Search

Objective To examine characteristics and survival outcomes of women with surgically-treated cervical cancer exhibiting uterine corpus tumor invasion. Methods We utilized The Surveillance, Epidemiology, and End Results Program to identify cervical cancer patients who underwent hysterectomy between 1973 and 2003. Logistic regression models were used to identify risk factors for uterine corpus tumor invasion on multivariable analysis. Association of uterine corpus tumor invasion and cause-specific survival (CSS) from cervical cancer was examined with Cox proportional hazard regression models on multivariable analysis. Results We identified 837 (4.9%) cases of uterine corpus invasion and 16,237 (95.1%) cases of non-invasion. Median follow-up time was 14.0 years. There were 1642 deaths due to cervical cancer. Uterine corpus invasion was independently associated with older age, non-squamous histology, high-grade tumors, large tumor size, and nodal metastasis on multivariable analysis (all, P < 0.001). On univariable analysis, uterine corpus tumor invasion was significantly associated with decreased CSS compared to the non-invasion (5-year rates, 79.0% versus 94.5%, P < 0.001). After controlling for other significant prognostic factors, uterine corpus tumor invasion remained an independent prognostic factor for decreased CSS (adjusted-hazard ratio 1.45, 95% confidence interval 1.21–1.74). Among stage T1b cases (n = 6730), uterine corpus tumor invasion remained an independent prognostic factor for decreased CSS (adjusted-hazard ratio 1.95, 95%CI 1.47–2.60). Uterine corpus tumor invasion was significantly associated with decreased CSS in stage T1b1 disease (74.5% versus 90.7%, P < 0.001) and in stage T1b2 disease (67.0% versus 79.5%, P = 0.01). Conclusion Uterine corpus tumor invasion is an independent prognostic factor for decreased survival of women with early-stage cervical cancer. [ABSTRACT FROM AUTHOR]

To examine the association between histology and utilization of lymph node evaluation at the time of minimally invasive hysterectomy when performed for endometrial hyperplasia in an ambulatory surgery setting. Population-based, retrospective cohort study. The National Ambulatory Surgery Sample, 2016-2019. 39,205 patients with endometrial hyperplasia who underwent minimally invasive hysterectomy (total laparoscopic, laparoscopic assisted vaginal, and total vaginal), including 19,653 cases with atypia and 19,552 cases without atypia. Patients with invasive uterine, cervical, and ovarian cancers were excluded. (i) Multivariable analysis with log-Poisson generalized linear regression model to compare the clinical characteristics between the atypia and non-atypia groups, and (ii) inverse probability of treatment weighting to assess the utilization of lymph node evaluation at the time of hysterectomy, stratified by histology type. In a multivariable analysis, patients in the atypia group were more likely to have older ages, obesity, medical comorbidities, a recent diagnosis, self-paid insurance, higher household incomes, and undergo surgery at large, urban teaching centers compared to those in the non-atypia group (all, P <0.05). Patients in the atypia group were less likely to undergo laparoscopic assisted vaginal or total vaginal hysterectomy compared to those in the non-atypia group (both, P <0.05). In a propensity score-weighted model, patients in the atypia group were more likely to have lymph node evaluation at the time of hysterectomy compared to those in the non-atypia group (8.8% versus 2.8%, odds ratio 3.37, 95% confidence interval 3.02-3.77). This national-level analysis suggests that lymph node evaluation was performed at the time of minimally invasive hysterectomy for endometrial hyperplasia in the ambulatory surgery setting in the United States from 2016-2019. Surgeons appear to evaluate lymph nodes more frequently for endometrial hyperplasia with atypia than without. [ABSTRACT FROM AUTHOR]

Background: To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma. Patients and methods: A multicenter retrospective study was conducted to examine uterine carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes. Results: Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/ homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001). Conclusion: Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma. [ABSTRACT FROM AUTHOR]

Tumor spill during surgical treatment is associated with adverse oncologic outcomes in many solid tumors. However, in minimally invasive hysterectomy for endometrial cancer, intraoperative tumor spill has not been well studied. This study examined surgeon experiences and practice patterns related to intraoperative tumor spill during minimally invasive hysterectomy for endometrial cancer. This was a cross-sectional survey composed of 20 questions regarding surgeon demographics, surgical practice patterns (fallopian tubal ablation / ligation, intra-uterine manipulator use, and colpotomy approach), and tumor spill experience (uterine perforation with intra-uterine manipulator and tumor exposure during colpotomy). An online survey sent to the Society of Gynecologic Oncology members on three separate occasions between December 2020 to January 2021 via SurveyMonkey. Gynecologic oncologists practicing minimally invasive hysterectomy for endometrial cancer in the United States. None. A total of 220 results were available for analysis. Nearly half of the responding surgeons completed subspeciality training >10 years ago (50.5%), and. 74.1% of surgeons had annual surgical volume of >40 cases. The majority of surgeons use an intra-uterine manipulator during minimally invasive hysterectomies for endometrial cancer (90.1%), and 87.2% of the users have experienced uterine perforation with an intra-uterine manipulator. Almost all surgeons perform the colpotomy laparoscopically (95.9%), and nearly 60% of surgeons have experienced tumor spill during colpotomy (59.8%). Nearly 10-15% of surgeons have changed their postoperative therapy as a result of intraoperative uterine perforation (11.8%) or tumor spill (14.5%). Surgeons were found to infrequently ablate or ligate the fallopian tube prior to performing the hysterectomy (14.1%). This survey study suggests that many surgeons have experienced intraoperative tumor spillage during minimally invasive hysterectomy for endometrial cancer, warranting further studies examining its incidence and impact on survival effect. [ABSTRACT FROM AUTHOR]

Background We compared clinical outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) against those of classical 2-stage hepatectomy in treating metastatic liver disease. Methods Short-term outcomes, serial changes in volume of the future liver remnant (FLR), functional FLR volume, and tumor growth activity during the treatment period, were compared between our first 11 consecutive patients treated with ALPPS and 54 patients treated with classical 2-stage hepatectomy. Results Mortality in the ALPPS group (9%) tended to be higher than in the classical 2-stage group (2%, P = 0.341). The FLR hypertrophy ratio (FLR volume after vs. before the procedure) 1 week after the first operation in the ALPPS group (1.54 ± 0.18) exceeded that in the classical 2-stage group (1.19 ± 0.29, P = 0.005), being similar to the ratio at 3 weeks after the first procedure in the classical 2-stage group (1.40 ± 0.43). However, functional volume of the FLR in the ALPPS group 1 week after the first procedure (52.1%) tended to be smaller than that in the classical group 3 weeks after the first procedure (59.2%). Conclusions ALPPS should be used with extreme caution, giving special attention to postoperative complications and grade of functional liver regeneration. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to evaluate the relationship of aquaporin-3 (AQP3) expression with clinico-pathological parameters and lymph node metastasis in patients with oral squamous cell carcinoma (SCC). The immunohistochemical distribution of AQP3 was investigated in normal squamous epithelium and SCC tissue of 48 cases of SCC of the tongue and floor of the mouth. The percentage of the total AQP3-positive SCC tissue area relative to the total tumour tissue area (T-AQP3) was calculated as a morphometric AQP3 parameter for each patient. Furthermore, the percentage of the AQP3-positive area relative to the SCC tissue area at the invasion front (F-AQP3) was calculated as another AQP3 parameter. The immunostaining pattern of AQP3 in SCC tissue was irregular and weaker than that in normal epithelium. Well-differentiated SCCs had higher T-AQP3 and F-AQP3 values than poorly differentiated SCCs. SCCs with an infiltrative invasion pattern had lower F-AQP3 than SCCs with expansive and intermediate patterns. SCCs with T-AQP3 <27% or F-AQP3 <17% showed an increased incidence of lymphatic metastasis, and multivariate analysis demonstrated that F-AQP3 was an independent prognostic factor of lymphatic metastasis. These results suggest that AQP3 is involved in keratinocyte differentiation and decreased AQP3 expression is associated with more aggressive tumour behaviour. [Copyright &y& Elsevier]

Abstract: Background: The prognosis in advanced hepatocellular carcinoma (HCC) with multiple intrahepatic metastases is extremely poor. Combination therapy with subcutaneous interferon (IFN) alfa and intraarterial 5-fluorouracil was reported to be effective against such advanced HCC. We describe results of debulking surgery followed by combination therapy with IFN alfa and 5-FU for massive HCC with multiple intrahepatic metastases. Methods: In 27 HCC patients with massive tumors and multiple intrahepatic metastases, we performed combination therapy with IFN alfa and 5-FU after maximal liver tumor resection. Results: Mean patient age was 63.3 years. Including intrahepatic metastases, tumors numbered 5 or more in 17 patients (63%). Portal or hepatic vein branches were invaded in 22 (81%). The mean maximum tumor diameter was 102 mm. Among 24 patients whose results were analyzed, an objective response by residual intrahepatic metastases was observed in 13 (54%; complete response in 12, and partial response in 1). Overall 1-, 3-, and 5-year survival was 73.2%, 38.7%, and 38.7%, respectively; 1-, 3-, and 5-year progression-free rates were 38.2%, 22.3%, and 22.3%. Conclusions: Debulking surgery followed by IFN alfa and 5-FU combination chemotherapy offers possibility of long-term survival despite massive HCC with multiple intrahepatic metastases. [Copyright &y& Elsevier]

Background Although the clinical relevance of the molecular subtypes of breast cancer is evident, etiological differences among subtypes have not been well established, especially among Asian. Here, we evaluated the hypothesis that the etiologic impact of reproductive and hormonal features differs among molecular subtypes. Materials and methods We conducted a case–control study in pre- and postmenopausal Japanese. We examined 706 breast cancer patients and 1412 age- and menopausal status-matched noncancer controls. Immunohistochemical stains for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were used to classify the cases into 554 luminal (hormone receptor positive), 84 HER2-overexpressing (hormone receptor negative, HER2 positive), and 68 triple-negative cases (hormone receptor negative, HER2 negative). Associations were evaluated using multivariate polytomous logistic regression models. Results A significant association was observed between early age at menarche and risk of luminal disease (odds ratios = 1.67, 95% confidence interval: 1.22–2.29; P trend = 0.001). No significant differences in association with parity, age at first live birth, breastfeeding history, age at menopause, or synthetic hormonal use were seen across molecular subtypes of breast cancer. Conclusions These findings indicate that reproductive events in adolescence have differential impact on the risk of breast cancer molecular subtypes in Japanese. [ABSTRACT FROM PUBLISHER]

Background: Non-Hodgkin lymphoma (NHL) is one of the common malignant tumors worldwide. Environmental factors, such as diet have an important association with the risk of cancer. Although soy intake has been associated with a reduced risk of several cancers, its association with NHL is not known.Patients and methods: We evaluated the association between soy consumption and risk of NHL by conducting a hospital-based case–control study in 302 patients with NHL and 1510 age- and sex-matched control subjects. Odds ratio (OR) and 95% confidence intervals (CIs) for groups with moderate (27–51 g/day) to high (>51 g/day) relative to low (<27 g/day) intake were calculated using multivariate conditional logistic regression model.Results: Soy intake was significantly associated with a reduced risk of NHL in women but not in men (OR [95% CI] for moderate and high intake: women, 0.64 [0.42–1.00] and 0.66 [0.42–1.02], respectively; men, 1.40 [0.87–2.24] and 1.33 [0.82–2.15], respectively; P-interaction = 0.02). This finding appeared consistent across NHL subtypes.Conclusion: These results indicate the potential importance of certain ingredients in soy for lymphomagenesis. Further studies to evaluate the mechanism behind the association between soy intake and lymphomagenesis are warranted. [ABSTRACT FROM PUBLISHER]

Background: Obesity has been recognized as important risk factors for colorectal cancer. However, limited evidence is available on colorectal cancer and body mass index (BMI) in Asian population. Methods: We conducted a pooled analysis of eight population-based prospective cohorts studies in Japan with more than 300 000 subjects to evaluate an impact of obesity in terms of BMI on colorectal cancer risk with unified categories. We estimated summary hazard ratio (HR) by pooling of study-specific HR for BMI categories with random effect model. Results: We found a significant positive association between BMI and colorectal cancer risk in male and female. Adjusted HRs for 1 kg/m2 increase were 1.03 [95% confidence interval (CI) 1.02–1.04] for males and 1.02 (95% CI 1.00–1.03) for females. The association was stronger in colon, especially in proximal colon, relative to rectum. Males showed a stronger association than females. Population attributable fraction for colorectal cancer by BMI ≥25 kg/m2 was 3.62% (95% CI 1.91–5.30) for males and 2.62% (95% CI 0.74–4.47) for females. Conclusions: We found significant association between BMI and colorectal cancer risk by pooling of data from cohort studies with considerable number of subjects among Japanese population. This information is important in cancer control planning, especially in Asian population. [ABSTRACT FROM PUBLISHER]

Background: The association between dietary folate intake, two polymorphisms in methylenetetrahydrofolate reductase (MTHFR) and thymidylate synthase (TYMS), and survival in head and neck squamous cell carcinoma (HNSCC) patients is not clarified.Patients and methods: We conducted a retrospective cohort study of 437 HNSCC patients treated at Aichi Cancer Center. We evaluated the survival impact of pretreatment dietary folate intake, which was estimated using a food-frequency questionnaire, and two polymorphisms, MTHFR C677T and a 6-bp insertion/deletion in the 3′-untranslated region of TYMS, using multivariate proportional hazard models.Results: Patients with high folate intake (≥320 μg/day; n = 144) had significantly higher survival than patients with low or medium folate intake (<320 μg/day; n = 278; 79.1% versus 68.2%, respectively, P = 0.020). This association was consistent with multivariate analyses adjusted for established prognostic factors (hazard ratio 0.56; 95% confidence interval 0.37–0.84). MTHFR and TYMS polymorphisms did not show significant association with survival, although the TYMS 6-bp insertion allele showed potential association with a reduced risk of death. Notably, no significant interaction was observed between folate intake and the two examined polymorphisms.Conclusions: High pretreatment dietary folate intake was identified as an independent prognostic factor associated with improved clinical outcomes in HNSCC patients. Further study is warranted. [ABSTRACT FROM AUTHOR]

Abstract: An otherwise-healthy 2-year-old Japanese female presented with a polyp-like lesion on the palatal surface at the incisive papilla. The appearance of the lesion was similar to that of a congenital epulis. The histological findings showed proliferating mesenchymal components that contained mainly smooth muscle admixed with collagen fibres, nerve fibres, small vessels and mucous salivary glands. The immunohistochemical staining findings for α-smooth-muscle actin, desmin and S-100 protein were all positive. The histological diagnosis was therefore leiomyomatous hamartoma, based on clinical microscopic observations. [Copyright &y& Elsevier]

Background: Neutropenia during chemotherapy has been reported to be a predictor of better survival in patients with several types of cancers, although there are no reports in pretreated patients.Methods: We retrospectively analyzed 242 patients with advanced gastric cancer (AGC) who received weekly paclitaxel (Taxol) as second-line chemotherapy. Background characteristics and neutropenia as time-varying covariates (TVCs) were analyzed as prognostic factors.Results: Of the 242 patients, mild neutropenia (grades 1–2) occurred in 101 patients (41.7%) and severe neutropenia (grades 3–4) occurred in 63 patients (26.0%). The other 78 patients (32.2%) did not experience neutropenia. According to a multivariate Cox model with neutropenia as a TVC, hazard ratios of death were 0.61 [95% confidence interval (CI) 0.43–0.85; P = 0.004] for patients with mild neutropenia and 0.61 (95% CI 0.41–0.88; P = 0.009) for those with severe neutropenia. Among the patients in landmark analysis (landmark of 2.5 months; median time to treatment failure of paclitaxel), mild and severe neutropenia remained significant prognostic factors.Conclusions: Our results indicate that neutropenia during chemotherapy is associated with improved survival in patients with AGC who received weekly paclitaxel as second-line chemotherapy. Prospective trials are required to assess whether dosing adjustments based on neutropenia may improve chemotherapy efficacy. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The aims of this study were to determine interobserver variability in volume measurements of lung tumors (including part-solid and nonsolid types) using novel computer-aided diagnosis (CAD) tools and a machine learning approach and to determine the potential reasons for variability. Materials and Methods: In 60 consecutive patients with peripheral lung cancer, the three-dimensional volumes of nodules were measured using the perimeter method by an experienced chest radiologist. In addition, for the same patients, maximal diameters and three-dimensional volumes were measured with and without a novel CAD tool by six observers. The coefficient of variance (CV) as index of interobserver variability was calculated. For the measurement of volume, the results of the perimeter method were compared to those of the CAD method. Furthermore, the CV was calculated for the following subgroups: nodule diameter, internal opacity, margin, spiculation, and adherence to vessels and the chest wall. Results: There was significant interobserver variability among the six observers for manual, but not CAD, measurements of maximal diameter (P < .001 and P = .207, respectively). Volume measured with the perimeter method by a chest radiologist was well correlated with volume measured with the aid of the CAD system by six radiologists (r = 0.98-0.99). There was no significant difference in the CV for size, internal opacity, spiculation of nodules, or adherence to pulmonary vessels and the chest wall. The CV was significantly higher for obscure marginal nodules than for clear marginal nodules (P < .01). Conclusions: The novel CAD tool could be used to measure the volume of not only solid but also part-solid and nonsolid lung tumors. [ABSTRACT FROM AUTHOR]