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Isolated tumor cells and micrometastases in regional lymph nodes in stage I to II endometrial cancer
Yukiharu Todo,Hidenori Kato,Kazuhira Okamoto,Shinichiro Minobe,Katsushige Yamashiro,Noriaki Sakuragi 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.1
Objective: The aim of this study was to clarify the clinical significance of isolated tumor cells (ITCs) or micrometastasis (MM) in regional lymph nodes in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I to II endometrial cancer. Methods: In this study, a series of 63 patients with FIGO stage I to II were included, who had at least one of the following risk factors for recurrence: G3 endometrioid/serous/clear cell adenocarcinomas, deep myometrial invasion, cervical involvement, lympho-vascular space invasion, and positive peritoneal cytology. These cases were classified as intermediate-risk endometrial cancer. Ultrastaging by multiple slicing, staining with hematoxylin and eosin and cytokeratin, and microscopic examination was performed on regional lymph nodes that had been diagnosed as negative for metastases. Results: Among 61 patients in whom paraffin-embedded block was available, ITC/MM was identified in nine patients (14.8%). Deep myometrial invasion was significantly associated with ITC/MM (p=0.028). ITC/MM was an independent risk factor for extrapelvic recurrence (hazard ratio, 17.9; 95% confidence interval [CI], 1.4 to 232.2). The 8-year overall survival (OS) and recurrence-free survival (RFS) rates were more than 20% lower in the ITC/MM group than in the node-negative group (OS, 71.4% vs. 91.9%; RFS, 55.6% vs. 84.0%), which were statistically not significant (OS, p=0.074; RFS, p=0.066). Time to recurrence tended to be longer in the ITC/MM group than in the node-negative group (median, 49 months vs. 16.5 months; p=0.080). Conclusions: It remains unclear whether ITC/MM have an adverse influence on prognosis of intermediate-risk endometrial cancer. A multicenter cooperative study is needed to clarify the clinical significance of ITC/MM.
Yukiharu Todo,Sho Takeshita,Kazuhira Okamoto,Katsushige Yamashiro,Hidenori Kato 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5
Objective: The aim of this study was to confirm the incidence and implications of a lymphaticspread pattern involving para-aortic lymph node (PAN) metastasis in the absence of pelviclymph node (PLN) metastasis in patients with endometrial cancer. Methods: We carried out a retrospective chart review of 380 patients with endometrial cancertreated by surgery including PLN dissection and PAN dissection at Hokkaido Cancer Centerbetween 2003 and 2016. We determined the probability of PAN metastasis in patients withoutPLN metastasis and investigated survival outcomes of PLN−PAN+ patients. Results: The median numbers of PLN and PAN removed at surgery were 41 (range: 11–107)and 16 (range: 1–65), respectively. Sixty-four patients (16.8%) had lymph node metastasis,including 39 (10.3%) with PAN metastasis. The most frequent lymphatic spread pattern wasPLN+PAN+ (7.9%), followed by PLN+PAN− (6.6%), and PLN−PAN+ (2.4%). The probabilityof PAN metastasis in patients without PLN metastasis was 2.8% (9/325). The 5-year overallsurvival rates were 96.5% in PLN−PAN−, 77.6% in PLN+PAN−, 63.4% in PLN+PAN+, and53.6% in PLN−PAN+ patients. Conclusion: The likelihood of PAN metastasis in endometrial cancer patients withoutPLN metastasis is not negligible, and the prognosis of PLN−PAN+ is likely to be poor. The implications of a PLN−PAN+ lymphatic spread pattern should thus be taken intoconsideration when determining patient management strategies
Pretreatment risk factors for parametrial involvement in FIGO stage IB1 cervical cancer
Hiroyuki Yamazaki,Yukiharu Todo,Kazuhira Okamoto,Katsushige Yamashiro,Hidenori Kato 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Objective: All patients with stage IB1 cervical cancer do not need to undergo parametrectomy. Some low-risk criteria for parametrial involvement (PI) have been proposed based on pathological findings. The aim of this study was to determine pretreatment risk factors for PI in stage IB1 cervical cancer. Methods: We retrospectively reviewed 115 patients with stage IB1 cervical cancer who underwent radical hysterectomy or radical trachelectomy. Magnetic resonance imaging (MRI) was performed and serum concentrations of squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 125 (CA-125) were determined in all patients before initial treatment. The following pretreatment factors were investigated: histological variant, maximum tumor diameter, tumor volume (volume index), pelvic lymph node enlargement, and serum tumor markers. Logistic regression analysis was used to select the independent risk factors for PI. Results: Eighteen of the 115 patients (15.7%) were pathologically diagnosed with PI. Multivariate analysis confirmed the following independent risk factors for PI: MRI-based tumor diameter ≥25 mm (odds ratio [OR], 9.9; 95% confidence interval [CI], 2.1 to 48.1), MRI-based volume index ≥5,000 mm3 (OR, 13.3; 95% CI, 1.4 to 125.0), and positive serum tumor markers SCC-Ag ≥1.5 ng/mL or CA-125 ≥35 U/mL (OR, 5.7; 95% CI, 1.3 to 25.1). Of 53 patients with no risk factors for PI, none had PI. Conclusion: Less radical surgery may become one of the treatment options for stage IB1 cervical cancer patients with MRIbased tumor diameter <25 mm, MRI-based volume index <5,000 mm3, and negativity for SCC-Ag and CA-125.