• Cancer
• Europe
• Luxembourg
• Mortality
• Trends

• Humans
• Luxembourg/epidemiology
• Male
• Female
• Neoplasms/mortality
• Neoplasms/epidemiology
• Middle Aged
• Adult
• Aged
• Young Adult
• Registries/statistics & numerical data
• Adolescent
• Mortality/trends
• Aged, 80 and over
• COVID-19/mortality
• COVID-19/epidemiology
• Child, Preschool
• Child
• Infant
• Infant, Newborn

• artificial intelligence in surgery
• gynecologic laparoscopy
• robotic surgery

• Humans
• Robotic Surgical Procedures/methods
• Laparoscopy/methods
• Female
• Gynecologic Surgical Procedures/methods

• cancer epidemiology
• medical research

• Humans
• Cholesterol, LDL
• Retrospective Studies
• Cholesterol, HDL
• Triglycerides
• Cholesterol
• Neoplasms
• Risk Factors

• Female
• Humans
• Breast Density
• Risk Factors
• Retrospective Studies
• Mammography
• Ovarian Neoplasms/diagnostic imaging
• Ovarian Neoplasms/epidemiology
• Republic of Korea/epidemiology
• Breast Neoplasms/diagnostic imaging
• Breast Neoplasms/epidemiology

• 2021R1A2C1011958 National Research Foundation of Korea (NRF)

• LDL cholesterol
• cancer
• mortality
• total cholesterol
• variability

• Circulating cell-free tumor DNA
• NSCLC
• Next generation sequencing
• Non-small cell lung cancer

• Humans
• Carcinoma, Non-Small-Cell Lung/diagnosis
• Carcinoma, Non-Small-Cell Lung/drug therapy
• Carcinoma, Non-Small-Cell Lung/genetics
• Lung Neoplasms/diagnosis
• Lung Neoplasms/drug therapy
• Lung Neoplasms/genetics
• Retrospective Studies
• Protein-Tyrosine Kinases
• Proto-Oncogene Proteins
• Cell-Free Nucleic Acids
• Genomics/methods
• Republic of Korea

• cancer
• endocrinology
• medical research
• nephrology
• oncology
• risk factors

• CD47
• clear cell renal cell carcinoma
• immunohistochemistry
• prognosis

• Brazil/epidemiology
• Humans
• Incidence
• Male
• Mortality
• Prostatic Neoplasms
• Stomach Neoplasms
• Uterine Cervical Neoplasms/epidemiology

• 001 World Health Organization

• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/surgery
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Humans
• Lung Neoplasms/pathology
• Lung Neoplasms/surgery
• Retrospective Studies
• Spinal Neoplasms/secondary
• Spinal Neoplasms/surgery

Some epidemiological studies have estimated exposure among flight attendants with and without breast cancer. However, it is difficult to find a quantitative evaluation of occupational exposure factors related to cancer development individually in the case of breast cancer in flight attendants. That is, most, if not all, epidemiological studies of breast cancer in flight attendants with quantitative exposure estimates have estimated exposure in the absence of individual flight history data.

A 41-year-old woman visited the hospital due to a left breast mass after a regular check-up. Breast cancer was suspected on ultrasonography. Following core biopsy, she underwent various imaging modalities. She was diagnosed invasive ductal carcinoma of no special type (estrogen receptor positive in 90%, progesterone receptor positive in 3%, human epidermal growth factor receptor 2/neu equivocal) with histologic grade 3 and nuclear grade 3 in the left breast. Neoadjuvant chemotherapy was administered to reduce the tumor size before surgery. However, due to serious chemotherapy side effects, the patient opted for alternative and integrative therapies. She joined the airline in January, 1996. Out of all flights, international flights and night flights accounted for 94.9% and 26.2, respectively. Night flights were conducted at least four times per month. Moreover, based on the virtual computer program CARI-6M, the estimated dose of cosmic radiation exposure was 78.81 mSv. There were no other personal triggers or family history of breast cancer.

This case report shows that the potentially causal relationship between occupational harmful factors and the incidence of breast cancer may become more pronounced when night shift workers who work continuously are exposed to cosmic ionizing radiation. Therefore, close attention and efforts are needed to adjust night shift work schedules and regulate cosmic ionizing radiation exposure.

Colorectal cancer (CRC) occurs in all age groups, and the application of treatment may vary according to age. The study was designed to identify the characteristics of CRC by age.

A total of 4,326 patients undergoing primary resection for CRC from September 2006 to July 2019 were reviewed. Patient and tumor characteristics, operative and postoperative data, and oncologic outcome were compared

Patients aged 60 to 69 years comprised the largest age group (29.7%), followed by those aged 50 to 59 and 70 to 79 (24.5% and 23.9%, respectively). Rectal cancer was common in all age groups, but right-sided colon cancer tended to be more frequent in older patients. In very elderly patients, there were significant numbers of emergency surgeries, and the frequencies of open surgery and permanent stoma were greater. In contrast, total abdominal colectomy or total proctocolectomy was performed frequently in patients in their teens and twenties. The elderly patients showed more advanced tumor stages and postoperative ileus. The incidence of adjuvant treatment was low in elderly patients, who also had shorter follow-up periods. Overall survival was reduced in older patients with stages 0 to 3 CRC (P<0.001), but disease-free survival did not differ by age (P=0.391).

CRC screening at an earlier age than is currently undertaken may be necessary in Korea. In addition, improved surgical and oncological outcomes can be achieved through active treatment of the growing number of elderly CRC patients.

• Chronology
• Colorectal neoplasms
• Diagnosis
• Hereditary cancer
• Minimally invasive surgical procedures

• chronic kidney disease
• glomerular filtration rate
• kidney cancer
• proteinuria
• risk factors

• Adult
• Aged
• Databases, Factual
• Female
• Glomerular Filtration Rate
• Humans
• Incidence
• Kidney/physiopathology
• Kidney Neoplasms/epidemiology
• Kidney Neoplasms/etiology
• Male
• Middle Aged
• Proportional Hazards Models
• Proteinuria/complications
• Proteinuria/physiopathology
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/physiopathology
• Republic of Korea/epidemiology
• Retrospective Studies
• Risk Factors
• Young Adult

• EGFR
• NSCLC
• afatinib
• osimertinib
• real-world data

• COVID-19
• Gene expression
• Neoplasms
• Pathway
• Prognosis

• Adenocarcinoma/complications
• Adenocarcinoma/diagnosis
• Adenocarcinoma/epidemiology
• Adenocarcinoma/genetics
• Angiotensin-Converting Enzyme 2/genetics
• Breast Neoplasms/complications
• Breast Neoplasms/diagnosis
• Breast Neoplasms/epidemiology
• Breast Neoplasms/genetics
• COVID-19/complications
• COVID-19/diagnosis
• COVID-19/epidemiology
• COVID-19/genetics
• Case-Control Studies
• Databases as Topic
• Female
• Gastrointestinal Neoplasms/complications
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Neoplasms/epidemiology
• Gastrointestinal Neoplasms/genetics
• Gene Expression Regulation, Neoplastic
• Genetic Predisposition to Disease
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnosis
• Liver Neoplasms/epidemiology
• Liver Neoplasms/genetics
• Lung Neoplasms/complications
• Lung Neoplasms/diagnosis
• Lung Neoplasms/epidemiology
• Lung Neoplasms/genetics
• Male
• Mutation
• Neoplasms/complications
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Neoplasms/genetics
• Pandemics
• Prognosis
• Prostatic Neoplasms/complications
• Prostatic Neoplasms/diagnosis
• Prostatic Neoplasms/epidemiology
• Prostatic Neoplasms/genetics
• Retrospective Studies
• SARS-CoV-2/physiology
• Serine Endopeptidases/genetics
• Survival Analysis

The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.

This retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.

The length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).

After the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased.

• Cardiopulmonary resuscitation
• Continuous renal replacement therapy
• Intensive care unit
• Intubation
• Length of hospital stay
• Life Extension Medical Decision law

• breast neoplasms
• extracellular vesicles
• klebsiella pneumoniae
• tamoxifen

• Antineoplastic Agents, Hormonal/pharmacology
• Antineoplastic Agents, Hormonal/therapeutic use
• Biological Products/pharmacology
• Biological Products/therapeutic use
• Breast Neoplasms/drug therapy
• Breast Neoplasms/pathology
• Cell Survival/drug effects
• Drug Screening Assays, Antitumor
• Drug Synergism
• Extracellular Vesicles/metabolism
• Female
• Gastrointestinal Microbiome
• Humans
• Klebsiella pneumoniae/cytology
• Klebsiella pneumoniae/metabolism
• MCF-7 Cells
• Tamoxifen/pharmacology
• Tamoxifen/therapeutic use
• Urine/cytology

• intramural research promotion grants from the Ewha Womans University School of Medicine Ewha Womans University

Venous thromboembolism (VTE) is a hospital‐associated severe complication that may adversely affect patient prognosis. In this study, we evaluated the incidence of VTE and its risk factors in patients with epithelial ovarian cancer (EOC).

We retrospectively analyzed the electronic health record data of 1268 patients with EOC who received primary treatment at the National Cancer Center, Korea between January 2007 and December 2017 to identify patients who developed VTE. Demographic, clinical, and surgical characteristics of these patients were ascertained. Competing risks analyses were performed to estimate the cumulative incidence of VTE according to the treatment type. The associations between putative risk factors and the incidence of VTE were evaluated using the Fine–Gray regression models accounting for competing risks of death.

VTE was the most prevalent cardiovascular event, found in 9.6% (n = 122) of all patients. Of these VTE events, 115 (94.3%) occurred within 2 years of EOC diagnosis. Advanced cancer stage at diagnosis (distant vs. localized, hazards ratio [HR])= 14.49, p = 0.015) and extended hospital stay (≥15 days, HR =3.87, p = 0.004) were associated with the incidence of VTE. There was no significant difference in the cumulative incidence of VTE between primary cytoreductive surgery followed by adjuvant chemotherapy and neoadjuvant chemotherapy followed by interval cytoreductive surgery (HR =0.81, p = 0.390).

Approximately 10% of patients with EOC were diagnosed with VTE, which was the most common cardiovascular disease found in this study. The assessment of VTE risks in patients with advanced‐stage EOC with an extended hospital stay is needed to facilitate adequate prophylactic treatment.

• cardiotoxicity
• cumulative incidence
• electronic health records
• epithelial ovarian cancer
• hospital-associated complication
• venous thromboembolism

The purpose of this study was to evaluate end-of-life resource utilization and costs for prostate cancer patients during the last year of life in Korea.

The study used the National Health Information Database (NHIS-2017-4-031) of the Korean National Health Insurance Service. Healthcare claim data for the years 2002 through 2015 were collected from the Korean National Health Insurance System. Among 83,173 prostate cancer patients, we enrolled 18,419 after excluding 1,082 who never claimed for the last year of life.

From 2006 to 2015, there was a 3.2-fold increase the total number of prostate cancer decedents. The average cost of care during the last year of life increased over the 10-year period, from 14,420,000 Korean won to 20,300,000 Korean won, regardless of survival time. The cost of major treatments and medications, other than analgesics, was relatively high. Radiologic tests, opioids, pain control, and rehabilitation costs were relatively low. Multiple regression analysis identified age and living in rural area as negatively associated with prostate cancer care costs, whereas income level and a higher number of comorbidities were positively associated.

Expenditure of prostate cancer care during the last year of life varied according to patient characteristics. Average costs increased every year. However, the results suggest underutilization of support services, likely due to lack of alternative accommodation for terminal prostate cancer patients. Further examination of patterns of utilization of healthcare resources will allow policymakers to take a better approach to reducing the burden of prostate cancer care.

• Health care costs
• Healthcare utilization
• Prostatic neoplasms
• Terminal care

Human papillomavirus (HPV) is associated with a significant public health burden, yet few studies have been conducted in Asia, especially on noncervical cancers. We estimated the incidence and cost of oropharyngeal and noncervical anogenital (anal, vulvar, vaginal, penile) cancer in Korea.

We conducted a retrospective cohort study using Korea’s National Health Insurance (NHI) claim database from 2013 to 2016. The main outcome measures were the number of respective cancer incidences during the study period and the annual costs per patient in the first year after diagnosis, which was adjusted by relevant variables based on the regression analysis.

During the study period, 8022 patients with these cancers were identified, and oropharyngeal cancer comprised 46% of them. The crude incidence rate for male oropharyngeal cancer was significantly higher than that of females (3.1 vs. 0.7 per 100,000 as of 2016, respectively). Additionally, the crude incidence of male oropharyngeal cancer increased from 2.7 in 2013 to 3.1 in 2016, whereas that of female and other cancers was stable during the study period. The mean annual incidence-based cost per patient in 2016 was highest for oropharyngeal cancers (21,870 USD), and it was significantly higher in males than in females based on then regression analysis (p < .001).

Oropharyngeal cancer comprises the highest number of HPV-associated noncervical cancer incidences in Korea, and the incidence and cost of oropharyngeal cancer was significantly higher among males than females. More aggressive public health policy toward males may decrease gender gap of oropharyngeal cancer.

Although venous invasion (VI) is a poor prognostic factor for patients with pancreatobiliary tract cancers, its histopathologic characteristics have not been well described. We evaluated the patterns of VI and the added benefit provided by CD31, desmin, and dual CD31‒desmin immunolabeling for identification of VI. We included 120 surgically resected pancreatobiliary tract cancer cases—59 cases as a test set with known VI and 61 cases as a validation set without information of VI. VI was classified into three patterns: intraepithelial neoplasia-like (IN-like), conventional, and destructive. Hematoxylin and eosin (H&E) staining and CD31, desmin, and dual CD31‒desmin immunolabeling were performed. Foci number and patterns of VI were compared with the test and validation sets. More foci of VI were detected by single CD31 (P = 0.022) than H&E staining in the test set. CD31 immunolabeling detected more foci of the conventional pattern of VI, and desmin immunolabeling detected more foci of the destructive pattern (all, P < 0.001). Dual CD31‒desmin immunolabeling identified more foci of VI (P = 0.012) and specifically detected more foci of IN-like (P = 0.045) and destructive patterns (P < 0.001) than H&E staining in the validation set. However, dual CD31‒desmin immunolabeling was not helpful for detecting the conventional pattern of VI in the validation set. Patients with VI detected by dual CD31‒desmin immunolabeling had shorter disease-free survival (P <0.001) than those without VI. VI detected by dual CD31‒desmin immunolabeling was a worse prognostic indicator (P = 0.009). More foci of VI could be detected with additional single CD31 or dual CD31‒desmin immunolabeling. The precise evaluation of VI with dual CD31‒desmin immunolabeling can provide additional prognostic information for patients with surgically resected pancreatobiliary tract cancers.

• Aged
• Biliary Tract Neoplasms/pathology
• Biomarkers, Tumor/analysis
• Desmin/analysis
• Female
• Humans
• Immunohistochemistry
• Male
• Middle Aged
• Neoplasm Invasiveness/diagnosis
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Pancreatic Neoplasms/pathology
• Platelet Endothelial Cell Adhesion Molecule-1/analysis

• National Research Foundation of Korea

This study was conducted on asymptomatic healthy individuals who underwent upper gastrointestinal endoscopy for the purpose of GC screening. Patients who were diagnosed with GC between October 2003 and December 2013 at Seoul National University Hospital Healthcare System Gangnam Center were identified. Demographic and clinicopathologic characteristics were compared between the groups with and without FHx of GC. Overall survival (OS) and recurrence-free survival (RFS) were assessed as primary outcomes.

There were no significant differences in tumor characteristics according to FHx of GC. However, preexisting adenoma was more frequent in patients with FHx than in those without FHx (14.5% vs. 6.3%, p = 0.035). The proportion of patients with microsatellite instability (MSI) was also higher in groups with FHx of GC (43.2% vs. 13.2%, p = 0.006). Helicobacter pylori infection rates of patients with FHx of GC tended to be higher although not significant (70.5% vs. 61.3%, p = 0.188). However, OS and RFS at 5 years of the GC patients with FHx were not significantly different from those of patients without FHx.

Preexisting adenoma and GC with MSI are more common in patients with FHx of GC than in those without. There were no significant differences in the survival rate according to FHx.

This study aimed to investigate the prevalence and risk factors of burnout and occupational stress among medical oncologists in Korea.

A survey was conducted of medical oncologists who were members of Korean Society for Medical Oncology (KSMO) using the Korean Occupational Stress Scale, the validated Maslach Burnout Inventory (MBI) and supplemental questions about work and lifestyle factors.

Among 220 active KSMO members, 111 responses were collected. The median age was 42 years (range, 32 to 63 years). Two-thirds of responders worked 6 days per week and half of them worked a total of 60-80 hours per week. Each medical oncologist treated a median of 90-120 patients per week in outpatient clinics and 20-30 patients per week in patient practices. MBI subscales indicated a high level of emotional exhaustion in 74%, a high level of depersonalization in 86%, and a low level of personal accomplishment in 65%: 68% had professional burnout according to high emotional exhaustion and high depersonalization scores. The risk of burnout was higher for medical oncologists aged from 30-39 than 40-49 years, and unmarried than married. Considering personal accomplishment, females had a higher risk of burnout. The median score of occupational stress was 63 (range, 43 to 88). Having night-duty call was the strongest risk factor on more stress. A higher stress score was associated with a higher prevalence of burnout.

Burnout and occupational stress are quite common amongst Korean medical oncologists. Achieving a healthy work-life balance, ensuring balanced workload distribution, and engaging in proper stress relief solutions are necessary.

• Burnout
• Medical oncologists
• Occupational stress

Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis.

We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points.

A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9±5.0 mm; short axis, 4.3±3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0±4.0 mm; short axis, 3.0±2.0 mm; all p<.001). Using a 10 mm cutoff, the sensitivity, specificity, positive predictive value, overall accuracy, and area under curve was 24.8%, 88.0%, 17.1%, 82.3%, and 0.60 for the long axis and 7.0%, 99.0%, 40.3%, 90.6%, and 0.61 for the short axis, respectively.

The metastatic nodes are larger than the non-metastatic nodes in PDAC patients. However, the difference in nodal size was too small to be identified with preoperative imaging. The performance of preoperative radiologic imaging to predict lymph nodal metastasis was not good. Therefore, nodal size cannot be used a surrogate preoperative marker of lymph node metastasis.

• Lymph node
• Metastasis
• Neoplasms
• Pancreas
• Size

Econazole, a potent broad-spectrum antifungal agent and a Ca²⁺ channel antagonist, induces cytotoxicity in leukemia cells and is used for the treatment of skin infections. However, little is known about its cytotoxic effects on solid tumor cells. Here, we investigated the molecular mechanism underlying econazole-induced toxicity in vitro and evaluated its regulatory effect on the metastasis of gastric cancer cells. Using the gastric cancer cell lines AGS and SNU1 expressing wild-type p53 we demonstrated that econazole could significantly reduce cell viability and colony-forming (tumorigenesis) ability. Econazole induced G0/G1 phase arrest, promoted apoptosis, and effectively blocked proliferation- and survival-related signal transduction pathways in gastric cancer cells. In addition, econazole inhibited the secretion of matrix metalloproteinase- 2 (MMP-2) and MMP-9, which degrade the extracellular matrix and basement membrane. Econazole also effectively inhibited the metastasis of gastric cancer cells, as confirmed from cell invasion and wound healing assays. The protein level of p53 was significantly elevated after econazole treatment of AGS and SNU1 cells. However, apoptosis was blocked in econazole-treated cells exposed to a p53-specific small-interfering RNA to eliminate p53 expression. These results provide evidence that econazole could be repurposed to induce gastric cancer cell death and inhibit cancer invasion.

• Apoptosis
• Econazole
• Gastric cancer
• Invasion
• Migration
• p53

• Clear cell renal cell carcinoma
• cancer prognosis
• immunohistochemistry
• single-stranded DNA binding protein 2

• Cohort studies
• periodontal disease
• periodontitis
• prostate cancer, risk factors

• KRAS
• colorectal carcinoma
• histology
• mutation
• prognosis

Gastric cancer has a relatively high prevalence and is one of the most common causes of cancer-related death worldwide. However, the prognosis for gastric cancer remains poor, especially in the advanced stages, despite many improvements in diagnosis and treatment.

To evaluate the outcomes regarding advanced gastric cancer development according to sex and age.

We retrospectively reviewed 2005 patients who underwent curative gastrectomy for advanced gastric cancer between 2002 and 2007 at a single Korean centre. Prognosis and risk factors for nodal involvement were evaluated according to sex and age.

In this retrospective cohort study, we examined the cases of 2005 patients [sex, 1384 men (69%), 621 women (31%)] with advanced gastric cancer. The patients’ age range was 22-87 years (mean age: 57.7 ± 12.3 years), with approximately 53.3% of the patients being ≤ 60 years old. Based on a Cox proportional hazards model, overall survival was independently predicted by older age, larger tumour size, lymphovascular invasion, lymph node metastasis, deeper tumour invasion, moderately-to-poorly differentiated tubular adenocarcinoma, and signet ring cell carcinoma. The same model revealed that relapse-free survival was independently predicted by advanced age, larger tumour size, lymphovascular invasion, deeper tumour invasion, poorly differentiated tubular adenocarcinoma, and signet ring cell carcinoma.

Among patients with advanced gastric cancer, older age independently predicted poor overall survival and relapse-free survival. However, there were no significant sex-based differences in relapse-free and overall survival.

• Carcinoma
• Prognosis
• Gastrectomy
• Risk factors
• Age
• Adenocarcinoma

Preoperative chemoradiotherapy (PCRT) followed by surgery and adjuvant chemotherapy is the current standard treatment for stage II/III rectal cancer. However, radiotherapy in the pelvic area is commonly associated with complications such as anastomotic leakage, sexual dysfunction, and fecal incontinence. Recently, the MERCURY study showed that preoperative high-resolution magnetic resonance imaging (MRI) helped to selectively avoid PCRT. It remains unclear whether PCRT is necessary in patients who can achieve a negative circumferential resection margin (CRM) with surgery alone and in patients with cT_1–2N₁ or cT₃N₀ without CRM involvement and lateral lymph node metastasis. This study aims to evaluate the efficacy of upfront radical surgery with total mesorectal excision (TME) followed by adjuvant chemotherapy with folinic acid (or leucovorin), fluorouracil, and oxaliplatin (FOLFOX) versus the current standard treatment in patients with surgically resectable, locally advanced rectal cancer.

This study, named TME-FOLFOX, is a prospective, open-label, multicenter, phase II randomized trial. Patients with locally advanced rectal cancer will be randomized to receive PCRT followed by TME and adjuvant chemotherapy (arm A) or upfront radical surgery with TME followed by adjuvant FOLFOX chemotherapy (arm B). Clinical stage II/III rectal cancer without CRM involvement and lateral lymph node metastasis will be defined using preoperative MRI. The primary endpoint is 3-year disease-free survival (DFS). Secondary endpoints include 5-year DFS, local recurrence rate, systemic recurrence rate, cost-effectiveness, and overall survival. We hypothesized that our experimental group (arm B) will have a 3-year DFS of 75% and a non-inferiority margin of 15%.

Identifying whether patients require PCRT is one of the critical issues in locally advanced rectal cancer. This study aims to elucidate whether PCRT may not be required for all patients with stage II/III rectal cancer, especially for the MRI-based intermediate-risk group (with cT_1–2N₁ or cT₃N₀) without CRM involvement and lateral lymph node metastasis. If the findings indicate that our proposed treatment, which omits PCRT, is non-inferior to the standard treatment, then patients may avoid unnecessary radiation-related toxicity, have a shorter treatment duration, and save on medical costs.

ClinicalTrials.gov, NCT02167321. Registered on 19 June 2014.

• Adjuvant chemotherapy
• Clinical trial
• FOLFOX
• Locally advanced rectal cancer
• Total mesorectal excision

The age thresholds for differentiating young and elderly patients are still under debate. This study aimed to evaluate the cut-off age for differentiating patients along with the prognostic value of age for operable gastric cancer (GC).

Patients diagnosed with resected gastric adenocarcinoma were identified from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database (training cohort and internal validation cohort) and Liaoning Cancer Hospital (external validation cohort). Kaplan-Meier plots were used to compare cancer-specific survival (CSS) across different age groups. Univariate and multivariate analysis was conducted using a Cox regression model. Predictive ability of the nomogram was determined by the Harrell’s concordance index (C-index), calibration curves, and Akaike’s Information Criterion (AIC).

A total of 17,339 patients with GC were included. According to the univariate analysis results, CSS was similar among patients aged 20–69 years old, started to worsen for patients over the age of 70, and was the worst for patients older than 79 years in the training cohort. Thus, we further divided the age groups into 20–69, 70–79, and >79, and multivariate analysis showed that patients above 70 years of age had worse CSS. The nomogram was established based on the results of the multivariate analysis. The C-indexes for the training, internal, and external validation cohorts were 0.7531, 0.7344, and 0.7431, respectively.

This study showed that age had a relative predictive ability for CSS, 70 years should be the cut-off age, and age ≥70 years is an independent prognostic risk factor for GC patients who undergo surgery. These data highlight the importance of individualized treatment to improve the prognosis of patients with GC.

• Age
• gastric cancer (GC)
• nomogram
• prognosis

Functional dyspepsia (FD) is a chronic upper gastrointestinal (GI) symptom complex that routine diagnostic work-up, such as endoscopy, blood laboratory analysis, or radiological examination, fails to identify a cause. It is highly prevalent in the World population, and its response to the various available therapeutic strategies is only modest because of the heterogenous nature of its pathogenesis. Therefore, FD represents a heavy medical burden for healthcare systems. We constituted a guideline development committee to review the existing guidelines on the management of functional dyspepsia. This committee drafted statements and conducted a systematic review and meta-analysis of various studies, guidelines, and randomized control trials. External review was also conducted by selected experts. These clinical practice guidelines for FD were developed based on evidence recently accumulated with the revised version of FD guidelines released in 2011 by the Korean Society of Neurogastroenterology and Motility. These guidelines apply to adults with chronic symptoms of FD and include the diagnostic role of endoscopy, Helicobacter pylori screening, and systematic review and meta-analyses of the various treatment options for FD (proton pump inhibitors, H.pylori eradication, and tricyclic antidepressants), especially according to the FD subtype. The purpose of these new guidelines is to aid the understanding, diagnosis, and treatment of FD, and the targets of the guidelines are clinicians, healthcare workers at the forefront of patient care, patients, and medical students. The guidelines will continue to be revised and updated periodically.

• Dyspepsia
• Endoscopy
• Evidence-based medicine
• Guideline
• Proton pump inhibitors

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Pancreatic Ductal/mortality
• Carcinoma, Pancreatic Ductal/secondary
• Carcinoma, Pancreatic Ductal/surgery
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Pancreatectomy/adverse effects
• Pancreatectomy/mortality
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome

• IMRT
• Japan
• Korea
• equipment
• facilities
• radiotherapy infrastructure

• Delivery of Health Care/methods
• Humans
• Japan
• Male
• Neoplasms/epidemiology
• Neoplasms/radiotherapy
• Quality of Health Care
• Radiotherapy, Intensity-Modulated/instrumentation
• Radiotherapy, Intensity-Modulated/methods
• Republic of Korea
• Surveys and Questionnaires
• Tokyo

• Imaging biomarker
• Non-small cell lung cancer
• Overall survival
• Prognosis
• Tumor shape

• Aged
• Biomarkers, Tumor/metabolism
• Cohort Studies
• Female
• Humans
• Lung Neoplasms/metabolism
• Lung Neoplasms/mortality
• Lung Neoplasms/pathology
• Male
• Prognosis
• Proportional Hazards Models
• Reproducibility of Results

• NRF-2015R1A2A1A15053854 National Research Foundation of Korea grants by Korea government (MSIP)
• NRF-2015R1A2A2A01002734 National Research Foundation of Korea grants by Korea government (MSIP)

As patients with brain metastasis (BM) of non-small cell lung cancer (NSCLC) have dismal prognosis, some of them decide to discontinue further treatment for BM. The objective of this study was to determine factors for renouncing further active therapy in patients with BM of NSCLC, focusing on their demographic and socioeconomic status.

Medical records of 105 patients with radiological diagnosis of BM of NSCLC for the recent 11 years at authors' institution were retrospectively reviewed. Clinical features as well as demographic and socioeconomic characteristics such as marriage status, cohabiting family members, religious affiliations, educational background, and economic responsibility were reviewed.

Median overall survival (OS) was 13.84 (95% CI: 10.26–17.42) years in 67 patients (group A) who underwent active treatment (radiotherapy and/or chemotherapy) and 4.76 (95% CI: 3.12–6.41) years in 38 patients (group B) who renounced active treatment. Less patients were unmarried (p=0.046), more cohabitating family members (p=0.008), and economically independent (p=0.014) in group A than those in group B. Similarly, the unmarried, and none cohabitating family members had short OS (5.17 and 7.38 years, respectively). In multivariate analysis for predisposing factors of OS in these patients, the following demographic and socioeconomic factors had independent significance: marriage status and cohabitating family members.

This study suggests that demographic and socioeconomic status as well as clinical factors could influence the decision of further active treatment and prognosis of patients with BM of NSCLC.

• Brain metastasis
• Demography
• Non-small cell lung cancer
• Palliative care
• Prognosis
• Socioeconomics

• epidemiology
• hematologic neoplasms
• incidence
• korea

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Female
• Hodgkin Disease/epidemiology
• Humans
• Infant
• Infant, Newborn
• Lymphoma, B-Cell/epidemiology
• Lymphoma, T-Cell/epidemiology
• Male
• Middle Aged
• Republic of Korea/epidemiology
• Socioeconomic Factors
• Young Adult

• cancer
• discoidin domain receptor 1
• gene expression
• sex difference
• zinc finger E-box binding homeobox 1

The human gut hosts a diverse community of bacteria referred to as the gut microbiome. We investigated the association between the relative abundance of gastric microbiota and gastric cancer (GC) risk in a Korean population. The study participants included 268 GC patients and 288 controls. DNA was extracted from gastric biopsies, and 16S rRNA gene analysis was performed. Unconditional logistic regression models were used to observe the associations. Of the participants, those who had the highest level (highest tertile) of relative Helicobacter pylori and Propionibacterium acnes abundances showed a significantly higher risk for GC after adjusting for potential confounding variables (odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.17–2.97, p for trend = 0.017 and OR = 4.77, 95% CI = 2.94–7.74, p for trend <0.001, respectively). Subjects who carried Prevotella copri had a significantly higher risk of GC than noncarriers (OR = 2.54, 95% CI = 1.42–4.55, p for trend = 0.002). There was a lower risk of GC in subjects carrying Lactococcus lactis than in noncarriers (OR = 0.21, 95% CI = 0.10–0.44, p for trend <0.001). H. pylori, P. acnes and P. copri are strong risk factors, whereas L. lactis is a protective factor, for GC development in Koreans. Further microbiome studies are warranted to verify the findings of the current study.

• fine needle aspiration
• thyroid papillary microcarcinoma
• active surveillance
• lobectomy

• Biopsy, Fine-Needle
• Carcinoma, Papillary/diagnostic imaging
• Carcinoma, Papillary/surgery
• Expert Testimony
• Humans
• Thyroid Neoplasms/diagnostic imaging
• Thyroid Neoplasms/surgery
• Thyroid Nodule/diagnostic imaging
• Thyroid Nodule/surgery
• Thyroidectomy

Gastric cancer (GC) is one of the deadliest malignancies in the world. Currently, clinical treatment decisions are mostly made based on the extent of the tumor and its anatomy, such as tumor-node-metastasis staging. Recent advances in genome-wide molecular technology have enabled delineation of the molecular characteristics of GC. Based on this, efforts have been made to classify GC into molecular subtypes with distinct prognosis and therapeutic response. Simplified algorithms based on protein and RNA expressions have been proposed to reproduce the GC classification in the clinical field. Furthermore, a recent study established a single patient classifier (SPC) predicting the prognosis and chemotherapy response of resectable GC patients based on a 4-gene real-time polymerase chain reaction assay. GC patient stratification according to SPC will enable personalized therapeutic strategies in adjuvant settings. At the same time, patient-derived xenografts and patient-derived organoids are now emerging as novel preclinical models for the treatment of GC. These models recapitulate the complex features of the primary tumor, which is expected to facilitate both drug development and clinical therapeutic decision making. An integrated approach applying molecular patient stratification and patient-derived models in the clinical realm is considered a turning point in precision medicine in GC.

• Adjuvant chemotherapy
• Molecular targeted therapy
• Precision medicine
• Stomach neoplasm
• Tumor biomarkers