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( Seung-hyuk Shim ),( Dae-yeon Kim ),( Young Hee Hong ),( Sun Joo Lee ),( Soo-nyung Kim ),( Soon-beom Kang ),( Shin-wha Lee ),( Jeong-yeol Park ),( Dae-shik Suh ),( Jong-hyeok Kim ),( Yong-man Kim ),( 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-
목적: Concurrent chemoradiotherapy is usually administered to patients with locally advanced cervical cancer (LACC). Extended-field chemoradiotherapy is required if para-aortic lymph node (PALN) metastasis is detected. This study aimed to construct a prediction model for PALN metastasis in patients with LACC before definitive treatment. 방법: Between 2009 and 2015, all consecutive patients with LACC who underwent para-aortic lymphadenectomy at two tertiary centers were retrospectively analyzed. A multivariate logistic model was constructed, from which a prediction model for PALN metastasis was developed and internally validated. Before analysis, risk grouping was predefined based on the likelihood ratio. 결과: In total, 245 patients satisfied the eligibility criteria. Thirty-four patients (13.9%) had pathologically proven PALN metastases. Additionally, 16/222 (7.2%) patients with negative PALNs on positron emission tomography/computed tomography (PET/CT) had PALN metastasis. Moreover, 11/105 (10.5%) patients with both negative PALNs and positive pelvic lymph nodes on PET/CT had PALN metastasis. Tumor size on magnetic resonance imaging and PALN status on PET/CT were independent predictors of PALN metastasis. The model incorporating these two predictors displayed good discrimination and calibration (bootstrap-corrected concordance index = 0.886; 95% confidence interval = 0.825-0.947). The model categorized 169 (69%), 52 (22%), and 23 (9%) patients into low-, intermediate-, and high-risk groups, respectively. The predicted probabilities of PALN metastasis for these groups were 2.9, 20.8, and 76.2%, respectively. 결론: We constructed a robust model predicting PALN metastasis in patients with LACC that may improve clinical trial design and help clinicians determine whether para-aortic lymphadenectomy should be performed.
( Seung Hyuk Shim ),( Dong Yun Lee ),( Shin Wha Lee ),( Jeong Yeol Park ),( Jong Jin Lee ),( Jong Hyeok Kim ),( Yong Man Kim ),( Young Tak Kim ),( Joo Hyun Nam ),( Dae Yeon Kim ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are functional tumor parameters which determine the metabolic activity of tumors with increased 18 fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography/computed tomography(PET/CT). The goal of this study was to evaluate whether these parameters have prognostic value in patients with endometrial cancer. Between 2004 and 2009, 84 patients with endometrial cancer who had undergone preoperative 18F-FDG PET/CT were included in this study. We measured the SUVmax, SUVavg, MTV, and TLG of the primary tumor. Patients` clinicopathologic characteristics and follow-up information were collected from hospital charts and clinic records retrospectively. Cox proportional hazards analysis and Kaplan-Meier method were used to identify the predictors for recurrence. Receiver operating curve (ROC) analysis was used to determine the cutoff value of continuous variables for predicting recurrence. The median age was 51 (range 24-76) years. The median follow-up period was 49 (range 3-85) months. International Federation of Gynecology and Obstetrics (FIGO) stage included: I (58), II (11), III (13), and IV (2). Histology included: endometrioid (63), papillary serous (10), carcinosarcoma (9), clear cell (1), and adenocarcinoma (1). There were 12 cases of recurrence and 9 cases of disease-specific death. The median progression free survival (PFS) duration was 48 (1-85) months. In univariate analysis, factors predicting for recurrence were myometrial invasion (p=0.012), lymphovascular space invasion (p=0.029), lymph node metastasis (p<0.001), non-endometrioid histology (p=0.002), advanced FIGO stage (p<0.001), MTV (p=0.001), and TLG (p=0.052) while SUVmax and SUVavg were not. However, multivariate analysis showed that only lymph node metastasis (p=0.001 , hazard ratio [HR] 9.286, 95% confidence interval [CI] 2.614-32.986), and MTV (p=0.009 , HR 1.007, 95% CI 1.002-1.013) remained as independent risk factors for recurrence. The area under the ROC plot for discriminating recurrence of MTV using the cutoff value of 17.15 was 0.679. The Kaplan-Meier survival graph showed that patients with a high MTV (≥17.15) had a significantly lower PFS rate than those with a low MTV (<17.15; p=0.034, log-rank test). MTV measured by preoperative 18F-FDG PET/CT was a significant independent prognostic factor predicting for recurrence in patients with endometrial cancer. This functional tumor parameter may be considered to plan further treatment and follow-up after operation.
( Seung Hyuk Shim ),( Shin Wha Lee ),( Jeong Yeol Park ),( Jong Hyeok Kim ),( Yong Man Kim ),( Young Tak Kim ),( Joo Hyun Nam ),( Dae Yeon Kim ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-
The aim of this study was to compare the surgical outcomes between single-port versus three-port laparoscopic myomectomy. This was a retrospective matched cohort study. We included patients who underwent single-port or three-port laparoscopic myomectomy between 2009 and 2011. We matched all cases of single-port laparoscopic myomectomy (SLM) 1:2 with three-port laparoscopic myomectomy (TLM) based on age, body mass index, diameter of largest myoma, and number of removed myoma. Clinicopathologic data of these patients were reviewed by medical records. During study period, 20 cases of SLM were performed. There were no statistically significant differences between the SLM and TLM groups in age, body mass index, diameter of largest myoma, and number of removed myoma. Mean age was 33.6±7.9 years versus 34.1±8.1 years, mean body mass index was 22.6±3.9 kg/m2 versus 22.9±4.3 kg/m2, and mean myoma diameter was 6.54±2.1 cm versus 7.08±2.49 cm, respectively. There were no differences in operating time (101.1±29.1 min vs. 105.8±25.3 min, p=0.545), estimated blood loss (202.8±161.3 mL vs. 195.2±161.3 mL, p=0.865), postoperative drop of hemoglobin level (2.1±1.6 mg/dL vs. 2.0±1.4 mg/dL, p=0.614), and transfusion requirement (5.56% vs. 6% p=0.596). However, single-port group had significantly shorter postoperative hospital stay (2.11±0.32 vs. 2.48±0.68, p<0.05), lower postoperative pain scores at POD 0 (3.9±0.9 vs. 4.5±0.9, p<0.05) and less postoperative opioids requirement (24.8% vs. 50.0%, p<0.05). Operation related complications occurred in 1 (5%) and 2 (4%) patients of single-port and three-port laparoscopic myomectomy group, respectively (p=0.371). This is the first matched cohort study to compare the surgical outcomes between single-port versus three-port laparoscopic myomectomy. Single-port laparoscopic myomectomy appeared to be as feasible and safe as three-port laparoscopic myomectomy. It was more minimally invasive surgery with more favorable operative outcomes in terms of postoperative pain, analgesics requirement and cosmetic outcome.
( Seung-hyuk Shim ),( Soo-nyung Kim ),( Young Hee Hong ),( Jung Eun Kim ),( Sun Joo Lee ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-
목적: To quantify the effect of adjuvant hysterectomy (AH) on prognosis in locally advanced cervical cancer (LACC) patients treated with definitive chemoradiation through a meta- analysis. 방법: We systematically reviewed published studies comparing AH with no AH in LACC patients through April 2016. Endpoints were recurrence and mortality rates. Study design features that possibly affected participant selection, recurrence/death detection, and manuscript publication were assessed. For pooled estimates of the effect of AH on recurrence/death, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. 결과: Two randomized trials and six observational studies (AH, 630 patients; no AH, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated a reduced recurrence risk among AH patients (odds ratio [OR]=0.64; 95% confidence interval [CI]: 0.47-0.87, p<0.05, I2=25.6), whereas its efficacy was not shown in two randomized controlled trials (hazard ratio, 1.05; 95% confidence interval, 0.84-1.31). Furthermore, no significant between-group difference in mortality was observed (OR=0.98; 95% CI: 0.42-2.29, p=0.97, I2=0). This pattern was observed in the subgroup analysis for stage, type of hysterectomy undergone, type of radiotherapy, chemotherapeutic regimen, and residual disease after CCRT. There was no evidence of publication bias. 결론: In this meta-analysis mainly based on observational studies, AH appeared to significantly reduce recurrence among LACC patients after CCRT. No survival impact was observed. Future research should verify this relationship through randomized controlled trials with large-sample size over a longer term.
심승혁 ( Seung-hyuk Shim ),( Dae-yeon Kim ),( Sun Joo Lee ),( Soo-nyung Kim ),( Soon-beom Kang ),( Shin-wha Lee ),( Jeong-yeol Park ),( Dae-shik Suh ),( Jong-hyeok Kim ),( Yong-man Kim ),( Young-tak Kim 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective Concurrent chemoradiotherapy is usually administered to patients with locally advanced cervical cancer (LACC). Extended-field chemoradiotherapy is required if para-aortic lymph node (PALN) metastasis is detected. This study aimed to construct a predictionmodel for PALNmetastasis in patients with LACC before definitive treatment. Methods Between 2009 and 2016, all consecutive patients with LACC who underwent para-aortic lymphadenectomy at two tertiary centers were retrospectively analyzed. A multivariate logistic model was constructed, from which a prediction model for PALN metastasis was developed and internally validated. Before analysis, risk grouping was predefined based on the likelihood ratio. Results In total, 245 patients satisfied the eligibility criteria. Thirty-four patients (13.9%) had pathologically proven PALN metastases. Additionally, 16/222 (7.2%) patientswith negative PALNs on positron emission tomography/computed tomography (PET/CT) had PALNmetastasis. Moreover, 11/105 (10.5%) patients with both negative PALNs and positive pelvic lymph nodes on PET/CT had PALN metastasis. Tumor size on magnetic resonance imaging and PALN status on PET/CT were independent predictors of PALN metastasis. The model incorporating these two predictors displayed good discrimination and calibration (bootstrap-corrected concordance index = 0.886; 95% confidence interval = 0.825-0.947). The model categorized 169 (69%), 52 (22%), and 23 (9%) patients into low-, intermediate-, and high-risk groups, respectively. The predicted probabilities of PALN metastasis for these groups were 2.9, 20.8, and 76.2%, respectively. Conclusion We constructed a robust model predicting PALN metastasis in patients with LACC that may improve clinical trial design and help clinicians determine whether nodal-staging surgery should be performed.