SCI 발표논문

2014년 253편

432014

제1저자 이소희 · 교신저자 박흥우

, , , , , ,
The Interaction Between Allelic Variants of CD86 and CD40LG: A Common Risk Factor of Allergic Asthma and Rheumatoid Arthritis.
Allergy Asthma Immunol Res. 2014;6(2):137-41.

Abstract
PURPOSE Allergic asthma (AA) and rheumatoid arthritis (RA) are immune tolerance-related diseases, and immune tolerance is known to be influenced by costimulatory molecules. In this study, we sought to identify common genetic susceptibility in AA and RA.
METHODS Two hundred cases of AA, 184 cases of RA, and 182 healthy controls were recruited at the Seoul National University Hospital, Seoul, Korea. Eight single nucleotide polymorphisms (SNPs) in five genes coding costimulatory molecules, namely, -318C>T, +49A>G, and 6230G>A in CTLA4, IVS3+17T>C in CD28, -3479T>G and I179V in CD86, -1C>T in CD40, and -3458A>G in CD40LG were scored, and genetic interactions were evaluated by multifactor dimensionality reduction (MDR) analysis.
RESULTS MDR analysis revealed a significant gene-gene interaction between -3479T>G CD86 and -3458A>G CD40LG for AA. Subjects with the T/T genotype of -3479T>G CD86 and the A/A genotype of -3458A>G CD40LG were found to be significantly more likely to develop AA than those with the T/T genotype of -3479T>G CD86 and A/- genotype of -3458A>G CD40LG (adjusted OR, 6.09; 95% CI, 2.89-12.98; logistic regression analysis controlled by age). Similarly those subjects showed a significant risk of developing RA (adjusted OR, 39.35; 95% CI, 15.01-107.00, logistic regression analysis controlled by age).
CONCLUSIONS Our findings suggest that a genetic interaction between CD86 and CD40LG favors the development of both AA and RA.
PubMed IF 4.3 알레르기내과
422014

제1저자 김윤정 · 교신저자 김세훈

, , , , , , , , , , , , ,
Cross-reactivity to Acetaminophen and Celecoxib According to the Type of Nonsteroidal Anti-inflammatory Drug Hypersensitivity.
Allergy Asthma Immunol Res. 2014;6(2):156-62.

Abstract
PURPOSE Identification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance.
METHODS We retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD).
RESULTS A total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001).
CONCLUSIONS Acetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.
PubMed IF 4.3 알레르기내과
412014

제1저자 김휘영 · 교신저자 김윤준

, , , , , ,
MicroRNA-196A-2 polymorphisms and hepatocellular carcinoma in patients with chronic hepatitis B.
J Med Virol. 2014;86(3):446-53.

Abstract
Single nucleotide polymorphisms (SNPs) in microRNA (miR)-196a-2 have been suggested to contribute to susceptibility to various human cancers. The aim of this study was to determine whether polymorphisms of miRNA-196a-2 affect the clinical outcomes of hepatitis B virus (HBV) infection in Korean patients. Genotyping was performed for 1,439 Korean patients with either past or present HBV infection, including 404 control subjects who underwent spontaneous recovery and 1,035 subjects with chronic HBV (313 cases of chronic hepatitis B, 305 cases of cirrhosis of the liver, and 417 cases of hepatocellular carcinoma [HCC]). Genotyping results revealed that the polymorphism rs12304647A>C, which lies in the pri-miRNA region of miR-196a-2, has a significant minor allele frequency (0.210). Logistic analysis revealed that the rs12304647A>C SNP was associated with a significant protective effect against HCC in patients with chronic hepatitis (odds ratio [OR] = 0.70, P = 0.005 in a codominant model; OR = 0.73, P = 0.03 in a dominant model; OR = 0.31, P = 0.004 in a recessive model), and in the patients with cirrhosis (OR = 0.63, P = 0.0009 in a codominant model; OR = 0.66, P = 0.01 in a dominant model; OR = 0.25, P = 0.001 in a recessive model). A Cox relative hazards model with adjustments for age, gender, HBeAg status, and cirrhosis revealed that rs12304647A>C retained its association with HCC in a codominant model (relative hazards [RH] = 1.14, P = 0.05) and in a recessive model (RH = 1.44, P = 0.03). However, the miR-196a-2 rs12304647A>C SNP had no association with HBV clearance. In conclusion, the miR-196a-2 rs12304647 CC genotype had a protective effect against development of HCC in comparison to the AA or AC genotypes in patients with chronic hepatitis and cirrhosis.
PubMed IF 3.7 소화기내과
402014

제1저자 최선미 · 교신저자 박종선

, , , , , , , , , , , ,
Postoperative pulmonary complications after surgery in patients with interstitial lung disease.
Respiration. 2014;87(4):287-93.

Abstract
BACKGROUND Patients with interstitial lung disease (ILD) have a high incidence of postoperative pulmonary complications (PPCs) after lung resection, but there is little data about these complications in ILD after other types of surgery.
OBJECTIVES The aim of this study was to examine the characteristics and predictors of PPCs after major surgery in patients with ILD.
METHODS We included 336 patients with ILD who underwent major surgery between January 2005 and December 2010 at two tertiary hospitals in Korea. All types of surgery that had been performed under general anesthesia were included. Demographic characteristics, preoperative lung function, and operative conditions including anesthesia time and estimated blood loss were compared between patients with and without PPCs.
RESULTS PPCs occurred in 37 patients (11%). Thirteen patients developed pneumonia, the most common PPC, and 11 had acute exacerbation of ILD. In multivariable analysis, BMI <23 (OR = 2.488, 95% CI: 1.084-5.710, p = 0.031), emergency surgery (OR = 23.992, 95% CI: 2.629-218.949, p = 0.005), lung surgery (OR = 5.090, 95% CI: 1.391-18.628, p = 0.014), and longer anesthesia time (OR = 1.595, 95% CI: 1.143-2.227, p = 0.006) were statistically significant risk factors.
CONCLUSIONS The incidence of PPCs detected over all surgeries was not as high as that reported for lung surgery alone in ILD patients. Lower BMI, emergency surgery, lung surgery, and longer anesthesia time were risk factors. Operative conditions as well as lung function should be considered in preoperative planning and management for ILD patients undergoing major surgery.
PubMed IF 2.6 호흡기내과
392014

제1저자 차명진 · 교신저자 오세일

, , , , ,
Prevalence of and risk factors for silent ischemic stroke in patients with atrial fibrillation as determined by brain magnetic resonance imaging.
Am J Cardiol. 2014;113(4):655-61.

Abstract
Varied silent ischemic stroke (SS) prevalence occurs in patients with atrial fibrillation (AF). Stroke history is worth 2 points in the CHADS2 scoring system. An unknown proportion of patients with AF with a CHADS2 score of 0 or 1 have been undertreated for stroke prevention. We investigated SS risk factors using magnetic resonance imaging and estimated SS impact on clinical outcomes in patients with AF. We analyzed a total of 1,200 patients (400 with AF and 800 with sinus rhythm) who had brain magnetic resonance imaging performed for routine health checkups. Clinical outcomes including symptomatic stroke, dementia, and cognitive disorder were also evaluated in patients with AF (follow-up duration: 66.7 ± 35.9 months; range 10 to 162). SS was observed in 113 patients with AF (28.3%), which was significantly higher than that in 53 subjects (6.6%) with sinus rhythm (p <0.001, odds ratio [OR] 5.549). Independent risk factors for SS in patients with AF were age (OR 1.049), hypertension (OR 2.086), dyslipidemia (OR 2.073), and valvular AF (OR 3.157). Symptomatic stroke incidence during the follow-up was significantly greater in patients with AF with SS than without SS (5.6% vs 2.7% per year, respectively; p = 0.022, hazard ratio 1.787, 95% confidence interval 1.089 to 2.933). Using current scoring systems without correcting for subclinical stroke, clinicians have likely underestimated the stroke risk in low-risk patients with AF; thus many patients with AF might not receive optimal anticoagulation treatment. In conclusion, a screening tool for detecting SS could be considered for stroke risk evaluation in patients with AF, especially those with valvular AF, elderly patients, and patients with dyslipidemia or hypertension.
PubMed IF 2.5 순환기내과
382014

제1저자 박경우 · 교신저자 김효수

, , , , , ,
Comparison of 2-year clinical outcomes between zotarolimus-, sirolimus-, and paclitaxel-eluting stents in real life clinical practice.
Catheter Cardiovasc Interv. 2014;83(3):349-59.

Abstract
BACKGROUND There are few studies comparing the long-term efficacy and safety of the zotarolimus-eluting stent (ZES) with sirolimus- (SES) and paclitaxel-eluting stents (PES) in the unselected cohorts that were subject to real life clinical practice.
METHODS Total 2,769 patient who underwent successful percutaneous coronary intervention (PCI) with the three drug-eluting stents (DES) between April 2006 and July 2008 were analyzed retrospectively. A total of 1,152 patients were treated with SES, 810 with PES, and 807 with ZES. The primary analysis endpoint was cumulative rate of target-lesion failure (TLF) at 24 months, defined as the composite of cardiac death, target-vessel-related myocardial infarction (MI), and target-lesion revascularization (TLR).
RESULTS At 24 months, the incidence of TLF was significantly lower in the SES group compared with the ZES (7.6% vs. 11.3%, HR = 0.66, CI = 0.49–0.88, P = 0.005) or the PES group (7.6% vs. 10.2%, HR = 0.74, CI = 0.55–0.99, P = 0.048), while similar between the PES and the ZES groups (HR = 0.89, CI = 0.66–1.20, P = 0.443). The difference was mostly driven by higher rate of TLR in the ZES and PES groups compared with the SES group, mostly within the first year post-PCI. However, the rate of hard endpoints (cardiac death or nonfatal MI) was similar among the three groups. These results were reproduced in the propensity score-matched cohort.
CONCLUSIONS This observational study shows that the use of SES is superior to PES or ZES for the TLF in the overall and matched analysis.
PubMed IF 1.9 순환기내과
372014

제1저자 김미소 · 교신저자 이종석

, , , , , , , , ,
Preoperative thrombocytosis is a significant unfavorable prognostic factor for patients with resectable non-small cell lung cancer.
World J Surg Oncol. 2014;12:37.

Abstract
BACKGROUND Previous studies have reported that pretreatment thrombocytosis is associated with poor outcomes in several cancer types. This study was designed to evaluate the prognostic significance of preoperative thrombocytosis in patients with non-small cell lung cancer (NSCLC) who undergo surgery.
METHODS We retrospectively reviewed the records of 199 patients who underwent R0 resection for NSCLC between May 2003 and July 2006 at Seoul National University Bundang Hospital, Seongnam, Korea.
RESULTS The frequency of preoperative thrombocytosis was 7.5% (15/199). Patients with preoperative thrombocytosis had shorter overall survival (OS, P = 0.003) and disease-free survival (DFS, P = 0.005) than those without thrombocytosis. In multivariable analysis, patients with preoperative thrombocytosis had a significantly greater risk of death and recurrence than those without preoperative thrombocytosis (risk of death: hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.39 to 6.37, P = 0.005; risk of recurrence: HR 2.47, 95% CI 1.22 to 5.01, P = 0.012). A tendency towards a shorter OS and DFS was observed in three patients with persistent thrombocytosis during the follow-up period when compared with those of patients who recovered from thrombocytosis after surgery.
CONCLUSIONS Preoperative thrombocytosis was valuable for predicting the prognosis of patients with NSCLC. Special attention should be paid to patients with preoperative and postoperative thrombocytosis.
PubMed IF 2.8 혈액종양내과
362014

제1저자 정희원 · 교신저자 김광일

, , , , , , , ,
Prevalence and outcomes of frailty in Korean elderly population: comparisons of a multidimensional frailty index with two phenotype models.
PLoS One. 2014;9(2):e87958.

Abstract
BACKGROUND Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model.
METHODS We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated.
RESULTS The prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6 ± 0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04-4.35) and CHS index (OR = 2.24, 95% CI 1.05-4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68-3.01).
CONCLUSION Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.
PubMed IF 2.8 순환기내과
352014

제1저자 김백남 · 교신저자 오명돈

, ,
Oral antibiotic treatment of staphylococcal bone and joint infections in adults.
J Antimicrob Chemother. 2014;69(2):309-22.

Abstract
Bone and joint infections, especially implant-associated infections, are difficult to cure. Long-term antibiotic therapy, combined with appropriate surgery and the removal of prostheses, is required. The most common causative organisms in bone and joint infections are staphylococci. Oral agents are often used after an initial course of parenteral antibiotic treatment. However, it is unclear which oral regimens are most effective in staphylococcal bone and joint infections. We review various oral antibiotic regimens and discuss which regimens are effective for this indication.
PubMed IF 3.6 감염내과
342014

제1저자 강승주 · 교신저자 김동희

, , , , , , ,
Visceral adipose tissue area is associated with coronary stenosis and noncalcified plaques.
Int J Obes (Lond). 2014;38(2):272-8.

Abstract
OBJECTIVE Few studies have investigated the relationships between visceral adipose tissue (VAT) and coronary stenosis and noncalcified plaques at the subclinical stage. The aim of this study was to investigate relationship between VAT and coronary lesions assessed by coronary computed tomography (CT) in an apparently healthy population.
DESIGN Retrospective cross-sectional study.
SUBJECTS One thousand six hundred and fifty-eight subjects free of cardiovascular disease underwent coronary CT and abdominal fat CT as part of a routine medical examination.
MEASUREMENT VAT area was measured at the level of the umbilicus using CT. Coronary stenoses and plaques were evaluated using coronary CT.
RESULTS The mean age of the study population was 55.9±8.0 years, and 1198 (72.3%) subjects were men. There were 201 subjects (12.1%) with coronary stenosis <50% and 144 (8.7%) had significant stenosis. Noncalcified plaques were observed in 108 (6.5%) subjects. Coronary stenosis <50% and noncalcified plaques increased steadily as the VAT area increased (P<0.001). The 4th quartile of VAT area was significantly associated with prevalence of coronary stenosis <50% and the presence of noncalcified plaques when compared with the first through third VAT quartiles in the cardiovascular risk factor-adjusted model (odds ratio (OR): 1.58, 95% confidence interval (CI): 1.09-2.30 and OR: 1.66; 95% CI: 1.02-2.68, respectively).
CONCLUSION Excess VAT area was associated with coronary stenosis <50% and noncalcified plaques, independent of traditional cardiovascular risk factors, in an asymptomatic population without a history of coronary artery disease.
PubMed IF 5.4 소화기내과
332014

제1저자 오태정 · 교신저자 조영민

, , , , , ,
The incretin effect in Korean subjects with normal glucose tolerance or type 2 diabetes.
Clin Endocrinol (Oxf). 2014;80(2):221-7.

Abstract
BACKGROUND The incretin effect is known to be decreased in type 2 diabetes. However, there are limited data on the incretin effect in non-Caucasian subjects. Because Asian patients with type 2 diabetes are characterized by decreased insulin secretion, this study set out to examine the incretin effect in Korean subjects with normal glucose tolerance (NGT) or type 2 diabetes.
METHODS We performed 75-g oral glucose tolerance tests (OGTTs) and corresponding isoglycaemic intravenous glucose infusion (IIGI) studies in Korean subjects with NGT (n = 14) or type 2 diabetes (n = 16). The incretin effect was calculated based on the incremental area under the curves (iAUCs) of the plasma levels of insulin, C-peptide or insulin secretion rate (ISR). The plasma levels of total glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were measured by ELISA.
RESULTS The incretin effect was not different between the subjects with NGT and type 2 diabetes (43 ± 6% vs 47 ± 4%, P = 0·575 by insulin; 29 ± 7% vs 38 ± 4%, P = 0·253 by C-peptide; 28 ± 7% vs 35 ± 5%, P = 0·372 by ISR, respectively). However, the gastrointestinally mediated glucose disposal (GIGD) was markedly decreased in type 2 diabetes (28·5 ± 4·2% vs 59·0 ± 4·3%, P < 0·001). The plasma levels of the total GLP-1 and GIP during the OGTTs were comparable between the two groups.
CONCLUSION In Koreans, the secretion of GLP-1 or GIP during OGTTs and the incretin effect were comparable between subjects with NGT and type 2 diabetes, whereas the GIGD was significantly decreased in patients with type 2 diabetes.
PubMed IF 2.8 내분비대사내과
322014

제1저자 조선욱 · 교신저자 박영주/이가희

, , , , , , , , ,
Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors.
Thyroid. 2014;24(2):277-86.

Abstract
BACKGROUND Distant metastasis, generally to lung and bone, is rare in differentiated thyroid carcinoma (DTC) and the prognosis is still elusive. We investigated long-term outcomes of lung metastasis in DTC patients and its prognostic factors.
METHODS A retrospective review was performed of 4572 patients who underwent surgery for DTC from 1962 to 2009 at Seoul National University Hospital. Among them, 164 patients were identified with lung metastasis and 152 patients were enrolled in the final analysis. Poor prognosis was defined as progressive disease or death.
RESULTS Of these 152 patients, 10- and 20-year survival rates were 85.0% and 71.0%, respectively. No evidence of disease, stable disease, progressive disease, and death was identified in 22.4%, 28.3%, 35.5%, and 13.8%, respectively, after 11 years of median follow-up (range 2-41 years). Older age at diagnosis (≥45 years), primary tumor size ≥2 cm, follicular thyroid cancer, metastasis diagnosed after initial evaluation or (131)I remnant ablation (late metastasis), multiple metastases other than lung, (131)I nonavidity, and the presence of macronodules (≥1 cm) were more frequent in poor prognoses. Cox proportional hazard ratio for progression-free survival showed that (131)I nonavidity was the only independent predictive factor for poor prognosis.
CONCLUSIONS The prognosis of lung metastasis from DTC in Korea within this study was favorable. (131)I nonavidity, observed more frequently in late metastasis, was the only independent factor predicting poor prognosis.
PubMed IF 6.6 내분비대사내과
312014

제1저자 이태진 · 교신저자 송영욱

, , , , ,
Cost-of-illness and quality of life in patients with ankylosing spondylitis at a tertiary hospital in Korea.
J Korean Med Sci. 2014;29(2):190-7.

Abstract
The objectives of this study were to estimate the cost-of-illness (COI) and health-related quality of life (HRQOL) in patients with ankylosing spondylitis (AS) in Korea and to evaluate the effects of socio-demographic and clinical factors on the COI and the HRQOL. Face-to-face interview surveys were taken from patients with AS at the Rheumatology Clinic of Seoul National University Hospital. Direct medical and non-medical costs, indirect costs (productivity loss due to job loss and sick leave), and deterioration of HRQOL in patients with AS were measured. Factors associated with COI and HRQOL were analyzed with multiple regression and multivariate logistic regression. A total of 191 patients with AS was enrolled in the study. The COI in patients with AS amounted to 11,646,180 Korean Won (KRW) per patient, and their HRQOL was 0.62. As functional severity worsened, the total costs increased (class I, KRW 7.7 million; class II, KRW 12.9 million; classes III & IV, KRW 25.2 million) and the HRQOL scores decreased (class I, 0.72; class II, 0.61; classes III & IV, 0.24). Functional severity is the major determinant of the COI and HRQOL in patients with AS.
PubMed IF 3.2 류마티스내과
302014

제1저자 황상연 · 교신저자 이정훈

, , , , , , , ,
Spontaneous fungal peritonitis: a severe complication in patients with advanced liver cirrhosis.
Eur J Clin Microbiol Infect Dis. 2014;33(2):259-64.

Abstract
Treatment of cirrhotic patients with spontaneous peritonitis using antibiotics occasionally fails. Fungal infections may be one of the causes of antibiotic treatment failure in such patients. In this study we evaluated the clinical significance and characteristics of spontaneous fungal peritonitis (SFP). Consecutive cirrhotic patients with spontaneous peritonitis treated between 2000 and 2005 at a tertiary care center in Seoul, Korea, were included. We analyzed the clinical characteristics and the prognosis of SFP patients compared with patients with spontaneous bacterial peritonitis (SBP). During the study period 416 patients developed spontaneous peritonitis and 15 (3.6 %) had SFP. Compared with patients with SBP, nosocomial peritonitis (peritonitis that developed after hospitalization for >72 h) was more common and the Child-Pugh score was higher in SFP patients (both, P < 0.01). Ten patients were infected with Candida spp. (C. albicans, 8; C. tropicalis, 1; C. glabrata, 1), and 5 with Cryptococcus neoformans. Eleven patients were co-infected with bacteria that were susceptible to the antibiotics administered. Only 5 patients were treated using appropriate anti-fungal agents. The 1-month mortality rate for SFP patients was 73.3 % (11 out of 15; median time to death, 2 days [range, 0-22]), which was significantly higher than patients with SBP alone (28.7 %, P = 0.0007). SFP is severe complication related to high mortality in cirrhotic patients. A longer admission and a higher Child-Pugh score may be risk factors. Immediate anti-fungal treatment is warranted in patients with spontaneous peritonitis, once fungus is found in the ascitic fluid.
PubMed IF 3.2 소화기내과
292014

제1저자 정영희 · 교신저자 송경호

, , , , , , , , , , , , , , ,
Area under the concentration-time curve to minimum inhibitory concentration ratio as a predictor of vancomycin treatment outcome in methicillin-resistant Staphylococcus aureus bacteraemia.
Int J Antimicrob Agents. 2014;43(2):179-83.

Abstract
There have been few clinical studies on the association between the 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio and vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections. Patients with MRSA bacteraemia between July 2009 and January 2012 were analysed retrospectively. All adult patients treated with vancomycin for ≥72 h without dialysis were included. The MIC was determined by Etest and broth microdilution (BMD). Initial steady-state AUC24 was estimated using a Bayesian model, and the AUC24/MIC cut-off value for differentiating treatment success and failure was calculated by classification and regression tree (CART) analysis. In total, 76 patients were enrolled; vancomycin treatment failure occurred in 20 patients (26.3%). Catheter-related infection was the most frequent (35.5%), followed by surgical site infection (26.3%), whilst 25 (32.9%) had complicated infections. In univariate analysis, decreased MRSA vancomycin susceptibility (MIC≥1.5 mg/L) and vancomycin trough levels (15-20 mg/L) were not associated with treatment outcomes. In the CART analysis, low initial vancomycin AUC24/MIC (<430 by Etest; <398.5 by BMD) was associated with a higher treatment failure rate (50.0% vs. 25.0%, P=0.039 by Etest; 45.0% vs. 23.2%; P=0.065 by BMD). In multivariate analysis, low initial vancomycin AUC24/MIC was a significant risk factor for treatment failure [adjusted odds ratio (aOR)=4.39, 95% confidence interval (CI), 1.26-15.35 by Etest; aOR=3.73, 95% CI 1.10-12.61 by BMD]. In MRSA bacteraemia, a low initial vancomycin AUC24/MIC is an independent risk factor for vancomycin treatment failure.
PubMed IF 5 감염내과
282014

제1저자 김성은, 박현경 · 교신저자 김나영

, , , , , , , , , , , , ,
Prevalence and risk factors of functional dyspepsia: a nationwide multicenter prospective study in Korea.
J Clin Gastroenterol. 2014;48(2):e12-8.

Abstract
GOALS To evaluate the prevalence of functional dyspepsia (FD) and its risk factors.
BACKGROUND FD is a common disorder, but its negative influences greatly affect the quality of life. The predictive factors of FD are still ambiguous.
STUDY A total of 3399 participants underwent screening gastroscopy at one of 7 nationwide health care centers in Korea and who completed a questionnaire. Atrophic gastritis was defined by gastroscopy. Serologic Helicobacter pylori immunoglobulin G antibody was measured by enzyme-linked immunosorbent assay.
RESULTS Of the 3399 participants who did not have organic diseases, 694 (20.4%) had dyspeptic symptoms such as epigastric pain/soreness or postprandial discomfort. Among the 694 participants, atrophic gastritis and positive H. pylori serology were found in 282 (40.6%) and 422 (60.8%), respectively; these proportions were not different from the remaining asymptomatic subjects. Multivariate analysis showed that having relatives with gastric cancer [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.01-1.81], education below college (OR, 1.32; 95% CI, 1.06-1.64), and high-salt diet (OR, 1.33; 95% CI, 1.05-1.68) were associated with FD symptoms.
CONCLUSIONS FD symptoms were frequently found in the health check-up subjects. Relatives of gastric cancer, education below college, and high-salt diet were risk factors of FD, suggesting that FD is a multifactorial disease.
PubMed IF 2.7 소화기내과
272014

제1저자 안신영 · 교신저자 김세중

, , , , , , , , , , ,
Serum anion gap is predictive of mortality in an elderly population.
Exp Gerontol. 2014;50:122-7.

Abstract
An elevated serum anion gap is known to be associated with hypertension, low cardiorespiratory fitness, and decreased renal function. We evaluated whether serum AG might be predictive of elderly mortality in a community-based cohort in Korea. We analyzed the available data from 862 elderly people in the Korean Longitudinal Study on Health and Aging. Over a 5-year observational period, 151/862 (17.5%) participants died, and a high albumin-adjusted anion gap (SAAG) was associated with an increased risk of all-cause mortality in unadjusted analyses (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.41-2.71) and fully adjusted analyses (HR, 1.77; 95% CI, 1.24-2.52), compared with a low SAAG group. The population attributable fraction of death due to high SAAG was 38.2% (95% CI 20.7-58.2%). In particular, the participants with high SAAG had higher cardiovascular and infection-related mortality rates than those with low SAAG (HR, 2.11; 95% CI, 1.06-4.19, and HR, 9.69; 95% CI, 1.12-83.4, respectively). High SAAG may be an independent predictor of mortality and is associated with higher cardiovascular and infection related mortality in the elderly.
PubMed IF 5.1 신장내과
262014

제1저자 문재훈/박영주 · 교신저자 김기웅/장학철

, , , , , , , ,
Lower-but-normal serum TSH level is associated with the development or progression of cognitive impairment in elderly: Korean Longitudinal Study on Health and Aging (KLoSHA).
J Clin Endocrinol Metab. 2014;99(2):424-32.

Abstract
CONTEXT The association between subclinical hyperthyroidism and the risk of dementia has been validated in several studies. However, the effect of thyroid function within reference range on the risk of cognitive dysfunction including mild cognitive impairment (MCI) and dementia is still unclear.
OBJECTIVE Our aim was to investigate the association between thyroid function and the risk of MCI and dementia in euthyroid elderly subjects.
DESIGN, SETTING, AND PARTICIPANTS We conducted a population-based prospective study as a part of the Korean Longitudinal Study on Health and Aging. A total of 313 participants who were euthyroid and nondemented at baseline and completed cognitive function tests at a 5-year follow-up evaluation (mean age 72.5 ± 6.9 y) were analyzed in the present study.
MAIN OUTCOME MEASURE Baseline thyroid function was compared according to the development of MCI or dementia during the study period. Binary logistic regression analysis was performed to investigate the independent association between thyroid function and cognitive impairment.
RESULTS At baseline evaluation, 237 subjects were cognitively normal, and 76 subjects had MCI. Diagnoses of cognitive function in 259 subjects remained unchanged or improved during the study period (nonprogression group), whereas 54 subjects showed progression of cognitive impairment to MCI or dementia (progression group). In the progression group, baseline serum TSH levels were lower than those in nonprogression group. Baseline serum free T₄ levels were not significantly different between these two groups. The association between lower baseline serum TSH levels and the development of MCI or dementia was maintained after adjustment for conventional baseline risk factors.
CONCLUSIONS Lower serum TSH level within the reference range was independently associated with the risk of cognitive impairment including MCI and dementia in elderly subjects.
PubMed IF 5.4 내분비대사내과
252014

제1저자 한정규 · 교신저자 구본권

, , , , , , , , , , , , , , , , , , , , , , ,
Optimal intravascular ultrasound criteria for defining the functional significance of intermediate coronary stenosis: an international multicenter study.
Cardiology. 2014;127(4):256-62.

Abstract
OBJECTIVE We aimed to assess the ideal cut-off value of minimal lumen area (MLA) by intravascular ultrasound (IVUS) and its diagnostic performance to predict ischemia, using a large-scale, pooled analysis.
METHODS Eleven centers worldwide were invited to provide their clinical, IVUS and fractional flow reserve (FFR) data. A total of 881 lesions were enrolled.
RESULTS Angiographic % diameter stenosis (r = -0.373, p < 0.0001) and IVUS MLA (r = 0.289, p < 0.0001) correlated with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR <0.8) was 2.75 mm(2) (AUC 0.646, 95% CI 0.609-0.684). When the diagnostic performance of IVUS MLA was tested according to the lesion location, BCV could be found only in lesions in the proximal artery and the mid-left anterior descending artery. Interestingly, Asians (n = 623) and Westerners (n = 258) showed different demographic and lesion characteristics as well as different BCVs to define ischemia. The BCV for the proximal/mid-left anterior descending artery lesions was 2.75 mm(2) (AUC 0.688, 95% CI 0.635-0.742) in Asians and 3.0 mm(2) (AUC 0.695, 95% CI 0.605-0.786) in Westerners.
CONCLUSION In this pooled analysis, an IVUS MLA of 2.75 mm(2) was the BCV to define the functional significance of intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion and patient characteristics should be considered.
PubMed IF 1.9 순환기내과
242014

제1저자 박한기 · 교신저자 강혜련

, , , ,
What makes a difference in exercise-induced bronchoconstriction: an 8 year retrospective analysis.
PLoS One. 2014;9(1):e87155.

Abstract
BACKGROUND Exercise-induced bronchoconstriction (EIB) was recently classified into EIB alone and EIB with asthma, based on the presence of concurrent asthma.
OBJECTIVE Differences between EIB alone and EIB with asthma have not been fully described.
METHODS We retrospectively reviewed who visited an allergy clinic for respiratory symptoms after exercise and underwent exercise bronchial provocation testing. More than a 15% decrease of forced expiratory volume in 1 second (FEV1) from baseline to the end of a 6 min free-running challenge test was interpreted as positive EIB.
RESULTS EIB was observed in 66.9% of the study subjects (89/133). EIB-positive subjects showed higher positivity to methacholine provocation testing (61.4% vs. 18.9%, p<0.001) compared with EIB-negative subjects. In addition, sputum eosinophilia was more frequently observed in EIB-positive subjects than in EIB-negative subjects (56% vs. 23.5%, p = 0.037). The temperature and relative humidity on exercise test day were significantly related with the EIB-positive rate. Positive EIB status was correlated with both temperature (p = 0.001) and relative humidity (p = 0.038) in the methacholine-negative EIB group while such a correlation was not observed in the methacholine-positive EIB group. In the methacholine-positive EIB group the time to reach a 15% decrease in FEV1 during exercise was significantly shorter than that in the methacholine-negative EIB group (3.2±0.7 min vs. 8.6±1.6 min, p = 0.004).
CONCLUSIONS EIB alone may be a distinct clinical entity from EIB with asthma. Conditions such as temperature and humidity should be considered when performing exercise tests, especially in subjects with EIB alone.
PubMed IF 2.8 알레르기내과
232014

제1저자 정재우 · 교신저자 강혜련

, , ,
The incidence and risk factors of infusion-related reactions to rituximab for treating B cell malignancies in a single tertiary hospital.
Oncology. 2014;86(3):127-34.

Abstract
BACKGROUND Rituximab is a chimeric anti-CD20 human/mouse monoclonal antibody. As its usage has increased, there have been growing concerns about rituximab-related infusion-related reactions (IRRs).
OBJECTIVE The aim of this study is to verify the clinical features and risk factors of IRRs by rituximab, and to help establish clinical guidelines for their prevention.
METHODS We reviewed electronic medical records of all the adult patients who were prescribed rituximab from January 2005 to July 2010 for B cell malignancy at Seoul National University Hospital.
RESULTS A total of 389 cases of IRRs by rituximab (12.5% of a total of 3,104 infusions) were identified in 281 patients (49.4% of a total of 568 patients). IRRs most frequently occurred during the first infusion (40.5%) and abruptly decreased in subsequent infusions to rates of 3-8% (p < 0.001). The incidence of IRRs in patients premedicated with corticosteroid for their first infusion was significantly lower when compared to patients not pretreated with corticosteroid prior to rituximab infusion (8.3 vs. 41.2%, p = 0.017).
CONCLUSION Almost half of all patients in the study experienced IRRs at least once during their scheduled rituximab treatment. Premedication with corticosteroid can be recommended in patients with high risk of IRR in the first infusion.
PubMed IF 1.9 알레르기내과
222014

제1저자 이창현 · 교신저자 김주성

, , , , ,
Enalapril inhibits nuclear factor-κB signaling in intestinal epithelial cells and peritoneal macrophages and attenuates experimental colitis in mice.
Life Sci. 2014;95(1):29-39.

Abstract
AIMS Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, has pleiotropic effects such as anti-inflammatory effects. This study investigated the effect of enalapril on the nuclear factor-kappa B (NF-κB) pathway and on experimental colitis.
MAIN METHODS The human intestinal epithelial cell (IEC) line COLO 205 and peritoneal macrophages from C57BL/6 wild-type mice and IL-10-deficient (IL-10(-/-)) mice were prepared and subsequently stimulated with lipopolysaccharide (LPS) alone or LPS plus enalapril. The effect of enalapril on NF-κB signaling was examined by western blotting to detect IκBα phosphorylation/degradation; an electrophoretic mobility shift assay (EMSA) to assess the DNA binding activity of NF-κB; and ELISAs to qualify IL-8, TNF-α, IL-6, and IL-12 production. In in vivo studies, dextran sulfate sodium (DSS)-induced acute colitis in wild-type mice and chronic colitis in IL-10(-/-) mice were treated with or without enalapril. Colitis was quantified by histologic scoring, and the phosphorylation of IκBα in the colonic mucosa was assessed using immunohistochemistry.
KEY FINDINGS Enalapril significantly inhibited LPS-induced IκBα phosphorylation/degradation, NF-κB binding activity, and pro-inflammatory cytokine production in both IEC and peritoneal macrophages. The administration of enalapril significantly reduced the severity of colitis, as assessed based on histology in both murine colitis models. Furthermore, in colon tissue, the up-regulation of IκBα phosphorylation with colitis induction was attenuated in enalapril-treated mice.
SIGNIFICANCE Enalapril may block the NF-κB signaling pathway, inhibit the activation of IECs and macrophages, and attenuate experimental murine colitis by down-regulating IκBα phosphorylation. These findings suggest that enalapril is a potential therapeutic agent for inflammatory bowel disease.
PubMed IF 6.4 소화기내과
212014

제1저자 오세원 · 교신저자 진호준

, , , , , , , ,
Relationship between changes in body fat and a decline of renal function in the elderly.
PLoS One. 2014;9(1):e84052.

Abstract
Obesity is a risk factor for chronic kidney disease, and its prevalence among the elderly is increasing. We investigated the effects of changes in body fat percentage (BFP) on the longitudinal changes in the estimated glomerular filtration rate (eGFR) in the elderly. This prospective cohort study included 390 participants aged >65 years who underwent bioelectrical impedance analysis at baseline and follow-up as a part of the Korean Longitudinal Study on Health and Aging. After a median follow-up period of 5.3 years, BFP was significantly higher than that at the start point (P<0.05). Participants who had the largest increase in BFP had the highest BMI and waist circumference (WC) (P<0.001). The highest tertile had the highest white blood cell count and erythrocyte sedimentation rate, incidence of rapid progression, and decline in eGFR >25% (P≤0.017, P = 0.025, P = 0.005, respectively). The lowest tertile had the lowest triglyceride and highest high-density lipoprotein levels (P<0.05). The adjusted decline rate in eGFR was correlated with a change in BFP (P = 0.039), but not with that in BMI or WC. The highest tertile had a 4.875-fold increase in the risk for rapid progression to a decline in eGFR (95% CI: 1.366-17.397) and a 4.931-fold decrease in the risk to a decline in eGFR>25% (95% CI: 1.617-15.037), when compared with the lowest tertile. In subgroup analysis, the incidence of renal outcomes was significantly increased according to the increase in BFP in patients with lower eGFR (P≤0.010). A change in BFP may be associated with inflammation and dyslipidemia development, and longitudinal changes in body fat are related to a decrease in eGFR in the elderly.
PubMed IF 2.8 신장내과
202014

제1저자 김미소 · 교신저자 김범석

, , , , , , , , ,
Adenoid cystic carcinoma of the breast: a case series of six patients and literature review.
Cancer Res Treat. 2014;46(1):93-7.

Abstract
Adenoid cystic carcinoma (ACC) of the breast is a very rare and indolent tumor with a favorable prognosis, despite its triple-negative status. Due to its rarity, there has been no consensus regarding treatments, and treatment guidelines have not been established. Here, we report on six patients with ACC of the breast. All of the patients initially presented with localized disease and no axillary lymph node metastases. Although some of our patients developed local recurrence or distant metastases, all patients had a favorable clinical course, and to date, none of the patients has died from complications of her disease. Here, we described the clinicopathologic features of ACC of the breast and review the current literature.
PubMed IF 4.2 혈액종양내과
192014

제1저자 최평균, 최형진 · 교신저자 김남중

, , , , , , , , , ,
High prevalence of low bone mass and associated factors in Korean HIV-positive male patients undergoing antiretroviral therapy.
J Int AIDS Soc. 2014;17(1):18773.

Abstract
INTRODUCTION Low bone mass is prevalent in HIV-positive patients. However, compared to Western countries, less is known about HIV-associated osteopenia in Asian populations.
METHODS We performed a cross-sectional survey in Seoul National University Hospital from December 2011 to May 2012. We measured bone mineral density using central dual energy X-ray absorptiometry, with consent, in male HIV-positive patients, aged 40 years and older. Diagnosis of low bone mass was made using International Society for Clinical Densitometry Z-score criteria in the 40-49 years age group and World Health Organization T-score criteria in the >50-year age group. The data were compared with those of a community-based cohort in Korea.
RESULTS Eighty-four HIV-positive male patients were included in this study. Median age was 49 (interquartile range [IQR], 45-56) years, and median body mass index (BMI) was 22.6 (IQR, 20.9-24.4). Viral suppression was achieved in 75 (89.3%) patients and median duration of antiretroviral therapy was 71 (IQR, 36-120) months. The overall prevalence of low bone mass was 16.7% in the 40-49 years age group and 54.8% in the>50 years age group. Our cohort had significantly lower bone mass at the femur neck and total hip than HIV-negative Koreans in the 40-49 years age group. Low bone mass was significantly associated with low BMI, and a high level of serum carboxy-terminal collagen crosslinks, but was not associated with antiretroviral regimen or duration of antiretroviral therapy.
CONCLUSIONS Low bone mass is prevalent in Korean HIV-positive males undergoing antiretroviral therapy, and may be associated with increased bone resorption.
PubMed IF 5.2 감염내과
182014

제1저자 윤연이 · 교신저자 임태환

,
Current roles and future applications of cardiac CT: risk stratification of coronary artery disease.
Korean J Radiol. 2014;15(1):4-11.

Abstract
Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.
PubMed IF 6.1 순환기내과
172014

제1저자 이해영 · 교신저자 이해영

, , , ,
Statins and renin-angiotensin system inhibitor combination treatment to prevent cardiovascular disease.
Circ J. 2014;78(2):281-7.

Abstract
Hypercholesterolemia and hypertension are common risk factors for cardiovascular disease (CVD). Updated guidelines emphasize target reductions of overall cardiovascular risks. Experimental studies have shown reciprocal relationships between insulin resistance (IR) and endothelial dysfunction. Hypercholesterolemia and hypertension have a synergistic deleterious effect on IR and endothelial dysfunction. Unregulated renin-angiotensin system (RAS) is important in the pathogenesis of atherosclerosis and hypertension. Various strategies with different classes of antihypertensive medications to reach target goals have failed to reduce residual CVD risk further. Of interest, treating moderate cholesterol elevations with low-dose statins in hypertensive patients reduced CVD risk by 35-40% further. Therefore, statins are important in reducing CVD risk. Unfortunately, statin therapy causes IR and increases the risk of type 2 diabetes mellitus. RAS inhibitors improve both endothelial dysfunction and IR. Further, cross-talk between hypercholesterolemia and RAS exists at multiple steps of IR and endothelial dysfunction. In this regard, combined therapy with statins and RAS inhibitors demonstrates additive/synergistic effects on endothelial dysfunction and IR in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. This is mediated by both distinct and interrelated mechanisms. Therefore, combined therapy with statins and RAS inhibitors may be important in developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity to prevent CVD.
PubMed IF 5.8 순환기내과
162014

제1저자 조유리,이정훈 · 교신저자 김윤준

, , , , , , , , , , ,
Prior exposure to lamivudine increases entecavir resistance risk in chronic hepatitis B Patients without detectable lamivudine resistance.
Antimicrob Agents Chemother. 2014;58(3):1730-7.

Abstract
The efficacy of entecavir (ETV) treatment in chronic hepatitis B (CHB) patients who were exposed to lamivudine (LAM) but had no detectable LAM resistance (LAM-R) is not well evaluated. In this study, we aimed to evaluate whether the probability of developing genotypic resistance to ETV in LAM-exposed patients with or without LAM-R is comparable to that in antiviral-naive patients. This retrospective cohort study included 500 consecutive patients with CHB who started ETV monotherapy at a single tertiary hospital in Korea. The patients were divided into three groups: nucleos(t)ide analogue (NA)-naive patients (group 1, n=142), patients who were previously exposed to LAM and had no currently or previously detected LAM-R (group 2, n=233), and patients with LAM-R when starting ETV (group 3, n=125). The overall median ETV treatment duration was 48.7 months. The probabilities of virologic breakthrough were significantly increased not only in group 3 (hazard ratio [HR]=14.4, P<0.001) but also in group 2 (HR=5.0, P<0.001) compared to group 1. Genotypic ETV resistance (ETV-R) developed more frequently in group 2 (HR=13.0, P=0.013) as well as group 3 (HR=43.9, P<0.001) than in group 1: the probabilities of developing ETV-R in groups 1, 2, and 3 were <1.0%, 8.0%, and 28.2%, respectively, at month 48. The results of this study indicate that ETV-R occurred more frequently in LAM-exposed patients, even though they had no detectable LAM-R, than in NA-naive patients. Therefore, LAM-exposed CHB patients, regardless of the presence or absence of LAM-R, should be monitored more cautiously for the development of ETV-R during ETV monotherapy.
PubMed IF 4.2 소화기내과
152014

제1저자 김준석 · 교신저자 김원

, , , ,
Topographical impact of hepatitis B-related hepatocellular carcinoma on local recurrence after radiofrequency ablation.
J Clin Gastroenterol. 2014;48(1):66-72.

Abstract
BACKGROUND Radiofrequency ablation (RFA) is an efficient and safe treatment modality for early-stage hepatocellular carcinoma (HCC). However, its application is sometimes limited by several topographical factors. Whether topographical characteristics are risk factors for local recurrence after RFA is still under debate.
GOALS The aims of this study were to identify topographical risk factors for the local recurrence of solitary HCC after RFA and to evaluate their impact on long-term treatment outcomes.
METHODS The clinical and radiologic findings of patients with solitary hepatitis B virus (HBV)-related HCC<4.0 cm undergoing RFA were retrospectively reviewed. The Cox regression model was used to identify risk factors that predicted local recurrence.
RESULTS A total of 300 patients with solitary, HBV-related HCC were included in this retrospective cohort study. Seventy patients (23.3%) experienced local recurrence after RFA during the median follow-up duration of 43.0 months (range, 3.0 to 69.0 mo). Multivariate analysis showed that tumor size ≥2.0 cm [hazard ratio (HR), 1.716; P=0.047], proximity to a large vessel (HR, 2.609; P=0.024), and proximity to the diaphragm (HR, 3.128; P=0.004) were independent predictors of the local recurrence of solitary HCC. Moreover, the cumulative risk of local recurrence after RFA increased with the number of risk factors.
CONCLUSIONS Proximity of HCC to a large vessel or the diaphragm as well as large tumor size may increase the risk of local recurrence after RFA. Therefore, the topographical factors of HCC should be considered to tailor therapeutic decisions for solitary, HBV-related HCC.
PubMed IF 2.7 소화기내과
142014

제1저자 한재준 · 교신저자 김유정

, , , , , , , , , , , ,
Salvage treatment with low-dose weekly paclitaxel in elderly or poor performance status patients with metastatic urothelial carcinoma.
Tumori. 2014;100(4):439-45.

Abstract
AIMS AND BACKGROUND To evaluate the efficacy of weekly, low-dose paclitaxel chemotherapy after the failure of platinum-based combination chemotherapy in elderly or poor performance status patients with metastatic urothelial carcinoma.
METHODS We retrospectively reviewed the medical records of 25 patients. The regimen consisted of paclitaxel, 60 mg/m2 on days 1, 8 and 15, with or without carboplatin (AUC 2). Treatment was repeated every 4 weeks until disease progression.
RESULTS Of 25 patients, the median age was 68 years (range, 47-82), 4 (16%) were female, and 15 (60%) had an ECOG performance status of 2. All patients were ≥65 years or had a performance status of 2 in the cases aged <65 years. Six patients received paclitaxel in combination with carboplatin. The overall response rate was 24% (95% CI, 7.3-40.7) with 6 partial responses. Eight patients (32%) achieved stable disease and 5 (20%) had progressive disease. The median time to progression was 4.0 months (95% CI, 2.9-5.1), and median overall survival was 5.5 months (95% CI, 3.7-7.3). Grade 3-4 toxicities were as follows: neutropenia in 9 patients (36%), anemia in 11 (44%), thrombocytopenia in 2 (8%), neutropenic fever in 2 (8%), asthenia in 4 (16%), anorexia in 2 (8%), nausea in 2 (8%), and peripheral neuropathy in 1 (4%). ECOG performance status (0-1 vs 2) was a significant prognostic factor in multivariate analysis.
CONCLUSIONS Low-dose weekly paclitaxel seems to be a meaningful salvage treatment with moderate activity and acceptable toxicity in elderly or poor performance status patients with metastatic urothelial carcinoma. Oncologists should carefully consider the opportunity of chemotherapy versus best supportive care in these patients.
PubMed IF 2 혈액종양내과

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