Ryo Onose

Antiendometrial autoantibodies are generated in patients with endometriosis

PROBLEM: Our aim was to investigate endometrial antigens involved in the autoimmunity of endometriosis.

Analysis of stage IVB endometrial carcinoma patients with distant metastasis: a review of prognoses in 55 patients

BackgroundAdequate treatment for extremely advanced endometrial cancer is unknown. The purpose of this study was to clarify the prognosis of patients with stage IVB endometrial carcinoma and the validity of treatment. Furthermore, we evaluated whether there was a connection between the prognosis and the site of metastasis.MethodsThe prognoses of 55 patients with stage IVB endometrial carcinoma were studied with reference to the initial treatment method and the metastatic site at the time of the initial treatment.ResultsThe median survivals of the group of 35 patients who were initially treated with surgery and the group of 10 patients who underwent radiotherapy or chemotherapy as their initial treatment followed by surgery were 11.5 months and 9.5 months, respectively. The residual tumor diameter after surgery was precisely measured in 40 of these 45 patients. The prognosis was significantly better in the patients with a residual tumor diameter of less than 2 cm compared to those with a tumor diameter of 2 cm or greater, and the median survival periods in these two groups were 23.5 months and 11.5 months, respectively (P = 0.027). Furthermore, the prognosis of patients with lung metastasis was significantly better than that of patients with non-lung hematogenous metastasis; the median survival periods of these two groups were 18.5 months and 10.5 months, respectively (P = 0.014).ConclusionFor operable patients, surgery as an initial treatment and reduction of the residual tumor size to less than 2 cm appeared to contribute to a better prognosis. In addition, conservative initial treatment and the presence of non-lung hematogenous metastasis were poor prognostic factors.

Post‐traumatic stress disorder in patients with gynecologic cancers

We present three cases of post‐traumatic stress disorder (PTSD) that occurred in patients with gynecologic cancers. Case 1 and 2 had ovarian cancer and case 3 had endometrial cancer. The patients developed anxiety, difficulty in sleeping, and complaints of various discomforts after their diagnosis. On consulting with psychiatrists, PTSD was diagnosed based upon the DSM‐IV classification. In cases 1 and 2, the symptoms worsened during the patients’ primary treatment and interfered with their ability to continue the treatment. Psychiatric interventions were provided making it possible to complete their treatment. In case 3, the patient needed psychiatric intervention because of her psychological distress during her treatment. She was finally diagnosed as having PTSD. There are few reports regarding PTSD occurring in gynecologic cancer patients. However, attention should be given to the symptoms of these disorders so that patients may complete their standard therapies.

A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy

OBJECTIVE This study aimed to validate the preoperative scoring system adopted in the Kanagawa Cancer Center (KCC) to stratify endometrial cancer patients for lymphadenectomy according to the risk of developing lymph node metastasis (LNM). METHODS The records of 432 and 221 uterine cancer patients treated in the KCC and Yokohama City University (YCU), respectively, were retrospectively analyzed. The KCC classified patients for LNM risk based on tumor volume, myometrial invasion, histological grade, and serum CA125 levels, while YCU used only myometrial invasion. Lymphadenectomy was omitted for 156 patients with 0 LNM risk, while pelvic lymphadenectomy (PLX) or PLX with para-aortic lymphadenectomy (PLAX) were performed for those with low and high LNM risk, respectively. The predicted and actual LNM rates were compared between the KCC and YCU patients, and cancer recurrence and overall survival were analyzed. RESULTS There was no difference in survival between patients with LNM score 0 who were or were not treated with lymphadenectomy. None (0%) developed LNM and only 1 (0.6%) had recurrence. Patients who underwent PLX but not PLAX (low LNM score) had a low tumor recurrence rate in the para-aortic nodes (1.3%). The KCC scoring system was significantly more accurate than the YCU system in predicting LNM in the high-risk group (P<0.05) and demonstrated that PLAX was unnecessary in almost 50% of the YCU cases. CONCLUSION The KCC preoperative scoring system is useful to predict LNM risk, and thereby prevent unnecessary lymphadenectomy or to determine its extent in endometrial cancer patients.

Historical control study of paclitaxel–carboplatin (TJ) versus conventional platinum-based chemotherapy (CAP) for epithelial ovarian cancer

BackgroundAs the first-line chemotherapy for epithelial ovarian cancer, the paclitaxel–carboplatin (TJ) regimen has replaced the cyclophosphamide, epirubicin, and cisplatin or carboplatin (CAP) regimen in our institutes since 1998. Both regimens were retrospectively compared for effectiveness and safety to verify the adequacy of the TJ regimen.MethodsWomen with epithelial ovarian cancer at FIGO stage Ic – IV were enrolled into the study and were assigned to either the CAP group (57 cases, from 1991 until 1998) or the TJ group (49 cases, from 1998 until 2002). The response rate, progression-free survival (PFS), and overall survival (OS) were compared in both groups. Adverse effects were also evaluated.ResultsThe TJ group received an average of 6.3 courses of paclitaxel at 170.6 mg/m2 and carboplatin with an AUC of 4.3, while the CAP group received 5.8 courses of cisplatin at 61.4 mg/m2. The response rates were 82.8% in the TJ group and 70.6% in the CAP group at stage III–IV. The median OS was 43.9 months in the TJ group and 44.3 months in the CAP group. There was no statistically significant difference in effectiveness between the two groups. Peripheral neuropathy, myalgia/arthralgia, and allergic reactions were found significantly more often in the TJ group, but every adverse effect occurring in the TJ group was clinically controllable. In contrast, renal dysfunction occurred more frequently in the CAP group.ConclusionThis study demonstrated that the TJ regimen is as effective as the CAP regimen in its antitumor effect for epithelial ovarian cancer, and has controllable adverse effects.

Endometrial aspiration cytology for diagnosis of peritoneal lesions in extrauterine malignancies.

OBJECTIVE To evaluate the usefulness of endometrial aspiration cytology for assessing malignant cells of extrauterine origin. STUDY DESIGN Endometrial cytology was performed on 224 patients with primary ovarian cancer, 10 with fallopian tube cancer and 45 with peritoneal tumors. RESULTS Of 224 patients with ovarian cancer, 53 (23.7%) had positive endometrial cytology. Positive rates were: stage I, 4.3%; stage II, 25.0%; stage III, 39.7%; stage IV, 34.5%. Histologic positive rates were: serous, 28.7%; mucinous, 11.4%; clear cell, 23.1%; endometrioid and unclassifiable adenocarcinomas, 28.0%. Of 5 patients with ovarian cancer, 2 were asymptomatic, but aspiration cytology was positive. Of 10 patients with fallopian tube cancer, 9 (90.0%) had positive endometrial cytology. The positive rate on endometrial cytology was 56.7% in stomach cancer, 60.0% in breast cancer and 20.0% in colon cancer. Of 1,209 women with stomach cancer, 30 (2.4%) displayed ovarian metastasis. Of these, 7 (23.3%) had Krukenbergs tumor; endometrial cytology was positive in 1 (14.3%). In 7 of 17 patients with positive endometrial cytology, clinical diagnosis was made before stomach cancer therapy. CONCLUSION Endometrial aspiration cytology is useful for identifying nongynecologic malignant cells, diagnosing ovarian and fallopian tube cancers, and determining peritoneal dissemination and metastasis originating from gastrointestinal and breast cancers.

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer

Objective Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS. Methods In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS. Results NAC-treated patients had stage III–IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p<0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p<0.001). Conclusion PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

Serum CA 125 Level after Neoadjuvant Chemotherapy is Predictive of Prognosis and Debulking Surgery Outcomes in Advanced Epithelial Ovarian Cancer

Recently, neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) has been recommended for selected patients with International Federation of Gynecology and Obstetrics (FIGO) stage III or IV disease and bulky tumors. The aim of this study was to evaluate associations between post-NACT serum CA 125 levels, surgical outcomes, and clinical outcomes in patients with advanced epithelial ovarian cancer. We retrospectively analyzed 107 patients with FIGO stage III or IV ovarian cancer who were treated with NACT-IDS at the Gynecology Department of Kanagawa Cancer Center between January 2001 and December 2012. Serum CA 125 levels after NACT were significantly lower in the complete/optimal IDS group compared to the suboptimal IDS group (mean±standard deviation: 48.1±27.6 vs. 346.5±295.2 U/mL, p<0.01). Patients with low preoperative CA 125 levels (<35 U/mL) had a higher probability of optimal IDS (78.1±41.9% vs. 33.3±19.2%, p<0.01) and longer progression-free survival (mean±standard deviation: 30.4±14.3 months vs. 21.3±7.3 months, p<0.05) than patients with high CA 125 levels (>100 U/mL). Patients with low CA 125 levels (<35 U/mL) had a higher probability of complete/optimal IDS and longer progression-free survival compared to patients with high CA 125 levels (>100 U/mL).

Clinicopathological study on adenoma malignum of the uterine cervix

目的:子宮頸部悪性腺腫症例の診断の問題点と臨床的取り扱いを検討した.方法:神奈川県立がんセンターで過去に悪性腺腫と診断した症例を津田らが提唱した定義に準じて臨床病理学的に再検討した.成績:過去に悪性腺腫と診断した6例を病理学的に再検討すると, 今回, 定義で悪性腺腫と診断できる症例は1例だけであり, 同時期に取り扱った子宮頸癌の0.1%に相当した. 悪性腺腫を疑った症例では診断的円錐切除術では全病巣が必ずしも評価できていなかった. また, 細胞診所見では一定の傾向を認めることはできなかった.結論:悪性腺腫の診断には診断的円錐切除術の併用が望ましい. その頻度は非常に少ないと思われるので病態の解明には多施設共同研究が望まれる.