Providing Reliable Prognosis to Patients with Gastric Cancer in the Era of Neoadjuvant Therapies: Comparison of AJCC Staging Schemata

Purpose@#Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. @*Materials and Methods@#Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. @*Results@#We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I–IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0–IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). @*Conclusions@#The cStage is unreliable for prognosis, and ypStage is moderately reliable.Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

Providing Reliable Prognosis to Patients with Gastric Cancer in the Era of Neoadjuvant Therapies: Comparison of AJCC Staging Schemata

Purpose@#Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. @*Materials and Methods@#Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. @*Results@#We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I–IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0–IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). @*Conclusions@#The cStage is unreliable for prognosis, and ypStage is moderately reliable.Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

A Case of Submuscular Lipoma on the Forehead / 대한피부과학회지

Lipomas are the most common mesenchymal neoplasms and are characterized by a lobular growth of mature adipocytes with a sharply demarcated border delineated by a thin fibrous capsule. Lipomas usually appear in the adipose tissue but occasionally develop in other mesenchymal tissues and can be classified as either subcutaneous or subfascial tumors. Subfascial lipomas are one of the most uncommon sites for soft-tissue tumors and can be intramuscular, intermuscular, or submuscular. Accordingly subfascial lipomas of the forehead can be differentiated into submuscular and subgaleal lipomas depending on the exact anatomic localization below the frontalis muscle or underneath the galea aponeurotica. The patient, a 33-year-old man, visited our clinic with a complaint of asymptomatic 2x2cm-sized dome-shaped tumor on his forehead. The tumor was surgically excised. During the operation the tumor was found to be located below the frontalis muscle and was revealed histopathologically as lipoma.

Hair Mineral Analysis of Normal Korean Children / 대한피부과학회지

BACKGROUND: Minerals play important roles in biological processes. They can cause disease through deficiency, imbalance, and toxicity. Many chronic diseases of children may be related to mineral status. But difficulty in sampling enough numbers and amount of body fluid to see long term mineral status for those children have been obstacles for detailed clinical studies. Though measurements of body mineral status are usually done for body fluid, hair mineral analysis method showed potentiality as a useful clinical tool. It could provide a continuous record of nutritional status and exposure history to heavy metal pollutants. Also it has advantages in sampling and observing the profiles of multiple minerals simultaneously. But lack of normal reference values of hair mineral contents focused on Korean children prevented us from conducting further studies. OBJECTIVE: The purposes of this study were to survey reference range of hair mineral concentration of Korean children 2 to 7 years old and analysis its characteristics. METHODS: Mineral concentrations of hair were measured in 78 children 2 to 7 years of age, living in the same area. The contents of fifteen nutritional elements(Ca, Mg, Na, K, Cu, P, Fe, Mn, Cr, Se, B, Co, Mo, S), eight toxic elements(Sb, U, As, Be, Hg, Cd, Pb, Al), and fifteen additional elements(Ge, Ba, Bi, Rb, Li, Ni, Pt, Tl, V, Sr, Sn, Ti, W, Zr) were determined by an inductive coupled plasma mass spectrometry(ICP-MS). Data are analyzed by meticulous statistical approaches. RESULTS: Though direct comparison was impossible in statistical manner, the suggested reference values of normal Korean children were different in K, Cr, Hg, Pb, Sn, Mg, Sb, Zn, Ge, and U content with American reference value. In normal Korean children, the contents of Ca, Mg, Fe, S, Al, Ba, Ni, Sr, U were higher in girls, and Na, Cr, As, V, Bi were higher in boys. Zn and Sr contents were increased with age, Rb, K, Ti, Pb, Mo, Sn, and V contents were decreased with age. CONCLUSION: There are considerable differences in hair mineral contents of normal population by race, age, sex. So it is important to use proper reference values to interpret the hair mineral analysis result correctly. We hope future study conducting for the children living in different geographic regions could verify our suggested reference data as a Korean reference value.

A Case of Acquired Cutaneous Smooth Muscle Hamartoma

Smooth muscle hamartoma was first described by Stokes in 1923 as the disease characterized by increase of well-defined bundles of smooth muscle fibers in the dermis. It can be either congenital or acquired. Acquired ones are aften in association with Becker's nevus. We present a case of acquired smooth muscle hamartoma that did not show any pigmentation or hair growth.