Details of a Researcher - Yamagami, Wataru

Papers - Yamagami, Wataru

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子宮体癌への妊孕性温存療法後の帝王切開分娩後に発生したretained products of conceptionに対し子宮鏡下手術を施行した1例

真壁健, 山上亘, 平野卓朗, 坂井健良, 千代田達幸, 片岡史夫, 青木大輔

日本産科婦人科内視鏡学会雑誌 ((一社)日本産科婦人科内視鏡学会) 36 ( 2 ) 317 - 321 2020.12

ISSN 1884-9938

Epidemiological guideline influence on the therapeutic trend and patient outcome of uterine cervical cancer in Japan: Japan society of gynecologic oncology guideline evaluation committee project

Shigeta S., Shida M., Nagase S., Ikeda M., Takahashi F., Shibata T., Yamagami W., Katabuchi H., Yaegashi N., Aoki D., Mikami M.

Gynecologic Oncology 159 ( 1 ) 248 - 255 2020.10

Research paper (scientific journal), Joint Work, Accepted, ISSN 00908258

© 2020 Elsevier Inc. Objective: The Japan Society of Gynecologic Oncology published its first clinical guidelines for uterine cervical cancer in 2007 which has been revised twice in 2011 and 2017. The aim of this study was to investigate the influence of the first guideline publication on the therapeutic trend and patient outcome by analyzing uterine cervical cancer cases registered to the cancer registry organized by the Japan Society of Obstetrics and Gynecology. Methods: Data of uterine cervical cancer cases registered to the cancer registry from 2000 to 2012 were provided. Epidemiological and clinical trend were analyzed by the Chi-squared test with subsequent standardized residual analysis. Overall survival among the patients registered between 2004 and 2009 was analyzed using the Fine and Gray competing risk model. Results: 68,707 cases were registered during the study period. A trend analysis revealed that the guideline publication may have led to a decrease in neoadjuvant chemotherapy in parallel with an increase in radiation therapy mainly in stage II and III patients undergoing primary treatment. A survival analysis indicated that the introduction of the guideline may have improved overall survival among stage III uterine cervical cancer patients, even though a significant difference was not observed in all of the cases. Conclusions: This study demonstrated the potential influence of the guideline publication on the clinical trend and patient outcome. As this is the first assessment of the guideline for uterine cervical cancer in Japan, continuous evaluation is necessary to further comprehend the significance of this guideline.

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Evaluation of safety and diagnostic performance for flexible hysteroscopy in 1591 outpatient cases

Kobayashi Y., Tsuji K., Nakamura K., Nagai S., Takahashi T., Kobayashi A., Anko M., Hirano T., Watanabe K., Matoba Y., Kunitomi H., Adachi M., Yamagami W., Tominaga E., Banno K., Aoki D.

Japanese journal of clinical oncology 50 ( 10 ) 1157 - 1161 2020.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 03682811

© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com. BACKGROUND: To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution's outpatient flexible hysteroscopy cases. METHODS: A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012-2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates. RESULTS: A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy. CONCLUSIONS: Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.

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Uterine cervical cancer associated with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome: A case report and review of the literature

Oka E., Chiyoda T., Iwata T., Yamagami W., Aoki D.

Gynecologic Oncology Reports 34 100645 2020.09

Research paper (scientific journal), Joint Work, Accepted

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Impact of the COVID-19 epidemic at a high-volume facility in gynecological oncology in Tokyo, Japan: A single-center experience

Nogami Y., Kobayashi Y., Tsuji K., Yokota M., Nishio H., Nakamura M., Yamagami W., Morisada T., Tominaga E., Banno K., Aoki D.

Journal of Ovarian Research 13 ( 1 ) 105 2020.09

Research paper (scientific journal), Joint Work, Accepted

© 2020 The Author(s). Background: The number of cases of novel coronavirus disease 2019 (COVID-19) in Japan have risen since the first case was reported on January 24, 2020, and 6225 infections have been reported as of June 30, 2020. On April 8, 2020, our hospital began screening patients via pre-admission reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chest computed tomography (CT). Although no patients exhibited apparent pneumonia, treatment delay or changes in treatment plans were required for a few patients based on the results of screening tests. During an emerging infectious disease pandemic, the likelihood of being infected, as well as the disease itself, affects clinical decision making in several ways. We summarized and presented our experience. Case presentation: After the introduction of pre-admission screening, RT-PCR and CT were performed in 200 and 76 patients, respectively, as of June 30, 2020. The treatment of five patients, including two patients with cervical cancer, two patients with ovarian tumors, and one patient with ovarian cancer, was affected by the results. Two asymptomatic RT-PCR-positive patients did not develop COVID-19, but their treatment was delayed until the confirmation of negative results. The other three patients were RT-PCR-negative, but abnormal CT findings suggested the possibility of COVID-19, which delayed treatment. The patients receiving first-line preoperative chemotherapy for ovarian cancer had clinically evident exacerbations because of the treatment delay. Conclusion: During the epidemic phase of an emerging infectious disease, we found that COVID-19 has several other effects besides its incidence. The postponing treatment was the most common, therefore, treatment of ovarian tumors and ovarian cancer was considered to be the most likely to be affected among gynecological diseases. Protocols that allow for easy over-diagnosis can be disadvantageous, mainly because of treatment delays, and therefore, the protocols must be developed in light of the local infection situation.

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Clinical implications of next-generation sequencing-based panel tests for malignant ovarian tumors

Saotome K., Chiyoda T., Aimono E., Nakamura K., Tanishima S., Nohara S., Okada C., Hayashi H., Kuroda Y., Nomura H., Susumu N., Iwata T., Yamagami W., Kataoka F., Nishihara H., Aoki D.

Cancer Medicine 9 ( 20 ) 7407 - 7417 2020.08

Research paper (scientific journal), Joint Work, Accepted

© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. Precision medicine based on cancer genomics is being applied in clinical practice. However, patients do not always derive benefits from genomic testing. Here, we performed targeted amplicon exome sequencing-based panel tests, including 160 cancer-related genes (PleSSision-160), on 88 malignant ovarian tumors (high-grade serous carcinoma, 27; endometrioid carcinoma, 15; clear cell carcinoma, 30; mucinous carcinoma, 6; undifferentiated carcinoma, 4; and others, 6 (immature teratoma, 1; carcinosarcoma, 3; squamous cell carcinoma, 1; and mixed, 1)), to assess treatment strategies and useful biomarkers for malignant ovarian tumors. Overall, actionable gene variants were found in 90.9%, and druggable gene variants were found in 40.9% of the cases. Actionable BRCA1 and BRCA2 variants were found in 4.5% of each of the cases. ERBB2 amplification was found in 33.3% of mucinous carcinoma cases. Druggable hypermutation/ultramutation (tumor mutation burden ≥ 10 SNVs/Mbp) was found in 7.4% of high-grade serous carcinoma, 46.7% of endometrioid carcinoma, 10% of clear cell carcinoma, 0% of mucinous carcinoma, 25% of undifferentiated carcinoma, and 33.3% of the other cancer cases. Copy number alterations were significantly higher in high-grade serous carcinoma (P <.005) than in other histologic subtypes; some clear cell carcinoma showed high copy number alterations that were correlated with advanced stage (P <.05) and worse survival (P <.01). A high count of copy number alteration was associated with worse survival in all malignant ovarian tumors (P <.05). Our study shows that targeted agents can be detected in approximately 40% of malignant ovarian tumors via multigene panel testing, and copy number alteration count can be a useful marker to help assess risks in malignant ovarian tumor patients.

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A retrospective study for investigating the relationship between old and new staging systems with prognosis in ovarian cancer using gynecologic cancer registry of Japan Society of Obstetrics and Gynecology (JSOG): disparity between serous carcinoma and clear cell carcinoma

Yamagami W., Nagase S., Takahashi F., Ino K., Hachisuga T., Mikami M., Enomoto T., Katabuchi H., Aoki D.

Journal of gynecologic oncology 31 ( 4 ) e45 2020.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 20050380

Copyright © 2020. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology. OBJECTIVE: International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube, and peritoneal cancers was revised in 2014. The aim of this study is to clarify whether the revised FIGO2014 staging reflects the prognosis of patients with ovarian cancer by histological type in Japan. METHODS: We extracted 9,747 patients who were diagnosed with ovarian cancer since 2004 until 2008 and who could be classified into appropriate stages from the Gynecologic Cancer Registry of Japan Society of Obstetrics and Gynecology. These cases were analyzed after revision to FIGO2014 based on the pTNM classification. RESULTS: Among stage I, the 5-year overall survival rate (5y-OS) in FIGO2014 was 94.9% in stage IA, 92.3% in stage IC1, 86.1% in IC2, and 84.9% in IC3 with significant differences between stages IA and IC1 (p=0.012), IC1 and IC2 (p<0.001). There was a significant difference between stages IA and IC1 in clear cell and mucinous carcinoma but not in serous and endometrioid carcinoma. Among stage III, the 5y-OS was 75.6% in stage IIIA1, 68.9% in IIIA2, 58.6% in IIIB, and 44.4% in IIIC, with significant differences between stages IIIA2 and IIIB (p=0.009), IIIB and IIIC (p<0.001). Among stage IV, the 5y-OS was 43.1% in stage IVA* and 32.1% in IVB with a significant difference (p=0.002). CONCLUSION: The results suggest that changes in classification for stage III and stage IV are appropriate, but the subclassification for stage IC might be too detailed. There was a discrepancy of prognosis by histological type between stage IA and IC1.

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更年期症状を契機に診断された甲状腺機能異常の2例

平田桃, 横田めぐみ, 谷本慧子, 仲村勝, 山上亘, 森定徹, 片岡史夫, 岩田卓, 阪埜浩司, 田中守, 青木大輔

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 69 ( 3 ) 575 - 580 2020.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 2186-0599

更年期障害を疑われ受診したが、甲状腺疾患を認めた2症例につき報告する。症例1:52歳、0妊0産。子宮頸部腺癌IB1期に対し広汎子宮全摘出術および両側付属器摘出術後である。冷え、関節痛を主訴に受診し、採血でTSH高値を認め精査にて潜在性甲状腺機能低下症の診断となった。症例2:65歳。1妊1産。ほてり、動悸を主訴に受診した。変動するTSHを認め、精査の結果、橋本病に合併した無痛性甲状腺炎の診断となった。甲状腺機能異常は亢進症/低下症ともに症状が更年期障害と類似していることから鑑別疾患の一つとして念頭に置くことが重要である。(著者抄録)

Patient-derived ovarian cancer organoids capture the genomic profiles of primary tumours applicable for drug sensitivity and resistance testing

Nanki Y., Chiyoda T., Hirasawa A., Ookubo A., Itoh M., Ueno M., Akahane T., Kameyama K., Yamagami W., Kataoka F., Aoki D.

Scientific Reports 10 ( 1 ) 12581 2020.06

Research paper (scientific journal), Joint Work, Accepted

© 2020, The Author(s). The use of primary patient-derived organoids for drug sensitivity and resistance testing could play an important role in precision cancer medicine. We developed expandable ovarian cancer organoids in < 3 weeks; these organoids captured the characteristics of histological cancer subtypes and replicated the mutational landscape of the primary tumours. Seven pairs of organoids (3 high-grade serous, 1 clear cell, 3 endometrioid) and original tumours shared 59.5% (36.1–73.1%) of the variants identified. Copy number variations were also similar among organoids and primary tumours. The organoid that harboured the BRCA1 pathogenic variant (p.L63*) showed a higher sensitivity to PARP inhibitor, olaparib, as well as to platinum drugs compared to the other organoids, whereas an organoid derived from clear cell ovarian cancer was resistant to conventional drugs for ovarian cancer, namely platinum drugs, paclitaxel, and olaparib. The overall success rate of primary organoid culture, including those of various histological subtypes, was 80% (28/35). Our data show that patient-derived organoids are suitable physiological ex vivo cancer models that can be used to screen effective personalised ovarian cancer drugs.

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Proposal of a two-tier system in grouping adenocarcinoma of the uterine cervix

Machida H., Matsuo K., Matsuzaki S., Yamagami W., Ebina Y., Kobayashi Y., Tabata T., Kaneuchi M., Nagase S., Enomoto T., Mikami M.

Cancers 12 ( 5 ) 1251 2020.05

Research paper (scientific journal), Joint Work, Accepted

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. (1) Background: This study examined the use of a two-tier system in grouping cervical adenocarcinoma for survival discrimination. (2) Methods: A nationwide retrospective observational cohort study was conducted using the Japan Society of Gynecologic Oncology tumor registry database from 2001 to 2015 (n = 86,754). Adenocarcinoma subtypes were grouped as type 1 (endocervical usual type and endometrioid) or type 2 (serous, clear, mucinous, and not otherwise specified), based on their relative survival compared with that of squamous tumors. (3) Results: The majority of the adenocarcinoma cases were type 1 (n = 10,121) versus type 2 tumors (n = 5157). Type 2 tumors were more likely to be old and have stage IV disease than those with squamous tumors. The number of type 2 tumors increased from 2001 to 2014 (106.1% relative increase, p < 0.001). Type 2 tumors had disproportionally poorer survival compared to other types (5-year survival rates: 68.9% for type 2, 75.4% for type 1, and 78.0% for squamous; p < 0.001). On multivariate analysis, type 2 tumors remained an independent prognostic factor associated with decreased survival compared with squamous (adjusted hazard ratio 2.00, 95% CI 1.84–2.15, p < 0.001). (4) Conclusion: The survival of cervical adenocarcinoma varies largely across the histological subtypes, and the proposed two-tier grouping may be useful for survival discrimination.

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骨転移を伴う再発子宮体癌に対して、ホルモン療法とデノスマブの併用療法が効果を示した1例

佐竹恵, 山上亘, 吉村拓馬, 平野卓朗, 真壁健, 坂井健良, 辻浩介, 小林佑介, 片岡史夫, 阪埜浩司, 青木大輔, 進伸幸

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 69 ( 2 ) 341 - 345 2020.04

Research paper (scientific journal), Joint Work, Accepted, ISSN 2186-0599

再発子宮体癌の化学療法無奏効例では治療法の選択に苦慮することが多い。われわれは、酢酸メドロキシプロゲステロン(MPA)を用いたホルモン療法とデノスマブを併用することで、長期の病勢コントロールが可能だった症例を経験した。症例は46歳で、子宮体癌IIIA期の類内膜癌G1に対して、広汎子宮全摘出術、両側付属器摘出術、傍大動脈リンパ節郭清、大網部分切除術を施行後、術後療法にてパクリタキセル、カルボプラチン療法(TC療法)を施行した。その後、骨盤腹膜および腟断端への再発が出現し、ドセタキセル、シスプラチン療法(DP療法)を施行するも奏効せず、その後症状を伴って出現した骨転移に対して緩和的放射線照射を施行した。しかし、照射野内再発により疼痛が増悪したことから、MPAとデノスマブを併用した治療を開始したところ、20ヵ月間にわたり病変縮小、疼痛軽快が維持された。骨転移を伴う婦人科癌では、デノスマブによる良好な病勢コントロールが得られる可能性が示唆された。(著者抄録)

Identification of a novel uterine leiomyoma GWAS locus in a Japanese population.

Sakai K, Tanikawa C, Hirasawa A, Chiyoda T, Yamagami W, Kataoka F, Susumu N, Terao C, Kamatani Y, Takahashi A, Momozawa Y, Hirata M, Kubo M, Fuse N, Takai-Igarashi T, Shimizu A, Fukushima A, Kadota A, Arisawa K, Ikezaki H, Wakai K, Yamaji T, Sawada N, Iwasaki M, Tsugane S, Aoki D, Matsuda K.

Sci Rep 10 ( 1 ) 1197 2020.01

Research paper (scientific journal), Joint Work, Accepted

Japan Society of Gynecologic Oncology 2018 guidelines for treatment of uterine body neoplasms

Yamagami W., Mikami M., Nagase S., Tabata T., Kobayashi Y., Kaneuchi M., Kobayashi H., Yamada H., Hasegawa K., Fujiwara H., Katabuchi H., Aoki D.

Journal of gynecologic oncology 31 ( 1 ) e18 2020.01

Research paper (scientific journal), Joint Work, Accepted

The Fourth Edition of the Guidelines for Treatment of Uterine Body Neoplasm was published in 2018. These guidelines include 9 chapters: 1. Overview of the guidelines, 2. Initial treatment for endometrial cancer, 3. Postoperative adjuvant therapy for endometrial cancer, 4. Post-treatment surveillance for endometrial cancer, 5. Treatment for advanced or recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment of uterine carcinosarcoma and uterine sarcoma, 8. Treatment of trophoblastic disease, 9. Document collection; and nine algorithms: 1-3. Initial treatment of endometrial cancer, 4. Postoperative adjuvant treatment for endometrial cancer, 5. Treatment of recurrent endometrial cancer, 6. Fertility-sparing therapy, 7. Treatment for uterine carcinosarcoma, 8. Treatment for uterine sarcoma, 9. Treatment for choriocarcinoma. Each chapter includes overviews and clinical questions, and recommendations, objectives, explanation, and references are provided for each clinical question. This revision has no major changes compared to the 3rd edition, but does have some differences: 1) an explanation of the recommendation decision process and conflict of interest considerations have been added in the overview, 2) nurses, pharmacists and patients participated in creation of the guidelines, in addition to physicians, 3) the approach to evidence collection is listed at the end of the guidelines, and 4) for clinical questions that lack evidence or clinical validation, the opinion of the Guidelines Committee is given as a "Recommendations for tomorrow".

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Evaluating the importance of routine drainage following laparoscopic pelvic lymph node dissection for gynecological malignancies

Sakai K., Nakamura M., Yamagami W., Chiyoda T., Kobayashi Y., Nishio H., Hayashi S., Nomura H., Kataoka F., Tominaga E., Banno K., Aoki D.

International Journal of Gynecology and Obstetrics (International Journal of Gynecology and Obstetrics) 2020

Research paper (scientific journal), Joint Work, ISSN 00207292

© 2020 International Federation of Gynecology and Obstetrics Objective: To determine the efficacy of drainage following pelvic lymph node (PLN) dissection, especially for cases involving laparoscopic surgery. Methods: In this retrospective study, 368 patients with malignant gynecological tumors who underwent systemic PLN dissection at Keio University Hospital between January 2012 and October 2018 were enrolled. Drainage tubes were placed in the retroperitoneal fossa in all patients. Medical records were used for data collection. Results: Laparoscopy was performed on 81 patients, and laparotomy was performed on 287 patients. In the laparoscopy group, tubes were removed 1 day post surgery. In the laparotomy group, tubes were removed 1 day post surgery in 167 patients and 4 days post surgery in 120 patients. Compared with the laparotomy group, we determined the laparoscopy group to have a significantly lower prevalence of lymphocyst (6.2% vs 20.2%, p = 0.002) but a similar prevalence of lymphedema (4.9% vs 5.2%), and symptomatic lymphocyst (2.5% vs 4.5%). The two laparotomy groups did not differ significantly with respect to the prevalence of lymphedema (4.8% vs 5.8%), lymphocyst (20.4% vs 20.0%), or symptomatic lymphocyst (4.2% vs 5.0%). Conclusion: Our results suggest that routine drainage should be omitted, especially in cases involving laparoscopic surgery.

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肥満が腹腔鏡下子宮体癌手術に及ぼす影響の検討

平野卓朗, 片岡史夫, 南木佳子, 吉浜智子, 真壁健, 坂井健良, 山上亘, 林茂徳, 野村弘行, 青木大輔

日本産科婦人科内視鏡学会雑誌 ((一社)日本産科婦人科内視鏡学会) 35 ( 2 ) 238 - 243 2019.12

ISSN 1884-9938

子宮体癌IA期に対し腹腔鏡下子宮体癌手術を行った150例を対象に、骨盤リンパ節郭清を施行した75例(A群)と未施行75例(B群)に分類した。検討項目は肥満症例(BMIが25以上)と非肥満症例における患者背景(年齢、未産婦数、糖尿病の頻度、高血圧の頻度、病理組織型、手術進行期、治療成績(手術時間、推定出血量、術後入院期間、リンパ節郭清群の摘出リンパ節個数)、術中・術後合併症、術後治療の有無、無増悪生存割合、全生存割合で、2群間で比較した。また、過去の開腹下子宮体癌手術49例の摘出リンパ節数を肥満症例と非肥満症例で比較した。その結果、A群において肥満症例が非肥満手術例に比べ手術時間、摘出リンパ節個数が有意に多かった。しかし、その他の項目に有意差はなく、肥満は腹腔鏡下子宮体癌手術に影響を及ぼさないと考えられた。

頸管浸潤を有する子宮体癌と鑑別困難な異型ポリープ状腺筋腫に対し子宮鏡下手術で妊孕性を温存し得た2例

早乙女啓子，平野卓朗，山上亘

日本子宮鏡研究会雑誌 1 ( 1 ) 15 - 17 2019.11

Research paper (scientific journal), Joint Work, Accepted

若年子宮体癌/子宮内膜異型増殖症に対する高用量黄体ホルモン療法の再発例の検討

北澤晶子, 山上亘, 真壁健, 平野卓朗, 坂井健良, 千代田達幸, 小林佑介, 野村弘行, 片岡史夫, 阪埜浩司, 進伸幸, 田中守, 青木大輔

関東連合産科婦人科学会誌 ((一社)関東連合産科婦人科学会) 56 ( 4 ) 591 - 596 2019.11

Research paper (scientific journal), Joint Work, Accepted, ISSN 2186-0610

背景:若年の子宮体癌,子宮内膜異型増殖症(AEH)に対する妊孕性温存療法として,medroxyprogesterone acetate(MPA)を用いた高用量黄体ホルモン療法があるがその再発率の高さが問題となる.本研究ではMPA療法後の再発例の特徴を明らかにすることを目的とした.方法:1998〜2015年,当科で初回治療としてMPA療法を施行した182名を対象とし,倫理委員会の承認のもと,臨床病理学的因子や予後について後方視的に解析した.初回治療前の組織型はAEHで再発時AEHであった34例をA群,初回治療時EMG1で再発時AEHであった37例をB群,初回治療時EMG1で再発時EMG1であった27例をC群とした.結果:病変消失率はいずれも100%で,A群はB+C群に比較し再々発率が低く,再々発までの期間が長かった.妊娠例と非妊娠例では再々発率,再々発までの期間に有意差を認めなかった.結論:G1症例では再発時に進行する可能性もあり慎重な管理が求められる.治療後妊娠例は再発が少ないことから病変消失後の積極的な不妊治療がすすめられるが,分娩後も再発する可能性があり継続した管理が求められる.(著者抄録)

Intraoperative Capsule Rupture, Postoperative Chemotherapy, and Survival of Women With Stage I Epithelial Ovarian Cancer.

Matsuo K, Machida H, Yamagami W, Ebina Y, Kobayashi Y, Tabata T, Kaneuchi M, Nagase S, Enomoto T, Mikami M

Obstet Gynecol 134 ( 5 ) 1017 - 1026 2019.10

Research paper (scientific journal), Joint Work, Accepted, ISSN 00297844

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. OBJECTIVE:To examine the incidence and prognostic effects of intraoperative capsule rupture and to assess the effectiveness of postoperative chemotherapy for intraoperative tumor rupture in apparent stage I epithelial ovarian cancer.METHODS:This is a society-based retrospective observational study in Japan that examined 15,163 women with stage IA-IC1 epithelial ovarian cancer who underwent primary surgical treatment between 2002 and 2015. Associations between intraoperative capsule rupture and cause-specific survival, and between postoperative chemotherapy and cause-specific survival among intraoperatively ruptured cases were examined by histology type (clear cell n=6,107, endometrioid n=3,910, mucinous n=3,382, and serous n=1,764).RESULTS:Clear cell histology had the highest risk of intraoperative capsule rupture (57.3%), followed by endometrioid (48.8%), serous (41.8%), and mucinous (32.0%) histologies (P<.001). On multivariable analysis, clear cell type exhibited the largest effect of intraoperative capsule rupture on cause-specific survival (adjusted hazard ratio [HR] 1.99, 95% CI 1.45-2.75), followed by serous (adjusted HR, 1.61, 95% CI 0.84-3.11), mucinous (adjusted HR 1.28, 95% CI 0.79-2.09), and endometrioid (adjusted HR, 1.14, 95% CI 0.64-2.01) tumors. Postoperative chemotherapy for intraoperatively ruptured cases did not improve cause-specific survival in any histologic types in multivariable analysis: clear cell, adjusted HR 0.86, 95% CI 0.56-1.31; serous, adjusted HR 1.08, 95% CI 0.42-2.74; mucinous, adjusted HR 1.11, 95% CI 0.55-2.27; and endometrioid, adjusted HR 2.81, 95% CI 0.85-9.30 (all, P>.05). In the cohort-level analysis of ruptured cases (n=7,227), postoperative chemotherapy use has significantly decreased in mucinous (16.3% relative decrease), endometrioid (13.1% relative decrease), and clear cell (9.3% relative decrease) (all, P<.05); but, the cohort-level 5-year cause-specific survival rate did not change over time (all, P>.05).CONCLUSION:Among apparent stage I epithelial ovarian cancer, the clear cell type possesses a disproportionally high risk of capsule rupture during adnexectomy and is associated with the most adverse effect on survival. A decrease in the use of postoperative chemotherapy for intraoperatively ruptured cases in Japan is likely the result of increasing awareness of the absence of survival benefits.

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子宮体癌の術前子宮鏡検査と腹腔細胞診

平野卓朗, 山上亘, 真壁健, 坂井健良, 二宮委美, 野村弘行, 片岡史夫, 平沢晃, 進伸幸, 青木大輔

日本臨床細胞学会雑誌 ((公社)日本臨床細胞学会) 58 ( 5 ) 196 - 201 2019.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 0387-1193

目的:子宮体癌の腹腔細胞診陽性の背景因子を明らかにし、子宮鏡検査が腹腔細胞診陽性に与える影響を検討することを目的とした。方法:当院にて子宮鏡検査を施行した後に、開腹もしくは腹腔鏡下に手術療法を施行した414例に関して、腹腔細胞診の結果と臨床病理学的因子との関連を後方視的に検討した。成績:414例中13例(3%)で腹腔細胞診陽性であった。腹腔細胞診陽性の有意なリスク因子として、単変量解析では類内膜癌Grade 3+特殊組織型、付属器転移、大網転移、腹膜播種が挙げられ(p<0.001)、多変量解析では類内膜癌Grade 3+特殊組織型(p=0.01)と大網転移が挙げられた(p<0.001)。またリスク因子別では大網転移陽性例で腹腔細胞診陽性例が最も多かった(7/10例、70%)。12例で腹腔細胞診陽性のリスク因子である類内膜癌Grade 3+特殊組織型もしくは大網転移を認めた。1例のみリスク因子を有さず腹腔細胞診が陽性となった症例を認め、多発子宮筋腫や子宮腺筋症によって、子宮鏡の検査時間や還流圧を通常より要したことが原因と推定されたが、術後再発を認めず経過している。結論:術前に子宮鏡検査を施行したにもかかわらず腹腔細胞診陽性となった例は少なく、そのほとんどが腹腔細胞診陽性のリスク因子を有する症例であったため、術前子宮鏡検査による腹腔細胞診への影響は軽微であろうと考えられた。(著者抄録)

Hysteroscopic Photodynamic Diagnosis Using 5-Aminolevulinic Acid: A High-Sensitivity Diagnostic Method for Uterine Endometrial Malignant Diseases.

Matoba Y, Banno K, Kisu I, Kobayashi Y, Tsuji K, Nagai S, Yamagami W, Nakamura M, Tominaga E, Kawaida M, Aoki D

J Minim Invasive Gynecol 27 ( 5 ) 1087 - 1094 2019.08

Research paper (scientific journal), Joint Work, Accepted

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