Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines.

Background/Aims: There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. Methods: The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. Results: Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). Conclusions: More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

Left ventricular metastasis from renal cell carcinoma causing left ventricular outflow tract obstruction.

Most cases of cardiac metastasis from renal cell carcinoma (RCC) involve the vena cava or right atrium. Left ventricular metastases from RCC without involving the vena cava or right atrium are extremely rare. Herein we report a case of RCC with left ventricular metastasis causing left ventricular outflow obstruction (LVOT).

A phase II study of combination chemotherapy with docetaxel and carboplatin for elderly patients with advanced non-small cell lung cancer.

BACKGROUND: More than 50% of all advanced non-small cell lung cancer (NSCLC) is diagnosed in patients older than 65 years. Chemotherapy in elderly patients has not been standardized even though cisplatin-based chemotherapy has been used in patients with advanced NSCLC as primary therapy. We investigated the efficacy and safety of combination chemotherapy with docetaxel and carboplatin for elderly patients with advanced NSCLC. METHODS: Chemotherapy-naïve patients (age > or = 65 years) with stage IIIB or IV NSCLC were enrolled. Patients received docetaxel (75 mg/m(2) on D1) and carboplatin (AUC of 5mg/ml/min on D1) every 3 weeks. The end points included the response rate, progression-free survival (PFS), overall survival (OS) and toxicity. RESULTS: A total of 43 patients was enrolled between March 2005 and December 2008, and 38 patients were evaluable. The median age was 74 years old (range, 65-84 years) and 39 patients (90.6%) had an ECOG PS of 0 or 1. Squamous cell carcinoma was observed in 18 patients (41.8%) and 24 patients (55.8%) had an increased Charlson comorbidity index score (CCI > or = 1). The median number of treatment cycles was five (range, 1-8) and the relative dose intensity was 90.4% for docetaxel and 92.7% for carboplatin. The overall response rate was 46.5% (95% CI, 31.6-61.4) for with one complete response and 19 partial responses. The median follow-up duration was 14.4 months. The median PFS was 6.9 months (95% CI, 6.25-7.55) and the median OS was 13.1 months (95% CI, 10.20-16.07). The 1-year survival rate was 60%. In grade 3 or 4 hematological toxicities, neutropenia (37.2%), anemia (18.6%) and thrombocytopenia (4.6%) were shown. The non-hematological toxicities were tolerable. CONCLUSIONS: The combination chemotherapy with docetaxel and carboplatin was effective with tolerable toxicities in elderly patients with advanced non-small cell lung cancer.