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심승혁,이선주,김수녕 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Hormone replacement therapy (HRT) is typically withheld from endometrial cancer survivors because of concerns about risk for recurrence. This study aimed to quantify the risk of recurrent endometrial cancer associated with HRT among endometrial cancer survivors. We performed a systematic literature review through May 2013, calculating the odds ratio (OR) of endometrial cancer recurrence in each study by comparing the number of recurrences in the HRT group to those in the control group. Study design features that might affect selection of participants, detection of recurrence, and manuscript publication were assessed. When statistical heterogeneity among studies was not significant, a fixed effect model was used to estimate the combined relative risks for endometrial cancer recurrence associated with HRT. One randomized trial and five observational studies included 896 endometrial cancer survivors who used HRT and 1,079 nonusers. Over the combined study periods, 19 of 896 HRT users experienced recurrence, compared with 64 of 1,079 controls. The fixed effect model meta-analysis suggested that risk of recurrence did not significantly increase in endometrial cancer survivors using HRT compared with controls (OR, 0.53; 95% confidence interval, 0.30 to 0.96). All tests for heterogeneity were nonsignificant. Although mainly based on observational design subject to a variety of biases, existing research does not support HRT use was associated with increased risk of endometrial cancer recurrence. To confirm this association, long-term randomized controlled trials are needed.
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심승혁,김수녕,채수현,김정은,이선주 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.2
Objective: Few data exist regarding adjuvant hysterectomy (AH) in locally advanced cervical cancer (LACC) patients treated with chemoradiotherapy. We investigated the effect of AH on prognosis in LACC patients, through meta-analysis. Methods: EMBASE and MEDLINE databases and the Cochrane Library were searched for published studies comparing LACC patients who received AH after chemoradiotherapy with those who did not, through April 2016. Endpoints were mortality and recurrence rates. For pooled estimates of the effect of AH on mortality/recurrence, random- or fixed-effects meta-analytical models were used. Results: Two randomized trials and six observational studies (AH following chemoradiotherapy, 630 patients; chemoradiotherapy, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant difference in mortality between the groups (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.58–1.78; p=0.968) with low cross-study heterogeneity (p=0.73 and I2=0.0). This pattern was observed in subgroup analysis for study design, radiation type, response after chemoradiotherapy, and hysterectomy type. The pooled OR for AH and recurrence was 0.59 (95% CI=0.44–0.79; p<0.05) with low cross-study heterogeneity (p=0.29 and I2=17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials. There was no evidence of publication bias. Conclusion: In this meta-analysis, AH following chemoradiotherapy did not improve survival in patients with LACC, although it seemed to reduce the risk of recurrence. Concerning the significant morbidity of AH after chemoradiotherapy, routine use of AH should be avoided.
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심승혁,이정윤,이유영,박정열,이용재,김세익,한관희,양은정,NOH JOSEPH JOONHO,임가원,손주혁,김남경,김태현,공태욱,최윤진,조안젤라,임현지,장은비,조현웅,서동훈 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2
In the 2023 series, we summarized the major clinical research advances in gynecologiconcology based on communications at the conference of Asian Society of GynecologicOncology Review Course. The review consisted of 1) Endometrial cancer: immunecheckpoint inhibitor, antibody drug conjugates (ADCs), selective inhibitor of nuclear export,CDK4/6 inhibitors WEE1 inhibitor, poly (ADP-ribose) polymerase (PARP) inhibitors. 2)Cer vical cancer: surger y in low-risk early-stage cer vical cancer, therapy for locally advancedstage and advanced, metastatic, or recurrent setting; and 3) Ovarian cancer: immunotherapy,triplet therapies using immune checkpoint inhibitors along with antiangiogenic agents andPARP inhibitors, and ADCs. In 2023, the field of endometrial cancer treatment witnesseda landmark year, marked by several practice-changing outcomes with immune checkpointinhibitors and the reliable efficacy of PARP inhibitors and ADCs.
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심승혁,김형수,손인숙,황한성,권한성,이선주,이지영,김수녕,이건세,장성훈 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5
Objective: The rates of participation in the Korean nationwide cervical cancer screeningprogram and the rates of abnormal test results were determined. Methods: The database of the National Health Insurance Service (NHIS) was used during thestudy period (2009–2014). Results: The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annualpercentage change, 4.126%; 95% confidence interval [CI]=2.253–6.034). During the studyperiod, women ≥70 years of age had the lowest rate of participation (range, 21.7%–31.9%) andthose 30–39 years of age the second-lowest (27.7%–44.9%). The participation rates of NationalHealth Insurance beneficiaries (range, 48.6%–52.5%) were higher than those of MedicalAid Program (MAP) recipients (29.6%–33.2%). The rates of abnormal results were 0.65% in2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest(30–39 years). Every year the abnormal result rates tended to decrease with age, from the agegroups of 30–39 years to 60–69 years but increased in women ≥70 years of age. The ratio ofpatients with atypical squamous cells of undetermined significance compared with those withsquamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. Conclusion: Differences related to age and occurring over time were found in the rates ofparticipation and abnormal results. Further efforts are needed to encourage participation incervical cancer screening, especially for MAP recipients, elderly women and women 30–39years of age. Quality control measures for cervical cancer screening programs should beenforced consistently.
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심승혁 ( Seung-hyuk Shim ),( Dae-yeon Kim ),( Sun Joo Lee ),( Soo-nyung Kim ),( Soon-beom Kang ),( Shin-wha Lee ),( Jeong-yeol Park ),( Dae-shik Suh ),( Jong-hyeok Kim ),( Yong-man Kim ),( Young-tak Kim 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective Concurrent chemoradiotherapy is usually administered to patients with locally advanced cervical cancer (LACC). Extended-field chemoradiotherapy is required if para-aortic lymph node (PALN) metastasis is detected. This study aimed to construct a predictionmodel for PALNmetastasis in patients with LACC before definitive treatment. Methods Between 2009 and 2016, all consecutive patients with LACC who underwent para-aortic lymphadenectomy at two tertiary centers were retrospectively analyzed. A multivariate logistic model was constructed, from which a prediction model for PALN metastasis was developed and internally validated. Before analysis, risk grouping was predefined based on the likelihood ratio. Results In total, 245 patients satisfied the eligibility criteria. Thirty-four patients (13.9%) had pathologically proven PALN metastases. Additionally, 16/222 (7.2%) patientswith negative PALNs on positron emission tomography/computed tomography (PET/CT) had PALNmetastasis. Moreover, 11/105 (10.5%) patients with both negative PALNs and positive pelvic lymph nodes on PET/CT had PALN metastasis. Tumor size on magnetic resonance imaging and PALN status on PET/CT were independent predictors of PALN metastasis. The model incorporating these two predictors displayed good discrimination and calibration (bootstrap-corrected concordance index = 0.886; 95% confidence interval = 0.825-0.947). The model categorized 169 (69%), 52 (22%), and 23 (9%) patients into low-, intermediate-, and high-risk groups, respectively. The predicted probabilities of PALN metastasis for these groups were 2.9, 20.8, and 76.2%, respectively. Conclusion We constructed a robust model predicting PALN metastasis in patients with LACC that may improve clinical trial design and help clinicians determine whether nodal-staging surgery should be performed.
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이광범, 심승혁,이종민 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.4
OBJECTIVE: To estimate the effect of adjuvant chemotherapy (AC) on the prognosis in cervical cancer patients with intermediate- or high-risk factors after radical hysterectomy (RH) compared to that for adjuvant radiotherapy (AR). METHODS: The Embase and MEDLINE databases and the Cochrane Library were searched for published studies comparing cervical cancer patients who received AC with those who received AR after RH. The endpoints were patient oncologic outcome. Random-effects meta-analytical models were used to calculate the pooled estimates of the effect of AC on mortality/recurrence. RESULTS: Two randomized trials and eleven observational studies (AC, 942 patients; AR, 1,721 patients) met our search criteria. There were no significant differences in mortality and any recurrence between two groups. The results for distant recurrence favored the AC group (pooled odds ratio: 0.69; 95% confidence interval: 0.54–0.88; p=0.03). In subgroup analyses (for study design, histology, indication for adjuvant treatment, AR type, AC type, and lymph node metastasis), there was no significant increase in mortality and recurrence for AC compared with that for AR. CONCLUSION: Compared to AR, AC showed similar survival outcomes in cervical cancer patients undergoing RH and also appeared to reduce the risk of distant recurrence.
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장하균,심승혁 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.2
The sociomedical environment is changing. In the traditional physician-patient relationship, the physician was authoritative and the patient was obedient. The contractual relationship featured patient consent to the physician’s decision. Today, the physician must explain fully the planned medical treatment, and any alternative, to the patient, who has the right to choose her treatment after considering the benefits and side-effects. The Korean Society of Gynecologic Oncology (KSGO) thus decided to standardize the surgical consent forms to meet the legal requirements of modern medicine, improve patient understanding of the surgical details, and protect medical staff from legal disputes. To determine the format and content, subcommittees for each cancer type collected and reviewed all relevant articles and the current consent forms of domestic medical institutions. After several meetings, 16 basic items to be included for each type of gynecologic cancer were selected. Also, to help patients understand the surgical details, figures were included. The revised forms were legally reviewed in terms of the appropriateness of the format and content. We also developed English versions to provide adequate information for foreign patients. We hope that these efforts will promote trust between patients and physicians, and contribute to effective treatment by laying a foundation of mutual respect.
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