of this study was to evaluate the impact of tumor morcellation on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma (LGESS). Outcomes were retrospectively compared between patients with apparently early LGESS who did not (group A, nxa0=xa027) or did (group B, nxa0=xa023) undergo tumor morcellation. There were no between-group differences in age, menopausal status, parity, body mass index, and preoperative presumptive diagnosis, nor were there between-group differences in tumor stage, tumor size, myometrial invasion, lymphovascular space invasion, frequency of ovarian preservation, adjuvant therapy, or follow-up time. More patients in group A underwent lymph node dissection (51.9 vs. 21.7%; Pxa0=xa00.029). Only 1 patient in each group had distant recurrence. There were 2 patients (7.4%) in group A and 7 (31.4%) in group B who had abdominopelvic recurrence. The risk of abdominopelvic recurrence was significantly higher in group B than in group A (odds ratio [OR], 5.47; 95% confidence interval [95% CI], 1.04–29.70; Pxa0=xa00.035). The 5-year disease-free survival (DFS) rates were 84% for group A and 55% for group B (Pxa0=xa00.028) and the 5-year abdominopelvic DFS rates were 89 and 58% (Pxa0=xa00.023), respectively. Multivariate analysis showed that tumor morcellation were significantly associated with poorer DFS (OR, 4.03; 95% CI, 1.06–15.30; Pxa0=xa00.040) and abdominopelvic DFS (OR, 5.06; 95% CI, 1.02–25.04; Pxa0=xa00.047). Inadvertent tumor morcellation during surgery has an adverse impact on the outcomes of patients with early LGESS.BackgroundThe purpose of this study was to evaluate the impact of tumor morcellation on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma (LGESS).MethodsOutcomes were retrospectively compared between patients with apparently early LGESS who did not (group A, nxa0=xa027) or did (group B, nxa0=xa023) undergo tumor morcellation.ResultsThere were no between-group differences in age, menopausal status, parity, body mass index, and preoperative presumptive diagnosis, nor were there between-group differences in tumor stage, tumor size, myometrial invasion, lymphovascular space invasion, frequency of ovarian preservation, adjuvant therapy, or follow-up time. More patients in group A underwent lymph node dissection (51.9 vs. 21.7%; Pxa0=xa00.029). Only 1 patient in each group had distant recurrence. There were 2 patients (7.4%) in group A and 7 (31.4%) in group B who had abdominopelvic recurrence. The risk of abdominopelvic recurrence was significantly higher in group B than in group A (odds ratio [OR], 5.47; 95% confidence interval [95% CI], 1.04–29.70; Pxa0=xa00.035). The 5-year disease-free survival (DFS) rates were 84% for group A and 55% for group B (Pxa0=xa00.028) and the 5-year abdominopelvic DFS rates were 89 and 58% (Pxa0=xa00.023), respectively. Multivariate analysis showed that tumor morcellation were significantly associated with poorer DFS (OR, 4.03; 95% CI, 1.06–15.30; Pxa0=xa00.040) and abdominopelvic DFS (OR, 5.06; 95% CI, 1.02–25.04; Pxa0=xa00.047).ConclusionsInadvertent tumor morcellation during surgery has an adverse impact on the outcomes of patients with early LGESS.

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

OBJECTIVEnTo compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer.nnnMETHODSnFrom November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone.nnnRESULTSnThere were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival.nnnCONCLUSIONnAs neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.

Vaccination with a Human Papillomavirus (HPV)-16/18 AS04-Adjuvanted Cervical Cancer Vaccine in Korean Girls Aged 10-14 Years

The human papillomavirus (HPV)-16/18 AS04-adjuvanted cervical cancer vaccine has been demonstrated to be highly efficacious and immunogenic with a favorable safety profile. This study assessed the immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine in healthy Korean girls aged 10-14 yr. This multi-center, observer-blind trial randomly assigned 321 healthy girls to receive three doses (0, 1, 6-month schedule) of HPV-16/18 AS04-adjuvanted vaccine or hepatitis A vaccine. Immunogenicity against vaccine antigens was assessed one month post-Dose 3. Solicited and unsolicited adverse events (AEs) and serious AEs (SAEs) were recorded. In the according-to-protocol analysis, all initially seronegative subjects vaccinated with the HPV-16/18 AS04-adjuvanted vaccine had seroconverted at Month 7, with a peak geometric mean titer (GMT) that was 600-fold higher than the natural infection titer of 29.8 EU/mL for HPV-16 and a peak GMT that was 400-fold higher than the natural infection titer of 22.6 EU/mL for HPV-18. The vaccine was well tolerated with no increase in reactogenicity with subsequent doses and no reports of vaccine-related SAEs. In conclusion, the HPV-16/18 AS04-adjuvanted vaccine is shown to be highly immunogenic and generally well-tolerated in Korean girls aged 10-14 yr.

Comorbidity in Disease-Free Survivors of Cervical Cancer Compared with the General Female Population

Objectives: We aimed to investigate the prevalence of comorbidities in cervical cancer survivors compared with the general population and to identify risk factors and impact on their quality of life (QoL). Methods: 860 female cervical cancer survivors enrolled at six tertiary hospitals and 994 women from the general population were surveyed on current comorbidities and QoL (EORTC QLQ-C30 and QLQ-CX24). Results: Compared with the general female population, the cervical cancer survivors reported higher prevalence of comorbidities (0.93 ± 2.91 vs. 0.37 ± 0.67, p < 0.01), significantly more heart disease (adjusted odds ratio (aOR), 2.64; 95% confidence interval (CI), 1.38–5.07), liver disease (aOR, 3.29; 95% CI, 1.54–7.02), hypertension (aOR, 1.72; 95% CI, 1.30–2.27), gastrointestinal disease (aOR, 1.79; 95% CI, 1.37–2.33) and musculoskeletal disease (aOR, 1.94; 95% CI, 1.45–2.59). Heart and renal disease significantly influenced QoL in many subscales. Patients with diabetes or cerebrovascular disease had an increased likelihood of sexual problems. Conclusions: The cervical cancer survivors had more comorbidities than the general population, and that in turn affected their QoL. Vigilant follow-up of comorbidities should be incorporated into in the care of cancer survivors.

Asian society of gynecologic oncology workshop 2010.

This workshop was held on July 31-August 1, 2010 and was organized to promote the academic environment and to enhance the communication among Asian countries prior to the 2nd biennial meeting of Australian Society of Gynaecologic Oncologists (ASGO), which will be held on November 3-5, 2011. We summarized the whole contents presented at the workshop. Regarding cervical cancer screening in Asia, particularly in low resource settings, and an update on human papillomavirus (HPV) vaccination was described for prevention and radical surgery overview, fertility sparing and less radical surgery, nerve sparing radical surgery and primary chemoradiotherapy in locally advanced cervical cancer, were discussed for management. As to surgical techniques, nerve sparing radical hysterectomy, optimal staging in early ovarian cancer, laparoscopic radical hysterectomy, one-port surgery and robotic surgery were introduced. After three topics of endometrial cancer, laparoscopic surgery versus open surgery, role of lymphadenectomy and fertility sparing treatment, there was a special additional time for clinical trials in Asia. Finally, chemotherapy including neo-adjuvant chemotherapy, optimal surgical management, and the basis of targeted therapy in ovarian cancer were presented.

Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer

Objective The objective of this study was to estimate the reproductive outcome of young women with early-stage cervical cancer who underwent fertility-sparing laparoscopic radical trachelectomy (LRT). Methods We performed a retrospective review of the medical records of patients with early-stage cervical cancer who underwent LRT. Clinicopathological data were obtained from patient medical records, and reproductive outcome data were obtained from patient medical records and telephone interviews. Results Fifty-five patients who underwent successful LRT were included in this study. The median age of patients was 32 years (range, 22 to 40 years), and the median follow-up time after LRT was 37 months (range, 3 to 105 months). Menstruation resumed in all patients after LRT, with fifty patients (90.9%) and five patients (9.1%) reporting regular and irregular menstruation, respectively. Six patients (10.9%) presented with cervical stenosis, which was manifested by regular but decreased menstrual flow and newly-developed dysmenorrhea. These patients underwent cervical cannulation and dilatation. Eighteen patients (32.7%) attempted to conceive, with six out of 18 patients receiving fertility treatments. Fourteen pregnancies (i.e., four missed abortions, six preterm births and four full-term births) occurred in 10 patients after LRT. Nine out of 10 patients gave birth to 10 healthy babies. The pregnancy rate after LRT was 55.6% (10/18). The spontaneous abortion rate and live birth rate were 28.6% (4/14) and 71.4% (10/14), respectively. The preterm birth rate was 60% (6/10). Conclusion Pregnancy and live birth rates after LRT were promising; however, the preterm birth rate was relatively high. Cervical stenosis also occurred in a small percentage of patients.

Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women: a Korean Gynecologic Oncology Group Study.

From January 1995 to December 2000, medical records of 196 patients were collected from 14 hospitals nationwide and were reviewed retrospectively. We evaluated the clinicopathologic characteristics of malignant germ cell tumors in the ovaries of South Korean women and determined the prognostic factors affecting recurrence. The mean patient age was 23.8 years (range, 4-63 years), and the median follow-up period was 67 months (range, 1-128 months). The distribution of the International Federation of Gynecology and Obstetrics stage was as follows: 128 cases (65.3%) in stage I, 27 cases (13.8%) in stage II, 39 cases (19.9%) in stage III, and 2 cases (1.0%) in stage IV. Histologically, immature teratoma was the most common tumor type (n = 68), followed by dysgerminoma (n = 54), endodermal sinus tumor (n = 38), mixed form (n = 24), and choriocarcinoma (n = 12). A fertility-sparing operation was performed in 134 patients, staging operation in 43 patients, and hysterectomy and bilateral salpingo-oophorectomy in 19 patients. Postoperative chemotherapy was administered in 166 patients, and the most common regimen was bleomycin, etoposide, and cisplatin (n = 120). Recurrence was observed in 13 patients (6.8%) and was influenced by the stage of the tumor and patient age (>40 years). The 5-year survival rate was 96.7%. During the follow-up period, 20 patients had 22 pregnancies that resulted in 17 normal deliveries at term and 5 abortions. The results of this study demonstrate that most malignant germ cell tumors of the ovary in Korean women are detected in the early stage and have excellent survival outcomes with conservative operation and platinum-based chemotherapy.

Quercetin Inhibits Pacemaker Potentials via Nitric Oxide/cGMP-Dependent Activation and TRPM7/ANO1 Channels in Cultured Interstitial Cells of Cajal from Mouse Small Intestine.

Background: Quercetin regulates gastrointestinal (GI) motor activity but the molecular mechanism involved has not been determined. The authors investigated the effects of quercetin, a flavonoid present in various foods, on the pacemaker activities of interstitial cells of Cajal (ICCs) in murine small intestine in vitro and on GI motility in vivo. Materials and Methods: Enzymatic digestion was used to dissociate ICCs from mouse small intestines. The whole-cell patch-clamp configuration was used to record pacemaker potentials in cultured ICCs in the absence or presence of quercetin and to record membrane currents of transient receptor potential melastatin (TRPM) 7 or transmembrane protein 16A (Tmem16A, anoctamin1 (ANO1)) overexpressed in human embryonic kidney (HEK) 293 cells. The in vivo effects of quercetin on GI motility were investigated by measuring the intestinal transit rates (ITRs) of Evans blue in normal mice. Results: Quercetin (100-200 μM) decreased the amplitudes and frequencies of pacemaker activity in a concentration-dependent manner in current clamp mode, but this action was blocked by naloxone (a pan-opioid receptor antagonist) and by GDPβS (a GTP-binding protein inhibitor). However, potassium channels were not involved in these inhibitory effects of quercetin. To study the quercetin signaling pathway, we examined the effects of 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), an inhibitor of guanylate cyclase, and of RP-8-CPT-cGMPS, an inhibitor of protein kinase G (PKG). These inhibitors blocked the inhibitory effects of quercetin on pacemaker activities. Also, L-NAME (100 μM), a non-selective NO synthase (NOS) inhibitor, blocked the effects of quercetin on pacemaker activity and quercetin stimulated cGMP production. Furthermore, quercetin inhibited both Ca2+-activated Cl- channels (TMEM16A, ANO1) and TRPM7 channels. In vivo, quercetin (10-100 mg/kg, p.o.) decreased ITRs in normal mice in a dose-dependent manner. Conclusions: Quercetin inhibited ICC pacemaker activities by inhibiting TRPM7 and ANO1 via opioid receptor signaling pathways in cultured murine ICCs. The study shows quercetin attenuates GI tract motility, and suggests quercetin be considered the basis for the development of novel spasmolytic agents for the prevention or alleviation of GI motility dysfunctions.

Practice guidelines for the early detection of cervical cancer in Korea: Korean Society of Gynecologic Oncology and the Korean Society for Cytopathology 2012 edition

The consensus guideline development committee of Korean Society of Gynecologic Oncology was reconvened in March 2012. The committee consisted of 36 experts representing 12 university hospitals and professional organizations. The objective of this committee was to develop standardized guidelines for cervical cancer screening tests for Korean women and to distribute these guidelines to every clinician, eventually improving the quality of medical care. Since the establishment of the consensus guideline development committee, evidence-based guidelines have either been developed de novo considering specific Korean situations or by adaptation of preexisting consensus guidelines from other countries. Recommendations for cervical cancer screening tests, management of atypical squamous and glandular cells, and management of low-grade and high-grade squamous intraepithelial lesions were developed. Additionally, recommendations for human papillomavirus DNA testing and recommendations for adolescent and pregnant women with abnormal cervical screening test results were also included.