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Yun SY, Suh CH, Byun JH, Jo SY, Chung SJ, Lim JS, Lee JH, Kim MJ, Kim HS, Kim SJ. Efficacy and safety of shunt surgery in patients with idiopathic normal-pressure hydrocephalus: can we predict shunt response by preoperative magnetic resonance imaging (MRI)? Clin Radiol 2024:S0009-9260(24)00142-9. [PMID: 38622045 DOI: 10.1016/j.crad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study was to identify preoperative magnetic resonance imaging (MRI) findings that can predict the shunt responsiveness in idiopathic normal-pressure hydrocephalus (iNPH) patients and to investigate postoperative outcome and complications. MATERIALS AND METHODS A total of 192 patients with iNPH who underwent shunt at our hospital between 2000 and 2021 were included to investigate complications. Of these, after exclusion, 127 (1-month postoperative follow-up) and 77 (1-year postoperative follow-up) patients were evaluated. The preoperative MRI features (the presence of tightness of the high-convexity subarachnoid space, Sylvian fissure enlargement, Evans' index, and callosal angle) of the shunt-response and nonresponse groups were compared, and a systematic review was conducted to evaluate whether preoperative MRI findings could predict shunt response. RESULTS Postoperative complications within one month after surgery were observed in 6.8% (13/192), and the most common complication was hemorrhage. Changes in corpus callosum were observed in 4.2% (8/192). The shunt-response rates were 83.5% (106/127) in the 1-month follow-up group and 70.1% (54/77) in 1-year follow-up group. In the logistic regression analysis, only Evans' index measuring >0.4 had a significant negative relationship with shunt response at 1-month follow-up; however, no significant relationship was observed at 1-year follow-up. According to our systematic review, it is still controversial whether preoperative MRI findings could predict shunt response. CONCLUSION Evans' index measure of >0.4 had a significant relationship with the shunt response in the 1-month follow-up group. In systematic reviews, there is ongoing debate about whether preoperative MRI findings can accurately predict responses to shunt surgery. Postoperative corpus callosal change was observed in 4.2% of iNPH patients.
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Affiliation(s)
- S Y Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - J H Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Y Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-S Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Cho J, Lee J, Kim J, Lee H, Kim MJ, Lee YJ, Yum MS, Byun JH, Lee CG, Lee YM, Lee J, Chae JH. Nusinersen demonstrates effectiveness in treating spinal muscular atrophy: findings from a three-year nationwide study in Korea. Front Neurol 2023; 14:1294028. [PMID: 38192577 PMCID: PMC10773909 DOI: 10.3389/fneur.2023.1294028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Nusinersen is the first drug approved for spinal muscular atrophy (SMA) treatment. In this study, we aimed to evaluate the long-term safety and efficacy of nusinersen, assess the therapeutic effects based on the treatment initiation timing and baseline motor function, and explore the perception of functional improvement from either parents or patients, utilizing 3-year nationwide follow-up data in South Korea. Methods We enrolled patients with SMA who were treated with nusinersen under the National Health Insurance coverage, with complete motor score records available and a minimum treatment duration of 6 months. To evaluate the motor function of patients, the Hammersmith Infant Neurological Examination-2 (HINE-2) was used for type 1 and the Expanded Hammersmith Functional Motor Scale (HFMSE) was used for types 2 and 3 patients. A significant improvement was defined as a HINE-2 score gain ≥5 for patients with type 1 and an HFMSE score ≥ 3 for patients with types 2 and 3 SMA. Effects of treatment timing were assessed. Patients with type 2 were further categorized based on baseline motor scores for outcome analysis. We also analyzed a second dataset from five tertiary hospitals with the information on parents/patients-reported impressions of improvement. Results The study comprised 137 patients, with 21, 103, and 13 patients representing type 1, 2, and 3 SMA, respectively. At the 3-year follow-up, the analysis encompassed 7 patients with type 1, 12 patients with type 2, and none with type 3. Nearly half of all enrolled patients across SMA types (42.8, 59.2 and 46.2%, respectively) reached the 2-year follow-up for analysis. Patients with type 1 SMA exhibited gradual motor function improvement over 1-, 2-, and 3-year follow-ups (16, 9, and 7 patients, respectively). Patients with type 2 SMA demonstrated improvement over 1-, 2-, and 3-year follow-ups (96, 61 and 12 patients, respectively). Early treatment from symptom onset resulted in better outcomes for patients with type 1 and 2 SMA. In the second dataset, 90.7% of 108 patients reported subjective improvement at the 1-year follow-up. Conclusion Nusinersen treatment for types 1-3 SMA is safe and effective in long-term follow-up. Early treatment initiation was a significant factor affecting long-term motor outcome.
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Affiliation(s)
- Jaeso Cho
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihye Kim
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Jee Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Chong Guk Lee
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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3
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Kim M, Lee JL, Shin SJ, Bae WK, Lee HJ, Byun JH, Choi YJ, Youk J, Ock CY, Kim S, Song H, Park KH, Keam B. Phase II study of a trastuzumab biosimilar in combination with paclitaxel for HER2-positive recurrent or metastatic urothelial carcinoma: KCSG GU18-18. ESMO Open 2023; 8:101588. [PMID: 37385153 PMCID: PMC10485395 DOI: 10.1016/j.esmoop.2023.101588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2) is a widely explored therapeutic target in solid tumors. We evaluated the efficacy and safety of trastuzumab-pkrb, a biosimilar of trastuzumab, in combination with paclitaxel, in HER2-positive recurrent or metastatic urothelial carcinoma (UC). PATIENTS AND METHODS We enrolled 27 patients; they were administered a loading dose of 8 mg/kg trastuzumab-pkrb on day 1, followed by 6 mg/kg and 175 mg/m2 paclitaxel on day 1 every 3 weeks, intravenously. All patients received six cycles of the combination treatment and continued to receive trastuzumab-pkrb maintenance until disease progression, unacceptable toxicity, or for up to 2 years. HER2 positivity (based on immunohistochemistry analysis) was determined according to the 2013 American Society of Clinical Oncology /College of American Pathologists HER2 testing guidelines. The primary endpoint was objective response rate (ORR); the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety. RESULTS Twenty-six patients were evaluated via primary endpoint analysis. The ORR was 48.1% (1 complete and 12 partial responses) and the duration of response was 6.9 months [95% confidence interval (CI) 4.4-9.3 months]. With a median follow-up of 10.5 months, the median PFS and OS were 8.4 months (95% CI 6.2-8.8 months) and 13.5 months (95% CI 9.8 months-not reached), respectively. The most common treatment-related adverse event (TRAE) of any grade was peripheral neuropathy (88.9%). The most common grade 3/4 TRAEs were neutropenia (25.9%), thrombocytopenia (7.4%), and anemia (7.4%). CONCLUSIONS Trastuzumab-pkrb plus paclitaxel demonstrates promising efficacy with manageable toxicity profiles in patients with HER2-positive recurrent or metastatic UC.
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Affiliation(s)
- M Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul
| | - J L Lee
- Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - S J Shin
- Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul
| | - W K Bae
- Department of Hemato-Oncology, Chonnam National University Medical School & Hwasun Hospital, Hwasun
| | - H J Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon
| | - J H Byun
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Y J Choi
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - J Youk
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul
| | - C Y Ock
- Lunit, Seoul, Republic of Korea
| | - S Kim
- Lunit, Seoul, Republic of Korea
| | - H Song
- Lunit, Seoul, Republic of Korea
| | - K H Park
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - B Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Cancer Research Institute, Seoul National University College of Medicine, Seoul.
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Moon SH, Kang DG, Byun JH. Direct thermal injury to the popliteal artery after total knee arthroplasty. Niger J Clin Pract 2023; 26:646-648. [PMID: 37357483 DOI: 10.4103/njcp.njcp_778_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Vascular damage after total knee arthroplasty is rare. However, delayed diagnosis and management may cause adverse outcomes for patients. In particular, direct thermal injury to the popliteal artery after total knee arthroplasty is extremely rare. A 74-year-old woman presented to another institution with a left popliteal artery injury after left total knee arthroplasty. Arteriography revealed total occlusion of the popliteal artery, and emergency surgery was performed. Because of the total occlusion of the popliteal artery due to severe direct thermal injury, anastomosis was performed in an end-to-end fashion with a right great saphenous vein graft. At the time of discharge, she had no specific symptoms other than pain at the surgical site, with a palpable left dorsalis pedis pulse. While performing total knee arthroplasty, the anatomical position of the popliteal artery should be carefully considered to prevent injury.
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Affiliation(s)
- S H Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - D G Kang
- Departmentof Orthopaedic Sugery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J H Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Han HS, Lee KE, Suh YJ, Jee HJ, Kim BJ, Kim HS, Lee KW, Ryu MH, Baek SK, Park IH, Ahn HK, Jeong JH, Kim MH, Byun JH, Kim DS, An H, Park YH, Zang DY. Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group (KCSG). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18759 Background: Electronic medical record (EMRs) have the highest reliability among real-world data (RWD), but controlling for biases that may affect study outcomes remains challenging. This study aimed to establish a data collection framework of EMR-based RWD to evaluate the effectiveness and safety of cancer drug by conducting a nationwide real-world study based on Korean Cancer Study Group. Methods: We selected ramucirumab plus paclitaxel (RAM/PTX) and trastuzumab-emtansine (T-DM1), which are currently used to treat advanced gastric cancer and breast cancer, respectively, under the national health insurance, and systematically collected EMR-based RWD at relevant institutions in South Korea. Investigator reliability was evaluated using the concordance rate between the recommended input value for representative fictional cases and the input value of each investigator. Reliability of collected data was evaluated twice during study period at three institutions randomly selected by statisticians using the concordance rate between the previously collected data and data collected by the independent investigator. Two statisticians independently analyzed the same data and compared their results to evaluate the data analysis reproducibility. Results: Between the starting date of medical insurance coverage and December 2018, a total of 1,063 patients at 56 institutions in the RAM/PTX cohort and 824 patients at 60 institutions in the T-DM1 cohort were included. Mean investigator reliability for major case report form (CRF) variables in the RAM/PTX and T-DM1 cohorts was 73.5% and 71.9%, respectively. The most common CRF variable with a concordance rate < 70% between the recommended input value and the input value of each investigator was related to adverse events in both cohorts. Mean reliability of collected data for major CRF variables in the RAM/PTX and T-DM1 cohort was 90.0% for both cohorts in the first analysis, and 88.0% and 89.0% in the second analysis, respectively. The input data discrepancies between previously collected data and data collected by independent investigators were due to the input for variables that were not categorized and were in textual form in the EMRs (performance status, reason for discontinuation, adverse events, best response or disease progression, and survival data). Conclusions: This real-world study provides a framework that ensures relevance and reliability of EMR-based RWD for evaluating the effectiveness and safety of cancer drugs. There is a need for a digital healthcare system in which EMR-based RWD can be structured, defined, formatted, and exchanged with an integrated computer system and converted into scientific data. Clinical trial information: NCT04192734 and NCT04202328.
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Affiliation(s)
- Hye Sook Han
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Young Ju Suh
- College of Medicine, Inha University, Incheon, South Korea
| | - Hee-Jung Jee
- Chungnam National University Sejong Hospital, Sejong, South Korea
| | | | - Hyeong Su Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Keun-Wook Lee
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - In Hae Park
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, South Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Hwan Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Hye Byun
- Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Dong Sook Kim
- Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyonggin An
- College of Medicine, Korea University, Seoul, South Korea
| | - Yeon Hee Park
- Hematology-Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-Si, South Korea
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Kim BJ, Jee HJ, Rha SY, Han HS, Ryu MH, Park SH, Kim JG, Bae WK, Lee KW, Oh DY, Byun JH, Kim DS, Suh YJ, An H, Zang DY. Ramucirumab plus paclitaxel as a second-line treatment in HER2-positive gastric cancer: subgroup analysis of a nationwide, real-world study in Korea (KCSG-ST19-16). Gastric Cancer 2022; 25:609-618. [PMID: 35015188 DOI: 10.1007/s10120-021-01276-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND A subgroup analysis of data from a nationwide study (KCSG-ST19-16) was performed to evaluate the efficacy and safety of second-line ramucirumab plus paclitaxel treatment in patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric or gastro-esophageal junction (GEJ) adenocarcinoma. METHODS The KCSG-ST19-16 study enrolled a total of 1063 patients from 56 hospitals in South Korea with advanced gastric or GEJ adenocarcinoma, who had received second-line treatment with ramucirumab plus paclitaxel. HER2 status was known for 994 (93.5%) of these patients, who were thus included in the subgroup analysis. RESULTS In total, 163 of 994 patients (16.4%), had HER2-positive gastric or GEJ adenocarcinoma. The objective response rate to ramucirumab plus paclitaxel treatment was significantly higher in patients with HER2-positive disease compared to those with HER2-negative disease (23.0% [95% confidence interval (CI), 15.9-30.1] vs. 15.1% [95% CI, 12.3-17.9], p = 0.025). The median progression-free survival was longer in patients with HER2-positive versus HER2-negative disease, but the difference was not statistically significant (4.3 months [95% CI, 3.7-5.3] vs 3.7 months [95% CI, 3.4-4.0], p = 0.054). There was no statistically significant difference in median overall survival (OS) between the groups (9.8 months [95% CI, 8.9-12.3] vs 10.1 months [95% CI, 9.2-10.9], p = 0.564). CONCLUSIONS In patients with HER2-positive gastric or GEJ adenocarcinoma, the objective response rate to second-line treatment with ramucirumab plus paclitaxel was significantly higher compared to patients with HER2-negative disease. However, an increased response to treatment was not associated with an improvement in OS.
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Affiliation(s)
- Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sun Young Rha
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, South Korea
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Gwang Kim
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Republic of Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Innovation Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong Sook Kim
- Review and Assessment Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dae Young Zang
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
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7
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Han HS, Lee KE, Suh YJ, Jee HJ, Kim BJ, Kim HS, Lee KW, Ryu MH, Baek SK, Park IH, Ahn HK, Jeong JH, Kim MH, Lee DH, Kim S, Moon H, Son S, Byun JH, Kim DS, An H, Park YH, Zang DY. Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group. Ther Adv Med Oncol 2022; 14:17588359221132628. [PMID: 36339930 PMCID: PMC9634188 DOI: 10.1177/17588359221132628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Electronic medical records (EMRs) have the highest value among real-world
data (RWD). The aim of the present study was to propose a data collection
framework of EMR-based RWD to evaluate the effectiveness and safety of
cancer drugs by conducting a nationwide real-world study based on the Korean
Cancer Study Group. Methods: We considered all patients who received ramucirumab plus paclitaxel (RAM/PTX)
for gastric cancer and trastuzumab emtansine (T-DM1) for breast cancer at
relevant institutions in South Korea. Standard operating procedures for
systematic data collection were prospectively developed. Investigator
reliability was evaluated using the concordance rate between the recommended
input value for representative fictional cases and the input value of each
investigator. Reliability of collected data was evaluated twice during the
study period at three institutions randomly selected using the concordance
rate between the previously collected data and data collected by an
independent investigator. The reliability results of the investigators and
collected data were used for revision of the electronic data capture system
and site training. Results: Between the starting date of medical insurance coverage and December 2018, a
total of 1063 patients at 56 institutions in the RAM/PTX cohort and 824
patients at 60 institutions in the T-DM1 cohort were included. Mean
investigator reliability in the RAM/PTX and T-DM1 cohorts was 73.5% and
71.9%, respectively. Mean reliability of collected data in the RAM/PTX and
T-DM1 cohort was 90.0% for both cohorts in the first analysis and 89.0% and
84.0% in the second analysis, respectively. Mean missing values of the
RAM/PTX and T-DM1 cohorts at the time of simulation of fictional cases and
final data analysis decreased from 20.7% to 0.46% and from 18.5% to 0.76%,
respectively. Conclusion: This real-world study provides a framework that ensures relevance and
reliability of EMR-based RWD for evaluating the effectiveness and safety of
cancer drugs.
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Affiliation(s)
- Hye Sook Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Hyeong Su Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - In Hae Park
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Hwan Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - Dae Hyung Lee
- Inha University Hospital, Incheon, Republic of Korea
| | - Siheon Kim
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyemi Moon
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Serim Son
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Innovation Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong Sook Kim
- Review & Assessment Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Anam-dong 5-ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yeon Hee Park
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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Han HS, Kim BJ, Jee HJ, Ryu MH, Park SH, Rha SY, Kim JG, Bae WK, Lee KW, Oh DY, Kim IH, Sym SJ, Oh SY, Kim HS, Byun JH, Kim DS, Suh YJ, An H, Zang DY. Ramucirumab plus paclitaxel as second-line treatment in patients with advanced gastric or gastroesophageal junction adenocarcinoma: a nationwide real-world outcomes in Korea study (KCSG-ST19-16). Ther Adv Med Oncol 2021; 13:17588359211042812. [PMID: 34552667 PMCID: PMC8450614 DOI: 10.1177/17588359211042812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Ramucirumab as monotherapy or in combination with paclitaxel is a second-line treatment option recommended for patients with locally advanced unresectable or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma. However, real-world data from large study cohorts focused on ramucirumab plus paclitaxel in gastric cancer are limited. Methods: The study population comprised all patients with gastric or GEJ cancer who received ramucirumab plus paclitaxel in South Korea between 1 May 2018 and 31 December 2018. We included patients with advanced gastric or GEJ adenocarcinoma and disease progression after first-line platinum and fluoropyrimidine-containing combination chemotherapy. Results: In total, 1063 patients were included in the present study. The objective response rate and disease control rate were 15.1% and 57.7%, respectively. The median progression-free survival was 4.03 months (95% confidence interval, 3.80–4.27) and the median overall survival was 10.03 months (95% confidence interval, 9.33–10.73). Grade 3 or higher treatment-related adverse events with incidence of ⩾5% were neutropenia (35.1%) and anemia (10.5%). Based on multivariable analysis, overall survival was negatively associated with Eastern Cooperative Oncology Group performance status ⩾2, weight loss ⩾10% in the previous 3 months, GEJ of primary tumor, poor or unknown histologic grade, number of metastatic sites ⩾3, presence of peritoneal metastasis, no prior gastrectomy, and time to second-line since first-line treatment <6 months. Conclusion: Our large-scale, nationwide, real-world data analysis of an unselected real-world population adds evidence for the efficacy and safety of second-line ramucirumab plus paclitaxel in patients with locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma.
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Affiliation(s)
- Hye Sook Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | - Sun Young Rha
- Songdang Institute for Cancer Research, Yonsei University College of Medicine; Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine; Brain Korea 21 PLUS Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Gwang Kim
- Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Ho Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Sun Jin Sym
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - So Yeon Oh
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyeong Su Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Innovation Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong Sook Kim
- Review & Assessment Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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Yang PS, Byun JH, Sung JH, Joung B. Early mortality and complications associated with catheter ablation of atrial fibrillation: analysis of the entire procedure in Korea from 2007 to 2016. Europace 2021. [DOI: 10.1093/europace/euab116.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
There is limited data regarding the early mortality and adverse outcomes from catheter ablation of atrial fibrillation (AF) in Korea. The aim of this study was to examine the early mortality and frequency of adverse outcomes associated with AF catheter ablation from 2006 to 2016 in Korea.
Methods
From 2006 to 2016 in the Korean National Health Insurance Service database, 11,893 individuals underwent catheter ablation for AF. We investigated the frequency of complications and early mortality associated with AF ablation and comorbidities that led to adverse outcomes after AF ablation.
Results
Out of all 11,893 procedures, early mortality occurred in 38 cases (0.32%). Annual trends in AF procedural complications occurring during index admission for AF ablation decreased from 9.25% in 2006 to 6.49% in 2016 (P for trend = 0.004). The early mortality rate after AF ablation had remained unchanged between 2006 and 2016. After adjustment for age, comorbidities, and medication, procedural complications (adjusted odds ratio[aOR]: 16.1; P < 0.001), age (aOR: 1.25; P = 0.024), history of hemorrhagic stroke (aOR: 4.74; P = 0.019), and less experience with AF ablation of the hospital (aOR: 2.85; P = 0.024) were associated with early mortality. Among procedural complications, atrioesophageal fistula (aOR: 199.8; P < 0.001), access site complications (aOR: 6.08; P = 0.005), complete heart block (aOR: 11.3; P = 0.029), pneumothorax (aOR: 62.0; P < 0.001), and procedure related pneumonia (aOR: 39.0; P < 0.001) were associated with early mortality.
Conclusions
Procedural complications, history of hemorrhagic stroke, and less experience with AF ablation of the hospital were predictors of early mortality. Out of all complications, atrioesophageal fistual, procedure related pneumonia, and in-hospital stroke were related to early mortality. Adequate management of complications may contribute to reducing the number of early mortalty rates following AF ablation. Abstract Figure. Trend of early mortality after ablation
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Affiliation(s)
- PS Yang
- CHA University, Seongnam, Korea (Republic of)
| | - JH Byun
- CHA University, Seongnam, Korea (Republic of)
| | - JH Sung
- CHA University, Seongnam, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
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Zang DY, Han HS, Kim BJ, Jee HJ, Suh YJ, An H, Byun JH, Kim DS, Park SH, Rha SY, Oh DY, Kim JG, Bae WK, Kim IH, Sym SJ, Oh SY, Kim HS, Lee KW, Ryu MH. Real-world outcomes of second-line ramucirumab plus paclitaxel in patients with advanced gastric or gastroesophageal junction adenocarcinoma: A nationwide retrospective study in Korea (KCSG-ST19-16). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4056 Background: Ramucirumab as monotherapy or in combination with paclitaxel is a second-line treatment option recommended for patients with locally advanced unresectable or metastatic gastroesophageal junction (GEJ) or gastric adenocarcinoma. However, real-world data of large samples focused on ramucirumab plus paclitaxel in gastric cancer are limited. We conducted a nationwide retrospective study to evaluate the efficacy, safety, and factors potentially associated with survival in patients with gastric or GEJ adenocarcinoma who received second-line ramucirumab plus paclitaxel in a real-world setting. Methods: The study population comprised all patients with gastric or GEJ cancer who received ramucirumab plus paclitaxel in South Korea between May 1, 2018, and December 31, 2018. We included patients with advanced gastric or GEJ adenocarcinoma and disease progression after first-line platinum and fluoropyrimidine-containing combination chemotherapy. Results: A total of 1,063 patients with advanced gastric or GEJ adenocarcinoma who received ramucirumab plus paclitaxel were included. The objective response rate and disease control rate were 15.1% and 57.7%, respectively; the median progression-free survival was 4.03 months (95% CI, 3.80–4.27), and the median overall survival was 10.3 months (95% CI, 9.33–10.73). The common treatment-related adverse events (TRAEs) at any grade were neutropenia (44.7%), anemia (41.8%), neuropathy (29.1%), fatigue (25.9%), and anorexia (25.0%). Grade 3 or higher TRAEs with incidences of ≥5% were neutropenia (35.1%) and anemia (10.5%). Adverse events of special interest were infrequent, including hypertension (2.1%) and proteinuria (3.0%). Based on multivariate analysis, overall survival was negatively associated with Eastern Cooperative Oncology Group performance status ≥2, weight loss in the previous 3 months ≥10%, GEJ of primary tumor, poor or unknown histology grade, number of metastatic sites ≥3, presence of peritoneal metastasis, no prior gastrectomy, and time to second-line since first-line treatment < 6 months. Conclusions: Our large-scale, nationwide, real-world data analysis of an unselected real-world population added evidence for the efficacy and safety of second-line ramucirumab plus paclitaxel in patients with locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma. Clinical trial information: NCT04192734.
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Affiliation(s)
- Dae Young Zang
- Hallym University Sacred Heart Hospital, Anyang, Korea South
| | - Hye Sook Han
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Bum Jun Kim
- Division of Internal Medicine, National Army Capital Hospital, The Armed Forces Medical Command, Sungnam-Si, South Korea
| | - Hee-Jung Jee
- Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Young Ju Suh
- College of Medicine, Inha University, Incheon, South Korea
| | - Hyonggin An
- College of Medicine, Korea University, Seoul, South Korea
| | - Ji-Hye Byun
- Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Dong Sook Kim
- Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Samsung Medical Center, Department of Medicine, Seoul, South Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Gwang Kim
- Department of Oncology/Hematology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Woo Kyun Bae
- Department of Medical Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - In-Ho Kim
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sun Jin Sym
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - So Yeon Oh
- Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Hyeong Su Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Keun Wook Lee
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min-Hee Ryu
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kim M, Hong JH, Park SK, Kim SJ, Lee JH, Byun JH, Ko YH. Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer: Two case reports. World J Clin Cases 2020; 8:4858-4865. [PMID: 33195654 PMCID: PMC7642552 DOI: 10.12998/wjcc.v8.i20.4858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carotid blowout syndrome (CBS) is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall. It is a life-threatening clinical situation. There is no established and effective mode of management of CBS. Furthermore, there is no established preceding sign or symptom; therefore, preventive efforts are not clinically meaningful.
CASE SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy (CRT) using three-dimensional conformal intensity-modulated radiation therapy. Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT. After completing CRT, both of them achieved complete remission. Subsequently, they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin. However, continuous follow-up imaging studies showed no evidence of cancer recurrence. Eleven to twelve months after completing CRT, the patients visited the emergency room complaining about massive oronasal bleeding. Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side. Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization, both patients died because of repeated bleeding from the pseudoaneurysms.
CONCLUSION In patients with persistent pain in irradiated sites, clinicians should be suspicious of progressing or impending CBS, even in the three-dimensional conformal intensity-modulated radiation therapy era.
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Affiliation(s)
- Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 403720, South Korea
| | - Ji Hyung Hong
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, South Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Sook Jung Kim
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
| | - Jung Hwi Lee
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
| | - JH Byun
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Eun-pyeoung St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
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Abstract
Osteoporosis is a chronic disease that requires continuous health care spending for pharmacotherapy and examinations. Osteoporotic fractures are a major economic burden. However, little is known about the economic effects of osteoporosis and osteoporotic fractures in Korea.The purpose of this study was to determine the predictors of osteoporosis-related health care costs and to evaluate the economic effects of fracture prevention through medication adherence among osteoporosis patients.Using the Korea National Health Insurance Claims Database (KNHICD), we identified osteoporosis patients aged 50 years and older from 2011 to 2012. Annual health care costs of osteoporosis were analyzed from the insurer's perspective and compared between patients with fractures and those without fractures. Adherents were defined as patients with a medication possession ratio of ≥80%. A generalized linear model (GLM) was used to estimate the predictors of osteoporosis-related health care costs.The major predictors of osteoporosis-related health care costs were age, medication adherence, and the occurrence of fractures (P < .001). The proportion of fractures among non-adherents was approximately 1.1 times the proportion among adherents. Health care costs per patient with fractures were 3.8 times the costs per patient without fractures. Patients with fractures had higher health care costs due to hospitalization and outpatient costs but lower pharmacy costs than non-adherents. We estimated that about $5 million of health insurance expenses could be saved annually if all non-adherents became adherents.Improved osteoporosis medication adherence can reduce osteoporosis-related health care costs by preventing fractures. Persistent pharmacotherapy for osteoporosis is necessary to prevent osteoporotic fractures and to reduce osteoporosis-related health care costs.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
| | - Ji-Hye Byun
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Inmyung Song
- College of Pharmacy, Sungkyunkwan University, Suwon
| | - Ha Y. Kim
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine
| | - Tae-Young Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon
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Byun JH, Jang S, Lee S, Park S, Yoon HK, Yoon BH, Ha YC. The Efficacy of Bisphosphonates for Prevention of Osteoporotic Fracture: An Update Meta-analysis. J Bone Metab 2017; 24:37-49. [PMID: 28326300 PMCID: PMC5357611 DOI: 10.11005/jbm.2017.24.1.37] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The efficacy of bisphosphonates for osteoporotic fracture has been consistently reported in recent randomized controlled trials (RCTs) enrolling hundreds of patients. The objective of this study was to update knowledge on the efficacy of available bisphosphonates in the prevention of vertebral and non-vertebral fractures. METHODS An approach "using systematic reviews" on PubMed and Cochrane Library was taken. Twenty-four RCTs investigating the effects of bisphosphonates for the prevention of osteoporotic fracture were included in final analysis. A pairwise meta-analysis was conducted with a random effects model. Subgroup analysis was performed according to the type of bisphosphonate. RESULTS The use of bisphosphonate decrease the risk of overall osteoporotic fracture (odds ratio [OR] 0.62; P<0.001), vertebral fracture (OR 0.55; P<0.001) and non-vertebral fracture (OR 0.73; P<0.001). Subgroup analysis indicated that zoledronic acid showed the lowest risk reduction (OR 0.61; P<0.001) for overall osteoporotic fractures but no significance was observed for etidronate (OR 0.34; P=0.127). CONCLUSIONS This update meta-analysis re-confirmed that bisphosphonate use can effectively reduce the risk of osteoporotic fracture. However, there is a lack of evidence regarding etidronate for the prevention of osteoporotic fracture.
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Affiliation(s)
- Ji-Hye Byun
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Sumin Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Suyeon Park
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hyun Koo Yoon
- Department of Internal Medicine, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Kwon SH, Park SK, Byun JH, Lee EK. Eliciting societal preferences of reimbursement decision criteria for anti cancer drugs in South Korea. Expert Rev Pharmacoecon Outcomes Res 2017; 17:411-419. [PMID: 28019130 DOI: 10.1080/14737167.2017.1277144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In order to look beyond the cost-effectiveness analysis, this study used a multi-criteria decision analysis (MCDA), which reflects societal values with regard to reimbursement decisions. This study aims to elicit societal preferences of the reimbursement decision criteria for anti cancer drugs from public and healthcare professionals. METHODS Eight criteria were defined based on a literature review and focus group sessions: disease severity, disease population size, pediatrics targets, unmet needs, innovation, clinical benefits, cost-effectiveness, and budget impacts. Using quota sampling and purposive sampling, 300 participants from the Korean public and 30 healthcare professionals were selected for the survey. Preferences were elicited using an analytic hierarchy process. RESULTS Both groups rated clinical benefits the highest, followed by cost-effectiveness and disease severity, but differed with regard to disease population size and unmet needs. Innovation was the least preferred criteria. CONCLUSIONS Clinical benefits and other social values should be reflected appropriately with cost-effectiveness in healthcare coverage. MCDA can be used to assess decision priorities for complicated health policy decisions, including reimbursement decisions. It is a promising method for making logical and transparent drug reimbursement decisions that consider a broad range of factors, which are perceived as important by relevant stakeholders.
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Affiliation(s)
- Sun-Hong Kwon
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Sun-Kyeong Park
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Ji-Hye Byun
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
| | - Eui-Kyung Lee
- a School of Pharmacy , Sungkyunkwan University , Suwon , South Korea
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Byun JH, Kwon SH, Ha JH, Lee EK. A benefit–risk assessment model for statins using multicriteria decision analysis based on a discrete choice experiment in Korean patients. Ther Clin Risk Manag 2016; 12:965-74. [PMID: 27358567 PMCID: PMC4912313 DOI: 10.2147/tcrm.s100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The benefit–risk balance for drugs can alter post approval owing to additional data on efficacy or adverse events. This study developed a quantitative benefit–risk assessment (BRA) model for statins using multicriteria decision analysis with discrete choice experiments and compared a recent BRA with that at the time of approval. Patients and methods Following a systematic review of the literature, the benefit criteria within the statin BRA model were defined as a reduction in the plasma low-density lipoprotein cholesterol level and a reduction in myocardial infarction incidence; the risk criteria were hepatotoxicity (Liv) and fatal rhabdomyolysis (Rha). The scores for these criteria were estimated using mixed treatment comparison methods. Weighting was calculated from a discrete choice experiment involving 203 Korean patients. The scores and weights were integrated to produce an overall value representing the benefit–risk balance, and sensitivity analyses were conducted. Results In this BRA model, low-density lipoprotein (relative importance [RI]: 37.50%) was found to be a more important benefit criterion than myocardial infarction (RI: 35.43%), and Liv (RI: 16.28%) was a more important risk criterion than Rha (RI: 10.79%). Patients preferred atorvastatin, and the preference ranking of cerivastatin and simvastatin was switched post approval because of the emergence of additional risk information related to cerivastatin. Conclusion A quantitative statin BRA model confirmed that the preference ranking of statins changed post approval because of the identification of additional benefits or risks.
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Affiliation(s)
- Ji-Hye Byun
- School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, South Korea
| | - Ji-Hye Ha
- Ministry of Food and Drug Safety, Cheongju-si, Chungcheongbuk-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, South Korea
- Correspondence: Eui-Kyung Lee, School of Pharmacy, Sungkyunkwan University, 300 Cheonchoen-dong, Jangan-gu, Suwon-si, Gyeonggi-do 440-746, South Korea, Tel +82 31 290 7786, Fax +82 31 299 4379, Email
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Byun JH, Kwon SH, Lee JE, Cheon JE, Jang EJ, Lee EK. Comparison of benefit-risk preferences of patients and physicians regarding cyclooxygenase-2 inhibitors using discrete choice experiments. Patient Prefer Adherence 2016; 10:641-50. [PMID: 27175064 PMCID: PMC4854248 DOI: 10.2147/ppa.s98228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To elucidate and compare benefit-risk preferences among Korean patients and physicians concerning cyclooxygenase-2 (Cox-2) inhibitor treatments for arthritis. MATERIALS AND METHODS Subjects included 100 patients with arthritis and 60 board-certified orthopedic surgeon physicians in South Korea. Through a systematic review of the literature, beneficial attributes of using Cox-2 inhibitors were defined as a decrease in the Western Ontario and McMaster Universities Arthritis Index for pain score and improvement in physical function. Likewise, risk attributes included upper gastrointestinal (GI) complications and cardiovascular (CV) adverse events. Discrete choice experiments were used to determine preferences for these four attributes among Korean patients and physicians. Relative importance and maximum acceptable risk for improving beneficial attributes were assessed by analyzing the results of the discrete choice experiment by using a conditional logit model. RESULTS Patients ranked the relative importance of benefit-risk attributes as follows: pain reduction (35.2%); physical function improvement (30.0%); fewer CV adverse events (21.5%); fewer GI complications (13.4%). The physicians' ranking for the same attributes was as follows: fewer CV (33.5%); pain reduction (32.4%); fewer GI complications (18.1%); physical function improvement (16.0%). Patients were more willing than physicians to accept risks when pain improved from 20% or 45% to 55% and physical function improved from 15% or 35% to 45%. CONCLUSION We confirmed that patients and physicians had different benefit-risk preferences regarding Cox-2 inhibitors. Patients with arthritis prioritized the benefits of Cox-2 inhibitors over the risks; moreover, in comparison with the physicians, arthritis patients were more willing to accept the trade-off between benefits and risks to achieve the best treatment level. To reduce the preference gap and achieve treatment goals, physicians must better understand their patients' preferences.
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Affiliation(s)
- Ji-Hye Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ji-Eun Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ji-Eun Cheon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Eun-Jin Jang
- Information Statistics, Andong National University, Andong, Gyeongsangbuk-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- Correspondence: Eui-Kyung Lee, School of Pharmacy, Sungkyunkwan University, 300 Cheonchoen-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746, South Korea, Tel +82 31 290 7786, Fax +82 31 299 4379, Email
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Song YG, Byun JH, Hwang SY, Kim CW, Shim SG. Use of vertebral body units to locate the cavoatrial junction for optimum central venous catheter tip positioning. Br J Anaesth 2015; 115:252-7. [PMID: 26170349 DOI: 10.1093/bja/aev218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Central venous catheter (CVC) placement plays an important role in clinical practice; however, optimal positioning of the CVC tip remains a controversial issue. The objective of this study was to evaluate the use of vertebral body unit (VBUs), to locate the cavoatrial junction (CAJ), for optimal CVC tip placement based on chest radiography (CXR) using the carina as a landmark. METHODS 524 patients who underwent coronary computed tomographic angiography (CTA) and CXR were included. The position of the CAJ was identified using VBUs, and the efficacy of VBUs for locating the CAJ with the carina as a landmark was analysed using multiple regression analysis. A VBU was defined as the distance between two adjacent vertebral bodies, including the inter-vertebral disk space. RESULTS The mean (sd) distance from the carina to the superior CAJ was 54.3 (9.7) mm on CTA; the mean distance in VBUs at the level of the carina was 21.4 (1.7) mm on CTA and 22.6 (2.1) mm on CXR. The mean CAJ position was 2.5 VBUs below the carina on CTA and 2.4 VBUs below on CXR with 95% limits of agreement between -0.6 and +0.3. CONCLUSIONS The position of the CVC tip in relation to the carina can be described using the thoracic spine as an internal ruler, and the position of the CAJ in adults was reliably estimated to be 2.4 VBUs below the carina. CLINICAL TRIAL REGISTRATION KCT0001319.
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Affiliation(s)
- Y G Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - J H Byun
- Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - S Y Hwang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - C W Kim
- Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
| | - S G Shim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University, School of Medicine, Changwon, South Korea
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Lee MY, Park SK, Park SY, Byun JH, Lee SM, Ko SK, Lee EK. Cost-effectiveness of Tofacitinib in the Treatment of Moderate to Severe Rheumatoid Arthritis in South Korea. Clin Ther 2015; 37:1662-76.e2. [PMID: 26243076 DOI: 10.1016/j.clinthera.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE This study evaluated the cost-effectiveness of introducing tofacitinib, an oral Janus kinase inhibitor, to the treatment of Korean patients with rheumatoid arthritis (RA) and an inadequate response to conventional disease-modifying antirheumatic drugs. METHODS In this cost-utility analysis model, patients transitioned through treatment sequences based on Korean guidelines for RA patients with inadequate response to conventional disease-modifying antirheumatic drugs. Lifetime health-related quality of life and costs were evaluated. Characteristics of the model cohort were based on those reported by the Oral Rheumatoid Arthritis phase 3 triaL (ORAL) Standard randomized Controlled trial of tofacitinib or adalimumab versus placebo. Efficacy was assessed using American College of Rheumatology response rates, converted to the changes in Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, based on tofacitinib clinical trials data. Published clinical trial data on discontinuation rates of the indicated drugs were incorporated in the model. The HAQ-DI scores were mapped onto utility values to calculate outcomes in terms of quality-adjusted life-years (QALYs); HAQ-DI-to-utility (EuroQoL 5D) mapping was based on data from 5 tofacitinib clinical trials. Costs were analyzed from a societal perspective, with values expressed in 2013 Korean won (KRW). Cost-effectiveness is presented in terms of incremental cost-effectiveness ratios (ICERs). One-way sensitivity analyses were performed to assess the robustness of the model. FINDINGS First-line tofacitinib used before the standard of care (base-case analysis) increased both treatment costs and QALYs gained versus the standard-of-care treatment sequence, resulting in an ICER of KRW 13,228,910 per QALY. Tofacitinib also increased costs and QALYs gained when incorporated as a second-, third-, or fourth-line therapy. The inclusion of first-line tofacitinib increased the duration of active immunomodulatory therapy from 9.4 to 13.2 years. Tofacitinib-associated increases in costs were attributable to the increased lifetime drug costs. In sensitivity analyses, variations in input parameters and assumptions yielded ICERs in the range of KRW 6,995,719 per QALY to KRW 37,450,109 per QALY. IMPLICATIONS From a societal perspective, the inclusion of tofacitinib as a treatment strategy for moderate to severe RA is cost-effective; this conclusion was considered robust based on multiple sensitivity analyses. The study was limited by the lack of clinical data on follow-up therapy after tofacitinib administration and a lack of long-term data on discontinuation of drug use.
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Affiliation(s)
- Min-Young Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Sun-Kyeong Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Sun-Young Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Ji-Hye Byun
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Sang-Min Lee
- Health and Value Department, Pfizer Pharmaceuticals Korea Ltd, Seoul, South Korea
| | - Su-Kyoung Ko
- Health and Value Department, Pfizer Pharmaceuticals Korea Ltd, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea.
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Byun JH, Kwon SH, Ha JH, Lee EK. A Comparison of Preferences for the Benefits and Risks of Statins Among Korean Physicians and Patients Using a Discrete-Choice Experiment. Value Health 2014; 17:A757. [PMID: 27202760 DOI: 10.1016/j.jval.2014.08.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J H Byun
- Sungkyunkwan University, Suwon, South Korea
| | - S H Kwon
- Sungkyunkwan University, Suwon, South Korea
| | - J H Ha
- Ministry of Food and Drug Safety, Chungcheongbuk-do, South Korea
| | - E K Lee
- Sungkyunkwan University, Suwon, South Korea
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Kim HL, Lee MY, Park SY, Park SK, Byun JH, Kwon S, Lee EK. Comparative effectiveness of cycling of tumor necrosis factor-α (TNF-α) inhibitors versus switching to non-TNF biologics in rheumatoid arthritis patients with inadequate response to TNF-α inhibitor using a Bayesian approach. Arch Pharm Res 2014; 37:662-70. [DOI: 10.1007/s12272-014-0337-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/10/2014] [Indexed: 01/27/2023]
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Kim YJ, Chung DJ, Byun JH, Kim YS. Metastatic acinar cell carcinoma of the liver from a benign-appearing pancreatic lesion: a mimic of hepatocellular carcinoma. Br J Radiol 2011; 84:e151-3. [PMID: 21750130 DOI: 10.1259/bjr/26942051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acinar cell carcinoma (ACC) is a rare pancreatic tumour with a favourable prognosis compared with the more common ductal adenocarcinoma. The radiological findings of this tumour have been described in the literature; however, only limited data are available regarding the metastatic features of ACC of the liver, the most common metastatic site. We report a case of ACC of the pancreas with a hepatic metastasis from a benign-appearing malignant pancreatic lesion.
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Affiliation(s)
- Y J Kim
- Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Choi SA, Lee SS, Jung IH, Kim HA, Byun JH, Lee MG. The effect of gadoxetic acid enhancement on lesion detection and characterisation using T₂ weighted imaging and diffusion weighted imaging of the liver. Br J Radiol 2010; 85:29-36. [PMID: 21123305 DOI: 10.1259/bjr/12929687] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T(2) weighted and diffusion weighted (DW) images. METHODS A total of 63 consecutive patients underwent T(2) weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T(2) weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions ≥ 1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations. RESULTS For both T(2) weighted and DW images, the accuracies for detecting focal lesions (p ≥ 0.52) and those for lesion characterisation (p ≥ 0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p=0.02), although the difference was not significant for T(2) weighted imaging (p=0.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p=0.75). CONCLUSION The acquisition of T(2) weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images.
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Affiliation(s)
- S A Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Hong HS, Byun JH, Won HJ, Kim KW, Lee SS, Lee MG, Yun SC. Characterization of liver metastases: the efficacy of biphasic magnetic resonance imaging with ferucarbotran-enhancement. Clin Radiol 2010; 65:701-7. [PMID: 20696297 DOI: 10.1016/j.crad.2010.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 04/19/2010] [Accepted: 04/25/2010] [Indexed: 11/26/2022]
Abstract
AIM To retrospectively evaluate the efficacy of biphasic magnetic resonance imaging (MRI) of the liver with ferucarbotran-enhancement for the characterization of hepatic metastases. MATERIALS AND METHODS Thirty-six patients underwent MRI of the liver with separate acquisition of double-contrast enhancement consisting of gadolinium and ferucarbotran. A total of 106 focal hepatic lesions (51 metastases, 31 cysts, 23 haemangiomas, and one eosinophilic abscess) were included. Two sets of MRI were analysed: (1) ferucarbotran set: ferucarbotran-enhanced T1-weighted (T1W) dynamic imaging combined with ferucarbotran-enhanced T2*-weighted (T2*W) delayed imaging and (2) double set: gadolinium-enhanced T1W dynamic imaging combined with ferucarbotran-enhanced T2*W delayed imaging. The diagnostic accuracy of the two sets was evaluated using alternative free-response receiver operating characteristic curve analysis. Sensitivity and specificity were compared using the McNemar test. The enhancement pattern of focal hepatic lesions was analysed on gadolinium and ferucarbotran-enhanced T1W dynamic imaging. RESULTS There was no significant difference in the accuracy of characterizing hepatic metastases between the two sets. Sensitivity and specificity were not significantly different between the sets (p>0.05). Peripheral rim enhancement was exhibited in 57% of metastatic lesions on ferucarbotran-enhanced T1W dynamic imaging. The majority (96%) of hepatic haemangiomas demonstrated typical peripheral nodular enhancement with progression on ferucarbotran-enhanced T1W dynamic imaging and were easily differentiated from metastases. CONCLUSION Biphasic MRI of the liver with ferucarbotran-enhancement alone provided comparable diagnostic efficacy to double-contrast MRI for the characterization of hepatic metastases.
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Affiliation(s)
- H S Hong
- Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
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Yoon SE, Byun JH, Kim KA, Kim HJ, Lee SS, Jang SJ, Jang YJ, Lee MG. Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings. Br J Radiol 2009; 83:318-26. [PMID: 19620175 DOI: 10.1259/bjr/69770140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n = 7, 58%) or cystic necrosis (n = 5, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n = 6, 86%) and eccentric locations (n = 6), whereas most cystic necroses had irregular margins (n = 4, 80%) and centric locations (n = 4). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations.
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Affiliation(s)
- S E Yoon
- Departments of Radiology, University of Ulsan College of Medicine,Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea
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Kim HJ, Byun JH, Lee SS, Park SH, Lee MG, Kim MH, Yu ES. Metachronous multi-organ lesions in a jaundiced patient. Gut 2008; 57:1297, 1299. [PMID: 18719140 DOI: 10.1136/gut.2007.138529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- H J Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap2-dong, Songpa-gu, Seoul, 138-736, Korea
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Hong HS, Ha HK, Won HJ, Byun JH, Shin YM, Kim AY, Kim PN, Lee MG, Lee GH, Kim MJ. Gastric schwannomas: radiological features with endoscopic and pathological correlation. Clin Radiol 2008; 63:536-42. [PMID: 18374717 DOI: 10.1016/j.crad.2007.05.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2006] [Revised: 05/17/2007] [Accepted: 05/31/2007] [Indexed: 02/08/2023]
Abstract
AIM To describe the radiological, endoscopic, and pathological findings of gastric schwannomas in 16 patients. MATERIALS AND METHODS The radiological, endoscopic, and pathological findings of 16 surgically proven cases of gastric schwannoma were retrospectively reviewed. All patients underwent computed tomography (CT) and four patients were evaluated with upper gastrointestinal series. Two radiologists reviewed the CT and upper gastrointestinal series images by consensus with regard to tumour size, contour, margin, and growth pattern, the presence or absence of ulcer, cystic change, and the CT enhancement pattern. Endoscopy was performed in eight of these 16 patients. Six patients underwent endoscopic ultrasonography. Pathological specimens were obtained from and reviewed in all 16 patients. Immunohistochemistry was performed for c-kit, CD34, smooth muscle actin, and S-100 protein. RESULTS On radiographic examination, gastric schwannomas appeared as submucosal tumours with the CT features of well-demarcated, homogeneous, and uncommonly ulcerated masses. Endoscopy with endoscopic ultrasonography demonstrated homogeneous, submucosal masses contiguous with the muscularis propria in all six examined cases. On pathological examination, gastric schwannomas appeared as well-circumscribed and homogeneous tumours in the muscularis propria and consisted microscopically of interlacing bundles of spindle cells. Strong positivity for S-100 protein was demonstrated in all 16 cases on immunohistochemistry. CONCLUSION Gastric schwannomas appear as submucosal tumours of the stomach and have well-demarcated and homogeneous features on CT, endoscopic ultrasonography, and gross pathology. Immunohistochemistry consistently reveals positivity for S-100 protein in the tumours.
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Affiliation(s)
- H S Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seodaemoon-gu, Seoul, Korea
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Choi E, Byun JH, Park BJ, Lee MG. Duplication of the extrahepatic bile duct with anomalous union of the pancreaticobiliary ductal system revealed by MR cholangiopancreatography. Br J Radiol 2007; 80:e150-4. [PMID: 17704313 DOI: 10.1259/bjr/50929809] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
MR cholangiopancreatography (MRCP) is a valuable, non-invasive tool for accurate examination of the biliary system. We report a case in which MRCP played a critical role in the diagnosis of a duplication of the extrahepatic bile duct with anomalous union of the pancreaticobiliary ductal system in a patient with hilar cholangiocarcinoma. This variant of a duplication of the extrahepatic biliary system has not been described previously in the literature.
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Affiliation(s)
- E Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, 138-736 Seoul, Korea
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Lim HK, Byun JH, Park SH, Jang SJ, Lee MG. Choledochal diverticulum with mucin-secreting mucinous hyperplasia. Clin Radiol 2007; 62:281-4. [PMID: 17293224 DOI: 10.1016/j.crad.2006.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 11/01/2006] [Accepted: 11/09/2006] [Indexed: 02/07/2023]
Affiliation(s)
- H-K Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea
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Ahn JE, Byun JH, Ko MS, Park SH, Lee MG. Case report: neuroendocrine carcinoma of the gallbladder causing hyperinsulinaemic hypoglycaemia. Clin Radiol 2007; 62:391-4. [PMID: 17331836 DOI: 10.1016/j.crad.2006.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 11/18/2006] [Accepted: 11/24/2006] [Indexed: 01/12/2023]
Affiliation(s)
- J E Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
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Kim YK, Seo IS, Jung NC, Kim JY, Byun JH. Status analysis and strategic framework for sanitation management in Asia and Africa. Water Sci Technol 2007; 56:25-31. [PMID: 17881834 DOI: 10.2166/wst.2007.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Following rapid population increase and industrial development, the ever increasing environmental pollution and the associated sanitation-related problem are no longer regional or local but have become an issue requiring global-dimensional concern and the provision of problem-solving alternatives. Especially, since most problems result from inappropriate sewerage and the lack of sewage treatment system are in a serious state occurring in economically underdeveloped regions, and as such, their significance is enormous. The United Nations Environment Programme (UNEP) has been making efforts to establish the technology selection methodology applicable in developing countries, through the accurate status, investigation and analysis of the wastewater management state in Asian and African regions, and the sanitation management guideline utilisable by political leaders or decision-makers. As part of this effort, the Korea Institute of Water Environment (KIWE), together with the UNEP, selected China and Vietnam (in Asia) and Kenya and Ethiopia (in Africa) as subject countries to investigate and perform on-site sanitation management investigations and analysis in this research. Results obtained from the on-site investigation were analysed, and in order to be helpful in establishing a strategy for sanitation management in underdeveloped countries, the strategic framework (SF) has been made based on characterised results.
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Affiliation(s)
- Y K Kim
- Korea Institute of Water and Environment, 462-1 Jeomin-dong, Yusung-gu, Daejeon, 305-730, Korea.
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Abstract
Sclerosing lipogranuloma is a rare, benign disease which is a peculiar granulomatous reaction of fatty tissue. This disease affects multiple organs and the majority of cases are secondary to exogenous foreign bodies. The authors report a case of primary sclerosing lipogranuloma of the rectum mimicking a submucosal rectal tumour.
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Affiliation(s)
- H-K Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea
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Sohn JH, Byun JH, Park SH, Yoon SE, Kim KW, Hong HS, Han JK, Ryu JS, Won HJ, Kim AY, Shin YM, Kim PN, Ha HK, Lee MG. Abdominal cavernous Iymphangiomas: CT findings. ACTA ACUST UNITED AC 2005; 30:689-93. [PMID: 16245018 DOI: 10.1007/s00261-005-0326-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Two adult patients with histopathologically proved cavernous lymphangiomas and one adult patient with lymphangiomas of strongly presumed cavernous type by cytologic and computed tomographic findings are reported. On computed tomograms, multiple, aggregated, small, and tiny cysts without a solid portion, along the lymphatic channels are characteristic computed tomographic findings for cavernous lymphangiomas.
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Affiliation(s)
- J-H Sohn
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
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Ahn JR, Byun JH, Koh H, Rotenberg E, Kevan SD, Yeom HW. Mechanism of gap opening in a triple-band Peierls system: in atomic wires on Si. Phys Rev Lett 2004; 93:106401. [PMID: 15447426 DOI: 10.1103/physrevlett.93.106401] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Indexed: 05/22/2023]
Abstract
One dimensional (1D) metals are unstable at low temperature undergoing a metal-insulator transition coupled with a periodic lattice distortion, a Peierls transition. Angle-resolved photoemission study for the 1D metallic chains of In on Si(111), featuring a metal-insulator transition and triple metallic bands, clarifies in detail how the multiple band gaps are formed at low temperature. In addition to the gap opening for a half-filled ideal 1D band with a proper Fermi surface nesting, two other quasi-1D metallic bands are found to merge into a single band, opening a unique but k-dependent energy gap through an interband charge transfer. This result introduces a novel gap-opening mechanism for a multiband Peierls system where the interband interaction is important.
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Affiliation(s)
- J R Ahn
- Center for Atomic Wires and Layers, Yonsei University, Seoul 120-749, Korea
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Kim I, Park S, Kim BK, Chang HM, Bang SM, Byun JH, Kim DJ, Min WS, Kim HJ, Kim CC. Allogeneic bone marrow transplantation for chronic myeloid leukemia: a retrospective study of busulfan-cytoxan versus total body irradiation-cytoxan as preparative regimen in Koreans. Clin Transplant 2001; 15:167-72. [PMID: 11389706 DOI: 10.1034/j.1399-0012.2001.150304.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
From January 1990 to December 1997, 53 Korean patients with chronic myeloid leukemia (CML) receiving bone marrow transplantation (BMT) from human leucocyte antigen (HLA)-identical sibling donors conditioned with either busulfan and cyclophosphamide (BU/CY regimen) or total body irradiation and cyclophosphamide (TBI/CY regimen) were compared retrospectively. Transplantation-related mortality was 19% in BU/CY and 12% in TBI/CY, and early death (<100 d) occurred in 3 patients conditioned with BU/CY. Grade II-IV acute graft-versus-host disease (GVHD) was 9% of BU/CY and 52% of TBI/CY patients. Overall incidence of chronic GVHD was 50% of BU/CY and 52% of TBI/CY patients. In patients with chronic phase, 5-yr overall survival was 73% in the BU/CY group compared with 87% in the TBI/CY group (p=NS), and overall disease-free survival was 75% in the BU/CY group and 59% in the TBI/CY group (p=NS). So far, with a median follow-up of 45 months, 11 patients have relapsed; three relapses occurred after BU/CY and 8 after TBI/CY. The actuarial 5-yr relapse rate was 15% after BU/CY, 34% after TBI/CY (p=0.46). For patients transplanted in chronic phase within 1 yr after diagnosis, there was a clear trend for a lower relapse rate in the BU/CY group (5-yr relapse rate 0%) compared with the TBI/CY group (5-yr relapse rate 30%). The BU/CY group had similar BMT-related toxicity and similar overall survival and showed a clear trend of low relapse compared with the TBI/CY group. Therefore, BU/CY is an acceptable alternative for patients with CML during HLA-identical sibling allogeneic BMT.
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Affiliation(s)
- I Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Bang SM, Heo DS, Lee KH, Byun JH, Chang HM, Noh DY, Choe KJ, Bang YJ, Kim SR, Kim NK. Adjuvant doxorubicin and cyclophosphamide versus cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy in premenopausal women with axillary lymph node positive breast carcinoma. Cancer 2000; 89:2521-6. [PMID: 11135211 DOI: 10.1002/1097-0142(20001215)89:12<2521::aid-cncr2>3.0.co;2-f] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This randomized controlled trial was to determine whether a combination chemotherapy regimen that contains anthracycline (doxorubicin and cyclophosphamide [AC]) is superior to the conventional cyclophosphamide, methotrexate, and 5-fluorouracil [CMF] combination in premenopausal women with axillary lymph node positive Stage II breast carcinoma. METHODS Premenopausal women with lymph node positive breast carcinoma were stratified according to age (younger than 35 or 35 years or older) and the number of positive axillary lymph nodes (1-3, 4-9, or >/= 10) and then randomly assigned to receive either doxorubicin 40 mg/m(2) and cyclophosphamide 600 mg/m(2) intravenously (i.v.) every 3 weeks or cyclophosphamide 100 mg/m(2) orally on Days 1 through 14, methotrexate 40 mg/m(2) and 5-fluorouracil 500 mg/m(2) i.v. on Days 1 and 8 every 4 weeks. Both arms were scheduled for six cycles. RESULTS The median follow-up was 57 months. Eighteen of the 55 AC patients developed recurrence compared with 16 of the 69 CMF patients. The corresponding 5-year recurrence free survival rates were 64% and 78%, respectively (P = 0.12). The site of the first recurrence for AC patients was locoregional in 7%, distant in 22%, and combined in 4%. The corresponding data for the CMF arm were 4%, 16%, and 3%, respectively. Six AC patients died compared with 9 CMF patients. The corresponding 5-year survival rates were 90% and 86%, respectively (P = 0.96). More leukopenia (52%, mostly Grade 1-2) occurred in the CMF arm than in the AC arm (33%, P = 0.001), but no febrile episode was accompanied with leukopenia. CONCLUSIONS This study showed no difference between AC and CMF with respect to both disease free and overall survival rates in premenopausal women with axillary lymph node positive breast carcinoma.
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Affiliation(s)
- S M Bang
- Department of Internal Medicine and Surgery, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
One hundred and sixteen Korean adults with biopsy-proven acute viral hepatitis were studied to determine the etiology and the outcome of the disease using paired sera obtained during acute and convalescent phases. The prevalence of acute viral hepatitis A, B, D and non-A non-B were 3.4%, 60.3%, 0.9% and 35.3%, respectively: hepatitis B virus infection was the most common cause and the hepatitis D virus superinfection was almost negligible. Only eleven (26.8%) of 41 patients with AVH NANB were negative for all serological markers of HBV. The rest (73.2%) were positive for at least one HBV marker: HBsAg was positive in 31.7%. Therefore, the presence of HBV serologic markers in the sera does not exclude the diagnosis of AVH NANB in Korea. In patients with acute viral hepatitis B, 27% remained positive for HBsAg. Chronic hepatitis developed in 12.8% and 17% patients with acute hepatitis B and non-A non-B, respectively. Progression to chronic hepatitis in patients with acute viral hepatitis B and non-A non-B occurred more commonly, although statistically not significant, in male sex and in patients who did not have clinical jaundice during the acute phase and who showed bridging necrosis in their liver biopsies. Age did not influence the progression to chronic hepatitis.
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Affiliation(s)
- H S Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
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Kim UB, Doo CJ, Baek SH, Kim JH, Lee HB, Park SK, Byun JH. Natural history and prognostic factors of primary hepatocellular carcinoma: study of 70 untreated patients. Korean J Intern Med 1989; 4:136-41. [PMID: 2562101 PMCID: PMC4534990 DOI: 10.3904/kjim.1989.4.2.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We carried out a study of the clinical courses of 70 untreated patients with primary hepatocellular carcinoma (HCC) in order to evaluate their survival period and the prognostic factors. The median survival was two months. We evaluated ten variables of biochemical parameters and findings of hepatic scintigraphy. Among them, six variables were chosen by univariate analysis. They were serum bilirubin (cut-off value 3.0 mg/dl), alkaline phosphatase (150 IU/ml), aspartate aminotransferase (AST) (200 IU/ml), alanine aminotransferase (ALT) (50 IU/ml), reticuloendothelial (RES) dysfunction (grade 1) and multiplicity of space occupying lesions (SOL). Multivariate analysis identified three variables. The RES dysfunction and multiplicity of SOL by hepatic scintigraphy and bilirubin were considered as important prognostic factors. We found that the functional reservoir of the underlying liver and multiplicity of the origin of the tumor were the most important prognostic factors.
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