• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권5호
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• pp.305-311
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• 2017

Objectives: TNM staging, especially for lymph node metastasis, is the scoring system most widely used among prognostic factors for cancer survival. Several biomarkers have been studied as serologic markers, but their specificity is low and clinical applications are difficult. This study aimed to establish a scoring system for patients with oral squamous cell carcinoma (OSCC) using platelet (PLT) and mean platelet volume (MPV) levels measured postoperatively and to evaluate their significance as prognostic factors. Materials and Methods: We studied 40 patients admitted to the Department of Oral and Maxillofacial Surgery of Dankook University Hospital who were diagnosed with primary OSCC histopathologically between May 2006 and May 2012. Clinical pathological information obtained from the medical records of each patient included age, sex, height, weight, tumor location, degree of differentiation, tumor diameter, lymph node metastasis, TNM stage, and other test values including white blood cell, MPV, PLT, C-reactive protein (CRP), and albumin obtained through a test conducted within 7 days before surgery. Count of platelet (COP)-MPV Score: Patients with both PLT and MPV values below the cut-off values were defined as score 0 (group A). Patients with at least one of the two higher than the cut-off value were defined as score 1 (group B). Results: Univariate analyses showed N-metastasis, COP-MPV (A vs B), PLT, platelet-lymphocyte ratio, and CRP were statistically significant prognostic factors. A multivariate Cox proportional hazards model showed N-metastasis (hazard ratio [HR] 6.227, P=0.016) and COP-MPV (A vs B) (HR 18.992, P=0.013) were independent prognostic factors with a significant effect on survival. Conclusion: COP-MPV score is a simple and cost-effective test method and is considered a more effective prognostic factor than other considered factors in predicting the prognosis of OSCC patients.

• 한국임상수의학회지
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• 제28권4호
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• pp.339-343
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• 2011

젖소에서 쌍태분만이 이후의 산후질병 발생, 도태, 번식능력에 대한 영향과 쌍태분만에 대한 위험요인을 조사하였다. 9개 목장 1,717 분만축의 번식, 위생 및 분만관련 상세 자료가 분석에 이용되었다. 쌍태 분만율은 3.4%였으며, 임신기간은 쌍태분만 시에 단태분만 시에 비해 9일 단축되었다($270.6{\pm}2.0$ vs. $279.5{\pm}0.2$일, P < 0.01). 쌍태분만 시가 후산정체(47.5 vs. 16.0%), 대사성질병(18.6 vs. 3.8%) 및 자궁내막염의 발생(62.7 vs. 28.2%)뿐만 아니라 도태율(32.2 vs. 16.5%)이 단태분만 시에 비해 현저하게 증가되었다(P < 0.01). 쌍태분만은 분만으로부터 임신까지의 간격에 유의적인 영향을 미치지 않았으나, 분만계절이 영향을 미쳤는데, 즉 봄에 분만 시가 겨울에 분만 시에 비해 임신율이 감소되었으며(AHR = 0.80; P = 0.01), 또한 자궁내막염의 발생이 임신율의 감소를 초래하였다(AHR = 0.46, P < 0.01). 로지스틱 분석은 산차의 증가(P < 0.01)와 수태 전 번식호르몬의 사용(OR = 1.84, P < 0.05)이 쌍태분만의 위험요인임을 나타내었다. 결론적으로, 젖소에서 쌍태분만은 산후질병 발생과 도태의 증가에 의한 심한 경제적 손실을 초래하므로, 쌍태분만에 대한 적절한 관리 및 고산차 소 및 번식호르몬 사용에 대한 적절한 통제를 통한 위험요인을 감소시키는 것이 요구된다.

• Nutrition Research and Practice
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• 제9권1호
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• pp.79-86
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• 2015

BACKGROUND/OBJECTIVES: It is well-known that alcohol consumption is associated with stroke risk as well as with aldehyde dehydrogenase 2 gene (ALDH2) polymorphisms. However, it is unclear whether ALDH2 polymorphisms are associated with stroke risk independent of alcohol consumption and whether such association is modified by sex. We evaluated sex-specific associations of a common ALDH2 polymorphism and alcohol consumption with stroke risk in a Korean population. SUBJECTS/METHODS: We conducted a prospective cohort study involving 8,465 men and women, aged 40-69 years and free of stroke between June, 2001 and January, 2003, and followed for the development of stroke. We identified new cases of stroke, which were self-reported or ascertained from vital registration data. Based on genome-wide association data, we selected a single-nucleotide polymorphism (rs2074356), which shows high linkage disequilibrium with the functional polymorphism of ALDH2. We conducted Cox proportional hazards regression analysis considering potential risk factors collected from a baseline questionnaire. RESULTS: Over the median follow-up of 8 years, 121 cases of stroke were identified. Carrying the wild-type allele of the ALDH2 polymorphism increased stroke risk among men. The multivariate hazard ratio [95% confidence interval] of stroke was 2.02 [1.03-3.99] for the wild-type allele compared with the mutant alleles, but the association was attenuated after controlling for alcohol consumption. Combinations of the wild-type allele and other risk factors of stroke, such as old age, diabetes mellitus, and habitual snoring, synergistically increased the risk among men. Among women, however, the ALDH2 polymorphism was not associated with stroke risk. CONCLUSIONS: The prospective cohort study showed a significant association between a common ALDH2 polymorphism and stroke risk in Korean men, but not in Korean women, and also demonstrated that men with genetic disadvantages gain more risk when having risk factors of stroke. Thus, these men may need to make more concerted efforts to control modifiable risk factors of stroke.

• Asian Pacific Journal of Cancer Prevention
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• 제16권6호
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• pp.2527-2530
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• 2015

Background: The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostate cancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus, CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen (PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion, extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In the present study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP) were evaluated by the CAPRA-S scoring system and its three-risk level model. Materials and Methods: CAPRA-S scores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated. Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate and high. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportional hazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). Results: BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was $51.7{\pm}33.0$ months. Mean BCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and high risk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups was significant (P = 0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilities in 5-yr were 0.87 and 0.81, respectively. Conclusions: Both CAPRA-S score and its three-risk level model well predicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operative risk stratifier and disease recurrence predictor for prostate cancer.

• 한국수자원학회:학술대회논문집
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• 한국수자원학회 2008년도 학술발표회 논문집
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• pp.490-494
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• 2008

본 연구에서는 상수도 배수관로의 내 외부적 특성에 따라 개별관로를 정의하는 방법을 연구대상 지역의 배수관로 파손 데이터베이스에 적용하여 비례위험모형을 구축하였다. 연구에 사용된 자료는 연구대상지역의 배수관로의 제원 및 파손시기를 포함하는 관로 파손데이터베이스, 관로매설지역의 급수인구 및 수압범위에 관한 자료를 포함하는 GRID 데이터베이스와 관로매설지역의 토지개발 정도에 관한 자료를 포함한다. 이러한 자료를 이용하여 관로를 순차적 파손경험에 따라 7개의 생존시간군(STG I $\sim$ VII)으로 구분하고 각 생존시간군에 대한 비례위험모형(Model I $\sim$ VII)을 구축하였다. 이러한 모형을 이용하여 관로의 파손횟수가 증가하는 동안 파손에 영향을 미치는 인자의 변화와 그 효과를 파악하였으며, 또한 추정된 공변수의 위험비율을 분석함으로써 관로의 제원 혹은 매설환경, 급수인구 등에 따른 위험률의 상대적인 변화를 분석하였다. 또한 비례 위험모형의 구축과정에서 관로의 파손에 영향을 미치는 공변수의 비례성 가정을 검토하여 시간종속형 공변수를 모형화하였으며, 모형의 이탈잔차(deviance residual)를 분석하여 모형의 적합성을 검토하였다. 본 연구에서 구축된 비례위험모형에 대해 Shoenfeld 잔차를 이용한 스코어 잔차의 변화(score process)를 검토한 결과, Model I 과 Model II 에 대해서는 공변수의 시간종속 효과가 발견되었다. Model I에 대해서는 관로재질과 급수인구의 영향이 시간에 따라 변하며 Model II에서는 급수인구의 영향만이 시간에 따라 변하는 것으로 나타났다. 한편 Model III $\sim$ Model VII 들에 대해서는 공변수의 영향이 시간에 따라 변하지 않는 것으로 나타났다. 각 생존시간군에 대해 관로재질, 토지개발정도, 관로길이 및 급수인구의 변화가 관로의 상대적 누수위험률에 미치는 영향을 상대위험률의 95% 신뢰구간을 고려하여 정량적으로 산정하였고, 시간 종속형 공변수로 모형화된 공변수는 시간에 따른 공변수 영향의 변화를 분석하였다. 순차적 파손사건에 대한 비례위험모형의 구축 결과 생존시간군(STG) I의 기저위험률은 매설 후 대략 450개월까지는 파손 위험률이 '0'에 가까우나 그 이후로 급격히 증가하다가 매설 후 약 700개월에 이르러서는 약간 감소하고 약 850개월 이후에는 다시 급격히 증가한다. STG II의 기저위험률은 첫 번째 파손 후 약 300개월이 되면 위험률이 급격히 증가하는 것으로 나타났다. STG III $\sim$ STG VII의 기저위험률은 이차함수의 형태를 띄며, 특히 STG V, STG VI 및 STG VII의 기저위험률은 욕조형 곡선(bathtub curve)의 형태를 가진다. 각 생존시간군의 기저생존함수의 생존확률 '0.5'에 해당하는 기저중간생존시간에 대한 분석으로부터 파손횟수가 많아질수록 순차적 파손사건 사이의 경과시간은 감소하는 것으로 나타났다. 이러한 기저생존시간에 대한 경향은 관로의 파손횟수가 많아질수록 관로의 일반적은 내구성은 감소하기 때문인 것으로 분석된다.

• Tuberculosis and Respiratory Diseases
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• 제75권2호
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• pp.52-58
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• 2013

Background: More than half of cases for advanced non-small-cell lung cancer (NSCLC) occur in elderly patients with a median age at diagnosis of 70 years. The aim of our study was to examine the clinical features and prognostic factors contributing to mortality in elderly patients with advanced NSCLC. Methods: Following a retrospective review of clinical data, 122 patients aged 70 years and over with a histopathological diagnosis of locally advanced (stage IIIB, n=32) and metastatic (stage IV, n=90) NSCLC between 2005 and 2011 were enrolled. Results: The median age was 76 years (interquartile range, [IQR], 72-80 years), and 85 (70%) patients were male. Fifty-seven (46%) patients had never smoked, and 17 (19%) were in a malnourished state with a body mass index (BMI) of <$18.5kg/m^2$. The initial treatments included chemotherapy (40%) and radiotherapy (7%), but 57% of the patients received supportive care only. The 1-year survival rate was 32%, and the 3-year survival rate was 4%, with a median survival duration of 6.2 months (IQR, 2.5-15.3 months). Male gender (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.3-3.9; p=0.005), low BMI (HR, 2.3; 95% CI, 1.3-3.9; p=0.004), and supportive care only (HR, 1.9; 95% CI, 1.2-2.9; p=0.007) were independent predictors of shorter survival based on a Cox proportional hazards model. Conclusion: Elderly patients with advanced NSCLC had a poor prognosis, particularly male patients, those with a low BMI, and those who received supportive care only.

• Journal of Gastric Cancer
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• 제2권1호
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• pp.5-11
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• 2002

Purpose: The purpose of this study is to identify immunohistochemical evidence of lymph-node micrometastasis in histologic node-negative gastric cancer patients and to evaluate the prognostic significance of lymph-node micrometastasis.Materials and Methods: A retrospective study of 50 gastric cancer patients who underwent curative resections from October 1990 to November 1994 was performed. Two consecutive sections were prepared: one for ordinary hematoxylin and eosin staining, and the other for immunohistochemical staining with Pan cytokeratin antibody (Novocastra, UK). In the univariate analysis, the survival rate was calculated using the Life Table Method, and the multivariate analysis was determined using a Cox Proportional HazardsModel. The statistical analyses of the relationships between the clinicopathologic factors and micrometastases were performed by using a Chi-square test. Results: Of 2522 harvested lymph nodes, 81 ($4.1\%$) nodes and 19 ($38\%$) of 50 patients were identified as having lymphnode micrometastases by using immunohistochemical staining for cytokeratin. The incidence of lymph-node micrometastases was significantly higher in diffuse type carcinomas ($54\%$, P=0.024) and in patients with serosal invasion ($52.2\%$, P=0.05). For patients with lymph-node micrometastases (n=19), the 5-year survival rate was significantly decreased ($73.7\%$, P=0.015). The Lauren's classirication (P=0.021) and the depth of invasion (P=0.035) were shown by multivariate analysis to have a significant relationship with the presence of micrometastases. Multivariate analysis revealed that lymph-node micrometastasis was independently correlated with survival in histologic node-negative gastic cancer patients. Conclusion: The presence of cytokeratin detected lymphnode micrometastases correlates with the worse prognosis for patients with histologic node-negative gastric cancer.

• Journal of Gastric Cancer
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• 제4권3호
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• pp.137-142
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• 2004

Purpose: There have been some controversies over the therapeutic principles of advanced gastric cancer, and the results of treatment have been variable, especially for stage III disease. This study was conducted to define the prognostic factors of stage III gastric cancer. Materials and Methods: This retrospective study was based on the medical records of 179 patients with stage III disease who received a gastrectomy from January 1990 to December 1994. The 5-year survival rate was analyzed according to the age, sex, tumor location, tumor size, Borrmann's type, depth of invasion, lymph-node metastasis, ratio of metastatic lymph nodes, type of surgical resection, extent of lymphnode dissection, curability of resection, postoperative chemotherapy, and pathological stage. The statistical analysis was done by using the Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model. Results: The overall 5-year survival rate was $61.6\%$ the 5-year survival rates according to subgroup were $69.7\%$ for stage IIIa ($100\%$ for $T_{2}N_{2}$, $70.0\%$ for $T_{3}N_{1}$, $68.6\%$ for $T_{4}N_{0}$), and $54.1\%$ for stage IIIb ($T_{3}N_{2}$) (P<0.05). Among various clinicopathologic factors of stage III gastric cancer, the age of the patient, the tumor location, the gross type of tumor, the type of gastric resection, the extent of lymph-node dissection, the curability of resection, and the subgroups of stage III were statistically significant in the univariate survival analysis. The multivariate analysis defined the curability of resection, the extent of lymph-node dissection, the type of operation, the stage of disease, and the age of the patient as independent prognostic factors. Conclusion: A curative surgical resection and an extended lymph-node dissection are thought to be most important for improving the survival rate in stage III gastric cancer patients.

• Journal of Preventive Medicine and Public Health
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• 제38권2호
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• pp.203-207
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• 2005

Objectives: Recently, the American Diabetes Association (ADA) redefined the criteria of prediabetes, which has lowered the diagnostic level of fasting plasma glucose (FPG) from 110 to 125 mg/dl, down to levels between 100 to 125mg/dl. The purpose of this study was to determine the predictive cutoff level of FPG as a risk for the development of diabetes mellitus in Korean men. Methods: A retrospective cohort study was conducted on 11,423 (64.5%) out of 17,696 males $\leq$30 years of age, and who met the FPG of $\leq$125 mg/dl and hemoglobin A1c of $\leq$ 6.4% criteria, without a history of diabetes, and who were enrolled at the screening center of a certain university hospital between January and December 1999. The subjects were followed from January 1999 to December 2002 (mean follow-up duration; 2.3(${\pm}0.7$) years). They were classified as normal (FPG <100mg/dl), high glucose (FPG $\geq$100mg/dl and <110mg/dl) and impaired fasting glucose (FPG $\geq$110mg/dl and $\leq$125mg/dl) on the basis of their fasting plasma glucose level measured in 1999. We compared the incidence of diabetes between the 3 groups by performing Cox proportional hazards model and used receiver operating characteristic analyses of the FPG level, in order to estimate the optimal cut-off values as predictors of incident diabetes. Results: At the baseline, most of the study subjects were in age in their 30s to 40s (mean age, 41.8(${\pm}7.1$) year). The incidence of diabetes mellitus in this study was 1.19 per 1,000 person-years (95% CI=0.68-1.79), which was much lower than the results of a community-based study that was 5.01 per 1,000 person-years. The relative risks of incident diabetes in the high glucose and impaired fasting glucose groups, compared with the normal glucose group, were 10.3 (95% CI=2.58-41.2) and 95.2 (95% CI= 29.3-309.1), respectively. After adjustment for age, body mass index, and log triglyceride, a FPG greater than 100mg/dl remained significant predictors of incident diabetes. Using the receiver operating characteristic (ROC) curve, the optimal cutoff level of FPG as a predictor of incident diabetes was 97.5 mg/dl, with a sensitivity and a specificity of 81.0% and 86.0%, respectively. Conclusion: These results suggest that lowering the criteria of impaired fasting glucose is needed in Korean male adults. Future studies on community-based populations, including women, will be required to determine the optimal cutoff level of FPG as a predictor of incident diabetes.

• Journal of Preventive Medicine and Public Health
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• 제41권4호
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• pp.249-254
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• 2008

Objectives: To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. Methods: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. Results: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the never-smokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). Conclusions: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.