Clinicopathological demographics of malignant melanoma of the vulva and vagina in Japan: Japanese Gynecologic Oncology Group (JGOG)/Japanese Skin Cancer Society (JSCS)—Intergroup Study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22106-e22106
Author(s):  
Shin Nishio ◽  
Dai Ogata ◽  
Yoshio Kiyohara ◽  
Munetaka Takekuma ◽  
Mikio Mikami ◽  
...  
Keyword(s):  
Gynecologic Oncology ◽  
Univariate Analysis ◽  
Surgical Margin ◽  
Nodal Status ◽  
Disease Stage ◽  
Depth Of Invasion ◽  
Gynecologic Oncology Group ◽  
Histologic Subtype ◽  
Malignant Melanomas ◽  
Ajcc Stage

e22106 Background: Malignant melanomas of the vulva (VuM) and vagina (VaM) represent a unique subgroup of malignant melanomas with important differences in biological properties and treatment. In Japan adequate surveys have not been performed.The objective of this study was to elucidate the clinicopathological demographics and outcomes of VuM and VaM in Japan. Methods: Women with invasive VuM or VaM were identified from a medical records. Data on clinician (Gynecologist or Dermatologist), age, location, node status, ulceration, mitotic count, histologic subtype, American Joint Committee on Cancer (AJCC) stage, primary surgery, and surgical margin were collected. The Kaplan-Meier method was used to analyze progression free survival (PFS) and overall survival (OS). Univariate and multivariate regression models were used to identify factors significantly related to survival. Results: A total of 217 patients (pts) were identified; 109 (50.2%) had VuM and 108 (49.8%) had VaM. The median age of the subjects was 67 years (range [R], 29-96 years). Surgery was performed in 84.3% of the women with VuM and 83.3% of those with VaM. The median depth of invasion was 4.5 mm (R, 0.1-12 mm). Ulceration was documented in 47.9% (104/217) of the lesions. Nodal status was positive in 60 pts (27.6%), negative in 149 pts (68.7%), and unknown in 8 (3.7%) pts. The AJCC stage was stage I in 37 pts (17.1%), II in 106 pts (48.8%), III in 46 pts (21.2%), and IV in 28 pts (12.9%). Nodular melanoma was the most common subtype (48.8%). The median PFS was 16.8 months in pts with VuM (95% confidence interval [CI] 23.1-87.7) and 15.6 months in pts with VaM (95% CI 8.4-12.6). The median OS was 43.9 months (95% CI 60-138) in pts with VuM and 31.1 months (95% CI 24.8-45.3) in pts with VaM. Univariate analysis showed that vaginal location, nodal metastases, stage, surgery, and surgical margin were associated with poorer PFS, whereas nodal status, histologic subtype, stage, surgery, and surgical margin were associated with poorer OS. Multivariate analysis showed that only disease stage (hazard ratio [HR] = 3.09; 95% CI = 1.73-5.49) was associated with poorer PFS. Surgical margin was the only independent factor influencing OS (HR = 2.39; 95% CI = 1.48-3.80). Conclusions: The overall outcomes of VuM and VaM remain poor in Japan. In particular, the outcomes of VaM are worse than those reported previously. AJCC stage and surgical margin are important predictors of survival. Regardless of disease stage, suitable surgical resection is required. Clinical trial information: UMIN000025968.

scholarly journals Clinicopathological Demographics of Malignant Melanoma of the Vulva and Vagina in Japan

2021 ◽  
Author(s):  
Dai Ogata ◽  
Shin Nishio ◽  
Naohito Hatta ◽  
Tatsuya Kaji ◽  
Kazuyasu Fujii ◽  
...  
Keyword(s):  
Medical Records ◽  
Regression Models ◽  
Surgical Margin ◽  
Progression Free Survival ◽  
Biological Properties ◽  
Disease Stage ◽  
Free Survival ◽  
Malignant Melanomas ◽  
Ajcc Stage ◽  
Kaplan Meier

Abstract Objective: Malignant melanomas of the vulva (VuM) and vagina (VaM) represent a unique subgroup of rare malignant melanomas with critical biological properties and treatment differing from that of other cancers. In Japan, adequate surveys on these have not been performed. The objective of this study was to elucidate the clinicopathological demographics and the outcomes of VuM and VaM in Japan.Methods: This retrospective observational study included women with invasive VuM or VaM, identified from older medical records in Japan. Clinical data were collected and the Kaplan-Meier method was used to analyze progression-free survival (PFS) and overall survival (OS). Univariate and multivariate regression models were used to identify factors significantly related to survival.Results: A total of 217 patients were identified: 109 (50.2%) with VuM and 108 (49.8%) with VaM. The median PFS was 16.8 months in patients with VuM (95% confidence interval [CI] 23.1-87.7) and 15.6 months in patients with VaM (95% CI 8.4-12.6). The median OS was 43.9 months (95% CI 60-138) and 31.1 months (95% CI 24.8-45.3) in patients with VuM and VaM, respectively. Multivariate analysis showed that a >III American Joint Committee on Cancer (AJCC) disease stage (hazard ratio [HR] = 2.063; 95% CI = 0.995-4.278) was associated with poorer PFS, and unknown surgical margin was the only independent factor influencing OS (HR = 2.188; 95% CI = 1.203-3.977).Conclusions: The overall outcomes of VuM and VaM remain poor in Japan. The AJCC stage and the surgical margin are significant predictors of survival.

Markers of angiogenesis in cervical cancer: A Gynecologic Oncology Group study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5536-5536
Author(s):  
L. Randall-Whitis ◽  
B. J. Monk ◽  
E. S. Han ◽  
K. Darcy ◽  
R. A. Burger ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Cox Regression ◽  
Gynecologic Oncology ◽  
Positive Control ◽  
Rank Test ◽  
Gynecologic Oncology Group ◽  
Continuous Variables ◽  
Histologic Subtype ◽  
Cd 31

5536 Background: Extensive tumor angiogenesis has correlated with poorer progression-free and overall survival in cervical cancer; however, specific markers of angiogenesis have not been studied prospectively. Methods: Cervical cancer patients with high-risk features on radical hysterectomy were eligible for randomization to adjuvant pelvic irradiation ± radiosensitizing platinum. Following central pathology review, formalin-fixed, paraffin-embedded tumors were sectioned into 4-micron specimens. Semi-quantitative immunohistochemisty (IHC) was performed using previously validated antibodies against mutant p53 (mp53), vascular endothelial growth factor (VEGF), thrombospondin-1 (TSP-1), and endothelial markers CD 31 and CD 105. Tumoral histoscores (HS) were calculated for mp53 and VEGF using the formula: [% cells positive × (intensity +1)], with a 5% threshold for positivity and intensity ranging 1–4+ (3+ = intensity of positive control). Intensity scores (0–4+) were assigned to TSP-1 specimens referencing the positive control (3+). MVD “hotspots” were counted in a 20X high-power field. HS and MVD counts were considered as continuous variables and TSP-1 intensity as an ordinal variable. Associations between markers were determined by Pearson’s and Spearman’s correlation tests, between markers and clinico-pathologic variables by Wilcoxon rank test, and between markers and survival by Cox regression modeling. Results: One hundred seventy-six specimens were analyzed. Acquisition of mp53 and increased VEGF expression were associated with increased MVD assessed by both CD31 (p=0.08 and p=0.002, respectively) and CD105 (p=0.02 and p=0.012, respectively). Statistically significant associations between markers and high-risk pathologic factors included: low-level TSP-1 and high CD-105 counts with lymph node metastases; high VEGF scores with advanced stage, non-squamous histologic subtype, and depth of tumor invasion; and high CD 31 counts with parametrial metastases. Survival analysis is currently being performed. Conclusions: Angiogenesis occurs early in cervical carcinogenesis, and may be a rational target for biologic therapy in cervical cancer. No significant financial relationships to disclose.

Margin distance as an independent predictor of survival after R0 resection for pancreatic adenocarcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 321-321
Author(s):  
George Van Buren ◽  
Herbert Zeh ◽  
Alyssa M Krasinskas ◽  
William E. Gooding ◽  
Jennifer Steve ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Vascular Invasion ◽  
Perineural Invasion ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Ajcc Stage ◽  
The Impact

321 Background: Microscopic tumor at the surgical margin is a predictor of recurrence and poor survival for pancreatic ductal adenocarcinoma (PDA). However, the impact of distance between the surgical margin and microscopic tumor on survival remains controversial. We hypothesized that margin distance (MD) would correlate with disease free survival (DFS) and overall survival (OS) in R0 resected PDA. Methods: Retrospective analysis of 191 resections for PDA. Margin distance was measured (0-1, 1-2, 2-4, 4-10, and > 10 mm) and categorized by location. Parameters including age, gender, BMI, TNM, AJCC stage, lymph node (LN) ratio, vascular and perineural invasion, vein resection, and adjuvant therapy were analyzed. Primary endpoints were DFS and disease specific OS. Univariate analysis was used to estimate factors associated with outcomes. The log rank test was applied to selected group comparisons. Results: 149 (78%) R0 outcomes were analyzed. 118 (79%) patients received adjuvant chemotherapy, 31 of whom also received XRT. Univariate analysis demonstrated reduced DFS (HR = 1.65, 95% CI = 1.13 – 2.48, p = .009) and OS (HR = 1.52 95% CI =.98 – 2.35, p = .059) among patients with margins ≤ 2mm compared to margins > 2mm. In addition LN status, LN ratio, tumor size, AJCC stage, vascular invasion, perineural invasion and adjuvant chemotherapy were found to influence OS on univariate analysis. Adjuvant XRT had no measurable effect on DFS or OS. Following adjustment for covariates in a multivariate model, margin distance >2mm did not correlate with DFS (HR = 1.14, 95%CI = .73 – 1.78, p = .57) or OS (HR = 1.13 95% CI = .69 – 1.85, p = .63), whereas adjuvant chemotherapy and presence of vascular invasion significantly affected OS (P=0.0006 and P=0.008 respectively). The retroperitoneal margin was the margin most commonly in close proximity to tumor (43% of Whipple), although there was no correlation between the closest margin and DFS (p=0.94) or OS (p=0.94). Conclusions: Margin distance is not an independent predictor of DFS or OS after R0 resection for PDA. Irrespective of margin distance, adjuvant chemotherapy, but not XRT, was associated with improved OS.

Does Omentectomy in Epithelial Ovarian Cancer Affect Survival? An Analysis of the Surveillance, Epidemiology, and End Results Database

2015 ◽  
Vol 25 (4) ◽  
pp. 607-615 ◽  
Author(s):  
Leah McNally ◽  
Nelson N.H. Teng ◽  
Daniel S. Kapp ◽  
Amer Karam
Keyword(s):  
Ovarian Cancer ◽  
Multivariate Analysis ◽  
Epithelial Ovarian Cancer ◽  
Univariate Analysis ◽  
Hazard Ratio ◽  
Disease Stage ◽  
Bulky Disease ◽  
Histologic Subtype ◽  
And Performance ◽  
End Results

ObjectiveAlthough omentectomy is part of the staging and treatment of epithelial ovarian cancer (EOC), its performance in a patient with a grossly normal omentum—acknowledging its role in debulking gross tumor deposits—has never been definitively shown to improve survival.Methods/MaterialsUsing Surveillance, Epidemiology, and End Results data from 1998 to 2010, we identified patients with EOC and assessed their age, race, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, lymph node dissection, nodal findings, and performance of omentectomy. We compared disease-specific survival (DSS) based on the presence or absence of omentectomy using log-rank univariate analysis, Cox multivariate analysis, and Kaplan-Meier survival curves.ResultsA total of 20,975 patients with invasive EOC underwent surgical treatment. Initial univariate analysis indicated a lower mean DSS with performance of omentectomy. However, multivariate analysis demonstrated no significant association between DSS and performance of omentectomy (hazard ratio, 0.978;P= 0.506). The DSS was improved if lymphadenectomy was performed (hazard ratio, 0.60;P< 0.001). In recent years, there was a trend toward decreased performance of omentectomy.To look specifically at patients without bulky omental disease, a subset analysis was done looking at patients with stage I-IIIA disease who had had lymphadenectomy performed. There were 5454 patients in the group who underwent an omentectomy and 2404 patients in the group who did not. No difference in DSS was seen between the groups based on performance of omentectomy (P= 0.89). However, the analysis was limited by the lack of Surveillance, Epidemiology, and End Results data on the extent of omentectomy, amount of residual disease, and adjuvant chemotherapy.ConclusionsIn this analysis, performance of omentectomy in patients with EOC without bulky disease (≤stage IIIA) did not seem to confer improvement in survival. A randomized control trial would be needed to fully address this question.

Prognostic significance of the number of pelvic lymph-nodes resection in patients with cervical adenocarcinoma: An analysis from JGOG 1070S study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5529-5529
Author(s):  
Yuji Ikeda ◽  
Tsunekazu Kita ◽  
Akiko Furusawa ◽  
Munetaka Takekuma ◽  
Mikio Mikami
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factor ◽  
Lymph Nodes ◽  
Clinical Stage ◽  
Gynecologic Oncology ◽  
Prognostic Significance ◽  
Pelvic Lymphadenectomy ◽  
Disease Stage ◽  
Significant Prognostic Factor ◽  
Gynecologic Oncology Group

5529 Background: Although resection of more than 20 lymph-nodes is considered to be adequate in pelvic lymphadenectomy for cervical cancer patients, prognostic significance of the number of resected lymph-nodes (PLN-num) is clinically still unknown. Methods: This nationwide multicenter retrospective study (JGOG 1070S) examined consecutive 693 patients with clinical stage IB-IIB cervical cancer who underwent radical hysterectomy including pelvic and/or para-aortic lymphadenectomy between 2008-2009 at 87 institutions of the Japanese Gynecologic Oncology Group. Maximum number of enrollments from one institution was limited 10 or less to minimize the inter-institutional bias. Correlation between PLN-num and prognosis was analyzed using Cox hazard model with considering histological subtypes. Results: Of 473 eligible cases in this study, the average PLN-num per a case in each institution was positively correlated with the number of total cases treated in each institution per year. (R = 0.42, P = 0.012). Patients with high PLN-num showed favorable progression free survival (PFS) (P = 0.12). Focusing on adeno and adeno-squamous carcinomas, significantly improved PFS was shown in high PLN-num cases (P = 0.012), although no significance was found in squamous cell carcinoma (P = 0.754). Multivariate analysis in adeno and adeno-squamous cases showed PLN-num as an independent prognostic factor (HR; 0.46, 95%CI; 0.24–0.84, P = 0.026) along with disease stage and adjuvant therapeutics. Subset analysis of adeno and adeno-squamous cases without adjuvant therapeutics showed significant improvement of survival in high PLN-num group (P = 0.019). Conclusions: In our study, PLN-num in lymphadenectomy for patients with cervical adeno or adeno-squamous carcinoma was clarified to be a significant prognostic factor. Systematic total lymphadenectomy is recommended for these patients to obtain a favorable prognosis.

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