젊은 연령에서의 급성심장허혈 : 임상적 특성 및 위험인자 Characteristics and Risk Factors

김갑득,박귀웅 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Purpose: Acute cardiac ischemia under the age of 45 years is uncommon. This study was to evaluate the prevalence of various risk factors, the angiographic characteristics, and the prognosis in young patients with acute cardiac ischemia compared with that in older patients. Methods: A review was retrospectively done of 554 patients with acute cardiac ischemia from January 2002 to December 2002. The patients were divided into two groups: patients under 45 years old (75 patients) and patients over 45 years old (479 patients). The clinical features which were compared between the two groups were demographic features, risk factors (cigarette smoking, history of hypertension and diabetes, hypercholesterolemia, hypertriglyceridemia, and family history of ischemic cardiac disease), coronary angiographic findings, and prognosis. Results: The incidence of acute cardiac ischemia in patients under 45 years old was 13.5% (75/554). Three clinical risk factors, a history of cigarette smoking, a positive family history coronary artery disease, and hypertriglyceridemia, were significantly more prevalent in the young patients. Angiographically, normal or minimal coronary obstructions were more frequently found in the young patients, and significant coronary obstructions were more frequently found in the older patients. However the incidences of single-vessel disease and multi-vessel disease between young patients and older patients were not different. Young patients with acute cardiac ischemia do not have a more favorable prognosis than older patients. Conclusion: Acute cardiac ischemia is found in young patients with less extensive disease, but young patients do not have a more favorable prognosis than older patients.

Clinico-Pathological Patterns and Survival Outcome of Colorectal Cancer in Young Patients: Western Saudi Arabia Experience

Elsamany, Shereef Ahmed,Alzahrani, Abdullah Saeed,Mohamed, Mervat Mahrous,Elmorsy, Soha Ali,Zekri, Jamal Eddin,Al-Shehri, Ahmed Saleh,Haggag, Rasha Mostafa,Alnagar, Ahmed Abdel-Reheem,El Taani, Hani A Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.13

Background: The prognosis of young colorectal cancer (CRC) patients has been addressed by several studies but with contradictory results. The aim of the present study was to evaluate the clinico-pathological features of young Saudi patients with CRC in addition to displaying their survival outcome. Materials and Methods: In this retrospective study, young CRC patients (${\leq}40$ years) diagnosed between 2007 and 2011 from 4 centres in western Saudi Arabia, were included. Clinico-pathological features, tumor markers, dates of disease relapse and death were collected. Survival parameters were compared with those of older Saudi patients, reported in previous studies. Results: One hundred and sixteen young patients with CRC were identified (32.2% rectal, 67.8% colon). Some 44% were metastatic while 32.7% had stage III at diagnosis. Patients with grade 3 tumors made up 29.4% of the total while 49.5% had positive lymphovascular invasion (LVI), 56% had a lymph node (LN) ratio ${\geq}0.2$ and 40.2% were K-ras mutant. Median disease-free survival (DFS) and overall survival (OS) in non-metastatic cases were 22.8 and 49.6 months respectively with better median DFS in K-ras wild compared to mutant patients (28.5 vs 20.9 months, p=0.005). In metastatic cases, median OS was 19.5 months. These survival outcomes are inferior compared to those of older Saudi patients reported in prior studies. Conclusions: Young CRC patients present more commonly with advanced stage and a high incidence of adverse prognostic factors such as LVI and high LN ratio. Young CRC patients seem to have worse survival compared to older Saudi patients.

Unique Features of Gastric Cancer in Young Patients: Experience from a General Hospital in Nepal

Kandel, Bishnu Prasad,Singh, Yogendra Prasad,Ghimire, Bikal Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.5

Background: Gastric cancer, the fifth most common malignancy in the world, usually affects older individuals but can occur in younger age groups. In this study we compared the clinicopathological profile of young patients of gastric cancer with that of older patients. Materials and Methods: It is a prospective study of gastric cancer patients treated over three year period (January 2012 to December 2014). Data of patients were obtained from the medical record. Clinical and pathological characters of younger patients (age 40 years or less) were compared with older patients (age more than 40 years). Results: There were total of 152 patients treated during the study period. Twenty patients (13.2%) were less than 40 years of age and 132 (86.8%) were older. The male to female ratio in younger patients was 1:1.5 whereas in older patients it was 1:0.6. In the younger age group 14 patients (70%) had poorly differentiated adenocarcinoma in contrast to 45% in the older age group (p<0.01). Some 55% of younger and 42% of older patients had stage IV disease at presentation and curative surgery was not possible. Palliative surgery for gastric outlet obstruction or bleeding from the tumor was performed on 25% and 21% respectively. Conclusions: Gastric cancer in young people aged less than 40 years has unique characters like female predominance, unfavorable tumor biology, and advanced stage at presentation. There should be a high index of suspicion of gastric cancer even in young patients.

Clinicopathological Features and Survival of Young Turkish Patients with Testicular Germ Cell Tumors

Ozgun, Alpaslan,Karagoz, Bulent,Tuncel, Tolga,Emirzeoglu, Levent,Celik, Serkan,Bilgi, Oguz Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Background: Testicular germ cell tumors (TGCTs) are a relatively common malignancy in young men. The aim of this study was to investigate the clinicopathological features and survival of young Turkish patients with TGCT. Materials and Methods: In this retrospective study, the clinical and pathological characteristics of young Turkish patients with TGCT who were monitored by the Department of Medical Oncology of a military hospital between 2008 and 2013 were investigated. Overall survival data were analyzed. Results: Ninety-six patients were included in the study. The mean age was 26.4 years. Among the patients, 17.7% had seminoma and 43.8% had mixed non-seminomatous germ cell tumors. Some 46.9% were Stage I, 30.2% were Stage II, and 22.9 were Stage III. Of the patients, 83.3% received chemotherapy, 25% underwent retroperitoneal lymph node dissection (RPLND), 3.1% received radiotherapy, and 12.5% were followed-up without treatment. In addition, 18.8% of the patients were administered salvage chemotherapy due to relapse or progression. The 5-year overall survival rate was 90.2% for all patients. The 2-year overall survival rate was 100% for Stage I patients, 94% for Stage II patients, and 70.2% for Stage III patients. The difference between the survival curves of stages was statistically significant (p=0.029). Conclusions: In young Turkish patients with TGCT, good results were obtained with appropriate treatment, most receiving chemotherapy. The prognosis of the disease was good even in the advanced stage.

Influence of the Obesity on Clinical Outcomes in the Young Korean Patients with Acute ST-Elevation Myocardial Infarction

강기운,이성규,윤현수,진정연,명진철,김원호,박상현,최유정,정경태,정명호 대한비만학회 2013 The Korean journal of obesity Vol.22 No.4

Background: Previous reports have demonstrated that obese patients may have better clinical outcomes after percutaneous coronary intervention (PCI) than non-obesepatients; however this “obesity paradox” remains still unknown in young patients. Therefore, we investigated the influence of obesity on the outcomes of young patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 541 young patients (≤ 45 year old) with acute STEMI undergoing urgent PCI were enrolled in the Korea Acute Myocardial Infarction Registry betweenJanuary 2008 and Aug 2011. These patients were categorized according to their body mass index (BMI, kg/m2) as non-obese (BMI < 27.5, N = 73), obese (27.5 ≤ BMI < 32.5,N = 183) and morbidly obese (BMI ≥ 32.5, N = 285). At follow-up, the major adverse cardiac events (MACE; defined as death, myocardial infarction, and target vesselrevascularization) were compared among the three groups. Results: The mean duration of follow-up was 384 ± 82 days. Among the three groups, age, sex, cardiovascular risk factors and left ventricular ejection fraction were similar andnumber of infarct-related artery or stenotic coronary artery was also similar. The length of stay in the coronary care unit was shorter among the obese and morbidly obese group compared with that of the non-obese group. In-hospital death and clinical outcomes among the three groups were not significantly different. At follow-up, the one-year MACE-free survival rate of those groups was not significantly different (93% in non-obese, 94% in obese and 95% in morbidly obese). Conclusion: In young patients with STEMI undergoing urgent PCI, influence of obesity on clinical outcomes was not observed as significant in the young Korean patients.

심리적 안정을 고려한 촬영실 내부 환경변화가 검사에 미치는 영향 - 유아 방사선검사의 불안감 해소 중심으로

김선칠(Seon-Chil Kim),석은조(Eun-Jo Seok) 대한방사선과학회(구 대한방사선기술학회) 2007 방사선기술과학 Vol.30 No.1

  최근 유아들을 위한 병원 환경개선에 관심이 높아지고 있다. 이는 병원이라는 거부감을 최소화하여 환자의 의료서비스에 만족을 높이고자 하는데 있다. 방사선과 또한 기존의 촬영실을 개선하여 유아들의 심리적 안정에 도움을 주어 검사와 치료과정에 긍정적인 결과를 도출하고자 한다. 따라서 본 연구는 방사선과 X선 촬영실 내부 환경의 변화를 통해 유아의 심리적 환경이 어떻게 변화되었는지를 연구하였다. 연구대상은 만 5세 유아 94명을 대상으로 유아촬영실이 환경 변화에 따른 심리적 변화를 측정도구를 통해 분석하였으며, 그 결과 환경개선 이후의 면접설문조사에서 긍정적인 결과를 얻을 수 있었다. 연구결과 유아촬영실의 환경은 심리적 측면에서 매우 중요하며 검사과정에서도 유아들에게 긍정적이며 협조적인 태도를 초래하여 의료서비스의 질을 향상시키는데 도움이 될 것으로 사료된다.   The attempt to enhance the environment of hospitals has increased recently to minimize young patients" anxiety about tests and inspections. This gives more satisfaction with the medical service to kids and young patients. The department of radiology endeavors to improve the conditions of existing radiography rooms to help young patients psychologically feel relaxed. This facilitates the process of inspections. This paper examines the relationship between the environment of radiography rooms and its effect on young patients" state of mind. 94 patients at the age of five were observed before and after the improvement of environment of the hospital. Positive results about the psychological state of the young patients were shown after the change of the environment. The result of this paper gives an idea that the modification of hospital environment has a critical importance to the young patients" psychological state. By this conclusion it may help to improve the quality of the medical service.

Clinicopathologic Features and Molecular Subtypes of Breast Cancer in Young Women (Age ≤35)

Goksu, Sema Sezgin,Tastekin, Didem,Arslan, Deniz,Gunduz, Seyda,Tatli, Ali Murat,Unal, Dilek,Salim, Derya,Guler, Tunc,Coskun, Hasan Senol Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.16

Introduction: Breast cancer in young women is a relatively rare disease; however it tends to be more aggressive and is the leading cause of cancer death in this population. The aim of this study is to investigate the clinical and biological features of breast cancer arising in young Turkish breast cancer patients. Materials and Methods: Patients with breast cancer aged 35 or less (${\leq}35$ years) were selected for the study. In total 211 cases were included. Pathologic features; histologic subtypes, grade, lymphovascular invasion, axillary involvement, and stage were recorded for each. Results: The most common subtype was luminal B (36.5%), followed by luminal A (30.8%), triple negative (23.2%) and HER2+(9.5%) subtypes. Twelve percent of the patients had stage 4, 32.7% had stage 3, 46.4% had stage 2, and 6.2% had stage 1 disease at the time of diagnosis. Mean tumour diameter was 3.87 cm (range 0.3-13 cm). The axillary lymph nodes were positive in 74.4% of the patients, while lympho-vascular invasion was seen in 56.4%. Some 9.5% of patients had grade 1, 51.2% had grade 2, and 31.8% had grade 3 tumors. Conclusions: Young women with breast cancer in Turkey are more likely to present with luminal B subtype. Tumors in young women are more likely to present with advanced disease, to be high grade and and to have more lymphovascular invasion. Further research should focus on whether we need new treatment strategies for young patients with breast carcinoma.

Prognostic implication of systemic inflammatory markers in young patients with resectable colorectal cancer

Suk-young Lee,Sun Il Lee,Byung-Wook Min,Sang Cheul Oh 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.100 No.1

Purpose: The prognosis of young colorectal cancer (CRC) patients has not fully been addressed. The prognostic significance of systemic inflammatory markers was examined in those patients. Methods: A total of 965 patients with resectable CRC were divided into young (≤ 50 years, n = 101) and old groups (>51 years, n = 864). Neutrophil-to-lymphocyte ratio (NLR) > 5, derived NLR (dNLR) > 3, lymphocyte-to-monocyte ratio (LMR) < 2, platelet-to-lymphocyte ratio (PLR) > 150, and prognostic nutritional index (PNI) < 45 were analyzed for prognosis. Overall survival (OS) and progression-free survival (PFS) were compared using the log-rank test. A multivariate analysis was performed using a Cox proportional hazards regression model. Results: In the young group, NLR > 5, LMR < 2, and PNI < 45 were significantly associated with OS with univariate analyses. dNLR > 3 and those markers showed significance for PFS. LMR < 2 was a significant marker for poor PFS (hazard ratio [HR], 5.81; P = 0.020) in the multivariate analysis. In the old group, all inflammatory markers were significantly associated with OS and PFS with univariate analyses. LMR < 2 (HR, 2.66; P = 0.016) and PNI < 45 (HR, 2.14; P = 0.016) were independently associated with OS in multivariate analyses. PLR > 150 (HR, 1.45; P = 0.036) and PNI < 45 (HR, 1.73; P = 0.002) were significant markers for PFS. Conclusion: Systemic inflammation might be one of biologic factors that influence on prognosis of young CRC.

젊은 연령의 간세포암종은 더 공격적인가?

이중민 ( Jung Min Lee ),김도영 ( Do Young Kim ) 대한간암학회 2009 대한간암학회지 Vol.9 No.-

In Korea, hepatocellular carcinoma (HCC) is a fourth leading malignancy with poor prognosis of 5 year survival reaching just 18.9%. The peak incidence is 6th decade and the incidence drops with decreasing age. However, young patients with HCC are not uncommonly encountered in clinical practice, and notably, even though managements with all available modalities are undertaken in these patients, the prognosis does not seem to be better. As such, many physicians feel that the behavior of HCC in young patients takes a more aggressive course than that in old patients. From this perspective, we performed a systemic review of previous literatures focusing on the question whether or not HCC in young patients is more aggressive; it was found that young patients with HCC had presentation of more advanced stage, more preserved liver function, but poor or equivocal survival rate. In the multivariate analysis, however, the poor outcome resulted not from young age, but from advanced stage, which was supported by similar or better outcome when the prognosis was compared with the same stage between young and old patients. Consequently, it could be inferred that an earlier detection of the tumor through earlier starting point of surveillance might improve the prognosis of young patients with HCC. However, a matter of cost-effectiveness should also be considered, which necessitates a further analysis on this issue.

Clinical Features of Lung Cancer in Japanese Patients Aged Under 50

Igata, Fumiyasu,Uchino, Junji,Fujita, Masaki,Iwasaki, Akinori,Watanabe, Kentaro Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.7

The proportion of lung cancer patients under 50 years old is small at approximately 5-10%, but as with patients older than 50, the number is on the rise. Although lung cancer treatment strategies have undergone extensive transformation in recent years based on the presence or absence of oncogenic driver mutations, there are few reports regarding these mutations in the young or the relationship between clinical setting and prognosis. Therefore, we conducted a study of clinical features in 36 patients under the age of 50 who were diagnosed with primary lung cancer from October 2008 to November 2015. The 22 patients in stages I through III A underwent operations, and all 17 whose lung cancer were detected through screening were candidates for surgery. Gene analysis was conducted for 26 (72.2%); 10 (38.5%) were positive for EGFR gene mutations, and ALK gene translocation was present in 4 (15.4%). In stage IV patients, the median progression free survival (PFS) in the ALK translocation positive and negative patients was 518 days and 130 days, respectively, and the median overall survival (OS) was not reached and 280 days, respectively. A trend toward extended PFS (p=0.203) and OS (p=0.056) was observed in patients positive for ALK translocation. We must strive for early detection by increasing screening rates and evaluate oncogenic driver mutations important for prognosis of lung cancer in the young.