Serum Tumor Marker Levels might have Little Significance in Evaluating Neoadjuvant Treatment Response in Locally Advanced Breast Cancer
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- Asian Pacific Journal of Cancer Prevention
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- v.16 no.11
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- pp.4603-4608
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- 2015
Background: To determine the potential value of serum tumor markers in predicting pCR (pathological complete response) during neoadjuvant chemotherapy. Materials and Methods: We retrospectively monitored the pro-, mid-, and post-neoadjuvant treatment serum tumor marker concentrations in patients with locally advanced breast cancer (stage II-III) who accepted pre-surgical chemotherapy or chemotherapy in combination with targeted therapy at Fudan University Shanghai Cancer Center between September 2011 and January 2014 and investigated the association of serum tumor marker levels with therapeutic effect. Core needle biopsy samples were assessed using immunohistochemistry (IHC) prior to neoadjuvant treatment to determine hormone receptor, human epidermal growth factor receptor 2(HER2), and proliferation index Ki67 values. In our study, therapeutic response was evaluated by pCR, defined as the disappearance of all invasive cancer cells from excised tissue (including primary lesion and axillary lymph nodes) after completion of chemotherapy. Analysis of variance of repeated measures and receiver operating characteristic (ROC) curves were employed for statistical analysis of the data. Results: A total of 348 patients were recruited in our study after excluding patients with incomplete clinical information. Of these, 106 patients were observed to have acquired pCR status after treatment completion, accounting for approximately 30.5% of study individuals. In addition, 147patients were determined to be Her-2 positive, among whom the pCR rate was 45.6% (69 patients). General linear model analysis (repeated measures analysis of variance) showed that the concentration of cancer antigen (CA) 15-3 increased after neoadjuvant chemotherapy in both pCR and non-pCR groups, and that there were significant differences between the two groups (P=0.008). The areas under the ROC curves (AUCs) of pre-, mid-, and post-treatment CA15-3 concentrations demonstrated low-level predictive value (AUC=0.594, 0.644, 0.621, respectively). No significant differences in carcinoembryonic antigen (CEA) or CA12-5 serum levels were observed between the pCR and non-pCR groups (P=0.196 and 0.693, respectively). No efficient AUC of CEA or CA12-5 concentrations were observed to predict patient response toward neoadjuvant treatment (both less than 0.7), nor were differences between the two groups observed at different time points. We then analyzed the Her-2 positive subset of our cohort. Significant differences in CEA concentrations were identified between the pCR and non-pCR groups (P=0.039), but not in CA15-3 or CA12-5 levels (p=0.092 and 0.89, respectively). None of the ROC curves showed underlying prognostic value, as the AUCs of these three markers were less than 0.7. The ROC-AUCs for the CA12-5 concentrations of inter-and post-neoadjuvant chemotherapy in the estrogen receptor negative HER2 positive subgroup were 0.735 and 0.767, respectively. However, the specificity and sensitivity values were at odds with each other which meant that improving either the sensitivity or specificity would impair the efficiency of the other. Conclusions: Serum tumor markers CA15-3, CA12-5, and CEA might have little clinical significance in predicting neoadjuvant treatment response in locally advanced breast cancer.
The purpose of this study was to analyze the users' behaviors and to suggest development strategies in Uljin Kumgang pine tree(Pinus densiflora for. erecta) eco-forest(UKPEF), which is located in Kyeongbuk. The data were collected by interviewing 122 visitors to september 3 from august 29, 2007 with a constructed questionnaire. The results of the analysis are as follows. 1. The major visitors of UKPEF are male and the age between 20 to 30, the residents of the Uljin county with relatively high academic background. 2. The motive of visiting UKPEF is mainly by the beauty and taste of Kumgang pine tree and the condition of the forest. The visitors are mainly composed of family, not big group. 3. The visitors of UKPEF have obtained information about the Kumgang fine tree forest mainly from friends, not from the internet or travel agency. 4. The visitors of UKPEF pointed out lack of convenient facilities such as toilets and water-supply facilities. However, visitors are satisfied by the condition of the forest. 5. The visitors of UKPEF set a high value on Kumgang fine tree, So, more active marketing strategy about Uljin Kumgang pine tree has to be established. 6. The visitors of UKPEF are more satisfied by the Uljin Kumgang pine tree forest than expected. The development strategies of UKPEF are suggest as follows. (1) Auto tram system has to be set up and new trail should be constructed to attract more visitors and people of other regions. (2) To attract group tourists, new program should be developed. (3) Advertisement through internet or travel agency has to be developed. (4) Government(local) should make a plan to register the forest as World natural heritage. (5) Monitoring and evaluation system has to be developed to satisfy tourists. In conclusion, the efforts of taking care of and preserving the UKPEF should be made at the national level. I hope that more Koreans can have chance to feel and experience the value and excellence ofthe Uljin Kumgang pine tree(Pinus densiflora for. erecta)
The present study was attempted to examine the patient satisfaction factors for dental services of several dental clinics to enhance their satisfaction and to provide information that will help dental clinics to have competitive edge over others. This study was conducted an on-site survey to the outpatients of a dentist at Jeollabuk-do, from March 23 to April 10, 2003. The results were as follows: 1. In the event of dental hygienists, their satisfaction with dental hygienists was statistically significantly different according to their occupation. The company employees(4.30) and self-employed people(4.36) were more satisfied with dental hygienists, and the government workers(3.86) were pleased with them the least. 2. Their satisfaction level with internal environments was statistically significantly different according to their age, educational background and occupation. Those who were in their 50s and up(4.23), who received middle-school or lower education(4.11), who were retired or unemployed (4.31), and who were self-employed(4.11) were most pleased with internal environments. 3. Their satisfaction level of external environments varied statistically significantly with their occupation. Those who were retired or jobless (3.57) expressed the most satisfaction, and the government workers(2.83) were pleased the least. 4. Their satisfaction level with treatment process differed statistically significantly with their occupation. Those who were self-employed(3.97) and who were retired or unemployed(3.89) were more pleased, and the public officials(3.34) and professionals(3.54) were satisfied the least. 5. As to satisfaction level with medical bills, those who were in their 50s and up(3.95), who received high-school education(3.80), who were self-employed(3.98), and whose monthly mean income was three million won or more(3.99) expressed the biggest satisfaction. 6. What factors affected their overall satisfaction level with treatment after receiving it was investigated, and it's found that their overall satisfaction level was under the statistically significant influence of dentists, dental hygienists, treatment process and medical bills.
Background : Reduced lung compliance and increased lung resistance are the primary lung mechanical abnormalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mechanisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patients. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the changes in the respiratory mechanics by salbutamol inhalation was measured under the variable PEEP level in patients with ARDS. Materials and Methods : Fifteen mechanically ventilated paralyzed ARDS patients (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compliance, and the maximum and minimum inspiratory resistance were obtained by the end-inspiratory occlusion method during constant flow inflation using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm
Background: Nocturnal hypoxemia occurs in patients with chronic obstructive pulmonary disease(COPD) and the detection and treatment of nocturnal hypoxemia should be part of the management of COPD patients. We performed this study to evaluate the factors influencing to sleep related arterial oxygen desaturation(
Franchising is one of the fastest growing types of business. It is already popular and well-known in the U.S., and has been growing in many other countries including Korea. Furthermore, many Korean franchising companies have expanded their business overseas actively. According to the data by the Ministry of Industry and Resource, 82 companies out of a sample of 500 franchising companies are already operating in many foreign countries and 48% of them have started their foreign business since 2006. This clearly indicates the fast growing current trend of foreign operation by Korean franchising companies. In spite of the fast growing trend of foreign expansion in the industry, academic research on internationalization of franchising companies is extremely difficult to find. Accordingly, academic research on the issue is necessary and urgent in Korea. Among the various research questions on internationalization of franchising business, this study intends to investigate the difference in organizational factors between the franchising companies doing foreign operation and those doing business only domestically. More specifically, this research has the following purposes. First, considering the lack of theoretical basis of previous studies, resource-based theory and agency theory are employed as the theoretical bases. Second, this study explains the difference in internationalization based on organizational factors such as company size, history and growth rate. Third, the five hypotheses regarding the difference in organizational factors are presented and tested empirically, which is the first attempt in the area of this topic. Finally, the study attempts to clarify the conflicting implications among theories regarding some organizational factos such as growth rate. As the theoretical background, resource-based theory and agency theory are discussed. According to resource-based theory, a firm can grow continuously when it has competence and resource, and also the ability to develop them. The competence and resource can include capital, human resource, management skill, market information, ability to manage risk, etc. Meanwhile, agency theory views the relationship between franchisor and franchisee as an agency relationship. In agency theory, bonding capability and monitoring capability are the two key factors which promote internationalization of franchising companies. Based on the two theories, a conceptual model is designed. The model consists of two groups of variables. One is organizational factors including size, history, growth rate, price bonding and geographic dispersion. The other is whether a franchising company is operating overseas or not. We developed the following five research hypotheses basically describing the relationship between organizational factors and internationalization of franchising companies. H1: The size of franchising companies operating overseas is larger than that of franchising companies operating domestically. H2: The history of franchising companies operating overseas is longer than that of franchising companies operating domestically. H3: The growth rate of franchising companies operating overseas is higher than that of franchising companies operating domestically. H4: The price bonding of franchising companies operating overseas is higher than that of franchising companies operating domestically. H5: The geographic dispersion of franchising companies operating overseas is wider than that of franchising companies operating domestically. Data for the analyses are obtained from 2005 Korea Franchise Survey data co-generated by Ministry of Industry and Resource, GS1 Korea, and Korea Franchise Association. Out of 2,804 population companies, 2,489 companies are excluded for various reasons and 315 companies are selected as the final sample. Prior to hypotheses tests, validity and reliability of the measures of size, history, growth rate and price bonding are examined for further analyses. Geographic dispersion is not validated since it is measured using nominal data. A series of independent sample T-tests is used to find out whether there exists any significant difference between the companies internationalized and those operating only domestically for each organizational factor. Among the five factors, size and geographic dispersion show significant difference, growth rate and price bonding do not reveal any difference and, finally, history factor shows conflicting results in the difference depending on how to measure it.