Ki Wook Chung

A randomized phase-III trial of docetaxel/capecitabine versus doxorubicin/cyclophosphamide as primary chemotherapy for patients with stage II/III breast cancer

We aimed to determine the efficacies of a non-anthracycline-containing regimen, docetaxel/capecitabine (TX), in comparison with an anthracycline-containing regimen, doxorubicin/cyclophosphamide (AC), as primary chemotherapy for node-positive early stage breast cancer. In this phase-III single center randomized study, we randomized 209 women with axillary node positive, stage II/III breast cancer to receive four cycles of either TX or AC followed by surgery and cross-over to the other treatment as an adjuvant therapy. The primary endpoint was tumor pathologic complete response (pCR). Clinical response rates, toxicity profiles, disease free survival (DFS), and overall survival were secondary objectives. In total, 204 patients had clinical and radiological evaluation of response, and underwent surgery. Compared with AC, TX increased pCR in primary tumors (21% vs. 10%, respectively, Pxa0=xa00.024) and clinical response (84% vs. 65%, Pxa0=xa00.003). TX was associated with less nausea and vomiting, but more stomatitis, diarrhea, myalgia, and skin/nail changes than AC. With a median follow-up of 37xa0months, there was no significant difference in DFS by treatment groups (Pxa0=xa00.932). Fewer patients developed recurrence who achieved pCR in lymph node (LN) (Pxa0=xa00.025; hazard ratio, 0.189; 95% CI, 0.044–0.815) in the multivariate analysis. TX showed superior efficacies to AC with increased pathologic and clinical complete response rates. Although these findings did not translate into a gain in DFS, the patients who achieved pCR in LN developed significantly less recurrence.

Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer.

BackgroundThe risk factors responsible for hypoparathyroidism after total thyroidectomy have not been completely defined. The present study evaluated one surgeon’s personal experience of postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer and predisposing risk factors of postoperative hypoparathyroidism.MethodsWe performed a retrospective analysis of 531 consecutive total thyroidectomy cases for thyroid cancer operated by single surgeon at the Center for Thyroid Cancer, National Cancer Center, Korea, from March 2003 to August 2006.ResultsPostoperative hypoparathyroidism occurred in 135 patients (25.4xa0%), 19 of whom (3.6xa0% of total patients) experienced permanent hypoparathyroidism. Parathyroid autotransplantation, bilateral central lymph node dissection, gross extrathyroidal extension, and the presence of parathyroid gland in the pathologic specimen were associated with postoperative hypoparathyroidism in multivariate analysis (pxa0<xa00.05, respectively). The presence of parathyroid gland in the pathologic specimen and the early period of surgeon’s practice were statistically significant risk factors for permanent hypoparathyroidism in multivariate analysis (pxa0<xa00.05, respectively).ConclusionsCareful surgical technique for in situ preservation of parathyroid gland and autotransplantation of inadvertently removed parathyroid gland are important, especially in case of gross extrathyroidal extension. Adequate surgical experience is also an important factor. And routine bilateral central lymph node dissection should be done thoughtfully for its effect on postoperative hypoparathyroidism.

Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy.

BACKGROUNDnVoice and throat dysfunction may occur in patients after thyroidectomy, even in the absence of apparent laryngeal nerve injury. We evaluated the impact of thyroid surgery on voice and throat function using perceptive, objective, and subjective measurements in a prospectively enrolled and serially followed cohort of thyroid cancer patients. We assessed the impact of surgical extent and intensity of postoperative treatment, including addition radioactive iodine treatment (RIT), on these functions.nnnMETHODSnConsenting patients undergoing thyroid lobectomy (TL; n = 33), total thyroidectomy (TT; nxa0=xa041), or TT plus RIT (n = 81), none of whom had laryngeal nerve dysfunction perioperatively, were enrolled prospectively. All underwent comprehensive functional evaluations, including perceptive voice quality using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale and acoustic voice analysis with multiple parameters, and filled out subjective questionnaires, including the Voice Handicap Index (VHI) and the Glasgow Edinburgh Throat Scale, before thyroidectomy and at 1, 6, and 12 months postoperatively.nnnRESULTSnIn this study, 14-83% of the patients developed some element of voice and throat dysfunction, shown consistently in different evaluations. Typical patterns were alterations of perceptive voice, deranged acoustic parameters, and subjective worsening on the VHI and GETS. Moreover, these changes were correlated with the extent of treatment, especially within 3 months after operation, and often persisted 12 months postoperatively. RIT had no effects on voice outcomes throughout the follow-up.nnnCONCLUSIONnVoice and throat dysfunction are evident after thyroidectomy, more severely after TT than TL. These potential disabilities should be considered carefully to further enhance patients quality of life.

Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: a prospective cohort study.

BackgroundSocial support may influence the impact of stressful life events on breast cancer patients’ psychological state. However, the precise status of depressive mood in breast cancer during the first year after diagnosis is not yet known.MethodsPerceived social support, health-related quality of life, and depressive mood were assessed at enrollment and 1xa0year after breast cancer diagnosis in 286 women newly diagnosed with stages I–III breast cancer. Breast cancer patients’ social support and depressive mood at diagnosis and 1xa0year after diagnosis were compared with the general female population (GFP), and predictors of worsened depressive mood were identified.ResultsAll subscales of social support and depressive mood among breast cancer patients were significantly lower at one after diagnosis than at diagnosis (all pu2009<u20090.001). At diagnosis, breast cancer patients reported better emotional (pu2009=u20090.004), informational (pu2009=u20090.006), and affectionate support (pu2009=u20090.002), and poorer depressive mood (pu2009<u20090.001) than the GFP. After 1xa0year, however, perceived social support in breast cancer patients was significantly decreased and depressive mood was significantly improved, becoming similar to scores of the GFP. Only tangible support was significantly lower than the GFP at 1xa0year after diagnosis (pu2009=u20090.028). Hierarchical multiple logistic regression analysis for best fitting the model statistically and clinically indicated that decreased emotional support, transition to post-menopausal status, impaired role functioning, and financial difficulties predicted deteriorated depressive mood.ConclusionBreast cancer patients might have greater control over tangible support than any other type of social support. Together with the transition to post-menopausal status, decreased perceived emotional social support was the best predictor of depressive mood among breast cancer patients during the first year after diagnosis.

Knowledge, attitudes, risk perception, and cancer screening behaviors among cancer survivors

Knowledge, attitudes, and risk perception in relation to second primary cancer (SPC) screening and their impact on screening practices in cancer survivors are largely unknown.

Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer

ObjectiveTo investigate predictors for successful ablation and disease-free status after high-dose radioiodine therapy in patients with differentiated thyroid cancer.MethodsWe enrolled 173 consecutive patients with differentiated thyroid cancer between November 2001 and December 2004 retrospectively (female 145, 46xa0±xa012xa0years). All patients underwent total thyroidectomy and I-131 ablative therapy (IAT) (3.7–5.4xa0GBq). The success or failure of ablation was assessed 6–9xa0months after the IAT with reference to undetectable thyroglobulin (Tg) and negative I-131 whole body scan (WBS). Afterward, the decision for disease-free status was evaluated using Tg and WBS (follow-up period after 1st IAT 7–81xa0months, median 43xa0months, criteria of disease-free: less than 10xa0ng/ml TSH-stimulated Tg or less than 2xa0ng/ml TSH-unstimulated Tg and/or negative WBS). Clinical and tumoral factors such as sex, age, pathologic type, the size of tumor, quantified cervical uptake in WBS1, pattern in WBS1, ablative therapy dose, AJCC stage, lymph node (LN) stage, Tg just before IAT (Tg1), and ablation status were assessed using logistic regression analyses.ResultsThere were 93 successful ablations (54xa0%). Significant predictors for the ablation failure were Tg1 (ORxa0=xa08.42; 95xa0% CIxa0=xa02.76–25.69; pxa0<xa00.0001), LN metastasis (ORxa0=xa03.05; 95xa0% CIxa0=xa01.11–8.37; pxa0=xa00.031), and quantified cervical uptake in WBS1 (ORxa0=xa04.95; 95xa0% CIxa0=xa01.07–22.88; pxa0=xa00.041). One hundred fifty-five patients were determined as disease-free after follow-up. All the eighteen patients with persistent disease were identified as ablation failure after first IAT. Significant predictors for the disease-free status were Tg1 (ORxa0=xa00.98; 95xa0% CIxa0=xa00.97–0.99; pxa0=xa00.028), tumor size (ORxa0=xa00.53; 95xa0% CIxa0=xa00.28–0.96; pxa0=xa00.044), and quantified cervical uptake in WBS1 (ORxa0=xa00.87; 95xa0% CIxa0=xa00.76–0.98; pxa0=xa00.024).ConclusionsThe thyroglobulin and quantified cervical uptake in whole body scan are significant predictors for the successful ablation and disease-free status after follow-up.

Administration of Radioactive Iodine Therapy Within 1 Year After Total Thyroidectomy Does Not Affect Vocal Function

The purpose of this study was to evaluate the impact of radioactive iodine therapy (RIT) on vocal function during the early follow-up period after total thyroidectomy (TT) using perceptive and objective measurements, questionnaires regarding subjective symptoms, and data on vocal function in a prospectively enrolled and serially followed thyroid cancer cohort. Methods: Of 212 patients who underwent TT and were screened between January and December 2010 at our hospital, 160 were included in the final analysis. Patients with the following histories were excluded: lateral neck dissection, organic vocal fold disease, external radiotherapy, and voice evaluation during thyroxine withdrawal. Patients were stratified into 3 groups: TT, TT with low-dose RIT (1.1–2.2 GBq), and TT with high-dose RIT (≥3.7 GBq). Voice evaluations were performed before surgery and at 1, 6, and 12 mo after TT. Results: Vocal characteristics were altered after TT, including changes on the grade, roughness, and strain scale; increased amplitude perturbation; decreased fundamental frequency; narrowed pitch range; and global disturbances in subjective functional parameters on the voice handicap index. However, the degree of vocal changes among the 3 groups did not significantly differ within the 1-y postoperative follow-up period. According to the results of subgroup analyses of patients who demonstrated good voice outcomes after TT, there were no significant functional differences among the 3 groups. Conclusion: RIT at any dose does not affect vocal function within 1 y of TT.

Efficacy of an Educational Material on Second Primary Cancer Screening Practice for Cancer Survivors: A Randomized Controlled Trial

Background Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors. Methods Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year. Results At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P<0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, Pu200a=u200a0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups. Conclusion While the educatinal material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population. Trial Registration ClinicalTrial.gov NCT00948337

Is Male Gender a Prognostic Factor for Papillary Thyroid Microcarcinoma

BackgroundMale gender is a prognostic factor of poor outcome in papillary thyroid carcinoma (PTC). We investigated the prognostic role of male gender in papillary thyroid microcarcinoma (PTMC).MethodsWe included 2930 patients who underwent surgery at Asan Medical Center for PTC. Clinicopathologic characteristics from the patients’ medical records were compared for male and female PTC patients. Independent prognostic factors for recurrence in PTC and PTMC were evaluated after propensity score matching analysis. The median follow-up period was 82xa0months.ResultsRecurrence and death were more common in male patients with PTC than in female patients with PTC (12.6 vs. 9.6%, pxa0=xa00.03 and 2.2 vs. 0.6%, pxa0<xa00.001, respectively). However, there was no difference in disease-free survival between male and female PTMC patients (pxa0=xa00.57). Multivariate analysis after propensity score matching revealed that male gender is not an independent prognostic factor of recurrence in PTMC (hazard ratio [HR] 1.5, 95% confidence interval 0.75–5.33, pxa0=xa00.17), but that it is an independent prognostic factor in PTC >1xa0cm (HRxa0=xa03.06, 95% confidence interval 1.34–6.98, pxa0=xa00.008).ConclusionsMale gender is an independent prognostic factor for recurrence in PTC >1xa0cm, but it is not a prognostic factor in PTMC.

The value of preoperative anti-thyroidperoxidase antibody as a novel predictor of recurrence in papillary thyroid carcinoma: Anti-TPO antibody and clinical outcomes of PTC

The link between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC) is widely recognized. Considering the strong association between raised antithyroidperoxidase antibody (TPOAb) and CLT, we postulated that the preoperative TPOAb can predict the prognosis of PTC, particularly for recurrence. A total of 2,070 patients who underwent total thyroidectomy for classical type PTC with tumor size ≥1 cm and with available data on preoperative TPOAb and TgAb were enrolled to compare disease‐free survival (DFS) according to the presence of preoperative TPOAb, TgAb, and coexistent CLT. Patients with positive preoperative TPOAb had a significantly better DFS compared to patients without positive preoperative TPOAb (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.30–0.94, p = 0.028) while no difference in DFS was found according to preoperative TgAb status. Positive preoperative TPOAb was an independent prognostic factor for structural persistent/recurrent disease after adjustment for major preoperative risk factors such as age, sex, and tumor size (HR 0.52, 95% CI 0.28–0.99, p = 0.048). Although the coexistence of CLT lowered the risk for structural persistence/recurrence in univariate analysis (HR 0.52, 95% CI 0.31–0.86, p = 0.012), it was not an independent favorable prognostic factor by multivariate analysis (HR 0.65, 95% CI 0.38–1.10, p = 0.106). However, when coexistent CLT was combined with positive preoperative TPOAb, it indicated an independent protective role in structural persistent/recurrent disease (HR 0.39, 95% CI 0.16–0.98, p = 0.045). Our study clearly showed that presence of preoperative TPOAb can be a novel prognostic factor in predicting structural persistence/recurrence of PTC.