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An Overview of Surgical Treatment of Thymic Epithelial Tumors in Korea: A Retrospective Multicenter Analysis

  • Lee, Jun Oh;Lee, Geun Dong;Kim, Hyeong Ryul;Kim, Dong Kwan;Park, Seung-Il;Cho, Jong Ho;Kim, Hong Kwan;Choi, Yong Soo;Kim, Jhingook;Shim, Young Mog;Park, Samina;Park, In Kyu;Kang, Chang Hyun;Kim, Young Tae;Park, Seong Yong;Lee, Chang Young;Lee, Jin Gu;Kim, Dae Joon;Paik, Hyo Chae;the Korean Association for Research on the Thymus,
    • Journal of Chest Surgery
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    • v.55 no.2
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    • pp.126-142
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    • 2022
  • Background: Thymic epithelial tumors (TETs) are rare, and information regarding their surgical outcomes and prognostic factors has rapidly changed in the past few decades. We analyzed surgical treatment practices for TETs and outcomes in terms of overall survival (OS) and freedom from recurrence (FFR) during a 13-year period in Korea. Methods: In total, 1,298 patients with surgically resected TETs between 2000 and 2013 were enrolled retrospectively. OS and FFR were calculated using the Kaplan-Meier method and evaluated with the log-rank test. Prognostic factors for OS and FFR were analyzed with multivariable Cox regression. Results: A total of 1,098 patients were diagnosed with thymoma, and 200 patients were diagnosed with thymic carcinoma. Over the study period, the total number of patients with surgically treated TETs and the proportion of patients who underwent minimally invasive thymic surgery (MITS) increased annually. The 5-year and 10-year survival rates of surgically treated TETs were 91.0% and 82.1%, respectively. The 5-year and 10-year recurrence rates were 86.3% and 80.0%, respectively. The outcomes of surgically treated TETs improved over time. Multivariable Cox hazards analysis for OS, age, tumor size, and Masaoka-Koga stage were independent predictors of prognosis. The World Health Organization classification and tumor-node-metastasis (TNM) staging were also related to the prognosis of TETs. Conclusion: Surgical treatment of TETs achieved a good prognosis with a recent increase in MITS. The M-K stage was the most important prognostic factor for OS and FFR. The new TNM stage could also be an effective predictor of the outcomes of TETs.

Prognostic Relevance of WHO Classification and Masaoka Stage in Thymoma (흉선종양에서의 WHO 분류와 Masaoka 병기, 임상양상간의 상관관계연구)

  • Kang Seong Sik;Chun Mi Sun;Kim Yong Hee;Park Seung Il;Eeom Dae W.;Ro Jaee Y.;Kim Dong Kwan
    • Journal of Chest Surgery
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    • v.38 no.1 s.246
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    • pp.44-49
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    • 2005
  • Although thymomas are relatively common mediastinal tumors, to date not only has a universal system of pathologic classification not been established but neither has a clearly defined predictable relationship between treatment and prognosis been made. Recently, a new guideline for classification was reported by WHO, and efforts, based on this work, have been made to better define the relationship between treatment and pro­gnostic outcome. In the present study a comparative analysis between the WHO classification and Masaoka stage system with the clinical disease pattern was conducted. Material and Method: A total of 98 patients undergoing complete resection for mediastinal thymoma between Juanuary 1993 and June 2003 were included in the present study. The male female ratio was 48 : 50 and the mean age at operation was $49.6{\pm}13.9\;years.$ A retrospective analytic comparison studying the relationship between the WHO classification and the Masaoka stage system with the clinical disease pattern of thymoma was conducted. Pathologic slide specimens were carefully examined, details of postoperative treatment were documented, and a relationship with the prognostic outcome and recurrence was studied. Result: There were 7 patients in type A according to the WHO system of classification, 14 in AB, 28 in B 1, 23 in B2, 18 in B3, and 9 in type C. The study of the relationship between the Masaoka stage and WHO classification system showed 4 patients to be in WHO system type A, 7 in type AB, 22 in B 1, 17 in B2, and 3 in type B3 among 53 $(54{\%})$ patients shown to be in Masaoka stage I. Among 28 $(28.5{\%})$ patients in Masaoka stage II system, there were 2 patients in type A, 7 in AB, 4 in B 1, 2 in B2, 8 in B3, and 5 in type C. Among 15 $(15.3{\%})$ in Masaoka stage III, there were 1 patient in type B1, 3 in B2, 7 in B3, and 4 in type C. Finally, among 2 $(2{\%})$ patients found to be in Masaoka stage IV there was 1 patient in type B1, and 1 in type B2. The mean follow up duration was $28{\pm}6.8$ months. There were 3 deaths in the entire series of which 2 were in type B2 (Masaoka stages III and IV), and 1 was in type C (Masaoka stage II). Of the patients that experienced relapse, 6 patients remain alive of which 2 were in type B2 (Masaoka III), 2 in type B3 (Masaoka I and III) and 2 in type C (Masaoka stage II). The 5 year survival rate by the Kaplan-Meier method was $90{\%}$ for those in type B2 WHO classification system, $87.5{\%}$ for type C. The 5 year freedom from recurrence rate was $80.7{\%}$ for those in WHO type B2, $81.6{\%}$ for those in type B3, and $50{\%}$ for those in type C. By the Log-Rank method, a statistically significant correlation between survival and recurrence was found with the WHO system of classification (p<0.05). An analysis of the relationship between the WHO classification and Masaoka stage system using the Spearman correction method, showed a slope=0.401 (p=0.023), showing a close correlation. Conclusion: As type C of the WHO classification system is associated with a high postoperative mortality and recurrence rate, aggressive treatment postoperatively and meticulous follow up are warranted. The WHO classification and Masaoka stage system were found to have a close relationship with each other and either the WHO classification method or the Masaoka stage system may be used as a predict prognostic outcome of Thymoma.

Machine learning-based corporate default risk prediction model verification and policy recommendation: Focusing on improvement through stacking ensemble model (머신러닝 기반 기업부도위험 예측모델 검증 및 정책적 제언: 스태킹 앙상블 모델을 통한 개선을 중심으로)

  • Eom, Haneul;Kim, Jaeseong;Choi, Sangok
    • Journal of Intelligence and Information Systems
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    • v.26 no.2
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    • pp.105-129
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    • 2020
  • This study uses corporate data from 2012 to 2018 when K-IFRS was applied in earnest to predict default risks. The data used in the analysis totaled 10,545 rows, consisting of 160 columns including 38 in the statement of financial position, 26 in the statement of comprehensive income, 11 in the statement of cash flows, and 76 in the index of financial ratios. Unlike most previous prior studies used the default event as the basis for learning about default risk, this study calculated default risk using the market capitalization and stock price volatility of each company based on the Merton model. Through this, it was able to solve the problem of data imbalance due to the scarcity of default events, which had been pointed out as the limitation of the existing methodology, and the problem of reflecting the difference in default risk that exists within ordinary companies. Because learning was conducted only by using corporate information available to unlisted companies, default risks of unlisted companies without stock price information can be appropriately derived. Through this, it can provide stable default risk assessment services to unlisted companies that are difficult to determine proper default risk with traditional credit rating models such as small and medium-sized companies and startups. Although there has been an active study of predicting corporate default risks using machine learning recently, model bias issues exist because most studies are making predictions based on a single model. Stable and reliable valuation methodology is required for the calculation of default risk, given that the entity's default risk information is very widely utilized in the market and the sensitivity to the difference in default risk is high. Also, Strict standards are also required for methods of calculation. The credit rating method stipulated by the Financial Services Commission in the Financial Investment Regulations calls for the preparation of evaluation methods, including verification of the adequacy of evaluation methods, in consideration of past statistical data and experiences on credit ratings and changes in future market conditions. This study allowed the reduction of individual models' bias by utilizing stacking ensemble techniques that synthesize various machine learning models. This allows us to capture complex nonlinear relationships between default risk and various corporate information and maximize the advantages of machine learning-based default risk prediction models that take less time to calculate. To calculate forecasts by sub model to be used as input data for the Stacking Ensemble model, training data were divided into seven pieces, and sub-models were trained in a divided set to produce forecasts. To compare the predictive power of the Stacking Ensemble model, Random Forest, MLP, and CNN models were trained with full training data, then the predictive power of each model was verified on the test set. The analysis showed that the Stacking Ensemble model exceeded the predictive power of the Random Forest model, which had the best performance on a single model. Next, to check for statistically significant differences between the Stacking Ensemble model and the forecasts for each individual model, the Pair between the Stacking Ensemble model and each individual model was constructed. Because the results of the Shapiro-wilk normality test also showed that all Pair did not follow normality, Using the nonparametric method wilcoxon rank sum test, we checked whether the two model forecasts that make up the Pair showed statistically significant differences. The analysis showed that the forecasts of the Staging Ensemble model showed statistically significant differences from those of the MLP model and CNN model. In addition, this study can provide a methodology that allows existing credit rating agencies to apply machine learning-based bankruptcy risk prediction methodologies, given that traditional credit rating models can also be reflected as sub-models to calculate the final default probability. Also, the Stacking Ensemble techniques proposed in this study can help design to meet the requirements of the Financial Investment Business Regulations through the combination of various sub-models. We hope that this research will be used as a resource to increase practical use by overcoming and improving the limitations of existing machine learning-based models.

A Study on the Model Development and Empirical Application for Measuring the Radial and Non-radial Efficiencies of Investment in Domestic Seaports (국내항만투자의 방사.비방사적 효율성 측정을 위한 모형개발 및 실증적 적용에 관한 연구)

  • Park, Ro-Kyung
    • Journal of Korea Port Economic Association
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    • v.27 no.1
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    • pp.185-212
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    • 2011
  • The purpose of this paper is to show the empirical analysis way for measuring the seaport efficiency by using the previous radial model and the newly modified non-radial models( panel additive model, panel RAM model, and panel SBM model)with Spearman rank order correlation coefficient(SROCC) for 20 Korean ports during 11 years(1997-2007) for 1 inputs(port investment amount) and 4 outputs(Number of Ship Calls, Port Revenue, Customer Satisfaction Score for Port Service and Container Cargo Throughput). The main empirical results of this paper are as follows. First, consistency ratio of SROCC in terms of efficiency scores between radial and panel Additive model was over about 76% and overall consistency ratio was about 71.6%. Second, an efficiency of panel RAM model was higher than that of radial model with similarity. However, panel SBM model shows the very similar efficiency scores with panel radial model. Third, the slack size of radial model is smaller compared to non-radial model. Models' ranking orders in terms of efficiency scores, number of efficient ports are panel RAM model, panel SBM model, and radial model. The order from the minimum efficiency scores was the same order like just before. The policy implication to the Korean seaports and planner is that Korean seaports should introduce the new methods like non-radial models(panel additive model, panel RAM model, and panel SBM model) for measuring the port performance.

Association between Spiritual Well-Being and Pain, Anxiety and Depression in Terminal Cancer Patients: A Pilot Study (말기암환자의 영적 안녕과 통증, 불안 및 우울과의 연관성: 예비 연구)

  • Lee, Yong Joo;Kim, Chul-Min;Linton, John A.;Lee, Duk Chul;Suh, Sang-Yeon;Seo, Ah-Ram;Ahn, Hong-Yup
    • Journal of Hospice and Palliative Care
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    • v.16 no.3
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    • pp.175-182
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    • 2013
  • Purpose: Spirituality is an important domain and is related with physical and psychological symptoms in terminal cancer patient. The aim of this study is to examine how patients' spirituality is associated with their physical and psychological symptoms as it has been explored by few studies. Methods: In this cross sectional study, 50 patients in the palliative ward of a tertiary hospital were interviewed. Spiritual well-being, depression, anxiety and pain is measured by Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), hospital anxiety and depression scale (HADS) and the Korean version of the Brief Pain Inventory (BPI-K). The correlations between patients' spiritual well-being and anxiety, depression and pain were analysed. The association between spiritual well-being and age, gender, palliative performance scale (PPS), religion, mean pain intensity, anxiety, depression were assessed by univariate and multivariate regression analyses. Results: Spiritual well-being was negatively correlated with the mean pain intensity (r=-0.283, P<0.05), anxiety (r=-0.613, P<0.05) and depression (r=-0.526, P<0.05). In multivariate regression analysis, spiritual well-being showed negative association with anxiety (OR=-1.03, 95% CI=-1.657~-0.403, P=0.002) and positive association with the existence of religion (OR=9.193, 95% CI=4.158~14.229, P<0.001). Conclusion: In this study, patients' anxiety and existence of religion were significantly associated with spiritual well-being after adjusting age, gender, PPS, mean pain intensity, depression. Prospective studies are warranted.

Significant Caries(SiC) Index Based on 2009 Korea National Health and Nutrition Examination Survey (2009년 국민건강영양조사에 근거한 Significant Caries(SiC) Index)

  • Han, Ji-Hyoung;Ann, Eun-Sook
    • Journal of dental hygiene science
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    • v.11 no.3
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    • pp.229-234
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    • 2011
  • This study obtained DMFT index(9271 people) in population with more than 6 years old based on data of 2009 Korea National Health and Nutrition Examination Survey, and calculated SiC index(2,517 people) by classifying group with high risk, which is 1/3 in high rank out of it. The aim was to confirm existence of the group with high risk of dental caries, and was to emphasize necessity of preventive strategy for the group with high risk. Statistical analysis was carried out t-test by using STATA 11.0 program. 1. DMFT index accounted for 45.0%(4,174 people) for men and 55.0%(5,097 people) for women. SiC index stood at 2,517 people. Men accounted for 36.3%(914 people). Thus, women were larger with 64.7%(1,603 people). 2. Seeing the mean in DMFT index and SiC index, the more rise in age led to the bigger difference in the mean between two groups. Especially, the difference was shown more than 4 points on the average for 13 and 14 years old and more than double on the average from over 15 years. 3. As a result of comparing gender, DMFT index was higher in women than men from over 14 years old. SiC index wasn't significant. However, women were indicated to be 1 piece more than men at the age of 9 and 14. 4. As a result of comparing by region, both DMFT index and SiC index were indicated to be higher in the rural area for their over 60s. Seeing the above results, the group with high risk is showing the higher rate of experiencing dental caries than DMFT-index in the whole. Thus, the comprehensively & intensively preventive management seems to be likely needed on group with high risk.

The Effect of Commercially Available Mouth Rinsing Solution and Alkaline Ionized Water on the Oral Bacteria (시판되는 구강 양치액과 알칼리 이온수가 구강 내 세균에 미치는 효과)

  • Park, Seon-Nyeo;Jeong, Soon-Jeong;Jeong, Moon-Jin;Ahn, Yong-Soon;Choi, Yoo-Seok;Lim, Do-Seon
    • Journal of dental hygiene science
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    • v.13 no.2
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    • pp.213-221
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    • 2013
  • The mouth rinsing solution currently on the market is used for oral hygiene and reduction of halitosis, and alkaline ionized water is used for drinking purposes. The aim of this germiculture and observation through a microscope is to investigate the effect they have on the oral bacteria, and the results are as follows. 1. The change in the number of cultivated bacteria before and after the use of gargle was most dramatic for Hexamedin. It showed the highest rate of decrease in bacteria by 71.29%, followed by Listerine with 62.25%, Caregargle with 42.26%, Garglin with 33.52%, saline solution with 21.62%, alkaline ionized water with 16.08% and distilled water with 7.67%. 2. After careful analysis of statistics, Hexamedin was found to result in a significant decrease in the number of bacteria after gargling (p<0.05). 3. From observing through an light microscope after gram staining, it was evident that both a number of cocci and a few of filamentous were present before the use of gargle, whereas mostly cocci was present after the use of gargle. 4. The difference in the pH of oral rinses and alkaline ionized water had no significant influence on the number of oral bacteria. In conclusion, Hexamedin and Listerine, with the rate of decrease of bacteria of co71.29% and 62.25% respectively, have proven to be highly effective when applied before dental treatment. Other oral rinses and alkaline ionized water are relatively less efficient in decreasing the number of oral bacteria. Also, the decrease of bacteria is more affected by the antibacterial component of oral rinses than by the change in pH.

A Study on the Habitat Use of Waterbirds and Grading Assessment of the Tidal Flat at Muan Bay in Jeollanamdo, Korea (전라남도 무안만에 도래하는 수조류의 서식지 이용 및 갯벌등급 평가)

  • Kang, Tae-Han;Yoo, Seung-Hwa;Lee, Si-Wan;Choi, Ok-In;Lee, Chong-Bin
    • Korean Journal of Environment and Ecology
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    • v.22 no.5
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    • pp.521-529
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    • 2008
  • This research conducted a survey on waterbirds visiting this area four times by season from February to October in 2007 to look into the habitat use of waterbirds, to do a value and grade testing of the tidal flat by dividing the foreshore on Muan Bay located in Jeollanam-do into four areas (Dongam, Guro, Bokryong and Wangsan tidal flats). The survey results revealed that there existed a total of 15,755 individuals of 54 species including 2 species of grebes, 7 species of herons, 7 species of dabbling ducks, 6 species of diving ducks, 20 species of waders, 3 species of gulls and 9 other species and this survey also observed 9,291 individuals of the wading birds as a dominant group on Muan Bay. In these classified groups, the gulls and waders were observed to mostly use Dongam tidal flat as their habitat, while the group using Guro tidal flat as their habitat was mostly grebes, dabbling and diving ducks. As a result of UPGMA clustering analysis in consideration of the species and number of individuals, there appear the close similarities between Dongam and Bokryong tidal flats and so do Guro and Wangsan tidal flats. Taking a look at the grading of tidal flats by setting up ecological indexes, such as diversity index, abundance index, and dominance index, etc. legally reserved species and maximum number of individuals as a standard, the rank for the value and importance degree of Bokryong tidal flat appeared higher than that of the other three tidal flats. Like this, the gradation of tidal flats according to waterbirds are judged to able to suggest objective data on the issue of proper judgment and designation of valuable tidal flat areas and its subsequent effective preservation and management.

Comparing Concurrent Chemoradiotherapy to Chemotherapy Alone for Locally Advanced Unresectable Pancreatic Cancer (절제 불가능한 췌장암의 동시 항암화학 방사선 요법과 항암화학 단독 요법의 비교)

  • Park, Jeong-Hoon;Kim, Woo-Chul;Kim, Hun-Jung;Gwak, Hee-Keun
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.64-70
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    • 2009
  • Purpose: Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced unresectable pancreatic cancer. However, the introduction of gemcitabine and the recognition of a benefit in patients with advanced disease stimulated the design of trials that compare chemotherapy alone to concurrent chemoradiation. Therefore, we evaluated role of CCRT for locally advanced unresectable pancreatic cancer. Materials and Methods: We carried out a retrospective analysis of treatment results for patients with locally advanced unresectable pancreatic cancer between January 2000 and January 2008. The radiation was delivered to the primary tumor and regional lymph nodes with a 1~2 cm margin at a total dose of 36.0~59.4 Gy (median: 54 Gy). The chemotherapeutic agent delivered with the radiation was 5-FU (500 mg/$m^2$). The patients who underwent chemotherapy alone received gemcitabine (1,000 mg/$m^2$) alone or gemcitabine with 5-FU. The follow-up period ranged from 2 to 38 months. The survival and prognostic factors were analyzed using Kaplan-Meier method and log-rank test, respectively. Results: Thirty-four patients received concurrent chemoradiotherapy, whereas 21 patients received chemotherapy alone. The median survival time was 12 months for CCRT patients, compared to 11 months for chemotherapy alone patients (p=0.453). The median progression-free survival was 8 months for CCRT patients, compared to 5 months for chemotherapy alone patients (p=0.242). The overall response included 9 partial responses for CCRT and 1 partial response for chemotherapy alone. In total, 26% of patients from the CCRT group experienced grade 3~4 bowel toxicity. In contract, no grade 3~4 bowel toxicity was observed in the chemotherapy alone group. The significant prognostic factors of overall survival were lymph node status, high CA19-9, and tumor location. Conclusion: The response rate and progression-free survival were more favorable in the CCRT group, when compared with the chemotherapy alone group. Therefore, radiation therapy seems to be an effective tool for local tumor control.

A Study on the Health Problem of the Industrial Workers (산업장 근로자 건강문제의 산업위생학적 연구)

  • Park Moon Hee;Suh In Sun;Ahn Ok Hee
    • Journal of Korean Public Health Nursing
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    • v.4 no.2
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    • pp.59-77
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    • 1990
  • The purpose of this study was to provide the basic data for the effective health management of the industrial workers, by classifying factors influencing their perceived symptoms to examine their health status and identifying the inter' relationship of their perceived symptom with their working department. the environment of working area and their general characteristics. The study was undertaken from October 1 to November 30. 1989. The subjects were 999 workers who had worked in Industrial Corps located in Chungbuk Province. The results of this study were as follows: I . Worker's perceived symptoms were classified according to the following eight factors; 1) musculo - skeletal symptoms of shoulder, neck, back and arm 2) optical symptoms 3) symptoms in head(such as headache and dull) 4) musculo - skeletal symptoms of leg and lower back 5) gastro - intestinal symptoms 6) mental symptoms. 7) neural symptoms 8) lung and heart symptoms II . The degrees of workers' perception of perceived symptoms; Mean score of perceived symptoms:7.0 The rank of degrees of perceived symptoms: The highest:musculo - skeletal symptoms of shoulder, neck, back, and arm The second:optical symptoms The third:musculo - skeletal symptoms of leg and lower back The fourth:mental symptoms the fifth:gastro-intestinal symptoms m . Analysis of the inter-relationship of perceived symptoms with working department, environment of working area and general characteristics; 1) sexuality The difference of degrees of perceived symptoms was significant;femanle was higher than male(P<0.000). 2) level of education The difference of degrees of perceived symptoms according to the level of education was significant; The higher the level of education, the higher the degree. 3) working department The working department played a significant part in the degrees of perceived symptoms of workers; Workers of assembling department:musculo-skeletal symptoms both of shoulder. neck, back and arm and of leg and lower back(P<0.000). Workers of inspection department:optical symptoms(P<0.05). Office workers:mental symptoms(P<0.05). 4) kinds of job The difference of the degrees of perceived symptoms according to kinds of job was significant; Workers dealing with chemical materials and workers dealing with job with high tension:gastro-intestinal symptoms and symptoms in head. Workers dealing with weighty things or working a long time with the same posture:musculo-skeletal symptoms both of shoulder, neck, back and arm and of lower back(P<0.000). 5) working posture The difference of the degrees of perceived symptoms related with working posture was significant; Sitting:optical symptoms(P<0.0000) and symptoms in head(P<0.005) Standing:musculo-skeletal symptoms of leg and lower back(P<0.0000). 6) satisfaction with their own duty The more dissatisfien they were. the higher became the degrees of their perceived symptoms(P<0.0001). 7) satisfaction with their working condition The more dissatisfied with their working condition they were, the higher became the degrees of their perceived symptoms(P<0.001). 8) environment of working area The environment of working area played a significant part in the degrees of perceived symptoms of workers; Workers exposed to most of the factors of the environment of working area were higher than those not exposed in the degrees of musculoskeletal symptoms. Workers in the noisy environment:optican symptoms(P<0.000), symptoms in head(P<0.005). Workers in the damp environment:optical symptoms(P<0.005) and lung and heart symptoms(P <0.01). Workers with illumination problem:optical symptoms(P<0.000), mental symptoms(P<0.005) and neural symptoms(P<0.01). Workers with ventilation problem:optical symptoms and lung and heart symptoms(P<0.001)

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