• Radiation Oncology Journal
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• 제26권1호
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• pp.45-55
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• 2008

목적: 45세 이하의 유방암 환자의 종양조직의 파라핀 블록을 조직미세배열법(Tissue Microarray, TMA)으로 만들어 에스트로겐 수용체(ER), 프로게스테론 수용체(PR), HER-2, COX-2 및 Survivin 등 5가지의 생체표지자의 발현상태와 상호관계, 환자의 치료 후 추적관찰 상태와 관련성을 분석하여 예후인자로서의 의의를 연구하는 데 있다. 대상 및 방법: 1994년 3월부터 2005년 8월까지 수술을 시행한 45세 이하의 유방암 환자 중에서 TMA 분석이 가능한 212명의 환자를 대상으로 하였다. 환자의 나이는 23세부터 45세까지로 중앙 나이가 39세이었으며 최소 추적관찰기간은 24개월, 중앙 추적 관찰기간은 60개월이었다. 45세 이하의 환자를 선택한 후 수술 조직표본을 찾아 HE 염색된 슬라이드를 통해 암 부위를 표시한 후 TMA 장비를 통해 미세조직배열을 만들었다. 그리고 다섯 가지 생체표지자에 대한 면역조직화학 염색을 시행하였으며 병리전문의가 판독하였다. 그리고 이 결과와 환자들의 연령, 병기, 림프절 전이, 수술방법, 다양한 약물요법과 가족력 등 여러 가지 인자와 환자의 추적 관찰 결과를 입력하여 예후인자들을 분석하였다. 결과: T 병기에 따른 환자 분포는 T1이 90명, T2가 101명으로 다수를 차지하였고 105명(49.5%)에서 액와 림프절의 전이가 있었다. 모든 환자의 5년 무병 생존율과 5년 생존율은 각각 82.3%, 90.4%이었으며 36명의 환자가 국소 재발이나 원격전이가 추적 관찰기간에 발생하였고 20명은 암과 관련하여 사망하였다. ER, PR, HER-2, COX-2, 그리고 survivin의 양성 발현비율은 각각 38.2%, 45.3%, 25.9%, 41.5%와 43.4%이었으며 종양의 크기, 나이, 림프절 전이의 여부, 호르몬 수용체의 상태, 그리고 HER-2의 상태가 무병 생존기간에 대한 단변량 분석상 중요한 예후인자 이었으며 생존율에 미치는 영향은 종양의 크기, 림프절의 전이, 호르몬 수용체, 그리고 HER-2의 발현이었다. COX-2나 survivin은 예후인자로서의 역할을 찾을 수 없었으나 HER-2와 COX-2가 동시에 발현되는 경우에 예후가 나쁜 경향을 관찰할 수 있었다. 다변량 분석상 오직 T-병기와 림프절의 전이 여부만이 중요한 예후 인자이었고 ER은 경계의 의미가 있었다. 결론: 45세 이하의 여성 유방암 환자에서 호르몬 수용체 상태와 HER-2는 예후인자이었고 COX-2와 survivin은 예후인자로서의 역할을 찾을 수 없었다.

• Radiation Oncology Journal
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• 제11권2호
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• pp.285-294
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• 1993

A total of forty patients with resected N2 stage non-small cell lung cancer treated with postoperative adjuvant radiation therapy between Jan. 1975 and Dec. 1990 at the Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center were retrospectively analysed to evaluate whether postoperative radiation therapy improves survival. Patterns of failure and prognostic factors affecting survival were also analysed. The 5 year overall and disease free survival rate were $26.3\%,\;27.3\%$ and median survival 23.5 months. The 5 year survival rates by T-stage were $T1\;66.7\%,\;T2\;25.6\%\;and\;T3\;12.5\%.$ Loco-regional failure rate was $14.3\%$ and distant metastasis rate was $42.9\%$ and both $2.9\%.$ Statistically significant factor affecting distant failure rate was number of postitive lymph nodes(>=4). This retrospective study suggests that postoperative radiation therapy in resected N2 stage non-small cell lung cancer can reduce loco-regional recurrence and may improve survival rate as compared with other studies which were treated by surgery alone. Further study of systemic control is also needed due to high rate of distant metastasis.

• Radiation Oncology Journal
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• 제8권1호
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• pp.35-43
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• 1990

1975년 1월부터 1984년 12월까지 원자력병원 치료 방사선과에서 악성 타액선 종양으로 방사선 치료를 받은 58명의 환자를 대상으로 하여 이들의 생존율을 후향적으로 분석하였다. 이들은 수술후 재발했거나, 수술이 불가능한 환자들이었다. 58명의 환자중 mucoepidermoid carcinoma를 가진 환자가 $43.1\%$, adenoid cystic carcinoma를 가진 환자는 $41.3\%$였다. 주 타액선 종양의 5년 보험생존율은 $68.2\%$, 10년 생존율은 $31.8\%$였으나, 무병생존율은 각각 $43.2\%\;13.0\%$로써 치료 후 재발된 상태에서도 비교적 오래 산다는 것을 알 수 있었다. TNM staging에 의한 생존율도 $T_1$의 5년 생존율이 $86.5\%,\;T_2+T_3$가 $40.0\%,\;T_4$가 $0\%$로, T stage가 높아지면 질수록 생존율도 현저히 감소하였다. 병리조직학적 관점에서 볼 때, adenoid cystic carcinoma의 5년 무병생존율은 $40.1\%$로써, mucoepidermoid ca.의 $49.8\%$보다 낮았으나, 전체적인 생존율은 $77.3\%$로써, mucoepidermoid ca.의 $51.5\%$보다 현저히 높았다. 따라서, adenoid cystic carcinoma는 치료실패후 병을 가진 상태에서도 상당 기간 생존할 수 있다는 것을 알았으며, 평균 생존기간은 2년 이었다. 또한 mucoepidermoid ca.인 경우에는 세포의 분화정도에 따라 생존율이 달라졌는데, 저등도 분화세포의 5년 생존율이 $78.8\%$로 고등도 분화세포의 $38.2\%$보다 거의 2배나 높았다. 암의 위치와 성별에 따른 생존율의 차이는 없었다. Minor salivary gland tumor는 6명으로 5년 보험생존률은 $32.3\%$였다. 따라서 주 타액선 종양의 생존율에 영향을 끼칠 수 있는 예후 인자는 1) 병리조직학적 세포종류, 2) T와 N stages (AJCC), 3) mucoepidermoid carcinoma에 있어서 분화 정도 였다.

• Journal of Chest Surgery
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• 제40권10호
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• pp.680-684
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• 2007

배경: IB기 비소세포폐암의 가장 효과적인 치료는 완전 절제이나, 수술 후 재발이 생기면 생존율이 떨어진다. 최근 IB기 비소세포폐암의 완전 절제 후 시행하는 보조 요법에 대해 관심이 높아지고 있다. 적절한 보조 요법을 사용하기 위해서는 재발의 위험 인자를 아는 것이 중요하다. 대상 및 방법: 114명을 대상으로 연구하였으며, 환자의 성별, 나이, 수술 방법, 조직학적 유형, 분화의 정도, 종양의 크기, 장측 흉막 침범 유무 등과 재발과의 관계를 분석하였다. 생존율과 무재발률은 Kaplan-Meier 방법으로 구하였으며, log rank test로 단변량 분석을, Cox's proportional hazard model을 이용하여 다변량 분석을 하였다. p값이 0.05 미만인 경우에 통계학적으로 유의하다고 판정하였다. 결과: 3년 생존율 및 무재발률은 각각 87.0%, 79.4%였다. 단변량 분석에서 분화도가 통계학적으로 의미가 있었으며, 다변량 분석에서도 저분화의 경우가 예후가 좋지 않았다. 결론: 완전 절제된 IB기 비소세포폐암 환자에서 저분화도가 재발과 연관된 인자이므로 수술 후 보조 요법이 필요할 것으로 기대된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.7029-7032
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• 2013

Background: Cholangiocarcinoma (CCA) is a very common cancer in Northeastern Thailand. Most CCA patients see a physician at a late stage when curative surgery is not possible. After diagnosis, they generally are treated by partial surgery/percutaneous drainage, chemotherapy and supportive treatment. Objective: This study aimed to assess the survival rates of CCA patients after supportive treatment. Methods: A retrospective cohort design was applied in this study. Data for 746 CCA patients were extracted from the hospital-based cancer registry of Srinagarind Hospital, Khon Kaen University. The patients were diagnosed (at least by ultrasonography) between 1 January, 2009 and 31 December, 2009 and then followed up for current status until 30 June, 2011. The cumulative survival rate was calculated by the Kaplan-Meier method, and independent prognostic factors were investigated using Cox regression. Results: The total follow-up time was 5,878 person-months, and the total number of deaths was 637. The mortality rate was therefore 10.8 per 100 person-year (95%CI : 10.1-11.7). The cumulative 3, 6, 9, 12 and 24 month survival rates were 59%, 39%, 31%, 24% and 14%, respectively. The median survival time after supportive treatment was 4 months. After adjusting for gender, age, stage, distant metastasis, histological grading and treatment, stage was a significant predictor of survival of CCA patients. Those in stage III and stage IV had a 6.78 fold higher mortality than the stage I and stage II cases (95% CI : 1.6-28.7). Conclusion: It is very important to encourage patients to see health personnel at an early stage.

• Gut and Liver
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• 제12권6호
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• pp.728-735
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• 2018

Background/Aims: The combination of nab-paclitaxel and gemcitabine (nab-P/Gem) is widely used for treating metastatic pancreatic cancer (MPC). We aimed to evaluate the therapeutic outcomes and prognostic role of treatment-related peripheral neuropathy in patients with MPC treated with nab-P/Gem in clinical practice. Methods: MPC patients treated with nab-P/Gem as the first-line chemotherapy were included. All 88 Korean patients underwent at least two cycles of nab-P/Gem combination chemotherapy (125 and $1,000mg/m^2$, respectively). Treatment-related adverse events were monitored through periodic follow-ups. Overall survival and progression-free survival were estimated by the Kaplan-Meier method, and the Cox proportional hazards regression linear model was applied to assess prognostic factors. To evaluate the prognostic value of treatment-related peripheral neuropathy, the landmark point analysis was used. Results: Patients underwent a mean of $6.7{\pm}4.2$ cycles during $6.3{\pm}4.4$ months. The median overall survival and progression-free survival rates were 14.2 months (95% confidence interval [CI], 11.8 to 20.3 months) and 8.4 months (95% CI, 7.1 to 13.2 months), respectively. The disease control rate was 84.1%; a partial response and stable disease were achieved in 30 (34.1%) and 44 (50.0%) patients, respectively. Treatment-related peripheral neuropathy developed in 52 patients (59.1%), and 13 (14.8%) and 16 (18.2%) patients experienced grades 2 and 3 neuropathy, respectively. In the landmark model, at 6 months, treatment-related peripheral neuropathy did not have a significant correlation with survival (p=0.089). Conclusions: Nab-P/Gem is a reasonable choice for treating MPC, as it shows a considerable disease control rate while the treatment-related peripheral neuropathy was tolerable. The prognostic role of treatment-related neuropathy was limited.

• Radiation Oncology Journal
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• 제13권2호
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• pp.143-148
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• 1995

Purpose: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in the hypopharyngeal cancer by retrospective analysis. Materials and Methods: Between Jul.1985 and Sep.1992, 42 patients of hypopharyngeal cancer were treated by conventional radiotherapy alone or combined with neoadjuvant chemotherapy. The male to female ratio was 20:1 with a median age of 58 years, Twelve Patients were treated by conventional radiotherapy alone and 30 patients were treated by neoadjuvant chemotherapy and radiotherapy. Results: Seven Patients were Stage I,II and the patients with stage III and IV were 10 and 25, respectively at the time of presentation. The overall survival and disease-specific survival rates at 24 months were $12.9\%$ and $15.5\%,$respectively Two-year survival rates of stage I+II and III+IV patients were $50\%$ and $6.3\%,$ respectively(p(0.05). Sixteen Patients$(38\%)$ revealed CR and 26 patients$(62\%)$ revealed less than CR at the end of radiotherapy and their 2-year survival rates were $31.3\%\;and\;0\%,$ respectively(p(0.05). On univariate analysis, stage, T-stage, N-stage and treatment response were the significant prognostic factors, but only stage and treatment response were significant on multivariate analysis Conclusion : This conventional radiotherapy alone or with neoadjuvant chemotherapy does not seem to be sufficient in the treatment of most advanced hypopharyngeal cancer Therefore other treatment modalities such as hyperfractionation or concurrent chemoradiotherapy should be considered.

• Journal of Preventive Medicine and Public Health
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• 제41권1호
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• pp.17-22
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• 2008

Objectives : Period analysis estimates up-to-date survival rates of cancer patients. In this approach, analysis is restricted to recent time period by left-truncating all observations at the beginning of the period and right-censoring at its end. Here, we applied period analysis to examine changes in 5-year relative survival (RS) by age group for 1997 and for 2002. Methods : Using the National Cancer Incidence Database, 5-year RS was estimated for 1997 and 2002 in four age groups (15-54, 55-64, 65-74, and 75 years old and over) using period analysis. After excluding death certificate-only cases, patients with an unknown date of diagnosis or follow-up length, a total of 813,889 patients diagnosed with a first primary invasive cancer during 1992 2002 were included for analysis. Followup for vital status was included until 31 December 2002. Results : Five-year RS increased from 41.7% for 1997 to 46.7% for 2002. Increases in survival occurred in all age groups except in the 75 and over group. Conclusions : The age gradient in cancer prognosis seems to have widened between 1997 and 2002, a finding that requires further study of prognostic factors, including stage at diagnosis. Period analysis accurately estimates survival rates, especially for cancers with better prognosis.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2967-2970
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• 2015

Many patients with few cerebral metastases receive radiosurgery alone. The goal of this study was to create a tool to estimate the survival of such patients. To identify characteristics associated with survival, nine variables including radiosurgery dose, age, gender, Eastern cooperative oncology group performance score (ECOG-PS), primary tumor type, number/size of cerebral metastases, location of cerebral metastases, extra-cerebral metastases and time between cancer diagnosis and radiosurgery were analyzed in 214 patients. On multivariate analysis, age (p=0.03), ECOG-PS (p=0.02) and extra-cerebral metastases (p<0.01) had significant impacts on survival. Scoring points for each patient were obtained from 12-month survival rates (in %) related to the significant variables divided by 10. Addition of the scoring points of the three variables resulted in a patient's total predictive score. Two groups were designed, A (10-14 points) and B (16-17 points). Twelve-month survival rates were 33% and 77%, respectively (p<0.001). Median survival times were 8 and 20 months, respectively. Because most patients of group A died from extra-cerebral disease and/or new cerebral lesions, early systemic treatment and additional WBI should be considered. As cause of death in group B was mostly new cerebral metastases, additional WBI appears even more important for this group.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.199-203
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• 2012

Purpose: To evaluate the prognostic value of serum CYFRA21-1, CEA and hemoglobin levels regarding long-term survival of patients with esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT). Methods: Age, gender, Karnofsky Performance Status (KPS), tumor location, tumor length, T stage, N stage and serum hemoglobin, and CYFRA21-1 and CEA levels before concurrent CRT were retrospectively investigated and related to outcome in 113 patients receiving 5-fluorouracil and cisplatin combined with radiotherapy for ESCC. The Kaplan-Meier method was used to analyze prognosis, the log-rank to compare groups, the Cox proportional hazards model for multivariate analysis, and ROC curve analysis for assessment of predictive performance of biologic markers. Results: The median survival time was 20.1 months and the 1-, 2-, 3-, 5- year overall survival rates were 66.4%, 43.4%, 31.9% and 15.0%, respectively. Univariate analysis showed that factors associated with prognosis were KPS, tumor length, T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level. Multivariate analysis showed T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis. By ROC curve, CYFRA21-1 and hemoglobin showed better predictive performance for OS than CEA (AUC= 0.791, 0.704, 0.545; P=0.000, 0.000, 0.409). Conclusions: Of all clinicopathological and molecular factors, T stage, N stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis for patients with ESCC treated with concurrent CRT. Among biomarkers, CYFRA21-1 and hemoglobin may have a better predictive potential than CEA for long-term outcomes.