Chumnan Kietpeerakool

Combined Oral Contraceptives and Endometrial Cancer Among Southeast Asian Women: A Secondary Analysis of Multicenter Case–Control Study

ABSTRACT Aim To determine the association of combined oral contraceptives (COCs) use and endometrial cancer risk in Southeast Asian women. Methods This is a secondary analysis of a previously conducted multicenter case–control study with the recruitment between 2015 and 2021. Cases were women with histologically confirmed diagnoses of endometrial cancer. Controls were women admitted to different wards for other medical conditions and were individually matched to cases by age and admission date, at a ratio of three controls per case. Data regarding contraception practices were collected through interviews conducted by trained personnel using a standardized questionnaire. Conditional logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results In total, 115 (30.4%) out of 378 cases and 574 (50.6%) out of 1134 controls reported a history of COCs use. The odds of endometrial cancer were lower in women who had ever used COCs than those who reported never use (aOR 0.60; 95% CI 0.44–0.82). For every additional 12 months of COCs use, the odds of endometrial cancer decreased by 10% (aOR 0.90; 95% CI 0.86–0.93). Former COCs users had a reduced odds of endometrial cancer for up to 30 years after discontinuation (aOR 0.44; 95% CI 0.25–0.77). Conclusion A noticeable trend was observed indicating a decline in the odds of endometrial cancer with increasing duration of COCs use. COCs users continued to receive long‐term protection against endometrial cancer after discontinuation.

Depot medroxyprogesterone acetate and endometrial cancer: A multicenter case–control study

AbstractObjectiveTo assess the associations between depot medroxyprogesterone acetate (DMPA) and endometrial cancer.MethodsThis multicenter case–control study was conducted among tertiary hospitals in Thailand. Patients were women with endometrial cancer. Controls were women admitted for other conditions, matched for age within 5 years of the patients' age. The controls had to have no abnormal vaginal bleeding, history of hysterectomy, or cancers of the other organs. A standardized questionnaire was used to gather information. Conditional logistic regression was applied to calculate adjusted odds ratio (aORs) and 95% confidence intervals (CIs).ResultsDuring 2015 to 2021, 378 patients and 1134 controls were included. Ever use of DMPA was associated with a 70% decreased overall risk of endometrial cancer (aOR, 0.30 [95% CI, 0.21–0.42]). Endometrial cancer risk declined by 3% (aOR, 0.97 [95% CI, 0.96–0.98]) for every 3 months of DMPA use. The magnitude of the decline in endometrial cancer risk did not vary appreciably by cancer subtypes (aOR, 0.26 [95% CI, 0.17–0.41] and 0.38 [95% CI, 0.22–0.65] for low‐grade and high‐grade tumors, respectively).ConclusionsDepot medroxyprogesterone acetate use was inversely associated with endometrial cancer risk in a duration‐dependent manner. This association was independent of cancer subtype.

Simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with stage IA2-IB1 cervical cancer

Radical hysterectomy is a standard operation for women with early-stage cervical cancer, involving removal of the womb, cervix (neck of the womb), surrounding tissues (parametrial tissue), and part of the vagina. Given a relatively low risk of parametrial involvement in a selected group of women with early-stage cervical cancer, simple hysterectomy (removing only the uterus and cervix) with pelvic lymphadenectomy (surgical removal of the lymph glands found in the pelvis) might be an alternative option to reduce risk of complications. To determine the benefits and harms of simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with stage IA2-IB1 cervical cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), Web of Science Core Collection, PubMed, and two trial registry databases, along with reference checking and citation searching. The last search date was 19 March 2025. We included randomised clinical trials comparing simple hysterectomy with pelvic lymphadenectomy versus radical hysterectomy with pelvic lymphadenectomy for women with cervical cancer FIGO 2019 stage IA2-IB1. Critical outcomes were all-cause mortality, overall survival (OS), cancer-related mortality, and disease-free survival (DFS). Important outcomes included cancer recurrence, adverse events, sexual dysfunction, cost-effectiveness, and quality of life (QoL). Two review authors independently assessed the risk of bias of each included study using the Cochrane Risk of bias 2 (RoB 2) tool. We conducted meta-analyses using random-effects models to calculate hazard ratios (HRs), risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for all outcomes. We used GRADE to assess the certainty of evidence. We included two trials involving 740 participants. One small trial was conducted in Brazil (40 participants). The larger trial, involving 700 participants, included centres in Western Europe, South Korea, and Canada. In this larger trial, 75.0% of participants were white. We classified one report as awaiting classification, and did not identify any ongoing studies. Critical outcomes Low-certainty evidence revealed that simple hysterectomy may result in little or no difference in all-cause mortality (RR 1.12, 95% CI 0.44 to 2.89; I Simple hysterectomy may be a viable option for carefully selected women with early-stage cervical cancer, as it may result in little to no differences in survival and cancer recurrence rates compared to radical hysterectomy. Additionally, there were likely fewer perioperative adverse events and there may be better short-term QoL and sexual function in women undergoing simple hysterectomy. The included studies did not directly compare the effect of the route of surgery (open versus minimal access). This review has a limited representation of non-white women and women from low-resource settings. No specific funding was received for this review. Cochrane protocol (2016) DOI: 10.1002/14651858.CD012335. PROSPERO 2016 CRD42016047631. Available from: crd.york.ac.uk/PROSPERO/view/CRD42016047631.