Korean Association for Clinical Oncology
402 32nd World Congress of Internal Medicine (October 24-28, 2014)
OP4-8 Palliative Cancer
A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7
Jin Won Kim1, Se-Hyun Kim1, Yu Jung Kim1, Keun-Wook Lee1, Kwang-Il Kim2, Jong Seok Lee1, Cheol-Ho Kim2, Jee Hyun Kim1
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National Uni- versity Bundang Hospital, Seoul National University College of Medicine, Korea1, Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea2
Background: Geriatric assessment (GA) is recommended to detect multiple problems in older patients with cancer. However, full GA is resource-consuming, necessitating screening tools to select appropriate patients who need full GA.
Methods: To design a novel screening tool, a development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain were selected according to sensitivity (SS) and specifi city (SF). Of the selected items, the fi nal questions were chosen by panels of oncologists and geriatri- cians to encompass all domains and also by feasibility and use with cancer patients.
Screening questions were validated in a separate cohort of 98 cancer patients Results: The median age of patients in the development cohort was 77 y. Abnormal GA, defi ned as defi cits in at least 2 domains, was identifi ed in 71.4% of patients. The KG-7 consisted of 7 items representing each domain. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confi dence interval (CI) 0.92-0.95) in the prediction of abnormal GA. The cut-off value was decided at 5.5 points, with a SS of 95.0%, SF of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73-0.90), and the SS, SF, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed signifi cantly longer overall survival (OS) in the development and validation cohorts.
Conclusions: The KG-7 showed high SS and NPV to predict abnormal GA. The KG-7 also predicted OS. A prospective validation study is underway currently to evaluate the usefulness of the KG-7 as a screening tool in older patients with cancer.
OP4-9 Palliative Cancer
Communication for End-of-Life Care Planning among Korean Patients with Terminal Cancer : A Context – Oriented Model
Sujin Koh1, Shinmi Kim2, JinShil Kim3
University of Ulsan College of Medicine, Ulsan University Hospital, Department of Hematology and Oncology, Korea1, Changwon National University, Department of Nursing, Korea2, Sunchon National University, Department of Nursing, Korea3
Background: Terminally ill patients or those with terminal cancer are often excluded in the loop of end-of-life (EOL) discussion in Korea. Further, healthcare professionals have diffi culty engaging in such communication in a variety of healthcare contexts. A communication model for EOL care planning is demanding in Korea.
To solicit professional opinions on communication with terminal cancer patients and their family caregivers and to develop a communication model for EOL care planning compatible with clinical environment in Korea.
Methods: Using focus group interview, six doctors and fi ve nurses who provide EOL care for terminal cancer patients in acute hospital settings or hospice care facility from distinct provinces of Korea participated in this study.
Results: Five themes emerged regarding EOL care planning that included right time, a responsible professional, preparedness for breaking bad news, content of EOL care dis- cussion, and implementation of EOL care decisions. These themes were based for the development of a communication algorithm for EOL discussion among patients with terminal cancer (Figure 1), in which a structural communication steps for delivering a terminal prognosis was specifi ed at the phase of preparedness beginning with deter- mination of a patient decision-making capability, followed by a patient perception of his/her condition, a patient’s wish to know, family decision-making dynamics, and a patient’s and/or family’s readiness for EOL discussion.
Conclusions: It is suggested that the proposed context-oriented communication al- gorithm be communication supporting guidelines for EOL discussion and accordingly, facilitate meaningful improvements in EOL care in clinical practice.
P-08 Breast Cancer
Prognostic Value of Axillary Nodal Ratio After Neoadjuvant Chemotherapy of AC Followed by Docetaxel: A Multicenter Retrospective Cohort Study
Se Hyun Kim1, Jee Hyun Kim1, Tae-Yong Kim2, In Sil Choi3, Yee Soo Chae4, Sun Kyung Baek5, Seok Yun Kang6, In Hae Park7, Yoon Ji Choi8, Soohyeon Lee9, Joo Hyuk Sohn9, Yeon-Hee Park10, Young-Hyuck Im10, Jin-Hee Ahn11, Sung-Bae Kim11, Kyung Hae Jung11
Seoul National University Bundang Hospital, Korea1, Seoul National University Hospital, Korea2, SMG- SNU Boramae Medical Center, Korea3, Kyungpook National University Hospital, Korea4, Kyung Hee Uni- versity Medical Center, Korea5, Ajou University Hospital, Korea6, National Cancer Center, Korea7, Korea University Anam Hospital, Korea8, Severance Hospital, Korea9, Samsung Medical Center, Korea10, Asan Medical Center, Korea11
Background: The ratio of involved to retrieved lymph nodes (LNR) is suggested as a prognostic factor in operable breast cancer. However, there are confl icting results re- garding its clinical signifi cance after neoadjuvant chemotherapy. We investigated the prognostic value of LNR with a thorough evaluation of potential prognostic factors in a large cohort constructed from Health Insurance Review and Assessment Service database of Korea.
Methods: This retrospective analysis is based on the data of 814 patients with clinical stage II/III breast cancer treated with four cycles of adriamycin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical signifi - cance of the LNR (3 categories: Low, 0-0.20 vs. Intermediate, 0.21-0.65 vs. High, 0.66 -1.00) using Kaplan-Meier method, log-rank test, and Cox proportional hazard regres- sion model.
Results: A total of 799 patients underwent breast surgery (Median age 45, range 16- 74; Mastectomy 369, Lumpectomy 380, and Others 50). Axillary lymph node dissec- tion was performed in 704 (88.1%) patients. Pathologic complete response (pCR) was achieved in 129 (16.1%) of 799 patients (HR+/HER2-, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; TNBC 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range 0-42) and 13.98 (range 1-64), respectively. The mean LNR was 0.17
WCIM 2014 SEOUL KOREA 403
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
(Low, 574 [71.8%]; Intermediate, 170 [21.3%]; High, 55 [6.9%]). In univariate analy- sis, LNR was signifi cantly associated with worse relapse-free survival (3-yr RFS rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; P <0.0001, log-rank test).
In multivariate analysis, LNR was not signifi cantly associated with recurrence after adjustment of other clinical factors (Age, histologic grade, intrinsic subtype, ypT-stage, ypN-stage, lymphatic or vascular invasion, and pCR).
Conclusions: LNR is not superior to ypN-stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy.
P-10 Colorectal Cancer
Activation of YAP1 Is Signifi cantly Associated with Poor Prognosis and Cetuximab Resistance in Colorectal Cancer Patients
Keun-Wook Lee1, Sung Sook Lee2, Sang-Bae Kim2, Yun-Yong Park2, Bo Hwa Sohn2, Hyun-Sung Lee2, Ju-Seog Lee2
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea1, Department of Systems Biology, The University of Texas MD Anderson Cancer Center, USA2
Background: To investigate the clinical signifi cance of activation of YAP1, a newly identifi ed oncogene in colorectal cancer (CRC).
Methods: A gene expression signature refl ecting YAP1 activation was identifi ed in CRC cells, and CRC patients were stratifi ed into two groups according to this signa- ture: activated YAP1 CRC (AYCC) or inactivated YAP1 CRC (IYCC). Stratifi ed patients in six test cohorts were evaluated to determine the effect of the signature on CRC prognosis and response to treatment with cetuximab.
Results: The activated YAP1 signature was associated with poor prognosis for CRC in four independent patient cohorts with stage I-III disease (total n = 1,028). In a mul- tivariate analysis, the impact of the YAP1 signature on the disease-free survival rate was independent of other clinical variables [hazard ratio (HR), 1.63; 95% confi dence interval (CI), 1.25-2.13; P < .001]. In patients with stage IV CRC, AYCC patients had a poorer disease control rate and progression-free survival duration after cetuxi- mab-based monotherapy than did IYCC patients (HR, 1.82; 95% CI, 1.05-3.16; P = .03). In multivariate analysis, the effect of YAP1 activation on PFS was independent of KRAS mutation status and cetuximab-based therapy was effective only in IYCC patients without KRAS mutations.
Conclusions: Activation of YAP1 is highly associated with poor prognosis for CRC and may be useful in identifying patients with CRC resistant to treatment with cetuximab.
P-12 Colorectal Cancer
Analysis of Young-Age Onset Colorectal Cancer in Korea
Jieun Lee1, Myung Ah Lee1, Jun Ki Kim2, Seung Tack Oh2, Won Kyung Kang2 Division of Medical Oncology, Department of Internal Medicine, Colorectal Cancer Center, Seoul St.
Mary’s Hospital; The Catholic University of Korea, Korea1, Department of Surgery; Colorectal Cancer Center, Seoul St. Mary’s Hospital; The Catholic University of Korea, Korea2
Background: The incidence of CRC is increasing in young age patients, but the natural history of young age CRC is not established. In this study, we analyzed the clinical outcomes of CRC arising in young age patient.
Methods: Between Jan.2006 to Jan.2014, 100 CRC patients diagnosed at the age of 10 to 39 were retrospectively analyzed. We reviewed the clinicopathologic character- istics and clinical outcomes (overall survival [OS], disease free survival [DFS]) based on the medical records.
Results: Eighty-six patients were diagnosed as CRC at their thirties. 79% of patients had no family history of cancer at fi rst or second-degree relatives. At initial diagnosis, 62.1%
of patients showed normal CEA level (=3ng/mL). 61% of patients were diagnosed as ad- vanced CRC (stage III 40% and stage IV 21%, respectively). 64% of cancer was located at the sigmoid colon, rectosigmoid junction, or rectum. Among 64 patients, 22 patients (34.4%) had K-ras mutation. Recurrence rate was 7.9% in stage I~III CRC. In patient population, OS was not reached but patients with normal CEA level showed better sur- vival outcome (P = 0.013). Patients with perineural invasion at surgical specimen showed poorer survival (median OS not reached, P=0.011). Mucinous or signet ring cell histology showed inferior outcome (P=0.019, OS not reached). The median OS of stage IV patients were 19 months (range 7.9-60.63), which is shorter than historical data.
Conclusions: Young age CRC was most commonly diagnosed at the thirties, with no familial history, normal range of CEA and located below sigmoid colon. The incidence rate of mucinous and signet ring cell carcinoma was similar to historical data. Stage IV CRC showed inferior OS compared to historical data. Considering the increasing inci- dence of CRC in young age group, active surveillance other than serum CEA level (e.g.
sigmoidoscopy) is warranted.
P-13 Colorectal Cancer
Carbohydrate Antigen 19-9 Levels Associated with Pathological Responses to Preoperative Chemoradiotherapy in Rectal Cancer
Seung-Gu Yeo1, Dae Yong Kim2, Tae Hyun Kim2, Sun Young Kim2, Ji Yeon Baek2, Hee Jin Chang2, Ji Won Park2, Jae Hwan Oh2
Soonchunhyang University Hospital, Korea1, National Cancer Center, Korea2
Background: To investigate whether pretreatment serum carbohydrate antigen 19-9 (CA 19-9) levels are associated with pathological responses to preoperative chemora- diotherapy (CRT) in patients with rectal cancer.
Methods: In total, 260 patients with locally advanced rectal cancer (cT3-4NanyM0) who underwent preoperative CRT and radical surgery were analyzed retrospectively.
CRT consisted of 50.4 Gy pelvic radiotherapy and concurrent chemotherapy. Radical surgery was performed at median 7 weeks after CRT completion. Pathological CRT response criteria included downstaging (ypStage 0-I) and ypT0-1. A discrimination threshold of CA 19-9 level was determined using a receiver operating characteristics analysis.
Results: The median CA 19-9 level was 8.0 (1.0-648.0) U/mL. Downstaging occurred in 94 (36.2%) patients and ypT0-1 in 50 (19.2%). The calculated optimal threshold of CA 19-9 level was 10.2 U/mL for downstaging and 9.0 U/mL for ypT0-1. On multivariate analysis, CA 19-9 (= 9.0 U/mL) was signifi cantly associated with downstaging (odds ratio, 2.089; 95% confi dence interval, 1.189-3.669; P = 0.010) or ypT0-1 (OR, 2.207;
95% CI, 1.079-4.512; P = 0.030), independent of clinical stage or carcinoembryonic antigen.
Conclusions: This study fi rstly showed a signifi cant association of pretreatment serum CA 19-9 levels with pathological CRT responses of rectal cancer. The CA 19-9 levels are suggested to be valuable in predicting CRT responses of rectal cancer before treat- ment.
