Kengo Hiranuma

Cell‐Free and Concentrated Ascites Reinfusion Therapy ( CART ) Shows Enhanced Efficacy in Gynecological Cancer Patients: A Post‐Marketing Surveillance Study

ABSTRACT Introduction Ascites management is crucial for gynecological cancer patients requiring long‐term treatment. Cancer type‐specific differences may influence CART outcomes, but comparative data remain limited. This study evaluated CART efficacy in gynecological versus other cancers. Methods This subgroup analysis included 125 cancer patients undergoing 296 CART sessions at 22 Japanese centers (2014–2015). Patients were divided into gynecological cancer (Group G, n  = 46) and other cancer groups (Group O, n  = 79). Results Group G had significantly higher concurrent chemotherapy rates (41.2% vs. 12.3%, p  < 0.001) and ascitic protein/albumin concentrations. Group G showed significant renal function improvements: decreased serum creatinine (0.7 ± 0.3 to 0.6 ± 0.3 mg/dL, p  < 0.001), decreased BUN (17.9 ± 8.7 to 14.5 ± 9.0 mg/dL, p  < 0.001), and increased eGFR (72.7 ± 24.8 to 81.3 ± 27.6 mL/min/1.73 m 2 , p  < 0.001). Drainage intervals were longer in Group G (20.0 ± 13.8 vs. 11.7 ± 10.9 days, p  < 0.001). Conclusion CART demonstrates enhanced efficacy in gynecological cancer patients, particularly improving renal function, potentially reducing chemotherapy‐related toxicity, and improving treatment tolerability.

Clinical features and impact of p53 status on sporadic mismatch repair deficiency and Lynch syndrome in uterine cancer

AbstractThe clinical features of sporadic mismatch repair deficiency (MMRd) and Lynch syndrome (LS) in Japanese patients with endometrial cancer (EC) were examined by evaluating the prevalence and prognostic factors of LS and sporadic MMRd in patients with EC. Targeted sequencing of five LS susceptibility genes (MLH1, MSH2, MSH6, PMS2, and EPCAM) was carried out in 443 patients with EC who were pathologically diagnosed with EC at the National Cancer Center Hospital between 2011 and 2018. Pathogenic variants in these genes were detected in 16 patients (3.7%). Immunohistochemistry for MMR proteins was undertaken in 337 of the 433 (77.9%) EC patients, and 91 patients (27.0%) showed absent expression of at least one MMR protein. The 13 cases of LS with MMR protein loss (93.8%) showed a favorable prognosis with a 5‐year overall survival (OS) rate of 100%, although there was no statistically significant difference between this group and the sporadic MMRd group (p = 0.27). In the MMRd without LS group, the 5‐year OS rate was significantly worse in seven patients with an aberrant p53 expression pattern than in those with p53 WT (53.6% vs. 93.9%, log‐rank test; p = 0.0016). These results suggest that p53 abnormalities and pathogenic germline variants in MMR genes could be potential biomarkers for the molecular classification of EC with MMRd.