Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study

Preoperative identification of individuals at low risk of lymph node metastasis is key to the proper management of endometrial cancer. This study evaluated the role of preoperative assessment based on magnetic resonance imaging (MRI) and histological analysis in identifying a group having a low risk of lymph node metastasis. Data of 529 patients with endometrial cancer were obtained from a prospective multicenter database, between January 2012 and December 2014. Clinical staging, based on MRI and histological analysis, was compared with final pathology results after the surgical staging procedure. The preoperative low-risk criteria, based on current guidelines from Korea, France, and Canada, and criteria used for fertility-sparing therapies, were applied to our multicenter cohort and the accuracy of each set of criteria for identifying group at low risk of lymph node metastasis was evaluated. When considering grades or MR stages separately, the overall agreement between preoperative and postoperative findings was poor (Kappa 0.45 for grades; 0.41 for stages). However, when combining these two parameters, the low-risk group, as defined by any of the guidelines, had an acceptable rate of lymph node metastasis (below 3%). The French guidelines identified 249 patients (47.1%) as being in the low-risk group. Criteria used to define fertility-sparing therapy candidates identified 48 patients (9.1%) among the study population, only one of whom had extra-uterine disease. This study shows that the current guidelines, using preoperative assessment based on MRI and histological analysis, can identify low-risk patients, who may be candidates for omitting lymphadenectomy.ope

Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era

PURPOSE: Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Materials and Methods: We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. RESULTS: We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). CONCLUSION: In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.ope

The institutional learning curve is associated with survival outcomes of robotic radical hysterectomy for early-stage cervical cancer-a retrospective study

BACKGROUND: Despite recent advances in diagnosis and treatment, cervical cancer continues to be a significant health problem worldwide. Whereas robot-assisted surgery has advantages over the abdominal approach, and minimally invasive techniques are being used increasingly, these may be associated with a higher recurrence rate and lower overall survival than the abdominal approach. The objective of this study was to compare the surgical and survival outcomes between abdominal radical hysterectomy (ARH) and robotic radical hysterectomy (RRH). METHODS: A retrospective cohort of patients undergoing radical hysterectomy for cervical cancer from 2006 to 2018 was identified. Patients with stage IA to IB cervical cancer were included and grouped: ARH vs. RRH. The RRH group was further divided into two groups based on the year of enrollment: RRH1 (2006-2012) and RRH2 (2013-2018). Tumor characteristics, recurrence rate, progression-free survival (PFS), and overall survival (OS) were compared between the groups. P-values < 0.05 (two-sided) were considered statistically significant. RESULTS: A total of 310 patients were identified: 142 and 168 underwent ARH and RRH, respectively. RRH1 and RRH2 had 77 and 91 patients, respectively. Interestingly, RRH2 was more likely to have a larger tumor size (1.7 ± 1.4 vs. 2.0 ± 1.1 vs. 2.4 ± 1.7 cm, P = 0.014) and higher stage (P < 0.001) than RRH1. However, RRH2 showed significantly favorable PFS in contrast to RRH1. There was no difference between ARH and RRH2 in PFS (P = 0.629), whereas overall, the RRH group showed significantly shorter PFS than the ARH group. In the multivariate analysis, the institutional learning curve represented by the operation year was one of the significant predictors for PFS (hazard ratio [HR] 0.065, P = 0.0162), along with tumor size (HR 5.651, P = 0.0241). CONCLUSIONS: The institutional learning curve, represented by the operation year, is one of the most significant factors associated with outcomes of RRH for early-stage cervical cancer.ope

Tumor evolution and intratumor heterogeneity of an epithelial ovarian cancer investigated using next-generation sequencing

BACKGROUND: The extent to which metastatic tumors further evolve by accumulating additional mutations is unclear and has yet to be addressed extensively using next-generation sequencing of high-grade serous ovarian cancer. METHODS: Eleven spatially separated tumor samples from the primary tumor and associated metastatic sites and two normal samples were obtained from a Stage IIIC ovarian cancer patient during cytoreductive surgery prior to chemotherapy. Whole exome sequencing and copy number analysis were performed. Omental exomes were sequenced with a high depth of coverage to thoroughly explore the variants in metastatic lesions. Somatic mutations were further validated by ultra-deep targeted sequencing to sort out false positives and false negatives. Based on the somatic mutations and copy number variation profiles, a phylogenetic tree was generated to explore the evolutionary relationship among tumor samples. RESULTS: Only 6% of the somatic mutations were present in every sample of a given case with TP53 as the only known mutant gene consistently present in all samples. Two non-spatial clusters of primary tumors (cluster P1 and P2), and a cluster of metastatic regions (cluster M) were identified. The patterns of mutations indicate that cluster P1 and P2 diverged in the early phase of tumorigenesis, and that metastatic cluster M originated from the common ancestral clone of cluster P1 with few somatic mutations and copy number variations. CONCLUSIONS: Although a high level of intratumor heterogeneity was evident in high-grade serous ovarian cancer, our results suggest that transcoelomic metastasis arises with little accumulation of somatic mutations and copy number alterations in this patient.ope

Mutation landscape of germline and somatic BRCA1/2 in patients with high-grade serous ovarian cancer

BACKGROUND: Poly (ADP-ribose) polymerase inhibitors targeting BRCA1/2 mutations are available for treating patients with high-grade serous ovarian cancer. These treatments may be more appropriately directed to patients who might respond if the tumor tissue is additionally tested by next-generation sequencing with a multi-gene panel and Sanger sequencing of a blood sample. In this study, we compared the results obtained using the next-generation sequencing multi-gene panel to a known germline BRCA1/2 mutational state determined by conventional Sanger sequencing to evaluate the landscape of somatic mutations in high-grade serous ovarian cancer tumors. METHODS: Cancer tissue from 98 patients with high-grade serous ovarian cancer who underwent Sanger sequencing for germline BRCA1/2 analysis were consecutively analyzed for somatic mutations using a next-generation sequencing 170-gene panel. RESULTS: Twenty-four patients (24.5%) showed overall BRCA1/2 mutations. Seven patients (7.1%) contained only somatic BRCA1/2 mutations with wild-type germline BRCA1/2, indicating acquired mutation of BRCA1/2. Three patients (3.1%) showed reversion of germline BRCA1 mutations. Among the 14 patients (14.3%) with both germline and somatic mutations in BRCA1/2, two patients showed different variations of BRCA1/2 mutations. The next-generation sequencing panel test for somatic mutation detected other pathogenic variations including RAD51D and ARID1A, which are possible targets of poly (ADP-ribose) polymerase inhibitors. Compared to conventional Sanger sequencing alone, next-generation sequencing-based tissue analysis increased the number of candidates for poly (ADP-ribose) polymerase inhibitor treatment from 17.3% (17/98) to 26.5% (26/98). CONCLUSIONS: Somatic mutation analysis by next-generation sequencing, in addition to germline BRCA1/2 mutation analysis, should become the standard of care for managing women with high-grade serous ovarian cancer to widen the indication of poly (ADP-ribose) polymerase inhibitors.ope

Identifying a low-risk group for parametrial involvement in microscopic Stage IB1 cervical cancer using criteria from ongoing studies and a new MRI criterion

BACKGROUND: There are currently three ongoing studies on less radical surgery in cervical cancer: ConCerv, GOG-278, and SHAPE. The aim of this study was to evaluate the performance of the criteria used in ongoing studies retrospectively and suggest a new, simplified criterion in microscopic Stage IB1 cervical cancer. METHODS: A retrospective analysis was performed in 125 Stage IB1 cervical cancer patients who had no clinically visible lesions and were allotted based on microscopic findings after conization. All patients had magnetic resonance imaging (MRI) after conization and underwent type C2 radical hysterectomy. We suggested an MRI criterion for less radical surgery candidates as patients who had no demonstrable lesions on MRI. The rates of parametrial involvement (PMI) were estimated for patients that satisfied the inclusion criteria for ongoing studies and the MRI criterion. RESULTS: The rate of pathologic PMI was 5.6% (7/125) in the study population. ConCerv and GOG-278 identified 11 (8.8%) and 14 (11.2%) patients, respectively, as less radical surgery candidates, and there were no false negative cases. SHAPE and MRI criteria identified 78 (62.4%) and 74 (59.2%) patients, respectively, as less radical surgery candidates; 67 patients were identified as less radical surgery candidates by both sets of criteria. Of these 67 patients, only one had pathologic PMI with tumor emboli. CONCLUSIONS: This study suggests that the criteria used in three ongoing studies and a new, simplified criterion using MRI can identify candidates for less radical surgery with acceptable false negativity in microscopic Stage IB1 disease.ope

음악 감상의 정서조절 기능

학위논문 (박사)-- 서울대학교 대학원 : 심리학과, 2015. 2. 민경환.본 연구에서는 음악 감상으로 기분을 조절하는 방략을 측정하는 도구를 마련하고 이를 이용하여 청년기 성인을 대상으로 음악 감상을 통해 기분을 조절하는 방략 사용에서 어떠한 개인차가 나타나는지 탐색하였으며 음악이 정서의 변화에 미치는 영향을 설문 연구와 실험 연구를 통하여 확인하였다. 연구 1에서는 Music in Mood Regulation Scale(Saarikallio, 2008)을 청년기의 한국인을 대상으로 타당화하여 척도의 구조를 살펴보았다. 한국판 음악 사용 기분조절 척도(K-MMR)는 6개의 하위 요인으로 이루어져 있으며 각 하위 방략의 이름은 회복, 분출, 강렬한 느낌, 오락, 주의전환, 위로였다. 각 요인의 신뢰도를 검증하고 수렴타당도와 변별타당도를 검증함으로써 K-MMR이 신뢰롭고 타당한 도구임을 확인하였다. 연구 2에서는 K-MMR을 이용하여 음악 감상을 통한 기분조절 방략의 사용에서 개인의 경험이나 특질에 따라서 어떠한 개인차가 나타나는지 탐색하였다. 음악을 기능적이라고 생각하는 사람들일수록 음악을 사용하여 기분을 조절하는 경향을 보였고, 음악을 사용한 기분조절 방략은 정적 감정의 경험과 유의한 상관이 있었다. 남성보다 여성이 더 음악으로 기분을 조절하는 방략을 사용하였으며 음악을 교육받은 집단이 그렇지 않은 집단보다 더 음악으로 기분을 조절하는 방략을 사용하였다. 음악을 사용한 기분조절 방략을 예측하는 성격특질은 하위 방략별로 차별적으로 나타났으며, 음악 감상을 통한 기분조절 방략과 가장 깊은 연관이 있는 성격특질은 우호성과 경험에 대한 개방성인 것으로 나타났다. 연구 3에서는 경험하는 정서와 감상하는 음악의 종류에 따라 정서의 개선에 차이가 나타나는지 알아보기 위해 실험 연구를 실시하였으며, 정서 측정의 신뢰도를 높이기 위하여 자기보고와 자율신경계의 활동을 반영하는 심전도를 동시에 측정하였다. 분노와 슬픔의 두 가지 정서를 유발하고 유쾌한 음악과 평온한 음악을 들려주었는데, 자기보고 상에서는 유발된 정서에 관계없이 유쾌한 음악이 정서 개선에 효과적이었지만 심박변이도 분석결과 분노를 경험할 때는 유쾌한 음악이, 슬픔을 경험할 때는 평온한 음악이 효과적으로 나타나 유발정서와 음악종류의 상호작용효과가 발견되었다. 음악이 정서변화에 미치는 효과에 음악에 대한 친숙성, 기질적 정서 경향성과 같은 변인은 영향을 주지 못하는 것으로 나타났다.목 차 서 론 1 심리학적 관점에서의 음악과 정서 연구 3 정서조절 수단으로서의 음악 8 연구의 필요성 및 목적 20 연구1. 한국판 음악 사용 기분조절 척도의 타당화 23 방법 26 결과 및 논의 30 연구2. 음악을 통한 기분조절 방략 사용에서의 개인차 탐색 39 방법 40 결과 및 논의 43 연구3. 음악 감상이 정서변화에 미치는 효과성 확인 55 방법 58 결과 및 논의 66 종합 논의 75 참고문헌 85 부록 105 Abstract 122Docto

성향점수매칭(PSM) 및 이중차이분석(DID) 방법을 중심으로

학위논문(석사) -- 서울대학교대학원 : 행정대학원 공기업정책학과, 2022. 8. 이석원.This study focused on the fact that many studies have been conducted on the effectiveness of sales and leaseback, but few studies have quantitatively analyzed the financial effects of sales and leaseback support for SMEs. Accordingly, the effect of supporting policy funds was analyzed by comparing the performance of companies supported by the sales and leaseback system operated by the Korea Asset Management Corporation(KAMCO). As previously known, in the case of policy finance support programs, there is a possibility that selection bias will occur in the process of reviewing and deciding whether or not to support it. Therefore, this study tried to minimize the problem of selection bias through the DID(difference-in-difference) after extracting the control group by performing PSM(propensity score matching). According to the analysis results, among the four areas of stability, profitability, activity, and growth, it shows the meaningful effect in stability indicators. Among the stability index, the currant ratio and the loan to sales ratio improved. In the case of profitability index, currant income, operating profit, and the net income to sales ratio increased. Among the activity index, the sales to total assets ratio was improved and in relation to growth index, the current asset growth rate improved. The results of this study suggest useful implications for analyzing the effectiveness of sales and leaseback support for SMEs, and it is also expected that the results will contribute to the activation of research for the effectiveness of sales and leaseback in public sector.본 연구의 목적은 세일앤리스백의 효과성과 관련하여 그동안 수많은 연구들이 이루어져 왔으나 중소기업을 대상으로 세일앤리스백 지원에 따른 재무효과를 계량적으로 분석한 연구는 거의 없다는 점에 착안하여 한국자산관리공사(캠코)에서 운영하고 있는 세일앤리스백 제도를 지원받은 기업과 비지원기업의 성과를 비교하여 정책효과를 확인해보고자 하였다. 기존에 알려진 바와 같이 정책금융 지원 프로그램의 경우에는 지원여부를 검토하여 결정하는 과정에서 자기선택에 의한 편의 요소가 발생하게 될 가능성이 매우 크다. 따라서 본 연구에서는 이러한 선택편의의 문제를 최소화하기 위해 성향점수매칭(Propensity Score Matching)을 실시하여 대조군을 추출하였고 이중차이분석(Difference-in-Difference)과 결합한 모형을 활용하여 관찰할 수 있는 특성과 관찰이 불가능한 여러 특성들을 통제하고자 노력하였다. 본 연구를 통한 실증분석 결과에 따르면 안정성, 수익성, 활동성, 성장성 4개 분야 중에서 안정성 지표가 가장 분명한 효과를 보이고 있는 것으로 나타났다. 안정성 지표 중 유동비율, 차입금매출액비율이 개선되었으며, 수익성 지표의 경우 당기순이익, 영업이익, 매출액순이익율이 개선되었음을 확인할 수 있었다. 활동성 지표의 경우 총자산회전율, 성장성 지표의 경우 유동자산증가율이 긍정적 효과를 보이고 있음이 확인되었다. 이상의 결과를 종합적으로 판단해보면 세일앤리스백을 지원받은 기업은 공장, 건물 등의 자산을 우선매수권 조건으로 매각해서 차입금 회수 등 유동성 부족을 일차적으로 해소하고 이에 따른 차입금 감소로 유동비율, 유동자산증가율, 차입금매출액비용 등 안정성과 직ㆍ간접적으로 관련된 지표가 개선되는 것으로 보인다. 유동성 문제를 해결한 기업은 운전자금을 활용하여 기업의 지속적인 수익창출을 위한 활동을 재개하여 당기순이익, 영업이익이 일부 증가함에 따라 매출액순이익율, 총자산회전율 등의 수익성, 활동성 지표가 개선되었다고 유추해볼 수 있다. 본 연구의 분석결과는 중소기업 세일앤리스백 지원의 효과성 분석에 유용한 시사점을 제시하며, 연구결과가 향후 세일앤리스백 실시에 따른 효과성을 파악하는 연구분야의 활성화에 기여하길 기대한다.제1장 서론 1 제1절 연구의 배경 및 목적 1 제2절 연구의 범위 및 방법 3 제2장 중소기업 구조조정과 세일앤리스백 5 제1절 중소기업 현황 5 제2절 구조조정 대상 중소기업 현황 7 제3절 세일앤리스백 프로그램 10 1.제도의 개요 10 2.캠코의 세일앤리스백 프로그램 운영 11 제3장 선행연구 검토 14 제1절 세일앤리스백 관련 선행연구 14 제2절 중소기업 정책자금 지원 기업의 재무적 효과성 연구 16 제3절 선행연구와의 차별성 18 제4장 연구의 설계 20 제1절 연구방법 및 가설설정 20 1.연구방법 20 2.가설의 설정 21 제2절 변수의 설정 23 1.독립변수 23 2.종속변수 24 3.통제변수 25 제3절 자료의 수집 및 분석 방법 26 1.성향점수매칭(PSM) 27 2.이중차분법(DID) 31 제5장 실증분석 결과 34 제1절 기술통계 분석 34 제2절 가설검증 36 1.안정성 지표 36 2.수익성 지표 40 3.활동성 지표 44 4.성장성 지표 47 제3절 가설검증결과 요약 50 제6장 결론 51 제1절 연구결과 요약 51 제2절 연구의 시사점 53 제3절 연구의 한계 54석

Safety of fertility-sparing surgery in primary mucinous carcinoma of the ovary

PURPOSE: The aim of this study is to evaluate the safety of fertility-sparing surgery as the treatment for patients with primary mucinous epithelial ovarian cancer. MATERIALS AND METHODS: A retrospective study of patients with mucinous ovarian cancer between 1991 and 2010 was performed. The demographics and survival outcomes were compared between patients who underwent fertility-sparing surgery and those who underwent radical surgery. RESULTS: A total of 110 patients underwent primary surgery. At the time of surgery, tumors appeared to be grossly confined to the ovaries in 90 patients, and evidence of metastasis was definite in 20 patients. Of the 90 patients with tumors that appeared to be grossly confined to the ovaries at surgical exploration, 35 (38.9%) underwent fertility-sparing surgery. The Kaplan- Meier curve and the log rank test showed no difference in either recurrence-free survival (p=0.792) or disease-specific survival (p=0.706) between the two groups. Furthermore, there was no significant difference in recurrence-free survival (p=0.126) or disease-specific survival (p=0.377) between the two groups, even when the analysis was limited to women below the age of 40. In a multivariate Cox model, fertility-sparing surgery had no effect on either recurrence-free survival (recurrence hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.25 to 5.71) or disease-specific survival (death HR, 0.88; 95% CI, 0.17 to 4.60). CONCLUSION: Fertility-sparing surgery in primary mucinous cancer grossly confined to the ovaries may be a safe option and one not associated with an increase in recurrence or mortality.ope

An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer.

PURPOSE: Adjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy. MATERIALS AND METHODS: We retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected. RESULTS: Of the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy. CONCLUSION: The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.ope