Association of menopause, aging and treatment procedures with positive margins after therapeutic cervical conization for CIN 3: a retrospective study of 8,856 patients by the Japan Society of Obstetrics and Gynecology

Masae Ikeda,Mikio Mikami,Miwa Yasaka,Takayuki Enomoto,Yoichi Kobayashi,Satoru Nagase,Masatoshi Yokoyama,Hidetaka Katabuchi 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.5

Objective: The Japan Society of Obstetrics and Gynecology conducted a retrospective multi- institutional survey of patients who underwent cervical conization in Japan. This study aimed to determine the predictive factors for positive surgical margins in cervical intraepithelial neoplasia grade 3 (CIN 3) patients after therapeutic cervical conization and those for positive margins in patients who did not experience recurrence and did not undergo additional treatment. Methods: In 2009 and 2013, 14,832 patients underwent cervical conization at 205 institutions in Japan. Of these, 8856 patients who underwent therapeutic conization fulfilled the inclusion criteria. Their histologic findings and clinical outcomes were evaluated based on standard statistical procedures and clinical and demographic characteristics. Results: Negative and positive margins were observed in 7,585 and 1,271 (14.4%) patients, respectively. The predictors of positive margins were menopausal status (p<0.001), loop electrosurgical excision procedure (p<0.001), and Shimodaira-Taniguchi (S-T) conization (p<0.001). Of 1,271 patients with positive margins, 1,060 underwent no additional treatment; among those 1,060 patients, 129 (12.2%) experienced recurrence. The predictors of positive margins in patients who did not undergo additional treatment and did not experience recurrence were age, parity, gravidity, S-T conization, and laser scalpel conization. Conclusion: Menopausal status and treatment procedures were associated with positive margins after therapeutic conization of CIN 3. It is important to understand the characteristics of treatment procedures and select an appropriate procedure for each case. For elderly or menopausal patients with positive margins, immediate additional treatment is recommended.

The trend and outcome of postsurgical therapy for high-risk early-stage cervical cancer with lymph node metastasis in Japan: a report from the Japan Society of Gynecologic Oncology (JSGO) guidelines evaluation committee

Masae Ikeda,Masako Shida,Shogo Shigeta,Satoru Nagase,Fumiaki Takahashi,Wataru Yamagami,Hidetaka Katabuchi,Nobuo Yaegashi,Daisuke Aoki,Mikio Mikami 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.3

Objective: The Japan Society of Gynecologic Oncology published the first guidelines for thetreatment of cervical cancer in 2007. The aim of this research was to evaluate the influence ofthe introduction of the first guideline on clinical trends and outcomes of patients with early stage cervical cancer who underwent surgery. Methods: This analysis included 9,756 patients who were diagnosed based on thepathological Tumor-Node-Metastasis (pTNM) classification (i.e., pT1b1, pT1b2, pT2b andpN0, pN1, pNX) and received surgery as a primary treatment between 2004 and 2009. Dataof these patients were retrospectively reviewed, and clinicopathological trends were assessed. The influence of the introduction of the guideline on survival was determined by using acompeting risk model. Results: For surgery cases, the estimated subdistribution hazard ratio (HR) by the competingrisk model for the influence of the guideline adjusted for age, year of registration, pTclassification, pN classification, histological type, and treatment methods was 1.024(p=0.864). Following the introduction of the first guideline in 2007, for patients with lymphnode metastasis, the use of chemotherapy (CT) as a postsurgical therapy increased, whereasthat of concurrent chemoradiotherapy (CCRT)/radiotherapy (RT) decreased (p<0.010). ForpN1 cases, the estimated subdistribution HR by the competing risk model for the influenceof the guideline was 1.094 (p=0.634). There was no significance in the postsurgical therapybetween CT and CCRT/RT (p=0.078). Conclusions: Survival of surgical cases was not improved by the introduction of theguidelines. It is necessary to consider more effective postsurgical therapy for high-risk early stage cervical cancer.

The use of conization to identify and treat severe lesions among prediagnosed CIN1 and 2 patients in Japan

Mikio Mikami,Masae Ikeda,Hidetaka Sato,Haruko Iwase,Takayuki Enomoto,Yoichi Kobayashi,Hidetaka Katabuchi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.4

OBJECTIVE: To evaluate the clinical efficiency of identifying patients with suspicious severe lesions by conization among prediagnosed cervical intraepithelial neoplasia (CIN) 1 and 2 patients in Japan. METHODS: The data in a Japanese nation-wide registry for cervical cancer (2009 and 2011) was collected to analyze the clinical efficacy of pre- and postdiagnosis for 13,215 Japanese women who underwent treatment by conization. Their preoperative and postoperative histologic findings and clinical outcomes were evaluated using standard statistical procedures including clinical and demographic characteristics. RESULTS: Almost half of 1,536 women who were treated by conization after the prediagnosis of CIN1 and 2 because the lesions showed no evidence of natural regression actually contained CIN1-2 (45.0%), CIN3 (47%), or invasive cancer (2.7%) in their cervical tissue. They underwent conization either for therapeutic (treatment) (78.5%) or diagnostic (21.5%) reasons. Invasive disease was diagnosed postoperatively more often in diagnostic cases (6.1%) than in therapeutic cases (2.8%). All the patients survived their diagnostic and therapeutic conization after approximately 30 months of follow up. CONCLUSION: Our study shows that the continuous observation of the prediagnosed CIN1 and 2 cases by the combination of cytology, colposcopy and histology in Japan has worked successfully to identify severe lesions by using conization as well in the process.

Assessing the effect of guideline introduction on clinical practice and outcome in patients with endometrial cancer in Japan: a project of the Japan Society of Gynecologic Oncology (JSGO) guideline evaluation committee

Shogo Shigeta,Satoru Nagase,Mikio Mikami,Masae Ikeda,Masako Shida,Isao Sakaguchi,Norichika Ushioda,Fumiaki Takahashi,Wataru Yamagami,Nobuo Yaegashi,Yasuhiro Udagawa,Hidetaka Katabuchi 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.6

Objective: The Japan Society of Gynecologic Oncology (JSGO) published the first practiceguideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessedthe effect of this guideline introduction on clinical practice and patient outcome using dataprovided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system. Methods: Data of patients with endometrial cancer registered between 2000 and 2012 wereanalyzed, and epidemiological and clinical trends were assessed. The influence of guidelineintroduction on survival was determined by analyzing data of patients registered between2004 and 2009 using competing risk model. Results: In total, 65,241 cases of endometrial cancer were registered. Total number ofpatients registered each year increased about 3 times in the analyzed period, and theproportion of older patients with type II endometrial cancer rapidly increased. The frequencyof lymphadenectomy had decreased not only among the low-recurrence risk group but alsoamong the intermediate- or high-recurrence risk group. Adjuvant therapy was integratedinto chemotherapy (p<0.001). Overall survival did not significantly differ before and afterthe guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealedpatients receiving adjuvant chemotherapy showed better prognosis than those receivingadjuvant radiation therapy when limited to stage I or II (HR=0.598; p=0.003). Conclusion: It was suggested that guideline introduction influenced the managementof endometrial cancer at several aspects. Better organized information and continuousevaluation are necessary to understand the causal relationship between the guideline andpatient outcome.

AKARI FAR-INFRARED ALL-SKY SURVEY MAPS

Doi, Yasuo,Komugi, Shinya,Kawada, Mitsunobu,Takita, Satoshi,Arimatsu, Ko,Ikeda, Norio,Kato, Daisuke,Kitamura, Yoshimi,Nakagawa, Takao,Ootsubo, Takafumi,Morishima, Takahiro,Hattori, Makoto,Tanaka, Masa The Korean Astronomical Society 2012 天文學論叢 Vol.27 No.4

Far-infrared observations provide crucial data for the investigation and characterisation of the properties of dusty material in the Interstellar Medium (ISM), since most of its energy is emitted between ~ 100 and $200{\mu}m$. We present the first all-sky image from a sensitive all-sky survey using the Japanese AKARI satellite, in the wavelength range $50-180{\mu}m$. Covering > 99% of the sky in four photometric bands with four filters centred at $65{\mu}m$, $90{\mu}m$, $140{\mu}m$, and $160{\mu}m$ wavelengths, this achieved spatial resolutions from 1 to 2 arcmin and a detection limit of < 10 MJy $sr^{-1}$, with absolute and relative photometric accuracies of < 20%. All-sky images of the Galactic dust continuum emission enable astronomers to map the large-scale distribution of the diffuse ISM cirrus, to study its thermal dust temperature, emissivity and column density, and to measure the interaction of the Galactic radiation field and embedded objects with the surrounding ISM. In addition to the point source population of stars, protostars, star-forming regions, and galaxies, the high Galactic latitude sky is shown to be covered with a diffuse filamentary-web of dusty emission that traces the potential sites of high latitude star formation. We show that the temperature of dust particles in thermal equilibrium with the ambient interstellar radiation field can be estimated by using $90{\mu}m$, $140{\mu}m$, and $160{\mu}m$ data. The FIR AKARI full-sky maps provide a rich new data set within which astronomers can investigate the distribution of interstellar matter throughout our Galaxy, and beyond.