Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis

Tatsuyuki Chiyoda,Manabu Sakurai,Toyomi Satoh,Satoru Nagase,Mikio Mikami,Hidetaka Katabuchi,Daisuke Aoki 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: To assess the effectiveness of lymphadenectomy at primary debulking surgery(PDS) on the survival of patients with epithelial ovarian cancer (EOC). Methods: We searched PubMed, Ichushi, and the Cochrane Library. Randomized controlledtrials (RCTs) and retrospective cohort studies comparing survival of women with EOCundergoing lymphadenectomy at PDS with that of women without lymphadenectomy wereincluded. We performed a meta-analysis of overall survival (OS), progression-free survival(PFS), and adverse events. Results: For advanced-stage EOC, 2 RCTs including 1,074 women and 7 cohort studiescomprising 3,161 women were evaluated. Meta-analysis revealed that lymphadenectomy wasassociated with improved OS (hazard ratio [HR]=0.80; 95% confidence interval [CI]=0.70–0.90). However, meta-analysis of 2 RCTs revealed no significant difference in OS betweenthe lymphadenectomy and no-lymphadenectomy groups (OS: HR=1.02; 95% CI=0.85–1.22). For early-stage EOC, 1 RCT comprising 268 women and 4 cohort studies comprising 14,228women were evaluated. Meta-analysis showed that lymphadenectomy was associatedwith improved OS (HR=0.75; 95% CI=0.68–0.82). A RCT of early-stage EOC reported thatlymphadenectomy was not associated with improved OS (HR=0.85; 95% CI=0.49–1.47). Surgery-related deaths were similar in both groups (risk ratio [RR]=1.00; 95% CI=0.99–1.01);however, blood transfusion was required less frequently in the no-lymphadenectomy group(RR=0.74; 95% CI=0.63–0.86). Conclusions: Meta-analysis of RCTs and observational studies suggest thatlymphadenectomy was associated with improved OS in advanced- and early-stage EOC. However, results from RCTs demonstrate that lymphadenectomy was not associated withimproved OS in advanced- and early-stage EOC.

Olaparib plus bevacizumab as maintenance therapy in patients with newly diagnosed, advanced ovarian cancer: Japan subset from the PAOLA-1/ENGOT-ov25 trial

Keiichi Fujiwara,Hiroyuki Fujiwara,Hiroyuki Yoshida,Toyomi Satoh,Kan Yonemori,Shoji Nagao,Takashi Matsumoto,Hiroaki Kobayashi,Hughes Bourgeois,Philipp Harter,Anna Maria Mosconi,Isabel Palacio Vazquez 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.5

Objective: The addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial (NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1. Methods: PAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint). Results: Of 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11–1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16–2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab. Conclusion: Results in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT02477644

Posttreatment human papillomavirus testing for residual or recurrent high-grade cervical intraepithelial neoplasia: a pooled analysis

Mamiko Onuki,Koji Matsumoto,Manabu Sakurai,Hiroyuki Ochi,Takeo Minaguchi,Toyomi Satoh,Hiroyuki Yoshikawa 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.1

Objective: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). Methods: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. Results: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). Conclusion: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.

The 2020 Japan Society of Gynecologic Oncology guidelines for the treatment of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer

Hideki Tokunaga,Mikio Mikami,Satoru Nagase,Yoichi Kobayashi,Tsutomu Tabata,Masanori Kaneuchi,Toyomi Satoh,Yasuyuki Hirashima,Noriomi Matsumura,Yoshihito Yokoyama,Kei Kawana,Satoru Kyo,Daisuke Aoki,Hid 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2

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Clinical and MRI Characteristics of Uterine Cervical Adenocarcinoma: Its Variants and Mimics

Tsukasa Saida,Akiko Sakata,Yumiko Oishi Tanaka,Hiroyuki Ochi,Toshitaka Ishiguro,Masafumi Sakai,Hiroaki Takahashi,Toyomi Satoh,Manabu Minami 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.3

Adenocarcinoma currently accounts for 10–25% of all uterine cervical carcinomas and has a variety of histopathological subtypes. Among them, mucinous carcinoma gastric type is not associated with high-risk human papillomavirus (HPV) infection and a poor prognosis, while villoglandular carcinoma has an association with high-risk HPV infection and a good prognosis. They show relatively characteristic imaging findings which can be suggested by magnetic resonance imaging (MRI), though the former is sometimes difficult to be distinguished from lobular endocervical glandular hyperplasia. Various kinds of other tumors including squamous cell carcinoma should be also differentiated on MRI, while it is currently difficult to distinguish them on MRI, and HPV screening and pathological confirmation are usually necessary for definite diagnosis and further patient management.

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.