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RISS 인기검색어
- 검색키워드
- 저자 : Satoshi KAJIYAMA (검색결과 5 건)
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Hiroaki Kajiyama,Shiro Suzuki,Nobuhisa Yoshikawa,Satoshi Tamauchi,Kiyosumi Shibata,Fumitaka Kikkawa 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4
Objective: The impact of systematic retroperitoneal lymphadenectomy (SRL) remainscontroversial in patients with advanced ovarian clear-cell carcinoma (CCC) who areoptimally debulked. Methods: Between 1986 and 2017, a total of 3,227 women with epithelial ovarian carcinomawere analyzed in a multi-institutional study. Among them, 166 optimally debulked womenwith stage IIB–IV CCC were collected (residual tumor of <1 cm). All patients were divided into2 groups: 1) Group I (n=112): underwent standard radical surgery with SRL, 2) Group II (n=54):underwent non-staging limited surgery. The pathological slides were assessed based on centralpathological review. Oncologic outcomes were compared between the two groups using apropensity score (PS)-matching technique to adjust for various clinicopathologic factors. Results: The median follow-up duration of all surviving women was 52.8 (1.6–184.2) months. Overall, 88 patients (53.0%) experienced recurrence and 68 patients (41.0%) died of thedisease. In the original cohort, the 5-year overall survival (OS) rates of groups I and II were57.9 and 64.9%, respectively (log-rank p=0.415). In the PS-adjusted cohort, the 5-year OSrates were 64.9 and 58.8% in women in groups I and II, respectively (p=0.453). Furthermore,in the PS-matched cohort after adjustment for multiple clinicopathologic factors, there wasno significant difference in OS between the 2 groups (group I vs. group II; hazard ratio=1.170;95% confidence interval=0.633–2.187; p=0.615). Conclusions: This study suggests that the performance of SRL including radical surgery maynot lead to a significant improvement in the oncologic outcome of advanced CCC patientswith optimal cytoreduction.
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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.
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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.
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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.
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