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Original Articles
Validation of 2023 FIGO Stage IA1–IIIC2 Endometrial Carcinoma: A Retrospective Analysis of Two Tertiary Centers in South Korea and Taiwan
Myeong-Seon Kim, Yen-Ling Lai, Yurimi Lee, Hyun-Soo Kim, Yu-Li Chen, Yoo-Young Lee
Received December 11, 2024  Accepted February 10, 2025  Published online February 17, 2025  
DOI: https://doi.org/10.4143/crt.2024.1190    [Accepted]
AbstractAbstract PDF
Purpose
As understanding of the molecular pathogenesis of endometrial carcinoma (EC) advanced, the International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2023. This study compared EC survival outcomes using the 2009 and 2023 FIGO staging systems.
Materials and Methods
We retrospectively analyzed 3,029 patients diagnosed with 2009 FIGO stage I–III EC between 1985 and 2022 in South Korea, and between 2020 and 2022 in Taiwan. All patients were reclassified using the 2023 FIGO staging, and survival and risk factors were examined under both systems.
Results
Transitioning from the 2009 to 2023 FIGO resulted in 549 (18.0%) patients being upstaged and their survival curves being diversified, indicating significant prognostic value of the 2023 FIGO. Re-classification using the 2023 FIGO upstaged the 2009 FIGO stage IA high-risk ECs, allowing more intensive treatment and potentially improving survival outcomes. The most significant changes occurred in the 2009 FIGO stages IA, IB, and IIIA ECs: upstaging in 16.5%, 49.0%, and 2.0% of IA, IB, and IIIA tumors, respectively, and downstaging 0.3% and 40.8% of IB and IIIA tumors, respectively. The risk factors for poor survival included old age (≥60), menopause, diabetes, substantial lymphovascular space invasion, aberrant p53 expression, and some aggressive histological types (carcinosarcoma, undifferentiated carcinoma, mesonephric-like adenocarcinoma, and neuroendocrine carcinoma).
Conclusion
The 2023 FIGO staging provides more refined stratification of early-stage EC than the 2009 version. Thus, the 2023 FIGO may more accurately guide prognosis and therapeutic decision-making.
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Gynecologic cancer
Effect of Waiting Time from Pathological Diagnosis to Definitive Concurrent Chemoradiation for Cervical Cancer on Overall Survival
Kyoung Won Noh, Bomi Kim, Chel Hun Choi, Tae-Joong Kim, Jeong-Won Lee, Byoung-Gie Kim, Duk-Soo Bae, Won Kyung Cho, Won Park, Yoo-Young Lee
Cancer Res Treat. 2022;54(1):245-252.   Published online April 15, 2021
DOI: https://doi.org/10.4143/crt.2021.023
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to evaluate the effect of waiting time, from diagnosis to initiation of definitive concurrent chemoradiation (CCRT), on overall survival in cervical cancer patients.
Materials and Methods
Patients with cervical cancer who were treated with definitive CCRT between 2000 and 2017 were retrospectively reviewed. Time from initial pathological diagnosis to definitive CCRT was analyzed both as a continuous variable (per day) and as a categorical variable in two groups (group 1 ≤ median, group 2 > median). Patients with a waiting time of more than 60 days were excluded.
Results
The median waiting time was 14 days (0-60). There were differences between group 1 and group 2 in age and chemotherapy regimens. However, no significant difference was found in the International Federation of Gynecology and Obstetrics stage, cell type, or the number of cycles of chemotherapy received during CCRT. A longer waiting time was associated with poorer overall survival on the Kaplan-Meier curve (group 1 vs. group 2, p=0.042). On multivariate analysis, intervals as either a continuous variable (hazard ratio [HR], 1.023; 95% confidence interval [CI], 1.006 to 1.040; p=0.007) or a categorical variable (HR, 1.513; 95% CI, 1.073 to 2.134; p=0.018), FIGO stage, cell type, and the number of cycles of chemotherapy received during CCRT were significant independent prognostic factors for overall survival.
Conclusion
A shorter waiting time from pathological diagnosis to definitive CCRT showed benefit on overall survival. Our findings suggest that an effort to minimize waiting times should be recommended in cervical cancer patients who are candidates for CCRT.

Citations

Citations to this article as recorded by  
  • Effect of waiting time for radiotherapy after last induction chemotherapy on prognosis of locally advanced nasopharyngeal carcinoma
    Kui‐Xuan Zhu, Ting Ding, Yi‐Min E, Hong‐Wei Yang, Rui‐Ping Wu, Run‐Jia Liu, Ling‐Li Zhou, Wen‐Jie Fu, Mei‐Ping Jiang, Xiao‐Li Wang
    Head & Neck.2024; 46(5): 1189.     CrossRef
  • An Innovative Thermal Imaging Prototype for Precise Breast Cancer Detection: Integrating Compression Techniques and Classification Methods
    Khaled S. Ahmed, Fayroz F. Sherif, Mohamed S. Abdallah, Young-Im Cho, Shereen M. ElMetwally
    Bioengineering.2024; 11(8): 764.     CrossRef
  • Prognostic impact of waiting time between diagnosis and treatment in patients with cervical cancer: A nationwide population-based study
    Amy P. Hack, Ronald P. Zweemer, Trudy N. Jonges, Femke van der Leij, Cornelis G. Gerestein, Max Peters, Ina M. Jürgenliemk-Schulz, Peter S.N. van Rossum
    Gynecologic Oncology.2022; 165(2): 339.     CrossRef
  • The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching
    Chi-Son Chang, Ji Song Min, Ki Hyeon Song, Chel Hun Choi, Tae-Joong Kim, Jeong-Won Lee, Byoung-Gie Kim, Yoo-Young Lee
    Cancers.2022; 14(16): 3863.     CrossRef
  • Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study
    Yu Min, Zheran Liu, Rendong Huang, Ruidan Li, Jing Jin, Zhigong Wei, Ling He, Yiyan Pei, Ning Li, Yongllin Su, Xiaolin Hu, Xingchen Peng
    Journal of Translational Medicine.2022;[Epub]     CrossRef
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Gynecologic Cancer
Early Metabolic Response Assessed Using 18F-FDG-PET/CT for Image-Guided Intracavitary Brachytherapy Can Better Predict Treatment Outcomes in Patients with Cervical Cancer
Nalee Kim, Won Park, Won Kyung Cho, Duk-Soo Bae, Byoung-Gie Kim, Jeong-Won Lee, Tae-Joong Kim, Chel Hun Choi, Yoo-Young Lee, Young Seok Cho
Cancer Res Treat. 2021;53(3):803-812.   Published online December 9, 2020
DOI: https://doi.org/10.4143/crt.2020.1251
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to identify the prognostic value of early metabolic response assessed using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiation therapy (RT) for cervical cancer.
Materials and Methods
We identified 116 patients treated with definitive RT, including FDG-PET/CT–guided intracavitary brachytherapy, between 2009 and 2018. We calculated parameters including maximum (SUVmax) and mean standardized uptake values (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for baseline FDG-PET/CT (PETbase) and image-guided brachytherapy planning FDG-PET/CT (PETIGBT). Multivariable analyses of disease-free survival (DFS) and overall survival (OS) were performed.
Results
We observed a time-dependent decrease in PET parameters between PETbase and PETIGBT; ΔSUVmax, ΔSUVmean, ΔMTV, and ΔTLG were 65%, 61%, 78%, and 93%, respectively. With a median follow-up of 59.5 months, the 5-year DFS and OS rates were 66% and 79%, respectively. Multivariable analysis demonstrated that ΔSUVmax ≥ 50% was associated with favorable DFS (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.14 to 5.77) and OS (HR, 5.14; 95% CI, 1.55 to 17.01). Patients with ΔSUVmax ≥ 50% (n=87) showed better DFS and OS than those with ΔSUVmax < 50% (n=29) (DFS, 76% vs. 35%, p < 0.001; OS, 90% vs. 41%, p < 0.001, respectively). Adenocarcinoma was frequently observed in ΔSUVmax < 50% compared to ΔSUVmax ≥ 50% (27.6% vs. 10.3%, p=0.003). In addition, models incorporating metabolic parameters showed improved accuracy for predicting DFS (p=0.012) and OS (p=0.004) than models with clinicopathologic factors.
Conclusion
Changes in metabolic parameters, especially those in SUVmax by > 50%, can help improve survival outcome predictions for patients with cervical cancer treated with definitive RT.

Citations

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  • Personalized strategies for brachytherapy of cervix cancer
    Guillaume Camprodon, Alexandra Gabro, Zineb El Ayachi, Supriya Chopra, Remi Nout, Philippe Maingon, Cyrus Chargari
    Cancer/Radiothérapie.2024; 28(6-7): 610.     CrossRef
  • Brachytherapy for cervical cancer: from intracavitary to interstitial technique
    Xiaojing Yang, Hanru Ren, Zhen Li, Jie Fu
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer
    Zhaoming Zhang, Ning Zhang, Guanghui Cheng
    La radiologia medica.2023; 128(5): 588.     CrossRef
  • MRI- and PET-Based Assessment of Radiological and Clinical Factors Associated With Cervical Cancer Response to External Beam Radiation Therapy
    Arun G Paul, Steven Miller, Lance K Heilbrun, Daryn W Smith
    Cureus.2022;[Epub]     CrossRef
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Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients
Min Ae Cho, Soo Young Jeong, Insuk Sohn, Myeong-Seon Kim, Jun Hyeok Kang, E Sun Paik, Yoo-Young Lee, Chel Hun Choi
Cancer Res Treat. 2020;52(2):645-654.   Published online January 16, 2020
DOI: https://doi.org/10.4143/crt.2019.509
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We investigated the impact of four types of antihypertensive medications, angiotensin receptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calcium channel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovarian cancer (EOC).
Materials and Methods
A single-institutional retrospective chart review of 878 patients with EOC was performed. Survival was compared according to use of the four antihypertensive medications during primary treatment. Propensity score matching (ratio 1:3) was performed to control possible associated covariates, such as age, International Federation of Gynecology and Obstetrics stage, residual status after primary debulking surgery, and co-morbidity.
Results
Among 878 patients, 56 patients (6.4%) were ARB users, 62 (7.1%) were BB users, 107 (12.2%) were CCBs users and 32 (3.6%) used TDs. Median progression-free survival (PFS) for ARB, BB, and CCB users was 37.8, 27.2, and 23.6 months compared with 33.6 months for non-users. ARB was associated with 35% decreased risk of disease progression (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.42 to 0.99; p=0.046) in multivariate analysis. After propensity score matching, median PFS for ARB users was 37.8 months and ARB use remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariate analysis (HR, 0.60; 95% CI, 0.39 to 0.93; p=0.022).
Conclusion
In this study, ARBs use during primary treatment is associated with lower recurrence in EOC patients. However, CCBs, BBs, and TDs did not show beneficial impact.

Citations

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  • Prognostic impact of renin-angiotensin system inhibitors in patients with ovarian cancer: a meta-analysis of real-world evidence
    Pian Wang, Xinmiao Zhang, Jinhai Shen
    Expert Review of Anticancer Therapy.2025; 25(3): 241.     CrossRef
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    Rūta Everatt, Irena Kuzmickienė, Birutė Brasiūnienė, Ieva Vincerževskienė, Birutė Intaitė, Saulius Cicėnas, Ingrida Lisauskienė
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  • Impact of ACEI/ARB use on the survival of hypertensive patients with cancer: A meta‑analysis
    Yao Xiao, Xinlong Chen, Wancheng Li, Xin Li, Wence Zhou
    Oncology Letters.2024;[Epub]     CrossRef
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    Yuanyuan Fan, Nazeer Hussain Khan, Muhammad Farhan Ali Khan, MD Faysal Ahammad, Tayyaba Zulfiqar, Razia Virk, Enshe Jiang
    Cancer Management and Research.2022; Volume 14: 1323.     CrossRef
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    Catherine H Schein
    British Medical Bulletin.2021; 137(1): 13.     CrossRef
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    Brain Research.2021; 1756: 147280.     CrossRef
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    Eerik E. E. Santala, Miia Artama, Eero Pukkala, Kala Visvanathan, Synnöve Staff, Teemu J. Murtola
    Cancers.2021; 13(9): 2087.     CrossRef
  • The Use of Antihypertensive Drugs as Coadjuvant Therapy in Cancer
    José A. Carlos-Escalante, Marcela de Jesús-Sánchez, Alejandro Rivas-Castro, Pavel S. Pichardo-Rojas, Claudia Arce, Talia Wegman-Ostrosky
    Frontiers in Oncology.2021;[Epub]     CrossRef
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    Zhao-Yan Wen, Song Gao, Ting-Ting Gong, Yu-Ting Jiang, Jia-Yu Zhang, Yu-Hong Zhao, Qi-Jun Wu
    Frontiers in Oncology.2021;[Epub]     CrossRef
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    Guoqiang Chen, Lei Qiu, Jinghai Gao, Jing Wang, Jianhong Dang, Lingling Li, Zhijun Jin, Xiaojun Liu
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Pretreatment Lymph Node Metastasis as a Prognostic Significance in Cervical Cancer: Comparison between Disease Status
Soo Young Jeong, Hyea Park, Myeong Seon Kim, Jun Hyeok Kang, E Sun Paik, Yoo-Young Lee, Tae Joong Kim, Jeong Won Lee, Byoung-Gie Kim, Duk Soo Bae, Chel Hun Choi
Cancer Res Treat. 2020;52(2):516-523.   Published online October 29, 2019
DOI: https://doi.org/10.4143/crt.2019.328
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Lymph node metastasis (LNM) is the most significant prognostic factor in cervical cancer that was recently incorporated into the International Federation of Gynecology and Obstetrics (FIGO) staging system. This study was performed to evaluate whether the prognostic significance of LNM differs according to disease status.
Materials and Methods
Patients with FIGO stage IB or higher cervical cancer who had pretreatment computed tomography and/or magnetic resonance imaging studies as well as long-term follow-up were enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was used to determine the prognostic significance of LNM. The HRs were compared between the different tumor groups (based on stage, histology, tumor size, primary treatment, age, parametrium involvement, and lymphovascular space invasion).
Results
A total of 970 patients treated between January 1999 and December 2007 were included. The pretreatment LNM had prognostic significance in patients with stage IB1/IIA (HR for progression-free survival 2.10, p=0.001; HR for overall survival 1.99, p=0.005). However, the significance gradually decreased or disappeared with advancing stages. Similarly, the prognostic significance of the pretreatment LNM decreased with advancing disease status, including old age, parametrial involvement or lymphovascular space involvement. In contrast, the tumor size was associated with the prognostic significance of LNM with advancing status. The significance of the clinical LNM did not reflect the significance of the clinical stage. In contrast, the tumor size, parametrial involvement, and significance of the pathologic LNM reflected the clinical stage.
Conclusion
In patients with cervical cancer, pretreatment LNM on imaging has different clinical significance depending on the tumor status.

Citations

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  • Predicting the risk of lymph node metastasis in colon cancer: development and validation of an online dynamic nomogram based on multiple preoperative data
    Longlian Deng, Lemuge Che, Haibin Sun, Riletu En, Bowen Ha, Tao Liu, Tengqi Wang, Qiang Xu
    BMC Gastroenterology.2025;[Epub]     CrossRef
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    Amir Asotić, Memić Asotić, Muhamed Memić, Kerim Asotić, Amra Asotić
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Patient-Derived Xenograft Models of Epithelial Ovarian Cancer for Preclinical Studies
Eun Jin Heo, Young Jae Cho, William Chi Cho, Ji Eun Hong, Hye-Kyung Jeon, Doo-Yi Oh, Yoon-La Choi, Sang Yong Song, Jung-Joo Choi, Duk-Soo Bae, Yoo-Young Lee, Chel Hun Choi, Tae-Joong Kim, Woong-Yang Park, Byoung-Gie Kim, Jeong-Won Lee
Cancer Res Treat. 2017;49(4):915-926.   Published online January 4, 2017
DOI: https://doi.org/10.4143/crt.2016.322
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Patient-derived tumor xenografts (PDXs) can provide more reliable information about tumor biology than cell line models. We developed PDXs for epithelial ovarian cancer (EOC) that have histopathologic and genetic similarities to the primary patient tissues and evaluated their potential for use as a platform for translational EOC research.
Materials and Methods
We successfully established PDXs by subrenal capsule implantation of primary EOC tissues into female BALB/C-nude mice. The rate of successful PDX engraftment was 48.8% (22/45 cases). Hematoxylin and eosin staining and short tandem repeat analysis showed histopathological and genetic similarity between the PDX and primary patient tissues.
Results
Patients whose tumors were successfully engrafted in mice had significantly inferior overall survival when compared with those whose tumors failed to engraft (p=0.040). In preclinical tests of this model, we found that paclitaxel-carboplatin combination chemotherapy significantly deceased tumor weight in PDXs compared with the control treatment (p=0.013). Moreover, erlotinib treatment significantly decreased tumor weight in epidermal growth factor receptor–overexpressing PDX with clear cell histology (p=0.023).
Conclusion
PDXs for EOC with histopathological and genetic stability can be efficiently developed by subrenal capsule implantation and have the potential to provide a promising platform for future translational research and precision medicine for EOC.

Citations

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    Minqi Liu, Xiaoping Yang
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Nomograms Predicting Platinum Sensitivity, Progression-Free Survival, and Overall Survival Using Pretreatment Complete Blood Cell Counts in Epithelial Ovarian Cancer
E Sun Paik, Insuk Sohn, Sun-Young Baek, Minhee Shim, Hyun Jin Choi, Tae-Joong Kim, Chel Hun Choi, Jeong-Won Lee, Byoung-Gie Kim, Yoo-Young Lee, Duk-Soo Bae
Cancer Res Treat. 2017;49(3):635-642.   Published online September 27, 2016
DOI: https://doi.org/10.4143/crt.2016.282
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study was conducted to evaluate the prognostic significance of pre-treatment complete blood cell count (CBC), including white blood cell (WBC) differential, in epithelial ovarian cancer (EOC) patients with primary debulking surgery (PDS) and to develop nomograms for platinum sensitivity, progression-free survival (PFS), and overall survival (OS).
Materials and Methods
We retrospectively reviewed the records of 757 patients with EOC whose primary treatment consisted of surgical debulking and chemotherapy at Samsung Medical Center from 2002 to 2012. We subsequently created nomograms for platinum sensitivity, 3-year PFS, and 5-year OS as prediction models for prognostic variables including age, stage, grade, cancer antigen 125 level, residual disease after PDS, and pre-treatment WBC differential counts. The models were then validated by 10-fold cross-validation (CV).
Results
In addition to stage and residual disease after PDS, which are known predictors, lymphocyte and monocyte count were found to be significant prognostic factors for platinum-sensitivity, platelet count for PFS, and neutrophil count for OS on multivariate analysis. The area under the curves of platinum sensitivity, 3-year PFS, and 5-year OS calculated by the 10-fold CV procedure were 0.7405, 0.8159, and 0.815, respectively.
Conclusion
Prognostic factors including pre-treatment CBC were used to develop nomograms for platinum sensitivity, 3-year PFS, and 5-year OS of patients with EOC. These nomograms can be used to better estimate individual outcomes.

Citations

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Case Report
Metastatic Skin Lesions on Lower Extremities in a Patient with Recurrent Serous Papillary Ovarian Carcinoma: A Case Report and Literature Review
Moon-Kyung Kim, Seo-Hee Kim, Yoo-Young Lee, Chel Hun Choi, Tae-Joong Kim, Jeoung-Won Lee, Je-Ho Lee, Duk-Soo Bae, Byoung-Gie Kim
Cancer Res Treat. 2012;44(2):142-145.   Published online June 30, 2012
DOI: https://doi.org/10.4143/crt.2012.44.2.142
AbstractAbstract PDFPubReaderePub
Clinical observation of skin metastasis in ovarian cancer cases is relatively uncommon. And distant metastatic skin lesions including the extremities are much rarer still as most metastatic skin lesions are located in the skin in the abdominal wall adjacent to where the primary ovarian tumors exist. We report the case of a 60-year-old woman who presented skin lesions on both lower extremities as a consequence of the metastasis of serous papillary adenocarcinoma of the ovary. She presented with erythematous and painful cutaneous nodules on both upper legs and in the inguinal area 42 months after initial diagnosis of ovarian cancer. Skin biopsy revealed metastasis of adenocarcinoma in the dermis. She was treated with surgical excision and systemic chemotherapy. Literature review has suggested that a combined modality approach including surgical excision and chemotherapy may be useful in the management of skin metastases due to ovarian cancer.

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