SCI 발표논문

전체 4,588편

26682018

제1저자 유정주,장영 · 교신저자 조은주

, , , , , , , , , ,
Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding.
World J Gastroenterol. 2018;24(44):5025-5033.

Abstract
AIM To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.
METHODS This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk.
RESULTS A total of 173 patients received urgent endoscopy (i.e., ≤ 12 h after admission), and 101 patients received non-urgent endoscopy (> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before (P = 0.266) and after IPW (P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group (P = 0.033); however, there was no significant difference in the in-hospital mortality rate between the two groups (8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality (hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).
CONCLUSION In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.
PubMed IF 7.7 소화기내과
26672018

제1저자 최윤진 · 교신저자 이동호

, , , , , , ,
Optimal Starting Age for Colorectal Cancer Screening in an Era of Increased Metabolic Unhealthiness: A Nationwide Korean Cross-Sectional Study.
Gut Liver. 2018;12(6):655-663.

Abstract
BACKGROUND/AIMS The association between metabolic syndrome and colorectal cancer (CRC) has been suggested as one of causes for the increasing incidence of CRC, particularly in younger age groups. The present study examined whether the current age threshold (50 years) for CRC screening in Korea requires modification when considering increased metabolic syndrome.
METHODS We analyzed data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was evaluated with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension).
RESULTS A total of 51,612,316 subjects enrolled during 2014 to 2015 were analyzed. Among them, 19.3% had diabetes, hypertension, dyslipidemia, or some combination thereof. This population had a higher incidence of CRC than did those without these conditions, and this was more prominent in subjects ＜40 years of age. The optimal cutoff age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension. Individuals with at least one of these components of metabolic syndrome had the highest Youden index at 62 years old, but the value was only 0.2. Resetting the cutoff age from 50 years to 45 years achieved a 6% increase in sensitivity for CRC detection among the total population.
CONCLUSIONS Starting CRC screening earlier, namely, at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.
PubMed IF 4.1 소화기내과
26662018

제1저자 유민수 · 교신저자 류지곤

, , , , , , ,
Efficacy of Nab-Paclitaxel Plus Gemcitabine and Prognostic Value of Peripheral Neuropathy in Patients with Metastatic Pancreatic Cancer.
Gut Liver. 2018;12(6):728-735.

Abstract
BACKGROUND/AIMS The combination of nab-paclitaxel and gemcitabine (nab-P/Gem) is widely used for treating metastatic pancreatic cancer (MPC). We aimed to evaluate the therapeutic outcomes and prognostic role of treatment-related peripheral neuropathy in patients with MPC treated with nab-P/Gem in clinical practice.
METHODS MPC patients treated with nab-P/Gem as the first-line chemotherapy were included. All 88 Korean patients underwent at least two cycles of nab-P/Gem combination chemotherapy (125 and 1,000 mg/m², respectively). Treatment-related adverse events were monitored through periodic follow-ups. Overall survival and progression-free survival were estimated by the Kaplan-Meier method, and the Cox proportional hazards regression linear model was applied to assess prognostic factors. To evaluate the prognostic value of treatment-related peripheral neuropathy, the landmark point analysis was used.
RESULTS Patients underwent a mean of 6.7±4.2 cycles during 6.3±4.4 months. The median overall survival and progression-free survival rates were 14.2 months (95% confidence interval [CI], 11.8 to 20.3 months) and 8.4 months (95% CI, 7.1 to 13.2 months), respectively. The disease control rate was 84.1%; a partial response and stable disease were achieved in 30 (34.1%) and 44 (50.0%) patients, respectively. Treatment-related peripheral neuropathy developed in 52 patients (59.1%), and 13 (14.8%) and 16 (18.2%) patients experienced grades 2 and 3 neuropathy, respectively. In the landmark model, at 6 months, treatment-related peripheral neuropathy did not have a significant correlation with survival (p=0.089).
CONCLUSIONS Nab-P/Gem is a reasonable choice for treating MPC, as it shows a considerable disease control rate while the treatment-related peripheral neuropathy was tolerable. The prognostic role of treatment-related neuropathy was limited.
PubMed IF 4.1 소화기내과
26652018

제1저자 김근우 · 교신저자 김윤준

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Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding.
Gut Liver. 2018;12(6):704-713.

Abstract
BACKGROUND/AIMS Gastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding.
METHODS This retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups.
RESULTS Patients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (log-rank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group.
CONCLUSIONS BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.
PubMed IF 4.1 소화기내과
26642018

제1저자 박선아 · 교신저자 김주성

, , , , , , , , ,
Increased end-stage renal disease risk in patients with inflammatory bowel disease: A nationwide population-based study.
World J Gastroenterol. 2018;24(42):4798-4808.

Abstract
AIM To estimate the risk of end-stage renal disease (ESRD) in patients with inflammatory bowel disease (IBD).
METHODS From January 2010 to December 2013, patients with Crohn's disease (CD) and ulcerative colitis (UC) were identified, based on both the International Classification of Diseases, 10^th revision (ICD-10) and the rare, intractable disease registration program codes from the National Health Insurance (NHI) database in South Korea. We compared 38812 patients with IBD to age- and sex-matched non-IBD controls with a ratio of 1:3. Patients newly diagnosed with ESRD were identified with the ICD-10 code.
RESULTS During a mean follow-up of 4.9 years, ESRD was detected in 79 (0.2%) patients with IBD and 166 (0.1%) controls. The incidence of ESRD in patients with IBD was 0.42 per 1000 person-years. Patients with IBD had a significantly higher risk of ESRD than controls [adjusted hazard ratio (HR) = 3.03; 95% confidence interval (CI): 1.77-5.20; P < 0.001]. The incidences (per 1000 person-years) of ESRD were 0.51 in patients with CD and 0.13 in controls, respectively (adjusted HR = 6.33; 95%CI: 2.75-14.56; P < 0.001). In contrast, the incidence of ESRD was similar between the UC and control groups (0.37 vs 0.37 per 1000 person-years; adjusted HR = 2.01; 95%CI: 0.90-4.51; P = 0.089).
CONCLUSION The risk of ESRD was elevated in patients with CD, but not UC. Patients with CD should be monitored carefully for signs of renal insufficiency.
PubMed IF 7.7 소화기내과
26632018

제1저자 김민정, 안은영 · 교신저자 박진균

, , , , , , ,
Association between fever pattern and clinical manifestations of adult-onset Still's disease: unbiased analysis using hierarchical clustering.
Clin Exp Rheumatol. 2018;36(6 Suppl 115):74-79.

Abstract
OBJECTIVES To perform unbiased analysis of fever patterns and to investigate their association with clinical manifestations and outcome of patients with adult-onset Still's disease (AOSD).
METHODS AOSD patients who were treated as in-patients from 2004 through 2015 were grouped according to 24-hour body temperature (BT) by hierarchical clustering using a Euclidean distance metric with complete linkage. The clinical and laboratory characteristics of the groups were then examined.
RESULTS Hierarchical clustering partitioned 70 AOSD patients into three distinct groups. Group 1 (n=14) had the highest mean BT (38.1± 0.4°C) and the widest variation in BT (2.7±0.9°C). Group 2 (n=35) had a lower mean BT (37.4±0.3°C) and a smaller variation (2.1±0.7°C). Group 3 (n=21) had the lowest mean BT (36.7±0.3°C) and the smallest variation (1.5±0.6°C). Clinical features and extent of organ involvement did not differ significantly between groups. However, Group 1 had lower platelet counts and higher lactate dehydrogenase, ferritin levels, and prothrombin time than the other groups. In addition, Group 1 exhibited higher risk of having a macrophage activation syndrome (MAS) and tended to require more intense treatment with corticosteroids and immunosuppressant to achieve clinical remission as compared to other groups.
CONCLUSIONS Hierarchical clustering identified three distinct fever patterns in patients with AOSD. Higher BT was associated with wider variations in diurnal temperature, higher risk of developing MAS, more intense treatment, and longer time to clinical remission, suggesting that fever pattern is a prognostic factor for AOSD.
PubMed IF 3.2 류마티스내과
26622018

제1저자 조준연 · 교신저자 박종선

, , , , , , , , , ,
Characteristics, incidence, and risk factors of immune checkpoint inhibitor-related pneumonitis in patients with non-small cell lung cancer.
Lung Cancer. 2018;125:150-156.

Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) can cause pneumonitis in lung cancer patients. We aimed to identify the clinical and radiologic characteristics, incidence, and risk factors of ICI-related pneumonitis in patients with non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS Medical records and chest computed tomography scans of NSCLC patients treated with an ICI over a 5-year period at a tertiary hospital were retrospectively analyzed. Clinical characteristics were compared between patients with and without ICI-related pneumonitis to identify risk factors.
RESULTS Data from 167 eligible patients were analyzed. The incidences of all-grade and grade 3-4 pneumonitis were 13.2% and 4.2%, respectively. The presence of preexisting interstitial lung disease [odd ratio (OR), 6.03; 95% confidence interval (CI), 1.19-30.45; P = 0.030] was associated with a higher incidence of ICI-related pneumonitis. The presence of extrathoracic metastasis [OR, 0.34; 95% CI, 0.13-0.92; P = 0.034] was associated with a lower incidence of ICI-related pneumonitis. The dominant radiologic pattern (72.7%) of ICI-related pneumonitis was organizing pneumonia. Half of the patients with pneumonitis completely recovered or improved; however, the mortality rate was 18.2%.
CONCLUSION ICIs should be used with caution when treating lung cancer patients who have underlying chronic lung disease, especially interstitial lung disease.
PubMed IF 5.3 호흡기내과
26612018

제1저자 최정연 · 교신저자 김광일

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Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia.
Clin Interv Aging. 2018;13:2237-2245.

Abstract
PURPOSE Pneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients.
PATIENTS AND METHODS This was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups.
RESULTS Among the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI.
CONCLUSION We identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients.
PubMed IF 4.1 노인병내과
26602018

제1저자 송영신,원재경 · 교신저자 박영주

, , , , , , , , , ,
Comprehensive Transcriptomic and Genomic Profiling of Subtypes of Follicular Variant of Papillary Thyroid Carcinoma.
Thyroid. 2018;28(11):1468-1478.

Abstract
BACKGROUND Among subtypes of follicular variant of papillary thyroid carcinoma (FVPTC), encapsulated FVPTC (EFVPTC) shows more indolent behavior than infiltrative FVPTC (IFVPTC). In particular, noninvasive EFVPTC, now designated as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), tends to have an excellent prognosis. However, it remains unclear whether the molecular pathogenesis or signature of the various forms of FVPTC is different. By massively parallel sequencing analysis, this study comprehensively characterized the transcriptional and mutational landscape of FVPTC and established correlations with phenotypic subtypes.
METHODS This study included 48 FVPTCs: 17 NIFTPs, 13 invasive EFVPTCs (I-EFVPTCs), and 18 IFVPTCs. For comparison, 55 classical papillary thyroid carcinomas (cPTCs) harboring a BRAF^V600E mutation, six follicular adenomas (FAs), and 15 minimally invasive follicular thyroid carcinomas (miFTCs) with RAS mutations were also included.
RESULTS In NIFTP, the BRAF^V600E mutation was not found, but RAS and other alterations were present in 64.7% and 17.6% of cases, respectively. However, in I-EFVPTC and IFVPTC, the proportions of BRAF^V600E mutation (38.5% and 38.9%, respectively) and of RAS mutations (38.5% and 38.9%, respectively) or other alterations (15.4% and 16.7%, respectively) were similar. On a molecular level, RAS-mutated FVPTCs were all RAS-like except for one IFVPTC case. Transcriptomic profiles of NIFTP, I-EFVPTC, and FA/miFTC were comparable, although the profile of RAS-mutated IFVPTC was altered to activate molecular pathways involved in cell adhesion and invasion. Interestingly, 80% of BRAF^V600E-mutated I-EFVPTCs were also classified as RAS-like, whereas all BRAF^V600E-mutated IFVPTCs were BRAF-like and indistinguishable from cPTC. Molecular pathways associated with cell adhesion and invasion were also differentially activated in BRAF^V600E-mutated IFVPTC.
CONCLUSIONS Molecular profiles of NIFTP and I-EFVPTC may be shared with FA/miFTC, while IFVPTC seems to be associated with a similar profile as cPTC. Activation of cell adhesion and invasion pathways may play a key role in the development of invasive phenotypes of FVPTC.
PubMed IF 6.6 내분비대사내과
26592018

제1저자 최윤진 · 교신저자 이동호

, , , ,
Abdominal obesity, glucose intolerance and decreased high-density lipoprotein cholesterol as components of the metabolic syndrome are associated with the development of colorectal cancer.
Eur J Epidemiol. 2018;33(11):1077-1085.

Abstract
Metabolic syndrome (MetS) and its components has been thought to be involved in the development of colorectal cancer (CRC). However, the results is often inconsistent according to gender or anatomical location of tumor. This study aimed to investigate the association between MetS and its components and CRC development by gender and tumor location. We evaluated the data of 22,809,722 Korean individuals of the National semi-compulsive cohort who underwent regular health check-ups between 2009 and 2012. Compared to subjects without MetS components, the hazard ratio for CRC development in patients with MetS was 1.22 (95% Confidence Interval [CI] 1.20-1.24) and this association was more prominent in men than in women (HR 1.41 95% CI 1.37-1.44 vs. HR 1.23 95% CI 1.20-1.27, P for interaction < 0.001). Left-sided colon cancers were more associated with MetS among men compared to women (HR 1.70, 95% CI 1.61-1.80 vs. HR 1.43, 95% CI 1.33-1.54), while right colon cancers showed a stronger association with MetS among women than men (HR 1.63, 95% CI 1.49-1.78 vs. HR 1.34, 95% CI 1.24-1.44) (all P for interaction < 0.001, respectively). Having two MetS components was still associated with CRC development and the association was the highest when two of glucose intolerance, abdominal obesity and low high-density lipoprotein cholesterol (HDL-C) combined. Individuals with glucose intolerance, abdominal obesity or low HDL-C levels, may need to undergo thorough screening for CRC even if they do not meet the diagnostic MetS criteria.
PubMed IF 6.6 소화기내과
26582018

제1저자 이창훈 · 교신저자 곽민선

, , , ,
Nonalcoholic fatty liver disease is associated with decreased lung function.
Liver Int. 2018;38(11):2091-2100.

Abstract
BACKGROUND & AIMS The association between nonalcoholic fatty liver disease and lung function has not been fully examined. The aim of this study was to clarify the association between nonalcoholic fatty liver disease and lung function in general population by performing cross-sectional and longitudinal analysis.
METHODS Participants without hepatic and respiratory disease who underwent regular health exams including hepatic sonography and spirometry with at least 3 years' follow-up were included. In cross-sectional analysis, the association between nonalcoholic fatty liver disease and lung function at baseline was examined with multiple regression models. The longitudinal analysis was performed by mixed linear regression models with propensity score matching.
RESULTS Of 11 892 eligible participants (mean age, 47.7 years; male, 47.2%), 3815(32.1%) had nonalcoholic fatty liver disease based on sonography. In cross-sectional analysis, the nonalcoholic fatty liver disease group had lower adjusted forced expiratory volume in 1-second (men, 3.52 vs 3.44 L, P < .001; women, 2.62 vs 2.45 L, P < .001) and forced vital capacity (men, 4.33 vs 4.24 L, P < .001; women, 3.11 vs 2.97 L, P < .001) than the control group. In longitudinal analysis, during the mean follow-up period of 6.6 years, there were no significant differences in forced expiratory volume in 1-second or forced vital capacity decline rates between two groups in the propensity score-matched cohorts (n = 4558). However, those with high nonalcoholic fatty liver disease fibrosis score and fibrosis-4 (men, -21.7 vs -27.4 mL/y, P = .001; women, -22.4 vs -27.9 mL/y, P = .016) showed significantly faster decline in forced vital capacity compared to those with low scores.
CONCLUSIONS Nonalcoholic fatty liver disease was associated with decreased lung function at baseline but was not associated with accelerated lung function decline in the propensity score-matched cohort. However, hepatic fibrosis was significantly associated with rapid forced vital capacity decline.
PubMed IF 6.2 소화기내과
26572018

제1저자 이슬기 · 교신저자 김윤준

, , , , , ,
Synergistic effect of ursodeoxycholic acid on the antitumor activity of sorafenib in hepatocellular carcinoma cells via modulation of STAT3 and ERK.
Int J Mol Med. 2018;42(5):2551-2559.

Abstract
Sorafenib has been approved for the treatment of advanced stage hepatocellular carcinoma but has limited efficacy. Ursodeoxycholic acid exerts cytoprotective activities in hepatocytes and is believed to suppress tumorigenesis through cell cycle arrest and induction of apoptosis. The present study examined whether co‑treatment with ursodeoxycholic acid has a synergistic effect on the antitumor activity of sorafenib in hepatocellular carcinoma cells. Notably, co‑treatment with both agents more effectively inhibited cell proliferation than sorafenib or ursodeoxycholic acid alone. Furthermore, co‑treatment inhibited the phosphorylation of signal transducer and activator of transcription 3 (STAT3) and activated extracellular signal‑regulated kinase (ERK), a mitogen‑activated protein kinase, accompanied by excessive intracellular reactive oxygen species generation in hepatocellular carcinoma cells. Thus, chemotherapy with sorafenib and ursodeoxycholic combination may be efficacious in hepatocellular carcinoma by inhibiting cell proliferation and inducing apoptosis through reactive oxygen species‑dependent activation of ERK and dephosphorylation of STAT3. The present findings may represent a promising therapeutic strategy for patients with advanced hepatocellular carcinoma.
PubMed IF 8.5 소화기내과
26562018

제1저자 서현민/차명진 · 교신저자 최의근/박용민

, , , , , , , , ,
Reciprocal relationship between herpes zoster and cardiovascular diseases: A nationwide population-based case-control study in Korea.
J Dermatol. 2018;45(11):1312-1318.

Abstract
Recently, herpes zoster (HZ) has been identified as a risk factor for stroke, but there have been few studies on the relationship between HZ and other cardiovascular diseases (CVD), including myocardial infarction (MI) and heart failure (HF). The purpose of this study was to investigate the risk of HZ occurrence after CVD and the occurrence of CVD after HZ. This was a retrospective case-control study based on the National Health Insurance System claims database for 20 311 patients with HZ and 13 980 patients with CVD and 1:5 age- and sex-matched control subjects for each from January 2006 to December 2013. We evaluated the reciprocal relationship between HZ and CVD including MI, ischemic stroke and HF. Severe HZ requiring hospitalization independently increased the risk of subsequent MI (hazard ratio [HR], 1.831; 95% confidence interval [CI], 1.354-2.476)], ischemic stroke (HR, 1.523; 95% CI, 1.212-1.915) and HF (HR, 2.034; 95% CI, 1.615-2.562) during the study period. Likewise, patients with an episode of MI, ischemic stroke or HF were also at increased risk of HZ hospitalization (after MI: HR, 1.625; 95% CI, 1.144-2.308; after stroke: HR, 1.518; 95% CI, 1.177-1.957; and after HF: HR, 1.485, 95% CI 1.041-2.117). Our results suggest that there is a significant reciprocal relationship between severe HZ requiring hospitalization and CVD including MI, ischemic stroke and HF.
PubMed IF 2.3 순환기내과
26552018

제1저자 최홍미 · 교신저자 김형관

,
Progressive nature of myocardial fibrosis in pediatric hypertrophic cardiomyopathy: from mutation carrier to myocardial fibrosis.
Ann Transl Med. 2018;6(Suppl 1):S52.

PubMed IF 3.689 순환기내과
26542018

제1저자 신동우, 최윤진 · 교신저자 이동호

, , , , , , ,
Secondary Breast, Ovarian, and Uterine Cancers After Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea.
Dis Colon Rectum. 2018;61(11):1250-1257.

Abstract
BACKGROUND The risk of a second primary cancer has increased along with the increasing life expectancies of colorectal cancer survivors.
OBJECTIVE We aimed to evaluate the incidence rate and risk factors of breast and gynecological (ovarian, uterine cervix/corpus) cancers among female colorectal cancer survivors.
DESIGN This is a retrospective population-based cohort study.
SETTINGS This study used data from the National Health Insurance Corporation of Korea.
PATIENTS Each patient with colorectal cancer diagnosed from 2007 to 2012 was followed until 2015 and compared with age-matched women without colorectal cancer at a 1:5 ratio.
MAIN OUTCOME MEASURES The primary outcome was de novo breast/gynecological cancer. Patients with available medical checkup data were included in an additional analysis.
RESULTS We analyzed 56,682 patients with colorectal cancer and 288,119 age-matched noncolorectal cancer controls. The risk of breast/gynecological cancer was higher among patients with colorectal cancer than among controls (HR, 2.91; p < 0.001). The association with colorectal cancer was the highest for ovarian cancer (HR, 6.72), followed by uterine corpus cancer (HR, 3.99), cervical cancer (HR, 2.82), and breast cancer (HR, 1.85). This association remained consistent in the subgroup analysis of medical checkup data (14,190 patients with colorectal cancer, 71,933 controls). Among patients with colorectal cancer, those aged <55 years had a higher risk of breast/gynecological cancers than those aged >55 years (HR, 3.51 vs 2.59), and those with dyslipidemia had a higher risk of breast cancer than those without dyslipidemia (HR, 2.66 vs 2.06).
LIMITATIONS This was a retrospective, population-based study. A prospectively designed study is needed to validate our conclusions.
CONCLUSIONS Compared with the general population, patients with colorectal cancer carry a higher risk of developing secondary breast, ovarian, and uterine cancers. See Video Abstract at http://links.lww.com/DCR/A731.
PubMed IF 3.1 소화기내과
26532018

제1저자 정수지 · 교신저자 강혜련

, , , , , , ,
A new non-dilution rapid desensitization protocol successfully applied to all-grade platinum hypersensitivity.
Cancer Chemother Pharmacol. 2018;82(5):777-785.

Abstract
PURPOSE Desensitization is a safe alternative for patients with hypersensitivity reactions (HSRs) to platinum-based chemotherapeutic agents and widely used in real practice by employing stepwise administration of multiple serial dilutions of the culprit drugs. However, its labor-intensive nature has required a simpler protocol that is easier to prepare and perform.
METHODS We performed an observational study of patients with platinum HSR who underwent a new non-dilution one-bag desensitization protocol. Premedication consisted of Montelukast as well as H1 and H2 blockers. The outcomes and safety profiles of a new protocol were assessed.
RESULTS A total of 36 patients were recruited (oxaliplatin 23, carboplatin 9, and cisplatin 4) and the most common grade of HSR presented was grade 2 (61.1%), followed by grade 3 (25%), and grade 1 (13.9%). Of 175 desensitization procedures, all cases were successfully completed in re-administration of culprit chemotherapeutic platinum agents; 146 (83.4%) had no breakthrough reactions (BTRs) while 29 (16.6%) did. Most BTRs were mild reactions (grade 1, 51.7%) or moderate reactions (grade 2, 44.8%) of Brown's Scale. Although there was one case of asymptomatic mild hypotension (grade 3, 3.5%), categorized as severe reaction, dyspnea, desaturation, and anaphylaxis did not occur. The proportion of severe HSRs was significantly lower than that of initial HSRs (3.5% vs. 25%, P = 0.0167).
CONCLUSIONS The new non-dilution desensitization protocol was safe and effective for re-administration of culprit platinum agents in patients with a history of HSRs. Therefore, this new protocol can be used as an alternative to existing protocols using multiple serial dilutions.
PubMed IF 2.5 알레르기내과
26522018

제1저자 박세훈 · 교신저자 이하정

, , , , , , , , , ,
Gestational Estimated Glomerular Filtration Rate and Adverse Maternofetal Outcomes.
Kidney Blood Press Res. 2018;43(5):1688-1698.

Abstract
BACKGROUND/AIMS The association between gestational estimated glomerular filtration rate (eGFR) and adverse pregnancy outcomes has not been fully investigated.
METHODS This observational cohort study included pregnancy cases of singleton mothers whose serum creatinine levels were measured during pregnancy at two tertiary hospitals in Korea from 2000 to 2015. Those with identified substantial renal function impairment (eGFR < 60 mL/min/1.73 m2 at baseline, during, or after pregnancy) were excluded. The Chronic Kidney Disease Epidemiology Collaboration equation was used for the eGFR calculation. We computed the time-averaged eGFR during gestation to determine representative values when there were multiple measurements. We studied the following three gestational complications: preterm birth (< 37 weeks' gestational age), low birth weight (< 2.5 kg), and preeclampsia.
RESULTS Among the 12,899 studied pregnancies, 4,360 cases experienced one or more gestational complications. The adjusted odds ratio (aOR) and 95% confidence interval of composite gestational complications for eGFR ranges other than the reference range of 120-150 mL/ min/1.73m2 were: ≥150 mL/min/1.73m2, aOR 1.64 (1.38-1.95), P< 0.001; 90-120 mL/min/1.73m2, aOR 1.41 (1.28-1.56), P< 0.001; and 60-90 mL/min/1.73m2, aOR 2.56 (1.70-3.84), P< 0.001. Incidence of preterm birth or low birth weight showed similar U-shaped association with eGFR values; otherwise, preeclampsia or small for gestational age occurred more often in mothers with a lower gestational eGFR than in those with a higher value.
CONCLUSION Considering the unique association between gestational eGFR and pregnancy outcomes, carefully interpreting these results may help predict obstetric complications.
PubMed IF 2.1 신장내과
26512018

제1저자 이주명 · 교신저자 구본권

, , , , , , , , , , , , , , , , , , , , ,
Prognostic Implications of Relative Increase and Final Fractional Flow Reserve in Patients With Stent Implantation.
JACC Cardiovasc Interv. 2018;11(20):2099-2109.

Abstract
OBJECTIVES The study sought to investigate the prognostic implications of relative increase of fractional flow reserve (FFR) with PCI in combination with post-percutaneous coronary intervention (PCI) FFR.
BACKGROUND FFR, measured after PCI has been shown to possess prognostic implications. The relative increase of FFR with PCI can be determined by the interaction of baseline disease pattern, adequacy of PCI, and residual disease burden in a target vessel. However, the role of relative increase of FFR with PCI has not yet been evaluated.
METHODS A total of 621 patients who underwent PCI using second-generation drug-eluting stents based on low pre-PCI FFR (≤0.80) and available post-PCI FFR were analyzed. The relative increase of FFR was calculated by %FFR increase with PCI ([post-PCI FFR - pre-PCI FFR]/pre-PCI FFR × 100). Patients were divided according to the optimal cutoff values of post-PCI FFR (<0.84) and %FFR increase (≤15%). The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization) at 2 years.
RESULTS Among the total population, 66.0% showed high post-PCI FFR (≥0.84) and 69.2% showed high %FFR increase (>15%). Patients with low post-PCI FFR showed a higher risk of 2-year TVF than did those with high post-PCI FFR (9.1% vs. 2.6%; hazard ratio [HR]: 3.367; 95% confidence interval [CI]: 1.412 to 8.025; p = 0.006). Patients with low %FFR increase also showed a higher risk of 2-year TVF compared with those with high %FFR increase (9.2% vs. 3.0%; HR: 3.613; 95% CI: 1.543 to 8.458; p = 0.003). Among the high post-PCI FFR group, there were no significant differences in clinical outcomes according to %FFR increase. Conversely, among the low post-PCI FFR group, those with low %FFR increase showed a significantly higher risk of TVF than did those with high %FFR increase (14.3% vs. 4.1%; HR: 4.334; 95% CI: 1.205 to 15.594; p = 0.025). Percent FFR increase significantly increased discriminant and reclassification ability for the occurrence of TVF when added to a model with clinical risk factors and post-PCI FFR (C-index 0.783 vs. 0.734; relative integrated discrimination improvement 0.702; p = 0.009; category-free net reclassification index 0.479; p = 0.031).
CONCLUSIONS Percent FFR increase with PCI showed similar prognostic implications with post-PCI FFR. Adding the relative increase of FFR to post-PCI FFR would enable better discrimination of high-risk patients after stent implantation. (Influence of FFR on the Clinical Outcome After Percutaneous Coronary Intervention [PERSPECTIVE]; NCT01873560).
PubMed IF 12.7 순환기내과
26502018

제1저자 이원재, 서정원 · 교신저자 연태진

, , , , , ,
Effect of tailored use of tirofiban in patients with Non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention: a randomized controlled trial.
BMC Cardiovasc Disord. 2018;18(1):201.

Abstract
BACKGROUND We conducted a randomized controlled trial to investigate whether an additional platelet inhibition with tirofiban would reduce the extent of myocardial damage and prevent periprocedural myonecrosis in patients with Non-ST-elevation acute coronary syndrome (NSTE-ACS) with a high residual platelet activity (HPR).
METHODS Patients with an HPR, defined as P₂Y₁₂ reaction unit (PRU) > 230, were randomly assigned to group A (tirofiban treatment, n = 30) or C1 (n = 30) and patients without an HPR to C2 (n = 78). Periprocedural myocardial damage was assessed using the area under the curve (AUC) of serial cardiac enzyme levels from the time of the procedure to post-36 h. Periprocedural myonecrosis incidence was evaluated.
RESULTS The troponin I AUC was not different between the groups (197.2 [41.5395.7], 37.9 [8.9313.9], 121.3 [43.7481.8] h∙ng/mL; p = 0.088). The results did not change when the baseline levels were adjusted (365.3 [279.5, 451.1], 293.0 [207.1, 379.0], and 298.0 [244.7, 351.3] h∙ng/mL; p = 0.487). The rate of periprocedural myonecrosis was also not different between the groups (53.0% vs. 50.0% vs. 33.3%, p = 0.092). The CK-MB isoenzyme analysis showed similar results. No difference in complications was noted.
CONCLUSION Additional tirofiban administration was not beneficial to patients with NSTE-ACS even with an HPR.
TRIAL REGISTRATION Clinical trial no. NCT03114995 , registered 11 April, 2017, retrospectively.
PubMed IF 3.1 순환기내과
26492018

제1저자 강지훈 · 교신저자 조현재

, , , , , , , , , , , , , , ,
Effects of Widespread Inotrope Use in Acute Heart Failure Patients.
J Clin Med. 2018;7(10):jcm7100368.

Abstract
Current guidelines recommend that inotropes should not be used in patients with normal systolic blood pressure (SBP). However, this is not supported with concrete evidence. We aimed to evaluate the effect of inotropes in acute heart failure (HF) patients from a nationwide HF registry. A total of 5625 patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. The primary outcomes were in-hospital adverse events and 1-month mortality. Among the total population, 1703 (31.1%) received inotropes during admission. Inotrope users had a higher event rate than non-users (in-hospital adverse events: 13.3% vs. 1.4%, p < 0.001; 1-month mortality: 5.5% vs. 2.5%, p < 0.001), while inotrope use was an independent predictor for clinical outcomes (in-hospital adverse events: OR_adjusted 5.459, 95% CI 3.622⁻8.227, p < 0.001; 1-month mortality: HR_adjusted 1.839, 95% CI 1.227⁻2.757, p = 0.003). Subgroup analysis showed that inotrope use was an independent predictor for detrimental outcomes only in patients with normal initial SBP (≥90 mmHg) (in-hospital adverse events: OR_adjusted 5.931, 95% CI 3.864⁻9.104, p < 0.001; 1-month mortality: HR_adjusted 3.584, 95% CI 1.280⁻10.037, p = 0.015), and a propensity score-matched population showed consistent results. Clinicians should be cautious with the usage of inotropes in acute heart failure patients, especially in those with a normal SBP.
PubMed IF 3.3 순환기내과
26482018

제1저자 임선희 · 교신저자 김나영

, , , , , , , , , , , , ,
Trends in the seroprevalence of Helicobacter pylori infection and its putative eradication rate over 18 years in Korea: A cross-sectional nationwide multicenter study.
PLoS One. 2018;13(10):e0204762.

Abstract
The aims of this study were to demonstrate the trends in seropositivity and the eradication therapy rate for Helicobacter pylori (H. pylori) over an 18-year period in an asymptomatic Korean population and to explore the factors associated with H. pylori seropositivity and its eradication therapy. In total, 23,770 subjects (aged 17-97 years) from a health examination center participated in this cross-sectional study from January 2016 to June 2017. Questionnaires that included questions about the participants' H. pylori eradication therapy history were collected, and anti-H. pylori IgG antibodies were measured. Among the eligible subjects, the seroprevalence of H. pylori infection was 41.5%. The H. pylori eradication therapy rate increased continuously from 2005 (13.9%) to 2011 (19.3%) and then increased again until the first half of 2017 (23.5%) (P < 0.001). After exclusion of subjects with a history of gastric surgery, gastric cancer, H. pylori eradication therapy, or gastric symptoms, H. pylori seropositivity was 43.9% in 16,885 subjects, which was significantly lower than the seropositivities in 1998 (66.9%), 2005 (59.6%), and 2011 (54.4%). The risk factors associated with H. pylori seropositivity according to multivariable analysis were male sex (odds ratio (OR) 1.34, 95% confidence interval (CI): 1.23-1.46), medium educational level (OR 1.17, 95% CI: 1.05-1.31), medium household income level (OR 1.10, 95% CI: 1.03-1.19), and age of 60-69 years (OR 8.78, 95% CI: 6.41-11.85). The observed downward trend in H. pylori seroprevalence and increase in H. pylori eradication over the 18-year period will affect upper gastrointestinal disorders in South Korea.
PubMed IF 2.8 소화기내과
26472018

제1저자 손대원 · 교신저자 손대원

, , , ,
Viewpoints in the diagnosis and treatment of cardiac sarcoidosis: Proposed modification of current guidelines.
Clin Cardiol. 2018;41(10):1386-1394.

Abstract
Isolated cardiac sarcoidosis is a generally accepted disease condition, and the low yield of endomyocardial biopsy because of patchy involvement is also well known. However, current guidelines still require histologic confirmation of granuloma for the diagnosis of cardiac sarcoidosis, either in myocardial or extra-cardiac tissues. Therefore, only a presumptive diagnosis of chronic multifocal myocarditis of unknown origin can be made in a large number of patients in whom the only considerable diagnosis is cardiac sarcoidosis based on current knowledge. Even if these patients are treated with the same treatment scheme as that for cardiac sarcoidosis, which may not cause harm in the absence of a definite diagnosis, the true spectrum of cardiac sarcoidosis could not be determined for deciding the optimal treatment strategy. In addition, the current recommendations for dose, duration of initial steroid therapy, and treatment in patients who did not respond to initial steroid therapy are not easy to follow in real-world practice. We would like to propose a scoring system for the diagnosis of cardiac sarcoidosis and suggest our adoption or modification of the diverse current recommendations.
PubMed IF 2.8 순환기내과
26462018

제1저자 손준혁,이희승 · 교신저자 이상협

, , , , , , ,
Revision of bilateral self-expandable metallic stents placed using the stent-in-stent technique for malignant hilar biliary obstruction.
Hepatobiliary Pancreat Dis Int. 2018;17(5):437-442.

Abstract
BACKGROUND Endoscopic biliary decompression using bilateral self-expandable metallic stent (SEMS) placed using the stent-in-stent (SIS) technique is considered favorable for unresectable malignant hilar biliary obstruction (MHBO). However, occlusion of the bilateral SIS placement is frequent and revision can be challenging. This study was performed to investigate the efficacy, the long-term patency and the appropriate approach for revision of occluded bilateral SIS placement in unresectable MHBO.
METHODS From January 2011 to July 2016, thirty-eight patients with unresectable MHBO underwent revision of occluded bilateral SIS placement. Clinical data including success rates and patency of revision, were retrospectively analyzed.
RESULTS The technical success rate of revision was 76.3%. The clinical success rate of revision was 51.7% and mean patency of revision was 49.1 days. No significant predictive factor for clinical failure of revision was observed. The cell size of SEMS was not found to have significant effects on clinical success rates or revision patency.
CONCLUSIONS Revision of occluded bilateral SIS placement for MHBO showed fair patency and clinical success rate. Revision method and cell size of SEMS were not found to influence clinical outcomes.
PubMed IF 3.9 소화기내과
26452018

제1저자 이종찬 · 교신저자 김재환

, , , , , , , , , ,
Outcome of endoscopic retrograde cholangiopancreatography in patients with clinically defined decompensated liver cirrhosis.
J Dig Dis. 2018;19(10):605-613.

Abstract
OBJECTIVE Decompensated liver cirrhosis (LC) can negatively affect the outcome of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to compare the efficacy and safety of ERCP in patients with clinically defined compensated and decompensated LC.
METHODS In a single tertiary hospital, 146 endoscopic sphincterotomy-naive patients with LC who underwent ERCP between 2005 and 2016 were reviewed. Patients with LC who had experienced variceal bleeding, ascites or hepatic encephalopathy were included in the decompensated LC group. Cannulation, technical and clinical successes, and major post-ERCP adverse events including bleeding, pancreatitis, cholangitis and perforation were compared between the two groups.
RESULTS Patients were divided into compensated and decompensated LC groups. Their baseline characteristics were not different, except for comorbid malignancy (22.3 % vs 38.5%, P = 0.038) and preprocedural transfusion (7.4% vs 36.5%, P < 0.001). The cannulation (97,9% vs 94.2%, P = 0.348) and technical (95.7% vs 88.5%, P = 0.167) success rates were not different. The clinical success rate was lower in the decompensated LC group (95.7% and 78.8%, P = 0.003), mainly due to comorbid hepatobiliary malignancy. Post-ERCP pancreatitis (6.4% vs 30.8%, P = 0.008) and cholangitis (18.1% vs 32.7%, P = 0.046) rates were higher in the decompensated LC group.
CONCLUSIONS Despite lower clinical success rates due to comorbid hepatobiliary malignancy, ERCP in patients with decompensated LC is technically feasible. Because postprocedural cholangitis and pancreatitis are more frequent in patients with decompensated LC, greater procedural precautions are needed in these patients.
PubMed IF 2.7 소화기내과
26442018

제1저자 홍승욱 · 교신저자 천재영

, , , , ,
Aloe vera Is Effective and Safe in Short-term Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.
J Neurogastroenterol Motil. 2018;24(4):528-535.

Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of Aloe vera (AV) in patients with irritable bowel syndrome (IBS).
METHODS We searched the MEDLINE, EMBASE, and Cochrane databases for studies dated between 1st January 1960 and 30th December 2017. Eligible randomized controlled trials (RCTs) compared AV to placebo in patients with IBS. The primary outcome was standardized mean difference of the change in severity of IBS symptoms as measured by patient-rated scales. Secondary outcomes included response rate of IBS symptoms and adverse events. Heterogeneity among studies was assessed using Cochrane's Q and I² statistics.
RESULTS Three RCTs with a total of 151 patients with IBS were included. The meta-analysis showed a significant difference for patients with AV compared to those with placebo regarding improvement in IBS symptom score (standardized mean difference, 0.41; 95% CI, 0.07-0.75; P = 0.020). Using intention-to-treat analysis, the AV patients showed significantly better response rates of IBS symptoms compared to placebo (pooled risk ratio, 1.69; 95% CI, 1.05-2.73; P = 0.030). No adverse events related with AV were found in included studies. There was no significant heterogeneity of effects across studies (P = 0.900; I² = 0%).
CONCLUSION AV is effective and safe for the treatment of patients with IBS compared to placebo.
PubMed IF 3.7 소화기내과
26432018

제1저자 김영선 · 교신저자 김나영

,
Sex-Gender Differences in Irritable Bowel Syndrome.
J Neurogastroenterol Motil. 2018;24(4):544-558.

Abstract
Because of the sex-gender differences that are shown in a diversity of physiological and psychological factors, it can be speculated that the clinical presentation of symptoms as well as treatment strategies in women and men with irritable bowel syndrome (IBS) may differ. Studies have revealed that IBS is more common in women than men. As for the IBS subtype, IBS with constipation is significantly more prevalent among women than men. Sex hormones and gender differences may play important roles in the pathophysiology of IBS. However, its pathophysiologic mechanisms still remain largely unknown, and therapeutic implications are limited. Moreover, women IBS patients have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men IBS patients. Furthermore, there has been evidence of differences in the appropriate treatment efficacy to IBS in men and women, although relatively few men are enrolled in most relevant clinical trials. A more sex-gender-oriented approach in the medical care setting could improve understanding of heterogeneous patients suffering from IBS. An individualized and multicomponent approach including sex and gender issues might help improve the treatment of IBS.
PubMed IF 3.7 소화기내과
26422018

제1저자 김성은 · 교신저자 김나영

, , , , , , , , , , , , , , , , ,
Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study.
J Neurogastroenterol Motil. 2018;24(4):603-613.

Abstract
BACKGROUND/AIMS Functional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea.
METHODS A nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and Helicobacter pylori serology (IgG).
RESULTS A total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of H. pylori seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14-2.21) and education below college level (OR, 1.45; 95% CI, 1.01-2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06-7.94) factor in the group ≥ 60 years.
CONCLUSIONS The prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.
PubMed IF 3.7 소화기내과
26412018

제1저자 Brito JP,문재훈 · 교신저자 박영주,Tuttle

, , , , , , , , , , , , ,
Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options.
Thyroid. 2018;28(10):1325-1331.

Abstract
BACKGROUND The 2015 American Thyroid Association guidelines recognize active surveillance as an alternative to immediate surgery in patients with papillary microcarcinomas (PMCs). As a way to incorporate active surveillance as one of the management options for patients with PMCs, we developed and tested a tool to support conversations between clinicians and patients with PMCs considering treatment options.
METHODS Thyroid Cancer Treatment Choice was developed using an iterative process based on the principles of interaction, design, and participatory action research. To evaluate the impact of the tool on treatment choice, a prospective study was conducted in two thyroid cancer clinics in Seongnam-si and Seoul, South Korea. Both clinics had the expertise to offer active surveillance as well as immediate surgery. One clinic was trained in the use of the conversation aid, while the other clinic continued to care for patients without access to the conversation aid.
RESULTS Between May 2016 and April 2017, 278 patients, mostly women (n = 220, 79%), were included in the study; 152 (53%) received care at the clinic using the conversation aid. Age, sex, and mean (±SD) tumor size (6.6 ± 1.6 mm and 6.5 ± 1.9 mm) distributions were similar across clinics. Overall, 233 (84%) patients opted for active surveillance and 53 (16%) for thyroid surgery. Patients in the conversation aid group were more likely to choose active surveillance than the patients seen in the usual care clinic (relative risk = 1.16 [confidence interval 1.04-1.29]). Of all patients opting for active surveillance, more patients in the conversation aid group had thyroid cancer nodules >5 mm than in the usual care group (81% vs. 67%; p = 0.013).
CONCLUSIONS Thyroid Cancer Treatment Choice is an evidence-based tool that supports the presentation of treatment options for PMCs. Pilot testing suggests that this conversation tool increases acceptance of active surveillance, suggesting that this option is an acceptable and preferable alternative for informed patients. Further studies are warranted to confirm this finding.
PubMed IF 6.6 내분비대사내과
26402018

제1저자 방영주 · 교신저자 방영주

, , , , , , , , , , , , , , , , , , ,
Phase III, randomised trial of avelumab versus physician's choice of chemotherapy as third-line treatment of patients with advanced gastric or gastro-oesophageal junction cancer: primary analysis of JAVELIN Gastric 300.
Ann Oncol. 2018;29(10):2052-2060.

Abstract
BACKGROUND There currently are no internationally recognised treatment guidelines for patients with advanced gastric cancer/gastro-oesophageal junction cancer (GC/GEJC) in whom two prior lines of therapy have failed. The randomised, phase III JAVELIN Gastric 300 trial compared avelumab versus physician's choice of chemotherapy as third-line therapy in patients with advanced GC/GEJC.
PATIENTS AND METHODS Patients with unresectable, recurrent, locally advanced, or metastatic GC/GEJC were recruited at 147 sites globally. All patients were randomised to receive either avelumab 10 mg/kg by intravenous infusion every 2 weeks or physician's choice of chemotherapy (paclitaxel 80 mg/m2 on days 1, 8, and 15 or irinotecan 150 mg/m2 on days 1 and 15, each of a 4-week treatment cycle); patients ineligible for chemotherapy received best supportive care. The primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.
RESULTS A total of 371 patients were randomised. The trial did not meet its primary end point of improving OS {median, 4.6 versus 5.0 months; hazard ratio (HR)=1.1 [95% confidence interval (CI) 0.9-1.4]; P = 0.81} or the secondary end points of PFS [median, 1.4 versus 2.7 months; HR=1.73 (95% CI 1.4-2.2); P > 0.99] or ORR (2.2% versus 4.3%) in the avelumab versus chemotherapy arms, respectively. Treatment-related adverse events (TRAEs) of any grade occurred in 90 patients (48.9%) and 131 patients (74.0%) in the avelumab and chemotherapy arms, respectively. Grade ≥3 TRAEs occurred in 17 patients (9.2%) in the avelumab arm and in 56 patients (31.6%) in the chemotherapy arm.
CONCLUSIONS Treatment of patients with GC/GEJC with single-agent avelumab in the third-line setting did not result in an improvement in OS or PFS compared with chemotherapy. Avelumab showed a more manageable safety profile than chemotherapy.
TRIAL REGISTRATION ClinicalTrials.gov: NCT02625623.
PubMed IF 80.4 혈액종양내과
26392018

제1저자 박효은 · 교신저자 정고은

, , , , , ,
Usefulness of controlled attenuation parameter for detecting increased arterial stiffness in general population.
Dig Liver Dis. 2018;50(10):1062-1067.

Abstract
BACKGROUND Liver fibroscan has recently been suggested as an alternative method to measure liver steatosis noninvasively. In this study, we evaluated usefulness of controlled attenuation parameter (CAP) for detecting increased arterial stiffness in general population.
METHODS A total of 515 asymptomatic patients without potential cause of liver disease who had liver fibroscan and cardio-ankle vascular index (CAVI) during their health check-up exams were included. A cut off of CAP ≥222 dB/m was used to define fatty liver and CAVI ≥ 8 for increased arterial stiffness.
RESULTS Both unadjusted and adjusted regression analyses showed significant association between fatty liver and increased arterial stiffness [unadjusted Odds ratio (OR) 1.896, 95% CI 1.305-2.754, p = .001 for CAP ≥ 222 dB/m alone]. With all traditional cardiovascular risk factors such as age, gender, body mass index, hypertension, diabetes mellitus, hypercholesterolemia and smoking adjusted, CAP ≥ 222 dB/m still showed significant association with increased arterial stiffness (OR 2.309, 95% CI 1.419-3.756, p = .001). The correlation between CAP-defined fatty liver and arterial stiffness was especially strong in subjects without diabetes (OR 2.959, 95% CI 1.709-5.122, p < 0.001).
CONCLUSION CAP ≥ 222 dB/m is independently associated with increased arterial stiffness. As increased arterial stiffness is a surrogate and prognosticator for cardiovascular disease, surveillance using liver fibroscan may help screen and further stratify risk of patients.
PubMed IF 4.9 소화기내과

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