• Journal of Korean Neurosurgical Society
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• v.49 no.1
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• pp.26-30
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• 2011

Objective: The primary objective of this study was to perform a retrospective evaluation of the radiological and pathological features influencing the formation of peritumoral brain edema (PTBE) in meningiomas. Methods: The magnetic resonance imaging (MRI) and pathology data for 86 patients with meningiomas, who underwent surgery at our institution between September 2003 and March 2009, were examined. We evaluated predictive factors related to peritumoral edema including gender, tumor volume, shape of tumor margin, presence of arachnoid plane, the signal intensity (SI) of the tumor in T2-weighted image (T2WI), the WHO histological classification (GI, GII/GIII) and the Ki-67 antigen labeling index (LI). The edema-tumor volume ratio was calculated as the edema index (EI) and was used to evaluate peritumoral edema. Results: Gender (p=0.809) and pathological finding (p=0.084) were not statistically significantly associated with peritumoral edema by univariate analysis. Tumor volume was not correlated with the volume of peritumoral edema. By univariate analysis, three radiological features, and one pathological finding, were associated with PTBE of statistical significance: shape of tumor margin (p=0.001), presence of arachnoid plane (p=0.001), high SI of tumor in T2WI (p=0.001), and Ki-67 antigen LI (p=0.049). These results suggest that irregular tumor margins, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI can be important predictive factors that influence the formation of peritumoral edema in meningiomas. By multivariate analysis, only SI of the tumor in T2WI was statistically significantly associated with peritumoral edema. Conclusion: Results of this study indicate that irregular tumor margin, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI may be important predictive factors influencing the formation of peritumoral edema in meningiomas.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7497-7500
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• 2013

Background: This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patients in University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms. Materials and Methods: The clinical characteristics, presenting symptoms and survival of RCC patients (n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flank pain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia and thrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic significance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis. Results: The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantly correlated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally, symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74). All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariate Cox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal mass remained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, $9.5{\pm}4.3cm$, was larger than non palpable masses, $5.3{\pm}2.7cm$ (p<0.001). Conclusions: This is the first report which includes survival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass were independent predictors for survival. Further investigations using a multicentre cohort to analyse mortality and survival rates may aid in improving management of these patients.

• Journal of Korean Neurosurgical Society
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• v.44 no.6
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• pp.358-363
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• 2008

Objective : This study was performed to assess the efficacy of GKS in patients with ten or more brain metastases. Methods : From Aug 2002 to Dec 2007, twenty-six patients (13 men and 13 women) with ten or more cerebral metastatic lesions underwent GKS. The mean age was 55 years (32-80). All patients had Karnofsky performance status (KPS) score of 70 or better. According to recursive partitioning analysis (RPA) classification, 3 patients belonged to class I and 23 to class II. The location of primary tumor was lung (21), breast (3) and unknown (2). The mean number of the lesions per patient was 16.6 (10-37). The mean cumulated volume was 10.9 cc (1.0-42.2). The median marginal dose was 15 Gy (9-23). Overall survival and the prognostic factors for the survival were retrospectively analyzed by using Kaplan Meier method and univariate analysis. Results : Overall median survival from GKS was 34 weeks (8-199). Local control was possible for 79.5% of the lesions and control of all the lesions was possible in at least 14 patients (53.8%) until 6 months after GKS. New lesions appeared in 7 (26.9%) patients during the same period. At the last follow-up, 18 patients died; 6 (33.3%) from systemic causes, 10 (55.6%) from neurological causes, and 2 (11.1 %) from unknown causes. Synchronous onset in non-small cell lung cancer (p=0.007), high KPS score (${\geq}80$, p=0.029), and controlled primary disease (p=0.020) were favorable prognostic factors in univariate analysis. Conclusion : In carefully selected patients, GKS may be a treatment option for ten or more brain metastases.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.3
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• pp.1629-1633
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• 2013

Background: Gene set analysis (GSA) incorporates biological with statistical knowledge to identify gene sets which are differentially expressed that between two or more phenotypes. Materials and Methods: In this paper gene sets differentially expressed between acute lymphoblastic leukaemia (ALL) with BCR-ABL and those with no observed cytogenetic abnormalities were determined by GSA methods. The BCR-ABL is an abnormal gene found in some people with ALL. Results: The results of two GSAs showed that the Category test identified 30 gene sets differentially expressed between two phenotypes, while the Hotelling's $T^2$ could discover just 19 gene sets. On the other hand, assessment of common genes among significant gene sets showed that there were high agreement between the results of GSA and the findings of biologists. In addition, the performance of these methods was compared by simulated and ALL data. Conclusions: The results on simulated data indicated decrease in the type I error rate and increase the power in multivariate (Hotelling's $T^2$) test as increasing the correlation between gene pairs in contrast to the univariate (Category) test.

• Journal of Gastric Cancer
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• v.13 no.2
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• pp.111-116
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• 2013

Purpose: Chronic inflammation induces cancer and cancer induces local tissue damage with systemic inflammation. Therefore, the aim of this study is to investigate the potential relationship between the severity of inflammation and prognosis in cancer patients. Materials and Methods: This study enrolled 220 patients from January 2002 to December 2006 who underwent gastric surgery. We evaluated the relationship between preoperative inflammatory parameters (erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio) and other clinicopathological factors. Survival outcomes were compared according to the extent of inflammation. Results: Significant elevation of erythrocyte sedimentation rate was related with old age, increased neutrophil-to-lymphocyte ratio, decreased hemoglobin, increased carcinoembryonic antigen, increased tumor size and advanced TNM stage. Neutrophil-to-lymphocyte ratio was significantly correlated with old age, increased erythrocyte sedimentation rate and advanced TNM stage. In the univariate analysis, elevated erythrocyte sedimentation rate and increased neutrophil-to-lymphocyte ratio had significantly poorer survival than those without elevation (all P<0.05). However, the multivariate analysis failed to prove erythrocyte sedimentation rate and neutrophil-tolymphocyte ratio as independent prognostic factors. Conclusions: The elevation of erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio were correlated with poor prognosis in the univariate analysis and there was a strong correlation between inflammatory parameters (erythrocyte sedimentation rate and neutrophil- to-lymphocyte ratio) and tumor progression. Thus, erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio are considered useful as follow-up factors.

• Safety and Health at Work
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• v.8 no.2
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• pp.162-168
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• 2017

Background: Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF. Methods: During the years 2003-2012, 282 injured individuals aged 20-55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment. Results: Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626-25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092-6.720) were identified as independent predictive factors of full RTW. Conclusion: PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.4
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• pp.208-215
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• 1999

The purpose of this study was to identify the independent clinicopathologic prognostic factors of soft tissue sarcoma affecting local recurrence, metastasis and survival. Retrospectively collected data from 130 patients with soft tissue sarcoma were analyzed. Patient, tumor and pathologic factors were analyzed by univariate and multivariate methods for the endpoints of local recurrence, metastasis and survival. In univariate analysis, wide surgical margin, adjuvant radiotherapy and age younger than 40 years reduced local recurrence. Tumor size larger than 5cm was related with a higher rate of metastasis. Patients with metastasis at initial presentation and with a large tumor size had a low survival rate. In multivariate analysis, adjuvant radiotherapy and young age were significantly correlated with a low local recurrence rate. In conclusion, patients with metastasis at initial presentation and a large tumor size had a reduced survival rate. Independent adverse prognostic factors for local recurrence were old age and not undergoing adjuvant therapy.

• The Journal of the Korean bone and joint tumor society
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• v.3 no.1
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• pp.1-8
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• 1997

Osteosarcoma is the most common primary bony malignancy and its survivorship has been progressed markedly through refined chemotherapy and surgery. But still there are many non-responders and analysis of prognostic factors may be helpful for them. Two hundred and sixty-six patients were enlisted between Mar, 1985 and Sep. 1994. Among them our inclusion criteria were: 1)primary, nonmetastatic classical osteosarcoma 2)extremity in location 3)no prior treatment at other institute and completed neoadjuvant chemotherapy and surgery according to our protocol. One hundred and eleven cases were eligible. Analyzed factors were:age, sex, location, tumor size, and pathologic response. Statistical methods were log-rank test for univariate and Cox's test for multivariate analysis. Male to female ratio was 69:42 with an average age of 17.2 years. Locations of tumor were distal femur 59, proximal tibia 29, and proximal humerus 8. Tumor size were measured by its maximal diameter and 48 cases were above 10cm and 47 cases were below 10cm. For pathologic response, 57 cases showed more than 90% and 54 cases were less than that. Limb salvage procedure was 101 cases and amputation was 10 cases and their local recurrence rate were 3.6%. Average follow-up period was 24(9-78.2) months and their final status was CDF 86, AWD 8, NED 5, and DOD 12 cases. In univariate study: type of operation(p=0.005), tumor size(p=0.005), and pathologic response(p=0.02) were significant variables. Pathologic response(p=0.03) and type of operation(p=0.01) were meaningful prognostic factors on multivariate analysis. But the latter result was interpreted as a bias, so pathologic response remained as a sole meaningful prognostic factor. More aggressive chemotherapy will be needed to improve the survival.

• Advances in pediatric surgery
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• v.20 no.1
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• pp.17-22
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• 2014

The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (<6 vs ${\geq}12$ months) (OR 4.713, 95% CI 1.198~18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846~11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (${\geq}48$ hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3801-3804
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• 2014

Background: The prognostic significance of the neutrophil-to-lymphocyte ratio for progression free survival in patients with metastatic renal cell carcinoma is unclear. Materials and Methods: We retrospectively reviewed 45 patients diagnosed with metastatic RCC previously treated with tyrosine kinase inhibitors from two centers, Akdeniz University Hospital and Afyon Kocatepe University. The prognostic value of the pretreatment neutrophil-tolymphocyte ratio, and other clinical and laboratory parameters were assessed by univariate and multivariate analysis. Results: Median progression free survival (PFS) was 13.9 months [95% CI for HR (6.88-20.91)] and overall survival figure of 16.6 months [95% CI for HR (7.23-26.03)] Univariate analysis revealed that PFS was significantly affected by hemoglobin level [p=0.013 (95% CI for HR (0.71-0.96))], eosinophil count [p=0.031 (95% CI for HR (0.20-0.92))], ratio of neutrophil lymphocytes (NLR) [p=0.007 (95% CI for HR (1.47-11.74))] and calcium level [p=0.006 (95% CI for HR (0.15-0.73))]. However, only NLR [p=0.031 (95% CI for HR (1.15-18.1))] and calcium levels [p=0.018 (95% CI for HR (0.20-18.1))] retained significance with multivariate analysis. Median PFS was 23.9 vs 8.6 months in patients with NLR ${\leq}2$ vs NLR >2 (Log rank; p= 0.040). Conclusions: This study showed that increased pretreatment NLR is an independent prognostic factor for patients with metastatic RCC using tyrosine kinase inhibitors.