Jun-Hyeong Seo

Impact of Para-Aortic Lymphadenectomy on Clinically FIGO Stage IIIC1 High-Grade Endometrial Cancer: A Retrospective Cohort Study from Two Tertiary Centers in Korea and Taiwan

Background and Objectives: The therapeutic effect of para-aortic lymphadenectomy in patients with clinically para-aortic node-negative diseases remains controversial. In this study, we investigated whether combined pelvic and para-aortic lymphadenectomy has a survival benefit compared with pelvic lymphadenectomy alone in patients with clinically FIGO stage IIIC1 high-grade endometrial cancer. Materials and Methods: We retrospectively reviewed patients with clinically FIGO stage IIIC1 high-grade endometrial cancer in the period between January 2000 and December 2020 at two tertiary centers. The patients were stratified according to type of lymphadenectomy and subgroup analyses performed. Kaplan–Meier analysis and a Cox proportional-hazards model were used to evaluate survival outcomes. Results: A total of 56 patients were identified. Of these patients, 18 underwent pelvic lymphadenectomy alone and 38 underwent combined pelvic and para-aortic lymphadenectomy. After staging surgery, 34 (60.7%) patients had pathologically confirmed lymph node metastases. Within a median follow-up of 57.5 months, there were no significant differences in recurrence-free survival (RFS) and overall survival (OS) between the two groups. In subgroup analyses, the node- and lymphovascular space invasion (LVSI)-positive patients characterized by grade 3 endometrioid histologic type (p = 0.010) or negative peritoneal washing cytology (p = 0.035) had an RFS benefit from combined pelvic and para-aortic lymphadenectomy. Conclusions: The addition of para-aortic lymphadenectomy to pelvic lymphadenectomy did not improve survival in patients with clinically FIGO IIIC1 endometrial cancer. However, para-aortic lymphadenectomy may have RFS benefit for patients with grade 3 endometrioid histologic type and positive LVSI.

Prognostic impact of primary surgery in human papillomavirus‐independent, advanced or metastatic endocervical adenocarcinoma: A bi‐institutional retrospective study

AbstractObjectiveTo evaluate the prognostic impact of primary surgery on patients with HPV‐independent, advanced or metastatic endocervical adenocarcinoma (EAC) who typically exhibit poor survival outcomes and resistance to conventional therapies such as chemoradiotherapy.MethodsA bi‐institutional retrospective study was conducted at Samsung Medical Center and Taiwan National University Hospital. Between 2001 and 2023, 92 patients with HPV‐independent advanced or metastatic EAC were included. Patients were divided into two groups: 54 (58.7%) underwent primary surgery and 38 (41.3%) received non‐surgical treatments, including definitive radiotherapy or palliative chemotherapy. Kaplan–Meier analysis was used to compare progression‐free survival (PFS) and overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors.ResultsThe surgery group demonstrated significantly improved outcomes, with a median PFS of 19.2 months, compared with 10.0 months in the non‐surgery group (P < 0.001). Median OS was not reached in the surgery group, whereas it was 24.1 months in the non‐surgery group (P = 0.002). Multivariate analysis showed that non‐surgical treatment was an independent predictor of poor PFS (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.18–4.29; P = 0.013) and OS (HR 3.25; 95% CI 1.37–7.73; P = 0.008). Additionally, the recurrence rate was significantly lower in the surgery group (55.6%) than in the non‐surgery group (84.2%; P = 0.006).ConclusionPrimary surgery significantly improves survival outcomes in patients with HPV‐independent advanced or metastatic EAC. These findings suggest that surgery should be considered as part of a multimodal treatment strategy for this aggressive subtype, highlighting the need for individualized therapeutic approaches beyond standard chemoradiotherapy protocols.

Pre-diagnostic physical activity and mortality in cervical cancer: a nationwide cohort study

The prognostic significance of pre-diagnostic physical activity in cervical cancer remains unclear. This study examined the association between pre-diagnostic physical activity and all-cause mortality among women with cervical cancer. In a population-based cohort study using nationwide South Korean registry data, 8833 women aged 19 to 79 years with newly diagnosed cervical cancer who completed health screenings within 1 year before diagnosis were analyzed. Physical activity was self-reported and categorized by intensity, duration, and total energy expenditure in metabolic equivalent task-minutes per week. All-cause mortality was assessed using multi-variable Cox proportional hazards models with sub-group analyses by Surveillance, Epidemiology, and End Results stage and age. Among the study population, 64.9% had localized, 23.7% regional, and 5.0% distant disease. Higher total energy expenditure was associated with reduced mortality. Compared with <500 metabolic equivalent task-minutes per week, 500 to 1499 metabolic equivalent task-minutes per week was associated with lower mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.98). Physical activity intensity alone was not independently associated with mortality; however, among patients with localized disease, vigorous-intensity activity (HR 0.64, 95% CI 0.43 to 0.95) and regular exercise (HR 0.62, 95% CI 0.43 to 0.88) were associated with lower mortality. Among patients aged ≥65 years, associations between physical activity and mortality were observed mainly in localized-stage disease, with no significant associations in other stages or younger age groups. Higher levels of pre-diagnostic physical activity were associated with improved survival in women with localized cervical cancer, particularly among those aged ≥65 years. These findings suggest that pre-diagnostic physical activity may have prognostic relevance in specific patient sub-groups.