Impact of incomplete surgery and adjuvant chemotherapy for the intraoperative rupture of capsulated stage I epithelial ovarian cancer: a multi-institutional study with an in- depth subgroup analysis

Masato Yoshihara,Satoshi Tamauchi,Shohei Iyoshi,Kazuhisa Kitami,Kaname Uno,Kazumasa Mogi,Hiroaki Kajiyama 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.5

Objective: The aim of the present study was to examine the effects of incomplete surgery and adjuvant chemotherapy on the prognosis of patients with intraoperative rupture of capsulated stage I epithelial ovarian cancer (OvCa). Methods: A regional retrospective study was conducted between 1986 and 2019. Among 4,730 patients with malignant ovarian tumors, 534 women with International Federation of Gynecology and Obstetrics stage IA and IC1 epithelial OvCa were eligible. Differences in survival outcomes were examined between patients with stage IA and IC1 tumors and the effects of uterine preservation, complete-staging lymphadenectomy, and adjuvant chemotherapy were investigated by an in-depth subgroup analysis. To analyze therapeutic effects, baseline imbalances were adjusted using propensity score (PS). Results: The prognosis of patients with stage IC1 tumors was worse than those with stage IA. Surgical spill did not affect the site of recurrence. In the PS-adjusted subgroup analysis, uterine preservation (hazard ratio [HR]=1.669; 95% confidence interval [CI]=1.052–2.744), incomplete-staging lymphadenectomy (HR=1.689; 95% CI=1.211–2.355), and the omission of adjuvant chemotherapy (HR=3.729; 95% CI=2.090–6.653) significantly increased the HR of recurrence for patients with stage IC1 tumors compared to those with stage IA tumors. Adjuvant chemotherapy decreased the impact of rupture with uterine preservation (HR=0.159; 95% CI=0.230–1.168) or incomplete-staging lymphadenectomy (HR=0.987; 95% CI=0.638–1.527). Conclusion: The present results suggest intraoperative rupture of capsulated stage I epithelial OvCa is associated with a poor prognosis. When chemotherapy is given for patients receiving incomplete surgery, there is no longer an increased risk of recurrence observed with the rupture.

Prognostic factors and effects of fertility-sparing surgery in women of reproductive age with ovarian clear-cell carcinoma: a propensity score analysis

Masato Yoshihara,Hiroaki Kajiyama,Satoshi Tamauchi,Shiro Suzuki,Kunihiko Takahashi,Shigeyuki Matsui,Fumitaka Kikkawa 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6

Objective: The aim of this study was to investigate the clinical characteristics of youngpatients with stage I clear-cell carcinoma (CCC) and evaluate the prognostic factors andeffects of fertility-sparing surgery (FSS) using propensity score (PS) adjustment. Methods: We conducted a regional multi-institutional study between 1986 and 2017. Among4,277 patients with ovarian tumor, clinical and pathological data of 103 fertile women withstage I unilateral CCC were collected. We evaluated survival and reproductive outcomesin these patients. Additionally, to analyze the effects of FSS, baseline imbalance betweenpatients with and those without FSS was adjusted with an inverse probability of treatmentweighting using PSs involving independent clinical variables. Results: The mean patient age was 39.4 years, and the median follow-up period for survivingpatients was 55.6 months. In multivariate analysis, stage IC2/IC3 (vs. IA/IC1) was the onlyindependent prognostic factor for recurrence-free survival (RFS) and overall survival (OS). FSS was not associated with poorer prognosis when compared to the prognosis with nonpreservingsurgery with regard to both RFS and OS. No statistical difference in survivaloutcomes between FSS and other approaches was confirmed after PS adjustment. Amongpatients who underwent FSS, four deliveries with healthy neonates were noted without anygestational complications. Conclusion: FSS can be considered in stage I CCC, specifically in stage IA and IC1 patientswho strongly desire to have children in the future. Further clinical research is needed toclarify the optimal application of FSS for CCC.

Survival benefits of retroperitoneal lymphadenectomy for optimally- resected advanced ovarian high-grade serous carcinoma: a multi-institutional retrospective study

Yoshiki Ikeda,Masato Yoshihara,Satoshi Tamauchi,Akira Yokoi,Nobuhisa Yoshikawa,Hiroaki Kajiyama 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.4

Objective: The survival benefits of retroperitoneal lymphadenectomy (RLNA) for epithelial ovarian cancer (EOC) remain controversial because clinical behaviors differ among subtypes. The purpose of the present study was to clarify whether RLNA increases the survival rate of advanced high-grade serous carcinoma (HGSC). Methods: This was a retrospective cohort analysis of 3,227 patients with EOC treated between 1986 and 2017 at 14 institutions. Among them, 335 patients with stage IIB-IV HGSC who underwent optimal cytoreduction (residual tumor of <1 cm) were included. Patients were divided into the RLNA group (n=170) and non-RLNA group (n=165). All pathological slides were assessed based on a central pathological review. Oncologic outcomes were compared between the two groups in the original and weighted cohorts adjusted with the inverse probability of treatment weighting. Results: The median observation period was 49.8 (0.5–241.5) months. Overall, 219 (65%) out of 335 patients had recurrence or progression, while 146 (44%) died of the disease. In the original cohort, RLNA was a significant prognostic factor for longer progression-free survival (PFS) (hazard ratio [HR]=0.741; 95% confidence interval [CI]=0.558–0.985) and overall survival (OS) (HR=0.652; 95% CI=0.459–0.927). In the weighted cohort in which all variables were well balanced as standardized differences decreased, RLNA was also a significant prognostic factor for more favorable oncologic outcomes (PFS, adjusted HR=0.742; 95% CI=0.613–0.899) and OS, adjusted HR=0.620; 95% CI=0.488–0.787). Conclusion: The present study demonstrated that RLNA for stage III-IV HGSC with no residual tumor after primary debulking surgery contributed to better oncologic outcomes.

Structural Design and Performance Evaluation of a Mid-story Seismic Isolated High-Rise Building

Tamari, Masatoshi,Yoshihara, Tadashi,Miyashita, Masato,Ariyama, Nobuyuki,Nonoyama, Masataka Council on Tall Building and Urban Habitat Korea 2017 International journal of high-rise buildings Vol.6 No.3

This paper describes some of the challenges for structural design of a mid-story seismic isolated high-rise building, which is located near Tokyo station, completed in 2015. The building is a mixed-use complex and encompasses three volumes: one substructure including basement and lower floors, and a pair of seismic isolated superstructures on the substructure. One is a 136.5m high Main Tower (office use), and the other is a 98.5 m high South Tower (hotel use). The seismic isolation systems are arranged in the $3^{rd}$ floor of the Main Tower and $5^{th}$ floor of the South Tower, so that we call this isolation system as the mid-story seismic isolation. The primary goal of the structural design of this building was to secure high seismic safety against the largest earthquake expected in Tokyo. We adopted optimal seismic isolation equipment simulated by dynamic analysis to minimize building damage. On the other hand, wind-induced vibration of a seismic isolated high-rise building tends to be excited. To reduce the vibration, the following strategies were adopted respectively. In the Main Tower with a large wind receiving area, we adopted a mechanism that locks oil dampers at the isolation level during strong wind. In the South Tower, two tuned mass dampers (TMDs) are installed at the top of the building to control the vibration. In addition, our paper will also report the building performance evaluated for wind and seismic observation after completion of the building. In 2016, an earthquake of seismic intensity 3 (JMA scale) occurred twice in Tokyo. The acceleration reduction rate of the seismic isolation level due to these earthquakes was approximately 30 to 60%. These are also verified by dynamic analysis using observed acceleration data. Also, in April 2016, a strong wind exceeding the speed of 25m/s occurred in Tokyo. On the basis of the record at the strong wind, we confirmed that the locking mechanism of oil damper worked as designed.