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Makiko So,Taito Miyamoto,Ryusuke Murakami,Kaoru Abiko,Junzo Hamanishi,Tsukasa Baba,Masaki Mandai 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6
Objective: In patients with recurrent ovarian cancer (ROC) in whom surgery is likely torender them disease-free, it is unclear whether secondary cytoreductive surgery (SCS)combined with chemotherapy is superior to chemotherapy alone. The aim of this study wasto evaluate the 2 treatment options in Tian-model low-risk patients. Methods: We retrospectively reviewed 118 ROC cases treated in our hospital between2004 and 2016. Of these, 52 platinum-sensitive cases were classified as low-risk (completeresection anticipated) using the Tian model. Prognostic factors were assessed with univariateand multivariate analysis using Cox's regression model. Progression-free survival (PFS)and overall survival (OS) were compared in patients treated with SCS plus chemotherapy(SCS group) and those treated with chemotherapy alone (chemotherapy group), using apropensity-score-based matching method. Results: By multivariate analysis, the only factor associated with better OS was SCS. PFS and OSwere significantly longer in the SCS group compared to the chemotherapy group in the matchedcohort (median PFS: 21.7 vs. 15.1 months, p=0.027 and median OS: 91.4 vs. 33.4 months,p=0.008, respectively). In cases with multiple-site recurrence, the SCS group also showedsignificantly longer OS than the chemotherapy group (median 91.4 vs. 34.8 months, p=0.022). In almost all SCS cases, cooperation was required from other departments, and operation timewas lengthy (median 323 minutes); however, no serious complications occurred. Conclusion: SCS combined with chemotherapy results in better PFS and OS than chemotherapyalone in first platinum-sensitive ROC patients categorized as low-risk by Tian's model.
Ayami Inoue,Ken Yamaguchi,Yasuhisa Kurata,Ryusuke Murakami,Kaoru Abiko,Junzo Hamanishi,Eiji Kondoh,Tsukasa Baba,Aki Kido,Ikuo Konishi,Noriomi Matsumura 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5
Objective: Carcinosarcoma of the uterine corpus has a poor prognosis. Although pathologicalnecrosis is a prognostic factor of endometrial cancer, the clinicopathological influences of anunenhanced region observed on magnetic resonance imaging (MRI) are inconclusive. The aimof our study was to determine the clinicobiological impact of the presence of an unenhancedregion on MRI, which can represent necrosis, in uterine carcinosarcoma. Methods: The clinicopathological factors of 29 patients diagnosed with uterinecarcinosarcoma were assessed retrospectively. The percentage of the tumor that wasunenhanced on MRI was determined. The clinicopathological factors related to theunenhanced regions were evaluated. The prognostic significance was assessed using theKaplan-Meier method and Cox regression model. Results: Although the presence of pathological necrosis was not a poor prognosticfactor (p=0.704), unenhanced regions on MRI correlated with poor prognosis when theunenhanced regions in the tumor accounted for more than 10% of the total tumor (p=0.019). The percentage of unenhanced regions was positively correlated with stage (p=0.028;r=0.4691) and related to tumor size (p=0.086; r=0.3749). The Cox regression analysisindicated that the presence of lymph node (LN) metastasis and more than 10% of the tumorbeing unenhanced on MRI were prognostic factors of overall survival in the univariateanalyses (p=0.018 and p=0.047, respectively). Conclusion: The unenhanced region on MRI, which represents pathological necrosis, reflectstumor progression, and semi-quantification of the region is useful to predict the prognosis inpatients with uterine carcinosarcoma.
Histopathological subtyping of high- grade serous ovarian cancer using whole slide imaging
Chiho Miyagawa,Hidekatsu Nakai,Tomoyuki Otani,Ryusuke Murakami,Shiki Takamura,Hisamitsu Takaya,Kosuke Murakami,Masaki Mandai,Noriomi Matsumura 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.4
Objective: We have established 4 histopathologic subtyping of high-grade serous ovarian cancer (HGSOC) and reported that the mesenchymal transition (MT) type has a worse prognosis than the other subtypes. In this study, we modified the histopathologic subtyping algorithm to achieve high interobserver agreement in whole slide imaging (WSI) and to characterize the tumor biology of MT type for treatment individualization. Methods: Four observers performed histopathological subtyping using WSI of HGSOC in The Cancer Genome Atlas data. As a validation set, cases from Kindai and Kyoto Universities were independently evaluated by the 4 observers to determine concordance rates. In addition, genes highly expressed in MT type were examined by gene ontology term analysis. Immunohistochemistry was also performed to validate the pathway analysis. Results: After algorithm modification, the kappa coefficient, which indicates interobserver agreement, was greater than 0.5 (moderate agreement) for the 4 classifications and greater than 0.7 (substantial agreement) for the 2 classifications (MT vs. non-MT). Gene expression analysis showed that gene ontology terms related to angiogenesis and immune response were enriched in the genes highly expressed in the MT type. CD31 positive microvessel density was higher in the MT type compared to the non-MT type, and tumor groups with high infiltration of CD8/CD103 positive immune cells were observed in the MT type. Conclusion: We developed an algorithm for reproducible histopathologic subtyping classification of HGSOC using WSI. The results of this study may be useful for treatment individualization of HGSOC, including angiogenesis inhibitors and immunotherapy.
Ikuo Konishi,Kaoru Abiko,Takuma Hayashi,Koji Yamanoi,Ryusuke Murakami,Ken Yamaguchi,Junzo Hamanishi,Tsukasa Baba,Noriomi Matsumura,Masaki Mandai,Kyoto Study Group for Ovarian Cancer Research 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5
Epithelial ovarian cancer remains the lethal gynecological malignancy in women. The representative histotype is high-grade serous carcinoma (HGSC), and most patients with HGSC present at advanced stages with peritoneal dissemination. Since the peritoneal dissemination is the most important factor for poor prognosis of the patients, complete exploration for its molecular mechanisms is mandatory. In this narrative review, being based on the clinical, pathologic, and genomic findings of HGSC, chromosomal instability and epigenetic dynamics have been discussed as the potential drivers for cancer development in the fallopian tube, acquisition of cancer stem cell (CSC)-like properties, and peritoneal metastasis of HGSC. The natural history of carcinogenesis with clonal evolution, and adaptation to microenvironment of peritoneal dissemination of HGSC should be targeted in the novel development of strategies for prevention, early detection, and precision treatment for patients with HGSC.