PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
Cohort Studies ; Disease-Free Survival ; Education ; Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Retrospective Studies* ; Treatment Outcome

PURPOSE: We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). MATERIALS AND METHODS: A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed. RESULTS: After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). CONCLUSION: This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.
Arm ; Chemoradiotherapy ; Compliance ; Disease-Free Survival ; Drug Therapy* ; Humans ; Induction Chemotherapy ; Methods ; Nasopharyngeal Neoplasms ; Propensity Score* ; Radiotherapy ; Recurrence ; Republic of Korea ; Retrospective Studies* ; Standard of Care ; Treatment Outcome

OBJECTIVE: To explore the association of the CYP 1A1 gene polymorphism with the risk of endometriosis in a Korean population. DESIGN: Case-control study METHODS: Two-hundred fifty two Korean women with surgically or histologically diagnosed endometriosis of stage I-IV (ASRM, 1997) were recruited, and 203 women with no evidence of endometriosis served as controls. CYP1A1 gene MspI polymorphism was analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. RESULTS: There was no significant difference in the genotype or allele distribution of CYP1A1 gene polymorphism between patients with endometriosis and controls. And when classified by stage, there was also no significant difference in the genotype and allele distribution of CYP1A1 gene MspI polymorphism between patients with stage I-II or stage III-IV endometriosis and controls. CONCLUSION: These results suggest that CYP1A1 gene MspI polymorphism is not associated with the risk of endometriosis in the Korean women.
Alleles ; Case-Control Studies ; Cytochrome P-450 CYP1A1* ; Endometriosis* ; Female ; Genotype ; Humans ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

BACKGROUND AND OBJECTIVES: A computerized database system could provide benefit to reducing the variability of reporting results of chronic ear surgery, where a variety of factors may influence the outcomes. In the present study, the factors contributing to hearing gains after chronic ear surgery were investigated using a computerized database. MATERIALS AND METHODS: Audiometric data were easily drawn from the database log of 622 surgical cases of chronic otitis media done by one surgeon from 1989 to 1996. Of these, 309 were collected with the inclusion criteria being the period of no shorter than 3 months following tympanoplasty procedures. Post-operative hearing gains were compared according to the patient factor (sex, age), disease factors (unilateral vs bilateral disease, existence of cholesteatoma, preoperative otorrhea), surgery factor (primary versus revision operation, types of mastoidectomy, ossiculoplasty, hearing status of the operated ear), and the surgeon's experience. RESULTS: Pre- and post-operative air-bone gaps of the pure tone averages for the 309 cases studied were 34.6+/-13.4 dBHL and 24.9+/-13.8 dBHL, respectively. The post-operative hearing gains were 9.6+/-13.6 dBHL. The hearing gains did not differ significantly beween the groups when it is compared with regards to the factors, such as sex and age of patients, revision operation, hearing status, surgeon's experience. But the hearing gains differed with regards to the other factors, such as cholesteatoma, otorrhea, mastoidectomy and ossiculoplasty (p<0.05). CONCLUSION: This kind of computerized database is very useful to assess the effect of factors on the hearing gains following chronic ear surgery.
Cholesteatoma ; Ear* ; Hearing* ; Humans ; Otitis Media ; Tympanoplasty

BACKGROUND/AIMS: Anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of carcinoma of the biliary tract. There is especially a malignant potential for gallbladder cancer without dilatation of bile duct. We intend to find the clinical significance of anomalous pancreaticobiliary ductal union (APBDU) and biliary malignancy, and the correlation between type of APBDU and that of biliary malignancy (gallbladder of bile duct). Our purpose is to certificate the propriety of prophylactic cholecystectomy and to recall operation. METHOD AND RESULTS: We reviewed 880 ERCP cases from September 1994 through February 1996. There were fifteen cases of APBDU and six cases of biliary tumor associated with APBDU. They consisted of three gallbladder cancer with all P-C type union, two bile duct cancer with C-P type union and one villous adenoma in dilated bile duct. In one reoperation case in which cystojejunostomy had already been performed, there was no evidence of malignancy, but one was inoperable due to multiple liver metastasis. CONCLUSION: The patients with APBDU showed an increase of gallbladder cancer occurrence and furthermore those with the C-P type of APBDU, not associated with bile duct dilatation had a higher occurrence. And therefore were censidered preventive cholecystectomy and in operation to divide the biliary duct and pancreatic duct. Preoperative CA 19-9 test is helpful in finding the hidden cancer and is a guide to preventive operation in APBDU patients and to post-operative follow-up.
Adenoma, Villous ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Dilatation ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Liver ; Neoplasm Metastasis ; Pancreatic Ducts ; Reoperation

All epithelial cells express more than 2 cytokeratins, and their tissue distribution is determined by cellular types, location, and degree of differentiation. It is known that changes in cytokeratin expression accompany squamous metaplasia of the human nasal epithelium. We analysed cytokeratin expression patterns and their significance in normal nasal mucosae, nasal polyps, inverted papillomas, and maxillary squamous cell carcinomas using immunohistochemical staining with anti-CK4, CK8, CK10, CK13, CK17, CK18, and CK19. Nasal polyp showed the same pattern of cytokeratin expression as that of nasal mucosa. While CK10 expression was present only in the tissue of squamous cell carcinoma, CK18 and CK19 were not expressed. Specimens of Inverted papilloma expressed CK4 and CK13 only in the suprabasal layer, and CK17 in the basal and suprabasal layers. In contrast, normal epithelium expressed CK13 and CK17 only in the basal layer, and CK4 in the basal and suprabasal layers. CK8 and CK18 were less expressed in the specimen of inverted papilloma than in the normal nasal mucosa. The expression patterns of CK10 and CK19 suggest that they may play a role in determinating the malignant change of inverted papilloma and in investigating the pathogenesis of inverted papilloma and maxillary cancer.
Carcinoma, Squamous Cell* ; Epithelial Cells ; Epithelium ; Humans ; Keratins* ; Metaplasia ; Nasal Mucosa* ; Nasal Polyps* ; Papilloma, Inverted* ; Tissue Distribution

No abstract available.
Cholesteatoma, Middle Ear* ; Lymphocytes*

No abstract available.

No abstract available.

No abstract available.
Hearing*