Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010

Lim, Myong Cheol,Moon, Eun-Kyeong,Shin, Aesun,Jung, Kyu-Won,Won, Young-Joo,Seo, Sang Soo,Kang, Sokbom,Kim, Jae-Weon,Kim, Joo-Young,Park, Sang-Yoon Asian Society of Gynecologic Oncology; Korean Soci 2013 Journal of Gynecologic Oncology Vol.24 No.4

<P><B>Objective</B></P><P>To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females.</P><P><B>Methods</B></P><P>Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated.</P><P><B>Results</B></P><P>The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females ≥80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%).</P><P><B>Conclusion</B></P><P>ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.</P>

Trends in gynecologic cancer mortality in East Asian regions

Lee, Jung-Yun,Kim, Eun-Yang,Jung, Kyu-Won,Shin, Aesun,Chan, Karen K. L.,Aoki, Daisuke,Kim, Jae-Weon,Low, Jeffrey J. H.,Won, Young-Joo Asian Society of Gynecologic Oncology; Korean Soci 2014 Journal of Gynecologic Oncology Vol.25 No.3

<P><B>Objective</B></P><P>To evaluate uterine and ovarian cancer mortality trends in East Asian countries.</P><P><B>Methods</B></P><P>For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases.</P><P><B>Results</B></P><P>Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized.</P><P><B>Conclusion</B></P><P>Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.</P>

Asian Society of Gynecologic Oncology International Workshop 2014

Park, Jeong-Yeol,Ngan, Hextan Yuen Sheung,Park, Won,Cao, Zeyi,Wu, Xiaohua,Ju, Woong,Chung, Hyun Hoon,Chang, Suk-Joon,Park, Sang-Yoon,Ryu, Sang-Young,Kim, Jae-Hoon,Cho, Chi-Heum,Lee, Keun Ho,Lee, Jeong Asian Society of Gynecologic Oncology; Korean Soci 2015 Journal of Gynecologic Oncology Vol.26 No.1

<P>The Asian Society of Gynecologic Oncology International Workshop 2014 on gynecologic oncology was held in Asan Medical Center, Seoul, Korea on the 23rd to 24th August 2014. A total of 179 participants from 17 countries participated in the workshop, and the up-to-date findings on the management of gynecologic cancers were presented and discussed. This meeting focused on the new trends in the management of cervical cancer, fertility-sparing management of gynecologic cancers, surgical management of gynecologic cancers, and recent advances in translational research on gynecologic cancers.</P>

Completeness of pedigree and family cancer history for ovarian cancer patients

Son, Yedong,Lim, Myong Cheol,Seo, Sang Soo,Kang, Sokbom,Park, Sang-Yoon Asian Society of Gynecologic Oncology; Korean Soci 2014 Journal of Gynecologic Oncology Vol.25 No.4

<P><B>Objective</B></P><P>To investigate the completeness of pedigree and of number of pedigree analysis to know the acceptable familial history in Korean women with ovarian cancer.</P><P><B>Methods</B></P><P>Interview was conducted in 50 ovarian cancer patients for obtaining familial history three times over the 6 weeks. The completeness of pedigree is estimated in terms of familial history of disease (cancer), health status (health living, disease and death), and onset age of disease and death.</P><P><B>Results</B></P><P>The completion of pedigree was 79.3, 85.1, and 85.6% at the 1st, 2nd, and 3rd time of interview and the time for pedigree analysis was 34.3, 10.8, and 3.1 minutes, respectively. The factors limiting pedigree analysis were as follows: out of contact with their relatives (38%), no living ancestors who know the family history (34%), dispersed family member because of the Korean War (16%), unknown cause of death (12%), reluctance to ask medical history of relatives (10%), and concealing their ovarian cancer (10%). The percentage of cancers revealed in 1st (2%) and 2nd degree (8%) relatives were increasing through surveys, especially colorectal cancer related with Lynch syndrome (4%).</P><P><B>Conclusion</B></P><P>Analysis of pedigree at least two times is acceptable in Korean woman with ovarian cancer from the first study. The completion of pedigree is increasing, while time to take family history is decreasing during three time survey.</P>

External validation of chemotherapy response score system for histopathological assessment of tumor regression after neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma

Lee, Jung-Yun,Chung, Young Shin,Na, Kiyong,Kim, Hye Min,Park, Cheol Keun,Nam, Eun Ji,Kim, Sunghoon,Kim, Sang Wun,Kim, Young Tae,Kim, Hyun-Soo Asian Society of Gynecologic Oncology; Korean Soci 2017 Journal of Gynecologic Oncology Vol.28 No.6

<P><B>Objective</B></P><P>The chemotherapy response score (CRS) system based on histopathological examination has been recently proposed for tubo-ovarian high-grade serous carcinoma (HGSC) to assess response to neoadjuvant chemotherapy (NAC). This study was aimed at validating the CRS system in an external cohort of tubo-ovarian HGSC patients.</P><P><B>Methods</B></P><P>This study included 110 tubo-ovarian HGSC patients who underwent NAC followed by interval debulking surgery. The 3-tiered CRS of the omental and adnexal tissue sections was determined by 3 independent pathologists. Differences in patient outcomes according to CRS were analyzed.</P><P><B>Results</B></P><P>The CRS system was highly reproducible among the 3 pathologists. Fleiss' kappa value and Kendall's coefficient of concordance for the omental CRS were 0.656 and 0.669, respectively. The omental CRS significantly predicted progression-free survival (PFS). The median PFS of patients whose tumors exhibited the omental CRS 1–2 (15 months) was significantly shorter than that of patients with an omental CRS of 3 (19 months; p=0.016). In addition, after adjusting for age, stage, and debulking status, the omental CRS was an independent prognostic factor for PFS of tubo-ovarian HGSC patients who were treated with NAC (adjusted hazard ratio [HR]=1.74; 95% confidence interval [CI]=1.05–2.87).</P><P><B>Conclusion</B></P><P>The CRS system for assessing NAC response was a reproducible prognostic tool in our cohort. The application of the CRS system after NAC can improve survival estimation in HGSC patients.</P>

High expression of epidermal growth factor-like domain 7 is correlated with poor differentiation and poor prognosis in patients with epithelial ovarian cancer

Oh, Jinju,Park, Sung Hae,Lee, Tae Sung,Oh, Hoon Kyu,Choi, Jung-Hye,Choi, Youn Seok Asian Society of Gynecologic Oncology; Korean Soci 2014 Journal of Gynecologic Oncology Vol.25 No.4

<P><B>Objective</B></P><P>The purpose of this study was to evaluate the expression of epidermal growth factor-like domain 7 (EGFL7) in epithelial ovarian cancer, and to assess its relevance to clinicopathological characteristics and patients' survival.</P><P><B>Methods</B></P><P>A total of 177 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for EGFL7 was performed using tissue microarrays made with paraffin-embedded tissue block. EGFL7 expression levels were graded on a grade of 0 to 3 based on the percentage of positive cancer cells. We analyzed the correlations between the expression of EGFL7 and various clinical parameters, and also analyzed the survival outcome according to the EGFL7 expression.</P><P><B>Results</B></P><P>The expression of EGFL7 in ovarian cancer tissues was observed in 98 patients (55.4%). High expression of EGFL7 (grade 2 or 3) was significantly correlated with pathologic type, differentiation, stage, residual tumor after debulking surgery, lymphovascular space involvement, lymph node metastasis, high cancer antigen 125, peritoneal cytology, and ascites. Among these clinicopathologic factors, differentiation was significantly correlated with EGFL7 expression in multivariate analysis (p<0.05). Survival analysis showed that the patients with high EGFL7 expression had a poorer disease free survival than those with low EGFL7 expression (p=0.002).</P><P><B>Conclusion</B></P><P>Our data suggest that EGFL7 expression is a novel predictive factor for the clinical progression of epithelial ovarian cancer, and may constitute a therapeutic target for antiangiogenesis therapy in patients with epithelial ovarian cancer.</P>

Incorporation of paclitaxel-based hyperthermic intraperitoneal chemotherapy in patients with advanced-stage ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery: a protocol-based pilot study

Lee, Yong Jae,Lee, Jung-Yun,Cho, Min-Soo,Nam, Eun Ji,Kim, Sang Wun,Kim, Sunghoon,Kim, Young Tae Asian Society of Gynecologic Oncology; Korean Soci 2019 Journal of Gynecologic Oncology Vol.30 No.1

<P><B>Objectives</B></P><P>We conducted a protocol-based cohort study to evaluate the outcomes of interval debulking surgery (IDS) followed by paclitaxel-based hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of advanced-stage ovarian cancer.</P><P><B>Methods</B></P><P>From October 2015 to May 2018, 65 patients with stages IIIC–IV ovarian cancer were treated according to the study protocol. HIPEC was performed with paclitaxel (175 mg/m<SUP>2</SUP>) for 90 minutes, only in cases of optimal cytoreduction.</P><P><B>Results</B></P><P>Of 65 patients, 40 (61.5%) patients underwent neoadjuvant chemotherapy (NAC), 34 (52.3%) patients had a high tumor burden with a Fagotti score ≥8 at diagnostic laparoscopy, and 6 (9.2%) had definite stage IV metastasis and/or poor performance status before NAC. Twenty-seven (41.5%) patients underwent IDS followed by HIPEC. The mean duration of IDS with HIPEC was 543.8 (range, 277.0–915.0) minutes. Grade III/IV perioperative complications occurred in 7.4% (n=2)/3.7% (n=1) of patients and no cases of mortality were reported within 30 days postoperatively. The median progression-free survival was 21.3 months, and the median overall survival was not reached for those who received HIPEC.</P><P><B>Conclusions</B></P><P>According to our study protocol, IDS followed by paclitaxel-based HIPEC as a first-line treatment appears to be feasible and safe for the treatment of advanced-stage ovarian cancer. Further evaluations of this procedure are required to assess its survival benefits.</P>

Survival outcomes after extensive cytoreductive surgery and selective neoadjuvant chemotherapy according to institutional criteria in bulky stage IIIC and IV epithelial ovarian cancer

Lim, Myong Cheol,Yoo, Heong Jong,Song, Yong Jung,Seo, Sang-Soo,Kang, Sokbom,Kim, Sun Ho,Yoo, Chong Woo,Park, Sang-Yoon Asian Society of Gynecologic Oncology; Korean Soci 2017 Journal of Gynecologic Oncology Vol.28 No.4

<P><B>Objective</B></P><P>To investigate the survival outcomes in patients with bulky stage IIIC and IV ovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvant chemotherapy (NAC) according to institutional criteria.</P><P><B>Methods</B></P><P>Medical records for advanced ovarian cancer patients who were treated at National Cancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewed in the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases were included. Current NCC indication for NAC is determined based on patients' performance status and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially including chemotherapy-resistant cancer cells, were surgically removed.</P><P><B>Results</B></P><P>Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136 (49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achieved in 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. The median progression-free survival (PFS) and overall survival (OS) time were 20 months and not reached, but might be estimated more than 70 months in the PDS group and 15 and 70 months in the NAC group, respectively.</P><P><B>Conclusion</B></P><P>Extensive cytoreductive surgery to minimize residual tumor and selective use of NAC based on the institutional criteria could result in improved survival outcomes. Until further studies can be done to define the selection criteria for NAC after surgery, institutional criteria for NAC should consider the ability of the surgeon and institutional capacity.</P>

Comparing prediction models for lymph node metastasis risk in endometrial cancer: the winner may not take it all

Asian Society of Gynecologic Oncology; Korean Soci 2017 Journal of Gynecologic Oncology Vol.28 No.6

Clinical outcomes of patients with clear cell and endometrioid ovarian cancer arising from endometriosis

Paik, E Sun,Kim, Tae-Joong,Choi, Chel Hun,Kim, Byoung-Gie,Bae, Duk-Soo,Lee, Jeong-Won Asian Society of Gynecologic Oncology; Korean Soci 2018 Journal of Gynecologic Oncology Vol.29 No.2

<P><B>Objective</B></P><P>The aim of this investigation is to compare outcomes of patients according to the presence of cancer arising from endometriosis in ovarian clear cell carcinoma (CCC) and endometrioid carcinoma (EC).</P><P><B>Methods</B></P><P>This study retrospectively investigated 224 CCC and EC patients treated in Samsung Medical Center from 2001 to 2015 to identify cancer arising from endometriosis according to Sampson and Scott criteria. Propensity score matching was performed to compare patients arising from endometriosis to patients without endometriosis (ratio 1:1) according to stage, age, lymph node metastasis (LNM), cancer antigen (CA)-125 level, and residual status after debulking surgery.</P><P><B>Results</B></P><P>Forty-five cases arising from endometriosis were compared with 179 cases without endometriosis. CCC and EC arising from endometriosis tended to present with early age (mean, 45.2 vs. 49.2 years; p=0.003), early-stage (stages I and II, 92.7% vs. 62.3%; p<0.001), lower CA-125 level (mean, 307.1 vs. 556.7; p=0.041), higher percentages of no gross residual disease after surgery (87.8% vs.56.8%; p=0.001), and higher percentages of negative LNM (82.9% vs. 59.0%; p=0.008) compared to cases without endometriosis. Kaplan-Meier curves for progression-free survival (PFS) and overall survival (OS) showed better outcomes for groups with cancer arising from endometriosis (p=0.014 for PFS; and p=0.010 for OS). However, the association with endometriosis was not significant in multivariate analysis. Also, after propensity score matching, survival differences between the 2 groups were not significant.</P><P><B>Conclusion</B></P><P>CCC and EC arising from endometriosis are diagnosed at an earlier age and stage. However, cancer arising from endometriosis was not a significant prognostic factor.</P>