Details of a Researcher - Iwata, Takashi

Papers - Iwata, Takashi

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Monitoring the impact of a national HPV vaccination program in Japan (MINT Study): rationale, design and methods

Matsumoto, K., Yaegashi, N., Iwata, T., Ariyoshi, K., Fujiwara, K., Shiroyama, Y., Usami, T., Kawano, Y., Horie, K., Kawano, K., Noda, K., Yoshikawa, H. and Group, MINT Study

Jpn J Clin Oncol 44 ( 10 ) 1000 - 3 2014.10

ISSN 1465-3621

We have developed a collaborative hospital-based approach to monitoring the impact of a human papillomavirus vaccine on cervical cancer, its precursor lesions and human papillomavirus type-specific prevalence in Japan. The monitoring will be conducted for a total period of 21 years on women aged <40 who are newly diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia or adenocarcinoma in situ at 21 participating institutes. Women are monitored to determine their vaccine history and will be human papillomavirus-genotyped each year. The primary endpoint is the human papillomavirus16/human papillomavirus18-positive rate in women aged 16-25 who are diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia grade 2/3 and adenocarcinoma in situ. The major secondary endpoints are the number of women aged <40 who are diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia grade 2/3 and adenocarcinoma in situ, the human papillomavirus type-specific prevalence, and the number of deaths from invasive cervical cancer in women aged <40. Long-term surveillance for human papillomavirus-associated cervical diseases in young females is important for the development of future strategies for cervical cancer prevention in Japan.

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Human papillomavirus genotype distribution in cervical intraepithelial neoplasia grade 2/3 and invasive cervical cancer in Japanese women

Azuma, Y., Kusumoto-Matsuo, R., Takeuchi, F., Uenoyama, A., Kondo, K., Tsunoda, H., Nagasaka, K., Kawana, K., Morisada, T., Iwata, T., Aoki, D. and Kukimoto, I.

Jpn J Clin Oncol 44 ( 10 ) 910 - 7 2014.10

ISSN 1465-3621

Human papillomavirus vaccines are being introduced worldwide and are expected to reduce the incidence of cervical cancer. Here we report a cross-sectional study using a validated human papillomavirus genotyping method to reveal the human papillomavirus prevalence and genotype distribution in Japanese women with cervical intraepithelial neoplasia Grade 2/3 and invasive cervical cancer.|Cervical exfoliated cells were collected from 647 patients with abnormal cervical histology (cervical intraepithelial neoplasia Grade 2, n = 164; cervical intraepithelial neoplasia Grade 3, n = 334; and invasive cervical cancer, n = 149), and subjected to the PGMY-PCR-based genotyping assay. The association between human papillomavirus infection and lesion severity was calculated using a prevalence ratio.|Overall, the prevalence of human papillomavirus deoxyribonucleic acid was 96.3% in cervical intraepithelial neoplasia Grade 2, 98.8% in cervical intraepithelial neoplasia Grade 3 and 88.0% in invasive cervical cancer (97.8% in squamous cell carcinoma and 71.4% in adenocarcinoma). The three most prevalent types were as follows: human papillomavirus 16 (29.3%), human papillomavirus 52 (27.4%) and human papillomavirus 58 (22.0%) in cervical intraepithelial neoplasia Grade 2; human papillomavirus 16 (44.9%), human papillomavirus 52 (26.0%) and human papillomavirus 58 (17.4%) in cervical intraepithelial neoplasia Grade 3; and human papillomavirus 16 (47.7%), human papillomavirus 18 (23.5%) and human papillomavirus 52 (8.7%) in invasive cervical cancer. The prevalence ratio of human papillomavirus 16 was significantly higher in cervical intraepithelial neoplasia Grade 3 compared with cervical intraepithelial neoplasia Grade 2 (prevalence ratio, 1.62; 95% confidence interval, 1.26-2.13) and in squamous cell carcinoma compared with cervical intraepithelial neoplasia Grade 3 (prevalence ratio, 1.55; 95% confidence interval, 1.25-1.87). Multiple infections decreased from cervical intraepithelial neoplasia Grade 2/3 (38.4/29.6%) to invasive cervical cancer (14.1%), whereas co-infections with human papillomavirus 16/52/58 were found in cervical intraepithelial neoplasia Grade 2/3.|The results of this study provide pre-vaccination era baseline data on human papillomavirus type distribution in Japanese women and serve as a reliable basis for monitoring the future impact of human papillomavirus vaccination in Japan.

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Candidate biomarkers for cervical cancer treatment: Potential for clinical practice (Review)

Iida, M., Banno, K., Yanokura, M., Nakamura, K., Adachi, M., Nogami, Y., Umene, K., Masuda, K., Kisu, I., Iwata, T., Tanaka, K. and Aoki, D.

Mol Clin Oncol 2 ( 5 ) 647 - 655 2014.09

ISSN 2049-9450

Cervical cancer ranks high among the causes of female cancer mortalities and is an important disease in developing and developed countries. Current diagnosis of cervical cancer depends on colposcopy, pathological diagnosis and preoperative diagnosis using methods, including magnetic resonance imaging and computed tomography. Advanced cervical cancer has a poor prognosis. The tumor marker squamous cell carcinoma is conventionally used for screening, but recent studies have revealed the mechanisms of carcinogenesis and the factors associated with a poor prognosis in cervical cancer. These include epigenetic biomarkers, with the methylation level of the checkpoint with forkhead and ring finger gene being potentially useful for predicting the malignancy of cervical cancer and sensitivity to treatment with paclitaxel. The extent of methylation of the Werner DNA helicase gene is also useful for determining sensitivity to an anticancer agent, CPT-11. In addition to epigenetic changes, the expression levels of hypoxia-inducible factor 1α subunit, epidermal growth factor receptor and cyclooxygenase-2 have been reported as possible biomarkers in cervical cancer. Novel prognostic factors, including angiogenic factors, fragile histidine triad, thymidylate synthase, glucose-related protein 58 and mucin antigens, have also been described, and hemoglobin and platelets may also be significant prognostic biomarkers. Utilization of these biomarkers may facilitate personalized treatment and improved outcomes in cervical cancer.

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子宮頸部円錐切除術後の出血に関する検討

渡邊, 慶子, 西尾, 浩, 冨永, 英一郎, 岩田, 卓, 杉山, 重里, 森定, 徹, 田中, 京子, 吉村, 泰典 and 青木, 大輔

東京産科婦人科学会会誌 63 ( 3 ) 394 - 399 2014.07

ISSN 2186-0599

子宮頸部円錐切除術は主に診断の確定のために行われ、異形成・上皮内癌の場合は治療法ともなりうる侵襲の少ない術式であるが、術後出血を認める例が少なくない。そこで今回、円錐切除術後の出血に関する検討を後方視的に行った。2012年1月から12月に当科での施行症例は228例であり、年齢・手術時間の中央値は39歳、22分であった。手術後に止血処置を要した症例(止血群)は21例(9.2%)、術後日数(中央値)は13日であった。このうち、4例で縫合止血を要し、17例では止血剤散布とガーゼ圧迫での止血が可能であった。年齢・手術時間は、止血群と非止血群で有意差を認めなかったが、止血群で年齢が高い傾向を認めた。使用器具や出産経験による出血の頻度に違いは認めなかった。子宮頸部円錐切除術は、術後1〜2週間を中心に約1割の症例で止血処置を要するため、出血に関する情報提供を行う必要がある。(著者抄録)

Immunosuppression through constitutively activated NF-κB signalling in human ovarian cancer and its reversal by an NF-κB inhibitor

Nishio H., Yaguchi T., Sugiyama J., Sumimoto H., Umezawa K., Iwata T., Susumu N., Fujii T., Kawamura N., Kobayashi A., Park J., Aoki D., Kawakami Y.

British Journal of Cancer 110 ( 12 ) 2965 - 2974 2014.06

ISSN 0007-0920

Background:Although T-cell immunity is thought to be involved in the prognosis of epithelial ovarian cancer (EOC) patients, immunosuppressive conditions hamper antitumour immune responses. Thus, their mechanisms and overcoming strategies need to be investigated.Methods:The role of NF-κB in human EOC cells and macrophages was evaluated by in vitro production of immunosuppressive IL-6 and IL-8 by EOC cells and in vivo analysis of immune responses in nude mice implanted with human EOC cells using an NF-κB inhibitor DHMEQ.Results:In EOC patients, increased plasma IL-6, IL-8, and arginase were observed. The NF-κB inhibitor DHMEQ inhibited the production of IL-6 and IL-8 by EOC cell lines. Immunosuppression of human DCs and macrophages by culture supernatant of EOC cells was reversed with the pretreatment of DHMEQ. Administration of DHMEQ to nude mice implanted with human EOC resulted in the restoration of T-cell stimulatory activity of murine DCs along with the reduction of tumour accumulation and arginase expression of MDSCs. Nuclear factor-κB inhibition in tumour-bearing mice also enhanced antitumour effects of transferred murine naive T cells.Conclusions:NF-κB is involved in the immunosuppression induced by human EOC, and its inhibitor may restore antitumour immune responses, indicating that NF-κB is an attractive target for EOC treatment. © 2014 Cancer Research UK.

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Immunosuppression through constitutively activated NF-κB signalling in human ovarian cancer and its reversal by an NF-κB inhibitor

Nishio, H., Yaguchi, T., Sugiyama, J., Sumimoto, H., Umezawa, K., Iwata, T., Susumu, N., Fujii, T., Kawamura, N., Kobayashi, A., Park, J., Aoki, D. and Kawakami, Y.

Br J Cancer 110 ( 12 ) 2965 - 74 2014.06

ISSN 1532-1827

Although T-cell immunity is thought to be involved in the prognosis of epithelial ovarian cancer (EOC) patients, immunosuppressive conditions hamper antitumour immune responses. Thus, their mechanisms and overcoming strategies need to be investigated.|The role of NF-κB in human EOC cells and macrophages was evaluated by in vitro production of immunosuppressive IL-6 and IL-8 by EOC cells and in vivo analysis of immune responses in nude mice implanted with human EOC cells using an NF-κB inhibitor DHMEQ.|In EOC patients, increased plasma IL-6, IL-8, and arginase were observed. The NF-κB inhibitor DHMEQ inhibited the production of IL-6 and IL-8 by EOC cell lines. Immunosuppression of human DCs and macrophages by culture supernatant of EOC cells was reversed with the pretreatment of DHMEQ. Administration of DHMEQ to nude mice implanted with human EOC resulted in the restoration of T-cell stimulatory activity of murine DCs along with the reduction of tumour accumulation and arginase expression of MDSCs. Nuclear factor-κB inhibition in tumour-bearing mice also enhanced antitumour effects of transferred murine naive T cells.|NF-κB is involved in the immunosuppression induced by human EOC, and its inhibitor may restore antitumour immune responses, indicating that NF-κB is an attractive target for EOC treatment.

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Application of microRNA in the treatment and diagnosis of cervical cancer

Banno Kouji, Iida Miho, Yanokura Megumi, Kisu Iori, Nakamura Kanako, Adachi Masataka, Iwata Takashi, Tanaka Kyoko, Aoki Daisuke

129 - 137 2014.02

MicroRNAs (miRNAs) are small non-coding RNA molecules of 20-23 nucleotides that regulate gene expression by binding to complementary mRNA sequences. Aberrant miRNA expression is implicated in carcinogenesis and malignancy of cancer. miRNAs involved in carcinogenesis are broadly classified into oncogenic and tumor suppressor miRNAs, and overexpression of oncogenic miRNAs and decreased expression of tumor suppressor miRNAs are found in cancer cells. Recent studies using miRNAs with different expression patterns between normal and cancer tissues have proposed use of miRNAs as biomarkers for cancer diagnosis and as treatment targets. In cervical cancer, miRNAs may be useful for onset detection, diagnosis and treatment. Here, we review the potential clinical applications of miRNAs for diagnosis and as a therapeutic strategy in cervical cancer.

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当院健康維持外来における慢性頭痛に対する呉茱萸湯の検討

堀場, 裕子, 吉野, 鉄大, 牧田, 和也, 横田, めぐみ, 岩田, 卓, 青木, 大輔 and 吉村, 泰典

産婦人科漢方研究のあゆみ ( 31 ) 89 - 93 2014

ISSN 0913-865X

2000年4月〜2012年12月に健康維持外来受診した初診患者で、頭痛に対して呉茱萸湯エキス製剤が処方された有経・閉経68例を抽出し、これらのうち初診時の症状に対する問診票への記載が確認できた40例の回答状況の相違について検討した。その結果、1)40例中、有効は32例、無効は8例であった。また、片頭痛と診断されたのは有効例では12例、無効例では1例であり、両群間の平均年齢・BMI・閉経例の割合は有意差は認められなかった。2)問診票の項目で有意差が認められた項目は「動悸」「意欲がわかない」「腟の痒み」であった。3)呉茱萸湯の投与目標としての「頭痛」「嘔気」「手足の冷え」「肩こり」は有効例と無効例においてどちらも有意差は認められなかった。4)重症度別で比較すると「動悸」は有効例では重症度2と3が合計37%であったのに対し、無効例では重症度2と3は認められなかった。一方、「意欲がわかない」は有効例では症状ありが70%であったのに対し、無効例では47%であった。更に「腟の痒み」は有効例では症状なしと重症度1しか認めず、無効例では重症度2が25%であった。以上より、「動悸」「意欲がわかない」は呉茱萸湯の奏功例を見分ける指標となり得ることが示唆された。

MicroRNA in cervical cancer

Banno Kouji, Iida Miho, Yanokura Megumi, Kisu Iori, Iwata Takashi, Tominaga Eiichiro, Tanaka Kyoko, Aoki Daisuke

The Scientific World Journal 2014 2014

Cervical cancer is a female-specific disease with a high incidence and mortality. MicroRNAs (miRNAs) are implicated in posttranscriptional regulation of gene expression and in the pathogenic mechanisms of cancer, suggesting their importance in diagnosis and treatment. miRNAs may have roles in the pathogenesis of cervical cancer based on the increases or decreases in several specific miRNAs found in patients with this disease. The miRNAs implicated in cervical cancer are miR-21, miR-126, and miR-143, and clinical application of these miRNAs for diagnosis and treatment is under investigation. Methods for diagnosis of cervical cancer include analysis of changes in the levels of specific miRNAs in serum and determination of aberrant hypermethylation of miRNAs. Supplementation of miR-143 or inhibition of miR-21 activity in vivo may be therapeutic strategy for cervical cancer. Previous approaches to development of siRNA as a drug have provided information for establishment of therapy based on these approaches, and an anti-miR-21 inhibitor has been developed. miRNAs also have effects on drug resistance and may be useful in combination therapy with other drugs. © 2014 Kouji Banno et al.

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MicroRNA in cervical cancer: OncomiRs and tumor suppressor miRs in diagnosis and treatment

Banno, K., Iida, M., Yanokura, M., Kisu, I., Iwata, T., Tominaga, E., Tanaka, K. and Aoki, D.

ScientificWorldJournal 2014 178075 2014

ISSN 1537-744X

Cervical cancer is a female-specific disease with a high incidence and mortality. MicroRNAs (miRNAs) are implicated in posttranscriptional regulation of gene expression and in the pathogenic mechanisms of cancer, suggesting their importance in diagnosis and treatment. miRNAs may have roles in the pathogenesis of cervical cancer based on the increases or decreases in several specific miRNAs found in patients with this disease. The miRNAs implicated in cervical cancer are miR-21, miR-126, and miR-143, and clinical application of these miRNAs for diagnosis and treatment is under investigation. Methods for diagnosis of cervical cancer include analysis of changes in the levels of specific miRNAs in serum and determination of aberrant hypermethylation of miRNAs. Supplementation of miR-143 or inhibition of miR-21 activity in vivo may be therapeutic strategy for cervical cancer. Previous approaches to development of siRNA as a drug have provided information for establishment of therapy based on these approaches, and an anti-miR-21 inhibitor has been developed. miRNAs also have effects on drug resistance and may be useful in combination therapy with other drugs.

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Repair of the threatened feminine identity: experience of women with cervical cancer undergoing fertility preservation surgery

Komatsu, H., Yagasaki, K., Shoda, R., Chung, Y., Iwata, T., Sugiyama, J. and Fujii, T.

Cancer Nurs 37 ( 1 ) 75 - 82 2014

ISSN 1538-9804

Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed.|The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer.|We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism.|Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery.|Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation.|Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

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【がん免疫療法の最前線】がん免疫病態の細胞分子機構

河上, 裕, 杉山, 重里, 西尾, 浩, 岩田, 卓 and 青木, 大輔

産科と婦人科 81 ( 2 ) 145 - 150 2014

ISSN 0386-9792

【がん免疫療法の最前線】細胞傷害性T細胞を用いた免疫療法

岩田, 卓, 杉山, 重里, 西尾, 浩, 平尾, 薫丸 and 青木, 大輔

産科と婦人科 81 ( 2 ) 151 - 156 2014

ISSN 0386-9792

【産婦人科手術Up to Date】 (第2章)婦人科　子宮頸癌　子宮頸癌における妊孕性温存術式

田中, 京子, 杉山, 重里, 西尾, 浩, 森定, 徹, 岩田, 卓 and 青木, 大輔

産科と婦人科 81 ( Suppl. ) 109 - 113 2014

ISSN 0386-9792

Methylation of human papillomavirus-52 and -58 is a candidate biomarker in cervical neoplasia

Murakami, I., Fujii, T., Dan, K., Saito, M., Ohno, A., Iwata, T. and Aoki, D.

J Clin Virol 58 ( 1 ) 149 - 54 2013.09

ISSN 1873-5967

Previous studies of human papillomavirus (HPV)16/18 genome methylation have concluded that methylation status of the L1 gene might act as a biomarker for cervical intraepithelial neoplasia (CIN).|We investigated the correlation between methylation status in the L1 gene and the long control region (LCR) of HPV52/58 and CIN.|Exfoliated cervical cells were taken from 54 HPV52-positive and 41 HPV58-positive women. The HPV genome was examined using bisulfite modification, polymerase chain reaction amplification, and sequencing.|The CpGs were unmethylated or hypomethylated in the HPV52/58 LCR. In contrast, the methylation status of the HPV52 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 15%, 34%, and 52% for cervicitis/CIN1, CIN2, and CIN3, respectively (P<0.05). Methylation status of the HPV52 L1 gene was also correlated with the prognosis of CIN1/2, with median percentages of 15% and 35% for regression and persistence/progression, respectively (P<0.05). The methylation status of the HPV58 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 12%, 38%, and 61% for cervicitis/CIN1, CIN2, and CIN3, respectively (P<0.05).|The increased methylation at the CpG sites in the HPV52/58 L1 gene was correlated with the severity of cervical neoplasia, similar to HPV16/18 in previous studies. These data suggest that HPV methylation status of the L1 gene is a candidate biomarker of CIN for detecting CIN2 and CIN3.

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Methylation of human papillomavirus-52 and -58 is a candidate biomarker in cervical neoplasia

Murakami Isao, Fujii Takuma, Dan Katsuaki, Saito Miyuki, Ohno Akiko, Iwata Takashi, Aoki Daisuke

Journal of Clinical Virology 58 ( 1 ) 149 - 154 2013.09

ISSN 1386-6532

Background: Previous studies of human papillomavirus (HPV)16/18 genome methylation have concluded that methylation status of the L1 gene might act as a biomarker for cervical intraepithelial neoplasia (CIN). Objectives: We investigated the correlation between methylation status in the L1 gene and the long control region (LCR) of HPV52/58 and CIN. Study design: Exfoliated cervical cells were taken from 54 HPV52-positive and 41 HPV58-positive women. The HPV genome was examined using bisulfite modification, polymerase chain reaction amplification, and sequencing. Results: The CpGs were unmethylated or hypomethylated in the HPV52/58 LCR. In contrast, the methylation status of the HPV52 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 15%, 34%, and 52% for cervicitis/CIN1, CIN2, and CIN3, respectively ( P<. 0.05). Methylation status of the HPV52 L1 gene was also correlated with the prognosis of CIN1/2, with median percentages of 15% and 35% for regression and persistence/progression, respectively ( P<. 0.05). The methylation status of the HPV58 L1 gene was correlated with the severity of cervical neoplasia, with average percentages of 12%, 38%, and 61% for cervicitis/CIN1, CIN2, and CIN3, respectively ( P<. 0.05). Conclusions: The increased methylation at the CpG sites in the HPV52/58 L1 gene was correlated with the severity of cervical neoplasia, similar to HPV16/18 in previous studies. These data suggest that HPV methylation status of the L1 gene is a candidate biomarker of CIN for detecting CIN2 and CIN3. © 2013 Elsevier B.V.

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p16(INK4a) immunohistochemistry is a promising biomarker to predict the outcome of low grade cervical intraepithelial neoplasia: comparison study with HPV genotyping

Nishio, S., Fujii, T., Nishio, H., Kameyama, K., Saito, M., Iwata, T., Kubushiro, K. and Aoki, D.

J Gynecol Oncol 24 ( 3 ) 215 - 21 2013.07

ISSN 2005-0380

In cervical intraepithelial neoplasia (CIN), p16(INK4a) immunohistochemistry has been reported to be a useful diagnostic biomarker. However, limited information is available about the association between the p16(INK4a) immunohistochemistry and the outcomes of CIN. Here, we report p16(INK4a) immunohistochemistry as an effective biomarker to predict the outcomes of CIN.|p16(INK4a) immunohistochemistry was performed in patients with CIN from January 2000 to August 2009. Among these patients, we have performed a retrospective analysis of the medical records to evaluate the outcome of CIN 1-2 and performed statistical analysis to determine the correlation between p16(INK4a) expression and the outcomes. We also performed HPV genotyping and analyzed the relation between the infecting human papillomavirus (HPV) genotype and the outcomes.|A total of 244 patients, including 82 with CIN 1, 60 with CIN 2, and 102 with CIN 3, were examined. The rate of p16(INK4a) overexpression increased with increasing CIN grade, 20.7% for CIN 1, 80.0% for CIN 2, and 89.2% for CIN 3, with significant differences between CIN 1 and CIN 2-3 group. In the 131 CIN 1-2 patients, the progression rate was significantly higher for the patients showing p16(INK4a) overexpression than for those not showing p16(INK4a) overexpression (p=0.005); the regression rate was also found to be significantly lower for the patients showing p16(INK4a) overexpression (p=0.003). High-risk HPV genotypes were detected in 73 patients (73.7%). Both progression and regression rates were not significantly different between the high-risk HPV-positive and HPV-negative groups (p=0.401 and p=0.381, respectively).|p16(INK4a) overexpression was correlated with the outcome of CIN 1-2, and p16(INK4a) is considered to be a superior biomarker for predicting the outcome of CIN 1-2 compared with HPV genotyping.

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Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies.

Nishio Hiroshi, Fujii Takuma, Sugiyama Juri, Kuji Naoaki, Tanaka Mamoru, Hamatani Toshio, Miyakoshi Kei, Minegishi Kazuhiro, Tsuda Hiroshi, Iwata Takashi, Tanaka Kyoko, Fukuchi Takeshi, Takehara Yuji, Yoshimura Yasunori, Aoki Daisuke

Human reproduction (Oxford, England) 28 ( 7 ) 1793 - 1798 2013.07

What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer? When RAT was performed before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥ 32 weeks of gestation. Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied. This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated. Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented. Patients' median age was 33 years (25-40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥ 37 weeks of gestation. Because of the retrospective data collection, not all pregnancies may have been recorded. Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.

Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies

Nishio, H., Fujii, T., Sugiyama, J., Kuji, N., Tanaka, M., Hamatani, T., Miyakoshi, K., Minegishi, K., Tsuda, H., Iwata, T., Tanaka, K., Fukuchi, T., Takehara, Y., Yoshimura, Y. and Aoki, D.

Hum Reprod 28 ( 7 ) 1793 - 8 2013.07

ISSN 1460-2350

What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer?|When RAT was performed before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥ 32 weeks of gestation.|Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied.|This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated.|Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented.|Patients' median age was 33 years (25-40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥ 37 weeks of gestation.|Because of the retrospective data collection, not all pregnancies may have been recorded.|Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.

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長期的なホットフラッシュに三物黄ごん湯が有効であった1例

堀場, 裕子, 牧田, 和也, 横田, めぐみ, 岩田, 卓, 青木, 大輔 and 吉村, 泰典

産婦人科漢方研究のあゆみ ( 30 ) 30 - 33 2013

ISSN 0913-865X

59歳女性。46歳時に子宮筋腫の術前診断にて単純子宮全摘術を施行された。摘出標本の病理組織学的所見では低分化型子宮肉腫で、高用量黄体ホルモン療法を施行され、再発や転移は認められなかった。しかし今回、50歳頃からホットフラッシュが出現、59歳頃からは全身倦怠感も感じるようになり、漢方治療を希望して健康維持の外来受診となった。初診時、漢方医学的所見から病態はお血が主体と考え、桂枝茯苓丸エキス製剤(7.5g/日、食前服用)を処方したところ、2週間後の再診時には便通が軽度軽快したのみであったが、処方は4週間継続された。一方、両親の介護が始まったことでイライラが増強したため、加味逍遙散エキス製剤(7.5g/日、食前服用)を追加したが、ホットフラッシュは明らかな変化なく、腹診所見から柴胡加竜骨牡蠣湯エキス製剤(6.0g/日)を処方するも、こちらも変化はみられなかった。以後、再度の問診にてホットフラッシュと同時に起こる手足のほてりと発汗を認めたことから三物黄ごん湯エキス製剤(7.5g/日、食前服用)を処方した結果、2週間経過でホットフラッシュの回数は軽減、1ヵ月後には日常生活で気にならなくなった。

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