Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2014

Breast Cancer Epidemiology of the Working-Age Female Population Reveals Significant Implications for the South Korean Economy

In this study, we aimed to evaluate the economic loss due to the diagnosis of breast cancer within the female South Korean working-age population. A population-based cost analysis was performed for cancer-related diagnoses between 1999 and 2014, using respective public government funded databases. Among the five most common cancers, breast cancer mortality was strongly associated with the growth in gross domestic product between 1999 and 2014 (R=0.98). In the female population, breast cancer represented the greatest productivity loss among all cancers, which was a consequence of the peak in the incidence of breast cancer during mid-working age in the working-age population, in addition to being the most common and fastest growing cancer among South Korean women. Our study shows that breast cancer not only represents a significant disease burden for individual patients, but also contributes a real, nonnegligible loss in productivity in the South Korean economy.

Prediction of Cancer Incidence and Mortality in Korea, 2018

PURPOSE

This study aimed to report on cancer incidence and mortality for the year 2018 to estimate Korea's current cancer burden.

MATERIALS AND METHODS

Cancer incidence data from 1999 to 2015 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2016 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against observed years, then multiplying the projected age-specific rates by the age-specific population. The Joinpoint regression model was used to determine at which year the linear trend changed significantly, we only used the data of the latest trend.

RESULTS

A total of 204,909 new cancer cases and 82,155 cancer deaths are expected to occur in Korea in 2018. The most common cancer sites were lung, followed by stomach, colorectal, breast and liver. These five cancers represent half of the overall burden of cancer in Korea. For mortality, the most common sites were lung cancer, followed by liver, colorectal, stomach and pancreas.

CONCLUSION

The incidence rate of all cancer in Korea are estimated to decrease gradually, mainly due to decrease of thyroid cancer. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluation of cancer-control programs.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2015

Purpose

This study presents the 2015 nationwide cancer statistics in Korea, including the incidence, survival, prevalence, and mortality.

Materials and Methods

Cancer incidence data from 1999 to 2015 was obtained from the Korea National Cancer Incidence Database and followed until December 31, 2016. Mortality data from 1983 to 2015 were obtained from Statistics Korea. The prevalence was defined as the number of cancer patients alive on January 1, 2016, among all cancer patients diagnosed since 1999. Crude and age-standardized rates (ASRs) for incidence, mortality and prevalence and 5-year relative survivals were also calculated.

Results

Herein, 214,701 and 76,855 Koreans were newly diagnosed and died from cancer in 2015, respectively. The ASRs for cancer incidence and mortality in 2015 were 258.9 and 82.0 per 100,000, respectively. The overall cancer incidence rate has increased significantly by 3.4% annually from 1999 to 2012, and started to decrease after 2012 (2012-2015, annual percent change, –6.1%). However, the overall cancer mortality has decreased 2.7% annually since 2002. The 5-year relative survival rate for patients diagnosed with cancer between 2011 and 2015 was 70.7%, an improvement from the 41.2% for patients diagnosed between 1993 and 1995.

Conclusion

Age-standardized cancer incidence rates have decreased since 2012 and mortality rates have declined since 2002; however, the 5-year survival rates have improved remarkably from 1993-1995 to 2011-2015 in Korea.

Randomized Phase III Trial of Irinotecan Plus Cisplatin versus Etoposide Plus Cisplatin in Chemotherapy-Naïve Korean Patients with Extensive-Disease Small Cell Lung Cancer

Purpose

This randomized phase III study was designed to compare the efficacy and safety of irinotecan plus cisplatin (IP) over etoposide plus cisplatin (EP) in Korean patients with extensive-disease small-cell lung cancer (SCLC).

Materials and Methods

Patients were randomly assigned to receive IP, composed of irinotecan 65 mg/m² intravenously on days 1 and 8+cisplatin 70 mg/m² intravenously on day 1 every 3 weeks, or EP, composed of etoposide 100 mg/m² intravenously on days 1, 2, 3+cisplatin 70 mg/m² intravenously on day 1, every 3 weeks for a maximum of six cycles, until disease progression, or until unacceptable toxicity occurred. The primary endpoint was overall survival.

Results

A total of 362 patients were randomized to IP (n=173) and EP (n=189) arms. There were no significant differences between IP and EP arms for the median overall survival (10.9 months vs. 10.3 months, p=0.120) and the median progression-free survival (6.5 months vs. 5.8 months, p=0.115). However, there was a significant difference in response rate (62.4% vs. 48.2%, p=0.006). The pre-planned subgroup analyses showed that IP was associated with longer overall survival in male (11.3 months vs. 10.1 months, p=0.036), < 65 years old (12.7 months vs. 11.3 months, p=0.024), and Eastern Cooperative Oncology Group performance status 0/1 (12.4 months vs. 10.9 months, p=0.040) patient groups. The severity of treatment-related adverse events such as grade 3/4 anemia, nausea and diarrhea was more frequent in patients treated with IP.

Conclusion

The IP chemotherapy did not significantly improve the survival compared with EP chemotherapy in Korean patients with extensive-disease SCLC.

Afatinib in heavily pretreated advanced NSCLC patients who progressed following prior gefitinib or erlotinib: Compassionate use program in Korea

INTRODUCTION

Afatinib, an irreversible ErbB family blocker, approved for first-line treatment of epidermal growth factor receptor (EGFR) mutated advanced non-small cell lung cancer (NSCLC). This study investigated experience of afatinib within a compassionate use program (CUP).

METHODS

The afatinib CUP was an open-label, multicenter, single-arm program in Korea. We enrolled patients with stage IV NSCLC and who had received at least one line of previous cytotoxic chemotherapy and previous EGFR TKI treatment with either an EGFR mutation or documented clinical benefit. The starting dose of afatinib was 50 mg once daily.

RESULTS

From August 2011 to September 2014, 332 patients received at least one dose of afatinib. Most patients were registered in the CUP for fourth- or fifth-line treatment with afatinib. Adverse events (AEs) occurred in 98.1% of patients, including 29.8% with serious AEs. The most common AEs (all grades) were diarrhea (90.1%) and skin rash (62.0%). Dose reductions occurred in 60.5% of patients and discontinuations due to AEs were reported in 11.1% of patients. The response rate and median time to treatment failure (TTF) were 27.4% and 3.3 months (CI 95%, 2.8-3.8 months), respectively, in this highly pretreated population. In subgroup analysis, ECOG PS 0 or 1 and immediate pretreatment with pemetrexed monotherapy or a platinum doublet were associated with a longer TTF for afatinib.

CONCLUSIONS

No additional or unexpected safety concerns were observed, and afatinib demonstrated moderate antitumor activity in advanced NSCLC patients with acquired resistance to gefitinib or erlotinib in a real-world setting.

Comparison of the short-term outcomes of reduced-port laparoscopic surgery and conventional multiport surgery in colon cancer: a propensity score matching analysis

Purpose

The feasibility of reduced-port laparoscopic surgery (RPS) in colon cancer remains uncertain. This study aimed to compare the short-term outcomes of RPS and multiport surgery (MPS) in colon cancer using propensity score matching analysis.

Methods

A total of 302 patients with colon cancer who underwent laparoscopic anterior resection (AR) (n = 184) or right hemicolectomy (RHC) (n = 118) by a single surgeon between January 2011 and January 2017 were included. Short-term outcomes were compared between RPS and MPS.

Results

Seventy-three patients in the AR group and 23 in the RHC group underwent RPS. After propensity score matching, the RPS and MPS groups showed similar baseline characteristics. In the AR group, patients who underwent RPS (n = 72) showed a shorter operation time (114.4 ± 28.7 minutes vs. 126.7 ± 34.5 minutes, P = 0.021) and a longer time to gas passage (3.6 ± 1.7 days vs. 2.6 ± 1.5 days, P = 0.005) than MPS (n = 72). Similarly, in the RHC group, the operation time was shorter (112.6 ± 26.0 minutes vs. 146.5 ± 31.2 minutes, P = 0.005), and the time to first flatus was longer (2.7 ±1.1 days vs. 3.8 ± 1.3 days, P = 0.004) in the RPS group (n = 23) than in the MPS group (n = 23). Other short-term outcomes were similar for RPS and MPS in both the AR and RHC groups.

Conclusion

The short-term outcomes of RPS were found to be acceptable compared to those of MPS in colon cancer surgery.

Forty-nine gastric cancer cell lines with integrative genomic profiling for development of c-MET inhibitor

Receptor tyrosine kinase MET (c-MET) has received considerable attention as a potential target for gastric cancer (GC) therapy and a number of c-MET inhibitors have been developed. For successful drug development, proper preclinical studies especially using patient derived cancer cell lines are very important. We profiled MET and MET-related characteristics in 49 GC cell lines to utilize them as models in preclinical studies of GC. Forty-nine cell lines were analyzed for genetic, biological, and molecular status to characterize MET and MET-related molecules. Four c-MET inhibitors were tested to elucidate the dependency on MET pathway in the 49 GC cell lines. Six of 49 cell lines were MET amplified with overexpression of c-MET and p-MET. The variants of MET were not associated with c-MET expression or amplification. Hs746T showed an exon 14 deletion in conjunction with MET amplification. The cell lines were divided into 6 MET amplified, 2 c-MET overexpressed, 2 hepatocyte growth factor (HGF) overexpressed, and 39 MET-negative subgroups. Except tivantinib, the c-MET inhibitors showed higher inhibition (%) in MET amplified than in MET nonamplified cell lines that MET amplified cell lines showed MET pathway dependency. However, the c-MET overexpressed and HGF overexpressed cell lines showed moderate dependency on MET pathway. Well-characterized cell lines are very important in studying drug development. Our 49 GC cell lines had various characteristics of MET and MET-related molecules and MET pathway dependency. These provide a promising platform for development of various RTK inhibitors including c-MET inhibitors.

The Correlation Between Serum Chemokines and Clinical Outcome in Patients with Advanced Biliary Tract Cancer

BACKGROUND

Biliary tract cancers (BTCs) are known to have a dismal prognosis. A number of chemokines play important roles in the progress of BTCs. However, the serum levels of chemokines in BTCs have not yet been explored.

METHODS

The sera of healthy donors (n = 8) and patients with BTCs who were enrolled in second line sunitinib trials (n = 27) were collected. The concentrations of three kinds of chemokines (CXCL5, CXCL8 and CXCL12) were measured using ELISA assay. The median concentrations of chemokines were compared between healthy donors and BTC patients and the role of chemokines as a prognostic biomarker was examined.

RESULTS

BTC patients generally had higher serum levels of CXCL5 and CXCL12 compared to healthy donors. Patients with cholangiocarcinoma showed significantly higher levels of serum CXCL12 than patients with gallbladder cancer. In survival analysis, only CXCL12 level showed a prognostic impact on overall survival (median OS: 6.9 vs. 0.9 months in low CXCL12 vs. high CXCL12, respectively; P = .008). High CXCL5 levels were also correlated with poor survival without statistical insignificance (median OS: 6.2 vs. 2.0 months in low CXCL5 vs. high CXCL5, respectively; P = .070).

CONCLUSIONS

There was a significant difference in OS according to the level of CXCL12, suggesting that serum CXCL12 levels may be a useful surrogate marker for clinical outcome in advanced BTCs.

Galanin is an epigenetically silenced tumor suppressor gene in gastric cancer cells

Galanin is a 30 amino-acid active neuropeptide that acts via three G-protein coupled galanin receptors, GALR1, GALR2 and GALR3. Recently, GALR1 was also suggested as a tumor suppressor gene that was frequently silenced in head and neck squamous cell carcinoma; moreover, galanin and GALR1 were reported to inhibit human oral cancer cell proliferation. However, the exact role of galanin in gastric cancer is unclear. Here, we describe the epigenetic silencing of galanin in human gastric cancer. Five gastric cancer cell lines (SNU-1, SNU-601, SNU-638, KATOIII, and AGS) showed a significant reduction in galanin expression that was restored by the demethylating agent 5-aza-2'-deoxycytidine. We confirmed the hypermethylation of CpG islands in the galanin promoter region by methylation-specific and bisulfate sequencing polymerase chain reaction (PCR). Interestingly, hypermethylated galanin did not affect galanin receptor expression. Exogenous galanin expression in silenced cells induced apoptosis and decreased phosphorylated Akt expression. Taken together, these data suggest that galanin hypermethylation impairs its tumor suppressor function in gastric cancer carcinogenesis.

A national survey of lung cancer specialists' views on low-dose CT screening for lung cancer in Korea

Lung cancer specialists play an important role in designing and implementing lung cancer screening. We aimed to describe their 1) attitudes toward low-dose lung computed tomography (LDCT) screening, 2) current practices and experiences of LDCT screening and 3) attitudes and opinions towards national lung cancer screening program (NLCSP). We conducted a national web-based survey of pulmonologists, thoracic surgeons, medical oncologists, and radiological oncologists who are members of Korean Association for Lung Cancer (N = 183). Almost all respondents agreed that LDCT screening increases early detection (100%), improves survival (95.1%), and gives a good smoking cessation counseling opportunity (88.6%). Most were concerned about its high false positive results (79.8%) and the subsequent negative effects. Less than half were concerned about radiation hazard (37.2%). Overall, most (89.1%) believed that the benefits outweigh the risks and harms. Most (79.2%) stated that they proactively recommend LDCT screening to those who are eligible for the current guidelines, but the screening propensity varied considerably. The majority (77.6%) agreed with the idea of NLCSP and its beneficial effect, but had concerns about the quality control of CT devices (74.9%), quality assurance of radiologic interpretation (63.3%), poor access to LDCT (56.3%), and difficulties in selecting eligible population using self-report history (66.7%). Most (79.2%) thought that program need to be funded by a specialized fund rather than by the National Health Insurance. The opinions on the level of copayment for screening varied. Our findings would be an important source for health policy decision when considering for NLCSP in Korea.

Sequential spinal and intracranial dural metastases in gastric adenocarcinoma: A case report

Dural metastasis from primary gastric adenocarcinoma has been rarely reported, and its prognosis is very poor because it frequently leads to acute subdural hematoma. Here, we describe a case with sequential spinal and cranial dural metastases from gastric adenocarcinoma without subdural hematoma. A 43-year-old woman with gastric adenocarcinoma and well-controlled peritoneal carcinomatosis presented with back pain, right radiating leg pain, left facial palsy, and hearing loss. Magnetic resonance imaging of the spine and brain revealed dural masses at the lumbosacral junction with invasion to the L5 and S1 nerve roots and at the skull base with invasion to the internal auditory canal. She was treated with local radiotherapy, and her pain and neurologic symptoms improved after palliative radiotherapy. This is the first reported case of dural metastases of gastric adenocarcinoma of the spine and skull base but with a relatively indolent course and without subdural hematoma.

Budget Impact of the Accreditation Program for Clinical Laboratories on Colorectal Cancer Screening via Fecal Immunochemical Testing: Results from the National Cancer Screening Program in Korea

Background

False-positive fecal immunochemical test (FIT) results in the National Cancer Screening Program (NCSP) for colorectal cancer may lead to unnecessary procedures, such as colonoscopies, increasing the medical costs. We estimated reductions in the cost of National Health Insurance according to the accreditation status of screening facilities participating in the NCSP for colorectal cancer.

Methods

We used data collected between 2007 and 2010 from NCSP and the Korea Central Cancer Registry to identify patients with colorectal cancer. We also ascertained the history of the accreditation of each facility by the Korean Laboratory Accreditation Program (KLAP). Budget impact was defined as a reduction in medical costs achieved when the false-positive rate of the non-accredited facilities decreased relative to that of the accredited facilities.

Results

A total of 3,285 screening facilities participated in the NCSP. Of these, 196 were accredited by the KLAP. The false-positive rate of the accredited facilities was 2.47%, and that of the non-accredited facilities was 6.83%. Medical costs were estimated to be reduced by approximately 19 million US dollars (USD), and the cost of detecting one case of colorectal cancer was estimated to decrease from 9,212 USD to 7,332 USD if the false-positive rate of non-accredited facilities were decreased to that of the accredited facilities. Clinics were estimated to have the largest associated cost reduction.

Conclusions

Quality assurance in clinical laboratories could lower false-positive rates and prevent the use of unnecessary procedures, ensuring patient safety and increasing the cost-effectiveness of FIT screening in the NCSP for colorectal cancer.

Changes in Clinical Characteristics of Patients with an Initial Diagnosis of Prostate Cancer in Korea: 10-Year Trends Reported by a Tertiary Center

BACKGROUND

The Korea Central Cancer Registry reported that incidence rates of prostate cancer have not increased continuously. We used recent trends in the incidence of prostate cancer to generate a preliminary report of the Korean population with prostate cancer.

METHODS

Patients initially diagnosed with prostate cancer by prostate biopsy from 2006 to 2015 at our tertiary center were selected. All patients were categorized according to age (< 65, 65-75, > 75 years), time period (2006-2010 vs. 2011-2015), and risk classification. Patients with insufficient data were excluded from the analysis.

RESULTS

Of 675 patients (median prostate-specific antigen [PSA], 9.09 ng/mL), those with a Gleason score (GS) of 6 (32.3%) comprised the largest proportion in our cohort. The proportion with a GS of 8 increased for those aged 65-75 years, despite the lack of increase in PSA. Treatment patterns changed for those with very low to low risk cancer. The overall survival (OS) rate and the cancer-specific survival (CSS) rate for all patients at 5 years were 87% and 90%, respectively. Patients with a low body mass index (BMI; ≤ 23 kg/m²) had worse median OS and CSS rates.

CONCLUSION

Significant differences in risk classifications and initial treatments were found between 2006-2010 and 2011-2015. Although PSA did not change, the GS did change. Lower BMI (≤ 23 kg/m²) had worse effects on OS and CSS rates for Korean prostate cancer patients.

Psychiatric comorbidities among ovarian cancer survivors in South Korea: A nationwide population-based, longitudinal study

PURPOSE

The aim of this time-dependent study was to analyze the prevalence of mental disorders in ovarian cancer survivors using claims data in South Korea.

MATERIALS AND METHODS

We confirmed mental disorders in a nationwide cohort of 9763 patients who were diagnosed with ovarian cancer between January 1, 2010 and December 31, 2014. We categorized the prevalence of mental disorders based on the age and the time of diagnosis.

RESULTS

A total of 821 ovarian cancer patients were diagnosed with a mental disorder, 1 year prior to the cancer diagnosis. Of those patients, 311 were diagnosed with depression (37.9%) and 245 with anxiety (29.8%) during their first visit. The overall frequency of mental disorders peaked within 2 months after the cancer diagnosis. The highest rate of increase after diagnosis was noted in stress reaction/adjustment disorders. While depression was relatively high (40.4%) in the younger age group under 60 years, anxiety was higher (39.4%) in the elderly group over 60 years old. Age was a significant predictive factor for mental disorders (P = 0.002), and patients over 50 years were at a higher risk for mental disorders (hazard ratio: 1.29, P = 0.002).

CONCLUSION

Mental disorders in ovarian cancer survivors showed different patterns of prevalence depending on age at the time of diagnosis and the nature of disease. Timely diagnosis and intervention for psychological distress could increase the quality of life for ovarian cancer survivors.

Interaction between physical activity, PITX1 rs647161 genetic polymorphism and colorectal cancer risk in a Korean population: a case-control study

This study assessed the interaction between physical activity and colorectal cancer (CRC) risk based on a polymorphism in the paired-like homeodomain 1 (PITX1) gene in Koreans. In total, 923 cases and 1,846 controls were enrolled at the National Cancer Center, Korea. Subjects who did regular exercise showed a significantly reduced risk of CRC than those did not exercise regularly (OR = 0.37, 95% CI = 0.30-0.45). Subjects in the highest tertile of metabolic equivalents of task (MET)-minutes per week showed a significantly lower risk of CRC (OR = 0.62, 95% CI = 0.48-0.79, p-trend < 0.001). In the dominant model, minor allele carriers showed a significantly higher risk of CRC than subjects homozygous for the major allele (OR = 1.46, 95% CI = 1.18-1.80). The PITX1 genetic variant showed significant interactions with regular exercise and CRC risk (p-interaction = 0.018) and colon cancer risk (p-interaction = 0.029) among all subjects. Subjects who carried at least one minor allele and did not regularly exercise showed a greater risk of CRC (OR = 1.81, 95% CI = 1.37-2.41). Subjects who were homozygous for the major allele with high physical activity showed a significantly reduced risk of CRC (OR = 0.56, 95% CI = 0.38-0.82). Thus, individuals with PITX1 genetic variants can have benefit from physical activity regarding prevention of CRC risk in a Korean population.

Prognostic Implications of Multiplex Detection of KRAS Mutations in Cell-Free DNA from Patients with Pancreatic Ductal Adenocarcinoma

BACKGROUND

Cell-free DNA (cfDNA) is known to provide potential biomarkers for predicting clinical outcome, but its value in pancreatic ductal adenocarcinoma (PDAC) has not been fully evaluated. The aim of this study was to evaluate the clinical applicability of quantitative analysis of multiplex KRAS mutations in cell-free DNA from patients with PDAC.

METHODS

A total of 106 patients with PDAC were enrolled in this prospective study. The concentration and fraction of KRAS mutations were determined through multiplex detection of KRAS mutations in plasma samples by use of a droplet digital PCR kit (Bio-Rad).

RESULTS

KRAS mutations were detected in 96.1% of tissue samples. Eighty patients (80.5%) harbored KRAS mutations in cfDNA, with a median KRAS mutation concentration of 0.165 copies/μL and a median fractional abundance of 0.415%. Multivariable analyses demonstrated that the KRAS mutation concentration [hazard ratio (HR), 2.08; 95% CI, 1.20-3.63] and KRAS fraction (HR, 1.73; 95% CI, 1.02-2.95) were significant factors for progression-free survival. KRAS mutation concentration (HR, 1.97; 95% CI, 1.05-3.67) also had prognostic implications for overall survival. Subgroup analyses showed that KRAS mutation concentration and fractional abundance significantly affected progression-free survival in resectable PDAC (P = 0.016). Moreover, when combined with the cancer biomarker CA19-9, the KRAS mutation concentration in cfDNA showed additive benefits for the prediction of overall survival.

CONCLUSIONS

This study demonstrates that multiplex detection of KRAS mutations in plasma cfDNA is clinically relevant, providing a potential candidate biomarker for prognosis of PDAC.

Phase II Study of Dovitinib in Patients with Castration-Resistant Prostate Cancer (KCSG-GU11-05)

Purpose

Fibroblast growth factor (FGF) signals are important in carcinogenesis and progression of prostate cancer. Dovitinib is an oral, pan-class inhibitor of vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor, and fibroblast growth factor receptor (FGFR). We evaluated the efficacy and toxicity of dovitinib in men with metastatic castration resistant prostate cancer (mCRPC).

Materials and Methods

This study was a single-arm, phase II, open-label, multicenter trial of dovitinib 500 mg/day (5-days-on/2-days-off schedule). The primary endpoint was 16-week progression-free survival (PFS). Secondary endpoints were overall survival (OS), toxicity and prostate-specific antigen (PSA) response rate. Biomarker analyses for VEGFR2, FGF23, and FGFR2 using multiplex enzyme-linked immunosorbent assay was performed.

Results

Forty-four men were accrued from 11 hospitals. Eighty percent were post-docetaxel. Median PSA was 100 ng/dL, median age was 69, 82% had bone metastases, and 23% had liver metastases. Median cycles of dovitinib was 2 (range, 0 to 33). Median PFS was 3.67 months (95% confidence interval [CI], 1.36 to 5.98) and median OS was 13.70 months (95% CI, 0 to 27.41). Chemotherapy-naïve patients had longer PFS (17.90 months; 95% CI, 9.23 to 28.57) compared with docetaxel-treated patients (2.07 months; 95% CI, 1.73 to 2.41; p=0.001) and the patients with high serum VEGFR2 level over median level (7,800 pg/mL) showed longer PFS compared with others (6.03 months [95% CI, 4.26 to 7.80] vs. 1.97 months [95% CI, 1.79 to 2.15], p=0.023). Grade 3 related adverse events were seen in 40.9% of patients. Grade 1-2 nausea, diarrhea, fatigue, anorexia, and all grade thrombocytopenia are common.

Conclusion

Dovitinib showed modest antitumor activity with manageable toxicities in men with mCRPC. Especially, patients who were chemo-naïve benefitted from dovitinib.

Insulin Resistance Associated With Differentiated Thyroid Carcinoma: Penalized Conditional Logistic Regression Analysis of a Matched Case-Control Study Data

BACKGROUND

In the recent years, thyroid cancer incidence has increased worldwide. It has been questioned whether factors, such as insulin resistance, are involved in this rise. The main aim of this study was to examine the association between insulin resistance and differentiated thyroid cancer.

METHODS

This case-control study was performed on 30 newly diagnosed patients with differentiated thyroid cancer and 30 healthy controls. Thirty euthyroid patients recently diagnosed with differentiated thyroid cancer, based on the fine needle aspiration cytology, were examined for insulin resistance before thyroidectomy in the euthyroid state. For each patient in the case group, one healthy euthyroid individual without thyroid nodule from general population was matched based on gender, age (± 1 year), and body mass index (BMI) (± 1). Thyroid function test, thyroid antibodies, serum glucose, serum insulin, and thyroid ultrasonography was performed for all participants. Insulin resistance was defined based on homeostasis model assessment of insulin resistance (HOMA-IR) to be more than 2.5.

RESULTS

In the patient group, 24 (80%) cases were female and 6 (20%) were male. Insulin resistance was more prevalent in the case group than the control group (43.3% versus 13.3%). Insulin sensitivity index was lower in the case group than in the control group (50 and 81, respectively). There was a significant positive association between serum HOMA-IR levels and differentiated thyroid cancer (OR: 2.43 for 1 unit increase in HOMA-IR, 95% CI: 1.35 - 5.51; P = 0.001). Insulin resistance was significantly associated with differentiated thyroid cancer (OR: 4, 95 % CI: 1.27 - 17.6; P = 0.016).

CONCLUSIONS

There was a significant association between insulin resistance and differentiated thyroid carcinoma. More research with a larger sample size and prospective design are needed to determine the role of this factor in the development of differentiated thyroid cancers.

Vitamin D Deficiency Associated with Differentiated Thyroid Carcinoma: A Case- Control Study

Objective:

In recent decades, the incidence of thyroid cancer has increased throughout the world. It is unclear whether factors such as vitamin D deficiency may have been involved in this increase. The present case-control study was conducted to examine any association between Vitamin D deficiency and thyroid cancers.

Methods:

The study was conducted on 85 patients with differentiated thyroid cancer diagnosed based on fine needle aspiration biopsy as the case group and 85 healthy controls. Serum levels of vitamin D were evaluated before thyroidectomy. For each patient in the case group, one healthy euthyroid person without any thyroid nodules from the general population matched based on season, sex, age (± 1 year) and BMI (± 1) was selected. Finally, 85 pairs were obtained considering inclusion and exclusion criteria. Thyroid function, thyroid antibodies and serum vitamin D were assessed and thyroid sonography was performed in all participants.

Results:

In the patient group, 72 (85%) were female and 13 (15%) were male. The mean (SD) serum vitamin D level was 8.00 (±3.7) in patient group, as compared to 13.4 (±7.90) in the control group, the difference being significant (OR: 6, 95 %CI: 1.02-113.3; P=0.046).

Conclusion:

A significant association was noted between vitamin D deficiency and differentiated thyroid cancer. Further studies with a prospective design are necessary to further define the roles of this factor.

Does breast density measured through population-based screening independently increase breast cancer risk in Asian females?

Purpose

The purpose of this study was to investigate the effects of breast density on breast cancer risk among women screened via a nationwide mammographic screening program.

Patients and methods

We conducted a nested case-control study for a randomly selected population of 1,561 breast cancer patients and 6,002 matched controls from the National Cancer Screening Program. Breast density was measured and recorded by two independent radiologists using the Breast Imaging Reporting and Data System (BI-RADS). Associations between BI-RADS density and breast cancer risk were evaluated according to screening results, time elapsed since receiving non-recall results, age, and menopausal status after adjusting for possible covariates.

Results

Breast cancer risk for women with extremely dense breasts was five times higher (adjusted odds ratio [aOR] =5.0; 95% confidence interval [CI]) =3.7-6.7) than that for women with an almost entirely fatty breast, although the risk differed between recalled women (aOR =3.3, 95% CI =2.3-3.6) and women with non-recalled results (aOR =12.1, 95% CI =6.3-23.3, P-heterogeneity =0.001). aORs for BI-RADS categories of breast density were similar when subjects who developed cancer after showing non-recall findings during initial screening were grouped according to time until cancer diagnosis thereafter (<1 and ≥1 year). The prevalence of dense breasts was higher in younger women, and the association between a denser breast and breast cancer was stronger in younger women (heterogeneously dense breast: aOR =7.0, 95% CI =2.4-20.3, women in their 40s) than older women (aOR =2.5, 95% CI =1.1-6.0, women in their 70s or more). In addition, while the positive association remained, irrespective of menopausal status, the effect of a dense breast on breast cancer risk was stronger in premenopausal women.

Conclusion

This study confirmed an increased risk of breast cancer with greater breast density in Korean women which was consistent regardless of BI-RADS assessment category, time interval after initially non-recall results, and menopausal status.

Dietary supplement use among cancer survivors and the general population: a nation-wide cross-sectional study

BACKGROUND

Use of dietary supplements among cancer survivors is common and controversial, but information on the amount of nutrients from supplements among cancer survivors is limited. We examined the amount of nutrients and their contribution to total nutrient intake from supplements and compared these data between cancer survivors and cancer-free individuals. We also identified factors associated with supplement use among cancer survivors.

METHODS

We identified 400 cancer survivors and 10,387 cancer-free individuals, aged ≥ 19 years, from the fifth Korea National Health and Nutrition Examination Survey (KNHANES) V-1, 2 (2010, 2011). We calculated the amount of nutrients consumed from foods and supplements, the percent contributions of supplement nutrients to total nutrient intakes and cancer survivors' nutrient intakes relative to the Estimated Average Requirements (EARs) and the Tolerable Upper Intake Levels (ULs). We examined factors associated with supplement use among cancer survivors.

RESULTS

We found that 33.3% of cancer survivors and 22.1% of cancer-free individuals reported the use of dietary supplements. Compared to cancer-free individuals, cancer survivors had higher intakes of riboflavin, folate, and iron from foods (p < 0.05 for each), and higher intakes of calcium (p = 0.05) and vitamin C (p = 0.01) from foods and supplements. The similar pattern was observed for the percent contributions to total nutrient intake. Cancer survivors had higher proportion of participants below EARs than cancer-free individuals for thiamin and niacin (p < 0.05 for each). The proportions of cancer survivors below the EARs were 61.2% for calcium, 49.1% for riboflavin, and 43.5% for folate and the proportions of cancer survivors above the ULs were 3.3% for iron, and 2.3% for vitamin A. For female cancer survivors, education above an elementary school level, moderate physical activity, low vegetable intake, and high circulating vitamin D levels were associated with supplement use. For male cancer survivors, living in an urban area, no consumption of alcohol, and lower energy intake, were associated with supplement use.

CONCLUSIONS

Korean cancer survivors have higher rate of dietary supplement use and higher contribution from supplements to total nutrient intake than cancer-free individuals. Demographic and lifestyle factors were associated with supplement use among cancer survivors.

[Gastric Cancer Recurrence in 12 Years after Surgical Resection]

Recurrence of gastric cancer after 10 years of surgical resection is highly rare. There are limited data on the surveillance of patients with gastric cancer after 10 years from gastrectomy. A 50-year-old man presented to the gastroenterology clinic at our hospital for the management of abnormal findings on a routine colonoscopic exam. He had undergone gastrectomy for advanced gastric cancer 12 years ago. At presentation, colonoscopic examination revealed asymmetrically edematous and hyperemic mucosal change with luminal narrowing on transverse colon. Abdominal computed tomography showed no evidence of distant metastasis, except for focal bowel wall thickening on transverse colon. He underwent a laparoscopic right-hemicolectomy, and the resected specimen revealed a recurrent and metastatic lesion. We report a case of recurrence of gastric cancer after 10 years from surgical resection with relevant literature review.

Treatment Patterns and Outcomes in Elderly Patients with Metastatic Breast Cancer: A Multicenter Retrospective Study

Purpose

Currently, there is little information regarding optimal treatment for metastatic breast cancer (MBC) in elderly patients. In this retrospective study, we examined a cohort of elderly patients with MBC receiving a range of treatments, in terms of demographic and clinicopathologic characteristics, treatment patterns, and outcomes.

Methods

Patients aged 65 years and older, and diagnosed with MBC between 2003 and 2015, were identified from the databases of three academic hospitals in South Korea. A total of 161 cases were eligible for inclusion. We assessed clinicopathologic features, treatment patterns, and outcomes, using the available electronic medical records. Based on age at MBC diagnosis, patients were divided into three groups: 65 to 69, 70 to 74, and ≥75 years.

Results

Most patients had received active treatment according to biologic subtype as in younger patients, although frequent dose modifications were observed during chemotherapy. The median overall survival (OS) for all patients was 30.3 months; age (≥70 years), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (≥2), triple-negative cancer, and number of metastatic sites (≥2) were significant poor prognostic factors for OS in multivariate analyses. All types of systemic treatments according to biologic subtype conferred more prolonged OS in patients receiving treatment. Patients aged ≥75 years were more likely to have a poor ECOG PS and advanced comorbidity, and tended to receive less intensive treatments compared to the other age groups.

Conclusion

Elderly patients with MBC should not be excluded from receiving standard treatments prescribed for younger patients. Future research plans for elderly patients, especially aged ≥75 years with breast cancer, should include a geriatric assessment for identifying individuals at risk for treatment-related toxicity. Overall, this analysis will provide a better understanding of this population and help guide clinical care in real-world practice.

Occupational radiation exposure and its health effects on interventional medical workers: study protocol for a prospective cohort study

INTRODUCTION

Although fluoroscopically guided procedures involve a considerably high dose of radiation, few studies have investigated the effects of radiation on medical workers involved in interventional fluoroscopy procedures. Previous research remains in the early stages and has not reached a level comparable with other occupational studies thus far. Furthermore, the study of radiation workers provides an opportunity to estimate health risks at low doses and dose rates of ionising radiation. Therefore, the objectives of this study are (1) to initiate a prospective cohort study by conducting a baseline survey among medical radiation workers who involve interventional fluoroscopy procedures and (2) to assess the effect of occupational radiation exposure and on the overall health status through an in-depth cross-sectional study.

METHODS AND ANALYSIS

Intervention medical workers in Korea will be enrolled by using a self-administered questionnaire survey, and the survey data will be linked with radiation dosimetry data, National Health Insurance claims data, cancer registry and mortality data. After merging these data, the radiation organ dose, lifetime attributable risk due to cancer and the risk per unit dose will be estimated. For the cross-sectional study, approximately 100 intervention radiology department workers will be investigated for blood tests, clinical examinations such as ultrasonography (thyroid and carotid artery scan) and lens opacity, the validation of badge dose and biodosimetry.

ETHICS AND DISSEMINATION

This study was reviewed and approved by the institutional review board of Korea University (KU-IRB-12-12-A-1). All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations, and a report will be submitted to the relevant public health authorities in the Korea Centers for Disease Control and Prevention to help with the development of appropriate research and management policies.

Incidental Anterior Mediastinal Nodular Lesions on Chest CT in Asymptomatic Subjects

OBJECTIVE

The aim of this study was to investigate the prevalence and characteristics of nodular lesions in the anterior mediastinum that had been found incidentally on screening chest computed tomography (CT) in asymptomatic subjects.

METHODS

We included 56,358 consecutive participants (mean age 52.4 ± 10.5 years; male-female ratio 35,306:21,052) who underwent a baseline low-dose chest CT scan as part of a health checkup from 2006 through 2013. After the presence of anterior mediastinal nodular lesion had been confirmed, their CT findings, confirmatory diagnosis, and interval CT scan were reviewed. The standardized prevalence ratio for thymic epithelial tumor was calculated on the basis of the Republic of Korea cancer statistics for 2014.

RESULTS

Of the 56,358 participants, 413 (0.73%) had lesions (95% confidence interval: 0.66-0.80%); the prevalence increased with age (p <0.001) and a history of malignancy (p = 0.005). Of the lesions, 85.2% were smaller than 2 cm, 61.3% were round, and 80.2% had CT attenuation higher than 20 Hounsfield units. Among 51 proven cases, 39 lesions (76.9%) were benign and 12 (23.1%) were malignant. The standardized prevalence ratio for thymic epithelial tumor was 2.04 (95% confidence interval: 1.01-3.42). Of 11 resected thymic epithelial tumors, five were carcinomas, 10 were stage I or II, and all were completely resected without recurrence. Of the 237 unconfirmed cases with a follow-up CT scan, 82.2% were stable, 8.9% had increased, and the other 8.9% had decreased.

CONCLUSIONS

The prevalence of incidental nodular lesion was 0.73%. Most lesions had CT features that were indistinguishable from thymic epithelial tumors, but a considerable portion of the lesions were suspected to be benign. Incidental thymic epithelial tumors were more prevalent than clinically detected tumors, were early-stage cancer, and showed favorable outcomes.

Active Surveillance of Papillary Thyroid Microcarcinoma: A Mini-Review from Korea

In Korea, the incidence of thyroid cancer increased explosively in the early 2000s, and reached a plateau in the early 2010s. Most cases of newly diagnosed thyroid cancer are small indolent microcarcinoma and could be good candidates for active surveillance (AS) instead of immediate surgery. Many considerations must be taken into account for establishing selection criteria for candidates for AS of papillary thyroid microcarcinoma (PTMC), including the characteristics of the tumor, the patient, and the medical team. If possible, AS of PTMC should be a part of a prospective clinical trial to ensure long-term safety and to identify clinical and/or molecular markers of the progression of PTMC. In this review, we discuss lessons regarding surgical interventions for PTMC, and then describe the concept, application, caveats, unanswered questions, and future perspectives of AS of PTMC. For appropriately selected patients with PTMC, AS can be a good alternative to immediate surgery.

Molecular targeted agents as second-line treatment for hepatocellular carcinoma: a meta-analysis and review

It is unclear whether targeted agents can produce survival advantage in patients with advanced HCC previously treated with sorafenib. We performed this meta-analysis of randomized trials and reviewed clinical outcomes of molecular targeted agents in the second-line treatment for advanced HCC. A systematic computerized search of the electronic databases PubMed, Embase, Google Scholar, and Cochrane Library (up to May 2017) was carried out. From six studies, 2,388 patients were included in the meta-analysis. Almost all patients were treated with sorafenib as first-line therapy. Compared with placebo, targeted agents significantly improved time-to-progression (hazard ratio = 0.62, 95% confidence interval: 0.49-0.78, P < 0.0001). In terms of overall survival, targeted therapy tended to improve prognosis (hazard ratio = 0.86, 95% confidence interval: 0.74-1.01, P = 0.06). In conclusion, this meta-analysis indicates that molecular targeted agents have a potential to improve prognosis after failure of first-line treatment with sorafenib in patients with advanced HCC.

Effect of Smoking Cessation and Reduction on the Risk of Cancer in Korean Men: A Population Based Study

Purpose

The purpose of this study was to investigate the effect of smoking habit change on the risk of cancer.

Materials and Methods

From the Korean National Health Insurance Service database, we determined the change in smoking habit between the first (2002 and 2003) and second (2004 and 2005) health examination periods. A total of 143,071 men were categorized into baseline heavy (≥ 20 cigarettes per day), moderate (10-19 cigarettes per day), light (< 10 cigarettes per day) smokers, quitters, and never smokers, after which the change in smoking status was determined during the second health examination. The participants were then followed up from 2006 to 2013 for all cancer, smoking related cancer, and lung cancer.

Results

Compared to heavy continual smokers, heavy smokers who quit had reduced risk of smoking related cancer (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.56 to 0.97) and tended to have reduced risk of all cancer (HR, 0.87; 95% CI, 0.75 to 1.00). Moderate smokers who reduced the amount of smoking to light levels had decreased risk of all cancer (HR, 0.82; 95% CI, 0.72 to 0.94), smoking related cancer (HR, 0.74; 95% CI, 0.59 to 0.93), and lung cancer (HR, 0.55; 95% CI, 0.38 to 0.79) compared to heavy continual smokers.

Conclusion

Smoking reduction decreases the risk of all cancer, smoking related cancer, and lung cancer. While smoking cessation should be the treatment of choice for smokers, smoking reduction may serve as an alternative strategy for those who cannot quit.

The role of anti-EGFR agents in the first-line treatment of advanced esophago-gastric adenocarcinoma: a meta-analysis

The role of anti-epidermal growth factor receptor (EGFR) therapy is controversial in patients with esophago-gastric adenocarcinoma. We performed this meta-analysis to evaluate whether the addition of an anti-EGFR agent to chemotherapy can produce survival benefits in patients with advanced esophageal adenocarcinoma, gastric adenocarcinoma, or gastroesophageal junction adenocarcinoma. Electronic databases were searched for eligible randomized studies. From six studies, 1,817 patients were included in the meta-analysis of hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS). Compared with chemotherapy alone, anti-EGFR agents in combination with chemotherapy were significantly associated with shorter PFS (HR = 1.14 [95% confidence interval {CI}, 1.01-1.28], P = 0.03). In terms of OS, the addition of an anti-EGFR agent to chemotherapy showed no advantage (HR = 1.10 [95% CI, 0.98-1.23], P = 0.11). In addition, the combination of an anti-EGFR agent with chemotherapy significantly increased some grade 3/4 toxicities including diarrhea (risk ratio {RR} = 1.42, [95% CI, 1.03-1.94], P = 0.03), mucositis (RR = 3.30 [95% CI, 1.54-7.07], P = 0.002), and skin rash (RR = 6.82 [95% CI, 3.15-14.78], P < 0.00001). In conclusion, this meta-analysis indicates that the addition of an anti-EGFR agent to chemotherapy conveys no additional benefit for patients with advanced esophago-gastric adenocarcinoma. As of now, anti-EGFR agents should not be used in the first-line treatment of adenocarcinoma of the upper gastrointestinal tract.

Health-Related Quality of Life in Non-Hodgkin Lymphoma Survivors: A Prospective Cohort Study

PURPOSE

We evaluated health-related quality of life (HRQOL) in long-term survivors of indolent and aggressive non-Hodgkin lymphoma (NHL).

Materials and Methods

TheHRQOLwas assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) at diagnosis in NHL patients between 2008 and 2011, and follow-up evaluation was conducted from June 2014 to February 2015 using EORTC QLQ-C30 and the quality of life in cancer survivors (QOL-CS) questionnaire. We used linear mixed models to compare changes in HRQOL between indolent and aggressive NHL over time.

RESULTS

The HRQOL of long-term survivors with aggressive NHL improved to the similar level of indolent NHL during the follow-up survey. However, survivors of NHL were found to fear the probability of relapse and second malignancy, and the degree of fear was not different between survivors with aggressive stage I/II or III/IV NHL (p > 0.05). Furthermore, a half of survivors reported impaired sense of psychosocial well-being regardless of aggressiveness and stage during follow-up survey. More than 65% of survivors thought they did not receive sufficient support from others, and patients who had financial difficulties at diagnosis were more frequently associated with suffering from insufficient support. Impaired physical and cognitive functioning at diagnosis was significantly associated with lack of life purpose in long-term survivors.

CONCLUSION

The HRQOL of aggressive NHL survivors improved to a similar level to that of indolent NHL. However, the majority of survivors still had fear of relapse, and psychosocial well-being remained unmet needs.

The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)

Purpose

We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence.

Materials and Methods

A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)).

Results

In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ ‒0.58 vs. > ‒0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71).

Conclusion

mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.

The role of anti-EGFR agents in patients with locoregionally advanced head and neck cancer: a meta-analysis of randomized trials

There has been a debate over whether the addition of anti-epidermal growth factor receptor (EGFR) agents to the conventional treatments has beneficial effects in patients with head and neck squamous cell carcinoma (HNSCC). This meta-analysis was performed to investigate the role of anti-EGFR agents in patients with locoregionally advanced HNSCC (LA-HNSCC). A systematic search of the electronic databases was carried out. From eight randomized controlled trials, 2,263 patients were included in the meta-analysis. Compared with chemoradiotherapy (CRT), the addition of an EGFR inhibitor to radiotherapy (RT) or CRT did not improve locoregional control (hazard ratio (HR) = 1.19 [95% confidence interval (CI): 0.99–1.42], P = 0.06), progression-free survival (HR = 1.07 [95% CI: 0.92–1.24], P = 0.37), and overall survival (HR = 1.04 [95% CI, 0.88–1.23], P = 0.65) in patients with LA-HNSCC. Moreover, the addition of anti-EGFR agents increased the risk of skin toxicities (odds ratio = 4.04 [95% CI: 2.51–6.48], P < 0.00001) and mucositis (odds ratio = 1.58 [95% CI: 0.99–2.52], P = 0.06). In conclusion, this meta-analysis indicates that the addition of an anti-EGFR agent to RT or CRT do not improve clinical outcomes compared with CRT in patients with LA-HNSCC. Except for patients with coexisting medical conditions or decreased performance status, concurrent CRT should remain the standard of care for patients with LA-HNSCC.

Mapping patterns of locoregional recurrence following contemporary treatment with radiation therapy for breast cancer: A multi-institutional validation study of the ESTRO consensus guideline on clinical target volume

BACKGROUND AND PURPOSE

To validate the ESTRO guideline on clinical target volume (CTV) delineation for breast cancer using a multi-centre dataset.

MATERIALS AND METHODS

Patients with axial imaging of gross locoregional recurrence (LRR) were identified from 10 participating institutions. All patients received RT, albeit not to all regional node. The location of LRR was transferred to the corresponding area on representative axial computed tomography images and compared with ESTRO-CTV.

RESULTS

The locations of LRRs in 234 patients with 337 recurrence lesions were mapped. The ESTRO-CTV encompassed 97.6% of all LRRs, except in lymph node level 4 and the pectoralis muscle. Although 8.8% of level 4 failures occurred outside the ESTRO-CTV, cranial to the subclavian artery, all nodes were located within 6 mm cranially. Another 20% occurred posterolateral to anterior scalene muscles; however, 11/16 cases had simultaneous multiple lymph node recurrences, and 8/16 initially had N2-3 tumours. Local recurrence at the pectoralis muscle was prominent in patients undergoing mastectomy but not breast-conservation surgery (28% vs. 2.9%, P = .001).

CONCLUSIONS

Our mapping data demonstrated that the ESTRO-CTV, with some considerations, successfully encompassed most LRRs in patients undergoing contemporary management, thus validating ESTRO-CTV to be valuable for highly conformal radiation therapy techniques.

Korean OBEsity Surgical Treatment Study (KOBESS): protocol of a prospective multicentre cohort study on obese patients undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

INTRODUCTION

Bariatric surgery effectively induces long-term weight loss in Western populations. However, its effectiveness in Asians remains to be confirmed objectively. The Korean Society for Metabolic and Bariatric Surgery proposes the first prospective cohort study on Koreans undergoing bariatric surgery.

METHODS AND ANALYSIS

The Korean OBEsity Surgical treatment Study (KOBESS) is a prospective, multicentre, single-arm, observational, cohort study on morbidly obese patients who undergo primary sleeve gastrectomy or Roux-en-Y gastric bypass in Korea. In total, 100 consecutive obese Asian patients who will undergo bariatric surgery will be recruited in 2016-2017; follow-up will be for 1 year. Primary outcomes are change in body weight and waist circumference at 1 year. All patients will undergo anthropometry, laboratory tests, bioelectrical impedance analysis, gastrofibroscopy, polysomnography and fat-measuring CT before and after surgery. Patients with diabetes will also undergo perioperative oral glucose tolerance and endocrinological hormone tests. Hypertensive patients will also undergo perioperative echocardiography and carotid Doppler ultrasonography. Female patients suspected of having polycystic ovarian syndrome will also undergo perioperative hormone tests and abdominal ultrasonography. Visceral and subcutaneous fat will be harvested during surgery. Blood, stool and urine samples will be taken at various perioperative time points. Although the cohort is small and the follow-up duration is relatively short, this study will determine whether bariatric surgery induces satisfactory weight loss in obese Koreans. Significantly, the tissue samples will also facilitate many studies examining the effects of bariatric surgery and their mechanisms.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the institutional review board of each participating hospital. All findings arising from this cohort study will be published in open-access peer-reviewed journals and will be presented at national and international meetings. All KOBESS investigators will be able to propose research studies and potential publications based on KOBESS data and tissue samples.

TRIAL REGISTRATION NUMBER

NCT03100292; Pre-results.

Association Between Health Behaviors and Family History of Cancer in Cancer Survivors: Data From the Korean Genome and Epidemiology Study

BACKGROUND

We compared health behaviors, including current smoking, alcohol drinking, regular exercise, obesity, and abdominal obesity, among Korean cancer survivors with and without family history of cancer.

METHODS

This study included 5,247 cancer survivors with family history of cancer (1,894 with and 3,353 without), who were recruited from the Health Examinee cohort. Health behaviors were identified using questionnaire. Adjusted ORs (aORs) between health behaviors and family history of cancer were estimated by multivariate logistic regression analysis adjusted for sociodemographic factors. All analyses were conducted separately according to sex.

RESULTS

Prevalence of current smoking, alcohol drinking, no regular exercise, obesity, and abdominal obesity was 16.3%, 48.3%, 36.0%, 31.3%, and 42.3% in male cancer survivors and 1.7%, 20.6%, 43.8%, 28.5%, and 72.5% in female, respectively. Health behaviors in male cancer survivors with and without family history of cancer were not significantly different after being adjusted for other covariates (aOR = 1.04, 95% CI = 0.75-1.44 for current smoking; aOR = 0.96, 95% CI = 0.76-1.22 for current drinking; aOR = 0.85, 95% CI = 0.66-1.10 for regular exercise; aOR = 0.96, 95% CI = 0.73-1.25 for obesity; aOR = 0.97, 95% CI = 0.75-1.25 for abdominal obesity). In female cancer survivors, there were no significant differences in health behaviors according to family history of cancer (aOR = 0.76, 95% CI = 0.44-1.32; aOR = 1.11, 95% CI = 0.94-1.31; aOR = 0.99, 95% CI = 0.87-1.14; aOR = 0.99, 95% CI = 0.85-1.16; aOR = 0.93, 95% CI = 0.80-1.10, respectively).

CONCLUSIONS

We identified no significant differences in health behaviors according to family history of cancer in cancer survivors. More studies should be conducted to identify correlations between family history of cancer and prognosis in cancer survivors.

Necessity of D2 lymph node dissection in older patients ≥80years with gastric cancer

OBJECTIVES

This study analyzed the effect of D2 lymph node (LN) dissection on complications and survival in older patients with gastric cancer.

MATERIALS AND METHODS

A total of 103 octogenarian patients who underwent curative gastrectomy for gastric cancer were divided into two groups (D2 and D1) according to the extent of LN dissection and analyzed retrospectively for complications and survival.

RESULTS

No differences were observed in short-term postoperative outcomes, including complication rates, between the two groups. In a survival analysis, D2 LN dissection did not improve overall survival (OS) in any patient, including advanced cases. A Cox regression analysis revealed that the independent risk factors for OS were history of coronary artery disease (hazard ratio [HR], 11.095), postoperative short-term complications (HR, 9.939), and TNM stage (HR, 6.299). The extent of LN dissection was not an independent risk factor for OS, and D2 or more LN dissection (odds ratio, 10.89) increased the risk independently.

CONCLUSIONS

D2 or more LN dissection did not improve survival, but rather increased the risk of complications. Thus, LN dissection should be performed sparingly in octogenarian patients with gastric cancer.

Clinicopathological impacts of high c-Met expression in head and neck squamous cell carcinoma: a meta-analysis and review

High c-Met expression has been observed in head and neck squamous cell carcinoma (HNSCC). However, its clinicopathological impact remains controversial. We performed this meta-analysis to evaluate the pathologic and prognostic impacts of c-Met overexpression in patients with HNSCC. A systematic computerized search of the electronic databases was carried out. From 16 studies, 1,948 patients with HNSCC were included in the meta-analysis. Compared with HNSCCs showing low c-Met expression, tumors with high c-Met expression were significantly associated with higher rate of lymph node metastasis (odds ratio = 3.26, 95% CI: 2.27–4.69, P < 0.00001) and higher T stage (odds ratio = 1.33, 95% CI: 1.03–1.71, P = 0.03). In addition, patients with c-Met-high HNSCC showed significantly worse disease-free survival (hazard ratio = 1.49, 95% CI: 1.04–2.14, P = 0.03) and overall survival (hazard ratio = 1.83, 95% CI: 1.29–2.60, P = 0.0007) than those with c-Met-low tumor. In conclusion, this meta-analysis demonstrates that high c-Met expression is significantly associated with worse pathological features and prognosis, indicating c-Met overexpression is an adverse prognostic marker for patients with HNSCC.

The addition of bevacizumab in the first-line treatment for metastatic colorectal cancer: an updated meta-analysis of randomized trials

Bevacizumab has shown survival benefits when added to chemotherapy in patients with metastatic colon cancer (mCRC). However, the efficacy of bevacizumab may depend on the accompanying chemotherapeutic regimen. We performed this meta-analysis to examine the impact of the choice of chemotherapy regimen on the survival benefits of bevacizumab in the first-line treatment for patients with mCRC. Electric databases were searched for eligible randomized trials. From 9 studies, 3,710 patients with mCRC were included in the meta-analysis of hazard ratios (HRs) for progression-free survival (PFS) or overall survival (OS). Compared with chemotherapy alone, the addition of bevacizumab to chemotherapy significantly prolonged PFS (HR = 0.66 [95% confidence interval (CI), 0.55-0.77], P < 0.0001) and OS (HR = 0.84 [95% CI, 0.77-0.92], P = 0.0001). In the subgroup analysis according to the chemotherapeutic regimens, bevacizumab showed both PFS (HR = 0.57 [95% CI, 0.41-0.77], P = 0.0004) and OS (HR = 0.79 [95% CI, 0.67-0.93], P = 0.004) advantages only in combination with irinotecan-based regimen. In conclusion, this meta-analysis confirms that the addition of bevacizumab to chemotherapy significantly prolongs PFS and OS in the first-line treatment for mCRC. The subgroup analyses suggest that irinotecan-based regimen may be a better partner of bevacizumab in terms of both PFS and OS.

MET inhibitors in advanced non-small-cell lung cancer: a meta-analysis and review

The alterations of MET have been detected in non-small-cell lung cancer (NSCLC). However, survival benefit of MET inhibitors remains controversial. We performed this meta-analysis to evaluate the survival benefit of MET inhibitors combined with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) or standard chemotherapy in patients with advanced or metastatic NSCLC. A systematic computerized search of the electronic databases was carried out. From seven studies, 2,577 patients were included in the meta-analysis. Compared with patients in the placebo group, patients who received an additional MET inhibitor did not show significantly improved progression-free survival (hazard ration (HR) = 0.92 [95% confidence interval (CI): 0.79–1.08], P = 0.33) and overall survival (HR = 1.0 [95% CI: 0.90–1.11], P = 0.97). In the subgroup analysis, patients with MET-high NSCLC tended to show longer survival when treated with an additional MET inhibitor than those in the placebo group (HR = 0.76, [95% CI: 0.58–1.01], P = 0.06). In conclusion, this meta-analysis indicates that the addition of a MET inhibitor to an EGFR TKI or chemotherapy has no survival benefit over placebo in patients with advanced or metastatic NSCLC. Although patients with MET-high tumor tended to show better survival, further studies to explore more specific biomarkers are warranted to identify ideal candidates for MET inhibitors in NSCLC.

Clinicopathological impacts of high c-Met expression in renal cell carcinoma: a meta-analysis and review

c-Met overexpression has been observed in renal cell carcinoma (RCC). However, its clinicopathological impacts remain uncertain. We performed this meta-analysis to evaluate the pathologic and prognostic impacts of high c-Met expression in patients with RCC. A systematic computerized search of the electronic databases PubMed and Embase was performed. From 12 studies, 1,724 patients with RCC were included in the meta-analysis. Compared with RCCs showing low c-Met expression, tumors with high c-Met expression showed significantly higher nuclear grade (odds ratio = 2.45 [95% CI: 1.43-4.19], P = 0.001) and pT stage (odds ratio = 2.18 [95% CI: 1.27-3.72], P = 0.005). In addition, patients with c-Met-high RCC showed significantly worse overall survival than those with c-Met-low tumor (hazard ratio = 1.32 [95% CI: 1.12-1.56], P = 0.0009). In conclusion, this meta-analysis demonstrates that high c-Met expression correlate with significantly worse pathological features and overall survival, indicating c-Met overexpression is a potential adverse prognostic marker for patients with RCC.

Stress and Depressive Symptoms in Cancer Survivors and Their Family Members: Korea Community Health Survey, 2012

This study examined the prevalence of perceived stress and depressive symptoms in cancer survivors and their family members compared with subjects without cancer and without family members with cancer. The subjects of this cross-sectional study were adults ≥19 years old who participated in the 2012 Korea Community Health Survey. Stress and depressive symptoms in cancer survivors and their family members were assessed and compared to symptoms in control groups by chi-square tests and multiple logistic regression analyses. Of the 6783 cancer survivors, 26.9% and 8.7% reported having stress and depressive symptoms, respectively, and 27.7% and 5.9% of family members of cancer survivors reported having stress and depressive symptoms, respectively. Cancer survivors showed higher adjusted odds ratio (aOR) for stress (aOR = 1.26, 95% confidence interval (CI) = 1.16-1.37) and depressive symptoms (aOR = 1.82, 95% CI = 1.57-2.11) than subjects without cancer history. Family members of cancer survivors showed a higher OR for stress and depressive symptoms than subjects without a family member who survived cancer. Cancer survivors and family members of cancer survivors had more stress and depressive symptoms than controls. Careful management for cancer patients and their family members should include screening for stress and depression to improve mental health associated with cancer survivorship.

Prognostic value of c-Met overexpression in pancreatic adenocarcinoma: a meta-analysis

The overexpression of c-Met protein has been detected in pancreatic adenocarcinoma (PAC). However, its prognostic impact remains unclear. We performed this meta-analysis to evaluate the prognostic value of c-Met overexpression in PAC. A systematic computerized search of the electronic databases such as PubMed, Embase, and Google Scholar was carried out. From 5 studies, 423 patients who underwent surgical resection for PAC were included in the meta-analysis. Compared with patients with PAC showing low c-Met expression, patients with c-Met-high tumor had significantly worse disease-free survival (hazard ratio = 1.94 [95% confidence interval, 1.46–2.56], P = 0.00001) and overall survival (hazard ratio = 1.86 [95% confidence interval, 1.19–2.91], P = 0.006). In conclusion, this meta-analysis demonstrates that c-Met overexpression is a significant prognostic marker for poor survival in patients who underwent surgical resection for PAC.