• Korean Journal of Radiology
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• v.22 no.2
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• pp.213-224
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• 2021

Objective: Clinical outcomes of patients who undergo transarterial chemoembolization (TACE) for single small hepatocellular carcinoma (HCC) are not consistent, and may differ based on certain imaging findings. This retrospective study was aimed at determining the efficacy of pre-TACE CT or MR imaging findings in predicting survival outcomes in patients with small HCC upon being treated with TACE. Besides, the study proposed to build a risk prediction model for these patients. Materials and Methods: Altogether, 750 patients with functionally good hepatic reserve who received TACE as the first-line treatment for single small HCC between 2004 and 2014 were included in the study. These patients were randomly assigned into training (n = 525) and validation (n = 225) sets. Results: According to the results of a multivariable Cox analysis, three pre-TACE imaging findings (tumor margin, tumor location, enhancement pattern) and two clinical factors (age, serum albumin level) were selected and scored to create predictive models for overall, local tumor progression (LTP)-free, and progression-free survival in the training set. The median overall survival time in the validation set were 137.5 months, 76.1 months, and 44.0 months for low-, intermediate-, and high-risk groups, respectively (p < 0.001). Time-dependent receiver operating characteristic curves of the predictive models for overall, LTP-free, and progression-free survival applied to the validation cohort showed acceptable areas under the curve values (0.734, 0.802, and 0.775 for overall survival; 0.738, 0.789, and 0.791 for LTP-free survival; and 0.671, 0.733, and 0.694 for progression-free survival at 3, 5, and 10 years, respectively). Conclusion: Pre-TACE CT or MR imaging findings could predict survival outcomes in patients with small HCC upon treatment with TACE. Our predictive models including three imaging predictors could be helpful in prognostication, identification, and selection of suitable candidates for TACE in patients with single small HCC.

• The Korean journal of internal medicine
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• v.39 no.3
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• pp.501-512
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• 2024

Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.399-404
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• 2013

Objective : The authors conducted a retrospective cohort study to determine prognostic factors and treatment outcomes of brain metastases (BM) from breast cancer (BC) after Gamma Knife radiosurgery (GKS). Methods : Pathologic and clinical features, and outcomes were analyzed in a cohort of 62 patients with BM from BC treated by GKS. The Kaplan- Meier method, the log-rank test, and Cox's proportional hazards model were used to assess prognostic factors. Results : Median survival after GKS was 73.0 weeks (95% confidence interval, 46.0-100.1). HER2+ [hazard ratio (HR) 0.441; p=0.045], Karnofsky performance scale (KPS) ${\geq}70$ (RR 0.416; p=0.050) and systemic chemotherapy after GKS (RR 0.282; p=0.001) were found to be a favorable prognostic factor of overall survival. Actuarial local control (LC) rate were $89.5{\pm}4.5%$ and $70.5{\pm}6.9%$ at 6 and 12 months after GKS, respectively. No prognostic factors were found to affect LC rate. Uni- and multivariate analysis revealed that the distant control (DC) rate was higher in patients with; a small number (${\leq}3$) of metastasis (HR 0.300; p=0.045), no known extracranial metastasis (p=0.013, log-rank test), or the HER2+ subtype (HR 0.267; p=0.027). Additional whole brain radiation therapy and metastasis volume were not found to be significantly associated with LC, DC, or overall survival. Conclusion : The treatment outcomes of patients with newly diagnosed BM from BC treated with GKS could be affected primarily by intrinsic subtype, KPS, and systemic chemotherapy. Therapeutic strategy and prognosis scoring system should be individualized based on considerations of intrinsic subtype in addition to traditionally known parameters related to stereotactic radiosurgery.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.5
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• pp.2219-2224
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• 2012

Background: Circulating lymphocyte subsets reflect the immunological status and might therefore be a prognostic indicator in cancer patients. Our aim was to evaluate the clinical significance of circulating lymphocyte subset in gastric cancer (GC) cases. Methods: A retrospective study on a prevalent cohort of 846 GC patients hospitalized at Hospital from Aug 2006 to Jul 2010 was conducted. We calculated the patient's disease free survival (DFS) after first hospital admission, and hazard ratios (HR) from the Cox proportional hazards model. Results: Our findings indicated a significantly decreased percentage of CD3+, and CD8+ cells, a significantly increased proportion of $CD4^+$, $CD19^+$, $CD44^+$, $CD25^+$, NK cells, and an increased $CD4^+/CD8^+$ ratio in GC patients as compared with healthy controls (all P < 0.05). Alteration of lymphocyte subsets was positively correlated with sex, age, smoking, tumor stage and distant metastasis of GC patients (all P<0.05). Follow-up analysis indicated significantly higher DFS for patients with high circulating $CD19^+$ lymphocytes compared to those with low $CD19^+$ lymphocytes (P=0.037), with $CD19^+$ showing an important cutoff of $7.91{\pm}2.98%$ Conclusion: Circulating lymphocyte subsets in GC patients are significantly changed, and elevated CD19+ cells may predict a favorable survival.

• Journal of Periodontal and Implant Science
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• v.50 no.6
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• pp.379-391
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• 2020

Purpose: The aims of this study were to evaluate the 5-year cumulative survival rate (CSR) of implants placed with guided bone regeneration (GBR) compared to implants placed in native bone, and to identify factors contributing to implant failure in regenerated bone. Methods: This retrospective cohort study included 240 patients who had implant placement either with a GBR procedure (regenerated bone group) or with pristine bone (native bone group). Data on demographic features (age, sex, smoking, and medical history), location of the implant, implant-specific features, and grafting procedures and materials were collected. The 5-year CSRs in both groups were estimated using Kaplan-Meier analysis. Risk factors for implant failure were analyzed with a Cox proportional hazards model. Results: In total, 264 implants in the native bone group and 133 implants in the regenerated bone group were analyzed. The 5-year CSRs were 96.4% in the regenerated bone group and 97.5% in the native bone group, which was not a significant difference. The multivariable analysis confirmed that bone status was not an independent risk factor for implant failure. However, smoking significantly increased the failure rate (hazard ratio, 10.7; P=0.002). Conclusions: The 5-year CSR of implants placed in regenerated bone using GBR was comparable to that of implants placed in native bone. Smoking significantly increased the risk of implant failure in both groups.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5767-5772
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• 2012

Introduction: Identification of simple and measurable prognostic factors is an important issue in treatment evaluation of breast cancer. The present study was conducted to evaluate the prognostic role of vascular invasion in lymph node negative breast cancer patients. Methods: in a retrospective design, we analyzed the recorded profiles of the 1,640 patients treated in the breast cancer department of Motahari clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, from January 1999 to December 2012. Overall and adjusted survivals were evaluated by the Cox proportional hazard model. All the hypotheses were considered two-sided and a p-value of 0.05 or less was considered as statistically significant. Results: Mean age in lymph node negative and positive patients was 50.0 and 49.8 respectively. In lymph node negative patients, the number of nodes, tumor size, lymphatic invasion, vascular invasion, progesterone receptor, and nuclear grade were significant predictors. In lymph node and lymphatic negative patients, vascular invasion also played a significant prognostic role in the survival which was not evident in lymph node negative patients with lymphatic invasion. Discussion: The results of our large cohort study, with long term follow up and using multivariate Cox proportional model and comparative design showed a significant prognostic role of vascular invasion in early breast cancer patients. Vascular invasion as an independent prognostic factor in lymph node negative invasive breast cancer.

• Journal of agricultural medicine and community health
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• v.32 no.1
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• pp.13-26
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• 2007

Objectives: This study was conducted to investigate the association between health risk factors and mortality in Juam cohort. Methods: The subjects were 1,447 males and 1,889 females who had been followed up for 68.5 months to 1 January 2001. Whether they were alive or not was confirmed by the mortality data of the National Statistical Office. A total of 289 persons among them died during the follow-up period. The Cox's proportional hazard regression model was used for survival analysis. Results: Age, type of medical insurance, self cognitive health level, habit of alcohol drinking, smoking, exercise and BMI level were included in Cox's proportional hazard model by gender. The hazard ratio of age was 1.07(95% CI: 1.05-1.10) in men, 1.09(95% CI: 1.06-1.12) in women. The hazard ratio of medical aid(lower socioeconomic state) was 1.43(95% CI 1.02-2.19) in women. The hazard ratios of current alcohol drinking and current smoking were respectively 1.69(95% CI: 1.01-2.98), 1.52(95% CI: 1.02-2.28) in women. The hazard ratio of underweight was 1.56(95% CI 1.08-2.47) in men. The hazard ratios of underweight, normoweight, overweight, and obesity were respectively 1.63(95% CI: 1.02-2.67), 1.0(referent), 0.62(95% CI: 0.32-1.63), 1.27(95% CI: 0.65-3.06), which supported the U-shaped relationship between body mass index and mortality among the men over 65. Conclusions: The health risk factors increasing mortality were age, underweight in male, age, lower socioeconomic state, current alcohol drinking, current smoking in female. To evaluate long-term association between health risk factors and mortality, further studies need to be carried out.

• Health Policy and Management
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• v.30 no.4
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• pp.522-530
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• 2020

Background: In 2008, Korea implemented a new type of social insurance known as "long-term care insurance". We examined the association between ownership of long-term care facilities and the incidence of pressure ulcers after the implementation of "long-term care insurance". This study is a population-based retrospective cohort study from 2006 to 2013. Methods: We used medical claims data from the Korean National Health Insurance Corporate Elderly Cohort Database from 2006 to 2013. These data comprise a nationally representative sample. To avoid confounders, only patients admitted to one long-term care facility and who stayed for >70% of the follow-up time were included; as a result, 3,107 individuals were enrolled. The main independent variable was the operating entity of the long-term care facility (local government, corporate bodies, and private for-profit owners), and the dependent variable was the 1-year incidence of pressure-ulcers. Survival analysis (Cox proportional hazard model) was used as an analysis method. Results: Compared to patients admitted to local government long-term care facilities, patients admitted to private long-term care facilities had a significantly higher 1-year risk of pressure ulcers (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.29-2.91); the risk was especially high among patients who were cognitively dependent (HR, 2.34; 95% CI, 1.25-4.37). Conclusion: Patients admitted to private for-profit long-term care facilities were more likely to have pressure ulcers compared to those in local government and corporate body long-term care facilities. Appropriate assessment tools and publicly available information, as well as more restricted legal requirements, are needed to improve the care quality and outcomes of patients in long-term care facilities.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.32-40
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• 2023

Background: The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. Methods: We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. Results: The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). Conclusions: There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.479-482
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• 2012

Aim: Soy foods are the major source of isoflavones, which are believed to play important roles in genesis of breast cancer and its progression. We here conducted a prospective study to evaluate the association of soy isoflavone food consumption with breast cancer prognosis. Methods: A prospective study was performed from January 2004 and January 2006 in China. Trained interviewers conducted face-to-face interviews using a structured questionnaire to collect information on dietary habits and potential confounding factors. The relative risk [hazard ratio (HR)] and 95% CI were calculated from the Cox regression model for all significant predictors from cancer diagnosis to the endpoint of the study (event). Results: After a median follow up of 52.1 months (range, 9-60 months), a total of 79 breast cancer related deaths were recorded in our study, risk being inversely associated with a high intake of soy isoflavone. With an average intake of soy isoflavone above 17.3 mg/day, the mortality of breast cancer can be reduced by about 38-36%. We also found the decreased breast cancer death with high soy protein intake, with a HR (95% CI) of 0.71 (0.52-0.98). Stratified analysis with reference to the ER status, further demonstrated a better prognosis of ER positive breast cancer with a high intake of soy isoflavone (HR 0.59, 0.40-0.93). Conclusion: Our study shows the soy food intake is associated with longer survival and low recurrence among breast cancer patients. A cohort study with a larger sample size and long term follow-up is now needed.