The Impact of Diabetes Mellitus and Metformin Treatment on Survival of Patients with Advanced Pancreatic Cancer Undergoing Chemotherapy

최연악,김태용,오도연,이경훈,한세원,임석아,김태유,방영주 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1

Purpose A causal relationship between diabetes mellitus (DM) and pancreatic cancer is well estab- lished. However, in patients with advanced pancreatic cancer (APC) who receive palliative chemotherapy, the impact of DM on the prognosis of APC is unclear. Materials and Methods We retrospectively enrolled APC patients who received palliative chemotherapy between 2003 and 2010. The patients were stratified according to the status of DM, in accordance with 2010 DM criteria (American Heart Association/American Diabetes Association). DM at least 2 years’ duration prior to diagnosis of APC was defined as remote-onset DM (vs. recent-onset). Results Of the 349 APC patients, 183 (52.4%) had DM. Among the patients with DM, 160 patients had DM at the time of diagnosis of APC (remote-onset, 87; recent-onset, 73) and the remaining 23 patients developed DM during treatment of APC. Ultimately, 73.2% of patients (134/183) with DM received antidiabetic medication, including metformin (56 patients, 41.8%), sulfonylurea (62, 45.5%), and insulin (43, 32.1%). In multivariate analysis, cancer extent (hazard ratio [HR], 1.792; 95% confidence interval [CI], 1.313 to 2.445; p < 0.001) showed association with decreased overall survival (OS), whereas a diagnosis of DM (HR, 0.788; 95% CI, 0.615 to 1.009; p=0.059) conferred positive tendency on the OS. Metformin treatment itself conferred better OS in comparison within DM patients (HR 0.693; 95% CI, 0.492 to 0.977; p=0.036) and even in all APC patients (adjusted HR, 0.697; 95% CI, 0.491 to 1.990; p=0.044). Conclusion For APC patients receiving palliative chemotherapy, metformin treatment is associated with longer OS. Patients with DM tend to survive longer than those without DM.

Concurrent Chemoradiotherapy Versus Chemotherapy Alone for Unresectable Locally Advanced Pancreatic Cancer: A Retrospective Cohort Study

최연악,오도연,김규보,지의규,김태용,이경훈,한세원,임석아,김태유,하성환,방영주 대한암학회 2016 Cancer Research and Treatment Vol.48 No.3

Purpose The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), particularly the role of concurrent chemoradiotherapy (CCRT), remains debatable. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with unresectable LAPC. Materials and Methods Patients with LAPC who were consecutively treated between 2003 and 2010 were included. Resectability was evaluated according to National Comprehensive Cancer Network ver. 1.2012. The clinical outcomes for each treatment group (CCRT vs. CA) were evaluated retrospectively. Results Sixty-three patients (58.9%) and 44 patients (41.1%) were treated with CCRT and CA, respectively. The CCRT cohort included patients who were treated with CCRT with or without chemotherapy backbone (CCRT alone, induction chemotherapy-CCRT, CCRT-maintenance chemotherapy, and induction-CCRT-maintenance chemotherapy). Median progression-free survival (PFS) and overall survival (OS) of all patients were 7.2 months and 13.1 months. PFS of the CCRT and CA groups was 9.0 months and 4.4 months, respectively (p=0.020). OS of the CCRT and CA groups was 15.4 months and 9.3 months, respectively (p=0.011). In multivariate analysis, the adjusted hazard ratio of CCRT was 0.536 (p=0.003) for OS and 0.667 (p=0.078) for PFS. Although the pattern of failure was similar in the CCRT and CA groups, the times to both local and distant failure were significantly longer in the CCRT group. Conclusion In patients with unresectable LAPC, those who underwent CCRT during their entire treatment courses had longer OS than patients treated with chemotherapy alone.

Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute

최연악,김범석,김태민,이세훈,김동완,허대석 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4

Purpose The purpose of this study was to investigate and compare cancer treatment near theend-of-life (EOL) over a 10-year period. Materials and MethodsPatients with advanced solid cancer at Seoul National University Hospital who receivedpalliative chemotherapy and had died were enrolled. We categorized the consecutivepatients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressivenessof cancer treatment near the EOL was evaluated. ResultsThe median patient age was 62, and 65.4% of patients (n=172) were male. Time from thelast chemotherapy to death (TCD) was found to have been significantly shortened, from66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received moleculartargeted agents as the last chemotherapy regimen in 2012. The proportion of patients whoreceived intensive care unit care within the last month increased from 1.8% in 2002 to19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increasedfrom 22.8% to 74.8% (p < 0.001). Although hospice referral increased from 9.1% to 37.4%(p < 0.001), timing of referral was delayed from median 53 days to 8 days before death(p=0.004). Use of targeted agents as the last chemotherapy for over-two-regimen userswas associated with shortened TCD (hazard ratio, 2.564; p=0.002). ConclusionCancer treatment near the EOL became more aggressive over 10 years.

경주지역 택시운전사들의 생활습관과 비만과의 관련성

장철호,최연악,이화미,강윤성,김창희,노수영,임영빈,임우현,이관,임현술,정철,배근량,정해관 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.2

택시운전사들을 대상으로 직업적 특성과 생활습관에 대해 알아보고, 이러한 생활양식이 비만 특히 복부비만과 어떠한 관련성이 있는지 알아보고자 이 연구를 시행하였다. 본 연구는 경주지역에서 근무하는30세 이상의 남자 택시운전사 105명을 대상으로 시행하였다. 2003년 9월 20과 21일에 걸쳐 직접 면담을 통해 설문지를 작성하고, 신체를 계측하였다. 본 연구에 사용된 신체 지수에 관련된 용어는 『건강통계자료 수집 및 측정의 표준화』의 정의를 이용하였다. 신체계측은 체중, 체지방률, 허리둘레 및 엉덩이둘레를 각 1인이 담당하여 측정하였다. 조사대상자의 신체측정치의 평균은 신장 169.8±5.5 cm, 체중 73.2±8.8 Kg, 허리둘레 92.5±7.5 cm, 엉덩이둘레 99.9±6.5 cm, 체지방률 24.7±4.5%, 체질량지수 25.3±2.3 Kg/m², 허리엉덩이둘레비 0.93±0.04이었다. 조사대상자의 비만율은 체질량지수를 기준으로 25 이상이 56명(53.4%)이었고, 허리엉덩이둘레비를 기준으로 0.9 이상이 80명(76.2%)이었다. 허리둘레를 기준으로 91.3 이상이 58명(55.2%)이었고, 체지방률을 기준으로 25% 이상이 47명(44.8%)이었다. 허리둘레와 체질량지수의 상관계수는 0.74로 엉덩이둘레 0.66, 허리엉덩이둘레비 0.39, 체지방률 0.57보다 높았다. 로지스틱 회귀분석에서 적당한 규칙적인 운동을 하는 군이 거의 하지 않는 군에 비하여 교차비는 0.15 (95% CI: 0.04-0.54)이었다. 또한 규칙적인 식사를 하는 군에 비해 중증도로 규칙적인 식사를 하는 군의 교차비는 6.29 (95% CI: 2.28- 17.34)로 중증도 식사규칙성군에서 비만율이 높았다. 신체적, 경제적 측면에서 상대적으로 열악한 근무조건에 처해있는 택시운전사들에서 높은 비만율을 관찰하였다. 이런 높은 비만율은 교대근무와 장시간의 근무시간으로 인한 운동 부족과 불규칙한 식생활로 인해 유발되었을 가능성이 높았다. 비만의 위험성에 대한 택시 기사들의 인식을 환기시키는 대책이 필요할 것이며, 기업은 자체적으로 보건교육을 강화하고, 여가 활용을 장려하거나 사내 운동 시설의 설립 등의 제도적인 차원의 비만 대책을 강구할 필요가 있다고 생각한다. Obesity is closely related to the socioeconomic factors and life style. Cab drivers are exposed to unfavorable life style due to their long shift work. We studied the relationship between obesity and life style factors in selected cab drivers. We conducted a questionnaire survey and measured the body weight, waist and hip circumference of 105 cab drivers over 30 years old from Sep. 20 to 21, 2003 in Gyeongju. We developed Dongguk Index (DI) to categorize the diet patterns of cab drivers and defined abdominal obesity as a waist circumference ≥91.3 cm. The proportion of obesity in our study population was 53.4% by body mass index (BMI), 76.2% by waist-hip Circumference (WHC), 55.2% by waist circumference (WC), and 44.8% by body fat (%). WC was significantly higher in longer working (≥12 hours), high pack-years of smoking, less exercising, and less regularly eating group than in shorter working (<12 hours), low pack years of smoking, frequently exercising, and regularly eating group (P<0.05). Odds ratio of regular exercise for obesity was 0.15 (95% CI: 0.04-0.54) for moderate exercising group and 0.53 (95% CI: 0.17-1.65) for frequently exercising group. Odds ratio of regluar diet for obesity was 6.29 (95% CI 2.28017.34) for those with moderately regular diet and 3.09 (95% CI0.96-9.92) in those with poor regularity in diet. In cab drivers, long working hours, and 12 hours per shift together with their irregular diet and exercise patterns makes the matter worse. Because of high socioeconomic costs caused by obesity, obesity is not simple problems to individual, but problems in view of public health. Supports and concerns for prevention and control of obesity will be needed.