• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4503-4508
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• 2015

Background: The aims of this study were compare the serum visfatin and resistin levels between endometrial cancer (EC) patients and controls and evaluate their power to predict prognosis. Materials and Methods: This prospective study was conducted between March 2013 to June 2014 on the Gynecologic Oncology Department of the University of Selcuk, Konya, Turkey. A total of 42 EC patients and 42 controls were included and assessed for differences in serum visfatin and resistin levels, along with prognostic factors. Results: Endometrial cancer patients had significantly higher visfatin levels than control s (p: 0.011), associated with deep myometrial invasion (p: 0.019). In contrast the serum level of resistin did not significantly differ between EC patients and controls (p: 0.362). However, high resistin level in EC patients was associated with increase lymph node metastasis (p: 0.009). On logistic regression analysis, we found that serum visfatin elevation was associated with risk of myometrial invasion (OR: 1,091; 95%CI: 1.021-1.166; p: 0.010) and serum resistin with risk of lymph node metastasis (OR: 1.018; 95%CI: 1.000-1.035; p: 0.046). For myometrial invasion prediction, a serum visfatin level greater than 26.8 ng/mL demonstrated a sensitivity and specificity of 66.6 % and 96.4%, respectively. For lymph node metastasis prediction, the best cut-off for serum resistin level was 599ng/mL. A serum resistin level greater than this demonstrated a sensitivity and specificity of 87.5% and 77.1%, respectively. Conclusions: Our data suggest that serum visfatin is elevated in patients with EC and serum visfatin and resistin levels could be used to predict the risk of advance stage lesions.

• Journal of Hospice and Palliative Care
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• 제15권3호
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• pp.155-161
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• 2012

목적: 많은 의료인들은 여명 예측을 어려워하는데, 교육의 부족이 이러한 어려움을 가져오는 요인들 중 하나이다. 그러나 최근 여명 예측에 도움이 되는 여러 가지 예후 지수가 발표되었다. 본 연구에서는 의료인들을 대상으로 예후 지수에 대해 교육을 실시하고 이러한 교육이 여명 예측의 정확도, 자신감, 지식을 향상시키는지 알아보고자 하였다. 방법: 2009년 7월 22일, 경기도 소재 일개 대학병원에서 '말기암환자의 여명 예측'에 대한 교육을 실시하고 간호사 및 의사 29명의 참가자를 대상으로 교육 전 후의 여명 예측에 대한 자신감, 정확도, 지식의 항목을 중심으로 변화를 측정하였다. 교육은 완화의학을 전공한 1인의 가정의학과 교수가 파워포인트를 사용하여 Palliative Prognostic score (PaP score)와 Objective Prognostic Score (OPS)에 대해 강의하고 상호문답 방식으로 40여분간 진행하였다. 결과: 교육 전 후의 자신감 평균은 교육 전의 $4.00{\pm}1.73$ (평균${\pm}$표준편차)점 (0~10 visual analog scale)에 비해서 교육 후가 $5.83{\pm}1.71$점으로 유의하게 높았으며(P<0.001) 나이가 많을수록 교육 전 여명 예측의 자신감이 유의하게 높았고(P=0.04), 진료 또는 간호 증례 수가 많을수록 여명 예측 교육 전 후의 자신감이 유의하게 높게 나왔다(각각 P=0.005, P=0.017). 교육 전 후의 여명 예측 정확도도 교육 후가 27/29명(93.1%), 교육 전이 14/29명(48.0%)으로, 교육 후가 교육 전보다 유의하게 높게 나왔다(P<0.001). 결론: 예후 지수를 활용하여 여명 예측을 교육했을 때 여명 예측에 대한 자신감, 정확도의 상승은 유의하였다. 이러한 결과의 일반화를 위해 앞으로 의료인들을 대상으로 하는 생존 기간 예측 교육이 필요할 것이다.

• Journal of Hospice and Palliative Care
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• 제1권1호
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• pp.30-38
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• 1998

배경: 간암은 우리나라에 흔한 암으로 암등록 자료($1991{\sim}1992$)에 의하면 암발생율 3위, 암에 의한 사망 원인 중 2위를 차지한다. 암환자에서 환자의 생존기간을 예측하는 것은 환자의 진료에서 환자 자신이나 가족, 의료진에게 매우 중요하다고 생각된다. 본 연구는 간암 환자에서 환자의 생존 기간을 예측할 수 있는 예후 인자를 찾아 간암 환자의 진료에 도움이 되고자 하였다. 방법: 1995년 1월부터 6월 사이에 연세대학교 의과대학 부속 영동세브란스 병원에 간암으로 입원한 환자 91명(남자 73명, 여자 18명)을 대상으로 의무기록을 통해 입원 당시 임상적인 특성 28가지를 조사하였으며, 의무기록과 동사무소 기록을 가지고 1996년 7월 31일까지 추적하여 생존 여부를 확인하였다. Cox proportional hazard model을 이용하여 임상적 특성 중 사망위험도를 높이는 유의한 변수를 얻은 후 이를 예후 인자로 삼았다. 이것을 life regression analysis을 통해 예후 인자 각각이 존재할 때의 생존 기간 및 동반된 예후 인자 갯수에 따른 생존 기간을 예측하였다. 결과: 1) 원발성 간암 91명 중 남자가 73명(80.2%), 여자가 18명(19.8%)이며, 평균 연령은 $56.7{\pm}10.6$세이었고, 추적 불가능한 사람 16명을 제외한 75%명중 그 기간 사이에 사망한 사람이 57명(76%), 생존한 사람이 18명(24%)이었다. 2) 임상적인 특성 중 프로트롬빈 시간(prothrombin time) 40% 미만(RR: relative risk. 10.8), 체중감소(RR. 4.4), 고혈압의 과거력(RR. 3.2), 복수(RR. 2.8), 저칼슘혈증(RR. 2.5)인 경우가 환자의 사망위험도의 유의한 예후 인자였다(P<0.01). 3) 사망위험도 예후 인자 5가지가 모두 있는 경우는 생존 기간이 1.7일, 4가지만 있는 경우는 $4.2{\sim}10.0$일, 3가지만 있는 경우는 $10.4{\sim}41.9$일, 2가지만 있는 경우는 $29.5{\sim}118.1$일, 1가지만 있는 경우는 $124.0{\sim}296.6$일, 모두 없는 경우는 724.0일이었다. 결론: 간암 환자에서 프로트롬빈 시간의 연장(<40%), 체중감소 고혈압의 과거력, 복수, 저칼슘혈증(<8.7mg/dl) 등의 순으로 높은 사망위험도를 예측하게 하는 유의한 인자임을 알 수 있었고, 동반된 예후인자의 갯수로써 생존 기간을 예측할 수 있을 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6935-6940
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• 2013

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.3331-3335
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• 2013

Background: The incidence of prostate cancer, one of the most common cancers in elderly men, is increasing annually in Thailand. Matrix metalloproteinase 11 (MMP-11) is a member of the extracellular matrix metalloproteases which has been associated with human tumor progression and clinical outcome. Aim: To quantify MMP-11 expression in prostatic adenocarcinoma tissues and to determine whether its overexpression correlates with survival outcome, and to assess its potential as a new prognostic marker. Materials and Methods: Expression of MMP-11 was analyzed using immunohistochemistry in 103 Thai patients with prostatic adenocarcinoma. Overall survival was analyzed using Kaplan-Meier methods and Cox regression models. Results: Immunoreactivity of MMP-11 was seen in the stroma of prostatic adenocarcinoma tissue samples, high expression being significantly correlated with poor differentiation in Gleason grading, pathologic tumor stage 4 (pT4), and positive-bone metastasis (p<0.05), but not age and prostatic-specific antigen (PSA) level. Patients with high levels of MMP-11 expression demonstrated significantly shorter survival (p<0.001) when compared to those with low levels. Multivariate analysis showed that MMP-11 expression and pT stage were related with survival in prostatic adenocarcinoma [hazard ratio (HR)=0.448, 95% confidence interval (95%CI)=0.212-0.946, HR=0.333, 95%CI=0.15-0.74, respectively]. Conclusions: Expression of MMP-11 is significantly associated with survival in prostatic adenocarcinoma. High levels may potentially be used for prediction of a poor prognosis.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5081-5084
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• 2015

Background: Breast cancer is a malignant tumor that starts from cells of the breast and is seen mainly in women. It's the most common cancer in women worldwide and is a major threat to health. The purpose of this study was to fit a Cox proportional hazards model for prediction and determination of years of survival in Iranian patients. Materials and Methods: A total of 366 patients with breast cancer in the Cancer Research Center were included in the study. A Cox proportional hazard model was used with variables such as tumor grade, number of removed positive lymph nodes, human epidermal growth factor receptor 2 (HER2) expression and several other variables. Kaplan-Meier curves were plotted and multi-years of survival were evaluated. Results: The mean age of patients was 48.1 years. Consumption of fatty foods (p=0.033), recurrence (p<0.001), tumor grade (p=0.046) and age (p=0.017) were significant variables. The overall 1- year, 3-year and 5-year survival rates were found to be 93%, 75% and 52%. Conclusions: Use of covariates and the Cox proportional hazard model are effective in predicting the survival of individuals and this model distinguished 4 effective factors in the survival of patients.

• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6353-6356
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• 2014

Background: The purpose of this study was to investigate and evaluate risk factors for lymph node metastases (LNM) in cases of endometrial cancer (EC). Materials and Methods: A retrospective single institution analysis of patients surgically staged for EC at Ankara Oncology Education and Research Hospital from 1996 to 2010 was performed. Roles of prognostic factors, such as age, histological type, grade, depth of myometrial invasion, cervical involvement, peritoneal cytology, and tumor size, in the prediction of LNM were evaluated. Fisher's exact test and logistic regression analysis were used to assess the effects of various factors on LNM. Results: LNM was observed in 22 out of 247 patients (8.9%) and was significantly more common in the presence of tumors of higher grade, deep myometrial invasion (DMI), cervical involvement, size >2cm, and with positive peritoneal cytology. Logistic regression analysis revealed that DMI remained the only independent risk factor for LNM. NPV, PPV, sensitivity, and specificity for satisfying LNM risk were 98.0, 19.5, 86.3, and 65.3%, respectively for DMI. Conclusions: The incidence of LNM is influenced independently by DMI. If data support a conclusion of DMI, LND should be seriously considered.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.497-501
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• 2016

Aim: To evaluate the relationship between pre-operative CA-125 levels and myometrial invasion in patients with early-stage endometrioid-type endometrial cancer. Materials and Methods: Two-hundred and sixty patients were diagnosed with endometrial cancer between January 2007 and December 2012. Of these, 136 patients with stage 1 endometrioid histologic-type and documented pre-operative serum CA-125 levels were included in the study. Age, preoperative CA-125 level, histologic grade, surgical grade, and presence of deep myometrial invasion were recorded. Additionally, 16, 20, and 35 IU/ml cutoff values were used and compared to evaluate the relationship between pre-operative CA-125 levels and myometrial invasion. Results: The average serum CA-125 level was $35.4{\pm}36.7$ in patients with deep myometrial invasion, and $21.5{\pm}35.8$ in cases without deep myometrial invasion. The relationship between the presence of deep myometrial invasion and CA-125 cut-off values (16, 20, 35 IU/ml) was statistically significant, although the correlation was weak (p<0.05). When the relationship between 16, 20 and 35 IU/ml CA-125 cut-off values and the presence of deep myometrial invasion was studied, specifity and sensitivity values were identified as: 0.60-0.68 for 16 IU/ml; 0.73-0.48 for 20 IU/ml; and 0.89-0.33 for 35 IU/ml. The sensitivity of 16 IU/ml cut-off value was higher when compared to other values. Conclusions: This study demonstrates that preoperative serum CA-125 values maybe used as a predictive test in patients with early stage endometrioid-type endometrium cancer, and as a prognostic factor alone. Further studies should be conducted to identify different CA-125 cut-off values in patients with low risk endometrial cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8075-8081
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• 2014

Background: The classical inflammatory biomarker, C-reactive protein (CRP), has been identified to be related to progression of esophageal cancer. Some research showed that elevated pretreatment serum CRP indicated a poor prognosis, but results have been inconsistent. Materials and Methods: We searched the Medline, Embase and the Cochrane Central Search Library for suitable studies and a meta-analysis of eleven (1,886 patients) was conducted to examine the relationship between elevated serum CRP level and overall survival (OS) in esophageal cancer cases. Moreover, correlation analyses were conducted to assess links between pretreatment serum CRP level and tumor node metastasis (TNM) stage as well as T, N, M grade, respectively. Results: The pooled analysis showed that elevated pretreatment serum CRP level was significantly associated with poorer overall survival (HR 2.09, 95%CI 1.52-2.87, p<0.01). Subgroup analyses were conducted by "country", "cut-off value", "treatment" and "number of patients", and no single factor could alter the result. Elevated pretreatment serum CRP was significantly correlated with more advanced TNM stage and T, N, M grade respectively. Conclusions: Elevated pretreatment serum CRP levels are associated with poorer prognosis in esophageal cancer patients, and could serve as a useful biomarker for outcome prediction.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.4113-4117
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• 2012

Breast cancer is a prevalent heterogeneous malignant disease. Gene expression profiling by DNA microarray can classify breast tumors into five different molecular subtypes: luminal A, luminal B, HER-2, basal and normal-like which have differing prognosis. Recently it has been shown that immunohistochemistry (IHC) markers including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2), can divide tumors to main subtypes: luminal A (ER+; PR+/-; HER-2-), luminal B (ER+;PR+/-; HER-2+), basal-like (ER-;PR-;HER2-) and Her2+ (ER-; PR-; HER-2+). Some subtypes such as basal-like subtype have been characterized by poor prognosis and reduced overall survival. Due to the importance of the ER signaling pathway in mammary cell proliferation; it appears that epigenetic changes in the $ER{\alpha}$ gene as a central component of this pathway, may contribute to prognostic prediction. Thus this study aimed to clarify the correlation of different IHC-based subtypes of breast tumors with $ER{\alpha}$ methylation in Iranian breast cancer patients. For this purpose one hundred fresh breast tumors obtained by surgical resection underwent DNA extraction for assessment of their ER methylation status by methylation specific PCR (MSP). These tumors were classified into main subtypes according to IHC markers and data were collected on pathological features of the patients. $ER{\alpha}$ methylation was found in 25 of 28 (89.3%) basal tumors, 21 of 24 (87.5%) Her2+ tumors, 18 of 34 (52.9%) luminal A tumors and 7 of 14 (50%) luminal B tumors. A strong correlation was found between $ER{\alpha}$ methylation and poor prognosis tumor subtypes (basal and Her2+) in patients (P<0.001). Our findings show that $ER{\alpha}$ methylation is correlated with poor prognosis subtypes of breast tumors in Iranian patients and may play an important role in pathogenesis of the more aggressive breast tumors.