論文 - 山上　亘

Atypical vessels in hysteroscopy: Usefulness in prediction of malignant diseases in patients treated with tamoxifen

Oka E., Sakai K., Yamagami W., Hirano T., Makabe T., Yoshihama T., Chiyoda T., Kataoka F., Banno K., Aoki D.

Journal of Obstetrics and Gynaecology Research （Journal of Obstetrics and Gynaecology Research）  47 （ 4 ） 1510 - 1515 2021年04月

研究論文（学術雑誌）, 査読有り,  ISSN  1341-8076

　概要を見る

Aim: Tamoxifen (TAM) is widely used in adjuvant endocrine therapy for invasive breast cancer as a selective estrogen modulator, but this treatment has a risk of developing endometrial malignancy. However, hysteroscopic findings during or after TAM treatment are unclear. The aim of this study is to examine the association between hysteroscopic patterns and malignant histological findings during or after treatment with TAM. Methods: The subjects were patients who received TAM after surgery for breast cancer and underwent hysteroscopy at our institution from January 2016 to December 2019. Clinicopathological factors and hysteroscopic findings were collected from medical records and investigated retrospectively. Histologically, atypical endometrial hyperplasia, endometrial cancer, and carcinosarcoma were classified as malignant diseases. Results: A total of 26 patients were eligible for the study. Hysteroscopic findings included an irregular surface of the endometrium (n = 3, 11.5%), atypical vessels (n = 10, 38.5%), papillary structure (n = 3, 11.5%), and polypoid structure (n = 18, 69.2%). Histological examination revealed malignancy in six patients (23.0%). The percentage of atypical vessels in patients with malignancies was significantly higher than that in patients with a normal endometrium or benign lesion (100% vs. 20%, p = 0.0009). The sensitivity and specificity of atypical vessels in hysteroscopy for diagnosis of malignant diseases were 100% and 80%, respectively. Conclusions: Hysteroscopic findings of atypical vessels may be useful for prediction of malignant diseases in patients treated with TAM.

• Access to Document (DOI)

術前診断は子宮体癌であったが、子宮摘出検体で絨毛癌の確定診断に至った1例

吉村 拓馬, 山上 亘, 川井田 みほ, 平野 卓朗, 坂井 健良, 真壁 健, 千代田 達幸, 小林 佑介, 片岡 史夫, 阪埜 浩司, 亀山 香織, 青木 大輔

日本婦人科病理学会誌 11 （ 1 ） 39 - 44 2021年03月

研究論文（学術雑誌）, 共著, 査読有り

Germline multigene panel testing revealed a BRCA2 pathogenic variant in a patient with suspected Lynch syndrome.

Yoshihama T, Hirasawa A, Sugano K, Yoshida T, Ushiama M, Ueki A, Akahane T, Nanki Y, Sakai K, Makabe T, Yamagami W, Susumu N, Kameyama K, Kosaki K, Aoki D

International cancer conference journal 10 （ 1 ） 6 - 10 2021年01月

研究論文（学術雑誌）, 共著, 査読有り

• Access to Document (DOI)

A prospective cohort study on the safety and efficacy of bevacizumab combined with chemotherapy in Japanese patients with relapsed ovarian, fallopian tube or primary peritoneal cancer

Nanki Y., Nomura H., Iwasa N., Saotome K., Dozen A., Yoshihama T., Hirano T., Hashimoto S., Chiyoda T., Yamagami W., Kataoka F., Aoki D.

Japanese Journal of Clinical Oncology （Japanese Journal of Clinical Oncology）  51 （ 1 ） 54 - 59 2021年01月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0368-2811

　概要を見る

Objective: this prospective cohort study aimed to assess the safety and efficacy of bevacizumab combined with chemotherapy in Japanese patients with relapsed ovarian, fallopian tube or primary peritoneal cancer. Methods: in this study, 40 Japanese patients with relapsed ovarian, fallopian tube or primary peritoneal cancer selected to receive bevacizumab with chemotherapy were enrolled. Patients in poor general condition were excluded. Each patient was monitored prospectively for adverse events, administration status, disease status and survival. Treatment was continued until intolerable adverse events or disease progression. The primary endpoint was safety. Results: bevacizumab plus platinum-based chemotherapy was performed for 30 patients (median cycle; 16.5), while bevacizumab plus non-platinum chemotherapy was performed for 10 patients (median cycle; 5.5). Among bevacizumab-related adverse events, hypertension occurred in 80% of patients, proteinuria in 83%, mucositis in 25%, bleeding in 20%, thromboembolic events in 5.0% and fistula in 2.5%. Gastrointestinal perforation or other life-threatening lethal adverse events were not observed. Response rate and median progression-free survival were 73% and 19.3 months for patients with bevacizumab plus platinum-based chemotherapy, and 30% and 3.9 months for patients with bevacizumab plus non-platinum chemotherapy, respectively. There was no correlation between response rate and occurrence of adverse events such as hypertension or proteinuria. Conclusion: bevacizumab combined with chemotherapy was tolerable and effective for Japanese patients with relapsed ovarian cancer, fallopian tube cancer or primary peritoneal cancer. Hypertension and proteinuria are frequently occurred and managed properly for continuing treatment.

• Access to Document (DOI)

Impact of lymphadenectomy on the treatment of endometrial cancer using data from the JSOG cancer registry

Saotome K., Yamagami W., Machida H., Ebina Y., Kobayashi Y., Tabata T., Kaneuchi M., Nagase S., Enomoto T., Aoki D., Mikami M.

Obstetrics and Gynecology Science （Obstetrics and Gynecology Science）  64 （ 1 ） 80 - 89 2021年01月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  2287-8572

　概要を見る

Objective Regional lymph node (LN) dissection is a standard surgical procedure for endometrial cancer, but there is currently no clear consensus on its therapeutic significance. We aimed to determine the impact of regional LN dissection on the outcome of endometrial cancer. Methods Study subjects comprised 36,813 patients who were registered in the gynecological tumor registry of the Japan Society of Obstetrics and Gynecology, had undergone initial surgery for endometrial cancer between 2004 and 2011, and whose clinicopathological factors and prognosis were appropriate for our investigation. The following clinicopathological factors were obtained from the registry: age, surgical stage classification, Union for International Cancer Control tumor, node, metastasis classification, histological type, histological differentiation, presence or absence of LN dissection, and postoperative treatment. We retrospectively analyzed the clinicopathological factors and therapeutic outcomes for patients with endometrial cancer. Results Analysis of all subjects showed that the group that underwent LN dissection had a significantly better overall survival than the group that did not undergo dissection. Analysis based on stage showed similar results across groups, except for stage Ia. Analysis based on stage and histological type showed similar results across groups, except for stage Ia endometrial carcinoma G1 or Ia G2. Multivariate analysis of prognostic factors indicated that LN dissection is an independent prognostic factor and that it has a greater impact on prognosis than adjuvant chemotherapy. Conclusion Despite the limitations of a retrospective study with some biases, the results suggest that LN dissection in endometrial cancer has a prognostic effect.

• Access to Document (DOI)

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年12月

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年10月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  00908258

　概要を見る

© 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.

• Access to Document (DOI)

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年09月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  03682811

　概要を見る

© 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.

• Access to Document (DOI)

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年09月

研究論文（学術雑誌）, 共著, 査読有り

• Access to Document (DOI)

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年09月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

© 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.

• Access to Document (DOI)

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年08月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

© 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.

• Access to Document (DOI)

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年07月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  20050380

　概要を見る

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.

• Access to Document (DOI)

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年07月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  2186-0599

　概要を見る

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年06月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

© 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.

• Access to Document (DOI)

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年05月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

© 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.

• Access to Document (DOI)

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年04月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  2186-0599

　概要を見る

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年01月

研究論文（学術雑誌）, 共著, 査読有り

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年01月

研究論文（学術雑誌）, 共著, 査読有り

　概要を見る

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".

• Access to Document (DOI)

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年

研究論文（学術雑誌）, 共著,  ISSN  00207292

　概要を見る

© 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.

• Access to Document (DOI)

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年12月

ISSN  1884-9938

　概要を見る

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。