IIIA기 비소세포 폐암환자에서 신보조 항암방사선치료 후 N병기의 변화에 따른 생존율 비교

배지훈,박승일,김용희,김동관 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.5

Background: Non-small cell lung cancer (NSCLC) patients histologically proven to have stage N2 disease by mediastinoscope or thoracoscope underwent subsequent neoadjuvant chemoradiotherapy. This study was designed to find out if there were any differences in survival or recurrence rates between N2 positive and N2 negative patients. Material and Method: Between January 1998 and December 2005, we retrospectively analyzed 69 patients who were divided into three groups. Group A consisted of patients whose N stage was downstaged, group B of patients whose N stage was the same, and Group C of patients who could not undergo surgery because of disease progression during neoadjuvant chemoradiotherapy. We analyzed and compared the mean survival, three-year survival, mean disease-free survival, and three-year disease-free survival rates for the three groups. Result: There were no demographic differences among the groups. The mean survival was 58, 47, and 21 months for groups A, B, and C, respectively. The mean survival was longest in group A, but no statistically significant difference was found on A-B or B-C group comparison (p>0.05). However, a significant difference was noted between group A and group C (p:0.01). Three-year survival rates were 67%, 41%, and 21.6% for groups A, B, and C, respectively, with a statistical difference similar to that seen in mean survival. The mean disease-free survival was 44 months in group A and 45 months in group B, with no statistically significant difference noted. No significant differences were noted in the three-year disease-free survival rates (55.1%, 46.8%). Conclusion: There were no significant differences in survival or recurrence rates with changes in N stage after neoadjuvant chemoradiotherapy. However, mean survival, three-year survival, and three-year disease-free survival rates tended to be higher in downstaged patients. Nevertheless, the difference was statistically insignificant, and therefore further studies with more patients and longer follow-up are necessary to clarify the positive effects on the survival and prognosis of downstaged patients.

Disparities in All-cancer and Lung Cancer Survival by Social, Behavioral, and Health Status Characteristics in the United States: A Longitudinal Follow-up of the 1997-2015 National Health Interview Survey-National Death Index Record Linkage Study

Lee Hyunjung,Singh Gopal K. 대한암예방학회 2022 Journal of cancer prevention Vol.27 No.2

Most research on cancer patient survival uses registry-based (e.g., SEER) incidence and survival data that have limited socioeconomic status and health-risk information. In this study, we used the 1997-2015 National Health Interview Survey-National Death Index prospectively-linked pooled cohort database (n = 40,291 cancer patients) to examine disparities in patient survival by a broad range of social determinants, including race/ethnicity, nativity, educational attainment, income/poverty level, occupation, housing tenure, physical and mental health status, smoking, physical activity, body mass index, and alcohol consumption. We used Cox proportional hazards models to estimate mortality hazard ratios and cause-specific 1-year, 5-year, and 10-year survival rates for all-cancer and lung cancer. During 1997-2015, the 10-year age-adjusted (all-cause) survival rate for cancer patients with professional and managerial occupations was 89.66%, significantly higher than the survival rate of 83.17% for laborers or 83.66% for the unemployed. Cancer patients with renting house had significantly lower age-adjusted survival rates than those owning house (82.65% vs. 85.80%). The 10-year age-adjusted survival rates were significantly greater among cancer patients with regular physical activity than those without regular physical activity (90.18% vs. 83.24%). Age-adjusted survival rates were significantly reduced for cancer patients with lower income and education, poor health, and serious psychological distress, and among current and former smokers. The gap in survival narrowed with additional sociodemographic, health, or behavioral adjustment. Similarly large differentials were found in lung cancer survival. Marked disparities in all-cancer and lung cancer survival were found by a wide range of sociodemographic and health characteristics.

What Should We Consider Carefully When Performing Survival Analysis?

곽상규,최은진 대한소아혈액종양학회 2019 Clinical Pediatric Hematology-Oncology Vol.26 No.1

The survival data and the survival analysis are the data and analysis methods used to study the probability of survival. The survival data consist of a period from the juncture of a start event to the juncture of the end event (occurrence event). The period is called the survival period or survival time. In this way, the method of analysing the survival time of subjects and appropriately summarizing the degree of survival is called survival analysis. To understand and analyse survival analysis methods, researchers must be aware of some concepts. Concepts to be aware of in the survival analysis include events, censored data, survival period, survival function, survival curve and so on. This review focuses on the terms and concepts used in the survival analysis. It will also cover the types of survival data that should be collected and prepared when using actual survival analysis method and how to prepare them.

Overall Survival of Non-Small Cell Lung Cancer With Spinal Metastasis: A Systematic Review and Meta-Analysis

Fon-Yih Tsuang,전진수,An-Ping Huang,Chung Liang Chai 대한척추신경외과학회 2023 Neurospine Vol.20 No.2

Objective: The long-term survival data of lung cancer patients with spinal metastases are crucial for informed treatment decision-making. However, most studies in this field involve small sample sizes. Moreover, survival benchmarking and an analysis of changes in survival over time are required, but data are unavailable. To meet this need, we performed a metaanalysis of survival data from small studies to obtain a survival function based on largescale data. Methods: We performed a single-arm systematic review of survival function following a published protocol. Data of patients who received surgical, nonsurgical, and mixed modes of treatment were meta-analyzed separately. Survival data were extracted from published figures with a digitizer program and then processed in R. Median survival time was used as an effect size for moderator analysis to explain the heterogeneity. Results: Sixty-two studies with 5,242 participants were included for pooling. The survival functions showed a median survival of 6.72 months for surgery (95% confidence interval [CI], 61.9–7.01; 2,367 participants; 36 studies), 5.99 months for nonsurgery (95% CI, 5.33–6.47; 891 participants; 12 studies), and 5.96 months for mixed (95% CI, 5.67–6.43; 1,984 participants; 18 studies). Patients enrolled since 2010 showed the highest survival rates. Conclusion: This study provides the first large-scale data for lung cancer with spinal metastasis that allows survival benchmarking. Data from patients enrolled since 2010 had the best survival and thus may more accurately reflect current survival. Researchers should focus on this subset in future benchmarking and remain optimistic in the management of these patients.

소아 청소년 골육종 재발 후 치료성적 : 한국의 단일기관 성적

이윤정,이현재,김동호,임중섭,이준아,박경덕,전대근,이수용 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.1

Purpose:Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. Although survival rate of osteosarcoma patients has markedly improved, about 20-30% of patients still have a relapse. This study was aimed to find factors that influence postrelapse survival of osteosarcoma in childhood and adolescents. Methods:Between 1985 and 2004, of 461 patients who were diagnosed and treated as osteosarcoma in Korean Cancer Center Hospital, 180 patients with recurrent osteosarcoma were retrospectively reviewed. We examined survival rates and analyzed prognostic factors, such as relapse site, post-relapse treatment methods, pathologic response to neoadjuvnat chemotherapy, metastasis at first diagnosis, and relapse free interval. Results:The overall recurrence rate of patients with osteosarcoma was 39%. The 5-year and 10-year postrelapse survival rates in the recurrent osteosarcoma were 13% and 4%, respectively. The 5-year post-relapse survival rate was influenced by site of relapse (lung, 39%; local, 0%; lung & bone, 25%; others, 12%; P<0.05), relapse-free interval (<12 months, 13%; ≥12 months, 44%, P<0.05), and post- relapse treatment methods (with surgery, 38%; without surgery, 11%; P<0.05). Conclusion:The survival rate of recurrent case is very low after 10 years, so new second-line chemotherapy and active treatment is needed to increase survival. Aggressive surgery with the removal of recurrence sites combined with multi-agent chemotherapy could either cure patients with recurrent osteosarcoma or significantly prolong their survival. (Korean J Pediatr 2008;51:78-83) Purpose:Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. Although survival rate of osteosarcoma patients has markedly improved, about 20-30% of patients still have a relapse. This study was aimed to find factors that influence postrelapse survival of osteosarcoma in childhood and adolescents. Methods:Between 1985 and 2004, of 461 patients who were diagnosed and treated as osteosarcoma in Korean Cancer Center Hospital, 180 patients with recurrent osteosarcoma were retrospectively reviewed. We examined survival rates and analyzed prognostic factors, such as relapse site, post-relapse treatment methods, pathologic response to neoadjuvnat chemotherapy, metastasis at first diagnosis, and relapse free interval. Results:The overall recurrence rate of patients with osteosarcoma was 39%. The 5-year and 10-year postrelapse survival rates in the recurrent osteosarcoma were 13% and 4%, respectively. The 5-year post-relapse survival rate was influenced by site of relapse (lung, 39%; local, 0%; lung & bone, 25%; others, 12%; P<0.05), relapse-free interval (<12 months, 13%; ≥12 months, 44%, P<0.05), and post- relapse treatment methods (with surgery, 38%; without surgery, 11%; P<0.05). Conclusion:The survival rate of recurrent case is very low after 10 years, so new second-line chemotherapy and active treatment is needed to increase survival. Aggressive surgery with the removal of recurrence sites combined with multi-agent chemotherapy could either cure patients with recurrent osteosarcoma or significantly prolong their survival. (Korean J Pediatr 2008;51:78-83)

Trends in Survival of Childhood Cancers in a University Hospital, Northeast Thailand, 1993-2012

Wongmeerit, Phunnipit,Suwanrungruang, Krittika,Jetsrisuparb, Arunee,Komvilaisak, Patcharee,Wiangnon, Surapon Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.7

Background: In Thailand, a national treatment protocol for childhood leukemia and lymphoma (LL) was implemented in 2006. Access to treatment has also improved with the National Health Security system. Since these innovations, survival of childhood LL has not been fully described. Materials and Methods: Trends and survival of children under 15 with childhood cancers diagnosed between 1993 and 2012 were investigated using the hospital-based data from the Khon Kaen Cancer Registry, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Childhood cancers were classified into 12 diagnostic groups, according to the ICCC based on the histology of the cancer. Survival rates were described by period, depending on the treatment protocol. For leukemias and lymphomas, survival was assessed for 3 periods (1993-99, 2000-5, 2006-12) while for solid tumors it was for 2 periods (before and after 2000). The impacts of sex, age, use of the national protocol, and catchment area on leukemia and lymphoma were evaluated. Overall survival was calculated using the Kaplan-Meier method while the Cox proportional hazard model was used for multivariate analysis. Trends were calculated using the R program. Results: A total of 2,343 childhood cancer cases were included. Survival for acute lymphoblastic leukemia (ALL) from 1993-9, 2000-5, and 2006-12 improved significantly (43.7%, 64.6%, and 69.9%). This was to a lesser extent true for acute non-lymphoblastic leukemia (ANLL) (28.1%, 42.0%, and 42.2%). Survival of non-Hodgkin lymphoma (NHL) also improved significantly (44%, 65.5%, and 86.8%) but not for Hodgkin disease (HD) (30.1%, 66.1%, and 70.6%). According to multivariate analysis, significant risk factors associated with poor survival in the ALL group were age under 1 and over 10 years, while not using the national protocol had hazard ratios (HR) of 1.6, 1.3, and 2.3 respectively. In NHL, only non-use of national protocols was a risk factor (HR 3.9). In ANLL and HD, none of the factors influenced survival. Survival of solid tumors (liver tumors, retinoblastomas) were significantly increased compared to after and before 2000 while survival for CNS tumors, neuroblastoma and bone tumors was not changed. Conclusions: The survival of childhood cancer in Thailand has markedly improved. Since implementation of national protocols, this is particularly the case for ALL and NHL. These results may be generalizable for the whole country.

A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients

김유정,Yusuke Hiratsuka,서상연,강버들,이시원,안홍엽,서경진,김지원,김세현,김진원,이근욱,김지현,이종석 대한암학회 2022 Cancer Research and Treatment Vol.54 No.2

Purpose We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. Materials and Methods In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. Results The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found six significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥ 2), not undergoing chemotherapy, anorexia, a low lymphocyte level (< 12%), a high lactate dehydrogenase (LDH) level (≥ 300 IU/L), and a low mid-arm circumference (< 23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥ 4.0 points had a short survival of less than 3 months (p < 0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve was 0.88. Conclusion The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late. PurposeWe aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic.Materials and MethodsIn this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. ResultsThe mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found 6 significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2), not undergoing chemotherapy, anorexia, a low lymphocyte level (<12%), a high lactate dehydrogenase (LDH) level (≥300 IU/L), and a low mid-arm circumference (<23 cm). We developed a prognostic model (score, 0-8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥4.0 points had a short survival of less than 3 months (p<0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve (AUC) was 0.88. ConclusionThe prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.

Influence of Donor’s Renal Function on the Outcome of Living Kidney Transplantation: 10-Year Follow-up

정현철,이성호,양대열,김성용,김하영,이삼열,김정원,이원기 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.2

Purpose: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor’s renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. Materials and Methods: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. Results: Mean follow-up duration of recipients after living kidney transplantation was 115.0±39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8±6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor’s mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8±21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor’s Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor’s Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). Conclusions: Donor’s 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation. Purpose: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor’s renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. Materials and Methods: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. Results: Mean follow-up duration of recipients after living kidney transplantation was 115.0±39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8±6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor’s mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8±21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor’s Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor’s Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). Conclusions: Donor’s 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation.

Worldwide comparison of ovarian cancer survival: Histological group and stage at diagnosis (CONCORD-2)

the CONCORD Working Group,Matz, M.,Coleman, M.P.,Carreira, H.,Salmeron, D.,Chirlaque, M.D.,Allemani, C. Academic Press 2017 Gynecologic oncology Vol.144 No.2

Objective: Ovarian cancer comprises several histological groups with widely differing levels of survival. We aimed to explore international variation in survival for each group to help interpret international differences in survival from all ovarian cancers combined. We also examined differences in stage-specific survival. Methods: The CONCORD programme is the largest population-based study of global trends in cancer survival, including data from 60 countries for 695,932 women (aged 15-99years) diagnosed with ovarian cancer during 1995-2009. We defined six histological groups: type I epithelial, type II epithelial, germ cell, sex cord-stromal, other specific non-epithelial and non-specific morphology, and estimated age-standardised 5-year net survival for each country by histological group. We also analysed data from 67 cancer registries for 233,659 women diagnosed from 2001 to 2009, for whom information on stage at diagnosis was available. We estimated age-standardised 5-year net survival by stage at diagnosis (localised or advanced). Results: Survival from type I epithelial ovarian tumours for women diagnosed during 2005-09 ranged from 40 to 70%. Survival from type II epithelial tumours was much lower (20-45%). Survival from germ cell tumours was higher than that of type II epithelial tumours, but also varied widely between countries. Survival for sex-cord stromal tumours was higher than for the five other groups. Survival from localised tumours was much higher than for advanced disease (80% vs. 30%). Conclusions: There is wide variation in survival between histological groups, and stage at diagnosis remains an important factor in ovarian cancer survival. International comparisons of ovarian cancer survival should incorporate histology.

Season of Diagnosis and Survival of Advanced Lung Cancer Cases - Any Correlation?

Oguz, Arzu,Unal, Dilek,Kurtul, Neslihan,Aykas, Fatma,Mutlu, Hasan,Karagoz, Hatice,Cetinkaya, Ali Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.7

Introduction: The influence of season at diagnosis on cancer survival has been an intriguing issue for many years. Most studies have shown a possible correlation in between the seasonality and some cancer type survival. With short expected survival, lung cancer is an arena that still is in need of new prognostic factors and models. We aimed to investigate the effect of season of diagnosis on 3 months, 1 and 2 years survival rates and overall survival of non small cell lung cancer patients. Materials and Methods: The files of non small cell lung cancer patients that were stages IIIB and IV at diagnosis were reviewed retrospectively. According to diagnosis date, the patients were grouped into 4 season groups, autumn, winter, spring and summer. Results: A total of 279 advanced non small cell lung cancer patients' files were reviewed. Median overall survival was 15 months in the entire population. Overall 3 months, 1 and 2 years survival rates were 91.0%, 58.2% and 31.2% respectively. The season of diagnosis was significantly correlated with 3 months survival rates, being diagnosed in spring being associated with better survival. Also the season was significantly correlated with T stage of the disease. For 1 and 2 years survival rates and overall survival, the season of diagnosis was not significantly correlated. There was no correlation detected between season and overall survivals according to histological subtypes of non small cell lung cancer. Conclusion: As a new finding in advanced non small cell lung cancer patients, it can be concluded that being diagnosed in spring can be a favorable prognostic factor for short term survival.