• Tuberculosis and Respiratory Diseases
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• 제66권4호
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• pp.280-287
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• 2009

연구배경: 표피성장인자수용체(epidermal growth factor receptor, EGFR) 티로신 활성효소 억제제(tyrosine kinase inhibitor, TKI)는 진행성 비소세포폐암의 새로운 치료제이다. 몇몇 연구 결과 gefitinib와 erlotinib에 대한 반응률과 반응 예측인자에 차이가 있을 가능성을 제시하였다. 저자들은 한국인 진행성 비소세포폐암에서 gefitinib와 erlotinib의 효과 및 독성을 비교하고 각 약제에 대해 서로 다른 반응 예측인자가 있는지 평가하였다. 방 법: 2003년 7월부터 2009년 2월까지 이화여자대학 교부속병원에서 진행성 비소세포폐암으로 gefitinib 또는 erlotinib로 치료 받은 환자들의 임상정보를 수집하였다. 중앙 생존기간은 Kaplan-Meier법으로 계산하였다. 결 과: 대상 환자는 총 86명이었다(gefitinib군 52명 대 erlotinib군 34명). 나이의 중앙값은 64세였고 53명(62%)이 남자였다. 86명 중 83명에서 반응평가가 가능했으며, 83명 중 35명이 반응을 보였고 12명이 안정성 질환이었으며 36명이 진행성 질환으로, 치료 반응률이 42%였고 질병 조절률이 57%였다. 중앙 추적관찰기간 502일 동안, 진행까지의 중앙기간은 129일이었으며 중앙 생존기간은 259일이었다. 치료 반응률(gefitinib 44% 대 erlotinib 39%, p=0.678), 중앙 생존기간(gefitinib 301일 대 erlotinib 202일, p=0.151) 및 병의 진행까지 기간의 중앙값(gefitinib 136일 대 erlotinib 92일, p=0.672)은 두 군 사이에 차이가 없었다. 두 약제는 비슷한 독성을 보였다. Cox 회귀모형을 이용한 다변수분석에서 선암이 생존과 관련된 독립적인 예후인자였다(상대위험도: 0.487, 95% 신뢰구간: 0.292~0.811, p=0.006). 아집단 분석 결과 두 약제에 대한 서로 다른 반응 예측인자는 없었다. 결 론: Gefitinib와 erlotinib 사이에 반응률, 생존기간, 진행까지의 기간 및 독성에 차이는 없었다. 각 약제에 대한 특이적인 반응 예측인자도 없었다.

• Korean Journal of Radiology
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• 제22권8호
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• pp.1253-1265
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• 2021

Objective: To investigate the prognostic value of preoperative cardiac magnetic resonance imaging (MRI) for long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR). Materials and Methods: The preoperative cardiac MR images, New York Heart Association functional class, comorbidities, and clinical events of 78 patients (median [interquartile range], 59 [51-66.3] years, 28.2% male) who underwent TV surgery for functional TR were comprehensively reviewed. Cox proportional hazards analyses were performed to assess the associations of clinical and imaging parameters with MACCEs and all-cause mortality. Results: For the median follow-up duration of 5.4 years (interquartile range, 1.2-6.6), MACCEs and all-cause mortality were 51.3% and 23.1%, respectively. The right ventricular (RV) end-systolic volume index (ESVI) and the systolic RV mass index (RVMI) were higher in patients with MACCEs than those without them (77 vs. 68 mL/m², p = 0.048; 23.5 vs. 18.0%, p = 0.011, respectively). A high RV ESVI was associated with all-cause mortality (hazard ratio [HR] per value of 10 higher ESVI = 1.10, p = 0.03). A high RVMI was also associated with all-cause mortality (HR per increase of 5 mL/m² RVMI = 1.75, p < 0.001). After adjusting for age and sex, only RVMI remained a significant predictor of MACCEs and all-cause mortality (p < 0.05 for both). After adjusting for multiple clinical variables, RVMI remained significantly associated with all-cause mortality (p = 0.005). Conclusion: RVMI measured on preoperative cardiac MRI was an independent predictor of long-term outcomes in patients who underwent TV surgery for functional TR.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2643-2648
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• 2016

Background: High-sensitivity C-reactive protein (hsCRP) levels are lower in Japanese compared with Western subjects. Since it is uncertain whether hsCRP is a potent predictor of mortality at low CRP concentrations, the present study examined associations with all-cause and cause-specific mortality in a large population of Japanese. Materials and Methods: Subjects were 4,737 men and 6,343 women aged 49-76 years participating in the baseline survey of an ongoing cohort study of lifestyle-related diseases between February 2004 and July 2006. Hazard ratios for all-cause and cause-specific mortality associated with hsCRP levels were estimated using Cox proportional hazards regression. Results: A total of 436 all-cause deaths occurred during a median follow-up of 8 years. The main cause of death was cancer. In men, hsCRP levels were positively associated with the risk of all-cause mortality as well as deaths from cancer and cardiovascular disease (CVD). All-cause mortality hazards for the 2nd (0.34-0.84 mg/L) and the 3rd (${\geq}0.85mg/L$) tertiles of hsCRP were 1.27 (95% confidence interval [CI], 0.93-1.73) and 1.75 (1.30-2.37), respectively (p for trend=0.001). In women, increased risk of all-cause and cause-specific mortality associated with elevated hsCRP levels was observed, but the associations were not statistically significant. Conclusions: HsCRP may be an independent predictor of all-cause, cancer and CVD mortality in apparently healthy Japanese men, but not women. The differential effect of hsCRP in predicting mortality risk by sex warrants further investigation.

• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6519-6524
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• 2014

The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followed by radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033) but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.

• Radiation Oncology Journal
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• 제33권1호
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• pp.29-35
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• 2015

Purpose: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. Materials and Methods: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). Results: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. Conclusion: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6455-6461
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• 2012

Objective: E-cadherin has been identified as a tumor suppressor in many types of carcinoma. However, some studies recently suggested that the role and expression of E-cadherin might be more complex and diverse. In the present study, we evaluated the prognostic value of E-cadherin expression with reference to levels in membranes and cytoplasm, and the membrane/cytoplasm ratio, in hepatocellular carcinomas (HCCs) after curative hepatectomy. Methods: The expression of E-cadherin was assessed by immunohistochemistry in HCC tissue microarrays from 125 patients, and its prognostic values and other clinicopathlogical data were retrospectively analyzed. Patients were followed for a median period of 43.7 months (range 1 to 126 months). Results: Univariate analysis demonstrated that a high membrane/cytoplasm (M/C) ratio of E-cadherin expression was associated with poor overall survival (OS) (P =0.001) and shorter time to recurrence (TTR) (P=0.038), as well as tumor size, intrahepatic metastasis, and TNM stage. In contrast, neither membrane nor cytoplasmic expression of E-cadherin was related with OS and TTR. Furthermore, multivariate analysis confirmed the M/C ratio to be an independent predictor of OS (P=0.031). ${\chi}^2$ tests additionally showed that the M/C ratio of E-cadherin expression was related with early stage recurrence (P=0.012), rather than later stage recurrence. Conclusion: The M/C ratio of E-cadherin expression is a strong predictor of postoperative survival and is associated with early stage recurrence in patients with HCC.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.883-886
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• 2014

Background: Prostate cancer is the second leading cause of cancer death in men worldwide. Several factors such as availability of screening tests, and dietary, other lifestyle, environmental and genetic influences contribute to worldwide disparities in prostate cancer incidence and mortality rates. Our aims were to investigate patient characteristics at the time of diagnosis, common treatment strategies employed and survival in an Iranian male population with prostate cancer. Materials and Methods: Archives of Pathology Departments of five referral centers affiliated with the School of Medicine of Shahid Sadoughi University in Yazd province were reviewed. Paraffin-embedded blocks were reviewed by two independent pathologists to confirm the diagnosis. The latest modification of the Gleason Scoring System was adopted to determine pathological grading. Following pathological evaluation, patients were contacted via telephone to acquire information regarding their current status. Results: Pathology blocks were available for 113 patients. However, upon phone contacts, we were unable to determine the survival status in 23 patients (response rate=83%). Therefore, 90 patients were enrolled in the final analysis. The median follow-up time was 6.0 years (ranging from 0.3 to 8.8 years). There were 30 death attributed to prostate cancer in the study group. Kaplan-Meier analysis revealed that patient age at the time of diagnosis was a significant predictor of survival. Another significant predictor of poorer survival was higher tumor grade. Conclusions: Our observations indicate that age and pathological grade can negatively affect survival of individuals with prostate cancer in Iran.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권1호
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• pp.22-26
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• 2017

Purpose: The diagnosis of cow's milk (CM) allergy is a challenge. The Cow's Milk-related-Symptom-Score ($CoMiSS^{TM}$) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the $CoMiSS^{TM}$ was evaluated in three clinical trials. Methods: Pooled analyses of the three studies were conducted based on regressing the results of the month-1 challenge test on the month-1 $CoMiSS^{TM}$, adjusting for baseline $CoMiSS^{TM}$ using a logistic regression model. In addition a logistic regression model was also fitted to the month-1 challenge test result with the change in $CoMiSS^{TM}$ from baseline as a predictor. Results: Results suggest that infants having a low $CoMiSS^{TM}$ (median, 5) after 1 month dietary treatment free from intact CM protein have a significant risk of having a positive challenge test (odds ratio, 0.83; 95% confidence interval, 0.75-0.93; p=0.002). Pooled data suggest that the change in $CoMiSS^{TM}$ from baseline to month-1 can predict CM related symptoms as a confirmed diagnosis according to the challenge test at month-1. However, in order to validate such a tool, infants without CM related symptoms would also need to be enrolled in a validation trial. A concern is that it may not be ethical to expose healthy infants to a therapeutic formula and a challenge test. Conclusion: Pooled data analysis emphasizes that the $CoMiSS^{TM}$ has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.

• Journal of Chest Surgery
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• 제56권3호
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• pp.186-193
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• 2023

Background: Complete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma. Methods: After excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT. Results: The study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT. Conclusion: ISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.

• Korean Journal of Radiology
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• 제22권5호
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• pp.735-741
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• 2021

Objective: To evaluate circularity as a quantitative shape factor of small renal tumor on computed tomography (CT) in differentiating fat-poor angiomyolipoma (AML) from renal cell carcinoma (RCC). Materials and Methods: In 257 consecutive patients, 257 pathologically confirmed renal tumors (either AML or RCC less than 4 cm), which did not include visible fat on unenhanced CT, were retrospectively evaluated. A radiologist drew the tumor margin to measure the perimeter and area in all the contrast-enhanced axial CT images. In each image, a quantitative shape factor, circularity, was calculated using the following equation: 4 x π x (area ÷ perimeter²). The median circularity (circularity index) was adopted as a representative value in each tumor. The circularity index was compared between fat-poor AML and RCC, and the receiver operating characteristic (ROC) curve analysis was performed. Univariable and multivariable binary logistic regression analysis was performed to determine the independent predictor of fat-poor AML. Results: Of the 257 tumors, 26 were AMLs and 231 were RCCs (184 clear cell RCCs, 25 papillary RCCs, and 22 chromophobe RCCs). The mean circularity index of AML was significantly lower than that of RCC (0.86 ± 0.04 vs. 0.93 ± 0.02, p < 0.001). The mean circularity index was not different between the subtypes of RCCs (0.93 ± 0.02, 0.92 ± 0.02, and 0.92 ± 0.02 for clear cell, papillary, and chromophobe RCCs, respectively, p = 0.210). The area under the ROC curve of circularity index was 0.924 for differentiating fat-poor AML from RCC. The sensitivity and specificity were 88.5% and 90.9%, respectively (cut-off, 0.90). Lower circularity index (≤ 0.9) was an independent predictor (odds ratio, 41.0; p < 0.001) for predicting fat-poor AML on multivariable logistic regression analysis. Conclusion: Circularity is a useful quantitative shape factor of small renal tumor for differentiating fat-poor AML from RCC.