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Purpose@#The biggest concern related to ductal carcinoma in situ (DCIS) is local recurrence and recurrence patterns. The purpose of this study was to investigate the relationship between clinicopathological factors and relapse in patients treated with DCIS. @*Methods@#We reviewed medical records of 104 patients who were diagnosed as DCIS between January 1999 and December 2015 at a single institute. We compared and analyzed clinicopathological factors such as age at diagnosis, preoperative lesions on ultrasonography, preoperative tumor markers, operation methods in the breast, histological grade, nuclear grade, resection margin, comedonecrosis, estrogen receptor/ progesterone receptor expression, human epidermal factor receptor 2eu expression, Ki-67, postoperative implementation of adjuvant hormonal therapy, and radiotherapy by dividing them into recurrent and non-recurrent groups. @*Results@#Seventeen patients (16.3%) of 104 patients relapsed in the ipsilateral or contralateral breast. The median follow-up period of non-relapsed group was 4.9 years (range, 0.5–19.15) and the median follow-up period of relapsed group was 3.5 years (range, 1.4–14.13). Clinicopathological factors that were significantly related to relapse were nuclear grade (p=0.022) and Ki-67 (p=0.025) based on the results of chi-square or Fisher’s exact analysis. In multivariate analysis using logistic regression, Ki-67 (p=0.021) was significantly associated with DCIS relapse. @*Conclusion@#This study suggested that the higher Ki-67 over 14% was strongly associated with DCIS relapse.
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Purpose@#The luminal subtype of breast cancer has heterogeneous biological characteristics with respect to the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), and Ki-67. We analyzed luminal B breast cancer subcategorized by PR expression and identified clinically relevant prognostic factors. @*Methods@#We collected the clinical and pathologic data of 247 breast cancer patients (stage 1-4) who were diagnosed with luminal B subtype, defined as ER- and/or PR-positive and/or HER2-positive and with a high Ki-67 proliferation index (>14%). We classified them into PR intact and PR low groups according to PR expression pattern. We also analyzed the clinical and pathological data of each group, including age at diagnosis, tumor size, node metastasis, breast and axillary operative method, margin involvement, tumor-node-metastasis (TNM) stage, histological grade, nuclear grade, number of tumors, and expression of ER, PR, Ki-67, and Bcl-2; evaluated recurrence or metastatic characteristics; and analyzed disease-free survival (DFS) and overall survival (OS) in both groups. @*Results@#Among the 247 luminal B breast cancer patients (stage 1-4), 141 were classified into the PR intact group (57.1%) and 106 into the PR low group (42.9%). The PR low group was associated with age >50 years (p=0.001), low Bcl-2 expression (p<0.001), and high proportion of mastectomies (p<0.001). DFS and OS were significantly lower in the PR low group (p=0.025 and 0.024, respectively). @*Conclusion@#This study showed that decreased in PR expression (PR low group) in luminal B breast cancer was related to poor prognosis compared to normal PR expression (PR intact group).
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Purpose@#Adjuvant chemotherapy (AC) is recommended for patients with stage II colorectal cancer with adverse features. However, the effect of adjuvant treatment in elderly patients with high-risk stage II colorectal cancer remains controversial. This study aimed to investigate the oncologic outcomes in elderly high-risk stage II colorectal cancer patients who underwent curative resection with or without AC. @*Methods@#Patients aged over 70 years having stage II colorectal adenocarcinoma with at least 1 adverse feature who underwent radical surgery between 2008 and 2017 at a single center were included. We compared recurrence-free survival (RFS) and overall survival (OS) between patients who received more than 80% of the planned AC cycle (the AC+ group) and those who did not receive it (the AC− group). @*Results@#The AC+ and AC– group contained 46 patients and 50 patients, respectively. The log-rank test revealed no significant intergroup differences in RFS (P = 0.083) and OS (P = 0.122). In the subgroup of 27 patients with more than 2 adverse features, the AC+ group (n = 16) showed better RFS (P = 0.006) and OS (P = 0.025) than the AC− group. In this subgroup, AC was the only significant factor affecting RFS in the multivariate analysis (P = 0.023). AC was significantly associated with OS (P = 0.033) in the univariate analysis, but not in the multivariate analysis (P = 0.332). @*Conclusion@#Among elderly patients with stage II high-risk colorectal cancer, the AC+ group did not show better RFS or OS than the AC− group. However, selected patients with more than 2 adverse features might benefit from AC.
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Purpose@#To investigate the characteristics of HER2-positive breast cancer according to HER2 low (2+) or high (3+) classification using immunohistochemistry (IHC). @*Methods@#Data were collected from 205 HER2-positive breast cancer patients in the final assay, regardless of IHC or in situ hybridization (ISH). We thus classified patients into two groups: HER2 2+/low and HER2 3+/high based on the IHC assay. We subsequently compared the clinical and pathological characteristics between groups. @*Results@#The median patient age was 49 years in the HER2 2+/low group and 53 years in the HER2 3+/high group. We observed a significantly lower Allred score for estrogen receptor (ER) and progesterone receptor (PR) (0-6) (p<0.001), less lymphatic invasion (LI), (p=0.010), neural invasion (p=0.041), higher Ki-67 (p=0.001), and lower Bcl-2 (p<0.001) in the HER2 3+/high group than in the HER2 2+/low group. Lymph node recurrence was more frequently observed in the HER2 2+/low group than in HER2 3+/high group (p=0.005). Disease-free survival (DFS) was better in the HER2 3+/high group than in the HER2 2+/low group (p=0.028), but there were no significant differences in overall survival between the groups (p=0.233). @*Conclusion@#The HER2 3+/high group was associated with lower ER and PR expression, less LI, higher Ki-67, and lower Bcl-2 than that in HER2 2+/low group in HER2-positive breast cancer. Furthermore, compared to the HER2 2+/low group, the HER2 3+/high group had an improved DFS.
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Purpose@#It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer. @*Methods@#Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS. @*Results@#Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS. @*Conclusion@#Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.
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Purpose@#To investigate the characteristics of HER2-positive breast cancer according to HER2 low (2+) or high (3+) classification using immunohistochemistry (IHC). @*Methods@#Data were collected from 205 HER2-positive breast cancer patients in the final assay, regardless of IHC or in situ hybridization (ISH). We thus classified patients into two groups: HER2 2+/low and HER2 3+/high based on the IHC assay. We subsequently compared the clinical and pathological characteristics between groups. @*Results@#The median patient age was 49 years in the HER2 2+/low group and 53 years in the HER2 3+/high group. We observed a significantly lower Allred score for estrogen receptor (ER) and progesterone receptor (PR) (0-6) (p<0.001), less lymphatic invasion (LI), (p=0.010), neural invasion (p=0.041), higher Ki-67 (p=0.001), and lower Bcl-2 (p<0.001) in the HER2 3+/high group than in the HER2 2+/low group. Lymph node recurrence was more frequently observed in the HER2 2+/low group than in HER2 3+/high group (p=0.005). Disease-free survival (DFS) was better in the HER2 3+/high group than in the HER2 2+/low group (p=0.028), but there were no significant differences in overall survival between the groups (p=0.233). @*Conclusion@#The HER2 3+/high group was associated with lower ER and PR expression, less LI, higher Ki-67, and lower Bcl-2 than that in HER2 2+/low group in HER2-positive breast cancer. Furthermore, compared to the HER2 2+/low group, the HER2 3+/high group had an improved DFS.
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Purpose@#It is known that as the T stage of a carcinoma progresses, the prognosis becomes poorer. However, there are few studies about factors that affect the prognosis of T4 advanced colon cancer. This study aimed to identify the prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in T4 colon cancer. @*Methods@#Patients diagnosed with stage T4 on histopathology after undergoing curative surgery for colon cancer between March 2009 and March 2018 were retrospectively analyzed for factors related to postoperative survival. Primary outcomes were DFS and OS. @*Results@#Eighty-two patients were included in the study. DFS and OS of the pathologic (p) T4b group were not inferior to that of the pT4a group. Multivariate analysis showed that differentiation (hazard ratio [HR], 4.994; P = 0.005), and laparoscopic surgery (HR, 0.323; P = 0.008) were significant prognostic factors for DFS, while differentiation (HR, 7.904; P ≤ 0.001) and chemotherapy (HR, 0.344; P = 0.038) were significant prognostic factors for OS. @*Conclusion@#Tumor differentiation, laparoscopic surgery, and adjuvant chemotherapy were found to be significant prognostic factors in patients with T4 colon cancer. Adjuvant chemotherapy and curative resections by laparoscopy might improve the prognosis in these patients.
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Purpose@#To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality. @*Methods@#This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data. @*Results@#Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity. @*Conclusion@#Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.
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Purpose@#Triple negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer. However, we have often experienced that triple positive breast cancer (TPBC) shows more aggressive clinical features than TNBC. In this retrospective study, we aimed to examine the differences in clinical courses between TNBC and TPBC. @*Methods@#Using medical records and clinical data, we selected patients with breast cancer who met the criteria for the two groups, TNBC and TPBC, based on the expression or absence of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). We then compared these groups with respect to clinical and pathological variables, such as patient age at diagnosis, TNM stage, number of tumors, involvement of resection margin, operation methods, histologic grade (HG), nuclear grade (NG), and lymphatic invasion (LI). We also compared the disease-free (DFS) and overall survival (OS) outcomes between the groups. @*Results@#Seventy patients with TNBC and 91 with TPBC were identified among a total of 628 patients. In univariate analysis, TPBC was significantly more frequently associated with lower HG (p=0.001), lower NG (p=0.003), LI (p=0.001), and a Ki-67 index ≤20% (p<0.001). In multivariate analysis, a lower Ki-67 index (p=0.031) and LI (p=0.022) were identified as significant and independent factors contributing to DFS. In a survival analysis over time, the TPBC showed a worse OS than TNBC 5 years post-treatment for breast cancer. Consequently, the TPBC group had definite worse 10-year DFS (p=0.012) and showed relatively lower OS rate (p=0.058), than the TNBC group. @*Conclusion@#Our results demonstrate considerable differences in long-term post-treatment survival of patients with TPBC and TNBC. Further studies to determine the proper management of both types of breast cancer and an accurate prognostic evaluation method are warranted.
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PURPOSE: We aimed to investigate organ-specific recurrence or the metastatic pattern of breast cancer according to biological subtypes and clinical characteristics. METHODS: We retrospectively analyzed the medical records of 168 patients with recurrent breast cancer who were diagnosed between January 1, 2000 and April 30, 2017. Four biological subtypes were classified according to estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 expression: luminal A, luminal B, HER2-enriched, and triple negative breast cancer (TNBC). To analyze recurrence patterns according to biological subtypes, we accessed clinical variables including age at diagnosis, TNM stage, type of surgery in the breast and axilla, histologic grade, nuclear grade, lymphatic, vascular, and neural invasion, Ki-67 expression and recurrence to distant organs. RESULTS: The biological subtypes of recurrent breast cancer comprised the following luminal A (n=33, 19.6%), luminal B (n=95, 56.5%), HER2 enriched (n=19, 11.3%), and TNBC (n=21, 12.5%). Luminal A (7.7%) and B (6.5%) subtypes were associated with the increased rate of local recurrence compared to HER2-enriched (2.4%) and TNBC subtypes (1.8%) (p=0.005). The bone (53.6%) was the most common metastatic organ, followed by the lung (34.5%), liver (29.8%), brain (17.9%), and other visceral organ (7.7%). Bone metastasis was commonly observed in individuals with luminal B (63.2%), HER2-enriched (57.9%), and luminal A (42.4%) subtypes (p=0.005). Most liver metastases occur in individuals with luminal B (40.0%) and HER2-enriched subtypes (31.6%) (p=0.002). CONCLUSION: Luminal B subtype was commonly observed in individuals with recurrent breast cancer, and the bone is the most common target organ for breast cancer metastasis, followed by the lungs and liver.
Subject(s)
Humans , Axilla , Brain , Breast Neoplasms , Breast , Diagnosis , Estrogens , Liver , Lung , Medical Records , Neoplasm Metastasis , Organ Specificity , Phenobarbital , ErbB Receptors , Receptors, Progesterone , Recurrence , Retrospective Studies , Triple Negative Breast NeoplasmsABSTRACT
PURPOSE: Approximately two-thirds of breast cancer are estrogen-dependent cancers, which express estrogen receptor (ER)/progesterone receptor (PR). We investigated the prognostic value of ER/PR expression in human epidermal growth factor receptor 2 (HER2)-negative and low proliferative (Ki-67 ≤20%) breast cancer. METHODS: A retrospective review was performed of 252 breast cancer data records, identified as ER/PR-positive, low Ki-67 proliferation index (≤20%) and HER2-negative. The data were divided into two subgroups: a strong luminal subgroup and a weak luminal subgroup, according to hormonal receptor expression status. Outcome measures included age at diagnosis, tumor size, tumor-node-metastasis (TNM) stage, ER, PR, Bcl-2, recurrent or metastatic characteristics, disease-free survival and overall survival, of each subgroup. RESULTS: There were no statistical differences in TNM stage or tumor numbers between the two subgroups. The strong luminal subgroup was associated with a higher Bcl-2 expression (p<0.001). The weak luminal subgroup was associated with more frequent neural invasion (p=0.051) and lung (p=0.031), liver (p=0.031) and brain (p=0.033) metastases, than the strong luminal subgroup. Disease-free survival was significantly longer in the strong luminal subgroup than weak luminal subgroup (p=0.015). Overall survival was also significantly improved in the strong luminal subgroup relative to the weak luminal subgroup (p=0.014). CONCLUSION: The weak luminal subgroup showed worse prognosis than the strong luminal subgroup, among ER/PR-positive HER2-negative low proliferative breast cancer patients. Weak ER or PR expression, can be considered a poor prognostic factor in ER/PR-positive HER2-negative low proliferative breast cancer.
Subject(s)
Humans , Brain , Breast Neoplasms , Diagnosis , Disease-Free Survival , Epidermal Growth Factor , Estrogens , Liver , Lung , Neoplasm Metastasis , Outcome Assessment, Health Care , Phenobarbital , Progesterone , Prognosis , ErbB Receptors , Receptors, Estrogen , Receptors, Progesterone , Retrospective StudiesABSTRACT
PURPOSE: For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. METHODS: We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications. RESULTS: The patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 +/- 22.74 minutes whereas that in the LA group was 61.70 +/- 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. CONCLUSION: Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.
Subject(s)
Humans , Appendectomy , Appendicitis , Body Mass Index , Cost Savings , Demography , Laparoscopes , Laparoscopy , Latex , Length of Stay , Operative Time , Pain, Postoperative , Surgical Instruments , Wound InfectionABSTRACT
PURPOSE: Incidental parathyroidectomy is the most common and unexpected consequence of a total thyroidectomy. It can cause hypocalcemia symptoms such as muscle cramping and even seizures. We conducted this study to compare several factors including the preservation rate of parathyroid glands during both a bilateral axillo-breast approach endoscopic thyroidectomy (BABA) and a conventional open thyroidectomy (CT) for papillary thyroid carcinomas. METHODS: We retrospectively reviewed the medical records of 299 papillary thyroid cancer patients who had a total thyroidectomy between January 2008 and December 2011. We grouped the patients into two groups: BABA (n=70) and CT (n=229). We analyzed age, tumor size, operation time, the number of preserved and removed parathyroid glands, amount and duration of seroma drainage, pain score, hypocalcemia symptoms, and serum total calcium level in both the BABA and CT groups. RESULTS: We observed a younger age (under 45 years old) (P=0.000), smaller tumor size (P=0.000), longer operation time (P=0.000), larger amount of drainage (P=0.000), longer duration of drainage (P=0.007), and larger pain score (P=0.000) in the BABA group. Of the 70 patients that received an endoscopic thyroidectomy, we preserved all four parathyroid glands in 56 patients (78.6%). Of the 229 patients that received an open thyroidectomy, we preserved all four parathyroid glands in 141 patients (61.6%, P=0.004). CONCLUSION: BABA results in more extensive tissue damage over a longer period of time than CT. However, BABA was an excellent method for preserving parathyroid glands when compared with CT for thyroid carcinoma. Thus, it seems to be feasible performing BABA when it matches the indications.
Subject(s)
Humans , Calcium , Drainage , Hypocalcemia , Hypoparathyroidism , Medical Records , Methods , Muscle Cramp , Parathyroid Glands , Parathyroidectomy , Retrospective Studies , Seizures , Seroma , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
PURPOSE: Luminal-type breast cancer has a good prognosis compared to other types, such as human epidermal growth factor receptor 2 and triple negative types. Luminal-type breast cancer is classified into luminal A and B, according to the proliferation index. We investigated the clinicopathological factors that affect the prognosis of the luminal-type subgroups. METHODS: We reviewed the medical records and the pathologic reports of 159 luminal-type breast cancer patients who were treated between February 2005 and November 2007. We divided luminal-type breast cancer into luminal A and B, according to Ki-67 (cutoff value, 14%) and analyzed the clinicopathologic factors, such as age at diagnosis, intensity score of estrogen receptor and progesterone receptor, histologic grade, and Bcl-2. Moreover, we compared the disease-free survival (DFS) of each group. RESULTS: In the univariate analysis, age (p=0.004), tumor size (p=0.010), lymph node metastasis (p=0.001), and Bcl-2 (p=0.002) were statistically significant factors in luminal-type breast cancer. In the multivariate analysis, lymph node (p=0.049) and Bcl-2 (p=0.034) were significant relevant factors in luminal-type breast cancer. In the subgroup analysis, the increased Bcl-2 (cutoff value, 33%) was related with a longer DFS in the luminal B group (p=0.004). CONCLUSION: In our study, luminal A breast cancer showed a longer DFS than luminal B breast cancer, further, Bcl-2 may be a potent prognostic factor in luminal-type breast cancer.