According to the research of Krolls and Hoffman 15 , oral cancer frequently strikes those in their 40s-70s. According to Kim et al.’s report 9 , males in their 70s and females in their 60s were affected mostly by oral cancer. In this study, out of all the age distributions of oral cancerpatients, patients in their 50s (11 patients in their 50s with the average)--with average age of 55.5 years (±13.9)--were most affected. There were 11 (29.7%) patients under 40 years and 26 (70.3%) patients over 50 years, resulting in a higher number of older patients. Note, however, that 26- and 28-year-old patients with tongue cancer were observed in these cases as well. It is the form of oral cancer that can affect even a healthier and younger age group as well. Out of the 37 patients, the oldest patient was an 81-year-old male who did not show any recur- rence of the primary site or cervical lymph node metastasis after 1 year since operation but expired due to general weak- ness and respiratory disease; thus, this case was processed as censored data. There were no significant changes in the survivalrateof oral cancerpatients by age group; as factors that can have an effect on the 5-year survivalrate among the elderly and patients who had systemic diseases, however, limitations in choosing the treatment method due to general condition, age, patient-related complications, and deaths caused by associated diseases may be considered 16 .
Yun, et al. Side Effects of Chronotherapy in Patients with Gastric Cancer
실험동물에서 종양이 있을 때, 최대 내성을 보이는 시간 (the time of best tolerance)이 최대 항암 효능을 보이는 시간 (the time of best antitumor efficacy)이라고 보고하고 있다. 14,15 DNA 세포 주기에서 밤 동안에 S상과 G2/M상이 낮에 비 해 적은 비율로 있으므로, 인간의 골수와 피부조직, 구강 점막, 직장점막 등은 0시와 4시 사이에 DNA 합성이 낮 시 간과 비교시 50%이상 감소한다. 16-18 또한, 세포 내의 5-FU 의 대사에 관여하는 인체의 단핵세포의 dihydropyrimidine dehydrogenase 활성도가 0시 부근에서 40% 정도 증가된다. 8 따라서 0시와 4시 사이에 항암화학요법을 시행한다면 골수 감수성이 감소하며, 약물에 대한 내성은 증가하고 약물 효 과는 증대될 것으로 기대된다. Chronotherapy는 0시에서 4시 사이에 DNA 합성이 8시에서 20시 사이보다 낮으며 5-FU 의 대사에 관여하는 dihydropyrimidine dehydrogenase의 활성 도가 하루 중 0시 부근에서 증가한다는 데 착안하였다. 8
gated prognostic factors which affect cancer‑specific CS rate to provide more accurate survival information.
Methods: Between 2004 and 2013, a total of 9760 patients with GB cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) data. The 3‑year cancer‑specific CS rate was calculated using the covariate‑
adjusted survival function in the Cox model for each year since diagnosis, and the results were analyzed together with the adjusted CSS rates at the same time points. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with CSS rate at diagnosis and cancer‑specific CS rates at 1, 3, and 5 years after diagnosis.
There has been a controversy regarding initiation of dialysis in very elderly patients. Although a randomized controlled study is the most reliable and informative method of comparing outcomes between conservative care and dialysis initiation, such a trial is difficult to perform due to ethical concerns. When standardized mortality ratios were calculated in comparison with the general population, the ratio for the dialysis patients decreased from 26.7 in the 18- to 44-year-old group to 3.5 in the $85-year-old group, which implicated that older ESRD patients experienced less excess mortality, and age per se is more important factors for mortality in the elderly than in the younger age group . Moreover, elderly patients have various chronic medical diseases concurrently, which have profound effects on their survival . Therefore, very elderly patients may not always be considered as suitable candidates for dialysis. In this study, age and various comorbidities were the main determinants for mortality, which is consistent with previous reports. However, we suggest that the benefit and risk of dialysis initiation should be weighed in each patient because survivalrate for elderly ESRD patients is not dismal in Korea and because the individualization strategy using predictors for mortal- ity is feasible.
showed long-term results of implants following radical head and neck cancer surgery with adjuvant radiation therapy, and the over- all 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Based on the results of the re- search mentioned above, it was concluded that radiotherapy was the essential cause of implant failure. Irradiation can produce both early and late tissue changes. Early effects include those on the salivary glands, skin, and oral mucosa, whereas later effects involve bone changes leading to demineralization, fibrosis, increased sus- ceptibility to infection, and finally, avascular necrosis [16-18]. Thus, the treatments against the changes in the soft and hard tissues af- ter radiotherapy are meaningful for the success of dental implants in patients with head and neck cancer.
Histological type is a prognostic factor for patientsof epi- thelial ovarian carcinomas [30,31]. Our data showed the 10- year survivalofpatients with mucinous, endometrioid or clear cell carcinoma was better than those of serous carcinoma, undifferentiated carcinoma or carcinosarcoma. It provided evidence to the current hypothesis of carcinogenesis of ovar- ian carcinoma. The type I tumors, including mainly mucinous, endometrioid, clear cell, and Brenner carcinomas, generally have an indolent behavior and favorable prognosis than the type II tumors consisting of high-grade serous carcinoma, undifferentiated carcinoma, and carcinosarcoma. Although the current managements for epithelial ovarian carcinoma were similar regardless different histological types, the modification of the treatments based on the histological types is necessary especially for patients with undifferentiated carcinoma or carci- nosarcoma because of their poorer outcome. Interestingly, the survivalof serous carcinoma dropped after 2 year follow-up, it might reflect the higher risk of recurrence and disease progres- sion of serous carcinoma within two years after diagnosis.
Our study had several limitations. First, it was a retrospective study with a small sample size, and the enrolled patients received uncontrolled adjuvant treatments. Particularly, most patients (88.5%) with HER2-positive tumors did not receive anti-HER2 therapy (S2 Fig) because most of the HER2-positive samples were collected prior to 2010 when the use of tras- tuzumab was not reimbursed by the national insurance system in Korea. In addition, there were higher proportions of HER2-positivie and TNBC subtypes in our study than there are in global breast cancer populations, because of selection bias during sample storage and preserva- tion. Despite these limitations, our study comprehensively showed the clinical outcomes based on A20 expression among patients with breast cancer and demonstrated A20 expression as an independent prognostic factor. Furthermore, prognostic discrimination based on A20 expres- sion was pronounced in aggressive tumors, such as HER2-positive and TNBC subtypes. Our findings suggest that A20 may be a valuable target in patients with aggressive breast cancer.
Despite its limitations, this study suggests that the con- founding effect of initial clinical stage on the waiting time and overall survival should be considered when investigat- ing the survival impact of waiting time and should be con- sidered when using this result for formulating or revising national health policy on quality cancer care. Furthermore, evidence for maximum acceptable waiting time is not ad- equate, and further studies are needed. Close monitoring of the treatment delay with the impact of centralization is critical for evaluating policy at the national level.
We noted a few potential limitations. Data were collected retrospectively, and were based on the inherent accuracy of patient records. Therefore, our study may have biases especially with incomplete data collection. For external validation, we used the data of EOC patients from other institution. However, due to the various numbers of variables required, patients without sufficient information were inevitably excluded from the test cohort. These limitations may have led to different characteristics between train and test cohort. There were differences between the training cohort and the external validation cohort except for age, stage, and histology. There were differences in type of treatment between train and test cohort. Although patients with primary debulking surgery and adjuvant chemotherapy were mostly included in both train and test cohort, there were no patients group with neoadjuvant chemotherapy in test cohort. This could lead to differences in survival, and could also affect the accuracy of analysis. However, since it is not comparison study of 2 groups, characteristics of 2 groups are not obligated to be evenly distributed. We think differences between train and test set is allowed, and it may shows generality of the model to work in various patient groups. In development of GB model, second year OS was selected as target for feature selection. It could be limitation of our analysis with expectation of predicting prognosis specifically for only second year OS. Selecting second year OS was not planned based on theoretical background, but performed in the process of obtaining more accurate results. It was selected with highest median AUC ofsurvival prediction among other years, and finally, GB model-guided staging showed more accurate result compared to FIGO staging. Racial and national differences were not considered as the study was performed in the single nation. With regard to the generalizability of this prediction model, validation with other races or other nations may be needed. In our study we used only clinicopathologic information of EOC patients. Lack of genomic data in analysis can be our limitation. Zou et al.  reported algorithm of discriminating cancer types for circulating tumor cells or cell-free DNAs in blood trained and validated on a large dataset with high accuracy. In similar perspective, adding genomic data to further analysis could result in higher accuracy of prognostic prediction. With the GB model, additional clinical information would provide more accurate results compared to the currently used Cox proportional hazards regression analysis. The use of larger-scale studies could potentially yield improved prognostic predictions of the GB model in the future.
Introduction: The survival outcomes and optimal extent of surgery of T2 gallbladder cancers remain controversial. We aimed to in- vestigate the difference in overall/disease-free survival rates and assess the prognosis of T2 gallbladder cancers.
Methods: We retrospectively reviewed electronic medical records of 147 patients who underwent surgical resection for pathologically confirmed T2 gallbladder cancer between January 2003 and December 2012. Patients were categorized into two groups according to the tumor location (T2a vs. T2b) and three groups according to surgery method (simple cholecystectomy, cholecystectomy with lymph node dissection, and extended cholecystectomy). We compared the overall and disease-free survival rates according to T2 subgroups and surgery methods. Cox proportional hazard analysis was performed to evaluate prognostic factors for the overall survivalof T2 gallbladder cancer.
At our institution, the incorporation of NAC resulted in increased optimal cytoreduction rates and a similar rateof AEs despite more radical surgery. There was no significant difference in survival outcomes between the 2 groups, although the rateof radical surgery was typically higher in our institution. Various factors potentially associated with increased extent of debulking surgery should be considered, including NAC and extended surgery for advanced- stage ovarian cancer. Primarily, the use of NAC has improved the cytoreduction rates achievable with IDS by reducing the disease burden [6,7]. Another important factor was the improvement of surgical skills in our institution during the study period. Specifically, we incorporated radical surgeries in an attempt to decrease residual disease at the time of PDS or IDS. Previous studies reported that radical surgery resulted in higher rates of complete gross resection and optimal resection (residual disease ≤1 cm) in advanced ovarian cancer [15,19,20]. At our institution, the rateof radical surgery increased from 35.6% in group 1 patients to 57.5% in group 2 patients.
Despite increased early detection through the develop- ment of preoperative diagnostic tools, greater acceptance of routine health checkups, and increased survivalrate through advanced operative procedures and post-operative care, gallbladder cancer still has a poor prognosis, espe- cially since many patients are inoperable at diagnosis. 3,4 In a study of 724 cases carried out by the French Surgical Association in 1994, the median survival period was 3 months, and 5 year survival rates were 5%. 5 Konstantinidis et al. 6 reported a 40-year follow-up study which showed medial survivalof 3.5 months between 1962 and 1979, 6.5 months between 1980 and 1997, and 12 months between 1998 and 2008. Liang et al. 7 reported a 25 year follow-up study which showed medial survivalof 12.3 months and survival rates at 1 year (50.5%), 3 years (29.5%), and 5 years (26.2%). In our study, com- parable survival rates are 1 year (83.7%), 3 years (67.4%), and 5 years (61.7%).
80% of the liver. 6-9 In general, the median survival period for untreated patients with hepatic metastases from color- ectal cancer is 6-12 months and 12-18 months for patients treated with chemotherapy alone. On the other hand, com- plete resection of detected hepatic metastases results in a 5-year survival for one third ofpatients even in the era that current adjuvant chemotherapy had not been establi- shed. A recent series reported a nearly 60% 5-year surviv- al rate when combined with modern neoadjuvant and ad- juvant chemotherapy and other ablation therapies. 10,11 Many investigators have identified clinical variables that predict long-term survival after hepatic resection in patients with hepatic metastases from colorectal cancer.
3. Statistical analysis
The Fisher exact and Wilcoxon rank-sum tests were used to compare clinical characteristics based on surgical status. Reasons for not undergoing surgery and their frequencies were reported. Overall survival (OS) was defined from date of pathologic diagnosis to death (all- cause) or last follow-up for those still alive. The Kaplan-Meier method was used to estimate the median OS and OS rate. The log-rank test and Cox proportional hazards (CoxPH) model were used to assess the relationship of covariates to outcome. The CoxPH model with time- dependent covariates was applied to variables collected after diagnosis including surgery versus no surgery. This methodology precluded generation ofsurvival curves or estimations of median OS/OS rate by surgical status using the Kaplan-Meier method.
of palliative surgery (extended resection or minimal resection) performed at a single institution.
A retrospective analysis was performed on patients under- going palliative resection for primary tumors for UCRC between 1998 and 2007 at the Chonnam National University Hospital. UCRC is when it is impossible to achieve complete and macroscopically curative resection of metastatic lesions because residual tu mor tissue was present in the surgical field, the presence of malig nant ascites/peritoneal carcinomatosis, and unresectable distant metastases. Patients’ demographics, tumor location, adjuvant therapy, pathologic grade, tumor size, metastases pattern, and the extent of resection were all collected from a database.
effects, resulting in increased use of conservative neck dis- section.
We analyzed 5-year survival rates in order to evaluate the curative effects of different treatments for oral cancer. We confirmed that 12 of 38 patients (31.6%) survived during 1982-1990 13 . Using life table methods, the 5-year survivalrate during 1991-1999 was 54% 14 . In addition, we found that the 5-year survival rates for 1999-2006 and 2007-2011 were 57.7% and 63.5% according to Kaplan-Meier analy- sis, respectively. In this study, we were unable to evaluate treatment modalities between 1982-1999 and choice of neck dissection methods between 1999-2006 as a result of patient charts having been missed or discarded during our transition to electronic medical records. To address this gap, we utilized results from previous studies, which was sufficient to under- stand changes in treatment trends and survival rates. Specifi- cally, the National Cancer Institute reported that the 5-year survivalrateof oral cancer during 2003-2009 was 62.2% 26 . Likewise, the Cancer Research UK reported that the 5-year survivalrate for oral cancer between 1996-1999 was 50% 16 . Together, these findings support the idea that our treatment level and 5-year survivalrate for oral cancer had caught up with those of developed countries.
We culled, treated, and observed patients from 10 gynecologic cancer centers; possibly analyzing clinical outcomes among patients with recurrence may not be equally balanced and objectively represented. However, given the low rateof recurrence in low-risk EC, the study design used here was necessary to achieve a satisfactory sample size. Despite above limitations, our study contributes to the limited body of knowledge associated with OSFR in low-risk recurrent EC.
This correction is being published to correct the errors of sentences and spelling in abstract.
The authors apologize for this error.
Materials and Methods: A total of 105 patients who had 467 Osstem implants that were placed at the Section of Dentistry, Seoul National University Bundang Hospital (Seongnam, Korea) from June 2003 through December 2005 were analyzed. The life table method and a cross-tubulation analysis, log rank test were used to evaluate the survival curve and the influence that the prognostic factors. The prognostic factors, i.e., age and gender ofpatients, diameter and length, type of implants, bone graft history and loading time were determined with a Cox proportional hazard model based on logistic regression analysis.
Although the exact reason why two factors are indepen- dently related to survival after relapse remains to be deter- mined, it is easy to speculate the possible reasons. Time to relapse within one year after primary surgery may largely depend on the aggressive phenotype and resistance to adjuvant chemotherapy of endometrial cancer cells, and multiple sites of recurrence may be related to the metastatic potential of endometrial cancer cells. Therefore, we need to establish a new treatment strategy to efficiently treat patients with recurrent endometrial cancer in addition to currently available treatment modalities including debulking surgery, chemotherapy, and radiotherapy. One of the promising molecular targeting agents is the vascular endothelial growth factor inhibitor, bevacizumab, which has been recently shown to improve progression-free survivalof the patients with ovarian cancer . To search for new molecular markers to predict survival after relapse and/or new molecular targets to improve survival, we need to further investigate the molecular mechanism of chemoresistance and radioresistance in endometrial cancer cells. Cyr61, a member of CCN family, may be a good target because Cyr61 predicts survivalofpatients Fig. 1. Stratificatiion ofsurvivalofpatients with recurrent endometrial
This study has several limitations. First, despite efforts to collect complete and accurate data, a retrospective review ofpatients from a single institution may diminish the reliability and generality of the results. For instance, primary tumor location may be reported differently by different surgeons, especially in cases of rectosigmoid junction tumors. However, a strength of this study is that treatment variability was likely minimized as treatments were performed at a single institution over a relatively short time period (7 years). Second, molecular profiling data for tumors was limited. BRAF and KRAS status was not available, which prevented testing the hypothesis that BRAF and KRAS mutations result in a worse prognosis for stage III RCC patients.