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- 저자 : Kanyarat Katanyoo (검색결과 2 건)
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Kanyarat Katanyoo 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.6
Objective: To evaluate treatment outcomes between stage IIIB cervical cancer with and without lower third of vaginal invasion (LTI) in terms of response to treatment and overall survival (OS). Methods: Matching one patient with LTI for 2 patients without LTI who had completed treatment between 1995 and 2012 were conducted by using treatment modalities (radiation therapy [RT] alone vs. concurrent chemoradiation therapy [CCRT]) and tumor histology (squamous cell carcinoma [SCC] vs. adenocarcinoma [ADC]). Treatment outcomes including complete response (CR) rate of RT/CCRT, patterns of treatment failure and survival outcomes were analyzed. Results: Of 216 stage IIIB cervical cancer patients, 114 of them had no LTI and 72 had LTI. Most of the patients (83.8%) had tumor histology as SCC. The CR rates between stage IIIB without LTI and with LTI were 93.8% and 81.9% (p=0.009), and corresponding with disease progression at pelvis accounted for 18.2% and 34.4% (p=0.017), respectively. Distant metastasis was comparable between 2 groups of patients, 28.9% in patients without LTI and 29.5% in patients with LTI (p=0.988). The 2-year and 5-year OS of stage IIIB without LTI were 66.5% and 46.8% compared to stage IIIB with LTI which were 43.1% and 28.9% (p=0.004), respectively. For multivariable analysis, stage IIIB with LTI were only the influential factor on OS with hazard ratio (HR) of 1.63 (p=0.012). Conclusion: Stage IIIB cervical cancer patients with LTI have poorer treatment outcomes including response to treatment and survival outcomes than patients in the same stage without LTI.
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Cost-utility analysis of treatments for stage IB cervical cancer
Kanyarat Katanyoo,Naiyana Praditsitthikorn,Siriwan Tangjitgamol,Sumonmal Manusirivithaya,Busaba Supawattanabodee 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.2
Objective: To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints. Methods: A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women. Results: From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%. Conclusion: RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.
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