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Hepatocellular Carcinoma in a Tertiary Referral Hospital in Indonesia: Lack of Improvement of One-Year Survival Rates between 1998-1999 and 2013-2014

  • Loho, Imelda M;Hasan, Irsan;Lesmana, C Rinaldi A;Dewiasty, Esthika;Gani, Rino A
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.2165-2170
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    • 2016
  • Background: The survival of hepatocellular carcinoma (HCC) patients is usually low due to late diagnosis. Cipto Mangunkusumo Hospital as the largest tertiary referral hospital in Indonesia, has recently improved its modalities for advanced HCC management, but there has not been any evaluation on any improvement in HCC patient survival. Materials and Methods: A retrospective analysis on 114 HCC patients in 2013-2014 were conducted and compared with the database for 77 HCC patients in 1998-1999. Clinical characteristics and treatment received were recorded and the survival of both groups was analyzed using the Kaplan-Meier method and compared using the log-rank test. Results: The percentage of HBV positive patients had increased after fifteen years from 32.5% to 67.5%. Only two patients (1.8%) in 2013-2014 were diagnosed with HCC during surveillance program. Proportions of Barcelona Clinic Liver Cancer A, B, C, and D in 2013-2014 were 1.8%, 42%, 28.1%, and 28.1%, respectively. There was an increase in the use of potentially curative treatment, such as surgical resection or combination of loco-regional therapies. The one-year survival rate increased from 24.1% in 1998-1999 to 29.4% in 2013-2014, while the median survival decreased from 146 days to 138 days, but the difference was not statistically significant (p=0.913). Conclusions: There was no improvement in the median survival of HCC patients after fifteen years because most continued to present at late stages. There is an urgent need for a nationwide implementation of a hepatitis screening program and HCC surveillance education.

Clinical Features and Treatment Outcome of Chordoid Meningiomas in a Single Institute

  • Jee, Tae Keun;Jo, Kyung-Il;Seol, Ho Jun;Kong, Doo-Sik;Lee, Jung-Il;Shin, Hyung Jin
    • Journal of Korean Neurosurgical Society
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    • v.56 no.3
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    • pp.194-199
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    • 2014
  • Objective : Meningioma is the second most common primary central nervous system neoplasm. In contrast, chordoid meningioma is rare; due to the paucity of cases, little is known about its clinical features or treatment outcomes. The objectives of this study were to describe the clinical characteristics and outcomes for patients with chordoid meningioma. Methods : In total, 16 patients, with newly diagnosed chordoid meningioma who underwent surgical excision between 1999 and 2012 were included. We retrospectively evaluated the medical records, radiological findings, and pathological findings. The median follow-up period was 56.5 (range, 3-170) months. The MIB-1 labeling index ranged from 1 to 26.60% (median, 5.04). Results : Simpson grade I, II, and III resections were performed in four, nine, and three patients, respectively. The overall recurrence rate was 37.5%. Overall progression-free survival (PFS) after resection was 94.7 months (95% CI=62.9-126.6). Of the 4 patients with Simpson grade I resection, recurrence occurred in one patient. Among the Simpson grade II and III resection groups, eight patients underwent adjuvant radiation therapy and they showed significantly longer PFS (121 months, 95% CI=82.1-159.9) than the patients who underwent surgery alone (40.5 months, 95% CI=9.6-71.3) by the log-rank test (p<0.05). Conclusion : Chordoid meningiomas are difficult to manage and have a high rate of recurrence. Complete resection of the tumor is a key determinant of better outcomes. Adjuvant radiation therapy is recommended, eparticulary when Simpson grade I resection was not achieved.

Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

  • Jeong, Jae Yoon;Lim, Sanghyeok;Sohn, Joo Hyun;Lee, Jae Gon;Jun, Dae Won;Kim, Yongsoo
    • Journal of Korean Medical Science
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    • v.33 no.50
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    • pp.299.1-299.13
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    • 2018
  • Background: Sarcopenia is associated with a poor prognosis in patients with liver cirrhosis. However, it is not known whether the rate of skeletal muscle depletion is also associated with a poor prognosis. We investigated the prognostic impact of the rate of skeletal muscle depletion in patients with liver cirrhosis. Methods: We included retrospectively all patients with liver cirrhosis who underwent both multiple computed tomography scans and hepatic venous pressure gradient (HVPG) measurements. Results: A total of 131 patients with liver cirrhosis were enrolled. The mean age of the patients was 53.7 years and alcoholic liver disease was the most common cause (61.8%). Sixty-four patients (48.9%) were diagnosed with sarcopenia. The median changes in skeletal muscle area per year (${\Delta}SMA/y$) were -0.89%. During a median follow-up period of 46.2 months (range, 3.4-87.6), 45 patients (34.4%) died. In multivariate analyses, age, Child-Pugh score, HVPG, presence of sarcopenia and ${\Delta}SMA/y$ were independently associated with mortality. Cumulative mortality was significantly higher in patients with ${\Delta}SMA/y$ < -2.4% than those with ${\Delta}SMA/y{\geq}-2.4%$ (log-rank test, P < 0.001). Conclusion: Both the presence and rate of change of sarcopenia are independently associated with long-term mortality in patients with liver cirrhosis.

Estimating the Survival of Patients With Lung Cancer: What Is the Best Statistical Model?

  • Abedi, Siavosh;Janbabaei, Ghasem;Afshari, Mahdi;Moosazadeh, Mahmood;Alashti, Masoumeh Rashidi;Hedayatizadeh-Omran, Akbar;Alizadeh-Navaei, Reza;Abedini, Ehsan
    • Journal of Preventive Medicine and Public Health
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    • v.52 no.2
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    • pp.140-144
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    • 2019
  • Objectives: Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer. Methods: In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups. Results: Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively. Conclusions: Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Characteristics and Socio-Demographic Distribution of Precarious Employment Among Korean Wage Workers: A Proposition of Multidimensional Approach Using a Summative Score

  • Seong-Uk Baek;Min-Seok Kim;Myeong-Hun Lim;Taeyeon Kim;Jin-Ha Yoon;Jong-Uk Won
    • Safety and Health at Work
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    • v.14 no.4
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    • pp.476-482
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    • 2023
  • Introduction: There is a growing global interest in the issue of precarious employment. We aimed to analyze the characteristics and socio-demographic distribution of precarious employment using a summative score approach. Methods: To operationalize precarious employment, we utilized data from the Korean Working Conditions Survey and focused on three distinct dimensions: employment insecurity, income inadequacy, and a lack of rights and protections. By constructing a summative scale ranging from -16 to 2, with lower scores indicating higher precariousness, we measured employment precariousness among Korean wage workers. To compare employment precariousness according to survey participant characteristics, we employed the Wilcoxon Rank Sum Test. Results: We analyzed a weighted number of 38,432 workers. The overall sample showed a median (Q1, Q3) summative scale score of -3 (-6, -1). The median summative score was lower for women compared to men (men: -2; women: -5; p < 0.001), as well as for young or older workers compared to middle-aged workers (young: -4; middle-aged: -2; older: -5; p < 0.001). Similarly, workers with lower educational levels (middle school or below: -8; high school: -5; college or above: -2; p < 0.001) and non-white collar workers (blue collar: -5; service/sales worker: -6; white collar: -2; p < 0.001) experienced higher levels of employment precariousness. Conclusion: Our findings indicate that certain vulnerable groups, such as women, young or older adults, workers with low educational attainment, and caregiving or low-skilled elementary workers, are disproportionately exposed to high employment precariousness. Active policy interventions are needed to improve the employment quality of vulnerable groups.

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

  • Charles Porsmoguer;Margaux Blondel;Pierre H. M. Moissonnier
    • Journal of Veterinary Science
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    • v.25 no.2
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    • pp.25.1-25.12
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    • 2024
  • Background: Surgical excision is the treatment of choice for feline intracranial meningioma. Objectives: To report clinical findings, complications, and outcomes following surgery for feline intracranial meningioma. Methods: Medical records (01/2000-01/2017) of cats that underwent surgical excision of an intracranial meningioma at our institution were reviewed. Patient data included signalment, clinical signs, surgical technique, complications, histopathologic diagnosis, survival time, and owners' answers to a satisfaction questionnaire. Survival was assessed using the Kaplan-Meier method and log-rank test. Results: Twenty-six cats were included in this study. The exact cause of death was known in 17 cases and was not related to meningioma in 9/17 cases. Overall median survival time was 881 days (95% confidence interval 518; 1248). The age of the cat did not influence survival (p = 0.94) or the occurrence of complications (p = 0.051). Complications occurred in 13/24 cats, including dramatic complications in 4/24 cats. Most complications appeared in the first 24 hours post-surgery (12/13). Males had more postoperative complications (p = 0.042), including more seizures (p = 0.016). Cats with cranioplasty had fewer complications (p = 0.021). Clinical recurrence was confirmed in 3 out of 17 cats. Recurrence-free survival time was 826 days. Most owners (12/14) were satisfied with the outcome. Conclusions: Surgical treatment of intracranial meningioma in cats was associated with a long median survival time but also with a high rate of minor and major postoperative complications, including early postoperative seizures. Cranioplasty may reduce complications. Age at the time of surgery had no effect on outcomes.

Impact of Cyclooxygenase-2 Expression on the Survival of Glioblastoma (다형성아교모세포종 환자에서 Cyclooxygenase-2 발현이 생존율에 미치는 영향)

  • Choi, Young-Min;Kim, Dae-Cheol;Kim, Ki-Uk;Song, Young-Jin;Lee, Hyung-Sik;Hur, Won-Joo;Choi, Sun-Seob;Seo, Su-Yeong
    • Radiation Oncology Journal
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    • v.25 no.3
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    • pp.145-150
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    • 2007
  • Purpose: To investigate the degree and effect of cyclooxygenase (COX)-2 expression on the survival of patients with glioblastoma multiforme (GM). Materials and Methods: Between 1997 and 2006, thirty consecutive GM patients treated with surgery and postoperative radiotherapy (dose range: $44{\sim}65.1$ Gy, median dose: 61.2 Gy) were included in the study. Three patients were excluded that discontinued radiotherapy before receiving a dose of 40 Gy due to mental deterioration. The expression of the COX-2 protein in surgical specimens was examined by immunohistochemical analysis. Survival analysis and verification were performed with respect to sex, age, performance status, resection extent, radiotherapy dose, and degree of COX-2 expression using the Kaplan-Meier method and the log rank test. Results: The median length of follow-up was 13.3 months (range:$6{\sim}83$ months). Staining for COX-2 was positive in all patient samples. Staining for COX-2 that was positive for over 75% of the tumor cells was found in 24 patients. Staining for COX-2 that was positive in less than 25% of tumor cells was found in 3 patients (10.0%), staining for COX-2 that was positive in 25 to 50% of tumor cells was found in 1 patient (3.3%), staining for COX-2 that was positive in 50 to 75% of tumor cells was found in 2 patients (6.7%) and staining for COX-2 that was positive in 75 to 100% of tumor cells was found in 24 patients (80.0%). The median survival and two-year survival rate were 13.5 months and 17.5%, respectively. The survival rate was influenced significantly by the degree of resection (tumor removal by 50% or more) and radiotherapy dose (59 Gy or greater) (p<0.05). The median survival of patients with staining for COX-2 that was positive in less than 75% of tumor cells and in at least 75% of tumor cells was 15.5 and 13.0 months, respectively (p>0.05), and the two-year survival for these groups was 33.3 and 13.3%, respectively (p>0.05). Conclusion: The absence of a statistical correlation between the degree of COX-2 expression and survival in GM patients, despite the high rate of COX-2 positive tumor cells in the GM patient samples, requires further studies with a larger series to ascertain the prognostic value of the degree of COX-2 expression in GM patients.

Optimal Time Interval for Position Change for ICU Patients using Foam Mattress Against Pressure Ulcer Risk (폼매트리스 사용 중환자의 욕창발생위험군별 적정 체위변경시간)

  • Kim, Hyean Jeong;Jeong, Ihn Sook
    • Journal of Korean Academy of Nursing
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    • v.42 no.5
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    • pp.730-737
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    • 2012
  • Purpose: This study was done to identify the time interval to pressure ulcer and to determine the optimal time interval for position change depending on pressure ulcer risk in patients using foam mattress in intensive care units. Methods: The Braden scale score, occurrence of pressure ulcers and position change intervals were assessed with 56 patients admitted to an intensive care unit from April to November, 2011. The time to pressure ulcer occurrence by Braden scale risk group was analyzed with Kaplan-Meier survival analysis and log rank test. Then, the optimal time interval for position change was calculated with ROC curve. Results: The median time to pressure ulcer occurrence was 5 hours at mild or moderate risk, 3.5 hours at high risk and 3 hours at very high risk on the Braden scale. The optimal time interval for position change was 3 hours at mild and moderate risk, 2 hours at high and very high risk of Braden scale. Conclusion: When foam mattresses are used a slight extension of the time interval for position change can be considered for the patients with mild or moderate pressure ulcer risk but not for patients with high or very high pressure ulcer risk by Braden scale.

Prediction of Fatigue Life using Extreme Statistics Analysis (표면미소균열의 극치통계해석을 이용한 피로수명예측)

  • Lee, Dong-U;Hong, Sun-Hyeok;Jo, Seok-Su;Ju, Won-Sik
    • Transactions of the Korean Society of Mechanical Engineers A
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    • v.26 no.9
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    • pp.1746-1752
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    • 2002
  • Fatigue fracture in machine components is produced by surface micro-crack from stress concentration area such as notch and material defect. It is difficult to predict the remaining fatigue lift of mechanical components because the surface micro-crack on critical area initiates and grows with statistical distribution. Plane bending fatigue tests were carried out on the plain specimen of Al 2024-T3 and the initiation and growth behavior of surface micro cracks were observed. The statistical distribution of surface length of multiple micro cracks and their maximum length were investigated. The maximum surface crack length distributions were analyzed on the basis of the statistics of extremes in order to examine the prediction of remaining life.

Survival Following Non Surgical Treatments for Oral Cancer: a Single Institutional Result

  • Larizadeh, Mohammad Hasan;Shabani, Mohammad
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.8
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    • pp.4133-4136
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    • 2012
  • Aim: To report the results of radiotherapy with or without chemotherapy in the patients with oral cancer. Methods: Over the 2003-2009 periods, a total number of 69 patients with squamous cell carcinoma of the oral cavity that refused surgery or had unresectable tumor were enrolled in this study. A total dose of 60 to 70 Gy (2 Gy per day) was given to the primary tumor and clinically positive nodes. In the patients with locoregionally advanced disease (57 patients with $T_3$, $T_4$ lesions and/ or $N^+$) induction chemotherapy following by concomitant chemoradiation was used. Induction chemotherapy consisted of 3 cycles of Cisplatin and 5-Flourouracil with or without Docetaxel. Weekly cisplatin was used in concomitant protocol. Kaplan-Meier method was used to calculate overall survival. Log-rank test and Cox regression model were used for comparison purposes. Results: Median follow-up was 32 months. The mean age of the patients was 59.2 years. The overall response rate after induction chemotherapy was 68.4%. Actuarial overall survival rates after 2 and 3 years were 38% and 26%, respectively. Clinical stage emerged as the only independent predictor of survival. Conclusion: Outcome of the patients with oral cancer is poor. Presenting with an advanced stage lesion contributed to this result. The role of chemotherapy in advanced cases remains to be defined.