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임명철,강석범,송용중,박세현,박상윤 대한의학회 2010 Journal of Korean medical science Vol.25 No.7
We performed a retrospective study to evaluate the feasibility and safety of extensive upper abdominal surgery (EUAS) in elderly (≥65 yr) patients with advanced ovarian cancer. Records of patients with advanced epithelial ovarian cancer who received surgery at our institution between January 2001 and June 2005 were reviewed. A total of 137 patients including 32 (20.9%) elderly patients were identified. Co-morbidities were present in 37.5%of the elderly patients. Optimal cytoreduction was feasible in 87.5% of the elderly while 95.2% of young patients were optimally debulked (P=0.237). Among 77 patients who received one or more EUAS procedures, 16 (20.8%) were elderly. Within the cohort, the complication profile was not significantly different between the young and the elderly,except for pleural effusion and pneumothorax (P=0.028). Elderly patients who received 2or more EUAS procedures, when compared to those 1 or less EUAS procedure, had significantly longer operation times (P=0.009), greater blood loss (P=0.002) and more intraoperative transfusions (P=0.030). EUAS procedures are feasible in elderly patients with good general condition. However, cautious peri-operative care should be given to this group because of their vulnerability to pulmonary complications and multiple EUAS procedures.
Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010
임명철,문은경,신애선,정규원,원영주,서상수,강석범,김재원,김주영,박상윤 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.4
Objective: To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females. Methods: Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated. Results: The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females ≥80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%). Conclusion: ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.
Second Primary Cancer after Diagnosis and Treatment of Cervical Cancer
임명철,원영주,임지원,김연주,서상수,강석범,이은숙,오재환,김주영,박상윤 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2
Purpose This study was conducted to investigate the incidence and survival outcomes of second primary cancers after the diagnosis of cervical cancer. Materials and Methods Data from the Korea Central Cancer Registry between 1993 and 2010 were reviewed and analyzed. Standardized incidence ratios (SIRs) of second primary cancers among women with cervical cancer were analyzed. Kaplan-Meier survival curves were constructed for cervical cancer patients with or without a second primary cancer. Results Among 72,805 women with cervical cancer, 2,678 (3.68%) developed a second primary cancer within a mean follow-up period of 7.34 years. The overall SIR for a second cancer was 1.08 (95% confidence interval, 1.04 to 1.12). The most frequent sites of second primary cancers were the vagina, bone and joints, vulva, anus, bladder, lung and bronchus, corpus uteri, and esophagus. However, the incidence rates of four second primary cancers (breast, rectum, liver, and brain) were decreased. The 5-year and 10-year overall survival rates were 78.3% and 72.7% in all women with cervical cancer, and for women with a second primary cancer, these rates were 83.2% and 65.5% from the onset of cervical cancer and 54.9% and 46.7% from the onset of the second primary cancer, respectively. Conclusion The incidence rates of second primary cancers were increased in women with cervical cancer compared to the general population, with the exception of four decreasing cancers. The 10-year overall survival rates were decreased in cervical cancer patients with a second primary cancer.
임명철,김태현,박소희,공선영,윤정현,강석범,서상수,박상윤,김주영 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6
Purpose: To analyze the effect of allogeneic blood transfusion on clinical outcome in 119 patients with stage IIB cervical cancer who were treated with radiotherapy±chemotherapy. Patients and Methods: Medical records were examined for hemoglobin levels before and during radiotherapy, history of allogeneic blood transfusions and the time point when transfusions were given. These factors were retrospectively analyzed along with other clinical risk factors for influences on the patients’ clinical outcomes. Results: Thirty-two patients (26.9%) received packed red blood cell transfusion (mean, 3.4 units; range, 1-12 units) before or during radiotherapy. Median follow-up period was 39.3 months (range, 7.6-58.4 months). Patients with history of transfusion showed poorer metastasis- free survival and a trend toward poorer overall survival than non-transfused patients. When patients who received transfusions were sub-divided by the time of transfusion, those who received transfusions before radiotherapy had significantly poorer clinical outcome than those who received transfusions during radiotherapy. In a multivariable analysis, patients with pretreatment transfusion showed a higher risk of distant metastasis (HR=3.75, 95% CI: 1.28-12.15, p=0.017) and decreased overall survival rates (HR=4.62, 95% CI: 1.15-18.54, p=0.031) compared with those of other patients. Conclusion: Our results suggest that allogeneic blood transfusions given before radiotherapy may be associated with higher incidence of distant metastases and decreased survival in patients with stage IIB cervical cancer.
임명철,유형종,송용중,서상수,강석범,김선호,유종우,박상윤 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4
Objective: To investigate the survival outcomes in patients with bulky stage IIIC and IVovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvantchemotherapy (NAC) according to institutional criteria. Methods: Medical records for advanced ovarian cancer patients who were treated at NationalCancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewedin the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases wereincluded. Current NCC indication for NAC is determined based on patients' performancestatus and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially includingchemotherapy-resistant cancer cells, were surgically removed. Results: Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136(49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achievedin 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. Themedian progression-free survival (PFS) and overall survival (OS) time were 20 months andnot reached, but might be estimated more than 70 months in the PDS group and 15 and 70months in the NAC group, respectively. Conclusion: Extensive cytoreductive surgery to minimize residual tumor and selective useof NAC based on the institutional criteria could result in improved survival outcomes. Untilfurther studies can be done to define the selection criteria for NAC after surgery, institutionalcriteria for NAC should consider the ability of the surgeon and institutional capacity
임명철,전소연,김세익,이정윤,이산휘,송용중,천경철,김재원,박상윤 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.5
Purpose: Human papillomavirus (HPV) infection is a well-known cause of cervical cancer, which, along with its precursors, can be diagnosed and treated with cervical conization (CC). This study aimed to assess HPV- and procedure-related knowledge among women who had undergone CC. Materials and Methods: Between February and May 2014, consecutive women who had undergone CC at five different educationalhospitals were recruited. All patients had undergone a loop electrosurgical excision procedure as the method of CC. A surveywas conducted with a self-developed, 29-item questionnaire, measuring knowledge related to HPV and CC. We analyzed the responses of 160 patients who completed the questionnaire. Results: Mean total knowledge scores (±standard deviation) for HPV and CC were 5.2±3.0 of a possible 13.0 and 8.3±4.2 of a possible16.0, respectively. While 73% of the patients knew that HPV is the main cause of cervical cancer, only 44% knew that HPV is sexually transmitted. The purpose of CC was correctly identified by 71% of the patients. However, 35% failed to indicate the anatomicalarea resected at the time of CC in the schematic diagram. Women who were younger (p<0.001), had higher education level (p<0.001), and higher family income (p=0.008) had higher knowledge scores. In contrast, neither interval from CC to survey nor disease severity were associated with total knowledge score. Conclusion: The level of knowledge related to HPV and CC was unexpectedly low in women who had undergone CC. Intuitive educational resources may improve this knowledge, and further cohort studies are warranted.
Incidence of cervical, endometrial, and ovarian cancer in Korea during 1999–2015
임명철,원영주,고문정,김미선,심승혁,서동훈,김재원 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1
Objective: To investigate the incidence and trends of cervical (C53), endometrial (C54.1), and ovarian cancer (C56) among Korean females between 1999 and 2015. Methods: The incidence of the three major gynecological cancers between 1999 and 2015 was analyzed based on the data from the Korea Central Cancer Registry. The age-standardized rates (ASRs) and the annual percent changes (APCs) for each site were calculated. Results: The absolute incidence rates of the three major gynecological cancers increased from 6,394 in 1999 to 8,288 in 2015. ASR for gynecologic cancer decreased from 23.7 per 100,000 in 1999 to 21.1 in 2015. This was mainly due to a definitive decrease in the incidence of cervical cancer, which recorded an APC of −3.7%. The trends of APC for gynecologic cancer were variable, being −1.36% between 1999 and 2006 and −0.11% between 2006 and 2015. A definitive but variable increase was noted for endometrial cancer, and the APC for this cancer was 7.4% between 1999 and 2009 and 3.5% between 2009 and 2015. The incidence of ovarian cancer gradually increased, with an APC of 1.8% between 1999 and 2015. Conclusion: Overall, ASRs and APCs for the three major gynecological cancers are decreasing, with a recent reduction in the width of the change. However, there has been a progressive increase in the incidence of endometrial and ovarian cancers.