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Purpose@#Lymph node metastasis (LNM) is the most significant prognostic factor in cervical cancerthat was recently incorporated into the International Federation of Gynecology and Obstetrics(FIGO) staging system. This study was performed to evaluate whether the prognosticsignificance of LNM differs according to disease status. @*Materials and Methods@#Patients with FIGO stage IB or higher cervical cancer who had pretreatment computedtomography and/or magnetic resonance imaging studies as well as long-term follow-upwere enrolled in this retrospective study. The hazard ratio (HR) of Cox regression was usedto determine the prognostic significance of LNM. The HRs were compared between the differenttumor groups (based on stage, histology, tumor size, primary treatment, age, parametriuminvolvement, 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 forprogression-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, theprognostic 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 advancingstatus. The significance of the clinical LNM did not reflect the significance of the clinicalstage. In contrast, the tumor size, parametrial involvement, and significance of the pathologicLNM reflected the clinical stage. @*Conclusion@#In patients with cervical cancer, pretreatment LNM on imaging has different clinical significancedepending on the tumor status.
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Purpose@#We investigated the impact of four types of antihypertensive medications, angiotensinreceptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calciumchannel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovariancancer (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 duringprimary treatment. Propensity score matching (ratio 1:3) was performed to control possibleassociated covariates, such as age, International Federation of Gynecology and Obstetricsstage, 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 monthsfor non-users. ARB was associated with 35% decreased risk of disease progression (hazardratio [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 ARBuse remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariateanalysis (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 EOCpatients. However, CCBs, BBs, and TDs did not show beneficial impact.
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OBJECTIVE: BRCA mutational status is important in the management of ovarian cancer, but there is a lack of evidence supporting genetic testing in Asian populations. This study was performed to investigate the prevalence and prognostic outcomes of BRCA1/2 mutation and variant of unknown significance (VUS) in Korean patients diagnosed with epithelial ovarian cancer (EOC). METHODS: Among patients newly diagnosed with EOC between January 2007 and January 2017, those tested for germline BRCA1/2 mutation were studied, regardless of family history. Overall survival (OS) and progression-free survival (PFS) were compared between the patients with and without BRCA1/2 mutation and VUS. RESULTS: A total of 313 patients underwent BRCA testing: 88 patients had a BRCA1/2 mutation and 48 patients had a BRCA1/2 VUS (28.1% and 15.3%, respectively). There were no significant associations between BRCA1/2 mutation, BRCA1/2 wild-type, or BRCA1/2 VUS with age at diagnosis, histologic distribution, or residual disease status after primary cytoreductive surgery. BRCA1 mutation, including BRCA1 VUS, showed no difference in PFS or OS compared to BRCA1 wild-type. In contrast, BRCA2 mutation showed longer PFS than that of BRCA2 wild-type (P=0.04) or BRCA2 VUS (P=0.02). BRCA2 mutation, including BRCA2 VUS, did not show any difference in OS compared to BRCA2 wild-type. CONCLUSION: BRCA mutation and BRCA VUS had similar clinical characteristics and survival outcomes, except that BRCA2 mutation showed better PFS. The results of this study will help to understand the prognostic significance of BRCA mutation and VUS in Korean patients.
Subject(s)
Humans , Asian People , Diagnosis , Disease-Free Survival , Genes, BRCA1 , Genes, BRCA2 , Genetic Testing , Korea , Ovarian Neoplasms , PrevalenceABSTRACT
Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.