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Ho-Young Yhim,Yong Park,Jeong-A Kim,Ho-Jin Shin,Young Rok Do,Joon Ho Moon,Min Kyoung Kim,Won Sik Lee,Dae Sik Kim,Myung-Won Lee,Yoon Seok Choi,Seong Hyun Jeong,Kyoung Ha Kim,Jinhang Kim,Chang-Hoon Lee 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.3
Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson’s Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30–3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.
Challenging issues in the management of cancer-associated venous thromboembolism
Ho-Young Yhim 대한혈액학회 2022 Blood Research Vol.57 No.-
Venous thromboembolism (VTE) is a common complication among patients with cancer and is associated with delays in underlying cancer treatment and increases in morbidity and mortality. Acute and long-term treatments with low-molecular-weight-heparin (LMWH) have been recommended as a standard of care for patients with cancer with VTE for the past 20 years. Direct oral anticoagulants (DOACs) have recently emerged as a new therapeutic modality for cancer-associated VTE because of the convenience of oral administration and rapid onset of action. Our knowledge regarding DOACs for cancer- associated VTD has expanded in recent years. Thus, this study aimed to review recent major pivotal trials comparing DOACs with LMWH for managing cancer-associated VTE. Moreover, a recently updated understanding of DOACs in the treatment of cancer-associated VTE in specific challenging situations is presented.
YHIM, HO-YOUNG,CHO, SANG-HEE,KIM, SAM YONG,CHO, IN SUNG,LEE, KYU TAEK,LEE, WON SUP,LEE, SOON IL,PARK, MOO RIM,PARK, SANG-GON,HAN, HYE-SUK,CHOI, YOON SEOK,CHUNG, IK-JOO,SHIM, HYUN-JEONG,LEE, NA-RI,SONG Spandidos Publications 2015 ONCOLOGY REPORTS Vol.34 No.1
<P>Thymidylate synthase (TS) gene polymorphisms such as tandem repeat (TR) polymorphisms and single-nucleotide polymorphisms (SNPs) affect transcriptional efficiency of the TS gene and may be prognostic markers for fluoropyrimidine-based therapy in various gastrointestinal cancers. However, data for TS polymorphisms on clinical outcomes in advanced small bowel adenocarcinoma (SBA) are limited. We retrospectively enrolled 58 locally advanced/metastatic SBA patients treated with first-line fluoropyrimidine-based chemotherapy and analyzed the relationship between TS genotypes and clinical outcomes in 30 patients who were available for tumor tissue. Based on TR polymorphisms and a G>C SNP in the promoter region of the TS gene, 74% of patients had high TS expression genotypes (2R/3RG, 3RG/3RC, 3RG/3RG); the remainder had low TS expression genotypes (2R/2R, 2R/3RC, 3RC/3RC). After a median follow-up of 48.8 months, median progression-free survival (PFS) and overall survival (OS) in all patients were 6.0 and 11.3 months, respectively. However, patients with low TS expression genotypes had better median PFS (12.8 vs. 4.3 months, P=0.027) and OS (28.8 vs. 8.9 months, P=0.025) than those with high TS expression genotypes. In multivariate analysis, poor Eastern Cooperative Oncology Group performance status [hazard ratio (HR), 2.85; 95% CI, 1.02-7.93] and high TS expression genotypes (HR, 3.49; 95% CI, 1.13-10.78) were independent prognostic factors for worse OS. Therefore, TS genotypes, based on a G>C SNP in the TR sequence of the TS gene, may be a useful biomarker for predicting outcomes for fluoropyrimidine-based chemotherapy in patients with locally advanced/metastatic SBA.</P>
( Ho Young Yhim ),( Sang Hee Cho ),( Samyong Kim ),( Hye Suk Han ),( Won Sup Lee ),( Soon Il Lee ),( Kyu Taek Lee ),( In Sung Cho ),( Moo Rim Park ),( Sang Gon Park ),( Yoon Seok Choi ),( Ik Joo Chung 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Data on TS gene polymorphisms in advanced SBA are limited. Methods: A total of 58 patients (39men, 19women) with advanced SBA treated with fi uoropyrimidine-based therapy were consecutively enrolled. Two main polymorphisms in the 5`-UTR of TS gene (tandem repeat [TR] and G>C single nucleotide polymorphism SNP]) were determined by direct sequencing from paraffi n-embedded tumor tissues at diagnosis. TS genotype was classifi ed as high (2R/3RG, 3RG/3RC, 3RG/3RG) or low 2R/2R, 2R/3RC, 3RC/3RC) expression groups. Results: Most (86%) were duodenal cancer and 43 patients (74%) were metastatic disease. Forty-two patients (72%) were treated with fi uoropyrimidines plus platinums cisplatin 53%, oxaliplatin 19%). Results for TR polymorphism and SNP of TS gene were available in 30 patients (52%). TR analyses revealed 2R/2R in 3 patients (10%), 2R/3R in 10 (33%), and 3R/3R in 17 (57%). SNP analyses revealed 2R/3RC in 2 patients (7%), 3RG/3RC in 6 (20%), and 3RC/3RC in 3 (10%). Overall response rate (ORR) was 26%, which was superior in low expression group (71% vs 23%, P=0.030). With a median follow-up of 48.8 months, median progression-free survival (PFS) and overall survival (OS) were 6.0 and 11.3 months, respectively. Patients in low expression group had better median PFS (12.8 vs 4.3 months, P=0.027) and OS (28.8 vs 8.9 months, P=0.025) than those in high expression group. In multivariate analysis, poor ECOG PS (HR, 2.70; 95%CI, 1.08-6.75) and high TS expression genotypes (HR, 2.47; 95%CI, 1.05-5.79) were independent predictors for worse PFS. Conclusions: This study suggests TS polymorphisms in the 5`-UTR affect ORR, PFS and OS in advanced SBA. Therefore, TS genotype may be a useful biomarker in predicting outcomes of fi uoropyrimidine-based chemotherapy in advanced SBA.
Quadruple Primary Malignancies of Liver, Bladder, Lung and Stomach in One Patient
Yhim, Ho-Young,Kim, Hee Sun,Lee, Na-Ri,Kwak, Jae-Yong,Yim, Chang-Yeol,Park, Ho Sung,Song, Eun-Kee SAGE Publications 2010 TUMORI Vol.96 No.5
<P>Multiple primary malignancies are defined as two or more malignancies in an individual without any relationship between the tumors. Because of advances in the early detection, treatment, and supportive care for cancer, the number of cancer survivors has been gradually increasing, and this has led to an increase in the possible occurrence of subsequent malignancies. Recently, there have been reports that smoking is associated with a specific genetic mutation (the tumor suppressor gene TP53), and this genetic predisposition may be related to the development of multiple primary malignancies. Here we present a rare case of quadruple primary malignancies of the liver, bladder, lung and stomach, some of which possibly linked to smoking-related TP53 mutation. Because of its extreme rarity and the clear relationship between multiple primary malignancies and smoking-related TP53 mutation, we report this case along with a review of the relevant literature.</P>
Yhim, Ho-Young,Han, Sae-Won,Oh, Do-Youn,Han, Wonshik,Im, Seock-Ah,Kim, Tae-You,Kim, Young Tae,Noh, Dong-Young,Chie, Eui Kyu,Ha, Sung Whan,Park, In Ae,Bang, Yung-Jue Wiley Subscription Services, Inc., A Wiley Company 2010 Cancer Vol.116 No.12
<B>BACKGROUND:</B><P>The aim of this study was to evaluate the clinical treatment outcomes of recurrent breast cancer with a limited number of isolated lung metastases, and to evaluate the role of pulmonary metastasectomy.</P><B>METHODS:</B><P>The authors consecutively enrolled 140 recurrent breast cancer patients with isolated lung metastasis from 1997 to 2007 in Seoul National University Hospital and retrospectively analyzed 45 patients who had <4 metastatic lesions.</P><B>RESULTS:</B><P>Fifteen patients had pulmonary metastasectomy followed by systemic treatment (pulmonary metastasectomy group), and 30 received systemic treatment alone (nonpulmonary metastasectomy group). The 3-year progression-free survival (PFS) and 4-year overall survival (OS) was significantly longer in the pulmonary metastasectomy group than in the nonpulmonary metastasectomy group (3-year PFS, 55.0% vs 4.5%, P < .001; 4-year OS, 82.1% vs 31.6%, P = .001). In multivariate analysis, a disease-free interval (DFI) of <24 months (hazard ratio [HR], 4.53; 95% CI, 1.72-11.90), no pulmonary metastasectomy (HR, 9.52; 95% CI, 3.34-27.18) and biologic subtypes such as human epithelial growth factor receptor-2 positive (HR, 3.00; 95% CI, 1.04-8.64) and triple negative (HR, 3.92; 95% CI, 1.32-11.59) were independent prognostic factors for shorter PFS.</P><B>CONCLUSIONS:</B><P>The authors' results demonstrated that DFI and biologic subtypes of tumor are firm, independent, prognostic factors for survival, and pulmonary metastasectomy can be a reasonable treatment option in this population. Further prospective studies are warranted to evaluate the role of pulmonary metastasectomy. Cancer 2010. © 2010 American Cancer Society.</P>
症例(증례) : 골수에서 발생한 CD34, CD99를 동반 발현하는 원시성 신경외배엽 종양
임호영 ( Ho Young Yhim ),김성식 ( Sung Sik Kim ),민경훈 ( Kyung Hoon Min ),이나리 ( Na Ri Lee ),송은기 ( Eun Kee Song ),곽재용 ( Jae Yong Kwak ),최삼임 ( Sam Im Choi ),임창열 ( Chang Yeol Yim ) 전북대학교 의과학연구소 2004 全北醫大論文集 Vol.28 No.1
Primitive neuroectodermal tumor (PNET) is a small round cell neoplasm that develops in children and young adults. The identification of immunoreactivity for CD99 is important for diagnosis of PNET. But, there have been no reports that PNET is immunoreactive for CD34. Therefore, we report a case of PNET developed in a 26 year-old man, which occurred primarily in the bone marrow. He was presented with hypercalcemia and pancytopenia. Bone marrow aspiration biopsy revealed that tumor cells were composed of round cells with hyperchromatic unclear chromatin and minimal eosinophilic cytoplasm. Rosette formations were occasionally observed. The tumor cells were diffusely immunopositive for CD99 and CD34, while they were immunonegative for vimentin, neuron specific enolase, cytokeratin, desmin, leukocyte common antigen, synaptophysin. He was treated with chemotherapy after general medical supportive care, and still alive during the 6 months of follow-up.
Multicenter retrospective analysis of patients with chronic lymphocytic leukemia in Korea
Jun Ho Yi,이경원,이지현,Kwai Han Yoo,Chul Won Jung,Dae Sik Kim,Jeong-Ok Lee,Hyeon Seok Eom,Ja Min Byun,Youngil Koh,Sung Soo Yoon,Jin Seok Kim,Jee Hyun Kong,Ho-Young Yhim,Deok Hwan Yang,Dok Hyun Yoon,Do Hyou 대한혈액학회 2021 Blood Research Vol.56 No.4
Background Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in Western countries but is rare in the East Asian countries. Due to its rarity and the lack of feasible novel agents and laboratory prognostic tools, there are limited data on the clinical outcomes of this disease in Asia. To clarify the current treatment status, we performed a multicenter retrospective analysis of patients with CLL in Korea. Methods The medical records of 192 eligible patients between 2008 and 2019 were reviewed for clinical characteristics, treatment courses, and outcomes. The first-line treatment regimens of the patients included in this analysis were as follows: fludarabine/cyclophosphamide/ rituximab (FCR) (N=117, 52.7%), obinutuzumab plus chlorambucil (GC) (N=30, 13.5%), and chlorambucil monotherapy (N=24, 10.8%). Results The median progression-free survival (PFS) was 55.6 months, and the average 2-year PFS rate was 80.3%. PFS was not significantly different between the patients receiving FCR and those receiving GC; however, chlorambucil treatment was associated with significantly inferior PFS (P <0.001). The median overall survival was 136.3 months, and the average 5- and 10-year OS rates were 82.0% and 57.4%, respectively. Conclusion This is one of the largest studies involving Korean patients with CLL. Although the patients had been treated with less favored treatment regimens, the outcomes were not different from those reported in Western studies.