• Tuberculosis and Respiratory Diseases
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• 제42권1호
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• pp.76-83
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• 1995

연구방법: 수술적 절제가 불가능하거나, 수술을 거부한 40예의 병기 3기와 4기의 비소세포성 폐암환자에서 MVP 복합화학요법을 2회이상 시행하였다. 결과: 1) 반응률에 있어서는, 부분 관해를 보인 예는 9예(23%)였으며, 23예(57%)에서 불변이었고, 8예(20%)에서 진행성 병변을 보였다. 완전 관해를 보인 예는 없었다. 2) 전체적인 중앙생존기간은 36주이었으며, 반응군에서의 중앙생존기간은 60주로서 비반응군의 31주에 비해 유의하게 연장되었다(p=0.03). 3) 여성에서 생존기간이 유의하게 연장되었다(p=0.01). 그외 예후인자인, 나이, 활동도, 조직형, 병기, LDH치, 혈색소치, 혈청 CEA치 등에 따른 반응률과 생존기간의 유의한 차이는 없었으나, 활동도가 양호한 군에서 반응률이, stage IIIa군에서 반응률 및 생존 기간이 높았음이 관찰되었다. 4) 화학 요법만을 받은 군과 고식적인 방사선 요법을 받은 군간의 생존기간의 차이는 없었다. 5) 부작용은 2예(5%)에서 지속적인 백혈구 감소증, 5예(12.5%)에서 말초 신경염이 관찰되었으나, 대다수 예에서 부작용 정도는 가역적이었고, 수용할만 하였다. 결론: 진행된 비소세포성 폐암의 치료에 있어서 MVP 요법은 반응률을 증가시키고 전체적인 생존기간을 연장시키는데 만족스럽지 못하였으나, 반응군에서는 유의하게 생존기간이 연장 되었다. 그래서, 새로운 화학요법의 개발과 아울러 대규모의 대상으로 수술이나 방사선 요법과의 병용치료등에 대한 연구가 필요하겠다.

• Radiation Oncology Journal
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• 제27권3호
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• pp.126-132
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• 2009

목 적: 비소세포성 폐암 림프절 병기 N2 환자에서 수술 후 방사선치료의 결과와 예후에 영향을 주는 인자에 대해 알아보고자 하였다. 대상 및 방법: 1999년부터 2008년 2월까지 비소세포성 폐암으로 진단받고 수술 후 병기 N2로 방사선치료를 시행받은 112명의 환자를 대상으로 하였다. 폐구간절제술(segmentectomy) 및 폐엽절제술(lobectomy)를 시행받은 환자는 75명(67%), 전폐절제술(pneumonectomy)을 시행 받은 환자는 37명(33%)였다. 절제연 음성인 환자는 94명(83.9%)이었고, 근접절제연 및 절제연 양성인 환자는 모두 18명(16.1%)이었다. 수술 후 보조적 요법으로 103명(92%)의 환자에서 항암치료가 시행되었다. 방사선치료의 분할선량은 1.8에서 2 Gy로 총선량은 45에서 66 Gy가(중앙값, 54 Gy) 시행되었다. 결 과: 전체환자의 2년 생존율과 무병생존율은 각각 60.2%와 44.7%였다. 예후 인자에 대한 단변량 분석을 하였을 때 종격동 림프절 부위(nodal station)의 전이가 단일 부위(single-station)인 환자에 비해 다발 부위(multiple-station)일 때 생존율과 무병생존율이 통계학적으로 의미 있게 감소하였다(p=0.047, p=0.007). T병기가 3기 이상일 때 생존율과 무병생존율이 의미 있게 감소하였다(p<0.001, p=0.025). 종양크기가 5 cm 이상이거나 림프혈관침윤이 양성인 경우 의미 있는 생존율의 감소를 보였고(p=0.035, p=0.034), 무병생존율은 통계학적으로 의미 있는 차이가 없었다. Cox-regression을 이용한 다변량 분석상 전이된 종격동 림프절 부위의 다발 부위 여부와 T병기가($\geq$T3) 생존율(p=0.046, p<0.001)과 무병생존율(p=0.005, p=0.033)에 통계학적으로 의미 있는 인자들이었다. 치료후 재발한 환자는 71명(63.4%)이었고, 국소재발은 23명(20.5%), 원격전이는 62명(55.4%), 그리고 국소재발과 원격전이가 동시에 진단된 환자는 14명(12.5%)이었다. 결 론: 수술 후 방사선치료를 시행받은 절제된 N2 병기 비소세포성 폐암에서 전이된 종격동 림프절 부위의 수가 다발 부위인 경우는 중요한 예후 인자로 향후 N2 병기와 관련된 하위 분류 연구와 그에 적절한 보조 요법에 대한 임상 연구가 필요할 것으로 생각한다.

• Radiation Oncology Journal
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• 제32권3호
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• pp.147-155
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• 2014

Purpose: This study was conducted to observe the outcomes of postoperative radiotherapy (PORT) with or without concurrent chemotherapy in resected non-small cell lung cancer (NSCLC) in single institution. Materials and Methods: From 2002 to 2013, 78 patients diagnosed with NSCLC after curative resection were treated with radiotherapy alone (RT, n = 48) or concurrent chemoradiation (CCRT, n = 30). The indications of adjuvant radiation therapy were N2 node positive (n = 31), close or involved resection margin (n = 28), or gross residual disease due to incomplete resection (n = 19). The median radiation dose was 57.6 Gy (range, 29.9 to 66 Gy). Results: Median survival time was 33.7 months (range, 4.4 to 140.3 months). The 5-year overall survival (OS) rate was 49.5% (RT 46% vs. CCRT 55.2%; p = 0.731). The 3-year disease-free survival rate was 45.5% (RT 39.4% vs. CCRT 55.3%; p = 0.130). The 3-year local control rate was 68.1% (RT 64.4% vs. CCRT 77.7%; p = 0.165). The 3-year DMFS rate was 56.1% (RT 52.6% vs. CCRT 61.7%; p = 0.314). In multivariate analysis, age ${\geq}66$ years and pathologic stage III were significant poor prognostic factors for OS. Treatment failure occurred in 40 patients. Four patients had radiologically confirmed grade 3 radiation pneumonitis. Conclusion: In NSCLC, adjuvant RT or CCRT after curative surgery is a safe and feasible modality of treatment. OS gain was seen in patients less than 66 years. Postoperative CCRT showed a propensity of achieving better local control and improved disease-free survival compared to RT alone according to our data.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.259-266
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• 2010

Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8893-8900
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• 2014

Dysregulated expression of microRNAs (miRNAs) has been shown to be closely associated with tumor development, progression, and carcinogenesis. However, their clinical implications for gastric cancer remain elusive. To investigate the hypothesis that genome-wide alternations of miRNAs differentiate gastric cancer tissues from those matched adjacent non-tumor tissues (ANTTs), miRNA arrays were employed to examine miRNA expression profiles for the 5-pair discovery stage, and the quantitative real-time polymerase chain reaction (qRTPCR) was applied to validate candidate miRNAs for 48-pair validation stage. Furthermore, the relationship between altered miRNA and clinicopathological features and prognosis of gastric cancer was explored. Among a total of 1,146 miRNAs analyzed, 16 miRNAs were found to be significantly different expressed in tissues from gastric cancer compared to ANTTs (p<0.05). qRT-PCR further confirmed the variation in expression of miR-193b and miR-196a in the validation stage. Down-expression of miR-193b was significantly correlated with Lauren type, differentiation, UICC stage, invasion, and metastasis of gastric cancer (p<0.05), while over-expression of miR-196a was significantly associated with poor differentiation (p=0.022). Moreover, binary logistic regression analysis demonstrated that the UICC stage was a significant risk factor for down-expression of miR-193b (adjusted OR=8.69; 95%CI=1.06-56.91; p=0.043). Additionally, Kaplan-Meier survival curves indicated that patients with a high fold-change of down-regulated miR-193b had a significantly shorter survival time (n=19; median survival=29 months) compared to patients with a low fold-change of down-regulated miR-193b (n=29; median survival=54 months) (p=0.001). Overall survival time of patients with a low fold-change of up-regulated miR-196a (n=27; median survival=52 months) was significantly longer than that of patients with a high fold-change of up-regulated miR-196a (n=21; median survival=46 months) (p=0.003). Hence, miR-193b and miR-196a may be applied as novel and promising prognostic markers in gastric cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4769-4774
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• 2013

This paper is the first to present the incidence and overall survival of patients with squamous cell carcinoma of the head and neck (SCCHN) from the extreme northern part of the Philippines. We retrospectively retrieved the records of patients with histologically-confirmed squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx and larynx at the Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines, from 2003 to 2012 and analysed prognostic factors associated with survival. Of the 150 cases, only 80 (53.3%) were still living when the study was terminated. Median age at initial diagnosis was 61.5 years and the male to female ratio was 7:3. The majority of the cases had tumours in the oral cavity (50.7%), followed by the larynx (36.7%). Sex (log rank=1.94, p value/${\alpha}$=0.16), tumor site (log rank=0.02, p value/${\alpha}$=0.90), tumor grade (log rank=1.74, p value/${\alpha}$=0.42), and node stage (log rank=0.07, p value/${\alpha}$=0.80) were not shown to be associated with the survival of our cases. Only 45 (30.0%) had no regional lymph node involvement (N0) at presentation and 12 (8.0%) had already developed distant metastases. Among the 150 patients, 71 (47.3%) were not able to receive treatment of any kind. Oddly, treatment (log rank=1.65, p value/${\alpha}$=0.20) was also shown to be not associated with survival. The survival rate of those who underwent surgery, radiotherapy, or both was not statistically different from those who did not receive any treatment. Only the tumor stage (log rank=4.51, p value/${\alpha}$=0.03) was associated with patient survival. The overall mean survival was 49.3 months, with survival rate diminishing from 88.3% during the 1st year to 1.80% by end of the study. This relatively low survival rate of our cases only reflects their poor access to quality diagnostic and treatment facilities.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.1847-1850
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• 2016

Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. Materials and Methods: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. Results: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, P<0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). Conclusions: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.

• 대한족부족관절학회지
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• 제22권1호
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• pp.21-25
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• 2018

Purpose: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. Materials and Methods: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. Results: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and fortyfive patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p<0.001). Conclusion: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.

• Asian Pacific Journal of Cancer Prevention
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• 제16권3호
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• pp.971-977
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• 2015

Malignant glioblastoma multiforme (GBM) is the most malignant brain tumor and despite recent advances in diagnostics and treatment prognosis remains poor. In this retrospective study, we assessed the clinical and radiological parameters, as well as fluorescence in situ hybridization (FISH) of 1p19q deletion, in a series of cases. A total of 816 patients with GBM who received surgery and radiation between January 2010 and May 2014 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patient progression free survival (PFS) and overall survival (OS). Age at diagnosis, preoperative Karnofsky Performance Scale (KPS) score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 and MMP9 expression level and adjuvant chemotherapy were statistically significant factors (p<0.05) for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age ${\leq}50$ years, preoperative KPS score ${\geq}80$, KPS score change after operation ${\geq}0$, involvement of single frontal lobe, deep structure involvement, low Ki-67 and MMP9 expression and adjuvant chemotherapy were independent favorable factors (p<0.05) for patient clinical outcomes.

• Journal of Breast Cancer
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• 제21권4호
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• pp.406-414
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• 2018

Purpose: T-cell immunoglobulin and mucin domain-containing molecule 3 (TIM-3) is an emerging immune response molecule related to T-cell anergy. There has been tremendous interest in breast cancer targeting immune checkpoint molecules, especially in the triple-negative breast cancer (TNBC). This study was designed to investigate TIM-3 expression on tumor infiltrating lymphocytes (TILs), its relationships with clinicopathological parameters and expression of programmed death receptor 1 (PD-1)/programmed death receptor ligand 1 (PD-L1), and its prognostic role. Methods: Immunohistochemistry on tissue microarray blocks produced from 109 samples of invasive ductal carcinoma type TNBC was performed with antibodies toward TIM-3, PD-1, PD-L1 and breast cancer-related molecular markers. Associations between their expression and clinicopathological parameters as well as survival analyses were performed. Results: TIM-3 was expressed in TILs from all 109 TNBCs, consisting of 17 cases (<5%), 31 cases (6%-25%), 48 cases (26%-50%), and 13 cases (>51%). High TIM-3 was significantly correlated with younger patients (p=0.0101), high TILs (p=0.0029), high tumor stage (p=0.0018), high PD-1 (p=0.0001) and high PD-L1 (p=0.0019), and tended to be associated with higher histologic grade, absence of extensive in situ components and microcalcification. High TIM-3 expression was significantly associated with a combinational immunophenotype group of high PD-L1 and high PD-1 (p<0.0001). High TIM-3 demonstrated a significantly better disease-free survival (DFS) (p<0.0001) and longer overall survival (OS) (p=0.0001), together with high TILs and high PD-1. In univariate survival analysis, high TIM-3 showed reduced relapse risk (p<0.0001) and longer OS (p=0.0003), together with high PD-1 expression. In multivariate analysis, high TIM-3 was statistically significant in predicting prognosis, showing better DFS (hazard ratio [HR], 0.0994; 95% confidence interval [CI], 0.0296-0.3337; p=0.0002) and longer OS (HR, 0.1109; 95% CI, 0.0314-0.3912; p=0.0006). Conclusion: In this study, we demonstrate that TIM-3 expression is an independent positive prognostic factor in TNBC, despite its association with poor clinical and pathologic features.