Yukio Suzuki

Inspection for micrometastasis is essential for predicting the prognosis of serous endometrial intraepithelial carcinoma: Case report and literature review

AbstractSerous endometrial intraepithelial carcinoma is the precursor of invasive uterine serous carcinoma. Here, we present two cases of serous endometrial intraepithelial carcinoma with omental micrometastasis and discuss their clinical significance. Two menopausal patients with abnormal endometrial biopsy findings underwent hysterectomy and comprehensive surgical staging (bilateral salpingo‐oophorectomy, omentectomy, and pelvic and para‐aortic lymphadenectomy). Although gross examination failed to detect tumors, the pathological diagnosis was serous endometrial intraepithelial carcinoma. Both patients had omental micrometastasis; they were diagnosed with International Federation of Gynecology and Obstetrics stage IVB disease and received postoperative chemotherapy. One patient died of the carcinoma 9 months after the hysterectomy, and the other had a recurrence of carcinoma 17 months after the end of the initial therapy. The present cases and literature review highlight the importance of meticulous inspection for micrometastasis in the abdominal cavity, including the omentum and peritoneum, for predicting prognosis.

Three‐year questionnaire study on human papillomavirus vaccination targeting new female college school students: Follow‐up to a 2021 report to reveal the impact of a policy change in Japan

Abstract Aim The purpose of this study was to examine the trend in human papillomavirus (HPV) vaccination rates in Japan before and after a policy change in 2022, involving resumption of active recommendation and start of catch‐up vaccination. Methods From 2021 to 2023, a web‐based questionnaire survey was administered to newly enrolled female college students in Yokohama, Japan. The questionnaire included items such as age, HPV vaccination status, HPV vaccine awareness, and awareness of catch‐up vaccination. We compared knowledge about the HPV vaccine and cervical cancer in 2021 and 2023, before and after resumption of the national vaccination program. Results The HPV vaccination rates were 5.4% in 2021, 7.5% in 2022, and 35.3% in 2023, with a significant upward trend ( p  < 0.001). A similar upward trend was observed for HPV vaccine awareness (p  < 0.001). Comparing 2022 and 2023 after the start of catch‐up vaccination, there was no significant difference in awareness of catch‐up vaccination ( p  = 0.669), but there was a significant increase in awareness of free vaccination tickets ( p  < 0.001). After resumption of the national vaccination program with adoption of the catch‐up vaccination program, there was no difference in knowledge of cervical cancer, but there was a difference in knowledge of the HPV vaccine. Conclusions Although the HPV vaccination rate has increased after the policy change, it has not recovered to the level before the suspension of active recommendation. It is important for healthcare providers and school educators to actively communicate the safety and effectiveness of the HPV vaccine.

The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial

Background Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf

Body composition as a predictive factor for chemotherapy-induced peripheral neuropathy and dose-limiting toxicity in patients with endometrial cancer undergoing carboplatin and paclitaxel

This study investigated whether lean body mass could predict the incidence of dose-limiting toxicity and chemotherapy-induced peripheral neuropathy in patients with endometrial cancer treated with carboplatin-paclitaxel. This retrospective study included patients with endometrial cancer who underwent carboplatin-paclitaxel after primary surgery. Lean body mass was calculated using an approximation formula based on abdominal computed tomography images. A multivariable analysis was conducted using a logistic regression model to explore the factors associated with the incidence of chemotherapy-induced peripheral neuropathy and dose-limiting toxicity, with age, body mass index, paclitaxel dose per lean body mass, and carboplatin dose per lean body mass as covariates. Subsequently, the cutoff value for the paclitaxel dose per lean body mass was determined based on the first quartile and receiver operating characteristic curve analysis, dividing the participants into high-dose and low-dose groups. Differences in the incidence of chemotherapy-induced peripheral neuropathy and dose-limiting toxicity between the 2 groups were examined. The study included 98 patients, with 35 (35.7%) and 31 (31.6%) experiencing chemotherapy-induced peripheral neuropathy and dose-limiting toxicity, respectively. The multivariable analysis showed that paclitaxel dose per lean body mass was significantly associated with the incidence of chemotherapy-induced peripheral neuropathy (OR 2.58, 95% CI 1.08 to 6.19) but was not significantly associated with the incidence of dose-limiting toxicity. The cutoff value for the paclitaxel dose per lean body mass was determined to be 8.12 mg/kg. The high-dose group showed a significantly higher incidence of chemotherapy-induced peripheral neuropathy (high-dose group, 52.0%; low-dose group 30.1%, p = .049) and a higher incidence of dose-limiting toxicity (high-dose group, 52.0%; low-dose group, 24.7%, p = .011) than the low-dose group. Paclitaxel dose per lean body mass may predict the incidence of chemotherapy-induced peripheral neuropathy in patients with endometrial cancer undergoing carboplatin-paclitaxel and could be suitable for dosage modulation of paclitaxel.