Trends in the incidence and survival outcomes of endometrial cancer in Korea: a nationwide population-based cohort study.

OBJECTIVE: To evaluate trends in the incidence and survival outcomes of endometrial cancer (EC) based on the year of diagnosis, stage, age, and histologic types. METHODS: Women with primary EC diagnosed between 1999 and 2018, and who were followed up with until 2019, were identified from the Korea Central Cancer Registry using the International Classification of Diseases, 10th revision. The age-standardized rates (ASRs) of incidence, annual percent changes (APCs), and survival were estimated according to age, stage, histology, and year of diagnosis. RESULTS: The ASR for EC increased from 2.38 per 100,000 in 1999 to 7.29 per 100,000 in 2018 across all histologic types (APCs of 9.82, 15.97, and 7.73 for endometrioid, serous, and clear cell, respectively, p<0.001). There were significant differences in the 5-year survival rates based on histology (90.9%, 55.0%, and 68.5% for endometrioid, serous, and clear cell, respectively, p<0.001), stage (93.4%, 77.0%, and 31.0% for localized, regional, and distant, respectively, p<0.001), and age (93.0% for <50 years and 80.6% for ≥50 years, p<0.001). The 5-year survival was significantly better in the group diagnosed between 2000 and 2018 (85.9%) than that in the 1999-2008 group (83.3%) (p<0.001). This trend was only observed for endometrioid cancer (p<0.001). CONCLUSION: The incidence of EC increased across the all 3 subtypes. Survival of patients with endometrioid histology improved over the past two decades, but remained static for serous or clear cell histology. Healthcare strategies to prevent EC incidence in at-risk populations and apply effective treatments for high-risk histology are needed.

Incidence and treatment outcomes of uterine cervical cancer in Korea 1999-2018 from the national cancer registry.

OBJECTIVE: To describe the incidence and survival outcomes of uterine cervical cancer during 1999-2018. METHODS: Patients who were diagnosed with cervical cancer during 1999-2018 were identified in the Korea Central Cancer Registry. Age-standardized incidence rates (ASRs) and annual percent changes (APCs) were calculated. Survival rates by histology, year of diagnosis (1999-2008 vs. 2009-2018), stage, and age at diagnosis were analyzed. RESULTS: The absolute incidence of cervical cancer decreased over 20 years from 4,488 in 1999 to 3,500 in 2018, with an APC of -3.42% (p<0.0001). While ASR of squamous cell carcinoma (SCCA) more than halved from 13.27 per 100,000 in 1999 to 6.16 in 2018 (APC, -4.04%), adenocarcinoma continued to rise (ASR, 1.30 per 100,000 to 1.92; APC, 1.52%; p<0.0001). Patients with adenocarcinoma were younger than those with SCCA (mean, 49.9±12.7 vs. 52.9 ±14.6 years; p<0.0001). Five-year survival rate of cervical cancer patients overall was 78.0%. Adenocarcinoma had poorer survival than SCCA (5-year survival rate, 76.8% vs. 79.8%; p<0.0001). There was no survival difference between patients who were diagnosed between 1999-2008 and 2009-2018. Earlier-stage disease had better survival (5-year survival rate for localized, regional, and distant disease, 90.0% vs. 69.9% vs. 26.5%; p<0.0001). Younger patients aged <50 years had better survival than those aged ≥50 years (87.1% vs. 69.8%; p<0.0001). CONCLUSION: The incidence of SCCA of the uterine cervix declined while adenocarcinoma continued to increase slowly but significantly from 1999 to 2018 in Korea. Adenocarcinoma was diagnosed at a younger age, but had poorer survival outcome than SCCA.

Preoperative laboratory parameters associated with deep vein thrombosis in patients with ovarian cancer: retrospective analysis of 3,147 patients in a single institute.

OBJECTIVE: Patients with ovarian cancer have a high risk of developing thrombosis. We aimed to investigate laboratory parameters associated with deep vein thrombosis (DVT) in patients treated for ovarian cancer. METHODS: We retrospectively analyzed pre-operation laboratory data of patients with ovarian cancer for DVT at the National Cancer Center, Korea, between January 2000 and February 2021. The test items were white blood cell count, absolute neutrophil count (ANC), hemoglobin, platelets, monocytes, serum glucose, CA125, D-dimer, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and body mass index (BMI). Differences between patients with and without DVT were compared with Wilcoxon rank-sum test. We analyzed the variables using logistic regression. Items with significant odds ratios were included in multivariate logistic regression. Significant variables were selected using backward elimination. Items were further categorized based on reference ranges. Univariate and multivariate analyses were performed to identify items with abnormal values associated with DVT. RESULTS: From 3,147 patient samples analyzed, 286 (9.1%) patients with DVT were selected. Differences between patients with vs without DVT were statistically significant for hemoglobin, monocyte, serum glucose, CA125, PT, aPTT, fibrinogen, D-dimer, and BMI. After univariate and multivariate analysis, monocyte, glucose, and PT remained significant. Among the categorical variables, low hemoglobin, high monocyte, high CA125, prolonged PT, and high BMI remained significant after univariate and multivariate analysis. CONCLUSION: Pre-operation laboratory data of low hemoglobin, high monocyte percentage, high serum glucose, high CA125, prolonged PT, and high BMI were associated with DVT.

Vitamin D Status and Bone Health in Postmenopausal Women Working in Greenhouses.

OBJECTIVES: Greenhouse workers synthesize less vitamin D because ultraviolet light is blocked by the vinyl that covers the greenhouses. This study aimed to investigate the vitamin D status and bone health of postmenopausal women working in greenhouses. METHODS: This observational study enrolled women living in urban (n = 70, group 1) and rural areas (n = 91, group 2) and those working in greenhouses (n = 112, group 3). Serum levels of total and bioavailable 25-hydroxy-vitamin D [25(OH)D] and vitamin D binding protein were measured. T-scores of the lumbar spine and femur neck were measured by dual-energy X-ray absorptionetry. RESULTS: Heights were shorter in group 2 and group 3 than in group 1. Bioavailable 25(OH)D levels were higher and T-scores of the spine and femur were lower in both group 2 and 3 than in group 1. T-scores of the femur in group 3 were lower than those in group 2. The linear regression analysis showed that levels of bioavailable 25(OH)D significantly correlated with the spine T-scores but not with the femur T-scores. The prevalence of spinal osteoporosis was higher in both groups 2 and 3 compared to group 1. Group 3 demonstrated greater femur osteoporosis compared to groups 1 and 2. CONCLUSIONS: Vitamin D plays an important role in spinal bone health. Moreover, working conditions are likely to play an important role in femur bone health. Therefore, appropriate working conditions and nutrition are paramount to improve bone health in postmenopausal women working in greenhouses.

Learning curve analysis of multiport robot-assisted hysterectomy.

PURPOSE: The purpose of this study was to evaluate the surgical outcomes and learning curve of multiport robot-assisted hysterectomy. METHODS: Eighty-eight patients were identified who underwent multiport robot-assisted surgery for hysterectomy. A retrospective analysis was performed. The cumulative summation technique (CUSUM) was used to investigate the learning curve in surgical proficiency by analyzing total operative, docking, and console times. RESULTS: The patients' median age was 51 years. In addition, the median operative time was 120.5 min (range 56-344 min). The most common indication for surgery was myoma (33.0%). The median estimated blood loss was 30 mL (range 5-200 mL). There was no conversion to laparoscopic or open surgery. No transfusion was required, and only one complication including umbilical incisional hernia was reported. A tendency of decline in total operative time following the first 23 cases was found. The CUSUM graph for total operative time indicated the generation of three distinct performance phases: learning (n = 23), competence (n = 36), and mastery (n = 29). The median docking time was 3 min (range 1-10 min) and median console time was 70 min (range 24-298 min). CONCLUSION: The multiport robot-assisted surgery is an easy and safe procedure with minimal postoperative complications and can be quickly learned. The learning curve was 23 cases to significantly decrease the operative time.

Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy.

We aim to analyze the surgical outcomes and learning curve of single-site robot-assisted hysterectomy. This was a retrospective cohort study from a single academic medical center. A total of 123 patients who underwent single-site robotic surgery for gynecologic disease were enrolled. Gynecologic surgeries were performed by a single surgeon using single-site robot-assisted hysterectomy. The median age of enrolled patients was 49 years (range: 30-74 years). The median operation time was 131 min (range: 59-502 min) and the median docking time was 3 min (range: 1-10 min). In addition, the median console time was 76 min (range: 29-465 min). The cumulative sum (CUSUM) graph for total operation time indicated an initial decrease at case 41, generating 3 distinct performance phases: learning (n = 41 initial cases), competence (n = 54 middle cases), and mastery (n = 28 final cases). There was one case conversion to open surgery due to the difficulty in securing the field of view because of a 16-cm bulky mass protruding from the left pelvic wall. No patients required a transfusion and two complications including vaginal cuff dehiscence were identified. The single-site robot-assisted hysterectomy is a safe and feasible procedure. The learning curve consisted of 41 cases to significantly decrease the total operation time.

Transvaginal lymphatic embolization of the fistula between a pelvic lymphocele and the vaginal stump following radical hysterectomy and sentinel pelvic lymph node biopsy in a patient with cervical cancer: A case report.

A lymphocele is a common complication that occurs following pelvic lymph node dissection. However, the complication of lymphoceles following sentinel pelvic lymph node biopsy has not been previously reported, to the best of our knowledge. A 49-year-old female patient had undergone radical hysterectomy and pelvic lymph node biopsy for stage IB1 cervical cancer 5 months previously and presented with a profuse watery vaginal discharge of ~2 liters per day. A fistula connecting the lymphocele and the vaginal stump was identified using lymphoscintigraphy and single photon emission CT/CT. Transvaginal lymphatic embolization was successfully performed through the vaginal fistulous tract, resulting in immediate reduction of the vaginal discharge. In conclusion, the case of fistula formation between pelvic lymphocele and vaginal stump was encountered at our department and was reported with a literature review. To the best of our knowledge, there are no previous reports on lymphoceles with direct communication to the vaginal mucosa, particularly following sentinel pelvic lymph node biopsy. The present study reported the case of a patient who was successfully treated for a pelvic lymphocele with direct communication to the vaginal mucosa.

Clinical outcomes of BRCA1/2 pathogenic variants in ovarian cancer cluster region in patients with primary peritoneal, epithelial ovarian, and fallopian tube cancer.

OBJECTIVE: An "ovarian cancer cluster region" (OCCR) has been reported in both BRCA1 and BRCA2. However, the clinical significance of the OCCR of BRCA1/2 has not yet been investigated. METHODS: The medical records of 991 patients with epithelial ovarian, primary peritoneal, and fallopian tube cancer who underwent genetic testing for BRCA1 and/or BRCA2 from January 1, 2006, to August 31, 2019, were retrospectively reviewed. Sanger and next-generation sequencing analyses were used to test the BRCA1 and BRCA2 mutation status. Progression-free survival (PFS) and overall survival (OS) were compared according to the mutation location (OCCR vs. non-OCCR region). Survival outcomes were determined using Kaplan-Meier survival analysis. RESULTS: A total of 162 patients had BRCA1 pathogenic variants (PVs), and 76 had BRCA2 PVs. Patients with BRCA1 PV that in the OCCR region showed shorter PFS than those with BRCA1 PV outside the OCCR (22.6 months vs. 27.6 months, P = 0.038). In the platinum-sensitive subgroup of BRCA1, patients with BRCA1 PV in the OCCR region showed shorter PFS than those in the non-OCCR group (P = 0.0197). On the other hand, BRCA2 variants did not exhibit any particular trend (32.8 months vs. 27.9 months, P = 0.468). However, no significant differences were detected in OS between patients with BRCA1/2 PVs, regardless of the location of the variants. CONCLUSIONS: Patients with BRCA1 PV in the OCCR had shorter PFS than those outside the OCCR. This tendency was more pronounced in the platinum-sensitive subgroup. To our knowledge, this is the first study of BRCA1/2 mutations based on the OCCR.

Incidence and treatment outcomes of ovarian sarcoma compared to epithelial ovarian cancer from the national cancer registry.

PURPOSE: To investigate the incidence and survival outcomes of primary ovarian sarcoma compared to those of epithelial ovarian cancer. METHODS: Data on primary ovarian sarcoma patients (n = 1361) and epithelial ovarian cancer patients (n = 30,366) between 1999 and 2017 were obtained from the Korea Central Cancer Registry, and their respective age-standardized incidence rate (ASR) and relative survival rate were calculated and compared. RESULTS: Based on the ASR, the incidence of epithelial ovarian cancer was 4.75 per 100,000 women, while that of primary ovarian sarcoma was 0.22 per 100,000 women. The ASR ratio was 21.94 without significant change of ASR during the study period. Primary ovarian sarcoma had a better survival curve compared with epithelial ovarian cancer, though the difference was not statistically significant (5 yr overall survival 64.0% vs. 61.5%; p = 0.6030). In addition, among the pure sarcomas, the fibrosarcoma histologic subtype showed the best overall survival, and that of liposarcomas and stromal cell sarcoma were behind that (5 yr overall survival 85.0%, 76.7%, and 72.7%; p < 0.0001). CONCLUSIONS: The incidence of primary ovarian sarcoma is quite low, with an ASR of 0.22/100,000 during the last 20 years. There were no significant differences between survival rates of primary ovarian sarcoma and epithelial ovarian cancer.

Angiopoietin-1 and -2 and vascular endothelial growth factor expression in ovarian grafts after cryopreservation using two methods.

OBJECTIVE: The favored method of preserving fertility in young female cancer survivors is cryopreservation and autotransplantation of ovarian tissue. Reducing hypoxia until angiogenesis takes place is essential for the survival of transplanted ovarian tissue. The aim of this study was to investigate the role of angiopoietin-1 (Angpt-1), angiopoietin-2 (Angpt-2), and vascular endothelial growth factor (VEGF) in ovarian tissue grafts that were cryopreserved using two methods. METHODS: Ovarian tissues harvested from ICR mice were divided into three groups: group I (control), no cryopreservation; group II, vitrification in EFS (ethylene-glycol, ficoll, and sucrose solution)-40; and group III, slow freezing in dimethyl sulfoxide. We extracted mRNA for VEGF, Angpt-1, and Angpt-2 from ovarian tissue 1 week following cryopreservation and again 2 weeks after autotransplantation. We used reverse transcriptase-polymerase chain reaction to quantify the levels of VEGF, Angpt-1, and Angpt-2 in the tissue. RESULTS: Angpt-1 and Angpt-2 expression decreased after cryopreservation in groups II and III. After autotransplantation, Angpt-1 and Angpt-2 expression in ovarian tissue showed different trends. Angpt-1 expression in groups II and III was lower than in group I, but Angpt-2 in groups II and III showed no significant difference from group I. The vitrified ovarian tissues had higher expression of VEGF and Angpt-2 than the slowfrozen ovarian tissues, but the difference was not statistically significant. CONCLUSION: Our results indicate that Angpt-2 may play an important role in ovarian tissue transplantation after cryopreservation although further studies are needed to understand its exact function.