Analysis of prognostic factors for Tis-2N0M0 early glottic cancer with different treatment methods / Análise de fatores prognósticos para o câncer glótico inicial Tis-2N0M0 com diferentes métodos de tratamento

Abstract Introduction In many regions, laryngeal carcinoma is a common upper respiratory tract cancer, most commonly involving the glottic region. The treatment of early glottic cancer includes radiotherapy, open surgery and laryngeal laser microsurgery. However, the preferred treatment for early glottic cancer is still controversial. Objectives To study the factors affecting the 5-year survival rate of Tis-2N0M0 early glottis cancer and to demonstrate the oncological safety of different treatments. Methods 144 patients with early glottic cancer were analyzed retrospectively. All patients were clinically node negative. 53 patients underwent open surgery, transoral CO2 laser microsurgery in 46 cases and radiotherapy in 45 cases. The patients were followed up for 26 − 84 months, with an average follow-up period of 62.9 months. Results The 5-year overall survival was 82.6%. The 5 year survival rates of open surgery, laser microsurgery and radiotherapy were 83.0%, 82.6% and 82.2%, respectively. There was no significant difference in 5-year survival rate among the three treatments (p= 0.987). In multivariate analysis, age, T-stage, pathological grading, and anterior commissure involvement were important prognostic factors for early glottic cancer. Conclusion There was no significant difference in 5 year survival rate among patients treated by either radiotherapy, laser microsurgery or open surgery for early glottic cancer. We urge more attention to the age, T-stage, pathological grade, and anterior commissure involvement of the patients.

Resumo Introdução Em muitas regiões, o carcinoma de laringe é um câncer comum do trato respiratório superior e geralmente envolve a região glótica. O tratamento do câncer glótico inicial inclui radioterapia, cirurgia aberta e microcirurgia a laser de laringe. Entretanto, a forma preferencial de tratamento do câncer glótico inicial ainda é controverso. Objetivos Estudar os fatores que afetam a taxa de sobrevida em 5 anos do câncer glótico inicial Tis-2N0M0 e demonstrar a segurança oncológica de diferentes tratamentos. Método Um total de 144 pacientes com câncer glótico inicial foram analisados retrospectivamente. Todos os pacientes eram clinicamente negativos para linfonodos. Cinquenta e três pacientes foram submetidos à cirurgia aberta, 46 à microcirurgia transoral a laser de CO2, e radioterapia em 45 casos. Os pacientes foram acompanhados por 26 a 84 meses, com um período médio de seguimento de 62,9 meses. Resultados A sobrevida global em 5 anos foi de 82,6%. As taxas de sobrevida em cinco anos da cirurgia aberta, microcirurgia a laser e radioterapia foram de 83,0%, 82,6% e 82,2%, respectivamente. Não houve diferença significante na taxa de sobrevida em cinco anos entre os três tratamentos (p = 0,987). Na análise multivariada, idade, estágio T, classificação histopatológica e envolvimento da comissura anterior foram fatores prognósticos importantes para o câncer glótico inicial. Conclusão Não houve diferença significante na taxa de sobrevida em 5 anos entre radioterapia, microcirurgia a laser e cirurgia aberta para câncer glótico inicial. Deve-se estar atento à idade, estágio T, histopatológico e envolvimento da comissura anterior dos pacientes.

Epidemiological status and survival rate of liver cancer in Yangpu District of Shanghai， 2002-2016 / 上海预防医学

Objective:To analyze the prevalence trend and survival of liver cancer in Yangpu District， Shanghai， from 2002 to 2016. Methods:Data on liver cancer incidence and mortality from 2002 to 2016 were collected from the Shanghai cancer registry system for the registered population in Yangpu District and the number of the registered population published by the public security department. The standardized liver cancer incidence and mortality rates were calculated using the world standard population to analyze the trends of the liver cancer incidence and mortality， in general， by gender and by age. Life table method was used to calculate the survival rate， and log-rank test was used to analyze the difference of 5-year survival rates and the period of diagnosis between patients with liver cancer by gender. Results:The overall incidence and mortality of liver cancer showed a decreasing trend from 2002 to 2016. After removing the influence of community aging， the standardized annual percentage change （APC） of morbidity and mortality was -3.10% （P<0.01） and -3.44% （P<0.01）， respectively. The morbidity and mortality of males were significantly higher than that of females （P<0.01） by Z test. The incidence of liver cancer started to rise obviously from 40 years old， and the death rate raised obviously from 50 years old. 4 007 liver cancer patients were followed up for 5 years. The 5 years observed survival rate was 12.45%， and the median survival time was 281.48 days. The 5-year survival rate of male liver cancer patients was higher than that of female patients， and there was a significant difference（P<0.01）.46.58% of liver cancer patients were diagnosed in the advanced stage， and only 13.46% was diagnosed at the early-stage. There was no statistical difference in the proportion between men and women at different stages （P=0.11）. Conclusion:The overall incidence and mortality rates of liver cancer from 2002 to 2016 show a slowly decreasing trend， with higher incidence and mortality rates in men than in women. Middle-aged and elderly people are still the main population of morbidity and death. The five-year survival rate is low， and the diagnostic periods are mostly in the middle and late stages of cancer.

The 5-year survival rate of 11 958 postoperative non-small cell lung cancer patients in stage Ⅰ-ⅢA by two different follow-up patterns: A multi-center, real-world study / 中国胸心血管外科临床杂志

@#Objective    To compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients. Methods    Pathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8 133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used. Results    The median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages. Conclusion    The proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.

Surgical treatment for lung cancer invading the heart and large blood vessels / 局解手术学杂志

Objective To investigate the surgical treatment of lung cancer invading the heart and large blood vessels.Methods The clinical data of 96 cases of lung cancer invading the heart and large blood vessel admitted into our hospital from March 2009 to March 2012 were retrospectively analyzed,especially the surgical methods,postoperative complications and 5-year survival rate.Results The 5-year survival rate of lung cancer patients who infringed the atrium and superior vena cava had no significant difference (P ＞ 0.05).However,the 5-year survival rate and median survival time of lung cancer patients who infringed the atrium and superior vena cava were significantly lower than those of lung cancer patients who infiltrated the pulmonary artery,and the difference was statistically significant(P ＜ 0.05).The median survival time of patients with lung cancer invading the atrium was lower than that of patients with lung cancer invading the superior vena cava,and the difference was statistically significant(P ＜ 0.05).The range of tumor involvement after operation was significantly lower than that before operation,and the difference was statistically significant(P ＜ 0.05).Three types of surgical methods were used for patients according to different invading sites,and the complication incidence of 3 surgical methods were similar with no statistically significant difference(P ＞ 0.05).Conclusion Surgical treatment for lung cancer invading the heart and large blood vessels has a good efficacy,which can improve the involved tumor range of patients without serious postoperative complications and provide opportunity for patients with comprehensive postoperative treatment.In addition,it can significantly improve the 5-year survival rate of patients.

Changes in the management and survival rates of patients with oral cancer: a 30-year single-institution study

OBJECTIVES: The aim of the present study was to evaluate changes in the management and 5-year survival rates of patients with oral cancer in our department over a 30-year period. MATERIALS AND METHODS: We investigated the patient distributions, treatment methods, method of neck dissection according to cancer stage, and 5-year survival rates for 700 oral cancer patients over the periods of 1982-1996 (256 patients), 1999-2006 (248 patients), and 2007-2011 (196 patients). RESULTS: Stage IV patients were the largest group in all of the time periods evaluated. Although surgery and radiotherapy were the most common methods in all periods (over 50%), the prevalence of patients who underwent concomitant chemoradiotherapy increased from 7.0% to 16.2%. The use of radical neck dissection decreased from 43.0% to 5.3%, while conservative surgical methods increased from 24.1% to 76.3%. Lastly, the overall 5-year survival rate increased from 31.6% to 63.5% during the study period. CONCLUSION: Although the 5-year survival rate reached the same level as that of other developed countries during the course of our study, most patients continue to come to the hospital with stage IV disease. In order to increase the 5-year survival rate of oral carcinoma, it may be necessary to improve public education and social efforts relevant to early diagnosis.

Comparison of TNM and Lugano staging systems in predicting 5-year survival rate of primary gastrointestinal lymphoma patients / 中国肿瘤临床

Objective:To assess the survival-predictive value of TNM and Lugano staging systems in patients with primary gastro-intestinal lymphoma (PGL). Methods:A total of 73 patients with PGL were recruited from February 2001 to August 2013. All patients were diagnosed according to the TNM and Lugano staging systems. Five-year survival rate was used as the major clinical outcome. Sur-vival curves were plotted using the Kaplan–Meier method and analyzed with the log-rank test. The prognostic value of different vari-ables for clinical outcomes was assessed using the Cox multiple regression model. Results:The median follow-up time of surviving pa-tients was 42.4 months (range:1.3-158.6 months). The estimated 5-year overall survival rate was 77.82%. When diagnosed with the TNM system, the 5-year survival rates in stagesⅠ,Ⅱ,Ⅲ, andⅣwere 100%, 90.0%, 67.4%, and 22.2%, respectively (χ2=17.7956, P=0.0005). When staged by the Lugano system, the 5-year survival rates in stagesⅠ,Ⅱ,ⅡE , andⅣwere 100%, 100%, 70.7%, and 46.2%, respectively (χ2=15.6776, P=0.0013). Cox analysis showed that the invasion depth (T) (P=0.0181) and metastasis (M) (P=0.0031) were covariates that were prognostically significant for the overall survival. Conclusion:The TNM staging system is more ac-curate than the Lugano system in predicting the 5-year survival rate of patients with PGL.

Effect of neoadjuvant chemotherapy for stages Ⅱ and Ⅲ A breast cancer / 国际外科学杂志

ObjectiveTo evaluate the therapeutic value of neoadjuvant chemotherapy for patients with stages Ⅱ and ⅢA(Only T3N1M0) breast cancer,and assess the relationship of the tumor size and pathologically complete response.MethodA total of 408 breast cancers patients at stages Ⅱ and ⅢA,were studied,which were divided into neoadjuvant chemotherapy group (group A) and control group (group B).All patients of group A received 2-4 cycles NAC with TE scheme in breast cancer.The impact of neoadjuvant chemotherapy on surgical methods choice,local control rate,5-year overall survival rate and 5-year disease free survival rate were analyzed.ResultsFor patients of stage Ⅱ,the rate of breast conservation significantly increased from 23.6％ to 49.1％ (P =0.000) and there was no significant difference between groups A and B ( P =0.939,0.858 ) in 5-year overall survival rate and disease free survival rate.For patients of stage ⅢA,the 5-year overall survival rate (59.8％ ) and disease free survival rate (51.8％) in group A were greatly higher than that in group B (35.7％ and 27.6％ ) (P =0.000,0.000).The 3-year local relapse and metastasis rate(7.9％ ) was lower than group B (18.4％)(P ＜ 0.05 ).The tumor less than 3.0 cm is easy to achieve pathological complete remission (P =0.001 ).ConclusionsThe neoadjuvant chemotherapy can improve potential rate of breast conservation,reduce the rate of local-regional recurrence rate for the patients with stage Ⅱ and ⅢA breast cancer,and also improve the 5-year survival rate for the patients of stage ⅢA.Patients with clinically complete response or PCR may have higher 5- year overall survival rate and disease free survival rate.Primary tumor size was found to be the significant predictive factor for pathologically complete response to neoadjuvant chemotherapy in patients with breast cancer,particularly,the small tumor is easy to reach pathologically complete response.

Oral cancer incidence based on annual cancer statistics in Korea

INTRODUCTION: The objective of this research was to determine the incidence of oral cancer in Korea. MATERIALS AND METHODS: The classifications of oral and maxillofacial cancer (OMFC) that we used are based on possible locations of OMFC: lip, tongue, mouth, salivary glands, tonsil, oropharynx, nasopharynx, hypopharynx, pharynx unspecified, and nose, sinuses. RESULTS: 1) There were 2,848 OMFC cases, accounting for 1.6% of all cancers. The male to female ratio was 2.72:1. 2) The estimated crude rates (CRs) were 5.7 overall, 8.4 for males, and 3.1 for females. The age-standardized incidence rates (ASRs) were 4.6 overall, 7.3 for males and 2.3 for females. 3) The incidence of mouth cancer was highest. The mouth and salivary glands were the most frequent sites for cancer among males and females, respectively. 4) Patients who were 40 years or older accounted for 91% of OMFC cases, with the highest proportion of cases in the 60-69 year-old age group for both sexes. 5) Tongue cancer was the most prevalent OMFC overall. Nasopharyngeal cancer was highest among males, and salivary gland cancer was highest among females. 6) From 2004 to 2008, the relative 5-year survival rate of OMFC patients was 57.5%. There was a trend of increasing survival among OMFC patients during the study period. The survival rate for females (69.3%) was much higher than that for males (53.1%). CONCLUSION: Social and personal efforts should be required to increase the survival rates of OMFC patients and Korean national cancer management policy should establish new measures for economic and social management and support.

Liposarcoma in the Extremity / 대한골관절종양학회지

PURPOSE: We analyzed disease free survival and the prognostic factors of liposarcoma in the extremity. MATERIALS AND METHODS: Between 1994 and 2005, of 44 patients who were diagnosed and treated for liposarcoma of the extremity, 40 patients were restrospectively analysed. 13 out of 40 patients got postoperative radiotherapy. We examined local recurrence, distant metastasis and disease free 5-year survival rate. We also analyzed clinical prognostic factors, such as age, gender, size of tumor, prior unplanned excision, histologic type, surgical excision margin and postoperative radiotherapy respectively. RESULTS: There were 3 cases of local recurrence and 4 cases of distant metastasis. The disease free 5-year survival rate was 85.0%. 26 patients presented with myxoid, 8 well differentiated, 4 round cell, 1 pleomorphic and 1 dedifferentiated histology. The disease free 5-year survival rate of mixoid, well differentiated and round cell liposarcoma were 100.0%, 84.6% and 75.0% (p=0.419). The 5-year disease free survival rate was 90.6% in negative surgical margin (n=25) and 62.5% in positive surgical margin (n=15) (p=0.003). CONCLUSION: Our study suggests that surgical excision margin is significant prognostic factor for 5-year disease free survival rate.

A clinicostatistical analysis of oral cancer patients for recent 8 years

We investigated 248 patients who were diagnosed as malignant tumor in the department of Oral and maxillofacial Surgery of Kyungpook National University from 1999 to 2006, and following results were obtained. 1. Among 248 patients who have malignant tumor, 164 were men and 84 were women, which made the ratio of male to female 1.95 : 1. 2. The average age of oral cancer patients was 58.3. 3. As of the primary origin site, lower alveolus and gingiva were the greatest with 70 cases(28.2percent), followed by tongue(16.9percent), upper alveolus and gingiva(14.9percent), palate(13.7percent), mouth floor(9.7percent), buccal mucosa(4.8percent), retromolar trigone(4.4percent), Mx. and Mn. bone(3.2percent) and lip(2.8percent). 4. As of histologic distribution, squamous cell carcinoma was the greatest with 170 cases(68.6percent), followed by sarcoma with 17 cases(6.9percent), adenoid cystic carcinoma with 17 cases(6.9percent), malignant lymphoma with 15 cases(6.0percent), mucoepidermoid carcinoma with 13 cases(5.2percent), metastatic carcinoma with 6 cases(2.4percent) and malignant melanoma with 4 cases(1.6percent). 5. Period between recognition of the symptom and the first visit to hospital was less than 3 months for 58.9percent of the patients, and more than 3 months for 41percent of the patients. 6. Investigation of whether the patients drink or smoke revealed that the number of non-smoking and non-drinking patients was 63 among 170 patients (37.0percent) that were able to investigate. The number of patients who smoke only was 29(17.1percent) and both drinking and smoking patients were 78(45.9percent). 7. In clinical stage order, Stage IV(61.7percent) was found th be the largest, followed by stage I(17.2percent), stage II(13percent) and stage III(7.8percent). 8. The 5-year survival rate of the entire oral cancer patients appeared to be 57.7percent. The survival rate was higher in younger group and women had higher survival rate but there was no statistical significance to this. In the aspect of stage, the survival rate was Stage I, Stage II, Stage IV and Stage III in decreasing order. The order according to T classification was the same. In N classification, patients with N0 had the highest survival rate and the survival rate decreased in the order of N1 and N2. Survival rate was especially low in patients with N2.

Clinicopathologic Characteristics and Prognostic Factors of Stage I and II Endometrial cancer of the uterus: A Study of 59 Cases / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the clinicopathologic findings, treatment, and prognostic factors of uterine endometrial cancer. METHODS: We retrospectively reviewed 59 patients with histologically proven stage I and II endometrial cancer between January 1994 and December 2004, for clinical profiles and survival. The survival of patients was determined by description of last follow up date in medical records or phone calls. RESULTS: The median age at the time of diagnosis was 51 years (range: 30-71 years) and the most common presenting symptom was vaginal bleeding (83.0%). Endometrioid adenocarcinoma was the most common (96.6%) histologic type of all cases. Forty-nine patients (83.0%) were FIGO stage I and 10 patients were stage II (17.0%), and the histological grades of the tumors were 23 (39.0%) grade 1, 17 (28.8%) grade 2, 7 (11.9%) grade 3, and 12 (20.3%) unknown, respectively. All patients were treated by surgery as primary treatment and given postoperative adjuvant therapy including radiation therapy (32.2%), concurrent chemotherapy and radiation therapy (6.8%), and chemotherapy (3.4%). The 5-year disease free survival rate (DFSR) of stage I and stage II were 92.7% and 66.7%, respectively. The age (> or =60) and menopausal status were significant prognostic factors by univariate anlaysis (p=0.0077; p=0.0149, respectively). However, parity, FIGO surgical stage, histological grade, myometrial invasion, and lymph-vascular space invasion were not significant prognostic factors (p>0.05). CONCLUSION: The age (> or =60) and menopause state were significant prognostic factors of stage I and II uterine endometrial cancer affecting survival of the patients.

Clinicopathologic characteristics and prognostic factors of adenocarcinoma of the uterine cervix: a study of 80 cases / 부인종양

OBJECTIVE: The purpose of this study was to evaluate the clinicopathologic findings, treatment, and prognostic factors of adenocarcinoma of the uterine cervix. METHODS: This study retrospectively reviewed 80 patients with histologically proven stage I, II, and III cervical adenocarcinoma, at the Department of Obstetrics and Gynecology of Korea University Anam, Guro, and Ansan Hospitals, between January 1990 and December 2005, for clinical profiles and survival. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. RESULTS: The mean age at the time of diagnosis was 48.5 years (range: 28-81 years) and the most common presenting symptom was uterine bleeding (51.3%). Fifty-eight patients (72.5%) presented with stage I, nineteen (23.7%) with stage II, and three (3.8%) with stage III. Surgery was the main treatment for stage I and IIa and radiation therapy for stage IIb or more. The 5-year survival rates for stages I, II, and III were 85.0%, 63.8%, and 0.0%, respectively. Univariate analysis showed that stage, lymph node metastasis, and lymph-vascular space invasion were significant prognostic factors (p or =50) were significant independent predictors for poor survival (OR 37.352, CI 3.167-440.579; OR 9.823, CI 1.808-53.354, respectively). CONCLUSION: The results suggest that FIGO stage and age are significant independent prognostic factors for patients with adenocarcinoma of the uterine cervix.

The Significance of Metastatic Lymph Node Ratio in the Survival Rate of pT2 Gastric Cancer

PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0

Analysis of prognostic factor and survival in patients with epithelial ovarian cancer treated with combination chemotherapy / 부인종양

OBJECTIVE: The purpose of this retrospective study is to identify and to discuss the clinical relevance of prognostic factors and survival rate in patients with epithelial ovarian cancer treated with combination chemotherapy. METHODS: A total of 98 histologically verified patients with epithelial ovarian cancer who were treated at Dong-A Medical Center between 1997 and 2002 were used for analysis. The 30 patients having borderline tumor were excluded. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. A multivariable Cox proportional hazard model was applied to access the prognostic significance of the different covariates. RESULTS: The median age of the patients with epithelial ovarian cancer was 46.6 years and FIGO stage distribution was 38.2% for stage I, 5.9% for stage II, 44.1% for stage III, 11.8% for stage IV. The histopathologic type distribution were serous type (45.6%), mucinous type (36.8%), endometriod type (8.8%), clear cell type (7.4%), mixed type (1.4%). Residual tumor volume size of less than 1 cm or 1 cm was identified in 50 patients (73.5%) and more than 1 cm in 18 patients (26.5%) after primary cytoreductive surgery. The overall 5-year survival rate was 55.7%. According to univariate analysis, FIGO stage (p<0.0001), residual volume (p<0.0001), ascitic fluid volume (p=0.0001), menopause (p=0.0021), CA125 (p=0.0058), tumor size (p=0.0099), age (p=0.0113) were significant prognostic factors affecting survival. However, multivariate analysis in this study demonstrated that FIGO stage (p=0.011), residual tumor volume (p=0.026), ascitic fluid volume (p=0.031) were found to be the most significant independent prognostic factors. CONCLUSION: In this retrospective study, the overall 5-year survival rate of patients with epithelial ovarian cancer treated with combination chemotherapy was 55.7% and 5-year survival rate of stage I/II was 95.8%, stage III 28.4%, stage IV 0%. The overall survival of stage I/II were 90 months, stage III 39 months, stage IV 17 months. In multiple analysis, FIGO stage, residual volume, ascitic fluid volume were identified as three most significant independent prognostic factors.

A Clinicopathologic Characteristics and Survival Analysis of Ovarian Tumors / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to identify the clinicopathologic characteristics, treatments and overall 5-year survival and to analyze the prognostic factors affecting the survival in patient with ovarian tumors. METHODS: We reviewed retrospectively the outcome of 116 patients with ovarian cancer and 64 patients with borderline malignant ovarian tumor, who had been treated at Department of Obstetrics and Gynecology, Korea University Anam Hospital from Jan. 1991 to Dec. 2001. Univariate and multivariate analysis for survival were conducted to test the prognostic significance of several clinicopathologic factors. RESULTS: The mean age of the patients with borderline malignant ovarian tumor was 39.9 years old, and nulliparity was most common (42.2%). Mucinous tumor was the most common histologic subtype (68.8%). The FIGO stage distribution of borderline malignancy were 89.1%, 1.6%, 9.3% for stage I, II, and III, respectively. The overall 5-year survival rate of patients with borderline malignancy was 98.4%. The mean age of the patients with ovarian cancer was 50.1 years old. The incidence of ovarian cancer according to histologic type were 74.1%, 12.9%, 11.2%, 0.9%, 0.9%, in epithelial ovarian cancer, Sex-cord stromal tumor, malignant germ cell tumor, metastatic carcinoma of the ovary, and small cell carcinoma, respectively. The FIGO stage distribution of ovarian cancer were 40.5%, 12.1%, 42.2%, 5.2% for stage I, II, III, and IV, respectively. The overall 5-year survival rate of patients with ovarian cancer was 60.9%. In multivariate analysis, FIGO stage was identified as a significant independent prognostic factor in this study. CONCLUSION: In this study, patients with borderline malignancy of the ovary have good prognosis and the overall 5-year survival rate was 98.4%. Otherwise, the overall survival rate of patients with ovarian cancer was 60.9% and the stage was most important prognostic factor.

Clinical Relevance of the CA 125 Assay in Monitoring of Epithelial Ovarian Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the significance of preoperative serum CA-125 level of primary epithelial ovarian carcinoma with respect to prognostic factors (histologic grade, tumor stage, success of cytoreductive operation) and to assess the relationship between the changes of serum CA-125 level and 5-year survival rate after the cytoreductive operation and chemotherapy. METHODS: We retrospectively investigated the results of 101 patients with primary epithelial ovarian cancer staged over IC, who had been diagnosed and treated at Kyung-Hee University Medical Center from January 1991 to April 2003. They were managed with cytoreductive operation and chemotherpy. They were monitored by serum CA-125 level serially during treatments. RESULTS: There were significant differences of preoperative serum CA-125 level in histologic types, histologic grades, presence of ascites, presence of lymph node involvement, success of cytoreduction and success of 5-year survival (P0.05). There were significant differences of 5-year survival rate in groups divided by pre- and postoperation serum CA-125 level (P<0.05). And significant differences were shown between serum CA-125 values and 5-year survival rate in three cycles of chemotherapy (P<0.05). CONCLUSION: Serum CA-125 level is a valid tumor marker in predicting the responsiveness of cytoreduction and combined chemotherapy in epithelial ovarian cancer. Measurement of serum CA-125 levels during treatment might permit an early change to optimal forms of therapeutic management or alternatives.

An Analysis of Clinicopathologic Factors Affecting Survival in Patients with Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to investigate the clinicopathologic characteristics of cervical carcinoma and to evaluate the prognostic factors which have an impact on 5-year survival. PATIENTS AND METHODS: 575 patients with invasive cervical carcinoma treated at Samsung Medical Center from November 1994 to January 2000, for whom the records were retrospectively analyzed, were included in this study. Of the 575 patients, 499 patients were primarily treated by surgery including conization or type I, II, III hysterectomy. Medical records including pathologic reports were reviewed to identify clinicopathologic characteristics. Survival was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison. Cox proportional hazards model was used for multivariate analysis. RESULTS: The age distribution of patients was from 26 to 84 years old, and the peak incidence was in the 5th decade. The International Federation of Gynecology and Obstetrics (FIGO) stage distribution of invasive cervical cancer was 76.4%, 19.2%, 1.9%, 1.2% for stage I, II, III, IV respectively. Among 354 patients with FIGO stage Ib and II a, 325 patients were treated by type III hysterectomy. The overall 5-year survival of 575 patients was 91.9%, and the 5-year disease-free survival rate (DFSR) according to FIGO stage was as follows: Ia 97.5%, Ib 95.5%, II a 85%, IIb 66.8%, III/IV 42%. The frequency of lymph node metastasis was 10.2% in stage Ib and 25.4% in stage II a. In multivariate analysis, only FIGO stage and lymph node involvement remained independent prognostic factors. CONCLUSION: This study showed that clinical stage and lymph node involvement status are identified as independent prognostic factors in the patients with cervical cancer.

Clinico-pathologic Profiles and 5-year Survival Rate of 2209 Patients with Invasive Cancer of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to investigate the clinico-pathologic characteristics and to analyze the 5-year survival rate and prognostic factors for invasive cancer of the uterine cervix. METHODS: From May 1982 to October 2000, 2209 patients with invasive cancer of the uterine cervix were diagnosed and treated at Samsung Cheil Hospital. In this retrospective study, we studied the clinico- pathologic characteristics (age, resident area, delivery type, FIGO stage, histologic type, nodal metastasis, lymph-vascular space invasion, endometrial extension), treatment modalities and 5-year survival rate. RESULTS: The mean age was 50.3 years (24-85) and the median age was 50.0 years old. The most common subsets of patients were found in the group of FIGO stage I b (41.9%) and age between 41 and 50 (30.0%). Surgery was the main treatment in stage I a, I b, II a and radiation in stage II b or more. Pelvic and para-aortic nodal metastasis were surgically identified in 1.9% and 0% of stage I a, 18.1% and 4.4% of stage I b, 22.6% and 5.7% of stage II a, 51.4% and 17.1% of stage II b, 14.3% and 0% of stage III/IV. Overall 5-year survival rate was 85.7%; stage I a (93.9%), I b (91.5%), II a (80.7%), II b (68.5%), III/IV (53.7%). The 5-year survival rate according to pelvic lymph node status in surgically confirmed patients were 95.4% in negative patients and 78.1% in positive patients respectively (P=0.0000). 5-year survival rate was significantly different according to age (P=0.0000), FIGO stage (P=0.0000), lymph-vascular space invasion (P=0.0001), endometrial extension (P=0.0199), pelvic (P=0.0000) and para-aortic nodal metastasis (P=0.0000). However, resident area, delivery type, histologic type did not show any significant differences in survival. CONCLUSION: Overall 5-year survival rate of 2209 patients with invasive cancer of the cervix who were diagnosed at Samsung Cheil Hospital from May 1982 to October 2000 was 85.7%. Five-year survival rate was different according to age, FIGO stage, lymph-vascular space invasion, endometrial extension, pelvic and para-aortic nodal metastasis.

An Analysis of Clinicopathologic Prognostic Factors affecting Survival in Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: In this retrospective study, we analyzed the clinicopathologic characteristics of epithelial ovarian cancer and evluated the prognostic factors which has an impact on survival of the patients with epithelial ovarian cancer. Patients and METHODS: Total 147 patients with epithelial ovarian cancer who were treated at Samsung Medical Center between 1995 and 2000 were included. Medical records including pathologic reports were reviewed to identify clinicopathologic characteristics. Survival was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison. Cox proportional hazards model was used for multivariate analysis. RESULTS: The histopathologic distribution of all the patients was as follows: serous type (57.1%), mucinous type (15.0%), endometrioid type (15.0%), clear cell type (9.5%). mixed type (3.4%). The FIGO stage distribution for invasive epithelial ovarian cancer was stage I (29.3%), stage II (4.1%), stage III (54.4%), and stage IV (12.2%). The mean value of pre-operative CA-125 according to histologic type was 2715 IU/ml (S.E. 637) for serous type, 2002 IU/ml (S.E. 687) for endometrioid type, 896 IU/ml (S.E. 290) for mixed type, 421 IU/ml (S.E. 145) for mucinous type, and 236 IU/ml (S.E. 140) for clear cell ovarian cancer. No residual tumor was identified in 67 patients (48.9%) after primary cytoreductive surgery. Sixteen patients (11.7%) exhibited less than 2 cm tumor and 54 patients (39.4%) 2 cm or more macroscopic residual tumor. Second-look laparotomy was undertaken and pathologic residual disease was observed in 12 cases out of 39 (30.7%) patients. The overall 5-year survival rate of all the patients was 46.7%. In univariate analysis, FIGO stage (p=0.0091), grade (p=0.0081), residual volume (p=0.0038) and histologic type (p=0.0313) were significant prognostic factors affecting survival. However, multivariate analysis demonstrated that only FIGO stage (p=0.0048) was identified as a significant independent prognostic factor in this study. CONCLUSION: This study showed that FIGO stage was identified as a significant independent prognostic factor in the patients with epithelial ovarian cancer of all stages.

An Analysis of Clinicopathologic Prognostic Factors Affecting Survival in Patients with Uterine Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the clinicopathologic characteristics and prognostic factors of uterine endometrial cancer affecting survival of the patients. METHODS: Form Jan. 1995 to Dec. 2001, medical records including operation record and pathologic reports of 111 patients with histologically proven endometrial cancer at Samsung Medical Center were reviewed. The survival of patients was determined by description of last follow up date in medical records or phone calls. RESULTS: The median age of all patients was 52 years and the most common presenting symptom was abnormal vaginal bleeding (74.0%). Histologic type of endometrioid adenocarcinoma was the most common (90%) type of all endometrial cancers. The grades were classified into G1 (65.7%), G2 (17.1%), G3 (12.6%) and unknown (4.5%). The FIGO surgical stage was also classified into stage I(75.7%), stage II (14.4%), stage III (9.0%), and stage IV (0.9%). All patients were treated by primary surgery and postoperative adjuvant therapy including radiation therapy (54.1%), chemotherapy (4.5%) was applied. The overall 5-year disease free survival rate (DFSR) was 86.5% and overall 5-year survival rate was 87.8%. The age (p=0.04), grade (p=0.04), myometrial invasion (p=0.047), FIGO surgical stage (p=0.0067), lymph node metastasis (p=0.0001), lymphovascular space invasion (p=0.01) and C-erb B2 (p=0.04) were significant prognostic factors by univariate analysis. CONCLUSION: The age, grade, myometrial invasion, FIGO surgical stage, lymph node metastasis, lymphovascular space invasion and C-erb B2 were significant prognostic factors of uterine endometrial cancer affecting survival of the patients.