• Radiation Oncology Journal
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• 제22권4호
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• pp.265-270
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• 2004

목적: 자궁경부암 환자에서 수술 후 방사선치료의 효과를 평가하고 생존율에 영향을 미치는 예후인자를 알아보고자 함이 본 연구의 목적이다. 대상 및 방법: 1992년 5월부터 2000년 4월까지 본원에서 수술 후 방사선치료를 받은 81명의 자궁경부암 환자를 후향적으로 분석하였다. 42명은 IB 병기였고 IIA 병기는 17명, IIB 병기는 22명이었다. 조직학적 분류는 상피세포암이 76명, 선암이 5명이었다. 자궁기질내 침범은 7 mm 이하가 20명 8 mm 이상이 61명이었고, 자궁주위조직의 침범은 16명에서 발견되었다. 8명은 수술 절제연에 양성이었고 12명에서는 림프혈관강이 침범되었다. 모든 환자에서 외부 방사선만으로 치료하였으며 대부분의 환자에서 총 5,500 cGy를 원발부위에 조사하였다. 최소 추적기간은 4년이었다. 결과: 모든 대상 환자의 2년 및 5년 생존율은 95% 및 ,89%였으며, IB 병기, IIA 병기 및 IIB 병기의 5년 무병생존율은 각각 97%, 87% 및 70%였다. 5명에서 국소재발을 보였으며 국소재발률은 3년에 6%였다. 자궁기질내 침범에 따른 생존율은 의미있는 차이를 나타내지 않았다. 자궁주위 조직을 침범한 환자(72% vs 92%)와 수술 절제연에서 양성인 환자(64% vs 94%)에서는 5년 무병생존율이 감소하는 양상을 보였다. 그러나 림프혈관강의 침범은 생존율에서 의미있는 차이를 관찰할 수 없었다. 결론: 고위험인자를 가진 자궁경부암 환자에서 수술 후 방사선치료가 효과적인 것으로 생각되며 자궁주위조직의 침범 및 수술절제연의 침범이 의미있는 예후인자임을 알 수 있었다.

• Radiation Oncology Journal
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• 제19권4호
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• pp.335-344
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• 2001

목적 : 본 연구에서는 자궁경부암에서 VEGF의 발현과 기존의 예후인자들인 종양의 크기, 골반내 림프절 전이, 자궁경부 심부침윤, 림프계 침윤, 혈관계 침윤과의 상관관계를 분석하고, 생존율을 분석하여 VEGF의 예후 예측인자로서의 임상적 의의에 대해 알아보고자 하였다. 대상 및 방법 : 대상환자들은 1986년 1월부터 1998년 10월까지 연세대학교 원주의과대학 원주기독병원에서 자궁경부암으로 진단 받고 자궁근치 절제술과 양측 골반 림프절 절제술을 받은 FIGO 병기 IB인 환자 118명으로, 88명은 수술 후 화학요법이나 방사선치료가 시행되었다. VEGF 발현은 수술을 시행한 파라핀 조직을 가지고 면역조직화학 염색을 시행하여 평가하였다. 분석은 염색의 강도에 따라 0, +, ++, +++로 판정하였으며 0에서 ++까지를 저발현(low expression), + + +를 고발현(high expression)으로 분류하였다. 결과 : 대상 환자 118명중 VEGF 고발현을 보이는 환자는 35명$(29.7\%)$이었으며 VEGF 발현은 자궁경부 심부침윤(p=0.01)과 골반내 림프절 전이(p=0.03)와 유의한 상관관계가 있었다. 5년 생존율과 무병생존율은 VEGF 발현이 낮을 때 각각 $85.6\%,\;79.7\%$이었고, 고발현일때는 $98.5\%,\;100\%$로 의미 있는 차이를 보였다(p=0.03, <0.001). 다변량분석에서 생존율에 의미 있는 예후인자는 VEGF 발현(p=0.03)과 골반내 림프절전이(p=0.03)였고 무병생존율에 의미 있는 예후인자는 VEGF 발현(p<0.001), 그리고 종양의 크기(p=0.01)였다. 전 118예 중 12예에서 재발을 보였는데(골반내 재발 7예, 원격전이 5예) 이 중 11예가 VEGF 고발현을 보인 환자이었고 단 1예에서 VEGF 저발현을 보여, VEGF 발현이 높은 환자에서 골반내 재발(p=0.001)과 원격전이(p<0.001)가 의미 있게 높았다. 결론 : 면역조직화학염색을 통한 VEGF 발현의 정도는 조기 자궁경부암에서 기존의 치료 후 재발의 위험도가 높은 환자들을 찾아내는데 가장 의미 있는 예후 인자의 하나로 생각되며 나아가서 향후 VEGF 항체 등의 새로운 혈관억제요법의 임상연구를 시도하는데 있어서도 적합한 대상 환자들을 찾아내는데 유용한 지표로 사용될 수 있을 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6935-6940
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• 2013

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.

• Radiation Oncology Journal
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• 제37권3호
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• pp.166-175
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• 2019

Purpose: This study aimed to investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors in patients with locally advanced non-small cell lung cancer (NSCLC) who received concurrent chemoradiotherapy (CCRT). Materials and Methods: We retrospectively analyzed 66 patients with locally advanced NSCLC treated with definitive CCRT. Among these patients, 95% received paclitaxel/carboplatin or docetaxel/cisplatin. The median radiation dose was 66 Gy in 33 fractions. The NLR and PLR before/after CCRT were evaluated. The maximally selected log-rank test was used to obtain the cutoff values related to the overall survival (OS). Results: Patients with high post-CCRT NLR (>3.12) showed worse OS, locoregional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS) than those with low NLR (2-year OS: 25.8% vs. 68.2%, p < 0.001; 2-year LRPFS: 12.9% vs. 33.8%, p = 0.010; 2-year DMFS: 22.6% vs. 38.2%, p = 0.030). Patients with high post-CCRT PLR (>141) showed worse OS and LRPFS than those with low PLR (2-year OS: 37.5% vs. 71.1%, p = 0.004; 2-year LRPFS: 16.5% vs. 40.3%, p = 0.040). Patients with high NLR change (>1.61) showed worse OS and LRPFS than those with low NLR change (2-year OS: 26.0% vs. 59.0%, p < 0.001; 2-year LRPFS: 6.8% vs. 31.8%, p = 0.004). The planning target volume (hazard ration [HR] = 2.05, p = 0.028) and NLR change (HR = 3.17, p = 0.025) were the significant factors for OS in the multivariate analysis. Conclusion: NLR change after CCRT was associated with poor prognosis of survival in patients with locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased treatment failure risk.

• Journal of Chest Surgery
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• 제57권5호
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• pp.460-466
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• 2024

Background: Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV₁) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV₁ poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DL_CO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection. Methods: From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DL_CO, predicted postoperative DL_CO (ppoDL_CO), and DL_CO divided by the alveolar volume (DL_CO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data. Results: Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DL_CO <80%, ppoDL_CO <60%, and DL_CO/VA <80% significantly influenced PPC occurrence. The model using DL_CO/VA had the best fit. Conclusion: Different DL_CO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DL_CO/VA as the most valuable predictor.

• 대한방사선기술학회지:방사선기술과학
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• 제43권2호
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• pp.105-114
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• 2020

This study aimed to assess of beam-matching accuracy for an 8 MV beam between the same model linear accelerators(Linac) commissioned over two years. Two models were got the customer acceptance procedure(CAP) criteria. For commissioning data for beam-matched linacs, the percentage depth doses(PDDs), beam profiles, output factors, multi-leaf collimator(MLC) leaf transmission factors, and the dosimetric leaf gap(DLG) were compared. In addition, the accuracy of beam matching was verified at phantom and patient levels. At phantom level, the point doses specified in TG-53 and TG-119 were compared to evaluate the accuracy of beam modelling. At patient level, the dose volume histogram(DVH) parameters and the delivery accuracy are evaluated on volumetric modulated arc therapy(VMAT) plan for 40 patients that included 20 lung and 20 brain cases. Ionization depth curve and dose profiles obtained in CAP showed a good level for beam matching between both Linacs. The variations in commissioning beam data, such as PDDs, beam profiles, output factors, TF, and DLG were all less than 1%. For the treatment plans of brain tumor and lung cancer, the average and maximum differences in evaluated DVH parameters for the planning target volume(PTV) and the organs at risk(OARs) were within 0.30% and 1.30%. Furthermore, all gamma passing rates for both beam-matched Linacs were higher than 98% for the 2%/2 mm criteria and 99% for the 2%/3 mm criteria. The overall variations in the beam data, as well as tests at phantom and patient levels remains all within the tolerance (1% difference) of clinical acceptability between beam-matched Linacs. Thus, we found an excellent dosimetric agreement to 8 MV beam characteristics for the same model Linacs.

• Clinical Nutrition Research
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• 제12권3호
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• pp.218-228
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• 2023

Recent studies have evaluated the association between specific beverage intake and metabolic risks in adults. However, more evidence is needed to examine the association between the Healthy Beverage Index (HBI) and metabolic factors. Therefore, this study investigated the relationship between HBI and metabolic factors in adults. In this cross-sectional study, 338 overweight and obese individuals living in Tabriz, Iran were selected. Data on beverage consumption, demographics, physical activity, and anthropometric characteristics were evaluated using validated standard protocols. The predefined HBI was calculated based on previous studies. The mean value of HBI index among all of the participants was 59.76 ± 6.51. Those at the higher HBI scores had significantly lower waist circumference, waist-to-hip ratio, fat mass, and weight (p < 0.05). HBI and triglyceride scores also had a significant relationship. It has been shown that at higher HBI scores compared to lower scores, high-density lipoprotein cholesterol levels increase while homeostatic model assessment for insulin resistance, low-density lipoprotein cholesterol, total cholesterol, and blood pressure decrease. HBI scores higher among Iranian adults were associated with a better chance of losing weight and weight loss and a better lipid profile, and lower blood pressure. Therefore, HBI can be a useful and helpful tool for assessing the overall quality of beverages adults consume. However, further studies are warranted to confirm the possible health effects of healthy beverage index.

• 대한두경부종양학회지
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• 제23권1호
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• pp.26-31
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• 2007

Background and Objectives：Microvascular free flap reconstruction has been revolutionized in last two decades, and became a standard option in the reconstruction of head and neck defects. We intended to review our experiences of 51 microvascular free flap for head and neck defects during 5-year period and to analyze the types of flaps according to primary sites, success and complication rates. Subjects and Methods：From Oct. 2001 through Dec. 2005, fifty one free flap reconstructions were performed in forty nine patients at ENT department of Soonchunhyang university bucheon hospital. Primary sites, pathology, T-stage, operative time, time interval of oral feeding, and various reconstructive factors such as recipient and donor vessels, free flap related complications, failure rates and salvage rates were retrospectively analyzed. The relation between complication rates and preoperative risk factors were statistically analyzed. Results：Methods of reconstruction were radial forearm free flap(RFFF)(n=28, 54.9%), anterolateral thigh free flaps(n=9, ALTFF)(17.6%), rectus abdominis free flap(n=7, RAFF)(13.7%), jejunal free flap(n=5, JFF)(9.8%), and miscellanous(n=2, 4.0%) in order. In free flap related complications, failure of free flap occurred in seven cases(13.7%) and pharyngocutaneous fistula occurred in five cases(9.8%) among fifty one free flaps. The overall success rate of free flaps was 86.3%. Salvage of free flaps was possible only one among eight cases(12.5%). In positive preoperative risk factor groups, failure of free flap was higher than in negative risk factor group. However, it was not statistically significant. Conclusion：We confirmed that free flap reconstructions are highly versatile and reliable options for use in the reconstruction of various soft tissue defects of the head and neck. Free flaps have gained great popularity given its versatility, ability for a two-team approach, and minimal donor site morbidity. However, complications related to microvascular surgery may be overcome by increased surgical experience and by intensive flap monitoring in early postoperative period.

• Journal of Nutrition and Health
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• 제45권6호
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• pp.552-561
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• 2012

Metabolic syndrome is a cluster of metabolic risk factors associated with increased risk of cardiovascular diseases. Recently, the prevalence of metabolic syndrome has increased in Korea. The aim of this study was to develop a Healthy Han-sik Nutrition Education Program (HHNEP) based on commonly recognized Korean foods in order to decrease metabolic syndrome risks. The target population of the HHNEP is adults with metabolic risk factors. The initial version of the HHNEP was developed based on a review of literature and various dietary guidelines by expert committees as well as the results of a survey on the perception of common Korean dishes and foods as Han-sik. The focus group discussion conducted of nine participants from the target population. After minor modification, the final version was developed. The contents included five sections: 1) aims, 2) introduction of Korean Food Guidance System, 3) cholesterol contents in food, 4) menu planning method using Han-sik, and 5) examples of daily Han-sik menu. The Han-sik list was selected based on the results from a Han-sik perception answered by 35 Korean adults aged 30-60 years using 517 frequently consumed Korean foods from the fourth Korea National Health and Nutrition Examination Survey. The nutrition education program was developed based on scientific evidence for the prevention of metabolic syndrome and focuses on tailoring education to an individual's dietary problems. Educational method was developed by a group of expert committees based in planned behavior theory and related research results. The education method consisted of assessment of current diet, four face-to-face nutrition education sessions over 8 weeks, and evaluation after 8 and 16 weeks. Initial version of nutrition education materials and methods was tested for feasibility by a select group of nine Korean healthy adults. Successful implementation of the program would include application by nutritional professionals at the health promotion center of the hospitals, public health center, and work sites. Intervention studies are needed to evaluate the feasibility and effectiveness of this program before large-scale applications.

• 디지털융복합연구
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• 제19권4호
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• pp.467-475
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• 2021

목적: 병동에서 급성악화 환자가 발생할 때 환자에게 집중치료가 필요한지 여부에 대한 결정은 환자의 예후를 향상시키기 위해서는 매우 중요하나, 특히 사용 가능한 ICU 자원이 제한적일 때는 ICU 전동 여부를 결정하기에는 어려움이 있다. 따라서 본 연구는 일반병동 급성 악화 환자를 대상으로 중환자실 전동 위험요인을 확인하고자 한다. 연구방법: 후향적 조사연구로서 대상자는 일 상급종합병원 일반병동에 입원한 18세 이상의 성인 환자 중 악화상태를 보여 신속대응팀에 의뢰된 환자 2,945명을 대상으로 하였다. 중환자실 전동 위험요인을 파악하기 위해 다변량 로지스틱 회귀분석을 시행하였다. 연구결과: 다변량 로지스틱 회귀분석 결과 입원시 고형암을 진단받은 경우 (odds ratio [OR] 0.39, 95% CI 0.32-0.47), 악화원인이 호흡문제인 경우 (OR 1.51, 95% CI 1.17-1.95), MEWS (OR 1.22, 95% CI 1.17-1.28)와 SpO2/FiO2 score (OR 2.41, 95% CI 2.23-2.60)가 중환자실 전동 위험요인으로 나타났다. 결론: 본 연구 결과는 중환자실 전동 위험이 높은 환자의 조기 예측을 가능하게 하여 환자의 예후를 향상시키는데 도움이 될 것으로 사료된다.