• Title/Summary/Keyword: multivariate analysis

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Radiotherapy of Locally Recurrent Rectal Carcinoma (수술 후 국소재발된 직장암의 방사선치료 결과)

  • Jeong Hyeon Ju;Shin Young Ju;Mo Yang Kwang;Suh Hyun Suk;Chun Hachung;Lee Myung Za
    • Radiation Oncology Journal
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    • v.17 no.1
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    • pp.36-41
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    • 1999
  • Purpose : We reviewed the treatment results for the patients with locally recurrent rectal carcinoma. The object was to evaluate the treatment outcome and to identify the prognostic factors influencing the survival. Methods and Materials: Twenty-eight patients with locally recurrent rectal carcinoma treated principally with external-beam radiation therapy between 1982 to 1996 in the Department of Radiation Oncology at Paik and Hanyang Hospital were reviewed retrospectively Of these, 17 patients had initially abdominoperineal resection, 9 had low anterior resection, and 2 had local excision. No patients had received adjuvant radiation therapy for the primary disease. There were 14 men and 14 women whose ages ranged from 31 to 72 years (median age:54.5). Median time from initial surgery to the start of radiation therapy for local recurrence was 11 months (4~47 months). Radiation therapy was given with total doses ranging from 27 to 64.8 Gy (median=51.2 Gy). Results : The median survival was 16.7 months. The 2-year and 5-year survival rates were 20.1%, 4.1% respectively. Upon multivariate analysis, overall survival was positively correlated with duration of intervals from initial surgery to local recurrence (P=0.039). Relief of pelvic symptoms was achieved in 17 of 28 patients (60.7%). Pain and bleeding responded in 40% and 100% of patients, respectively Conclusions : Patients with locally recurrent rectal carcinoma treated with radiotherapy have benefited symptomatically, and might have increased survivals with a small chance of cure. But, patient were rarely cured (median survival : 10 months, 5-year survival : less than 5%). Overall survival was positively correlated with long intervals from initial surgery to local recurrence. Future efforts should be directed to the use of effective therapy for patients with locally recurrent rectal carcinoma and adjuvant therapy for patients with rectal cancer to reduce the incidence of pelvic recurrence.

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The Significance of Prophylactic Gastrojejunostomy for Patients with Unresectable Stage IV Gastric Cancer (절제 불가능한 4기 위암에서 예방적 위 공장 우회술의 의의)

  • Kim, Hwan-Soo;Kim, Chong-Suk;Kim, Jong-Han;Mok, Young-Jae;Park, Sung-Soo;Park, Seong-Heum;Jang, You-Jin;Kim, Seung-Joo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.231-237
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    • 2009
  • Purpose: The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer. Materials and Methods: We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups. Results: For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer. Conclusion: A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.

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Evaluation of the Safety and Feasibility of D2 Lymphadenectomy in Elderly Patients with Gastric Cancer (평균 수명 이상의 고령 위암 환자에서의 D2 림프절 절제술의 안정성)

  • Kang, Woo Sung;Cheong, Oh;Jeong, Mi Ran;Kim, Ho Goon;Ryu, Sung Yeop;Park, Yeong Kyu;Kim, Dong Yi;Kim, Young Jin
    • Journal of Gastric Cancer
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    • v.8 no.2
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    • pp.85-90
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    • 2008
  • Purpose: The aim of this study was to evaluate the safety and feasibility of D2 lymphadenectomy in elderly patients with gastric cancerby comparing the surgical outcomes and postoperative courses between an elderly group and a control group undergoing the same procedure. Materials and Methods: Clinical information was reviewed for 1251 patients with gastric cancer who underwent gastrectomy between May 2004 and May 2007. Patients were classified into the following two groups: an elderly group (older than the average life span in Korea) and a control group (younger than the elderly group). Clinicopathologic features and postoperative courses after D2 lymphadenectomy were reviewed and compared between the two groups. Results: There were a total of 120 (9%) elderly group patients among all those reviewed, and 86 (72.2%) of them underwent D2 lymphadenectomy. There was 27.5% postoperative morbidity in the elderly group, which was significantly different from thecontrol group (12.8%, p=0.003). However, on multivariate analysis, ASA score and combined resection were independent predictive factors of postoperative complications, while age was not predictive. Conclusion: Older age is not a predictive factor of postoperative complications in itself, and D2 lymphadenectomy can be safely performed in elderly patients with gastric cancer, provided they have good ASA scores and do not undergo accompanying combined resection.

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Cyclin G2 Expression in Gastric-cancer Tissues (위암조직에서 Cyclin G2 발현의 의의)

  • Choi, Min-Gew;Hong, Seong-Kweon;Park, Sung-Bae;Paik, Yong-Hae;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung-Joo;Kim, Sung
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.273-280
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    • 2005
  • Purpose: Cyclin G2 has been reported to be a negative cell-cycle regulator in various cancer tissues. However, the pattern of cyclin G2 expression in gastric cancer is relatively unknown. We investigated the expression of cyclin G2 in gastric cancer tissues and evaluated the clinical significance of its expression. Materials and Methods: Well-preserved gastric cancer tissues were consecutively obtained from 172 patients who underwent gastric cancer operations at Samsung Medical Center between November 1994 and December 1997. Cyclin G2 expression in the tissues was examined immunohistochemically, and the clinicopathological features and prognostic significance according to the expression were analyzed. Results: Of the 172 gastric cancer tissues, cyclin G2 expression was positive in 43 tissues (25.0%). According to the stage, cyclin G2 expression was lower in more advanced stages (P<0.001). Negative expression of cyclin G2 was positively correlated with more advanced depth of tumor invasion (P<0.05), presence of lymph-node metastasis (P<0.05) and presence of lymphatic invasion (P<0.05). The prognosis of the cyclin G2(+) group was significantly better than that of the cyclin G2(-) group (P<0.001). Multivariate analysis revealed that T stage, lymph-node metastasis, distant metastasis, and lymphatic invasion were independent prognostic factors, but the expression of cyclin G2 was not. Conclusion: Cyclin G2 was expressed in 25% of the gastric cancer tissues, and negative expression of cyclin G2 was associated with more advanced tumor progression. Cyclin G2 may be a negative cell-cycle regulator in gastric cancer, and further studies are necessary to elucidate its exact role in the mechanism of carcinogenesis.

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Clinicopathologic Characteristics of and Prognosis for Patients with a Borrmann Type IV Gastric Carcinoma (Borrmann 4형 위암의 임상병리학적 특성과 예후)

  • Kim, Taeg-Hyun;Song, Kyo-Young;Kim, Seung-Nam;Park, Cho-Hyun
    • Journal of Gastric Cancer
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    • v.6 no.2
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    • pp.97-102
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    • 2006
  • Purpose: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. Materials and Methods: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. Results: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). Conclusion: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup. (J Korean Gastric Cancer Assoc 2006;6:97-102)

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Influence of Cathepsin D Expression on Prognosis in Non-Small Cell Lung Cancer (Cathepsin D의 발현이 비소세포 폐암의 예후에 미치는 영향)

  • Youm, Hyung-Roul;Myeong, Jae-Il;Lim, Jong-Chul;Kim, Han-Kyun;Lee, Nam-Hun;Lee, Dae-Ho;Ko, Hyang-Mee;Moon, Jong-Yeoung;Kang, Heon-Seok;Rheu, Heong-Seon;Kim, Wan;Park, Chang-Soo;Park, Kyung-Ok
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.1
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    • pp.60-71
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    • 2000
  • Backgrounds : Cathepsin D, an aspartic lysosomal proteinase, is believed to be involved in local invasion and metastasis of tumor cells by its proteolytic activity and has been described to be associated with tumor progression and prognosis in some human malignancies including breast cancer. But, its prognostic value for human lung cancer remains to be determined. The purpose of this study is to determine clinicopathological and prognostic significance of cathepsin D expression in non-small cell lung cancer. Method : Using a polyclonal antibody, immunohistochemical analysis of cathepsin D was performed on paraffin embedded sections of tumors obtained surgically from 54 patients with non-small cell lung cancer (37 squamous cell carcinoma, 14 adenocarcinoma, 2 large cell carcinoma, and 1 undifferentiated carcinoma). Results : Eighteen patients (33.3%) showed positive immunoreactivities of cathepsin D in tumor cells. No significant correlation of cathepsin D expression in tumor cells was found in p-stage (surgical-pathologic stage), tumor size, tumor factor, nodal involvement, and differentiation. Of 54 patients, 29 (53.7%) patients showed moderate to massive cathepsin D-positive stromal cells within the tumor tissues, while the rest (46.3%) showed few cathepsin D-positive stromal cells within the tumor tissues. Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung canær (p=0.031). No significant correlation of the degree of cathepsin D-positive stromal cells was found in tumor size, T -factor, nodal involvement, differentiation Cathepsin D expression status in tumor cells and stromal cells was not significantly associated with prognosis expressed by survival rate. The results of multivariate analyses of variables possibly associated with prognosis showed that nodal involvement was the only independent prognostic factor in all patients. Conclusion : Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung cancer. However, it was not related to other clinicopathologic features and prognosis, and Cathepsin D expression in tumor was not related to p-stage and prognosis.

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Comparison of Efficacy of Overlapped Versus Long Eluting Stent in Acute Myocardial Infarction Patients with Diffuse Long Lesion (미만성 긴 병변이 있는 급성심근경색환자에서 긴 단일 용출 스텐트 시술과 중첩 스텐트 시술의 효과 비교)

  • Kim, Won Hyo;Kim, In Soo;Kong, Chang gi;Han, Jae Bok
    • Journal of the Korean Society of Radiology
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    • v.14 no.3
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    • pp.319-336
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    • 2020
  • The purpose of this study was to compare the outcomes of two interventional methods, overlapping drug-eluting stents (DES) and long DES, for long-term clinical outcomes in patients with acute myocardial infarction (AMI). A total of 438 patients with AMI (65.9±11.0 years, 306 males) from June 2008 to March 2019 who had diffuse long coronary artery lesion, more than 30mm were divided into two groups; group I (overlapped DES group; n=140) and group II (long DES group; n=298). We compared the incidences of major adverse cardiac events [MACEs; cardiac death, myocardial infaction (MI), target lesion revascularization (TLR) and stent thrombosis (ST)] during 12 months between the two groups. Everolimus-eluting stent was more commonly used in group II than in group I (28.1% vs. 51.8% p<0.001). Mean lesion diameter was slightly longer in group II (3.1±0.3mm vs. 3.2±0.3mm, p=0.042), and prevalence of ACC/AHA lesion type C was higher in group I (41.7% vs. 25.4%, p<0.001). Incidences of MACEs during 12 months were higher in group I than group II (18.5% vs. 14.4%, p=0.034). The rates of cardiac death (2.1% vs. 4.4%, p=0.667), MI (5.0% vs. 2.7%, p=0.260) and stent thrombosis rate (0.7% vs. 1.7%, p=0.669) were similar between the two groups. However, TLR rate was higher in group I (10.7% vs. 5.6%, p=0.041). In multivariate logistic regression analysis, presence of diabetes mellitus [Hazard ratio (HR) 2.383, 95% confidence interval (CI) 1.332-4.260, p=0.003] and use of paclitaxel-eluting stent (HR) 2.367, 95% CI 1.371-4.086, p=0.002) were independent predictors of 12-month MACEs, without significant differences in prevalence between the two groups. In AMI patients with diffuse long lesion, TLR rate was higher in the overlapped DES group during 12-month follow-up. Presence of diabetes and use of paclitaxel-eluting stent were independent predictors of MACEs.

Correlation of Hepatic $^{18}F-Fluorodeoxyglucose$ Uptake with Fatty Liver (간의 $^{18}F-Fluorodeoxyglucose$ 섭취 양상과 지방간의 관계)

  • An, Young-Sil;Yoon, Joon-Kee;Hong, Seon-Pyo;Joh, Chul-Woo;Yoon, Seok-Nam
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.5
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    • pp.243-248
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    • 2006
  • Purpose: Liver demonstrates heterogeneous FDG uptake and sometimes it shows abnormally increased uptake even though there is no malignant tissue. However, there was no previous study to correlate these various pattern of hepatic FDG uptake with benign liver disease. Therefore, we evaluated the significance of hepatic FDG uptake associated with various clinical factors including fatty liver, liver function tests and lipid profiles. Materials and Methods: We reviewed a total of 188 patients (male/female: 120/68, mean age: $50{\pm}9$) who underwent PET/CT for screening of malignancy. Patients with DM, impaired glucose tolerance, previous severe hepatic disease or long-term medication history were excluded. The FDG uptake in liver was analyzed semi-quantitatively using ROI on transaxial images (segment 8) and we compared mean standardized uptake value (SUV) between fatty liver and non-fatty liver group. We also evaluated the correlation between hepatic FDG uptake and various clinical factors including serum liver function test (ALT, AST), ${\gamma}-GT$, total cholesterol and triglyceride concentration. The effect of alcoholic history and body mass index on hepatic FDG uptake was analyzed within the fatty liver patients. Results: The hepatic FDG uptake of fatty liver group was significantly higher than that of non-fatty liver group. Serum total cholesterol and triglyceride concentration showed significant correlation with hepatic FDG uptake. However, there was no significant correlation between other factors (ALT, AST, and ${\gamma}-GT$) and FDG uptake. Also there was no difference of mean SUV between normal and abnormal groups on the basis of alcoholic history and body mass Index within fatty liver patients. Fatty liver and high serum triglyceride concentration were the independent factors affecting hepatic FDG uptake according to multivariate analysis. Conclusion: In conclusion, hepatic FDG uptake was strongly correlated with fatty liver and serum triglyceride concentration.

Community Structure and Health Assessment of Macrobenthic Assemblages at Spring and Summer in Geoje-Hansan Bay, Southern Coast of Korea (거제한산만에 서식하는 대형저서동물의 춘계와 하계의 군집구조 및 건강도 평가)

  • Jung, Rae Hong;Seo, In-Soo;Choi, Byoung-Mi;Choi, Minkyu;Yoon, Sang-Pil;Park, Sang Rul;Na, Jong Hun;Yun, Jae Seong
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.22 no.1
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    • pp.27-41
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    • 2016
  • This study was performed to investigate the community structure and health assessment of macrobenthic assemblages in Geoje-Hansan Bay, Southern Coast of Korea. Macrobenthos were collected by van Veen grab sampler at May (spring) and August (summer) 2013. The total species number and mean density were 300 species $7.6m^{-2}$ and $1,994ind.\;m^{-2}$, respectively. The major dominant species were the polychaetes Lumbrineris longifolia ($299{\pm}164ind.\;m^{-2}$), Aphelochaeta monilaris ($100{\pm}57ind.\;m^{-2}$), the bivalve Musculista senhousia ($91{\pm}96ind.\;m^{-2}$) and the polychaete Praxillella affinis ($80{\pm}66ind.\;m^{-2}$). From the community statistics [cluster analysis and nonmetric multidimentional scaling (NMDS) ordination], the macrobenthic community was distinguished into two groups of inner bay (farming ground of near Sandal Island) and channel station(from Hansan Island to Chubong Island) group. In this study, the ecological status was assessed by four biotic indices Shannon's H', the ATZI Marine Biotic Index (AMBI), multivariate-AMBI (M-AMBI) and the Environment Conservation Index (ECI). The ecological status of the macrobenthic community in Geoje-Hansan Bay were poorer in the inner bay station than in the channel station. The results of the present study showed that three biotic indices (Shannon's H', M-AMBI and ECI) were valid as an index for evaluating the ecological status than the AMBI.

The Structure of Plant Community in Jungdaesa-Birobong Area, Odaesan National Park (오대산국립공원 중대사-비로봉 구간 식물군집구조)

  • Han, Bong-ho;Choi, Jin-woo;Noh, Tai-hwan;Kim, Dong-wook
    • Korean Journal of Environment and Ecology
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    • v.29 no.5
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    • pp.764-776
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    • 2015
  • This study aims to identify the structure of the plant community, and the ecological succession sere and the change in the forest ecosystem in Jungdaesa-Birobong area, Odaesan National Park_(i._e., located at high altitudes(over 1,000m)). It seeks to offer the basic data for the planning of vegetation management. In order to verify the status of the forest vegetation between Jungdaesa-Birobong, seventeen plots(size is $20m{\times}20m$) were set up as research sites at high altitudes. Importance value, distribution by diameter at breast height(DBH), the growth volume and age of the sample trees, similarity index and species diversity index of each survey plot were analysed. According to the results of DCA(Detrended Correspondence Analysis), one of the multivariate statistical techniques. It was found that the plant communities were classified into five groups: community I_(Quercus mongolica-Tilia amurensis community), community II_(Q. mongolica-Deciduous broad-leaved community), community III_(Q. mongolica-Pinus koraiensis community), community IV_(Abies holophylla-Q. mongolica community) and community V_(A. holophylla-Deciduous broad-leaved community). Community I which is dominated by Quercus mongolica and Deciduous broad-leaved communities is located at an altitude of over 1,300 meters(ranging from 1,335m to 1,495m), the community IV and V which are dominated by Abies holophylla are located at an altitude of under 1,200 meters(ranging from 1,115m to 1,175m) and the community II and III which include the main species of Quercus mongolica, Pinus koraiensis and Abies holophylla are located at an altitude of between 1,160 meters and 1,300 meters. The results showed that Quercus mongolica tends to have a higher importance value of woody species at a higher altitude while Abies holophylla tends to have higher importance value at a lower altitude. For the importance value woody species and -DBH class distribution, the communites I, II and III are expected to continuously maintain the present status. Whereas, for the influence of communities IV and V, Q. mongolica is predicted to be weakened. The age of sample trees was between 85 and 161; the average age was 123. The index of Shannon's Species diversity (H') showed heterogeneity was found among community I_(i._e., located at high altitude) and communities IV and V_(i._e., located at low altitude). As a results of analysing the index of Shannon's Species diversity (H': unit: $400m^2$), community III showed the highest diversity intex with 1.1109 followed by community II with 1.0475, community I with 1.0125, community IV with 0.9918 and community V with 0.8686. This study verified that the index of Shannon's species was significantly different by plant communities. For instance, when comparing the index of Shannon's species diversity in Quercus mongolica communities of this study and that of past relevant research, the value of index is very similar. However, the diversity index for the community which is dominated by Abies holophylla showed lower value when compared to the results from past relevant research.