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- 저자 : Ayumi Shikama (검색결과 3 건)
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Lymphadenectomy issues in endometrial cancer
Yosuke Konno,Hiroshi Asano,Ayumi Shikama,Daisuke Aoki,Michihiro Tanikawa,Akinori Oki,Koji Horie,Akira Mitsuhashi,Akira Kikuchi,Hideki Tokunaga,Yasuhisa Terao,Toyomi Satoh,Kimio Ushijima,Mitsuya Ishika 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objectives: This review aims to introduce preoperative scoring systems to predict lymphnode metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role oflymphadenectomy for endometrial cancer. Methods: We summarized previous reports on the preoperative prediction models forLNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, wecompared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) toexamine the survival benefit of lymphadenectomy in endometrial cancer, and described thedetails of JCOG1412. Results: Lymphadenectomy has been omitted for 64 endometrial cancer patients who met low risk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphaticfailure has been observed. Other two models also produced comparable results. Two randomizedphase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrialcancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aorticlymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients atrisk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, includinglower limit of the number of resected nodes, and submission of photos of dissected area toevaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showedthat the quality of lymphadenectomy has been well-controlled in JCOG1412. Conclusion: Our strategy seems reasonable to omit lymphadenectomy and could begeneralized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms ofthe quality of surgical procedures, which would draw the bona-fide conclusions regarding thetherapeutic role of lymphadenectomy for endometrial cancer.
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Harunobu Matsumoto,Mototsugu Shimokawa,Kaei Nasu,Ayumi Shikama,Takaya Shiozaki,Masayuki Futagami,Kentaro Kai,Hiroaki Nagano,Taisuke Mori,Mitsutake Yano,Norihiro Sugino,Etsuko Fujimoto,Norihito Yoshiok 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.6
Objective: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. Methods: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. Results: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. Conclusion: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
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Kan Yonemori,Keiichi Fujiwara,Kosei Hasegawa,Mayu Yunokawa,Kimio Ushijima,Shiro Suzuki,Ayumi Shikama,Shinichiro Minobe,Tomoka Usami,김재원,김병기,Peng-Hui Wang,Ting-Chang Chang,Keiko Yamamoto,Shirong Han,Jo 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2
Objective: In the global phase 3 Study 309/KEYNOTE-775 (NCT03517449) at the first interimanalysis, lenvatinib+pembrolizumab significantly improved progression-free sur vival (PFS),overall sur vival (OS), and objective response rate (ORR) versus treatment of physician’schoice chemotherapy (TPC) in patients with previously treated advanced/recurrentendometrial cancer (EC). This explorator y analysis evaluated outcomes in patients enrolledin East Asia at the time of prespecified final analysis. Methods: Women ≥18 years with histologically confirmed advanced, recurrent, or metastaticEC with progressive disease after 1 platinum-based chemotherapy (2 if 1 given in neoadjuvant/adjuvant setting) were enrolled. Patients were randomized 1:1 to lenvatinib 20 mg orallyonce daily plus pembrolizumab 200 mg intravenously ever y 3 weeks (≤35 cycles) or TPC(doxorubicin or paclitaxel). Primar y endpoints were PFS per RECIST v1.1 by blindedindependent central review and OS. No alpha was assigned for this subgroup analysis. Results: Among 155 East Asian patients (lenvatinib+pembrolizumab, n=77; TPC, n=78),median follow-up time (data cutoff: March 1, 2022) was 34.3 (range, 25.1–43.0) months. Hazard ratios (HRs) with 95% confidence inter vals (CIs) for PFS (lenvatinib+pembrolizumabvs. TPC) were 0.74 (0.49–1.10) and 0.64 (0.44–0.94) in the mismatch repair proficient(pMMR) and all-comer populations, respectively. HRs (95% CI) for OS were 0.68 (0.45–1.02)and 0.61 (0.41–0.90), respectively. ORRs were 36% with lenvatinib+pembrolizumab and 22%with TPC (pMMR) and 39% and 21%, respectively (all-comers). Treatment-related adverseevents occurred in 97% and 96% (grade 3–5, 74% and 72%), respectively. Conclusion: Lenvatinib+pembrolizumab provided clinically meaningful benefit withmanageable safety compared with TPC, supporting its use in East Asian patients withpreviously treated advanced/recurrent EC. Trial Registration: ClinicalTrials.gov Identifier: NCT03517449
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