Clinical statistics of gynecologic cancers in Japan

Wataru Yamagami,Satoru Nagase,Fumiaki Takahashi,Kazuhiko Ino,Toru Hachisuga,Daisuke Aoki,Hidetaka Katabuchi 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.2

Cervical, endometrial, and ovarian cancers, have both high morbidity and mortality among the gynecologic malignant tumors in Japan. The present study was conducted using both the population-based cancer registry and the gynecologic cancer registry to elucidate the characteristics of gynecologic malignant tumors in Japan. Based on nationwide estimates from the population-based cancer registry in Japan, the morbidities and mortality of cervical, endometrial, and ovarian cancers were obtained and used for analysis. Clinicopathologic factors for cervical cancer, endometrial cancer, ovarian cancer, including age, clinical stage, postsurgical stage, histological type, therapeutic strategy, and prognosis were retrieved from the gynecologic cancer registry published by the Japan Society of Obstetrics and Gynecology and used for analysis. The morbidities of cervical, endometrial, and ovarian cancers were 10,908, 13,606, and 9,384 women in 2012, respectively. The prevalence of endometrial cancer has significantly and consistently been increasing and represents the most common gynecologic malignant tumor in Japan. The mortalities of cervical, endometrial, and ovarian cancers were 2.1, 1.3, and 3.2 per 100,000 in 2012, respectively. In 2014, 52.2% of cervical cancer patients were classified as stage I, 22.5% as stage II, 10.2% as stage III, and 11.2% as stage IV. In addition, 71.9% of endometrial cancer patients were classified as stage I, 6.0% as stage II, 13.3% as stage III, and 7.5% as stage IV. Finally, 43.2% of ovarian cancer patients were classified as stage I, 9.1% as stage II, 27.6% as stage III, and 7.2% as stage IV. Twelve point five percent of ovarian cancer patients received neoadjuvant chemotherapy.

Japan Society of Gynecologic Oncology 2018 guidelines for treatment of uterine body neoplasms

Wataru Yamagami,Mikio Mikami,Satoru Nagase,Tsutomu Tabata,Yoichi Kobayashi,Masanori Kaneuchi,Hiroaki Kobayashi,Hidekazu Yamada,Kiyoshi Hasegawa,Hiroyuki Fujiwara,Hidetaka Katabuchi,Daisuke Aoki 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.1

The Fourth Edition of the Guidelines for Treatment of Uterine Body Neoplasm was published in 2018. These guidelines include 9 chapters: 1. Overview of the guidelines, 2. Initial treatment for endometrial cancer, 3. Postoperative adjuvant therapy for endometrial cancer, 4. Post-treatment surveillance for endometrial cancer, 5. Treatment for advanced or recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment of uterine carcinosarcoma and uterine sarcoma, 8. Treatment of trophoblastic disease, 9. Document collection; and nine algorithms: 1-3. Initial treatment of endometrial cancer, 4. Postoperative adjuvant treatment for endometrial cancer, 5. Treatment of recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment for uterine carcinosarcoma, 8. Treatment for uterine sarcoma, 9. Treatment for choriocarcinoma. Each chapter includes overviews and clinical questions, and recommendations, objectives, explanation, and references are provided for each clinical question. This revision has no major changes compared to the 3rd edition, but does have some differences: 1) an explanation of the recommendation decision process and conflict of interest considerations have been added in the overview, 2) nurses, pharmacists and patients participated in creation of the guidelines, in addition to physicians, 3) the approach to evidence collection is listed at the end of the guidelines, and 4) for clinical questions that lack evidence or clinical validation, the opinion of the Guidelines Committee is given as a “Recommendations for tomorrow”.

Is repeated high-dose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility?

Wataru Yamagami,Nobuyuki Susumu,Takeshi Makabe,Kensuke Sakai,Hiroyuki Nomura,Fumio Kataoka,Akira Hirasawa,Kouji Banno,Daisuke Aoki 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.2

Objective: Reports on the repeated administration of medroxyprogesterone acetate (MPA) for intrauterine recurrence after fertility-preserving therapy for atypical endometrial hyperplasia (AEH) and early grade 1 endometrioid carcinoma (G1) are lacking. We aimed to clarify the outcomes of repeated MPA therapy in cases of intrauterine recurrence after fertility-preserving therapy with MPA against AEH/early G1. Methods: Patients with AEH or stage IA well-differentiated endometrioid carcinoma without myometrial invasion who underwent first-line MPA therapy for primary lesions or intrauterine recurrence were divided into initial treatment and repeated treatment groups (162 and 82 patients, respectively). Oral MPA administration (400−600 mg/day) was continued until pathological tumor disappearance. Data regarding clinicopathological factors, adverse events, and outcomes following the initial and repeated hormonal treatments were extracted from medical records and analyzed. Results: Complete response rates in the initial and repeated treatment groups were 98.5% and 96.4%, respectively, among patients with AEH, and were 90.7% and 98.1%, respectively, among patients with G1. In the initial treatment group, 5-year recurrence-free survival (RFS) rates were 53.7% and 33.2% among patients with AEH and G1, respectively. In the repeated treatment group, RFS rates were 14.0% and 11.2% among patients with AEH and G1, respectively. Among patients with AEH, the pregnancy rate tended to be lower in the repeated treatment group than in the initial treatment group (11.1% vs. 29.2%; p=0.107), while no significant group difference was observed among patients with G1 (20.8% vs. 22.7%). Conclusion: Repeated treatment is sufficiently effective for intrauterine recurrence after hormonal therapy for AEH/early G1.

A retrospective study for investigating the relationship between old and new staging systems with prognosis in ovarian cancer using gynecologic cancer registry of Japan Society of Obstetrics and Gynecology (JSOG): disparity between serous carcinoma and c

Wataru Yamagami,Satoru Nagase,Fumiaki Takahashi,Kazuhiko Ino,Toru Hachisuga,Mikio Mikami,Takayuki Enomoto,Hidetaka Katabuchi,Daisuke Aoki 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4

Objective: International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian,fallopian tube, and peritoneal cancers was revised in 2014. The aim of this study is to clarifywhether the revised FIGO2014 staging reflects the prognosis of patients with ovarian cancerby histological type in Japan. Methods: We extracted 9,747 patients who were diagnosed with ovarian cancer since 2004until 2008 and who could be classified into appropriate stages from the Gynecologic CancerRegistry of Japan Society of Obstetrics and Gynecology. These cases were analyzed afterrevision to FIGO2014 based on the pTNM classification. Results: Among stage I, the 5-year overall survival rate (5y-OS) in FIGO2014 was 94.9% instage IA, 92.3% in stage IC1, 86.1% in IC2, and 84.9% in IC3 with significant differencesbetween stages IA and IC1 (p=0.012), IC1 and IC2 (p<0.001). There was a significantdifference between stages IA and IC1 in clear cell and mucinous carcinoma but not in serousand endometrioid carcinoma. Among stage III, the 5y-OS was 75.6% in stage IIIA1, 68.9% inIIIA2, 58.6% in IIIB, and 44.4% in IIIC, with significant differences between stages IIIA2 andIIIB (p=0.009), IIIB and IIIC (p<0.001). Among stage IV, the 5y-OS was 43.1% in stage IVA*and 32.1% in IVB with a significant difference (p=0.002). Conclusion: The results suggest that changes in classification for stage III and stage IVare appropriate, but the subclassification for stage IC might be too detailed. There was adiscrepancy of prognosis by histological type between stage IA and IC1.

Impact of lymphadenectomy on the treatment of endometrial cancer using data from the JSOG cancer registry

( Keiko Saotome ),( Wataru Yamagami ),( Hiroko Machida ),( Yasuhiko Ebina ),( Yoichi Kobayashi ),( Tsutomu Tabata ),( Masanori Kaneuchi ),( Satoru Nagase ),( Takayuki Enomoto ),( Daisuke Aoki ),( Miki 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.1

Objective Regional lymph node (LN) dissection is a standard surgical procedure for endometrial cancer, but there is currently no clear consensus on its therapeutic significance. We aimed to determine the impact of regional LN dissection on the outcome of endometrial cancer. Methods Study subjects comprised 36,813 patients who were registered in the gynecological tumor registry of the Japan Society of Obstetrics and Gynecology, had undergone initial surgery for endometrial cancer between 2004 and 2011, and whose clinicopathological factors and prognosis were appropriate for our investigation. The following clinicopathological factors were obtained from the registry: age, surgical stage classification, Union for International Cancer Control tumor, node, metastasis classification, histological type, histological differentiation, presence or absence of LN dissection, and postoperative treatment. We retrospectively analyzed the clinicopathological factors and therapeutic outcomes for patients with endometrial cancer. Results Analysis of all subjects showed that the group that underwent LN dissection had a significantly better overall survival than the group that did not undergo dissection. Analysis based on stage showed similar results across groups, except for stage Ia. Analysis based on stage and histological type showed similar results across groups, except for stage Ia endometrial carcinoma G1 or Ia G2. Multivariate analysis of prognostic factors indicated that LN dissection is an independent prognostic factor and that it has a greater impact on prognosis than adjuvant chemotherapy. Conclusion Despite the limitations of a retrospective study with some biases, the results suggest that LN dissection in endometrial cancer has a prognostic effect.

Trends and characteristics of fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer in Japan: a survey by the Gynecologic Oncology Committee of the Japan Society of Obstetrics and Gynecology

Kimio Ushijima,Naotake Tsuda,Wataru Yamagami,Akira Mitsuhashi,Mikio Mikami,Nobuo Yaegashi,Takayuki Enomoto 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.3

Objective: The objective of this study was to examine the current trends in fertility-sparing (FS) treatment for young atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients in Japan. Methods: This study was conducted by the Committee on Gynecologic Oncology of the Japan Society of Obstetrics and Gynecology (JSOG) in the 2017–2018 fiscal year. A nationwide, retrospective questionnaire-style survey—as performed. We collected the data of 413 patients from 102 JSOG gynecological cancer registered institutions. Results: FS treatment was performed with medroxyprogesterone (MPA) (87.2%) or MPA + metformin (11.6%). Pathological complete remission (CR) after initial treatment was achieved in 78.2% of patients. The significant clinicopathological factors correlated to CR after initial treatment were histology (AEH vs. endometrioid carcinoma grade 1 [ECG1]), body mass index (BMI) (<25 vs. ≥25 kg/m2), and treatment period (<6 vs. ≥6 months). ECG1, time to complete remission (TTCR) ≥6 months, maintenance therapy (−), and pregnancy (−) were associated with a significantly higher risk of recurrence on multivariate analysis. The total pregnancy rate was 47%, and the live birth rate was 40.1%. Patients who received infertility treatments showed a higher live birth rate (50.6%) than those who did not (7.7%). Conclusion: In this survey, we confirmed that FS treatment in Japan is centered on MPA alone and in combination with metformin, and that the treatment efficacy is similar to that reported in previous reports. A multicenter survey study in Japan showed FS treatment for young AEH and EC patients in compliance with the indications is feasible.

Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology

Mikio Mikami,Satoru Nagase,Wataru Yamagami,Kimio Ushijma,Hironori Tashiro,Hidetaka Katabuchi 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4

Objective: Recent evidence has supported the concept that epithelial ovarian cancer (EOC)arises from the cells of the fallopian tube or endometrium. This study investigated currentpractice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS)during gynecological surgery for benign disease for Ovarian Cancer Prevention. Methods: We mailed a questionnaire to 767 hospitals and clinics, comprising 628 accreditedtraining institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Societyof Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopyand Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOEcertifiedlicensed gynecologic laparoscopist. Results: Among the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%)that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88(19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It wasfound that awareness and performance of OBS largely depended on the JSGO and/or JSGOEaccreditation status. OBS was only performed at 54.0% of responding institutions and just6.8% of the institutions were willing to participate in randomized controlled trials to validatethis method for reducing the incidence of ovarian cancer. Conclusion: The JSOG Gynecologic Tumor Committee will announce its opinion onsalpingectomy for ovarian cancer prevention to all JSOG members and will develop a systemfor monitoring the number of OBS procedures in Japan.

Impact of adjuvant chemotherapy on the overall survival of patients with resectable bulky small cell neuroendocrine cervical cancer: a JSGO-JSOG joint study

Manabu Seino,Satoru Nagase,Tsuyoshi Ohta,Wataru Yamagami,Yasuhiko Ebina,Yoichi Kobayashi,Tsutomu Tabata,Masanori Kaneuchi,Takayuki Enomoto,Mikio Mikami 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.1

Objective: The aim of this study was to review the clinicopathological characteristics of small cell neuroendocrine cervical cancer (SCNEC) and to identify the optimal treatment. Methods: The Japanese Society of Gynecologic Oncology conducted a retrospective cohort study of SCNECs enrolled in the Gynecological Tumor Registry of the Japan Society of Obstetrics and Gynecology between 2004 and 2015. All cases were modified and unified by International Federation of Gynecology and Obstetrics 2008 (Union for International Cancer Control 7th edition). Results: There were 822 registered patients diagnosed with SCNEC from 2004 to 2015 which comprised 1.1% (822/73,698) of all uterine cervical cancer cases. Rates of lymph-node and distant metastasis were significantly higher in T1b2 (38.9% and 13.7%, respectively) than T1b1 (14.2% and 4.4%, respectively) (p<0.01). In IB2 and T1bN1M0 SCNEC, the 5-year survival rate with surgery followed by chemotherapy was significantly higher than that with surgery followed by radiation therapy/concurrent chemoradiation therapy (p<0.01). Conclusion: SNCEC tumors >4 cm in size had greater rates of lymph-node and distant metastasis when compared with tumors ≤4 cm. Adjuvant chemotherapy, rather than radiotherapy, may improve prognosis after surgery in T1bN1M0 SCNEC.

Japan Society of Gynecologic Oncology 2022 guidelines for uterine cervical neoplasm treatment

Manabu Seino,Satoru Nagase,Hideki Tokunaga,Wataru Yamagami,Yoichi Kobayashi,Tsutomu Tabata,Masanori Kaneuchi 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.1

The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2022 for the Treatment ofUterine Cer vical Cancer are revised from the 2017 guideline. This guideline aimed to providestandard care for cer vical cancer, indicate appropriate current treatment methods for cer vicalcancer, minimize variances in treatment methods among institutions, improve diseaseprognosis and treatment safety, reduce the economic and psychosomatic burden of patientsby promoting the performance of appropriate treatment, and enhance mutual understandingbetween patients and healthcare professionals. The guidelines were prepared through theconsensus of the JSGO Guideline Committee, based on a careful review of evidence gatheredthrough the literature searches and the medical health insurance system and actual clinicalpractice situations in Japan. The guidelines comprise seven chapters and 5 algorithms. The main features of the 2022 revision are as follows: 1) added discussed points at the finalconsensus meeting; 2) revised the treatment methods based on the International Federationof Gynecology and Obstetrics 2018 staging system; 3) examined minimally invasive surger ybased on Laparoscopic Approach to Cer vical Cancer trial; 4) added clinical question (CQ)for treatments of rare histological types, gastric type, and small-cell neuroendocrinecarcinoma; 5) added CQ for intensity-modulated radiation therapy; 6) added CQ for cancergenomic profiling test; and 7) added CQ for cancer sur vivorship. Each recommendationis accompanied by a classification of recommendation categories based on the consensusreached by the Guideline Committee members. Here, we present the English version of theJSGO Guidelines 2022 for the Treatment of Uterine Cer vical Cancer.

Comparison of treatment outcomes of surgery and radiotherapy, including concurrent chemoradiotherapy for stage Ib2-IIb cervical adenocarcinoma patients: a retrospective study

Eiji Kondo,Kenta Yoshida,Tsutomu Tabata,Yoichi Kobayashi,Wataru Yamagami,Yasuhiko Ebina,Masanori Kaneuchi,Satoru Nagase,Hiroko Machida,Mikio Mikami 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.2

Objective: The study compared the treatment outcomes of surgery versus radiotherapy, including concurrent chemoradiotherapy, in stage Ib2–IIb cervical adenocarcinoma patients in Japan. Methods: Of 57,470 patients diagnosed with stage I–IV cervical cancer from January 2001– December 2011, 1,932 patients with stage Ib2–IIb cervical adenocarcinoma were initially treated by surgery or radiotherapy. The primary endpoint was 5-year overall survival (OS) in all and 614 propensity score-matched (PSM) patients (307 per group). We compared OS and prognosis factors based on age, primary stage, and treatment arm. Results: In Japan, >80% (n=1,573) of stage Ib2–IIb cervical adenocarcinoma patients underwent surgery. The 5-year OS of surgery vs. radiotherapy groups were 82.1% (n=704) vs. 79.7% (n=59) (hazard ratio [HR]=1.494; 95% confidence interval [CI]=0.826–2.702; p=0.181)for stage Ib2, 76.6% (n=239) vs. 66.7% (n=54) (HR=1.679; 95% CI=0.986–2.858; p=0.053)for stage IIa, and 71.1% (n=630) vs. 58.9% (n=246) (HR=1.711; 95% CI=1.341–2.184; p<0.001)for stage IIb. In 614 PSM patients balanced for age and carcinoma stage Ib2–IIb, the 5-year OS of surgery vs. radiation groups was 73.0% (n=307) vs. 65.5% (n=307) (HR=1.394; 95% CI=1.044–1.860; p=0.023).In multivariable analysis, age (HR=1.293; 95% CI=1.045–1.601; p=0.018), treatment arm, radiotherapy (HR=1.556; 95% CI=1.253–1.933; p<0.001), and stage IIb (HR=1.783; 95% CI=1.443–2.203; p=0.018) were independent prognosis factors for 5-year OS in stage Ib2–IIb adenocarcinoma patients. Conclusion: Age (>65 years), treatment arm (radiotherapy), and stage IIb significantly affect OS in cervical adenocarcinoma patients. Surgery may be considered for <65-year-old patients with stage IIb adenocarcinoma.