Our data indicate that the oncologic outcome was excellent but infertility treatment was necessary to achieve the majority of conceptions. Additionally, preterm premature rupture of the membranes and premature delivery were frequently observed. An improved pregnancy rate and prevention of complications during pregnancy are issues that should be addressed in future studies.

The distribution of tumor histological type (tumor-like lesions, benign, LMP and malignant) was correlated against patient age and lesion diameter, with tumors in older patients or larger tumors more likely to be malignant.

Expression of RCAS1 is significantly associated with clinical prognosis in 15 different types of human cancer. We have previously reported that RCAS1 expression is correlated with a decreasing number of vimentin-positive stromal cells in cervical cancer. Moreover, RCAS1 expression is related to the expression of matrix metalloprotease 1 and laminin 5 and angiogenesis. We examined whether RCAS1 contributes to connective tissue remodeling in epithelial ovarian cancer. RCAS1 expression was studied retrospectively via immunohistochemistry. Samples were obtained from resected tumor tissues from 65 patients with epithelial ovarian cancer. Statistical analysis was done to correlate RCAS1 expression and clinicopathologic variables. The associations between RCAS1 expression and the number of vimentin-positive cells or microvessel density were evaluated. Western blot analysis was also performed to verify the perturbation of vimentin expression in fibroblast L cells, following stimulation by soluble RCAS1. RCAS1 expression was detected in 72.3% (47/65 total cases) and significantly correlated with age and histological subtype. Patients with advanced stage, positive lymph node metastasis, or positive peritoneal cytological results had significantly shorter overall survival rates; however, no significant relationship was detected between RCAS1 immunoreactivity and overall survival. In the connective tissue surrounding tumor cells, the number of cells expressing vimentin significantly decreased in relation to the RCAS1 expression level. The growth of L cells was suppressed after stimulation by soluble RCAS1, and the expression of vimentin was markedly diminished. RCAS1 may contribute to connective tissue remodeling by altering the number of vimentin-positive cells in epithelial ovarian cancer.

Using SNNS for early-stage cervical cancer is safe and effective and does not increase the recurrence rate. A future multicenter trial is warranted.

In spite of efforts to preserve fertility, some patients have severe complications after trachelectomy, such as Asherman's syndrome, resulting in infertility. Clinicians should pay careful attention to the status of the endometrial cavity after trachelectomy.

To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy.Methods.-This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes.Results.-Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99-7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68-17.8, P = 0.001) compared with ideal candidates. Similarly, lessideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05).Conclusion.-Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

BACKGROUND MRP1/CD9 and integrin α3 have played crucial roles in cell adhesion, motility, and signaling events. The loss of MRP1/CD9 and integrin α3 has been involved in tumor growth and metastasis of cancer cells. The aim of the current study was to clarify the clinical significance of MRP1/CD9 and integrin α3 in endometrial cancer. METHODS The expression of MRP1/CD9 and integrin α3 from the same tissue sample were examined immunohistochemically in 15 patients with normal endometrium and in 56 patients with uterine endometrioid adenocarcinoma. Disease‐free survival curves were estimated using the Kaplan–Meier method and analyzed by the log‐rank test between the positive and reduced expression statuses of both MRP1/CD9 and integrin α3. These expressions and clinicopathologic variables were analyzed univariately and multivariately. RESULTS In normal endometrium, MRP/CD9 was expressed at the cell membrane of cell contact sites, and the expression of integrin α3 was detected also at the cell membrane of cell contact sites and at borders of stromal tissues. In patients with endometrioid adenocarcinoma, 17 cases showed reduced expression of MRP1/CD9, and 20 cases had reduced expression of integrin α3. Fourteen cases indicated a reduced expression of both MRP1/CD9 and integrin α3. Each reduced expression of MRP1/CD9 or integrin α3 was significantly correlated with histologic grade and metastasis. Multivariate analysis using the Cox regression model disclosed that age at surgery, metastasis, and expression status of MRP1/CD9 were significant prognostic factors for disease‐free survival. CONCLUSIONS These findings suggested that the analysis for the expression statuses of MRP1/CD9 and integrin α3 may provide important information on the clinical behavior of endometrial cancer. Cancer 2001;92:542–8. © 2001 American Cancer Society.

Background and Objectives: Trachelectomy, a fertility-sparing surgery for early-stage cervical cancer, can be performed only when there is no extrauterine extension present. Therefore, identifying the sentinel lymph nodes (SLNs) and using them to obtain an intraoperative pathologic diagnosis can provide information on the feasibility and safety of trachelectomy. Our aim was to assess the value of an intraoperative SLN diagnosis. Methods: We retrospectively analyzed the accuracy of intraoperative imprint cytology and frozen-section examination in 201 patients at our institution in whom trachelectomy was planned. Results: All patients could be evaluated for SLNs; a total of 610 SLNs were analyzed. Although the specificity of both imprint cytology and frozen-section examination was 100.0%, the sensitivity was only 58.6 and 65.5%, respectively. The diagnostic sensitivity was higher in 2-mm slices along the short axis than on bisection along the longitudinal axis. Imprint cytology correctly diagnosed 2 patients who had false-negative results on frozen section. The nature of the metastatic foci that caused an intraoperative false-negative diagnosis was either micrometastasis or isolated tumor cells. Conclusions: The accuracy of intraoperative SLN diagnosis requires improvement, especially when small metastatic foci are present.