Il Tae Son

Cultural adaptation and validation of the Korean version of the EORTC QLQ-CR29 in patients with colorectal cancer.

PurposeWe aimed to evaluate the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Colorectal Cancer-Specific Quality of Life Questionnaire (QLQ-CR29), based on a sample of patients with colorectal cancer.MethodsA total of 123 patients treated for colorectal cancer participated in the validation study. Test–retest reliability was assessed using intra-class correlations from a random sample. Internal consistency reliability was estimated using Cronbach’s α coefficient. Convergent and discriminant validity was analyzed with multi-trait scaling. Clinical validity was assessed in terms of clinical differences using known-group comparisons. Concurrent validity was determined by correlations with the EORTC QLQ-C30, which was a generic core questionnaire to evaluate issues common to different cancer sites and treatments.ResultsThe test–retest, administered to 35 patients, showed acceptable reproducibility (0.62–1.00) except the constipation scale of the QLQ-C30 (0.43). Cronbach’s α coefficient (0.70–0.87) exceeded the 0.7 criterion. Multi-trait scaling analysis showed that multi-item scales met standards of convergent and discriminant validity. The known-group comparisons showed quality of life (QOL) differences between groups of patients based on tumor location, receipt of neoadjuvant therapy, and with/without a stoma. Correlations between the scales of the QLQ-CR29 and QLQ-C30 were low in most areas, whereas correlations in several areas with related content were higher.ConclusionThis study shows that the Korean version of the EORTC QLQ-CR29 is a reliable and valid tool for measuring QOL, as determined by application to a sample of Korean colorectal cancer patients.

Is MRI of the Liver Needed During Routine Preoperative Workup for Colorectal Cancer

BACKGROUND: The clinical efficacy of gadoxetic acid–enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer remains unclear. OBJECTIVE: The purpose of this study was to evaluate the efficacy of preoperative gadoxetic acid–enhanced liver MRI for the diagnosis of liver metastasis in patients with colorectal cancer. DESIGN: This was a retrospective analysis from a prospective cohort database. SETTINGS: All of the patients were from a subspecialty practice at a tertiary referral hospital. PATIENTS: Patients who received preoperative gadoxetic acid–enhanced liver MRI after CT and attempted curative surgery for colorectal cancer were included. MAIN OUTCOME MEASURES: The number of equivocal hepatic lesions based on CT and gadoxetic acid–enhanced liver MRI and diagnostic use of the gadoxetic acid–enhanced liver MRI were measured. RESULTS: We reviewed the records of 690 patients with colorectal cancer. Equivocal hepatic lesions were present in 17.2% of patients based on CT and in 4.5% based on gadoxetic acid–enhanced liver MRI. Among 496 patients with no liver metastasis based on CT, gadoxetic acid–enhanced liver MRI detected equivocal lesions in 15 patients and metastasis in 3 patients. Among 119 patients who had equivocal liver lesions on CT, gadoxetic acid–enhanced liver MRI indicated hepatic lesions in 103 patients (86.6%), including 90 with no metastasis and 13 with metastasis. Among 75 patients who had liver metastasis on CT, gadoxetic acid–enhanced liver MRI indicated that the hepatic lesions in 2 patients were benign, in contrast to CT findings. The initial surgical plans for hepatic lesions according to CT were changed in 17 patients (3%) after gadoxetic acid–enhanced liver MRI. LIMITATIONS: This study was limited by its retrospective design. CONCLUSIONS: The clinical efficacy of gadoxetic acid–enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer is low, in spite of its high diagnostic value for detecting liver metastasis. However, this study showed gadoxetic acid–enhanced liver MRI was helpful in characterizing equivocal hepatic lesions identified in CT and could lead to change in treatment plans for some patients. See Video Abstract at http://links.lww.com/DCR/A420.

Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades.

Purpose The Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients. Materials and Methods Data on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time. Results The period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly—period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001). Conclusion Colorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry’s establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.

Isolation of internal and external sphincter progenitor cells from the human anal sphincter with or without radiotherapy

We aimed to isolate and propagate internal and external anal sphincter progenitor cells from the human anal sphincter, with or without radiotherapy, for tailored cell therapy of faecal incontinence.

Oncologic relevance of magnetic resonance imaging–detected threatened mesorectal fascia for patients with mid or low rectal cancer: A longitudinal analysis before and after long-course, concurrent chemoradiotherapy

Background. The oncologic importance of threatened mesorectal fascia detected with magnetic resonance imaging is obscured by the heterogeneity of preoperative treatments. We evaluated the oncologic relevance of threatened mesorectal fascia detected with consecutive magnetic resonance imaging performed before and after long‐course, concurrent chemoradiotherapy (LCRT) for mid or low rectal cancer. Methods. We evaluated 196 patients who underwent total mesorectal excision with LCRT. Threatened mesorectal fascia was defined as a shortest distance from tumor to mesorectal fascia of ≤ 1 mm on magnetic resonance imaging. Multivariate analyses for disease‐free survival using magnetic resonance imaging–based parameters were conducted with a Cox proportional hazard model before and after LCRT, respectively. Results. The pathologic positivity of the circumferential resection margin was greater for threatened mesorectal fascia than for clear mesorectal fascia (pre‐LCRT, 14.8% vs 3.0%, P = .004; post‐LCRT, 15.4% vs 4.5%, P = .025). At a median follow‐up of 68 months, 3‐year disease‐free survival was worse for threatened mesorectal fascia than for clear mesorectal fascia (pre‐LCRT, 77.0% vs 88.1%, P = .023; post‐LCRT, 76.9% vs 86.6%, P = .029). On multivariate analyses, threatened mesorectal fascia on pre‐LCRT magnetic resonance imaging was an independent factor for poor disease‐free survival (hazard ratio = 2.153, 95% confidence interval, 1.07–4.32, P = .031), whereas threatened mesorectal fascia on post‐LCRT magnetic resonance imaging was not (hazard ratio = 1.689, 95% confidence interval, 0.77–3.66, P = .189). Conclusion. This study confirms that magnetic resonance imaging–detected threatened mesorectal fascia predicts poor oncologic outcomes for mid or low rectal cancer and shows that the diagnostic performance of pre‐LCRT magnetic resonance imaging is different from that of post‐LCRT magnetic resonance imaging.

Comparison of long-term oncological outcomes of appendiceal cancer and colon cancer: A multicenter retrospective study.

BACKGROUND There has been no comparative study of the long-term oncological outcomes of appendiceal cancer and colon cancer. We hypothesized that the oncological outcome is worse in appendiceal cancer because perforation is more frequent than in colon cancer. METHODS Patients with stage I-III were selected from 5046 patients with appendiceal or colon cancer, between September 2001 and June 2010. The 5-year disease-free survival (DFS) was the primary endpoint. Multivariate analyses with Cox proportional hazards model for DFS and logistic regression model for perforation were conducted. A matching model was used to compensate for the heterogeneity between groups. RESULTS The perforation rate was 44.7% in appendiceal cancer (n = 47), but 1.1% in colon cancer (n = 2828) (p = 0.001). The 5-year DFS rate was lower in appendiceal cancer than in colon cancer (57.9% vs. 85.2%, p = 0.001; matching model, 54.2% vs. 78.4%, p = 0.038), with a higher rate of peritoneal seeding (25.5% vs. 2.5%, p = 0.001; matching model, 24.0% vs. 4.0%, p = 0.007). Multivariate Cox regression showed that appendiceal cancer was an independent prognostic factor for poor DFS (hazard ratio = 2.602, 95% confidence interval = 1.26-5.35, p = 0.009), and logistic regression confirmed that appendiceal cancer was the risk factor associated with perforation (odds ratio = 66.265, 95% confidence interval = 28.21-155.61, p = 0.001). CONCLUSIONS This study suggested that the long-term oncological outcomes are worse for appendiceal cancer than for colon cancer, attributed to higher perforation rate in appendiceal cancer.