• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5355-5358
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• 2014

Background: To assess the role of sonographic endometrial thickness and hysteroscopic polyp size in predicting premalignant and malignant polyps in postmenopausal women. Materials and Methods: A total of 328 postmenopausal women with abnormal uterine bleeding and thickened endometrium underwent operative hysteroscopy due to detection of endometrial polyps were included in this retrospective study. Preoperative endometrial thickness measured by transvaginal ultrasonography and polyp size on hysteroscopy were noted. Hysteroscopic resection with histology was performed for endometrial polyps. Endometrial thickness and polyp size were evaluated on the basis of final diagnosis established by histologic examination. Receiver operator characteristic curves were calculated to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of endometrial thickness and polyp size for detecting pemalignant and malignant polyps. Results: Premalignant and malignant polyps were identified in 26 (7.9%) of cases. Sonographic measurement showed a greater endometrial thickness in cases of premalignant and malignant polyps when compared to benign polyps. On surgical hysteroscopy, premalignant and malignant polyps were also larger. Endometrial thickness demonstrated a sensitivity of 53.8%, specificity of 85.8%, PPV of 24.6% and NPV of 95.6% at a cut-off limit of 11.5 mm with diagnostic accuracy of 83.2%. Polyp size has a diagnostic accuracy of 94.8% with a sensitivity of 92.3%, specificity of 95.0%, PPV of 61.5% and NPV of 99.3% at a cut-off point of 19.5mm. Conclusions: Endometrial thickness measured by transvaginal ultrasonography is not sufficient in predicting premalignant and malignant endometrial polyps in postmenopausal women with abnormal uterine bleeding and thickened endometrium. Polyp size on hysteroscopy is a more accurate parameter, because of better sensitivity and specificity. However, while polyp size ${\geq}19.5mm$ seems to have a great accuracy for predicting premalignancy and malignancy, histologic evaluation is still necessary to exclude premalignant and malignant polyps.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5337-5341
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• 2014

Background: The standard therapy for stage I rectum cancer is surgical resection. Currently, there is no strong evidence to suggest that any type of adjuvant therapy is beneficial. The risks of local relapse and distant metastasis are higher in rectal tumors. Therefore, while there is no clearly defined absolute indication for adjuvant therapy in lymph node negative colon cancers, rectum tumors that are T3N0 and higher require adjuvant treatment. Due to the more aggressive nature of rectal cancers, we explored the clinical and pathologic factors that could predict the risk of relapse in Stage I (T1-T2) disease and whether there was any progression-free survival benefit to adjuvant therapy. Materials and Methods: This multicenter study was carried out by the Anatolian Society of Medical Oncology. A total of 178 patients with rectal cancers who underwent curative surgery between January 1994 and August 2012 in 13 centers were included in the study. Patient demographics, including survival data and tumor characteristics were obtained from medical charts. Results: The median age was 58 years (range 26-85 years). Most tumors were well or moderately differentiated. For adjuvant treatment, 13 patients (7.3%) received radiotherapy alone, 12 patients (6.7%) received chemotherapy alone and 15 patients (8.4%) were given chemoradiotherapy. Median follow up was 29 months (3-225 months). Some 42 patients (23.6%) had relapse during follow up; 30 with local recurrence (71.4%) whereas 12 (28.6%) were distant metastases. Among the patients, 5-year DFS was 64% and OS was 82%. Mucinous histology and receiving adjuvant therapy were found to have statistically insignificant correlations with relapse and survival. Conclusions: In our retrospective analysis, approximately one quarter of patients exhibited either local or systemic relapse. The rates of relapse were slightly higher in the patients who had no adjuvant therapy. There may thus be a role for adjuvant therapy in high-risk stage I rectal tumors.

• Radiation Oncology Journal
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• 제12권1호
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• pp.33-42
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• 1994

1982년부터 1991년까지 경희대학병원 치료방사선과에서 원발성 중추신경계 림프종으로 확진되어 방사선치료를 받은 16명의 환자를 대상으로 치료결과를 후향적으로 분석하였다. 가장 흔한 세포아형은 large, noncleaved cell과 B cell의 immunoblastic 림프종이었으며 측두엽과 심핵부위에 호발하였다. 치료는 환자를 생검 또는 절제술후 전뇌에 40 Gy(range=30-50 Gy)를 방사선 조사하였으며 원발병소에 15-20 Gy를 추가조사하였다. 16명의 환자중 14명은 방사선치료후 2개월에서 49개월 사이에 사망하였으며, 2명은 재발없이 각각 8개월과 22개월째 생존하고 있다. 1년 및 2년생존율은 각각 55.6$ \% $와 34.7$ \% $이었고, 중간 생존기간은 12개월이었다. 16명의 환자중 재발된 11명을 분석하였다. 방사선치료후 원발부위에 재발은 드물었으나 전뇌조사에서 불구하고 다른 부위에서 재발하였다. 재발율은 뇌에서 68.7$ \% $ (l1/16)이고 척추에서 25.0$ \% $(4/16)이었다. 나이, 성별 발생부위, 병소수, 방사선치료선량등은 각각 생존율과 무관하였다. 이와 같은 결과로 중추신경계 림프종은 방사선 치료의 초기반응은 양호하나 통상적인 방사선치료만으로는 조절이 어려운 질환이다. 따라서 분할치료방법에 의한 방사선량 증가와 항암제의 병용으로 중추신경계 림프종에 대한 치료효과를 향상시키리라 기대한다.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.472-476
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• 2011

Purpose: Traditional transcutaneous incision and transconjunctival incision methods are commonly used in the lower blepharoplasty. The transconjunctival method leaves no visible scars nor does it change the shape of lower eyelid contour and the surgical technique is not difficult. However removal of excess baggy skin is not possible through this method. Therefore, the transconjunctival incision method is useful only for patients who still have normal elasticity of the lower eyelids and fat that is protruding only anterocaudally. The Author will introduce a technique, which complements the limitations of these two methods mentioned above. Methods: The author combined the transconjunctival approach and lower blepharoplasty with only the excised skin flap method. This method does not go beyond the previous methods but does apply the advantages of them. Results: From March 2007 to October 2010, this new technique was performed in a total of 62 patients. Fat was removed and repositioned through transconjunctival incision. Drooped skin was excised as in the traditional blepharoplasty but only the skin flap was elevated. This prevents post-operative complications such as ectropion, sclera show, and deformation of the shape of the lower eyelids or under-resection of fat. All patients were satisfied with the post-operative appearance. Conclusion: The author was able to get satisfactory results while avoiding complications of traditional transcutaneous technique with this combined technique of the transconjunctival approach and the lower blepharoplasty method of skin flaps only.

• Journal of Yeungnam Medical Science
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• 제39권2호
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• pp.141-149
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• 2022

Background: The present study evaluated the clinical implications of adjuvant chemotherapy according to the mismatch repair (MMR) status and clinicopathologic features of patients with intermediate- and high-risk stage II colon cancer (CC). Methods: This study retrospectively reviewed 5,774 patients who were diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The patients were enrolled according to the following criteria: (1) pathologically diagnosed with primary CC; (2) stage II CC classified based on the 7th edition of the American Joint Committee on Cancer staging system; (3) intermediate- and high-risk features; and (4) available test results for MMR status. A total of 286 patients met these criteria and were included in the study. Results: Among the 286 patients, 54 (18.9%) were identified as microsatellite instability-high (MSI-H) or deficient MMR (dMMR). Although all the patients identified as MSI-H/dMMR showed better survival outcomes, T4 tumors and adjuvant chemotherapy were identified as independent prognostic factors for survival. For the intermediate-risk patients identified as MSI-low (MSI-L)/microsatellite stable (MSS) or proficient MMR (pMMR), adjuvant chemotherapy exhibited a significantly better disease-free survival (DFS) but had no impact on overall survival (OS). Oxaliplatin-containing regimens showed no association with DFS or OS. Adjuvant chemotherapy was not associated with DFS in intermediate-risk patients identified as MSI-H/dMMR. Conclusion: The current study found that the use of adjuvant chemotherapy was correlated with better DFS in MSI-L/MSS or pMMR intermediate-risk stage II CC patients.

• Tuberculosis and Respiratory Diseases
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• 제86권3호
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• pp.203-215
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• 2023

Background: Surgical resection is the standard treatment for early-stage lung cancer. Since postoperative lung function is related to mortality, predicted postoperative lung function is used to determine the treatment modality. The aim of this study was to evaluate the predictive performance of linear regression and machine learning models. Methods: We extracted data from the Clinical Data Warehouse and developed three sets: set I, the linear regression model; set II, machine learning models omitting the missing data: and set III, machine learning models imputing the missing data. Six machine learning models, the least absolute shrinkage and selection operator (LASSO), Ridge regression, ElasticNet, Random Forest, eXtreme gradient boosting (XGBoost), and the light gradient boosting machine (LightGBM) were implemented. The forced expiratory volume in 1 second measured 6 months after surgery was defined as the outcome. Five-fold cross-validation was performed for hyperparameter tuning of the machine learning models. The dataset was split into training and test datasets at a 70:30 ratio. Implementation was done after dataset splitting in set III. Predictive performance was evaluated by R² and mean squared error (MSE) in the three sets. Results: A total of 1,487 patients were included in sets I and III and 896 patients were included in set II. In set I, the R² value was 0.27 and in set II, LightGBM was the best model with the highest R² value of 0.5 and the lowest MSE of 154.95. In set III, LightGBM was the best model with the highest R² value of 0.56 and the lowest MSE of 174.07. Conclusion: The LightGBM model showed the best performance in predicting postoperative lung function.

• Korean Journal of Radiology
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• 제22권1호
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• pp.106-117
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• 2021

Objective: To explore the value of magnetic resonance imaging (MRI)-based whole tumor texture analysis in differentiating borderline epithelial ovarian tumors (BEOTs) from FIGO stage I/II malignant epithelial ovarian tumors (MEOTs). Materials and Methods: A total of 88 patients with histopathologically confirmed ovarian epithelial tumors after surgical resection, including 30 BEOT and 58 MEOT patients, were divided into a training group (n = 62) and a test group (n = 26). The clinical and conventional MRI features were retrospectively reviewed. The texture features of tumors, based on T2-weighted imaging, diffusion-weighted imaging, and contrast-enhanced T1-weighted imaging, were extracted using MaZda software and the three top weighted texture features were selected by using the Random Forest algorithm. A non-texture logistic regression model in the training group was built to include those clinical and conventional MRI variables with p value < 0.10. Subsequently, a combined model integrating non-texture information and texture features was built for the training group. The model, evaluated using patients in the training group, was then applied to patients in the test group. Finally, receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of the models. Results: The combined model showed superior performance in categorizing BEOTs and MEOTs (sensitivity, 92.5%; specificity, 86.4%; accuracy, 90.3%; area under the ROC curve [AUC], 0.962) than the non-texture model (sensitivity, 78.3%; specificity, 84.6%; accuracy, 82.3%; AUC, 0.818). The AUCs were statistically different (p value = 0.038). In the test group, the AUCs, sensitivity, specificity, and accuracy were 0.840, 73.3%, 90.1%, and 80.8% when the non-texture model was used and 0.896, 75.0%, 94.0%, and 88.5% when the combined model was used. Conclusion: MRI-based texture features combined with clinical and conventional MRI features may assist in differentitating between BEOT and FIGO stage I/II MEOT patients.

• 대한관절경학회지
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• 제10권1호
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• pp.77-82
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• 2006

목적: 40세 이상의 성인에서 발견된 외측 원판형 연골의 임상적 특징에 대해서 분석하고자 한다. 재료 및 방법: 1994년 3월부터 2004년 3월까지 40세 이상에서 원판형 연골이 발견되어 관절경적 치료후 1년 이상 추시가 가능한 48명의 환자 53예를 대상으로 하였고 환자의 평균 연령은 48.4세($40{\sim}62$세)였다. 환자군을 대상으로 이학적 검사 소견, 단순 방사선 및 MRI 소견, 관절경 소견을 분석하였다. 결과: 전체 53예중 증상 이환 기간은 1년이내가 42예(79.2%)로 대부분을 차지하였고 26예(49.1%)에서 외상의 기왕력이 있었으며, 방사선학적 검사상 대퇴골 외과의 편평화, 외측 구획의 퇴행성 변화가 37예(69.8%)에서 관찰되었다. 또한 내측 구획의 퇴행성 변화는 16예(30.2%)에서 관찰되었다. 슬관절경 검사상 45예(84.9%)에서 원판형 연골의 파열이 관찰되었고 파열이 없었던 경우는 8예(15.1%)였다. 파열형태는 복합형(18예, 40.0%)의 파열 형태가 가장 흔하게 나타났으며 그외 종파열(longitudinal) 12예(26.7%), 수평파열(horizontal) 11예(24.4%), 횡파열(transverse) 4예(8.9%)가 관찰되었고, 내측 연골판 파열을 동반하는 경우는 7예(13.2%)였다. 치료 방법으로는 관절경하 연골판 성형술이 46예(86.8%), 이중 6예에서 연골판 성형술 후 부분적 봉합술을 함께 시행하였으며 연골판 아절제술이 5예(9.4%), 연골판 전절제술이 1예(1.9%), 1예(1.9%)에서 관절경 검사후 슬관절 전치환술을 시행하였다. 결론: 성인의 원판형 연골은 소아의 경우와는 달리 외상의 기왕력을 가지고 있는 빈도가 높으며 가벼운 외상에 의해 증상이 발현된다. 또한 슬관절 내 외측 구획의 퇴행성 변화 등 방사선학적인 변화를 관찰할 수 있어 가능한 보존적인 수술적 치료가 필요할 것으로 사료된다.

• Journal of Gastric Cancer
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• 제8권2호
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• pp.85-90
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• 2008

목적: 고령 위암환자의 근치적 절제 후 생존율은 약년층에 비해 낮지 않다고 보고되고 있으나 고령 환자에 대한 적절한 수술 범위에 대해서는 저자들마다 이견이 많다. 본 연구에서는 D2 림프절 절제술이 시행된 고령 위암환자들의 수술 후 경과 및 합병증에 관하여 분석하여 고령 환자에서 D2 림프절 절제술의 안정성을 평가하고자 하였다. 대상 및 방법: 2004년 5월부터 2007년 5월까지 위암으로 근치적 위절제를 시행 받은 1,251명 중 D2 림프절 절제술을 시행 받았던 946명을 대상으로 국내 평균수명인 남자 73세, 여자 80세 이상을 고령환자로 구분 하여 비 고령 환자와 비교하였다. 결과: 전체 고령 환자 120명 가운데 86명(72.2%)에게 D2 이상의 림프절 절제술이 시행되었다. 고령 D2 림프절제술 환자의 남녀비는 11.3:1이었고, 평균 연령은 $76.2{\pm}3.1$세였다. 62명에서 위원위부절제술, 24명에서 위전절제술이 시행되었으며 이 중 16명(17.6%)은 주변장기를 합병 절제하였다. 수술 후 합병증은 22명(25.6%)에서 발생하였고 1명(1.2%)이 사망하였다. 전체 D2 림프절 절제환자를 대상으로 한 단변량 분석에서 고령환자에서 유의하게 합병증 발생율이 높았으나(P=0.003) 다변량 분석에서 ASA score와 동반절제 여부만이 독립적인 합병증 발생 위험인자였으며 고령은 포함되지 않았다. 결론: D2 림프절 절제에 있어서 고령 자체는 독립적인 합병증 발생 위험인자가 아니었다. ASA score가 높지 않고 기저질환이 없는 평균 수명 이상의 고령환자에게서 D2 림프절 절제술은 안전하게 시행될 수 있다고 생각된다.

• Journal of Gastric Cancer
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• 제6권2호
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• pp.109-113
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• 2006

목적: 위내시경의 보급으로 조기위암의 빈도가 증가하고 축소치료가 활성화되고 있다. 이러한 치료는 장점도 있으나 림프절 곽청의 측면에서 제한점이 있다. 림프절 전이를 동반하는 조기위암의 대부분은 UICC-TNM 분류의 N1 또는 N2이지만 드물게 N3의 보고도 있다. pT1N3 위암은 증례보고는 있지만 review논문은 없어서 특성을 이해하거나 치료방침을 세우기가 어렵고 UICC-TNM에서 4기로 예후가 나쁜 위암으로 분류되어 있으나 객관적인 증거는 없다. 저자들은 국내 6개 대학에서 9예의 pT1N3 위암 치험예를 모아서 문헌 고찰과 함께 분석하였다. 대상 및 방법: 분당차병원,한양의대,충북의대,고려의대 구로병원, 아주의대, 가톨릭의대 성가병원의 6개 병원에서 기간은 서로 다르지만 의무기록 분석이 가능하였던 기간동안 수술을 받았던 2,772예의 조기위암 중에서 UICC-TNM의 pT1N3 위암 9예를 분석하였다. 비교 대조군은 분당 차병원에서 수술을 받은 210예의 조기위암 환자이다. 결과: 9예는 전체 조기 위암 2,772예의 0.32%이며 남자는 3명, 여자는 6명이었고 평균연령은 57세였다. 점막암이 2예, 점막하층암이 7예이고 전이된 림프절의 수는 18에서 52개로 평균 27개였다. 5예는 표층 팽창형으로 대조군에 비해서 많았고 종양의 크기도 N3군이 N0, N1, N2군보다 컸다. 7예에서 림프관 침윤이 있었으며 대조군에 비하여 높았다. 1예는 대동맥주위 림프절 전이가 있어서 비치유 절제가 되었고 2예에서 조기재발이 있는 등 예후가 불량하였다. 결론: pT1N3 위암의 위험 인자로는 여성, 점막하층암, 종양의 크기, 림프관 침윤을 들 수 있다. pT1N3 위암의 존재는 조기위암의 축소 치료 시 주의를 요하며 예후가 불량하기 때문에 적극적인 항암 보조 요법이 필요할 것으로 생각된다.