일반연제 발표 : 국내 정상임신부에서 음향자극검사(AST) 자료의 컴퓨터분석을 통한 계산도표(nomogram) 작성

백민현,김성희,최원영,박영선,차경준,박원식,이해진,오재응,정성노,박문일 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

Feasibility and safety of fertility sparing surgery in epithelial ovarian cancer with dense adhesion: a long term result from a single institution

백민현,박정열,김대연,서대식,김종혁,김용만,김영탁 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6

Objective: We investigated the feasibility and safety of fertility-sparing surgery (FSS) inpatients with epithelial ovarian cancer (EOC) with dense adhesions. Methods: Patients were divided into cases with and without dense adhesions in thisretrospective study. Results: Of the 95 eligible patients, 29 patients had dense adhesions. Mean age, proportionof staging procedure, distribution of histologic type, and co-presence of endometriosis weredifferent (p=0.003, 0.033, 0.011, and 0.011, respectively). The median follow-up period was57.8 (0.4–230.0) months. There were no differences in the rates of recurrence (21.2% vs. 20.7%, p=1.000) or death (16.7% vs. 6.9%, p=0.332) between the 2 groups. There was nodifference in the pattern of recurrence or in disease-free survival (DFS) and overall survival(OS) between the 2 groups. In multivariate analysis, pretreatment cancer antigen-125 >35U/mL and International Federation of Gynecology and Obstetrics stage IC were significantfactors of worse DFS and OS, while dense adhesion was not a prognostic factor for both DFS(hazard ratio [HR]=0.9; 95% confidence interval [CI]=0.3–2.7; p=0.792) and OS (HR=0.2;95% CI=0.1–1.8; p=0.142), nor were age, proportion of staging procedure, histologic type, andco-presence of endometriosis. Moreover, the distribution of those 2 significant prognosticfactors was not different between the 2 groups. Dense adhesions were subgrouped into non tumor and tumor associated dense adhesions for further analysis and the results were same. Conclusion: FSS is feasible and safe in EOC, regardless of the presence of dense adhesions.

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

백민현,이신화,박정열,김대연,김종혁,김용만,김영탁,남주현 대한의학회 2014 Journal of Korean medical science Vol.29 No.11

The purpose of this study was to evaluate the surgical feasibility of and survival outcomeafter laparoscopy in obese Korean women with endometrial cancer which has recentlybeen increasing. We reviewed the medical records of the patients treated at our medicalinstitution between 1999 and 2012. The patients were divided into three groups, nonobese(Body Mass Index [BMI] < 25.0), overweight (BMI 25-27.99), and obese (BMI ≥28.0). These patient groups were compared in terms of their clinical characteristics,treatment methods, as well as surgical and survival outcomes. In total, 55 of the 278eligible patients were obese women. There were no differences in the three groups in termsof the proportion of patients who underwent lymphadenectomy, their cancer stage,histologic type, type of adjuvant treatment administered, intra-, post-operative, and longtermcomplications, operative time, number of removed lymph nodes, blood loss, andduration of hospitalization (P = 0.067, 0.435, 0.757, 0.739, 0.458, 0.173, 0.076, 0.124,0.770, 0.739, and 0.831, respectively). The Disease-Free Survival (DFS) times were 139.1vs. 121.6 vs. 135.5 months (P = 0.313), and the Overall Survival (OS) times were 145.2 vs. 124.8 vs. 139.5 months (P = 0.436) for each group, respectively. Obese women withendometrial cancer can, therefore, be as safely managed using laparoscopy as women withnormal BMIs.

Androgen receptor as a prognostic biomarker and therapeutic target in uterine leiomyosarcoma

백민현,박정열,박양순,김규래,김대연,서대식,김종혁,김용만,김영탁,남주현 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3

Objective: To investigate the expression of androgen receptor (AR) and its correlation with disease status and survival outcome in uterine leiomyosarcoma with other hormone receptors. Methods: The medical records and paraffin blocks of 42 patients were reviewed. The immunohistochemical expression of AR, estrogen receptor (ER), progesterone receptor (PR), gonadotropin releasing hormone (GnRH), and cytochrome P450, family 19, subfamily A, polypeptide 1 (CYP19A1) were assessed using tissue microarray. Results: In total, AR expression was observed in 11 patients (26.2%). International Federation of Gynecology and Obstetrics (FIGO) stage and AR were independent factors for disease-free survival (DFS) in multivariate regression analysis (odds ratio [OR]=5.8; 95% confidence interval [CI]=1.2–28.4 and OR=0.2; 95% CI=0.05–0.90; p=0.029 and 0.032, respectively). There were no deaths in the AR expression group, whereas the 5-year overall survival (OS) was 54.8% in the no expression group (p=0.014). Co-expression of ER and/or PR with AR was associated with significantly better 5-year DFS and OS than those with negative AR (72.7% vs. 28.6% and 100% vs. 64.3%; p=0.020 and 0.036, respectively). AR may be an independent prognostic marker regardless of ER/PR. Conclusion: AR can be a potential prognostic biomarker in uterine leiomyosarcoma.

Impact of beta blockers on survival outcomes in ovarian cancer: a nationwide population-based cohort study

백민현,김대연,Seon-Ok Kim,김예지,박영한 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6

Objective: The impact of beta blockers (BBs) on survival outcomes in ovarian cancer was investigated. Methods: By using Korean National Health Insurance Service Data, Cox proportional hazards regression was performed to analyze hazard ratios (HRs) with 95% confidence intervals (CIs) adjusting for confounding factors. Results: Among 866 eligible patients, 206 (23.8%) were BB users and 660 (76.2%) were non-users. Among the 206 BB users, 151 (73.3%) were non-selective beta blocker (NSBB) users and 105 (51.0%) were selective beta blocker (SBB) users. BB use in patients aged ≥60 years, longer duration use (≥1 year), in patients with Charlson Comorbidity Index (CCI) ≥3, and in cardiovascular disease including hypertension was associated with better survival outcome. These findings were observed in both NSBB and SBB. When duration of medication was analyzed based on number of days, NSBB (≥180 days) was associated with improved overall survival (OS) with a relatively shorter period of use compared to SBB (≥720 days). In multivariate Cox proportional hazards model, longer duration of BB medication (≥1 year) was an independent favorable prognostic factor for both OS and disease-specific survival in ovarian cancer patients. Conclusion: In our nationwide population-based cohort study, BB use was associated with better survival outcomes in ovarian cancer in cases of long term duration of use, in older patients, and in cardiovascular and/or other underlying disease (CCI ≥3).

Utility of pre-operative CA-125, hormone receptor in the management and as a prognostic factor of uterine papillary serous carcinoma

백민현,한지현,김주연,심승혁,나연식,이신화,박정열,김종혁,김용만,김영탁,남주현,김대연 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

We evaluated the usefulness of pre-operative serum CA-125 and Hormone receptors in the management of women diagnosed with uterine papillary serous carcinoma (UPSC). We hypothesized that elevated pre-operative levels of serum CA-125 and hormone receptor(HR) negative group will correlate with higher disease stage and poorer prognosis. Patients diagnosed with UPSC and treated in our institution were identified from 1989 to 2012, over a period of 23 years. All required information were extracted from EMR(electric medical records). We used Receiver operator characteristic curves (ROC) to find the optimal cut off value and quantify marker performance in UPSC. Disease free survival(DFS) and overall survival(OS) were analyzed using Kaplan-Meier method. Multivariate analyses were performed with a Cox proportional regression method. A total of 67 patients met the study criteria. Mean pre-operative serum CA-125 levels were significantly higher in patients with more advanced stage. CA-125 correlated strongly with stage. On the ROC, a cut-off of 39 IU/mL provided the best sensitivity and specificity (48% vs. 100% respectively) for extra-uterine disease. DFS and OS were longer in patients with CA-12539 U/mL.(P=0.0003) Also DFS and OS were relatively longer in patients with positive HR group but had no statistical significance.(P=0.2851) Pre-operative serum CA-125 levels correlate with stage of disease in patients with UPSC. This may be important for management planning, prognostication and counseling in these women.

정상 만삭산모에서 신생아 체중 및 성별에 따른 태아심박동의 컴퓨터를 이용한 분석

백민현 ( Min Hyun Baek ),천상훈 ( Sang Hoon Chun ),이수진 ( Soo Jin Lee ),김영재 ( Young Jae Kim ),최재호 ( Jai Ho Choi ),박문일 ( Moon Il Park ),정성노 ( Sung No Chung ),최원영 ( Won Young Choi ),차경준 ( Kyung Joon Cha ) 대한주산의학회 2008 Perinatology Vol.19 No.2

목적: 정상만삭임신부에서 신생아 체중 및 성별에 따른 태아심박동(FHR)의 여러 가지 변수에 대한 차이를 분석하고자 시도되었다. 방법: 2006년 7월부터 2007년 6월까지 한양대학병원 산부인과 외래를 통원하거나 외래를 통해 입원한 산모의 분만 전 NST를 시행한 산모 400명을 연구대상으로 선정하여 FHR과 제 변수의 기본적 통계치를 총괄적으로 비교 관찰하였다. 태아 체중별로 산모를 4군으로 나누었으며 이 각 군은 50명의 남아와 50명의 여아로 이루어져 있고(2,500 g 미만, 2,500-3,000 g 미만, 3,000-3,500 g 미만 그리고 3,500 g 이상) 이를 분석하였다. 분석에는 컴퓨터화된 태아심박동 분석체계인 Hanyang Fetal Monitoring System-II (HYFM-II, Window version 1.0)을 동원하였다. 결과: 태아심박동 제 변수에 대해 신생아체중에 따라 분류된 각 군에서 성별 간의 유의한 차이는 보이지 않았다. FHR 제 변수에 대한 신생아체중에 따라 분류된 각 군 간의 차이와 성별 간의 차이를 검증하기 위하여 시행한 분산분석에서 태아체중에 따라 분류된 각 군 간의 유의한 차이는 없었다. FHR 제 변수에 대한 각 신생아체중 군의 성별 간 검증을 위한 분산분석에서는 태아심박동 감소수 (15 bpm~15 sec)에서만 신생아체중에 따른 군에서 성별 간의 유의한 차이를 확인할 수 있었고, 이 외의 제 변수에서는 유의한 차이가 없었다. 결론: 적어도 정상 만삭임신에서 태아심박동의 각 변수는 태아의 체중과 성별로 분류한 각 군에서 별 차이를 보이지 않았다. 이는 정상만삭임신에서는 태아심박동을 조정하는 태아의 자율신경계가 거의 성숙단계에 이르렀기 때문이라 판단되는데, 저자들은 향후 만삭전 임신 및 각종 고위험임신에서의 신생아 성별 및 체중별 분석을 시도할 예정이다. Purpose: The objective of this study is to compare the difference of each fetal heart rate (FHR) variables between each categorized group according to birth weight and fetal sex using computerized analysis system of fetal heart rate. Methods: Non stress test (NST) of four hundred normal pregnant women were grouped based on birth weight to 4 groups, <2,500 g, 2,500~<3000 g, 3,000~<3,500 g and above 3,500 g. Fifty male and 50 female babies entered to each group. So, 100 normal pregnant women entered for the study in each group. For collection and analysis of data and values of each variables, our own FHR interpretation sofware, HYFM-II (Windows version 1.0) was used. Result: From the comparison between each group classified by each criteria, there were no specific significant differences in baseline FHR, FHR variability (amplitude & mean minute range), signal loss rate, number of fetal movements, the number of FHR acceleration & the number of FHR deceleration those were obtained by our computerized FHR analysis system. Conclusion: We confirm that there were no specific differences in each FHR varibles according to birth weight and fetal sex at least in term normal pregnancy.

GO-86 : Can pure mucinous borderline ovarian tumor recur actually?; Clinical analysis of 373 cases of mucinous borderline ovarian tumor in single institute in Korea

한지현,백민현,이신화,박정열,김대연,김종혁,김용만,김영탁,남주현 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

Classification of mucinous borderline ovarian tumor(MBOT) is very complicated, the clinical course about recurrence and metastasis of which is not completely concluded. The authors give a new opinion about necessity of closed follow-up for recurrence detection of pure MBOT among a lot of controversy Medical records and pathologic slides were reviewed retrospectively about the clinical course of 373 cases of MBOT in Asan Medical Center in Korea from 1991 to 2012. Total 11 cases recurred and were reviewed again by pathologist. 3 cases had initially intraepithelial carcinoma(IEC) component on review. 6 of the others 8 cases recurred as pure MBOT. Pathologic review could not be performed in 2 cases, which eventually recurred as invasive carcinoma( IC). Inferring from their poor prognosis, they might be originally IEC or IC. The recurrence rate of pathologically reviewed pure MBOT was 1.1%(4/373). A thing worthy of note is that 3 cases recurred at the contralateral ovary, 2 cases were endocervical type and 1 case was initially mixed epithelial type arising from endometriosis. That might mean not recurrence but newly developed tumor associated with endometriosis. Moreover it could be progression of residual tumor because most patients were young women and surgeon would debulk less radically. The recurrence rate of pure MBOT might be much lower than rate reported so far. The authors suggest carefully that if surgeon debulk completely in non-mixed, non- endocervical type of pure MBOT with stage Ia and Ib, the physician might reduce or omit unnecessary repetitive checking-up of tumor marker and imaging study for the long term.

Impact of metformin on survival outcome in ovarian cancer: a nationwide population-based cohort study

박정열,임명철,백민현,박영한,김선옥 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.4

Objective: Investigation of new drugs (INDs) is a tremendously inefficient process in terms of time and cost. Drug repositioning is another method used to investigate potential new agents in well-known drugs. This study assessed the survival impact of metformin medication on ovarian cancer. Methods: A national sample cohort of the Korean National Health Insurance Service Data was analyzed. Cox proportional hazards regression was used to analyzing hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for underlying diseases and medications as confounding factors for overall survival (OS) and cancer-specific survival (CSS). Results: A total of 866 eligible patients were included from among 1,025,340 cohort participants. Among them, 101 (11.7%) were metformin users. No difference in OS was observed between non-users and users. No difference in OS was observed according to age and Charlson Comorbidity Index. Long-term metformin use (≥720 days) was associated with better OS (adjusted HR=0.244; 95% CI=0.090–0.664; p=0.006). A multivariate Cox proportional hazards model showed that long-term metformin use was an independent favorable prognostic factor for OS (HR=0.193; 95% CI=0.070–0.528; p=0.001) but not for CSS (HR=0.599; 95% CI=0.178–2.017; p=0.408). Conclusion: Long-term metformin use reduced all-cause mortality, but not CSS in ovarian cancer. Whether metformin itself reduces deaths because of ovarian cancer requires further investigation.

Concurrent chemoradiation is better than systemic chemotherapy as a postoperative adjuvant therapy in advanced cervical cancer

성중엽,이석우,백민현,김성주,임채춘,강영모,이지희,박성택,박성호,김홍배,경민선,김보욱,박영한 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-