• Radiation Oncology Journal
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• 제8권2호
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• pp.169-176
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• 1990

1980년 3월부터 1987년 8월까지 서울대학교병원 치료방사선과에서 망막아세포종으로 방사선 치료를 받았던 23예의 치료 성적을 보고한다. 20예의 편측성 종양에서, 13예는 안구적출술후 방사선치료를, 2예는 방사선치료만, 5예는 안구 적출후 동측 재발종양의 방사선치료를 받았다. 재발성 종양을 제외한 15예의 병기는 St. Jude Children's Research Hospital의 병기분류 기준에 의한 I 기(retinal)는 없고, II기(global) 5예, III기 (orbital) 8예, IV기 (cranial or metastatic) 2예였다. 양측성 종양 3예는 생후 1개월 이내에 증상이 나타났고, 진행된 종양측은 안구적출술을 시행했으며 조기 종양측은(3예 모두 I기)방사선 치료를 하였다. 시신경 절단부 또는 뇌척수액에서 종양 세포가 확인된 경우에는 항암화학치료를 병용하였다. 수술후 계획대로 방사선치료를 받은 12예의 5년 생존율은 $82.2\%$이며, 국소재발 또는 원격전이는 없었으나, 2환아(III기)의 진단시 무병상태였던 반대측 망막에서 종양이 속발하였다. 일차적 방사선 치료를 계획대로 받은 1예의 반대측 망막에서 종양이 속발하였다. 따라서 양측성 종양의 전반적 빈도는 $33\%$였다. 재발성종양 5예의 치료성적은 매우 불량하여 생존율은 $20\%$였다. 양측성 종양 3예중 2예가 무병상태로 생존하고 있다. 방사선 치료후의 변화로는 안와 연조직 위축이 관찰되었다. 방사선 치료성적은 조기 병기 또는 종양의 크기가 작은 경우에 양호하여 조기 치료가 중요하며 진단후 치료가 지연되지 않도록 함이 중요하다.

• 대한두경부종양학회지
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• 제26권1호
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• pp.14-18
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• 2010

Objectives : We evaluated the use of FDG PET/CT for the identification of cervical nodal metastases of SCC of the oral cavity and oropharynx with histological correlation. Material and Methods : We reviewed 46 medical records, from January 2004 to July 2007, of patients who underwent FDG PET/CT and CT/MRI for SCC of the oral cavity and oropharynx before surgery. We recorded the lymph node metastases according to the neck level affected and the system used for the imaging-based nodal classification. Results : The FDG PET/CT had a sensitivity of 75.6% and a specificity of 96.7% ; it had a higher sensitivity than the CT/MRI for identification of cervical metastases on the side of the neck(26/28 vs. 20/28, p=0.031) and at each of the cervical levels(34/45 vs. 26/45, p=0.008). There was a significant difference in the $SUV_{max}$ between the benign and malignant cervical lymph nodes($3.31{\pm}3.23$ vs. $4.22{\pm}2.57$, p=0.028). The receiver-operating-characteristic (ROC) curve analysis for differentiating the benign from the malignant cervical lymph nodes, showed that the area under the curve(AUC) of the FDG PET/CT was 0.775. The cut-off value for the $SUV_{max}$ was 2.23 based on the ROC curve. There was a significant correlation between the $SUV_{max}$ and the size of the cervical lymph nodes(Spearman r=0.353, p=0.048). Conclusion : FDG PET/CT images were more accurate than the CT/MRI images. In addition, the $SUV_{max}$ cut-off values were important for evaluating cervical the cervical nodes in the patients with SCC of the oral cavity and oropharynx.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10217-10223
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• 2015

Hyperactivated ${\alpha}2$-6-sialylation on N-glycans due to overexpression of the Golgi enzyme ${\beta}$-galactoside: ${\alpha}2$-6-sialyltransferase (ST6Gal-I) often correlates with cancer progression, metastasis, and poor prognosis. This study was aimed to determine the association between ST6Gal-I expression and the risk of recurrence and survival of patients with localized clear-cell renal cell carcinoma (ccRCC) following surgery. We retrospectively enrolled 391 patients (265 in training cohort and 126 in validation cohort) with localized ccRCC underwent nephrectomy at a single center. Tissue microarrays were constructed for immunostaining of ST6Gal-I. Prognostic value and clinical outcomes were evaluated. High ST6Gal-I expression was associated with Fuhrman grade (p<0.001 and p=0.016, respectively) and the University of California Los-Angeles Integrated Staging System (UISS) score (p=0.004 and p=0.017, respectively) in both cohorts. Patients with high ST6Gal-I expression had significantly worse overall survival (OS) (p<0.001 and p<0.001, respectively) and recurrence free survival (RFS) (p<0.001 and p=0.002, respectively) than those with low expression in both cohorts. On multivariate analysis, ST6Gal-I expression remained associated with OS and RFS even after adjusting for the UISS score. Stratified analysis suggested that the association is more pronounced among patients with low and intermediate-risk disease defined by the UISS score. High ST6Gal-I expression is a potential independent adverse predictor of survival and recurrence in ccRCC patients, and the prognostic value is most prominent in those with low and intermediate-risk disease defined by the UISS score.

• Asian Pacific Journal of Cancer Prevention
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• 제15권3호
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• pp.1149-1154
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• 2014

Background: In Malaysia, data from the Malaysian Health Ministry showed colorectal cancer (CRC) to be the second most common type of cancer in 2007-2009, after breast cancer. The same was apparent after looking at males and females cases separately. In the present study, the Geographic Information System (GIS) was employed to describe the distribution of CRC cases in Kuala Lumpur (KL), Malaysia, according to socio-demographic factors (age, gender, ethnicity and district). Materials and Methods: This retrospective review concerned data for patients diagnosed with colorectal cancer in the years 1995 to 2011 collected from the Wilayah Persekutuan Health Office, taken from the cancer notification form (NCR-2), and patient medical records from the Surgical Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 146 cases were analyzed. All the data collected were analysed using ArcGIS version 10.0 and SPSS version 19.0. Results: Patients aged 60 to 69 years accounted for the highest proportion of cases (34.2%) and males slightly predominated 76 (52.1%), Chinese had the highest number of registered cases at 108 (74.0%) and staging revealed most cases in the 3rd and 4th stages. Kernel density analysis showed more cases are concentrated up in the northern area of Petaling and Kuala Lumpur subdistricts. Spatial global pattern analysis by average nearest neighbour resulted in nearest neighbour ratio of 0.75, with Z-score of -5.59, p value of <0.01 and the z-score of -5.59. Spatial autocorrelation (Moran's I) showed clustering significant with p<0.01, Z score 3.14 and Moran's Index of 0.007. When mapping clusters with hotspot analysis (Getis-Ord Gi), hot and cold spots were identified. Hot spot areas fell on the northeast side of KL. Conclusions: This study demonstrated significant spatial patterns of cancer incidence in KL. Knowledge about these spatial patterns can provide useful information to policymakers in the planning of screening of CRC in the targeted population and improvement of healthcare facilities to provide better treatment for CRC patients.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.2091-2095
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• 2013

Background: The $7^{th}$ TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

• Journal of Gastric Cancer
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• 제6권3호
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• pp.173-180
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• 2006

목적: 위암 병기 4기는 다른 병기에서와 같이 여러 T인자 및 N인자로 구성되어 있으며, 특히 원격 전이가 존재하는 경우가 포함되어 있다. 4기에 속하는 위암 중 원격 전이군(M1)의 경우는 근치적 절제가 불가능한 경우로서 비 원격 전이군(M0)과 함께 동일 병기로 분류되어 있어 원격 전이 유무에 따라 환자의 생존율에 의미있는 차이가 있을 수 있다는 가능성을 가지고 비교 분석하였다. 대상 및 방법: 1992년 6월부터 2005년 12월까지 본원에서 위암으로 수술한 1,630명 가운데 위절제술이 가능했던 4기 환자 308명을 대상으로 원격 전이 유무에 따른 여러 임상병리학적 인자들의 특성과 생존율을 비교 분석하였으며 추적기간의 중앙값은 43개월(범위, $1{\sim}154$개월)이었다. 결과: M0군의 5년 생존율은 35%, M1군은 16%로 M0군의 생존율은 M1군에 비해 의미 있게 높았으며(P=0.0000), M0군 중 T1-3N3M0군과 T4N1-2M0군간의 생존율은 통계학적으로 유의한 차이를 보이지 않았다. 결론: 현재의 TNM 분류법상 4기로 구분되는 예들을 비교 분석한 결과 M0군은 M1군에 비해서 통계적으로 유의하게 예후가 좋으므로 M0군은 stage IVa로, M1군은 stage IVb로 세분류하는 것이 타당하겠다.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2015년도 춘계학술대회
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• pp.383-387
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• 2015

현대인들의 불규칙한 생활과 서구화된 식습관에 의해 대장 및 직장 질환이 증가하고 있는 추세로, 특히 직장암은 전체 대장암의 50%를 차지하고 있다. 초기 직장암의 경우 표면으로 돌출되는 부분이 없으므로 초음파로 조직 내부를 보지 않으면 직장 농양으로 오진하는 오류를 범하기도 한다. 그러나 초음파 진단을 하더라도 직장암의 병기에 따라 농양과 육안으로 구별이 어려운 경우가 있기 때문에 보다 정확한 진단이 필요하다. 그러므로 본 연구에서는 직장암과 농양 영상에 대한 컴퓨터 알고리즘을 이용하여 정량적인 분석을 하였다. GLCM을 적용하여 정상 20증례와 농양, 직장암 각 20증례를 분석영역($50{\times}50$ 픽셀)으로 설정하고, 각 영상에서 Autocorrelation, Max probability, Sum average, Sum variance 4가지 파라미터를 비교하여 분석하였다. 결과적으로 Autocorrelation, Max probability, Sum variance 3개의 파라미터에서는 100%, Sum average 파라미터에서는 암 95%, 농양에서 90% 이상의 높은 병변 질감 검출 효율이 나타났다. 이러한 파라미터들이 직장에서의 정상조직, 농양조직, 암조직 간의 판별의 기준으로 가치가 있다고 사료된다. 임상에서의 활용정도에 따라 컴퓨터 보조진단으로서의 충분한 유용성을 볼 수 있을 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8993-9004
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• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.691-694
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• 2014

Background: Tumor length in patients with esophageal cancer (EC) has recently received great attention. However, its prognostic role for EC is controversial. The purpose of our study was to characterize the prognostic value of tumor length in EC patients and offer the optimum cut-off point of tumor length by reliable statistical methods. Materials and Methods: A retrospective analysis was conducted on 71 consecutive patients with EC who underwent surgery. ROC curve analysis was used to determine the optimal cut-off point for tumor length, measured with a handheld ruler after formalin fixation. Correlations between tumor length and other factors were surveyed, and overall survival (OS) rates were compared between the two groups. Potential prognostic factors were evaluated by univariate Kaplan-Meier survival analysis. A P value less than 0.05 was considered significant. Results: There were a total of 71 patients, with a male/female divide of 43/28 and a median age of 59. Characteristics were as follows: squamous/adenocarcinoma, 65/6; median tumor length, 4 (0.9-10); cut-off point for tumor length, 4cm. Univariate analysis prognostic factors were tumor length and modality of therapy. One, three and five year OS rates were 84, 43 and 43% for tumors with ${\leq}4cm$ length, whereas the rates were 75, 9 and 0% for tumors >4 cm. There was a significant association between tumor length and age, sex, weight loss, tumor site, histology, T and N scores, differentiation, stage, modality of therapy and longitudinal margin involvement. Conclusions: Future studies for modification of the EC staging system might consider tumor length too as it is an important prognostic factor. Further assessment with larger prospective datasets and practical methods (such as endoscopy) is needed to establish an optimal cut-off point for tumor length.

• Journal of Korean Neurosurgical Society
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• 제44권1호
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• pp.26-35
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• 2008

Objective : In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. Methods : Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. Results : All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. Conclusion : Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients' comfort and improve the clinical symptoms in harmony with STN stimulation.