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  • BMJ  (15)
  • Kim, Tae-Joong  (15)
  • 1
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    Patterns and risk factors of recurrence in low-risk early-stage cervical adenocarcinoma treated with surgery alone: implications on risk group stratification
    BMJ ; 2022
    In:  International Journal of Gynecologic Cancer Vol. 32, No. 12 ( 2022-12), p. 1524-1530
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 32, No. 12 ( 2022-12), p. 1524-1530
    Abstract: Cervical adenocarcinoma has poorer outcomes compared with squamous cell carcinoma; however, treatment is identical irrespective of histologic sub-types. This study aimed to investigate the patterns and risk factors of recurrence following surgery alone for low-risk early-stage cervical adenocarcinoma. Methods We retrospectively reviewed patients who underwent surgery alone for low-risk early-stage cervical adenocarcinoma between January 2001 and December 2018 in a single institution. Baseline clinicopathological characteristics were collected to identify the factors associated with recurrence-free survival. Results A total of 252 patients met the inclusion criteria. Most patients underwent radical hysterectomy (218 patients, 86.5%) and had usual type endocervical adenocarcinoma (190 patients, 75.4%). The International Federation of Gynecology and Obstetrics 2018 stage was IA1 in 72 patients (27.4%), IA2 in 58 (22.1%), IB1 in 51 (19.4%), and IB2 in 71 patients (27.0%). With a median follow-up of 70.4 months (range 6.2–252.5 months), 5-year survival rates were as follows: locoregional recurrence-free survival, 93.0%; recurrence-free survival, 89.6%; overall survival, 94.7%. The recurrence patterns were local in nine patients (32.1%), regional in five patients (17.8%), distant in 10 patients (35.7%), local and distant in one patient (3.6%), regional and distant in two patients (7.2%), and locoregional and distant in one patient (3.6%). In multivariable analysis, negative human papillomavirus (HPV) status (HR 7.314; p 〈 0.001) and deep cervical stromal invasion (HR 5.110; p=0.003) were associated with poor locoregional recurrence-free survival. Patients were stratified based on the number of risk factors and a statistically significant difference in locoregional recurrence-free survival was observed: 5-year survival rates of 99.0%, 84.2%, and 50.0% for patients with 0, 1, and 2 risk factors (0 vs 1, p=0.001; 1 vs 2, p=0.011). Conclusion Surgery alone for low-risk early-stage cervical adenocarcinoma was associated with favorable outcomes over a long follow-up period. Patients with the highest risk of recurrence were those with a negative HPV status and deep cervical stromal invasion. Additional management following surgery may be considered in patients with these risk factors.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    URL: Article
    DOI: 10.1136/ijgc-2022-003971
    DOI: 10.1136/ijgc-2022-003971.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2009072-9
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  • 2
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    Role of salvage radiotherapy for recurrent ovarian cancer
    BMJ ; 2023
    In:  International Journal of Gynecologic Cancer Vol. 33, No. 1 ( 2023-01), p. 66-73
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 33, No. 1 ( 2023-01), p. 66-73
    Abstract: This study aimed to report clinical outcomes of salvage radiotherapy for recurrent ovarian cancer and identify predictors of clinical outcomes. Methods We retrospectively reviewed data of patients who received salvage radiotherapy for recurrent ovarian cancer between January 2011 and June 2021. Stereotactic body radiotherapy, involved-field radiotherapy with conventional fractionation, and non-involved-field radiotherapy with conventional fractionation were included in this study. Local failure-free survival, progression-free survival, chemotherapy-free survival, and overall survival were assessed. Additionally, potential prognostic factors for survival were analyzed. Results A total of 79 patients were included with 114 recurrent lesions. The median follow-up was 18.3 months (range 1.7–83). The 2-year local failure-free survival, progression-free survival, chemotherapy-free survival, and overall survival rates were 80.7%, 10.6%, 21.2%, and 74.7%, respectively. Pre-radiotherapy platinum resistance (hazard ratio (HR) 3.326, p 〈 0.001) and short pre-radiotherapy CA-125 doubling time (HR 3.664, p 〈 0.001) were associated with poor chemotherapy-free survival. The 1-year chemotherapy-free survival rates of patients with both risk factors, a single risk factor, and no risk factor were 0%, 20.4%, and 53.5%, respectively. The difference between risk groups was statistically significant: low risk versus intermediate risk (p 〈 0.001) and intermediate risk versus high risk (p 〈 0.001). Conclusions Salvage radiotherapy for recurrent ovarian cancer resulted in local control with improved chemotherapy-free survival in carefully selected patients. Our results suggest that the consideration of pre-radiotherapy platinum resistance and pre-radiotherapy CA-125 doubling time could help with patient selection.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    URL: Article
    DOI: 10.1136/ijgc-2022-003834
    DOI: 10.1136/ijgc-2022-003834.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2023
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  • 3
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    Correlation Between Location of Transposed Ovary and Function in Cervical Cancer Patients Who Underwent Radical Hysterectomy
    BMJ ; 2015
    In:  International Journal of Gynecologic Cancer Vol. 25, No. 4 ( 2015-05), p. 688-693
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 25, No. 4 ( 2015-05), p. 688-693
    Abstract: The study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies. Methods Retrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function. Results Twenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24–39 years) and 21.3 kg/m 2 (range, 17.7–31.2 kg/m 2 ), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4–143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, −2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = −8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = −59.93, P = 0.05; overweight: β = −40.62, P = 0.041). Conclusions Location of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0000000000000404
    Language: English
    Publisher: BMJ
    Publication Date: 2015
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  • 4
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    Peritoneal Tuberculosis: A Retrospective Review of 20 Cases and Comparison With Primary Peritoneal Carcinoma
    BMJ ; 2010
    In:  International Journal of Gynecologic Cancer Vol. 20, No. 5 ( 2010-06), p. 798-803
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 20, No. 5 ( 2010-06), p. 798-803
    Abstract: To evaluate the clinical features of peritoneal tuberculosis (TB) and to compare them with those of primary peritoneal carcinoma (PPC). Methods: We conducted a retrospective review of women with peritoneal TB who were managed at Samsung Medical Center from January 1996 to October 2006. As a control sample, patients with a diagnosis of PPC during the same period were also selected for comparison. Results: During the study period, we identified 20 female patients with peritoneal TB. The median age was 39 years (range, 23-69 years), and the median cancer antigen 125 (CA-125) level was 448 U/mL (range, 32-1725 U/mL). Seventeen patients with PPC whom we examined were older, with a median age of 63 years (range, 50-73 years); their median CA-125 level was higher at 1848 U/mL (range, 42-14,380 U/mL). Compared with those of PPC, the radiologic findings of peritoneal TB indicated less severe involvement of the omentum and the mesentery ( P = 0.03). Among the 20 patients who underwent operations, 6 (30%) underwent exploratory laparotomy; 12 (60%), diagnostic laparoscopy; and 2 (10%), laparoscopy converted to laparotomy because of severe adhesion. Frozen tissue sections revealed chronic granulomatous tissue reaction in 15 (83.3%) of 18 women with peritoneal TB. Conclusions: Maintaining a high index of suspicion is very important for the successful treatment of peritoneal TB, especially in developing countries. Age, CA-125 level, and omental involvement as identified by computed tomography may be helpful for the differential diagnosis of peritoneal TB and PPC.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1111/IGC.0b013e3181e23c8f
    Language: English
    Publisher: BMJ
    Publication Date: 2010
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  • 5
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    Long-term Outcomes of MRI Stage IIB Cervical Cancer
    BMJ ; 2016
    In:  International Journal of Gynecologic Cancer Vol. 26, No. 7 ( 2016-09), p. 1252-1257
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 26, No. 7 ( 2016-09), p. 1252-1257
    Abstract: Magnetic resonance imaging (MRI) can be used to assess parametrial invasion (PMI) in cervical cancer. Discordance between MRI findings and International Federation of Gynecology and Obstetrics (FIGO) staging is not uncommon because FIGO staging depends on physical examination. The purpose of this study was to retrospectively evaluate the long-term outcomes of MRI stage IIB cervical cancer. Methods A total of 312 patients with MRI stage IIB cervical cancer were retrospectively found between 2002 and 2011. Of these patients, 171 (group 1) were FIGO stage IIB cervical cancers and 141 (group 2) were MRI stage IIB cervical cancers that were negative PMI on physical examination. Group 1 was treated with chemotherapy and/or radiation therapy, and group 2 was treated with radical hysterectomy and lymph node dissection. The FIGO stages and pathologic findings of group 2 were recorded. Groups 1 and 2 were compared regarding 5-year overall survival rate. Results The FIGO stages of group 2 were IB1 in 51 (36.2%), IB2 in 28 (19.9%), and IIA in 62 (44%), whereas those of group 1 were all IIB. Group 2 showed lymphovascular space invasion in 71 (50.4%), lymph node metastasis in 48 (34.0%), PMI in 46 (32.6%), and vagina invasion in 9 (6.4%). Five-year overall survival rates of groups 1 and 2 were 73.7% and 84.5%, respectively ( P = 0.013). Conclusions Magnetic resonance imaging stage IIB cervical cancers with negative PMI on physical examination should be surgically treated because of better survival rate than FIGO stage IIB cervical cancers.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0000000000000762
    Language: English
    Publisher: BMJ
    Publication Date: 2016
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  • 6
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    Patterns of Recurrence in Endometrial Cancer Patients at Risk of Lymph Node Metastasis or Recurrence According to Extent of Lymphadenectomy
    BMJ ; 2012
    In:  International Journal of Gynecological Cancer Vol. 22, No. 4 ( 2012-05), p. 611-616
    Details
    In: International Journal of Gynecological Cancer, BMJ, Vol. 22, No. 4 ( 2012-05), p. 611-616
    Type of Medium: Online Resource
    ISSN: 1048-891X
    URL: Article
    DOI: 10.1097/IGC.0b013e318249472d
    Language: English
    Publisher: BMJ
    Publication Date: 2012
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  • 7
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    Fertility-Sparing Surgery for Borderline Ovarian Tumors: Oncologic Safety and Reproductive Outcomes
    BMJ ; 2011
    In:  International Journal of Gynecologic Cancer Vol. 21, No. 4 ( 2011-04), p. 640-646
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 21, No. 4 ( 2011-04), p. 640-646
    Abstract: To evaluate the oncological safety and reproductive outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. Methods: Patients with BOTs who underwent radical or fertility-sparing surgery between 1997 and 2009 were identified from an institutional database. The recurrence rates were compared between the 2 surgery groups. To compare the reproductive outcomes, all patients who underwent fertility-sparing surgery were interviewed by telephone. Results: One hundred forty-three patients underwent radical surgery, and 155 patients underwent fertility-sparing surgery. After a median interval of 38 months from the initial surgery (range, 10-77 months), 19 patients had a recurrence. The recurrence rate was similar in the radical and fertility-sparing surgery groups (4.9% and 7.7%, respectively; P = 0.280). In the fertility-sparing surgery group, however, the main site of recurrence was the remaining ovary that was successfully salvaged with a second round of fertility-sparing surgery. Of 51 patients who attempted to conceive, 45 patients (88.2%) were successful and resulted in 54 term deliveries. Conclusions: Fertility-sparing surgery for BOTs is safe and can result in future pregnancies, suggesting that such surgery should be considered for young patients who desire preservation of fertility.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0b013e3182129842
    Language: English
    Publisher: BMJ
    Publication Date: 2011
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  • 8
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    Prognostic Factors Influencing Decisions About Surgical Treatment of Villoglandular Adenocarcinoma of the Uterine Cervix
    BMJ ; 2014
    In:  International Journal of Gynecologic Cancer Vol. 24, No. 7 ( 2014-09), p. 1299-1305
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 24, No. 7 ( 2014-09), p. 1299-1305
    Abstract: The objectives of this study were to analyze the clinicopathologic features of villoglandular adenocarcinoma (VGA) of the uterine cervix, a variant of cervical adenocarcinoma with good prognosis, and to discuss the association of human papillomavirus (HPV) infection with VGA. Methods A retrospective review of medical records was performed to identify the patients with VGA between 1999 and 2007 at the Samsung Medical Center. Results Fifteen patients were identified among 171 women diagnosed with adenocarcinoma of the cervix. The median age was 40 years (range, 32–72 years). Four patients were treated by cone biopsy and 10 patients by hysterectomy with or without pelvic lymphadenectomy. Five patients had invasion of more than half of the depth of tumor in the cervix. Lymphovascular space invasion was present in 2 patients, one of whom also had lymph node metastases. Three recurrences were identified during the median follow-up of 64 months (range, 9–149 months). An HPV test was positive in 6 of 7 patients. Of the 6 patients with HPV infection, 2 were positive for HPV type 18, one for HPV type 6, and the remaining 3 were positive for 1 or more types of high-risk HPV. Conclusions Although VGA has been reported to have a favorable prognosis, we observed recurrences in those patients with close margins by the tumor, lymph node metastasis, or advanced stage. Human papillomavirus DNA, mostly HPV types 16 and 18, was associated with VGA. Further studies are warranted on prognostic factors and the pathogenetic role of HPV infections.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0000000000000197
    Language: English
    Publisher: BMJ
    Publication Date: 2014
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  • 9
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    Bone Metastasis in Primary Endometrial Carcinoma: Features, Outcomes, and Predictors
    BMJ ; 2014
    In:  International Journal of Gynecologic Cancer Vol. 24, No. 1 ( 2014-01), p. 107-112
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 24, No. 1 ( 2014-01), p. 107-112
    Abstract: This study aimed to describe the clinicopathologic characteristics and outcomes and to assess the predictors associated with prognosis in endometrial carcinoma that developed bone metastasis. Methods A retrospective review of medical records was performed to identify the patients with endometrial carcinoma who developed bone metastasis between October 1994 and May 2012. Results Of the 1185 patients with endometrial carcinoma, 22 (1.8%) were identified with bone metastasis, and 21 patients were analyzed in the study. Seventeen (80.9%) patients had advanced-stage disease (2009 International Federation of Gynecologists and Obstetricians stages III-IV). Four (19.0%) patients had a bone lesion at the diagnosis of endometrial cancer. The median time of recurrence to the bone in 17 patients was 9 months (range, 2–43 months). The median overall survival (OS) and survival after bone metastasis of the entire cohort were 33 months (range, 9–57 months) and 15 months (range, 12–17 months), respectively. The patients with bone metastasis at recurrence had significantly longer OS than those patients with bone metastasis at diagnosis of endometrial cancer (36 vs 13 months; P = 0.042). Metastasis to extrapelvic bone was significantly associated with longer OS (46 vs 19 months; P = 0.001) and longer survival after bone metastasis (25 vs 12 months; P = 0.002). Isolated bone recurrence without extraosseous metastases and extrapelvic bone metastasis revealed independent predictors for survival after bone metastasis (hazard ratio, 0.09; 95% confidence interval, 0.01–0.67; P = 0.019 and hazard ratio, 0.07; 95% confidence interval, 0.01–0.53; P = 0.01). Conclusions In endometrial carcinoma that develops bone metastasis, isolated bone recurrence and extrapelvic bone metastasis are significant predictors of prolonged survival after the diagnosis of bone metastasis. Further researches on the optimal treatment modality and factors that have the clinical implications are warranted.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0000000000000015
    Language: English
    Publisher: BMJ
    Publication Date: 2014
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  • 10
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    Contributing Factors for Bone Metastasis in Uterine Cervical Cancer
    BMJ ; 2013
    In:  International Journal of Gynecologic Cancer Vol. 23, No. 7 ( 2013-09), p. 1311-1317
    Details
    In: International Journal of Gynecologic Cancer, BMJ, Vol. 23, No. 7 ( 2013-09), p. 1311-1317
    Abstract: The purpose of this study was to describe the clinical characteristics and to assess the contributing factors in patients developing bone metastasis in uterine cervical cancer. Methods Two thousand thirteen patients had a diagnosis of uterine cervical cancer at Samsung Medical Center between June 1994 and December 2011. During the study period, 105 patients with bone metastasis were identified, and their clinicopathologic data were investigated retrospectively. Results Among 105 patients with bone metastasis, 14 patients were excluded and 91 patients were evaluable. The median bone metastasis–free survival was 27 months (range, 0–279 months). The time to bone metastasis was significantly shorter in patients with adenocarcinoma than in patients with squamous cell carcinoma (median duration, 12 vs 29 months; P = 0.016). In addition, it was shorter in patients with stage IIB to stage IV disease than in those with stage I to stage IIA disease (15 vs 22 months; P = 0.02). The median survival after bone metastasis was 10 months, longer in the patients who received radiotherapy (± chemotherapy) than in the patients who received chemotherapy alone as a salvage therapy (12 vs 7 months; P = 0.01). Initial stage, number of bone metastases, location of involved bone, and coexisting metastatic lesion were not associated with the overall survival of the patients. Conclusions Our study demonstrates that adenocarcinoma, advanced stage (IIB-IV) and initial multiple bone metastases contribute to earlier bone metastasis. Once bone metastasis was recognized, the survival of these patients was poor and no factors were identified to predict survival of those patients.
    Type of Medium: Online Resource
    ISSN: 1048-891X , 1525-1438
    URL: Article
    DOI: 10.1097/IGC.0b013e31829da127
    Language: English
    Publisher: BMJ
    Publication Date: 2013
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