Current status of gynecologic cancer in Japan

To make an overview of the current status of gynecologic cancer in Japan, we reviewed the recent incidence of cervical, endometrial, and ovarian cancer in Japanese women. The incidence of all three cancers has increased, but trends differ respectively. In age specific cancer site distribution data, the uterus and ovary are leading sites of high incidence among Japanese women younger than 40 years of age. Therefore, fertility sparing cancer treatment has received much attention. Several multicenter clinical trials have been done by Japanese groups, and some excellent evidence has been collected for endometrial and ovarian cancer. A promising international collaboration trial for ovarian clear cell carcinoma is also underway at the present time.     

Current status and perspectives of brachytherapy for cervical cancer

Standard definitive radiotherapy for cervical cancer consists of whole pelvic external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). In Japan, high-dose-rate ICBT (HDR-ICBT) has been utilized in clinical practice for more than 40 years. Several randomized clinical trials demonstrated that HDR-ICBT achieved comparative outcomes, both for pelvic control and incidences of late complications, to low-dose-rate (LDR) ICBT. In addition, HDR-ICBT has some potential advantages over LDR-ICBT, leading to further improvement in treatment results. Prior to the current computer planning systems, some excellent treatment planning concepts were established. At present, systems modified from these concepts, or novel approaches, such as image-guided brachytherapy (IGBT) are under investigation. One serious problem to be solved in HDR-ICBT for cervical cancer is that of the discrepancy in standard treatment schedules for combination HDR-ICBT and EBRT between the United States and Japan. Prospective studies are ongoing to assess the efficacy and toxicity of the Japanese schedule.     

图像引导对宫颈癌治疗的作用

目的:分析宫颈癌根治性图像引导放疗(IGRT)对靶区剂量的影响,探讨其合理应用模式。方法:选取2012—2016年于中国人民解放军总医院第七医学中心行螺旋断层放疗(HT)的20例宫颈癌患者,应用兆伏级CT(MVCT)图像在HT自适应模块上进行重建及模拟,分别得到有/无图像引导下的受照剂量参数;将各单次剂量分布和对应的融...     

联合贝伐珠单抗新辅助化疗+同步放化疗治疗局部晚期巨块型宫颈癌的初步临床研究

目的 初步观察联合贝伐珠单抗的新辅助化疗+同步放化疗在局部晚期巨块型宫颈癌中的临床疗效及不良反应。方法 联合贝伐珠单抗新辅助化疗的 24例局部晚期巨块型宫颈癌患者作为研究组,前瞻性随机对照的Ⅱ期临床研究(ChiCTR-TRC-11001832)的 30例新辅助化疗患者作为对照组。Kaplan-Meier法计算生存率并log-rank检验差异。结果 新辅助化疗后研究组与对照组肿瘤体积分别为(1.64±23.15)cm³与(12.83±15.08)cm³(P=0.037),完全缓解(CR)率分别为45.8%与13.3%(P=0.004);后装治疗前研究组与对照组肿瘤体积分别为(0±1.5)cm³与(1.00±10.63)cm³(P=0.022),CR率分别为70%与50%(P=0.009)。中位随访24.6(9.3~101.7)个月。研究组与对照组1、2年总生存率分别为96%、96%与90%、71%(P=0.110),无局部复发生存率分别为96%、96%与97%、89%(P=0.512),无远处转移生存率分别为96%、88%与83%、80%(P=0.297)。两组患者不良反应可接受。结论 联合贝伐珠单抗的新辅助化疗可明显缩小肿瘤体积、提高肿瘤CR率,不良反应可耐受。     

复发宫颈癌近距离治疗进展

宫颈癌是女性常见的恶性肿瘤,其主要的治疗方式是手术和放疗。宫颈癌治疗后复发率高,复发后预后较差。复发宫颈癌可分为盆腔中央型、盆腔外周型和盆腔外复发,其治疗方案取决于患者初始治疗方式和复发位置。无放疗史的患者如有手术指征,可首选手术,也可联合放化疗±近距离治疗。放疗后盆腔中央复发的患者可选择盆腔廓清术±术中放疗,但其适应...     

慢病毒介导的LKB1基因在子宫内膜癌HEC-1A细胞中的表达

目的：探讨慢病毒系统介导的LKB1基因在子宫内膜癌HEC-1A细胞中的过表达,为进一步研究LKB1基因在子宫内膜癌的作用机制奠定基础。方法以PCR扩增LKB1克隆质粒获得全长cDNA,将LKB1 cDNA链接到慢病毒载体pWPI,构建慢病毒表达质粒LKB1/pWPI。通过与包装质粒pCMV-Dr8.74和pMD2.G共转染293T细胞进行病毒包装,用包装成功后的病毒液感染子宫内膜癌HEC-1A细胞,以荧光定量PCR、Western blot法检测HEC-1A细胞中LKB1的相对表达量。结果成功扩增LKB1全长cDNA和构建LKB1重组慢病毒表达载体LKB1/pWPI。转染包装293T细胞后能产生慢病毒颗粒并能有效感染靶细胞HEC-1A。转染后HEC-1A-LKB1-pWPI细胞中LKB1的表达率明显高于亲本细胞和空白对照细胞（P〈0.01）。结论成功构建携带LKB1基因的慢病毒表达载体,包装病毒后能有效地感染子宫内膜癌HEC-1A细胞,为进一步探讨LKB1基因在子宫内膜癌中的生物学效应奠定了基础。     

Current status of gynecological cancer care in India

Cancer has become an important public health problem with over 800,000 new cases occurring every year in India. It is estimated that there are nearly 2.5 million cases in the country with nearly 400,000 deaths occurring due to cancer. Cancers of the female reproductive tract and breast has a high incidence amongst Indian women. Cancer registries have also highlighted that more than 70% of cancers in females occur in the age group of 35-64, and that these cancers exercise an adverse influence on the productive role of women in our society. Over 70% of patients report for diagnostic and treatment services at an advanced stage of disease, resulting in poor survival and high mortality rates. More than 50% were compliant to treatment protocol, less than 30% default during adjuvant therapy and 20% default after the preliminary investigation. Overall, 30% complete follow up in the regional institutes and 70-80% in private comprehensive care centers for five years.     

中国晚期乳腺癌诊疗现状的调查研究

目的 了解中国近年来晚期乳腺癌的诊疗现状,为推进中国乳腺癌规范化治疗提供依据和建议.方法 选取2011年4月至2012年8月,由中国临床肿瘤学会(CSCO)指导下中国乳腺癌调研项目所收集的910例晚期乳腺癌患者作为调查对象,调查内容包括患者的临床特征和一线解救治疗现状.应用EpiData 3.02软件进行数据录入和整理,SPSS 18.0软件进行统计分析.结果 晚期乳腺癌患者激素受体在原发灶和转移灶的不一致率为10.2％(x2=3.571,P=0.059),激素受体阳性转为阴性者占9.2％(19/206),阴性转为阳性者占13.0％(9/69);Her-2的不一致率为10.0％(x 2=9.846,P=0.002),Her-2阴性转为阳性者占10.0％(21/210),阳性转为阴性者占10.0％(5/50).接受新辅助治疗、辅助化疗、辅助内分泌治疗的比例分别为7.8％(71/910)、67.6％(615/910)和35.4％(322/910).术后辅助化疗以蒽环和紫杉类药物为主(46.8％).激素受体阳性复发转移乳腺癌一线解救治疗首选化疗者占97.7％(589/603),有效率(完全缓解+部分缓解)为60.1％(306/509);Her-2阳性复发转移乳腺癌一线治疗首选化疗者占96.9％(216/223),有效率(完全缓解+部分缓解)为56.2％(91/162),首选靶向治疗者仅占1.4％(3/223).辅助化疗仅使用蒽环类者,一线解救化疗使用紫杉类者占8.8％(19/215);辅助化疗仅使用紫杉类者,一线解救化疗均不含蒽环和紫杉类药物者占93.3 ％(42/45);辅助化疗蒽环和紫杉类均使用者,一线解救化疗均不含这两类药物者占95.1％(274/288);辅助化疗均未使用蒽环和紫杉类者,一线解救化疗使用蒽环和(或)紫杉类者占9.1％(33/362).结论 雌激素受体(ER)、孕激素受体(PR)及Her-2等重要的生物指标在乳腺癌原发灶和复发灶中存在一定程度的不一致性,因此对复发转移灶进行再活组织检查对指导临床治疗具有重要意义.在复发转移乳腺癌的治疗过程中,普遍现象是遵循了乳腺癌的治疗指南或规范,但也有认识不足的现象.     

Current status of the National Cancer Screening Program for cervical cancer in Korea, 2009

Objective

The National Cancer Screening Program (NCSP) began in 1999. In this report, we evaluate the results of the NCSP for cervical cancer in 2009 and provide participation rates in an organized cervical cancer screening program in Korea.

Methods

Using data obtained from the National Cancer Screening Information System, cervical cancer screening participation rates were calculated. Recall rates, defined as the proportion of abnormal cases among women screened, were also estimated with 95% confidence intervals.

Results

The target population of cervical cancer screening in 2009 included 4,577,200 Korean women aged 30 and over, 1,349,668 of whom underwent the Papanicolaou smear test (29.5% participation rate). Compared with the participation rate of women covered by the National Health Insurance Program (31.3%), the participation rate of women covered by the Medical Aid Program was lower (18.4%). Participation rates also varied in different age groups (the highest of 39.3% in women aged 50 to 59 and the lowest of 14.4% in those aged 70 and older), and different areas (the highest of 34.1% in Busan and the lowest of 21.5% in Chungnam). The overall recall rate for cervical cancer screening was 0.41% (95% confidence interval, 0.40 to 0.42).

Conclusion

According to our study, efforts to facilitate participation and reduce disparities in cervical cancer screening among Korean women are needed.     

Biologic rationale and clinical activity of mTOR inhibitors in gynecological cancer

Advanced recurrent gynecological malignancies have a poor prognosis despite systemic treatment, which is usually cytotoxic chemotherapy. Responses are generally short-lived and more effective treatments are needed. Rationally designed molecularly targeted therapy is an emerging and important option in this setting. The mammalian target of rapamycin (mTOR) is a serine/threonine protein kinase of the phosphatidylinositol-3-kinase (PI3K)/AKT signaling pathway with a critical role in controlling cancer cellular growth, metabolism and cell cycle progression. Aberrant PI3K-dependent signaling occurs frequently in a wide range of tumor types, including ovarian, endometrial and cervical cancer. Early clinical studies of first-generation mTOR inhibitors have shown promising clinical activity in endometrial cancer. However, the molecular basis of sensitivity and resistance to these agents remains largely unknown. In this review, we will update the clinical and biological data underlying the development of first generation mTOR inhibitors in the treatment of gynecological tumors. The role of potential new combination regimens with mTOR inhibitors in gynecological cancers will also be discussed.     

宫颈癌患者生命质量评价量表的编制及测评

目的:编制一套适合测评中国宫颈癌患者的生命质量评价量表(quality of life scale for cervical cancer patients,QLS-CCP),并评价其信度和效度.方法:通过文献查阅法、访谈法和专家咨询等方法确定条目池,形成初始量表.采用变异度法、t检验法、相关系数法和逐步回归法对初始量表进行条目筛选,形成最终的测试量表;采用新编制的Q LS-CCP对136例子宫颈癌患者进行调查,并对其信度和效度进行评价.结果:最终QLS-CCP包含躯体功能、心理、社会及与疾病症状4个维度,共32个条目.量表的重测相关系数、Cronbach'α系数和分半信度系数分别为0.96、0.93和0.85.效标效度较好(rs=0.591,P=0.000).因子分析找到4个公因子,可以解释总变异的57.22％,显示量表的结构效度良好,量表结构与理论构想相符,具有较好的区分效度.结论:新编制的QLS-CCP具有良好的信度和效度,可用于中国宫颈癌患者生存质量的测评.     

Current status in the management of uterine corpus cancer in Korea

Uterine corpus cancer has increased in prevalence in Korean women over the last decade. Recently, elegant studies have been reported from many institutes. To improve treatment strategies, a review of our own data is warranted. This work will discuss the risks and prognostic factors for uterine corpus cancer, and the radiologic evaluation, prediction of lymph node metastasis, systematic lymphadenectomy, minimally invasive surgery, ovarian-saving surgery, fertility-sparing treatment, and adjuvant treatment in women with uterine cancer.     

根治性宫颈切除术在浸润性宫颈癌中的应用

根治性宫颈切除术(RT)被誉为宫颈癌治疗在21世纪手术发展的标志,给渴望保留生育能力的早期宫颈癌患者带了希望.手术范围包括RT及盆腔淋巴清扫术,手术方式包括阴式及腹式,疗效及可行性与标准的治疗方法相近,在临床上有较大的应用价值.     

Characteristics of mortality rates from breast and ovarian cancer in Japan

Objective: Breast and ovarian cancer is rare in Japan compared with other developed countries but their mortality rates are increasing. It is necessary to examine the experience of Japan as a guide to further prevent breast and ovarian cancer in our country.Methods: We conducted an epidemiological study of breast and ovarian cancer in the past 50 years to investigate the trends and characteristics of the mortality rates in Japan. The numbers of age-specific death from breast and ovarian cancer and the population of 5-year groups were obtained from the Vital Statistics of Japan. The truncated age specific mortality rates were calculated according to the patterns of age specific mortality rates from both cancers. Age adjustments were made to the standard world population. Results: In the past 50 years, mortality ratesof breast and ovarian cancer increased about 2 or 6 fold,respectively. This increase was most marked over 50 years old. The death pattern of breast cancer was same as that of ovarian cancer, but that of ovarian cancer changed greatly with time. The birth cohort study had some interesting findings. Common to breast and ovarian cancer, the later the year of birth, the higher the mortality rates from both malignancies in later life.Conclusion: The increase of the yearly mortality rates from breast and ovarian cancer might be due to changesin lifestyle and environmental factors. We are very concerned about dietary practices. Further investigation is needed to clarify the possible causes of animal food.     

Screening behavior in women at increased familial risk for breast cancer

This multicenter study examined the adherence of high-risk women to screening recommendations for breast and ovarian cancer following consultation at a familial cancer clinic (FCC). Self-report questionnaires assessing recall of screening advice, tests undertaken, risk perception, anxiety (Impact of Events Scale) and demographics were mailed to 396 consecutive eligible women who had attended one of six FCCs a median of 3.6 years prior. Family history, genetic test results and screening recommendations were abstracted from medical records. 182/266 (68.4%) women responded with 130 lost to follow-up. The proportions of women undertaking at least the recommended frequency of screening tests were: breast␣self examination (BSE) 50.4%, clinical breast examination (CBE) 66.0%, mammography 82.2%, transvaginal ultrasound (TVUS) 70.0%, CA125 84.0%. Factors associated with adherence to screening were: higher anxiety for BSE and CBE, being BRCA1/2 positive for CBE, older age, method of arrangement and having at least one affected first degree relative for mammography. Factors significantly associated with over-adherence were higher scores for anxiety for BSE and CBE and younger age (< 40 years) for TVUS. Between 41.3% (BSE) and 57.6% (CBE) of women incorrectly recalled their screening recommendations. A substantial minority of high-risk women do not adhere to screening advice. Strategies to improve the accuracy of recall of recommendations and the uptake of recommended screening are required.This study was supported by the National Breast Cancer Centre, Australia.Yoland Antill is the recipient of a Goodman Fielder National Breast Cancer Foundation Scholarship.Kelly-Anne Phillips is the Cancer Council Victoria, Dr John Colebatch Clinical Research Fellow     

A case of primary retroperitoneal undifferentiated endometrial stromal sarcoma after concurrent chemoradiation therapy for cervical cancer

Endometrial stromal sarcoma (ESS) is a relatively rare uterine sarcoma, especially extrauterine ESS. Furthermore, retroperitoneal ESS are extremely rare. Up to now, there are only four cases of primary retroperitoneal ESS reported in the literature. We report one case of primary retroperitoneal undifferentiated endometrial stromal sarcoma after concurrent chemoradiation therapy for cervical cancer with a brief review of the literature.     

Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies

Aims

The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies.

Materials and methods

The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined.

Results

The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies.

Conclusion

Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates.     

子宫颈癌中乳腺癌耐药蛋白mRNA的表达及其临床意义

目的 研究乳腺癌耐药蛋白（BCRP）mRNA在子宫颈癌中的表达及临床意义.方法 实时定量PCR检测12例正常子宫颈组织和47例子宫颈癌组织中BCRP mRNA的表达,并分析其与临床因素间的关系.结果 BCRPmRNA在正常子宫颈组织中低表达,相对表达值为0.19±0.17,在癌组织中高表达,相对表达值为0.59±0.26,两种组织间表达差异有统计学意义（P＜ 0.001）.子宫颈癌患者不同临床病理特征之间BCRPmRNA表达差异无统计学意义（P＞0.05）.结论 BCRP mRNA在子宫颈癌中高表达,可能参与了子宫颈癌原发性耐药的形成,并且BCRP mRNA表达的检测可能对临床选择化疗方案有一定的指导意义.     

免疫组化标记物在子宫内膜样腺癌与宫颈腺癌鉴别诊断中的表达及意义

目的探讨免疫组化标记物波形蛋白(Vimentin)、癌胚抗原(CEA)、雌激素受体(ER)、孕激素受体(PR)和p16蛋白在子宫内膜样腺癌与宫颈腺癌鉴别诊断中的表达和意义。方法采用免疫组织化学染色法检测48例子宫内膜样腺癌和21例宫颈腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16的表达,并分析其临床意义。结果子宫内膜样腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16阳性表达率分别为79.2%、31.3%、87.5%、81.3%和20.8%。宫颈腺癌患者肿瘤组织中Vimentin、CEA、ER、PR和p16阳性表达率分别为14.3%、90.5%、23.8%、42.9%和81.0%。经2检验,Vimentin(2=25.50)、CEA(2=20.50)、ER(2=27.29)、PR(2=10.17)和p16(2=22.17)在子宫内膜样腺癌和宫颈腺癌患者肿瘤组织中阳性表达率的差异均有统计学意义(P<0.05)。结论免疫组化法检测Vimentin、CEA、ER、PR和p16的表达有助于临床鉴别诊断宫颈腺癌和子宫内膜样腺癌。