Journal of Korean Medical Science

Risk of Pelvic Insufficiency Fractures in Cervical Cancer Survivors: Using the National Claim Database

Cervical cancer, one of the most prevalent cancers among women worldwidely, has seen improved survival rates due to advancements in pelvic radiation therapy (RT). Several risk factors for pelvic insufficiency fracture (PIF) have been reported in patients with cervical cancer. This study aimed to estimate the incidence of PIFs in patients with cervical cancer and assess the potential risk factors for PIF using a national claim database. A total of 13,480 cervical cancer patients were identified during 2007 to 2016 from linkage between the Korea National Health Insurance Service and Korea Central Cancer Registry. Patients were identified and divided into PIF and non-PIF groups. The incidence of PIFs was estimated and risk factors for PIFs, including age, type of medical institution, residential area, insurance type, Surveillance, Epidemiology, and End Results summarized stage, RT and comorbidities, were assessed using multivariate Cox proportional hazards regression analysis. In a cohort of 13,480 patients diagnosed with cervical cancer, PIF occurred in 134 (1.0%). Among the variables, older age (adjusted hazard ratio [aHR], 1.063; 95% confidence interval [CI], 1.047-1.079; The incidence of PIFs in cervical cancer survivors was 1.0% in this national claim database study and it demonstrated that RT and older age were significantly associated with an increased risk of PIF. Our findings suggest that clinicians should be aware of the risk of PIF, especially in older patients who underwent RT.

Impact of Clostridium difficile Infection on Chemotherapy in Patients With Primary Ovarian Cancer

To investigate the impact of This retrospective study included patients with primary ovarian cancer diagnosed with CDI at the National Cancer Center, Korea, between January 2014 and December 2023. Patients with gastrointestinal symptoms and positive A total of 111 CDI episodes were identified in 90 patients, with 17 patients experiencing recurrent CDI. Among initial CDI episodes, 51.1% occurred during the first or second cycle of adjuvant chemotherapy after cytoreductive surgery. Adjuvant chemotherapy cycles were delayed in 81.1% of cases, with a median delay of 13 days. Additionally, 7.8% of patients discontinued chemotherapy, and CDI-related mortality was 2.2%. Severe or fulminant CDI was associated with higher rates of intensive care unit admission, bowel surgery, or death (38.9% vs. 4.2%; CDI can cause chemotherapy delays and severe adverse outcomes, such as septic shock or death. Early identification of CDI and a multidisciplinary approach are essential to minimize CDI-related complications in patients with ovarian cancer. Further research is needed to develop preventive strategies and evaluate the long-term impact of CDI on cancer prognosis.

Different Patterns of the Relationship Between Gynecological Malignancy and Obesity Index: A Nationwide Retrospective Cohort Study in Korea

In Korea, the patterns of prevalence of gynecological cancers have shifted due to rising obesity-related cancer cases. We evaluated the associations of body mass index (BMI) and waist circumference (WC) with the risk of gynecological malignancy in Korean women. Using National Health Insurance Service cohort data, we analyzed 365,581 participants among the 1,999,980 women aged ≥ 19 years who underwent health check-ups at the baseline year 2009-2010, excluding those who died, those with prior cancer diagnoses, underwent hysterectomy and/or salpingo-oophorectomy before the index date (January 1st, 2011), or missing/outliers BMI and WC values. Follow-up extended to December 31st, 2021, evaluating the incidences of endometrial, ovarian, and cervical cancer. The hazard ratios (HRs) and 95% confidence intervals (CIs) for each gynecological malignancy according to BMI and WC were calculated using Cox proportional hazard regression. Among the 365,581 participants, 898, 1,268, and 873 cases of endometrial, ovarian, and cervical cancer occurred, respectively. HRs (95% CIs) for endometrial cancer were 1.37 (1.15-1.63), 1.63 (1.38-1.94), and 3.64 (2.81-4.70) for BMIs of 23.0-24.9, 25.0-29.9, and ≥ 30 kg/m² compared to BMI of 18.5-22.9 kg/m² ( In Korean women, the risks of endometrial and ovarian cancers increased significantly from the pre-obese level as BMI and WC increased, while cervical cancer risk tended to increase as WC decreased. Management of obesity should be reinforced for the prevention of obesity-related gynecological cancers, considering the increasing incidence of these cancers among Korean women.

A Successful Live Birth From a Vitrified Oocyte for Fertility Preservation of a Patient With Borderline Ovarian Tumor Undergoing Bilateral Ovarian Surgery: A Case Report

This article reports the live birth of a healthy newborn using vitrified-warmed oocytes from fertility preservation before ovarian surgery. The patient in our case underwent two cycles of controlled ovarian stimulation before laparoscopic bilateral ovarian cystectomy for endometriosis, and a total of 23 mature oocytes were vitrified. After surgery, her pathologic reports revealed a serous borderline tumor and endometrioma. Fifteen months after her second surgery of laparoscopic right salpingo-oophorectomy and left ovarian cystectomy owing to recurrence, she had been married by then, and three of the frozen oocytes were thawed for intracytoplasmic sperm injection. These oocytes were cryopreserved for 2.5 years. All three were fertilized, and two grade-A cleavage-stage embryos were transferred. A singleton pregnancy was achieved, resulting in the delivery of a healthy baby boy at 39.3 weeks of gestation. Oocyte cryopreservation is an effective method for fertility preservation prior to ovarian surgery when ovarian function decline is predictable.

Preoperative Prognostic Nutritional Index Is a Prognostic Indicator of Cancer-Specific Survival in Patients Undergoing Endometrial Cancer Surgery

The prognostic nutritional index (PNI) reflects systemic inflammation and nutritional status. This study aimed to evaluate the effect of preoperative PNI on postoperative cancer-specific survival in patients with endometrial cancer (EC). Demographic, laboratory, and clinical data were retrospectively collected from 894 patients who underwent surgical resection of EC. Preoperative PNIs were determined from the serum albumin concentration and total lymphocyte count, which were measured within 1 month before surgery. Patients were classified into high PNI (n = 619) and low PNI (n = 275) groups according to the preoperative PNI cut-off value of 50.6. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce bias: a weighting cohort divided into high PNI (n = 615.4) and low PNI (n = 272.3) groups. The primary outcome measure was postoperative cancer-specific survival. The postoperative cancer-specific survival rate was higher in the high PNI group than the low PNI group in the unadjusted cohort (93.1% vs. 81.5%; proportion difference [95% confidence interval; 95% CI], 11.6% [6.6-16.6%]; High preoperative PNI was associated with improved postoperative cancer-specific survival in patients undergoing surgery for EC.

Disparities between Uptake of Germline BRCA1/2 Gene Tests and Implementation of Post-test Management Strategies in Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Patients

To assess the rate of germline Institutional databases were searched to identify patients who were diagnosed with epithelial ovarian, fallopian tube, or primary peritoneal cancer (EOC) between 2009 and 2019 in two academic hospitals. Retrospective review on medical records was performed to collect clinico-pathologic variables, including performance of germline A total of 840 women with EOC were identified during the study period. Of these, 454 patients (54.0%) received Although

Risk for Human Papillomavirus-Associated Gynecologic Cancers Among Women of Childbearing Age With Rheumatic Diseases: A Population-Based Cohort Study

This study evaluated the risk of human papillomavirus (HPV)-associated gynecologic cancers in women with rheumatic diseases (RD) during their childbearing years. Using the Korean National Health Insurance Service-National Health Information Database (2011-2021), we conducted a cohort study of 40,514 women with RD and 199,366 women without RD aged 20-49 years. The RD cohort included 9,932 women with systemic lupus erythematosus (SLE), 23,731 with seropositive rheumatoid arthritis (SPRA), and 6,851 with ankylosing spondylitis (AS). Incidence rates and hazard ratios (HRs) for HPV-associated gynecologic cancers, including cervical intraepithelial neoplasia grade 3, and cervical, vaginal, and vulva cancers, were estimated using Cox regression. Over the mean (standard deviation) follow-up period of 67.5 (37.7) months, the incidence rate of HPV-associated gynecologic cancers was 111.5/100,000 person-years in the RD cohort and 73.2/100,000 person-years in the non-RD cohort. The incidence rate/100,000 person-years of HPV-associated gynecologic cancers in the RD subcohorts was higher in SLE (223.6) and SPRA (83.1) and lower in AS (69.1) than in the non-RD cohort. The fully adjusted HR for HPV-associated gynecologic cancers was higher in the RD cohort (HR, 2.95; 95% confidence interval [CI], 2.44-3.57) and all the RD subcohorts (SLE: HR, 1.85; 95% CI, 1.33-2.57, SPRA: HR, 4.10; 95% CI, 3.03-5.55, and AS: HR, 1.91; 95% CI, 1.06-3.43). After adjusting for comorbidities and medication use, hazard ratios increased in SPRA and AS but decreased in SLE. Korean women of childbearing age with RD have a threefold increased risk for HPV-associated gynecologic cancers compared with those without RD. Comorbidities and medication use in SLE may influence the risk. Improved screening strategies are needed for these women.

Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Associated With Mediastinal and Ovarian Teratomas: A Case Report

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common type of autoimmune encephalitis. Approximately 80% of patients with anti-NMDAR encephalitis are women. Tumors are detected in approximately 50% of female patients with anti-NMDAR encephalitis, of which 96% are ovarian teratomas. We describe the case of a 28-year-old woman diagnosed with anti-NMDAR encephalitis with mediastinal and bilateral ovarian teratomas in July 2019. The patient recovered following surgical management of the mediastinal mass and both ovarian teratomas, and immunotherapy. This case shows that teratomas can be found at multiple sites other than ovaries. Therefore, detecting teratomas using whole-body evaluation may be helpful for diagnosis and treatment.

Perception of Family Genetic Testing for Hereditary Breast and Ovarian Cancer: A Survey of Patients and General Public

Family genetic testing facilitates early cancer diagnosis and prevention for relatives of individuals carrying Breast Cancer Susceptibility Genes 1 and 2 ( A total of 186 participants (86 patients with cancer and 100 public controls) were educated on hereditary breast and ovarian cancer and family genetic testing via a presentation video accessed through QR codes or smartphone links. Afterward, participants completed a 10-question knowledge test, and perceptions were assessed using a questionnaire featuring a hypothetical Post-education, knowledge scores were significantly higher in the patient group than in the controls (median: 10 vs. 9, Promoting family genetic testing requires effective communication and dissemination of accurate information. Developing systematic genetic counseling programs is essential to achieving these objectives.

Anti-N-methyl-D-aspartate Receptor Encephalitis: a Rare Complication of Ovarian Teratoma

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a potentially life-threatening but reversible autoimmune disorder characterized by psychiatric symptoms, cognitive dysfunction, speech dysfunction, seizures, movement disorder, decreased level of consciousness, and autonomic dysfunction or central hypoventilation. It occurs predominantly in young women and approximately half of them have underlying tumors, mainly ovarian teratoma. A 24-year old woman was admitted because of fever, headache, abnormal movement and decreased mental status. Five cycles of plasmapheresis improved her neurological and mental status. Anti-NMDAR antibodies in her CSF and serum were positive, and computed tomography revealed a 1-cm sized mass suggestive of mature cystic teratoma arising from the right ovary. We promptly performed laparoscopic right ovarian cystectomy. She was discharged after 2 weeks with mild memory deficit. Prompt removal of ovarian teratoma and multidisciplinary care are particularly important for good outcome.

Sarcopenia as a Predictor of Prognosis in Early Stage Ovarian Cancer

To identify sarcopenia as a predictive prognostic factor of ovarian cancer in terms of survival outcome in patients with early-stage ovarian cancer. Data of Konkuk University Medical Center from March 2002 to December 2017 were reviewed retrospectively. Eighty-two patients who underwent surgery due to early-stage (International Federation of Gynecology and Obstetrics stage I/II) ovarian cancer and had computed tomography (CT) images taken at the initial diagnosis were included. The initial CT scan images were analyzed with SliceOmatic software (TomoVision). A sarcopenia cutoff value was defined as a skeletal muscle index of ≤ 38.7 cm²/m². Overall survival (OS) times were compared according to the existence of sarcopenia, and subgroup analyses were performed. A Kaplan-Meier analysis showed a significant survival disadvantage for patients with early-stage ovarian cancer when they had sarcopenia ( This study demonstrated that sarcopenia was predictive of OS in patients with early-stage ovarian cancer. Further prospective studies with a larger number of patients are warranted to determine the extent to which sarcopenia can be used as a prognostic factor in ovarian cancer.

Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors. Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected. In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19-88) years and mean BMI was 22.5 (16.9-34.1) kg/m². The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475-3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367-0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385-2.469). Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.

Prevalence and Treatment of Vulvar Cancer From 2014−2018: A Nationwide Population-Based Study in Korea

Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients' age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.

Effect of Quality Control Program in Surgical Management of Early Cervical Cancer

Regular assessments of clinical performance in gynecologic cancer surgery is important for the safety of patients. We evaluated the effects of quality control (QC) program on the treatment pattern and clinical outcomes of early cervical cancer. Medical records of cervical cancer patients who received operation in our institution from January 2007 to December 2018 were retrospectively reviewed. Cases were divided into 2 groups, before and after the initiation of QC program, group 1 (2007-2013) and group 2 (2014-2018), based on the operation date. Two groups were compared in clinicopathologic variables, surgical methods, operative details, adjuvant treatments, recurrence and survival. A total of 305 cervical cancer patients were included in the analysis, 210 in group 1 and 95 in group 2. In group 2, minimally invasive surgery (MIS) was more frequently performed (60.0% vs. 76.8%, QC program enforced stricter patient selection criteria for MIS and positively affected clinical outcomes in cervical cancer patients who underwent surgery. Systemic monitoring should be considered for patient safety.