Identification of Patients with Recurrent Epithelial Ovarian Cancer Who Will Benefit from More Than Three Lines of Chemotherapy

설애란,임가원,정주연,김세익,이마리아,김희승,정현훈,김재원,박노현,송용상 대한암학회 2022 Cancer Research and Treatment Vol.54 No.4

Purpose This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC). Materials and Methods Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, pati-ents were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated. Results A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group res-pectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167). Conclusion Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen. Purpose This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC).Materials and Methods Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients’ survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated.Results A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167).Conclusion Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.

컨볼루션 신경망의 신뢰도 규제를 이용한 CT 영상에서 악성 난소 종양 판별 방법

이민경,정민영,설애란,정현훈,신영길 한국차세대컴퓨팅학회 2020 한국차세대컴퓨팅학회 논문지 Vol.16 No.2

의료 영상 분야에서 컴퓨터 보조 진단 시스템은 의사의 영상 판독을 보조하기 위한 도구로써 필요성이 점차 증대되 고 있다. 특히, CT 영상에서 악성 종양에 대한 정확한 진단을 위해 보조 진단 시스템이 크게 요구된다. 최근 딥러닝 이 의료 보조 진단 시스템 개발에 도입되면서 획기적인 결과를 보이고 있으나, 실제 임상에서 필요한 높은 일반화 성능을 기대하기에는 여전히 한계가 있다. 낮은 일반화 성능의 주 요인은 훈련 데이터의 부족 및 극심한 불균형이 다. 본 논문에서는 의료 영상 분야 최초로 신뢰도 페털티를 도입하여 높은 정확도로 CT 영상에서 악성 난소 종양을 판별하는 방법을 제안한다. 과적합을 방지하고 일반화 성능을 향상시키기 위해 딥러닝의 마지막 출력에 신뢰도 페널 티를 도입하였다. 마지막 출력 분포의 정규화는 적은 훈련 데이터를 사용하였음에도 불구하고 일반화 성능을 성공적 으로 향상시켰다. 50명의 영상에 대해 실험한 결과, AU-ROC(Area Under the Receiver Operating Characteristics Curve) 점수와 분류 정확도가 각각 0.99, 96%로, 신뢰도 페널티를 추가하기 전보다 정확도가 각각 10%, 20% 향상되었다. 또한 클래스 액티베이션 맵의 가시화를 통해 딥러닝 모델의 예측에 근거를 제시함으 로써 제안한 방법이 실제 임상에서 성공적인 보조적 도구가 될 수 있음을 확인하였다. Deep learning has been widely developed to provide Computer-Aided Diagnosis(CAD) system in the field of medical imaging. Among the applications, an accurate diagnosis of malignant tumor from CT images is one of the most highly demanded field. Although deep learning is showing groundbreaking results on medical CAD systems, it is still challenging to provide high generalization performance, which is critical for an actual deployment of the system on daily medical diagnosis. The main difficulty arises from the deficiency of training data and extreme class imbalance. In this paper, we propose an accurate classification method for the malignant tumor in ovarian CT images based on preventing overfitting. To avoid the overfitting and improve the performance of generalization, we employed confidence penalty loss to the final output. A regularization on the final output distribution successfully achieved high generalization performance while training with insufficient dataset. In the experiment, AU-ROC(Area Under the Receiver Operating Characteristics Curve) score and classification accuracy marked 0.99 and 96%, which were 10% and 20% improvements, respectively, compared to the loss without the confidence penalty. Moreover, we present a visualization of class activation maps, which provides an explainable results indicating that the proposed method can be a successful measure for a CAD system.

COS-Color System 개발을 위한 국내 섬유패션업계의 활용색 분석연구

김영인(KIM, Youngin),설용건(SHUL, Yonggun),박민용(PARK, Minyong),박영순(PARK, Youngsoon),고애란(GOH, Aeran) 한국색채학회 1998 한국색채학회 학술대회 Vol.1998 No.6

Uptake Rate of Risk-Reducing Salpingo-Oophorectomy and Surgical Outcomes of Female Germline BRCA1/2 Mutation Carriers: A Retrospective Cohort Study

임현지,김세익,현소운,이광빈,설애란,이마리아 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.12

Purpose: This study investigated the uptake rate of risk-reducing salpingo-oophorectomy (RRSO) and surgical outcomes of germline BRCA1/2 mutation carriers at Seoul National University Hospital (SNUH). Materials and Methods: We examined the records of 824 women who underwent germline BRCA1/2 gene testing at SNUH between 2005 and 2020. Among them, we identified women with a pathogenic mutation on either the BRCA1 or the BRCA2 gene, and excluded ovarian cancer patients. Characteristics of participants who underwent RRSO (RRSO group) were compared to those who did not (non-RRSO group). Surgical outcomes and pathologic results were investigated in the RRSO group. Results: There were 117 BRCA1/2 mutation carriers included in the analysis. The uptake rate of RRSO was 70.1% (82/117). Older age (mean: 48.8 years vs. 42.1 years; p=0.002) and higher employment rate (65.9% vs. 14.3%; p<0.001) were observed in the RRSO group compared to the non-RRSO group. However, no differences in other factors, such as personal and family history of breast cancer, were observed between the two groups. In the RRSO group, the median time interval between the genetic test and RRSO was 10.0 months, and there were three (3.7%) incidental cases of high-grade serous carcinoma. However, one patient in the non-RRSO group developed primary peritoneal cancer after 103.8 months of surveillance. Conclusion: The uptake rate of RRSO in BRCA1/2 mutation carriers was about 70%. Considering incidental cancer cases in women without abnormal findings on preoperative evaluation, BRCA1/2-mutated women might refrain from the delayed implementation of RRSO after the genetic test.

한국 표준 섬유활용색 모음(Color System) 제작에 관한 연구

김영인(Kim Youngin),고애란(Goh Aeran),박영순(Park Youngsoon),강죽형(Kang Jukhyung),추선형(Choo Sunhyung),조민정(Cho Minjung),설용건(Shul Yonggun),박민용(Park Minyong) 한국디자인학회 1997 디자인학연구 Vol.- No.22

Rotational intraperitoneal pressurized aerosol chemotherapy with paclitaxel and cisplatin: pharmacokinetics, tissue concentrations, and toxicities in a pig model

Soo Jin Park,Eunji Lee,설애란,Sunwoo Park,Jiyeon Ham,Ga Won Yim,심승혁,Whasun Lim,Suk-Joon Chang,Gwonhwa Song,Ji Won Park,Hee Seung Kim,on behalf of the Korean Rotational Intraperitoneal pressurized Aerosol 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5

Objective: We used paclitaxel and cisplatin, known to be effective in intraperitoneal chemotherapy, in a novel prototype of rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) and evaluated the pharmacokinetics, tissue concentrations, and toxicities in a pig model. Methods: We developed RIPAC, including the nozzle with the conical pendulum motion, and used 10% of intravenous doses of paclitaxel and cisplatin. We used high-performance liquid chromatography followed by tandem mass spectrometry to analyze serum and tissue concentrations. We applied a non-compartment model to study pharmacokinetics to analyze the time-dependent serum concentrations measured before RIPAC to 48 hours. We evaluated the difference in tissue concentrations between twelve peritoneal regions by the modified peritoneal cancer index. For evaluating toxicities, we observed hepatic and renal function until 4 days after RIPAC. Results: Six pigs underwent RIPAC using paclitaxel (n=3) and cisplatin (n=3). The peak serum concentration (Cmax) and the area under the curve were higher for cisplatin, while the time to the peak serum concentration (Tmax) was longer for paclitaxel. Moreover, the parietal peritoneum showed higher tissue concentrations than the visceral peritoneum, and the ratio of tissue to serum concentrations using Cmax was higher for paclitaxel (172.2–6,237.9) than for cisplatin (0.1–9.3). However, there were no renal and hepatic toxicities after RIPAC with paclitaxel or cisplatin. Conclusion: Delayed absorption of paclitaxel sprayed by RIPAC into the peritoneum to the bloodstream may lead to higher tissue concentrations at different regions and lower serum concentrations than cisplatin.