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Mikio Mikami,Masako Shida,Takeo Shibata,Hidetaka Katabuchi,Junzo Kigawa,Daisuke Aoki,Nobuo Yaegashi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.2
Objective: The Japan Society of Gynecologic Oncology (JSGO) initiated a nation-wide training system for the education and certification for gynecologic oncologists in 2005. To assess the impact of the quality of the JSGO-accredited institutions, JSGO undertook an analysis of the Uterine Cervical Cancer Registry of the Japan Society of Obstetrics and Gynecology (JSOG) to determine the effectiveness of the JSGO-accredited institutions on the treatment and survival of women with cervical cancer. Methods: The effectiveness of 119 JSGO-accredited institutions and 125 non-JSGO-accredited institutions on the treatment and survival of women with cervical cancer were compared by analyzing the tumor characteristics, treatment patterns, and survival outcomes of women with stage T1B–T4 cervical cancer utilizing the data in the JSOG nation-wide registry for cervical cancer (2006–2009). Results: A total of 14,185 eligible women were identified: 10,920 (77.0%) cases for 119 JSGO-accredited institutions and 3,265 (23.0%) cases for 125 non-accredited institutions. A multivariate analysis showed that age, stage, histology type, and treatment pattern were independently associated with mortality. Moreover, women who received treatment at the JSGO-accredited institutions had a significantly decreased mortality risk compared to non-accredited institutions (adjusted hazard ratio [aHR]=0.843; 95% confidence interval [CI]=0.784–0.905). Similar findings on multivariate analysis were seen among subset of women who received surgery alone (aHR=0.552; 95% CI=0.393–0.775) and among women who received radiotherapy (aHR=0.845; 95% CI=0.766–0.931). Conclusion: Successful implementation of gynecologic oncology accrediting institution was associated with improved survival outcome of women with cervical cancer in Japan.
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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.
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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.
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