OBJECTIVE: To assess whether there is an association between improvement of computed tomography imaging results prior to interval debulking with survival in patients treated by neoadjuvant chemotherapy. METHODS: The clinical and outcome data of all advanced ovarian, primary peritoneal and tubal carcinoma patients who after diagnosis had neoadjuvant chemotherapy and underwent interval debulking during the period 2000-2010, were abstracted. Results of computed tomography imaging at diagnosis and prior to interval debulking were compared. Two parameters were assessed: the change of the size and number of abnormal findings and the change in the amount of ascites. CA-125 level response was also calculated. An assessment of progression free survival and of survival by the Kaplan-Meier method was made according to the change in computed tomography imaging results and according to response of CA-125 levels. RESULTS: The median progression free survival and the median survival of the 37 study group patients were 7.9 and 49.2 months respectively. No significant difference in progression free survival and survival was observed between patients with marked improvement in the computed tomography results and those with less desirable results (7.93 vs. 7.23 months respectively, p=0.89; 45.8% vs. 52.5% months respectively, p=0.95). There were also no statistically significant difference according to CA-125 level response. CONCLUSION: It seems that neither improvement in imaging results nor CA-125 level response can predict the survival of ovarian carcinoma patients prior to interval debulking after neoadjuvant chemotherapy.
Ascites ; Disease-Free Survival ; Humans

PURPOSE: We analyzed the clinical outcome of osteosarcoma developed in distal radius and the effect of delayed treatment on prognosis. MATERIALS AND METHODS: Twelve patients with distal radius osteosarcoma were analysed. We categorized patients into two groups of standard treatment or non-standard treatment. The patients of standard treatment group are all stage IIB and non-standard treatment group includes five stage IIB and one stage III. RESULTS: Five-year overall survival and disease-free survival rates of standard treatment group were 100% and 83%. Five-year overall survival rate of non-standard treatment group was 44%. Between two group, there are differences in age, tumor size, surgery type, symptom duration. CONCLUSION: Distal radius osteosarcoma have good prognosis than other extremity osteosarcoma. Survival rate of non-standard treatment group were lower than standard treatment group. Although the prognosis of non standard treatment group is poorer, the duration till death was longer than that of other sites with similar condition. Further multi-institutional study should be needed.
Disease-Free Survival ; Extremities ; Humans ; Osteosarcoma ; Prognosis ; Radius ; Survival Rate

PURPOSE: Hepatic resection and liver transplantation are considered a curative treatment for hepatocellular carcinoma (HCC) within the Milan criteria. In this study, we examine the outcome of hepatic resection for HCC within the Milan criteria, and determine the effectiveness of hepatic resection as the primary treatment for HCC within the Milan criteria in Child-Pugh class A. METHODS: 110 patients underwent curative surgical resection for HCC in Child-Pugh class A between August 1991 and June 2008. Fifty-six patients met Milan criteria (Group M) and the remaining 54 did not (Group N). RESULTS: Overall survival rates at 1, 3, and 5 years were 92.6%, 72.5% and 54.6% versus 70.4%, 43.1%, and 28.7% in Group M and Group N, respectively (P=0.0043). The corresponding disease-free survival rates were 81.5%, 69.7%, and 38.2% versus 46.0%, 32.9%, and 26.9% in Group M and Group N (P=0.0012). HCC recurred in 25 patients in Group M (44.6%) and 35 patients in Group N (64.8%)(P=0.034). Outcomes of hepatic resection in Group M were significantly better compared to Group N. CONCLUSION: Hepatic resection can achieve a comparable 5-year overall survival & disease-free survival to that reported for liver transplantation. Hepatic resection should be considered as the standard therapy for HCC within the Milan criteria in Child-Pugh class A patients.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Humans ; Liver Transplantation ; Survival Rate

Authors analyzed the results of treatment in 49 cases of medulloblastoma who had been operated upon at the Seoul National University Hospital from January 1972 to June 1987. There were 2 cases(4%) of postoperative mortality(death within postoperative one month) and 13 cases of late moratlity. The 3-year overall survival rate was 49.3% and 3-year disease-free survival rate was 48.5%. The risk period of recurrence was about 2 years after surgery. The 3-year survival rate was significantly better in "grow total resection" group, "radiation dose more than 50 Gy" group, and group II(23 cases operated after July 1982) (p<0.05). The rate of posterior fossa recurrence was lower in "gross total resection" group for the patients who received posterior fossa irradiation of more than 50 Gy.
Disease-Free Survival ; Humans ; Medulloblastoma ; Prognosis* ; Recurrence ; Seoul ; Survival Rate

Epithelial ovarian cancer is one of the last treatment areas to be influenced by the 'personalized medicine' bandwagon. Some anti-angiogenic agents, poly (ADP-ribose) polymerase (PARP), and immune checkpoint inhibitors have shown efficacy in early stages of development for the treatment of epithelial ovarian cancer. As a result of vigorous clinical trials, bevacizumab, cediranib, pazopanib, olaparib, and rucaparib, either used alone or in adjunct to conventional cytotoxic agents, have all been shown to improve progression-free survival in first-line/maintenance, platinum-resistant or sensitive recurrent settings. A biomarker for bevacizumab is currently elusive. Olaparib is the first drug approved for the treatment of high-grade serous tumors and requires routine testing for BRCA mutation. Trial results of PARP inhibitors in the homologous recombination-deficient (non BRCA mutation) population are awaited and the introduction of these agents into the clinic will require robust methods of detecting homologous recombination-deficiency. Second-generation studies combining anti-angiogenic agents with PARP inhibitors are in progress and early results in the recurrent setting are encouraging. Trials with immune checkpoint inhibitors such as nivolumab produced prolonged responses in a small set of ovarian cancer cases and need further exploration, for example in combination with anti-angiogenic agents. The application of targeted agents and immunologics, alone or in combination, to induce a survival advantage in patients with epithelial ovarian cancer should be continued.
Bevacizumab ; Cytotoxins ; Disease-Free Survival ; Humans ; Immunotherapy* ; Ovarian Neoplasms*

Ganglioneuromas are benign tumors. Surgical excision is the treatment of choice with very good prognosis. However, neuroblastomatous malignant transformation of ganglioneuromas was previously reported. We report a patient with spinal neuroblastoma recurrent from a ganglioneuroblastoma after disease free survival of 13 years. This is one of the rare examples of spinal neuroblastoma and to our knowledge the second case report with malignant transformation from a ganglioneuroblastoma or a ganglioneuroma. The present case is the only report in the literature with further genetic investigations.
Disease-Free Survival ; Ganglioneuroblastoma* ; Ganglioneuroma ; Humans ; Neuroblastoma* ; Prognosis

Survival after acute myocardial infarction (AMI) is related to the number of diseased vessel, ejection fraction, extent of residual ischemic tissue, presence of ventricular arrhythmia. Because a variety of revascularization modalities are tried in recent years, the natural course after AMI seems to become difficult ot assess. From the experience of 129 cases of coronary angiography in AMI from Jan 1984 to Apr 1987, the factors related to invasive modality were analysed to evaluate the effect on the survival after AMI. The following results are obtained. 1) Single vessel disease and insignificant lesion were present in 60%, and multivessel disease comprised 40% in all group. 2) Patients were followed for a mean of 16.3 months and 2 cases(1.6%) expired suddenly and reinfarction developed in 6 cases(4.7%). 3) After exclusion of 4 cases taken CABG operation, the event free survival of all patients was 0.98, 0.90, 0.78, 0.78, 0.78 in double vessel disease, 0.94, 0.87, 0.87, 0.77, 0.51 in triple vessel disease. The survival was better in single vessel disease compared to multivessel disease (p<0.05), but no difference was present between double and triple vessel disease. 5) Event free survival in group with left ventricular end diastolic pressure(LVEDP) >16mm Hg was better than that of a group with LVEDP <16mm Hg. But no difference was present between group with ejection fraction <40% and group with ejection fraction >40%. From the above results, it can be concluded that the event free survival after mainly uncomplicated AMI in Koreans depends on the number of diseased vessel and LVEDP.
Arrhythmias, Cardiac ; Coronary Angiography ; Disease-Free Survival* ; Humans ; Myocardial Infarction*

BACKGROUND: Parafibromin is a recently defined tumor suppressor gene. The aim of our study was to determine the relationships of parafibromin expression in urothelial carcinomas (UCs) with prognostic parameters and to evaluate the use of parafibromin as a potential marker of UC. METHODS: Parafibromin expression was assessed in 49 UC specimens using immunohistochemistry. The correlations between parafibromin expression and clinical and pathologic parameters were investigated. RESULTS: Of the patients, 42 (85.7%) were male, and the mean age was 69.6 +/- 8.2 years (range, 54 to 88 years). Morphologically, the UCs were divided into two groups: papillary (n = 27) and non-papillary (n = 22). There were seven low-grade (14.3%) and 42 high-grade (85.7%) tumors. Parafibromin was negative in 13 tumors (26.5%), partially positive in 19 tumors (38.8%), and positive in 17 tumors (34.7%). Parafibromin expression was more negative in UCs from upper urinary locations (n=17) and with muscularis propria invasion (n=28), which was statistically significant (p = .009 and p = .007, respectively). There was no statistically significant relationship between parafibromin expression and gender, age, tumor grade, survival, or disease-free survival. CONCLUSIONS: We found that UC cases with parafibromin positivity had less of a tendency to show muscularis propria invasion and were more commonly located in the lower urinary system. These results need to be confirmed with studies based on larger case series.
Disease-Free Survival ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Male

PURPOSE: To evaluate the correlation between serum methotrexate (MTX) peak levels and clinical outcome of osteosarcoma, as well as to determine the correlation of these levels with the histologic response and event-free survival (EFS). METHODS: To maintain the homogeneity of the study population, we selected 52 patients with localized extremity osteosarcoma who had received two cycles of neoadjuvant chemotherapy consisting of high-dose (HD) MTX (12 g/m2), cisplatin (100 mg/m2), and doxorubicin (60 mg/m2). RESULTS: Totally, 204 courses of HD MTX were administered. The serial MTX levels (mean+/-SE) at 4 h (peak), 24 h, 48 h, and 72 h were 1292.14+/-12.83 micrometer, 9.29+/-3.89 micrometer, 1.73+/-1.37 micrometer, and 0.58+/-0.44 micrometer, respectively. The peak MTX serum level was 1292.14+/-12.83 micrometer. Neither the continuous average MTX peak level nor the dichotomized MTX peak level was related to the histologic response. However, the patients with a high 24-h MTX level (3.4 micrometer) had a poor histologic response (P=0.044). An inverse relationship was observed between MTX levels and survival: the EFS was better in the patients with a mean MTX peak level of less than 1,400 micrometer (P=0.002) and mean 24-h MTX level of less than 3.4 micrometer (P=0.011). CONCLUSION: The inverse correlation between the MTX level and the outcome is an unexpected finding. Further study on the pharmacokinetics of MTX is required to substantiate our findings and elucidate the mechanism involved.
Cisplatin ; Disease-Free Survival ; Doxorubicin ; Extremities ; Humans ; Methotrexate ; Osteosarcoma

PURPOSE: To evaluate the correlation between serum methotrexate (MTX) peak levels and clinical outcome of osteosarcoma, as well as to determine the correlation of these levels with the histologic response and event-free survival (EFS). METHODS: To maintain the homogeneity of the study population, we selected 52 patients with localized extremity osteosarcoma who had received two cycles of neoadjuvant chemotherapy consisting of high-dose (HD) MTX (12 g/m2), cisplatin (100 mg/m2), and doxorubicin (60 mg/m2). RESULTS: Totally, 204 courses of HD MTX were administered. The serial MTX levels (mean+/-SE) at 4 h (peak), 24 h, 48 h, and 72 h were 1292.14+/-12.83 micrometer, 9.29+/-3.89 micrometer, 1.73+/-1.37 micrometer, and 0.58+/-0.44 micrometer, respectively. The peak MTX serum level was 1292.14+/-12.83 micrometer. Neither the continuous average MTX peak level nor the dichotomized MTX peak level was related to the histologic response. However, the patients with a high 24-h MTX level (3.4 micrometer) had a poor histologic response (P=0.044). An inverse relationship was observed between MTX levels and survival: the EFS was better in the patients with a mean MTX peak level of less than 1,400 micrometer (P=0.002) and mean 24-h MTX level of less than 3.4 micrometer (P=0.011). CONCLUSION: The inverse correlation between the MTX level and the outcome is an unexpected finding. Further study on the pharmacokinetics of MTX is required to substantiate our findings and elucidate the mechanism involved.
Cisplatin ; Disease-Free Survival ; Doxorubicin ; Extremities ; Humans ; Methotrexate ; Osteosarcoma