• 제목/요약/키워드: Tumor Regression

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제한된 평균 생존시간을 이용한 위암 3기 자료 분석에 관한 연구 (Analysis of stage III stomach cancer using the restricted mean survival time)

  • 김빛나;이민정
    • 응용통계연구
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    • 제34권2호
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    • pp.255-266
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    • 2021
  • 본 연구는 미국 국립암연구소의 SEER 프로그램에서 제공하는 위암 3기 자료에 대해 항암치료의 효과를 비교하고 위암 생존율에 유의한 영향을 미치는 요인을 알아보고자 한다. 본 연구에서 분석한 위암 3기 자료는 비례위험 가정이 성립하지 않아 대안으로 제한된 평균 생존시간을 이용한 분석 방법을 자료 분석에 적용하였다. 의사-관측들을 이용하여 제한된 평균 생존시간을 추정하였고, 제한된 평균 생존시간 추정량에 기반한 검정통계량을 이용하여 항암치료의 효과를 파악하였다. 일반화 선형모형을 이용한 회귀모형을 통해 위암 3기 환자의 평균 생존시간에 유의한 영향을 미치는 공변량들의 효과를 추정하였다. 항암치료법에 따라 위암 3기 환자의 평균 생존시간에 유의한 차이가 있음을 확인하였고, 진단연령, 인종, 세분화병기, 분화도, 종양의 크기, 수술여부, 항암치료가 위암 3기 환자의 평균 생존시간에 유의한 영향을 미치는 요인들이였으며, 그 중 수술여부가 위암 3기 환자의 평균 생존시간을 늘리는데 가장 큰 영향을 미치는 요인임을 확인하였다.

Scoring Model Based on Nodal Metastasis Prediction Suggesting an Alternative Treatment to Total Gastrectomy in Proximal Early Gastric Cancer

  • So, Seol;Noh, Jin Hee;Ahn, Ji Yong;Lee, In-Seob;Lee, Jung Bok;Jung, Hwoon-Yong;Yook, Jeong-Hwan;Kim, Byung-Sik
    • Journal of Gastric Cancer
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    • 제22권1호
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    • pp.24-34
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    • 2022
  • Purpose: Total gastrectomy (TG) with lymph node (LN) dissection is recommended for early gastric cancer (EGC) but is not indicated for endoscopic resection (ER). We aimed to identify patients who could avoid TG by establishing a scoring system for predicting lymph node metastasis (LNM) in proximal EGCs. Materials and Methods: Between January 2003 and December 2017, a total of 1,025 proximal EGC patients who underwent TG with LN dissection were enrolled. Patients who met the absolute ER criteria based on pathological examination were excluded. The pathological risk factors for LNM were determined using univariate and multivariate logistic regression analyses. A scoring system for predicting LNM was developed and applied to the validation group. Results: Of the 1,025 cases, 100 (9.8%) showed positive LNM. Multivariate analysis confirmed the following independent risk factors for LNM: tumor size >2 cm, submucosal invasion, lymphovascular invasion (LVI), and perineural invasion (PNI). A scoring system was created using the four aforementioned variables, and the areas under the receiver operating characteristic curves in both the training (0.85) and validation (0.84) groups indicated excellent discrimination. The probability of LNM in mucosal cancers without LVI or PNI, regardless of size, was <2.9%. Conclusions: Our scoring system involving four variables can predict the probability of LNM in proximal EGC and might be helpful in determining additional treatment plans after ER, functioning as a good indicator of the adequacy of treatments other than TG in high surgical risk patients.

CT imaging features of fat stranding in cats and dogs with abdominal disorder

  • Seolyn, Jang;Suhyun, Lee;Jihye, Choi
    • Journal of Veterinary Science
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    • 제23권6호
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    • pp.70.1-70.13
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    • 2022
  • Background: Fat stranding is a non-specific finding of an increased fat attenuation on computed tomography (CT) images. Fat stranding is used for detecting the underlying lesion in humans. Objectives: To assess the clinical significance of fat stranding on CT images for identifying the underlying cause in dogs and cats. Methods: In this retrospective study, the incidence, location, extent, distribution, and pattern of fat stranding were assessed on CT studies obtained from 134 cases. Results: Fat stranding was found in 38% (51/134) of all cases and in 35% (37/107) of tumors, which was significantly higher in malignant tumors (44%) than benign tumors (12%). Moreover, fat stranding was found in more than two areas in malignant tumors (16/33) and in a single area in benign tumors (4/4). In inflammation, fat stranding was demonstrated in 54% (7/13) in a single area (7/7) as a focal distribution (6/7). In trauma, fat stranding was revealed in 50% (7/14) and most were in multiple areas (6/7). Regardless of the etiologies, fat stranding was always around the underlying lesion and a reticular pattern was the most common presentation. Logistic regression analysis revealed that multiple areas (p = 0.040) of fat stranding and a reticulonodular pattern (p = 0.022) are the significant predictors of malignant tumor. Conclusions: These findings indicated that CT fat stranding can be used as a clue for identifying the underlying lesion and can be useful for narrowing the differential list based on the extent and pattern.

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Lesion Conspicuity and Size Assessment according to Background Parenchymal Enhancement

  • Soo-Yeon Kim;Nariya Cho;Yunhee Choi;Sung Ui Shin;Eun Sil Kim;Su Hyun Lee;Jung Min Chang;Woo Kyung Moon
    • Korean Journal of Radiology
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    • 제21권5호
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    • pp.561-571
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    • 2020
  • Objective: To evaluate the clinical utility of ultrafast dynamic contrast-enhanced (DCE)-MRI compared to conventional DCE-MRI by studying lesion conspicuity and size according to the level of background parenchymal enhancement (BPE). Materials and Methods: This study included 360 women (median age, 54 years; range, 26-82 years) with 361 who had undergone breast MRI, including both ultrafast and conventional DCE-MRI before surgery, between January and December 2017. Conspicuity was evaluated using a five-point score. Size was measured as the single maximal diameter. The Wilcoxon signed-rank test was used to compare median conspicuity score. To identify factors associated with conspicuity, multivariable logistic regression was performed. Absolute agreement between size at MRI and histopathologic examination was assessed using the intraclass correlation coefficient (ICC). Results: The median conspicuity scores were 5 at both scans, but the interquartile ranges were significantly different (5-5 at ultrafast vs. 4-5 at conventional, p < 0.001). Premenopausal status (odds ratio [OR] = 2.2, p = 0.048), non-mass enhancement (OR = 4.1, p = 0.001), moderate to marked BPE (OR = 7.5, p < 0.001), and shorter time to enhancement (OR = 0.9, p = 0.043) were independently associated with better conspicuity at ultrafast scans. Tumor size agreement between MRI and histopathologic examination was similar for both scans (ICC = 0.66 for ultrafast vs. 0.63 for conventional). Conclusion: Ultrafast DCE-MRI could improve lesion conspicuity compared to conventional DCE-MRI, especially in women with premenopausal status, non-mass enhancement, moderate to marked BPE or short time to enhancement.

Pericardial Window Operation in Oncology Patients: Analysis of Long-Term Survival and Prognostic Factors

  • Sung Min Kim;Jun Ho Lee;Su Ryeun Chung;Kiick Sung;Wook Sung Kim;Yang Hyun Cho
    • Journal of Chest Surgery
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    • 제57권2호
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    • pp.169-177
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    • 2024
  • Background: Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods: We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results: All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion: This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.

Nomogram Models for Distinguishing Intraductal Carcinoma of the Prostate From Prostatic Acinar Adenocarcinoma Based on Multiparametric Magnetic Resonance Imaging

  • Ling Yang;Xue-Ming Li;Meng-Ni Zhang;Jin Yao;Bin Song
    • Korean Journal of Radiology
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    • 제24권7호
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    • pp.668-680
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    • 2023
  • Objective: To compare multiparametric magnetic resonance imaging (MRI) features of intraductal carcinoma of the prostate (IDC-P) with those of prostatic acinar adenocarcinoma (PAC) and develop prediction models to distinguish IDC-P from PAC and IDC-P with a high proportion (IDC ≥ 10%, hpIDC-P) from IDC-P with a low proportion (IDC < 10%, lpIDC-P) and PAC. Materials and Methods: One hundred and six patients with hpIDC-P, 105 with lpIDC-P and 168 with PAC, who underwent pretreatment multiparametric MRI between January 2015 and December 2020 were included in this study. Imaging parameters, including invasiveness and metastasis, were evaluated and compared between the PAC and IDC-P groups as well as between the hpIDC-P and lpIDC-P subgroups. Nomograms for distinguishing IDC-P from PAC, and hpIDC-P from lpIDC-P and PAC, were made using multivariable logistic regression analysis. The discrimination performance of the models was assessed using the receiver operating characteristic area under the curve (ROC-AUC) in the sample, where the models were derived from without an independent validation sample. Results: The tumor diameter was larger and invasive and metastatic features were more common in the IDC-P than in the PAC group (P < 0.001). The distribution of extraprostatic extension (EPE) and pelvic lymphadenopathy was even greater, and the apparent diffusion coefficient (ADC) ratio was lower in the hpIDC-P than in the lpIDC-P group (P < 0.05). The ROC-AUCs of the stepwise models based solely on imaging features for distinguishing IDC-P from PAC and hpIDC-P from lpIDC-P and PAC were 0.797 (95% confidence interval, 0.750-0.843) and 0.777 (0.727-0.827), respectively. Conclusion: IDC-P was more likely to be larger, more invasive, and more metastatic, with obviously restricted diffusion. EPE, pelvic lymphadenopathy, and a lower ADC ratio were more likely to occur in hpIDC-P, and were also the most useful variables in both nomograms for predicting IDC-P and hpIDC-P.

Non-atrophic gastric mucosa is an independently associated factor for superficial non-ampullary duodenal epithelial tumors: a multicenter, matched, case-control study

  • Azusa Kawasaki;Kunihiro Tsuji;Noriya Uedo;Takashi Kanesaka;Hideaki Miyamoto;Ryosuke Gushima;Yosuke Minoda;Eikichi Ihara;Ryosuke Amano;Kenshi Yao;Yoshihide Naito;Hiroyuki Aoyagi;Takehiro Iwasaki;Kunihisa Uchita;Hisatomi Arima;Hisashi Doyama
    • Clinical Endoscopy
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    • 제56권1호
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    • pp.75-82
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    • 2023
  • Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.

Prognostic Value of an Immune Long Non-Coding RNA Signature in Liver Hepatocellular Carcinoma

  • Rui Kong;Nan Wang;Chun li Zhou;Jie Lu
    • Journal of Microbiology and Biotechnology
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    • 제34권4호
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    • pp.958-968
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    • 2024
  • In recent years, there has been a growing recognition of the important role that long non-coding RNAs (lncRNAs) play in the immunological process of hepatocellular carcinoma (LIHC). An increasing number of studies have shown that certain lncRNAs hold great potential as viable options for diagnosis and treatment in clinical practice. The primary objective of our investigation was to devise an immune lncRNA profile to explore the significance of immune-associated lncRNAs in the accurate diagnosis and prognosis of LIHC. Gene expression profiles of LIHC samples obtained from TCGA database were screened for immune-related genes. The optimal immune-related lncRNA signature was built via correlational analysis, univariate and multivariate Cox analysis. Then, the Kaplan-Meier plot, ROC curve, clinical analysis, gene set enrichment analysis, and principal component analysis were performed to evaluate the capability of the immune lncRNA signature as a prognostic indicator. Six long non-coding RNAs were identified via correlation analysis and Cox regression analysis considering their interactions with immune genes. Subsequently, tumor samples were categorized into two distinct risk groups based on different clinical outcomes. Stratification analysis indicated that the prognostic ability of this signature acted as an independent factor. The Kaplan-Meier method was employed to conduct survival analysis, results showed a significant difference between the two risk groups. The predictive performance of this signature was validated by principal component analysis (PCA). Additionally, data obtained from gene set enrichment analysis (GSEA) revealed several potential biological processes in which these biomarkers may be involved. To summarize, this study demonstrated that this six-lncRNA signature could be identified as a potential factor that can independently predict the prognosis of LIHC patients.

일부 농촌지역 주민에서 혈청 CA19-9 및 CA125 농도에 영향을 미치는 인자에 관한 연구 (Factors Related to Serum Level of Carbohydrate Antigen 19-9 and Cancer Antigen 125 in Healthy Rural Populations in Korea)

  • 이수근;유근영;박수경;강대희;김진규;정준기;이명철
    • 대한핵의학회지
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    • 제32권1호
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    • pp.71-80
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    • 1998
  • 우리 나라의 일부 지역 주민에서 혈청 CA19-9과 CA125 농도의 분포를 관찰함으로써 경계치 설정 이전에 미리 예비적 자료를 확보하고, 두 종양표지자의 측정치에 영향을 미치는 인자들, 특히 음주와 흡연 습관에 대한 통계적 유의성을 평가하기 위해 단시적 조사연구를 시도하였다. 1995년에 일부 농촌지역 성인 171명(남자 76명, 여자 95명)을 대상으로 하여 설문조사와 혈청 검사를 통해 개개인의 음주, 흡연습관 및 생식요인에 관한 정보 및 혈청 CA19-9 및 CA125 농도를 분석한 결과는 다음과 같다. 1) 혈청 CA19-9 농도의 평균 및 표준편차는 남녀 각각 $10.4{\pm}11.1{\mu}/ml$, $10.1{\pm}10.0{\mu}/ml$로 남녀간의 차이가 없었으나, 혈청 CA125 농도의 평균 및 표준편차는 각각 $2.5{\pm}12.2{\mu}/ml$, $11.2{\pm}7.4{\mu}/ml$로 여자에서 높았다. 한편 현재 임상적으로 적용되고 있는 양성판정치를 근거로 하여 판정한 혈청 CA19-9 및 CA125 양성률은 각각 2.9%, 1.8%이었으며, 각각 남녀간에 통계적으로 유의한 차이는 없었다. 2) 혈청 CA19-9 농도는 일일 흡연량(r=0.23, p=0.054) 및 총 흡연량(r=0.28, p=0.017)과 양의 상관관계를 보였으며, 성별로는 여자에서만 유의한 상관관계를 나타내었다(일일흡연량 r=0.59, p=.0.026 ; 총흡연량 r=0.74, p=0.003). 3) 혈청 CA125 농도는 흡연시작연령(r=0.51, p=0.000) 과는 양의 상관관계를, 총흡연기간(r=-0.23, p=0.051) 및 총흡연량(r=-0.23, p=0.057)과는 음의 상관관계를 보였는데, 성별로는 남자에서만 흡연시작연령(r=0.28, p=0.031)과 유의한 상관관계를 나타내었다. 4) 혈청 CA125 농도는 여자에서 연령(r=-0.20, p=0.058), 생리중단 연령(r=-0.28, p=0.030), 총수유기간(r=-0.29, p=0.014)과 음의 상관관계를 보였다. 5) 혈청 CA19-9 및 CA125 농도는 비만, 학력, 그리고 음주와 유의한 상관관계가 없었으며, 여자에서는 혈청 CA19-9 및 CA125 농도간에 양의 상관관계를 보였다(r=0.20, p=0.047). 6) 연령 및 비만의 교란효과를 통제하기 위한 중회귀분석 결과, 혈청 CA19-9 농도와 유의한 회귀관계를 보이는 변수는 없었다. 이에 비해 혈청 CA125 농도는 전체대상례에선 흡연시작연령이 빠르거나(p=0.000), 총 흡연기간이 길거나(p=0.001), 총흡연량이 많거나(p=0.020), 생리중단연령이 늦거나(p=0.035), 수유를 오래 할수록(p=0.050) 감소하는 것으로 나타났으나, 성별로 분석하였을 때 여자에서 흡연인자들의 유의한 회귀관계가 모두 소실되었다. 결론적으로, 혈청 CA19-9 농도는 흡연, 음주, 월경-출산관련 변수들에 의해 영향을 받는 않는 것으로 보여 실제 임상에 적용할 때 이들 변수를 고려하지 않고도 이용될 수 있는 비교적 안정된 종양표지자로 생각된다. 이에 비해 혈청 CA125 농도는 흡연량이 증가할수록 감소하는 경향을 보였으나 연령과 비만지수에 따라 흡연량이 교란영향을 받고 있는 지표임을 알 수 있었다. 한편, 여성에서는 폐경연령과 총수유기간이 유의한 관계를 보여 향후 정상치역 결정시 생리, 수유 등의 변수를 고려해야 할 것으로 사료된다.

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지방육종의 예후 인자: 52예 후향적 연구 (Prognostic Factors in Liposarcomas: A Retrospective Study of 52 Patients)

  • 정양국;강용구;박원종;이승구;이안희;박정미;김민우
    • 대한골관절종양학회지
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    • 제16권1호
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    • pp.14-20
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    • 2010
  • 목적: 지방육종의 국소재발과 원격전이 및 무병생존율에 영향을 미치는 예후인자들에 대해 알아보고자 하였다. 대상 및 방법: 1993년 이후 치료받은 52명의 지방육종 환자들을 대상으로 진단시 연령, 종양의 크기, 발생 부위, 조직학적 유형, 조직학적 악성도, 절제 유형, 수술적 절제연, 항암화학요법 및 방사선 치료가 국소재발, 원격 전이 그리고 무병생존율에 미치는 영향을 분석하였다. 평균 추시기간은 39개월이었고 통계적 분석에는 단일변수 및 다중변수 회귀분석을 이용하였다. 결과: 국소 재발이 11예(21.2%)에서 발생하였으며 원격전이는 4예(8%)에서 발생하였다. 지속적 무병생존율은 술 후 4년에 67%였다. 단일변수 분석에서 조직학적 악성도, 절제연, 항암화학요법, 방사선 치료가 국소재발과 관련이 있었으나(p<0.05) 다중변수 분석에서는 절제연과 항암화학요법, 방사선 치료가 불량한 예후인자로 나타났다. 종양이 체간에서 발생한 경우 통계적으로 유의하게 원격 전이율이 높았다(p<0.05). 무병생존율에 대한 단일변수 분석에서는 조직학적 악성도 및 항암화학요법이 유의한 차이를 보였으나(p<0.05) 다중변수 분석에서는 유의한 인자가 없었다. 결론: 선택오차를 고려할 때 절제연 양성이 국소재발의 불량한 예후인자였으며 종양이 체간에서 발생한 경우 원격 전이율이 높았다. 무병생존율과 관련하여서는 유의한 인자가 없었다.