Cancer Research and Treatment

Original Articles

Breast cancer

Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09): Jieun Lee, Keun Seok Lee, Sung Hoon Sim, Heejung Chae, Joohyuk Sohn, Gun Min Kim, Kyung-Hee Lee, Su Hwan Kang, Kyung Hae Jung, Jae-ho Jeong, Jae Ho Byun, Su-Jin Koh, Kyoung Eun Lee, Seungtaek Lim, Hee Jun Kim, Hye Sung Won, Hyung Soon Park, Guk Jin Lee, Soojung Hong, Sun Kyung Baek, Soon Il Lee, Moon Young Choi, In Sook Woo; Cancer Res Treat. 2023;55(1):123-135. Published online March 24, 2022; DOI: https://doi.org/10.4143/crt.2021.1561

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Purpose
The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea.
Materials and Methods
We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016.
Results
The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003).
Conclusion
Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

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Clinicopathologic Features and Prognoses of Male Patients With Breast Cancer
Meiling Huang, Jingjing Xiao, Changjiao Yan, Rui Ling, Ting Wang
American Journal of Men's Health.2024;[Epub] CrossRef

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Clinical Characteristics of Clear Cell Ovarian Cancer: A Retrospective Multicenter Experience of 308 Patients in South Korea: Hee Yeon Lee, Ji Hyung Hong, Jae Ho Byun, Hee-Jun Kim, Sun Kyung Baek, Jin Young Kim, Ki Hyang Kim, Jina Yun, Jung A Kim, Kwonoh Park, Hyo Jin Lee, Jung Lim Lee, Young-Woong Won, Il Hwan Kim, Woo Kyun Bae, Kyong Hwa Park, Der-Sheng Sun, Suee Lee, Min-Young Lee, Guk Jin Lee, Sook Hee Hong, Yun Hwa Jung, Ho Jung An; Cancer Res Treat. 2020;52(1):277-283. Published online July 12, 2019; DOI: https://doi.org/10.4143/crt.2019.292

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Purpose
The purpose of this study was to evaluate clinical characteristics and treatment pattern of ovarian clear cell carcinoma (OCCC) in Korea and the role of adjuvant chemotherapy in early stage.
Materials and Methods
Medical records of 308 cases of from 21 institutions were reviewed and data including age, performance status, endometriosis, thromboembolism, stage, cancer antigen 125, treatment, recurrence, and death were collected.
Results
Regarding stage of OCCC, it was stage I in 194 (63.6%), stage II in 34 (11.1%), stage III in 66 (21.6%), and stage IV in 11 (3.6%) patients. All patients underwent surgery. Optimal surgery (residual disease ≤ 1 cm) was achieved in 89.3%. Majority of patients (80.5%) received postoperative chemotherapy. The most common regimen was taxane-platinum combination (96%). Median relapse-free survival (RFS) was 138.5 months for stage I, 33.4 for stage II, 19.3 for stage III, and 9.7 for stage IV. Median overall survival (OS) were not reached, 112.4, 48.7, and 18.3 months for stage I, II, III, and IV, respectively. Early-stage (stage I), endometriosis, and optimal debulking were identified as favorable prognostic factors for RFS. Early-stage and optimal debulking were also favorable prognostic factors for OS. Majority of patients with early-stage received adjuvant chemotherapy. However, additional survival benefit was not found in terms of recurrence.
Conclusion
Majority of patients had early-stage and received postoperative chemotherapy regardless of stage. Early-stage and optimal debulking were identified as favorable prognostic factors. In stage IA or IB, adding adjuvant chemotherapy did not show difference in survival. Further study focusing on OCCC is required.

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From clinical management to personalized medicine: novel therapeutic approaches for ovarian clear cell cancer
Zesi Liu, Chunli Jing, Fandou Kong
Journal of Ovarian Research.2024;[Epub] CrossRef
SOX17 expression in ovarian clear cell carcinoma
Daichi Kodama, Motoki Takenaka, Chiemi Saigo, Masako Azuma, Yuki Hanamatsu, Masanori Isobe, Tamotsu Takeuchi
Journal of Ovarian Research.2024;[Epub] CrossRef
Construction of a Prediction Model of Cancer-Specific Survival after Ovarian Clear Cell Carcinoma Surgery
Mengqi Huang, Li Ling, Yanbo Liu, Yujuan Li
Clinical and Experimental Obstetrics & Gynecology.2024;[Epub] CrossRef
Patients with stage IA ovarian clear cell carcinoma do not require chemotherapy following surgery
Li Shuqing, Zhu Zhiling
Cancer Medicine.2023; 12(6): 6668. CrossRef
Clear cell carcinoma of the ovary and venous thromboembolism: a systematic review and meta-analysis
Hamidreza Didar, Farah Farzaneh, Hanieh Najafiarab, Kosar Namakin, Kimiya Gohari, Ali Sheidaei, Sepehr Ramezani
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Cancer Control.2023;[Epub] CrossRef
Clinical perspectives of rare ovarian tumors: clear cell ovarian cancer
Satoe Fujiwara
Japanese Journal of Clinical Oncology.2023; 53(8): 664. CrossRef
Application of precision medicine based on next-generation sequencing and immunohistochemistry in ovarian cancer: a real-world experience
Yoo-Na Kim, Yun Soo Chung, Ji Hyun Lee, Eunhyang Park, Seung-Tae Lee, Sunghoon Kim, Jung-Yun Lee
Journal of Gynecologic Oncology.2023;[Epub] CrossRef
Characteristics and Prognosis of Ovarian Pure Clear Cell Carcinoma: A Retrospective Experience of 136 Patients
Yang Gao, Wei Ding, Pengpeng Qu
Clinical and Experimental Obstetrics & Gynecology.2023;[Epub] CrossRef
A clearer view on ovarian clear cell carcinoma
Aglaja De Pauw, Eline Naert, Koen Van de Vijver, Tummers Philippe, Katrien Vandecasteele, Hannelore Denys
Acta Clinica Belgica.2022; 77(4): 792. CrossRef
Friend or foe? The prognostic role of endometriosis in women with clear cell ovarian carcinoma. A UK population-based cohort study
Anastasios Tranoulis, Felicia Helena Buruiana, Bindiya Gupta, Audrey Kwong, Aarti Lakhiani, Jason Yap, Janos Balega, Kavita Singh
Archives of Gynecology and Obstetrics.2022; 305(5): 1279. CrossRef
Association Between Endometriosis and Prognosis of Ovarian Cancer: An Updated Meta-Analysis
Peng Chen, Chi-Yuan Zhang
Frontiers in Oncology.2022;[Epub] CrossRef
Clinical analysis and literature review of a case of ovarian clear cell carcinoma with PIK3CA gene mutation: A case report
Abdulkarim Mohamed Farah, Shiyu Gu, Yan Jia
Medicine.2022; 101(37): e30666. CrossRef
Clear cell carcinoma of the ovary: a clinical and molecular perspective
Yasushi Iida, Aikou Okamoto, Robert L Hollis, Charlie Gourley, C Simon Herrington
International Journal of Gynecological Cancer.2021; 31(4): 605. CrossRef
Clinical characteristics and prognosis of ovarian clear cell carcinoma: a 10-year retrospective study
Chenchen Zhu, Jing Zhu, Lili Qian, Hanyuan Liu, Zhen Shen, Dabao Wu, Weidong Zhao, Weihua Xiao, Ying Zhou
BMC Cancer.2021;[Epub] CrossRef
The oncological outcome of the patients with ovarian clear cell cancer: Platinum-based adjuvant chemotherapy is not suitable
Caner ÇAKIR, Fatih KILIÇ, Çiğdem KILIÇ, Dilek YÜKSEL, Vakkas KORKMAZ, Günsu KİMYON CÖMERT, Osman TÜRKMEN, Taner TURAN
Journal of Surgery and Medicine.2021; 5(8): 1. CrossRef
Development and validation of Nomograms for predicting overall survival and Cancer-specific survival in patients with ovarian clear cell carcinoma
Qian Chen, Shu Wang, Jing-He Lang
Journal of Ovarian Research.2020;[Epub] CrossRef

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Clinical Features of Male Breast Cancer: Experiences from Seven Institutions Over 20 Years: Ji Hyung Hong, Kyung Sun Ha, Yun Hwa Jung, Hye Sung Won, Ho Jung An, Guk Jin Lee, Donghoon Kang, Ji Chan Park, Sarah Park, Jae Ho Byun, Young Jin Suh, Jeong Soo Kim, Woo Chan Park, Sang Seol Jung, Il Young Park, Su-Mi Chung, In Sook Woo; Cancer Res Treat. 2016;48(4):1389-1398. Published online April 11, 2016; DOI: https://doi.org/10.4143/crt.2015.410

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Purpose
Breast cancer treatment has progressed significantly over the past 20 years. However, knowledge regarding male breast cancer (MBC) is sparse because of its rarity. This study is an investigation of the clinicopathologic features, treatments, and clinical outcomes of MBC.
Materials and Methods
Clinical records of 59 MBC patients diagnosed during 1995-2014 from seven institutions in Korea were reviewed retrospectively.
Results
Over a 20-year period, MBC patients accounted for 0.98% among total breast cancer patients, and increased every 5 years. The median age of MBC patientswas 66 years (range, 24 to 87 years). Forty-three patients (73%) complained of a palpable breast mass initially. The median symptom duration was 5 months (range, 1 to 36 months). Mastectomy was performed in 96% of the patients. The most frequent histology was infiltrating ductal carcinoma (75%). Ninety-one percent of tumors (38/43) were estrogen receptor–positive, and 28% (11/40) showed epidermal growth factor receptor 2 (HER-2) overexpression. After curative surgery, 42% of patients (19/45) received adjuvant chemotherapy; 77% (27/35) received hormone therapy. Five out of ten patients with HER-2 overexpressing tumors did not receive adjuvant anti–HER-2 therapy, while two out of four patients with HER-2 overexpressing tumors received palliative trastuzumab for recurrent and metastatic disease. Letrozole was used for one patient in the palliative setting. The median overall survival durations were 7.2 years (range, 0.6 to 17.0 years) in patients with localized disease and 2.9 years (range, 0.6 to 4.3 years) in those with recurrent or metastatic disease.
Conclusion
Anti–HER-2 and hormonal therapy, except tamoxifen, have been underutilized in Korean MBC patients compared to female breast cancer patients. With the development of precision medicine, active treatment with targeted agents should be applied. Further investigation of the unique pathobiology of MBC is clinically warranted.

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Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09)
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Case Report

HPV-Related Retroperitoneal Squamous Cell Carcinoma of Unknown Primary: A Case Report: Hyun Jin Oh, Eun Hye Park, Yeong Bok Lee, Jooyeun Hu, Guk Jin Lee, Sang Hoon Chun, Mi Yeong Lee, Dae Woo Lee, Jeana Kim, Jong-Youl Jin; Cancer Res Treat. 2015;47(4):954-957. Published online February 17, 2015; DOI: https://doi.org/10.4143/crt.2014.111

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A 56-year-old female was referred to our hospital due to a mass measuring 5 cm in size in the left pelvic cavity, which was found incidentally during a health examination by ultrasonography. Exploratory laparotomy was performed and the mass was located at the left retroperitoneal parametrium without invasion of the uterus and ovary. The pathology report confirmed squamous cell carcinoma. Even after further studies, we did not find any other primary lesion. Human papillomavirus (HPV) DNA chip test (HPV 9G DNA Membrane Kit, Biometrixtechnology Inc.) showed that the surgical specimen was positive for HPV 18. She received adjuvant chemotherapy and would receive radiation therapy for the possibility of occult gynecologic cancer. Retroperitoneal squamous cell carcinoma of unknown primary is extremely rare and little is known about it. It is reported that HPV may be associated with the disease. Hence, the result of HPV test could have an impact on finding a suspicious primary lesion and treatment modality in this case.

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Original Articles

Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer: Mi Joo Chung, Guk Jin Lee, Young Jin Suh, Hyo Chun Lee, Sea-Won Lee, Songmi Jeong, Jeong Won Lee, Sung Hwan Kim, Dae Gyu Kang, Jong Hoon Lee; Cancer Res Treat. 2015;47(4):774-780. Published online February 13, 2015; DOI: https://doi.org/10.4143/crt.2014.189

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Purpose
This study investigated setup error and effectiveness of weekly image-guided radiotherapy (IGRT) of TomoDirect for early breast cancer. Materials and Methods One hundred and fifty-one breasts of 147 consecutive patients who underwent breast conserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013 were evaluated. All patients received weekly IGRT. The weekly setup errors from simulation to each treatment in reference to chest wall and surgical clips were measured. Random, systemic, and 3-dimensional setup errors were assessed. Extensive setup error was defined as 5 mm above the margin in any directions.
Results
All mean errors were within 3 mm of all directions. The mean angle of gantry shifts was 0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariate analysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significant factor for extensive error. The largest significant deviation of setup error was observed in the first week of radiotherapy (p < 0.001) and the deviations gradually decreased with time. The deviation of setup error was 5.68 mm in the first week and within 5 mm after the second week. Conclusion In this study, there was a significant association between breast size and significant setup error in breast cancer patients who received TomoDirect. The largest deviation occurred in the first week of treatment. Therefore, patients with large breasts should be closely observed on every fraction and fastidious attention is required in the first fraction of IGRT.

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Xihuang pill promotes apoptosis of Treg cells in the tumor microenvironment in 4T1 mouse breast cancer by upregulating MEKK1/SEK1/JNK1/AP-1 pathway
Liang Su, Yiming Jiang, Yu Xu, Xinye Li, Wenbin Gao, Chunwei Xu, Changqian Zeng, Jie Song, Wencai Weng, Wenbo Liang
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The Antitumor Effect of Xihuang Pill on Treg Cells Decreased in Tumor Microenvironment of 4T1 Breast Tumor‐Bearing Mice by PI3K/AKT~AP‐1 Signaling Pathway
Xin-ye Li, Liang Su, Yi-ming Jiang, Wen-bin Gao, Chun-wei Xu, Chang-qian Zeng, Jie Song, Yu Xu, Wen-cai Weng, Wen-bo Liang, Jian-Li Gao
Evidence-Based Complementary and Alternative Medicine.2018;[Epub] CrossRef
Setup errors and effectiveness of Optical Laser 3D Surface imaging system (Sentinel) in postoperative radiotherapy of breast cancer
Xiaobo Wei, Mengjiao Liu, Yun Ding, Qilin Li, Changhai Cheng, Xian Zong, Wenming Yin, Jie Chen, Wendong Gu
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Applying human factors engineering methods for hazard identification and mitigation in the radiotherapy process
Mariana Bernardes, Clarissa Trzesniak, Patricia Trbovich, Carlos Henrique Pereira Mello
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Compared with intensity‐modulated radiotherapy, image‐guided radiotherapy reduces severity of acute radiation‐induced skin toxicity during radiotherapy in patients with breast cancer
Jang‐Chun Lin, Jo‐Ting Tsai, Yu‐Ching Chou, Ming‐Hsien Li, Wei‐Hsiu Liu
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Patient’s Factors at Entering Hospice Affecting Length of Survival in a Hospice Center: Guk Jin Lee, Hye Shin Ahn, Se Eun Go, Ji Hyun Kim, Min Wu Seo, Seung Hun Kang, Yeo Ree Yang, Mi Yeong Lee, Ku Ock Lee, Sang Hoon Chun, Jong Youl Jin; Cancer Res Treat. 2015;47(1):1-8. Published online August 28, 2014; DOI: https://doi.org/10.4143/crt.2013.148

Abstract PDF PubReader ePub

Purpose
In order to provide effective hospice care, adequate length of survival (LOS) in hospice is necessary. However the reported average LOS is much shorter. Analysis of LOS in hospice has not been reported from Korea. We evaluated the duration of LOS and the factors associated with LOS at our hospice center.
Materials and Methods
We retrospectively examined 446 patients who were admitted to our hospice unit between January 2010 and December 2012. We performed univariate and multivariate analysis for analysis of factors associated with LOS.
Results
The median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%) was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completely bedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients (30.1%) had decreased consciousness, from confusion to coma. The median time interval between the day of the last anticancer treatment and the day of hospice admission was 75 days. By analysis of the results of multivariate analysis, decreased intake and laboratory results showing increased total white blood cell (WBC), decreased platelet count, increased serum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival in hospice.
Conclusion
Before hospice admission, careful evaluation of the patient’s performance, particularly the oral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, because these were strong predictors of shorter LOS. In the future, conduct of prospective controlled studies is warranted in order to confirm the relationship between potential prognostic factors and LOS in hospice.

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Changes in the palliative performance scale may be as important as the initial palliative performance scale for predicting survival in terminal cancer patients
Guk Jin Lee, Ji Hyun Gwak, Myoung Sim Kim, Mi Yeong Lee, Seo Ree Kim, Sang Hoon Chun, Jong Youl Jin
Palliative and Supportive Care.2021; 19(5): 547. CrossRef
Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study
Eun Ju Park, Kwonoh Park, Jae-Joon Kim, Sang-Bo Oh, Ki Sun Jung, So Yeon Oh, Yun Jeong Hong, Jin Hyeok Kim, Joo Yeon Jang, Ung-Bae Jeon
Cancer Research and Treatment.2021; 53(3): 881. CrossRef
Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study
Min-Seok Seo, In Cheol Hwang, Jaehun Jung, Hwanhee Lee, Jae Hee Choi, Jae-Yong Shim
BMC Palliative Care.2020;[Epub] CrossRef
The Impact of Combined Use of Opioids, Antipsychotics, and Anxiolytics on Survival in the Hospice Setting
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Aleksandar Čubranić
Journal of Pain and Symptom Management.2018; 55(1): 22. CrossRef
Cancer-related hypercalcemia in oral cancer
T.-C. Lin, K.-L. Liang, L.-C. Lee, C.-Y. Hsu, T.-T. Yen
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Physical Exercise: An Evaluation of a New Clinical Biomarker of Survival in Hospice Patients
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Lidija Gović-Golčić, Aleksandar Čubranić
American Journal of Hospice and Palliative Medicine®.2018; 35(11): 1377. CrossRef
Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea
Youngin Lee, Seung Hun Lee, Yun Jin Kim, Sang Yeoup Lee, Jeong Gyu Lee, Dong Wook Jeong, Yu Hyeon Yi, Young Jin Tak, Hye Rim Hwang, Mieun Gwon
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A Case-Control Study to Identify Risk Factors for Totally Implantable Central Venous Port-Related Bloodstream Infection: Guk Jin Lee, Sook Hee Hong, Sang Young Roh, Sa Rah Park, Myung Ah Lee, Hoo Geun Chun, Young Seon Hong, Jin Hyoung Kang, Sang Il Kim, Youn Jeong Kim, Ho Jong Chun, Jung Suk Oh; Cancer Res Treat. 2014;46(3):250-260. Published online July 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.3.250

Abstract PDF PubReader ePub

Purpose
To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer.
Materials and Methods
A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time.
Results
CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047).
Conclusion
In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted.

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Wei Wang, Chunling Zhao, Qinglian Ji, Ying Liu, Guirong Shen, Lili Wei
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Central venous access in oncology: ESMO Clinical Practice Guidelines
B. Sousa, J. Furlanetto, M. Hutka, P. Gouveia, R. Wuerstlein, J.M. Mariz, D. Pinto, F. Cardoso
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Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli
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