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Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion

  • Cushman, Taylor R.;Haque, Waqar;Menon, Hari;Rusthoven, Chad G.;Butler, E. Brian;Teh, Bin S.;Verma, Vivek
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.97.1-97.12
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    • 2018
  • Objective: Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods: The National Cancer Database was queried for patients ${\geq}70$ years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

Factors Related to Smoking Recurrence within Six-months Smoking Cessation among Employees in Enterprises with Smaller than 300 Workers (300인 미만 사업장근로자의 6개월 이내 재흡연 관련요인)

  • Jin, Byung Jun;Kim, Chul-Woung;Lee, Seung Eun;Im, Hyo-Bin;Lee, Tae-Yong
    • Research in Community and Public Health Nursing
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    • v.32 no.1
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    • pp.107-115
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    • 2021
  • Purpose: The purpose of this study is to identify factors associated with smoking relapse within six months after quit attempts among workers in small and medium-sized enterprises in South Korea. Methods: The analysis was conducted for a total of 194 people who attempted to quit smoking by applying for a smoking cessation support service at the Regional Tobacco Control Center. The data used in the study were extracted from the Smoking Cessation Service Integrated Information System. Kaplan-Meier estimator and Cox proportional hazards regression model were used to identify variables associated with smoking relapse within six months' time period. Results: Smoking relapse rate within six months was 66.0%, and variables associated with relapse included the cases such as carbon monoxide (CO) at the time of registration (HR: 2.15, 95% CI: 1.10~4.22 for CO ≥20 ppm or more vs.CO <10 ppm), the average number of cigarettes smoked per day (HR: 1.04, 95% CI: 1.00~1.07), and the number of counseling(HR: 0.60, 95% CI: 0.54~0.67). Conclusion: Smoking characteristics and counseling showed one of the strongest correlations with relapse within six months. This implies that it is necessary to understand the smoking characteristics and patterns of workers and to provide continuous smoking cessation counseling tailored to individual characteristics for effective smoking relapse prevention.

The Prognostic Value of Lymph Node Ratio after Neoadjuvant Chemotherapy in Patients with Locally Advanced Gastric Adenocarcinoma

  • Zhu, Kankai;Jin, Hailong;Li, Zhijian;Gao, Yuan;Zhang, Qing;Liu, Xiaosun;Yu, Jiren
    • Journal of Gastric Cancer
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    • v.21 no.1
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    • pp.49-62
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    • 2021
  • Purpose: This study aimed to investigate the prognostic value of lymph node ratio (LNR) in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy. Materials and Methods: We retrospectively enrolled gastric cancer patients treated with neoadjuvant chemotherapy and curative surgery at the First Affiliated Hospital of Zhejiang University from 2004 to 2015 as the study cohort. Patients with the same inclusion criteria treated in 2016-2017 were enrolled as the validation cohort. Kaplan-Meier curves were assessed using the log-rank test to analyze the differences in overall survival (OS). Multivariate survival analysis was performed using the Cox proportional hazards model. The areas under the receiver operating characteristic curve of ypN and LNR categories for predicting the actual 3-year OS were compared. Results: A total of 265 patients were included in the proposal cohort. The median number of retrieved lymph nodes (rLNs) was 32. The number of positive lymph nodes (pLNs) increased as rLN increased (P=0.037), but the LNR remained relatively constant (P=0.462). The LNR was categorized into 4 groups according to the prognosis: ypNr0, node-negative with rLN>25; ypNr1, node-negative with rLN≤25 or 00.3. In the validation cohort of 43 enrolled patients, there was a clear distinction in OS that significantly (P<0.001) varied depending on the LNR values and LNR was the only independent prognostic factor in multivariate analysis (P<0.001). Conclusions: LNR was an independent prognostic factor for survival of patients with gastric cancer after preoperative chemotherapy and might be an alternative predictor for ypN stage.

Genetic Diversity of Hard Ticks (Acari: Ixodidae) in the South and East Regions of Kazakhstan and Northwestern China

  • Yang, Yicheng;Tong, Jin;Ruan, Hongyin;Yang, Meihua;Sang, Chunli;Liu, Gang;Hazihan, Wurelihazi;Xu, Bin;Hornok, Sandor;Rizabek, Kadyken;Gulzhan, Kulmanova;Liu, Zhiqiang;Wang, Yuanzhi
    • Parasites, Hosts and Diseases
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    • v.59 no.1
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    • pp.103-108
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    • 2021
  • To date, there is no report on the genetic diversity of ticks in these regions. A total of 370 representative ticks from the south and east regions of Kazakhstan (SERK) and Xinjiang Uygur Autonomous Region (XUAR) were selected for molecular comparison. A fragment of the mitochondrial cytochrome c oxidase subunit I (cox1) gene, ranging from 631 bp to 889 bp, was used to analyze genetic diversity among these ticks. Phylogenetic analyses indicated 7 tick species including Hyalomma asiaticum, Hyalomma detritum, Hyalomma anatolicum, Dermacentor marginatus, Rhipicephalus sanguineus, Rhipicephalus turanicus and Haemaphysalis erinacei from the SERK clustered together with conspecific ticks from the XUAR. The network diagram of haplotypes showed that i) Hy. asiaticum from Almaty and Kyzylorda Oblasts together with that from Yuli County of XUAR constituted haplogroup H-2, and the lineage from Chimkent City of South Kazakhstan was newly evolved; and ii) the R. turanicus ticks sampled in Israel, Almaty, South Kazakhstan, Usu City, Ulugqat and Baicheng Counties of XUAR were derivated from an old lineage in Alataw City of XUAR. These findings indicate that: i) Hy. asiaticum, R. turanicus and Ha. erinacei shared genetic similarities between the SERK and XUAR; and ii) Hy. marginatum and D. reticulatus show differences in their evolution.

Objective Quantitation of EGFR Protein Levels using Quantitative Dot Blot Method for the Prognosis of Gastric Cancer Patients

  • Xin, Lei;Tang, Fangrong;Song, Bo;Yang, Maozhou;Zhang, Jiandi
    • Journal of Gastric Cancer
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    • v.21 no.4
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    • pp.335-351
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    • 2021
  • Purpose: An underlying factor for the failure of several clinical trials of anti-epidermal growth factor receptor (EGFR) therapies is the lack of an effective method to identify patients who overexpress EGFR protein. The quantitative dot blot method (QDB) was used to measure EGFR protein levels objectively, absolutely, and quantitatively. Its feasibility was evaluated for the prognosis of overall survival (OS) of patients with gastric cancer. Materials and Methods: Slices of 2×5 ㎛ from formalin-fixed paraffin-embedded gastric cancer specimens were used to extract total tissue lysates for QDB measurement. Absolutely quantitated EGFR protein levels were used for the Kaplan-Meier OS analysis. Results: EGFR protein levels ranged from 0 to 772.6 pmol/g (n=246) for all gastric cancer patients. A poor correlation was observed between quantitated EGFR levels and immunohistochemistry scores with ρ=0.024 and P=0.717 in Spearman's correlation analysis. EGFR was identified as an independent negative prognostic biomarker for gastric cancer patients only through absolute quantitation, with a hazard ratio of 1.92 (95% confidence interval, 1.05-3.53; P=0.034) in multivariate Cox regression OS analysis. A cutoff of 208 pmol/g was proposed to stratify patients with a 3-year survival probability of 44% for patients with EGFR levels above the cutoff versus 68% for those below the cutoff based on Kaplan-Meier OS analysis (log rank test, P=0.002). Conclusions: A QDB-based assay was developed for gastric cancer specimens to measure EGFR protein levels absolutely, quantitatively, and objectively. This assay should facilitate clinical trials aimed at evaluation of anti-EGFR therapies retrospectively and prospectively for gastric cancer.

Analysis of Determinants of Employment Quality of Youth in Seoul: Focused on Population Movement, Labor Market Trends, Job Duration and Wages (서울시 청년층의 고용의 질 결정요인 분석: 인구이동, 노동시장 동향, 일자리 지속기간 및 임금을 중심으로)

  • Hwang, Kwanghoon
    • Land and Housing Review
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    • v.13 no.1
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    • pp.39-54
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    • 2022
  • Using the 1st to 13th rounds of occupational history data of the Korea Employment Information Service's Youth Panel (YP2007), this study explores the trends and characteristics of the youth labor market in Seoul. We further empirically investigated the job duration and wage determinants of youth employed in Seoul. The results confirm that workers who have a higher income and a higher consistency with their majors are less likely to leave. In addition, we find that workers in full-time, householders, or labor unions have a higher income if they are men and work in large companies. In particular, compared to the reference group (appropriate academic background, appropriate skill), mismatches in the lack of education and skill showed a wage increase effect of 4.9% and 5.5%, respectively. For the major consistency, the wage of the matched major group is 3.8% higher than the non-matched major group.

The Anti-inflammatory Effects of Golden Apple Snail (Pomacea canaliculata) in Reflux Esophagitis Model (왕우렁이 추출물의 역류성 식도염 억제 효과)

  • Nam, Hyeon Hwa;Ryu, Seung Mok;Yang, Sungyu;Kim, Wook Jin;Moon, Byung Cheol;Seo, Yun-Soo
    • Korean Journal of Organic Agriculture
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    • v.29 no.1
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    • pp.85-96
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    • 2021
  • Reflux esophagitis (RE) is a common gastrointestinal disease observed at all ages, which seriously affects the quality of life. In this study, we investigated the anti-inflammatory effects of Pomacea canaliculata extract (PCE) using the experimental RE rat model. RE was induced by a surgical procedure. The rats were randomly divided into 4 groups: normal group, RE group, PCE group (RE treated with PCE, 100 mg/kg), positive control group (RE treated with ranitidine, 40 mg/kg). We performed the histological examination and measured the expression of tight junction complex and inflammatory mediators using western blot analysis. The phenotypes of RE were attenuated by PCE treatment. PCE administration significantly reduced esophageal mucosal damage and protected tight junction confirmed by claudin-5. Furthermore, PCE treatment reduced inflammatory reaction by inhibiting the expression of COX-2 and TNF-α. PCE treatment, also, reduced translocation of NF-κB into nuclear and IκB-α phosphorylation at the same time. Our findings indicate that PCE has the potential as a novel therapeutic agent to inhibit RE by protecting mucosal damage and regulating inflammatory reactions mediated by NF-κB signaling.

Prognostic Impact of Postoperative Complications in High-Risk Operable Non-small Cell Lung Cancer

  • Lee, Seungwook;Roknuggaman, Md;Son, Jung A;Hyun, Seungji;Jung, Joonho;Haam, Seokjin;Yu, Woo Sik
    • Journal of Chest Surgery
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    • v.55 no.1
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    • pp.20-29
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    • 2022
  • Background: Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients. Methods: In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification. Results: The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients. Conclusion: The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.

The protective effect of methanol extract of Corni Fructus on brain injury caused by unilateral common carotid artery occlusion in mice (산수유(山茱萸) 메탄올 추출물이 편측 경동맥 폐색으로 유도된 생쥐의 허혈성 뇌손상에 미치는 영향)

  • Choi, Na Ri;Jo, Sung Hyeon;Lee, Se-Eun;Lee, Min Ji;Cho, Suin
    • The Korea Journal of Herbology
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    • v.35 no.1
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    • pp.1-8
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    • 2020
  • Objectives : This study was conducted to evaluate the effects of Corni Fructus, the dried fruits of Cornus officinalis Sieb., on unilateral common carotid artery occlusion (UCCAO) in mouse model. Methods : The Corni Fructus used in the experiment was extracted with anhydrous methanol, then filtered and freeze-dried. C57BL/6 mice used in the experiments were conducted left UCCAO surgery to set up UCCAO rodent model for mice. The mice were divided into five groups for evaluate the effect of methanol extract of Corni Fructus (COM) on UCCAO induced ischemic brain injury. The expression levels of nitric oxide in cerebrum and serum, body weight change were measured. To determine the effect of UCCAO and COM administration on brain neurons, morphological changes of the cerebrum through a microscope was conducted. And western blot was performed to confirm the underlying mechanism of neuroprotective effect of COM administration. Results : COM administered UCCAO groups (CO50, CO150, and CO500) had no significant effects on nitric oxide production in ipsilateral hemisphere proteins and sera. The CO500, 500 mg/kg COM administration, attenuated UCCAO-induced p38 inflammatory signaling pathway and inflammatory mediators such as iNOS and COX-2. The CO500 group showed resilient morphological changes of hippocampus neuronal cells about brain damage caused by decreased flow of blood. These group also showed decreased inflammation and cellular stress response in neuronal cells. Conclusions : From these results, COM has a neuroprotective property via moderating inflammatory factors and cellular stress inducing factors in brain cells.

Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts

  • Park, You Kyeong;Lim, Jae Woong;Choi, Chang Woo;Her, Keun;Shin, Hwa Kyun;Shinn, Sung Ho
    • Journal of Chest Surgery
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    • v.54 no.6
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    • pp.500-508
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    • 2021
  • Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519-0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.