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11 "Jeanny Kwon"
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Breast cancer
Locoregional Recurrence in Adenoid Cystic Carcinoma of the Breast: A Retrospective, Multicenter Study (KROG 22-14)
Sang Min Lee, Bum-Sup Jang, Won Park, Yong Bae Kim, Jin Ho Song, Jin Hee Kim, Tae Hyun Kim, In Ah Kim, Jong Hoon Lee, Sung-Ja Ahn, Kyubo Kim, Ah Ram Chang, Jeanny Kwon, Hae Jin Park, Kyung Hwan Shin
Cancer Res Treat. 2025;57(1):150-158.   Published online July 12, 2024
DOI: https://doi.org/10.4143/crt.2024.201
AbstractAbstract PDFPubReaderePub
Purpose
This study aims to evaluate the treatment approaches and locoregional patterns for adenoid cystic carcinoma (ACC) in the breast, which is an uncommon malignant tumor with limited clinical data.
Materials and Methods
A total of 93 patients diagnosed with primary ACC in the breast between 1992 and 2022 were collected from multi-institutions. All patients underwent surgical resection, including breast-conserving surgery (BCS) or total mastectomy (TM). Recurrence patterns and locoregional recurrence-free survival (LRFS) were assessed.
Results
Seventy-five patients (80.7%) underwent BCS, and 71 of them (94.7%) received post-operative radiation therapy (PORT). Eighteen patients (19.3%) underwent TM, with five of them (27.8%) also receiving PORT. With a median follow-up of 50 months, the LRFS rate was 84.2% at 5 years. Local recurrence (LR) was observed in five patients (5.4%) and four cases (80%) of the LR occurred in the tumor bed. Three of LR (3/75, 4.0%) had a history of BCS and PORT, meanwhile, two of LR (2/18, 11.1%) had a history of mastectomy. Regional recurrence occurred in two patients (2.2%), and both cases had a history of PORT with (n=1) and without (n=1) irradiation of the regional lymph nodes. Partial breast irradiation (p=0.35), BCS (p=0.96) and PORT in BCS group (p=0.33) had no significant association with LRFS.
Conclusion
BCS followed by PORT was the predominant treatment approach for ACC of the breast and LR mostly occurred in the tumor bed. The findings of this study suggest that partial breast irradiation might be considered for PORT in primary breast ACC.
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The Pattern of Care for Brain Metastasis from Breast Cancer over the Past 10 Years in Korea: A Multicenter Retrospective Study (KROG 16-12)
Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki Chung, Kyung Su Kim, Ji Ho Nam, Won Sup Yoon, Jin Hee Kim, Jihye Cha, Yoon Kyeong Oh, In Ah Kim
Cancer Res Treat. 2022;54(4):1121-1129.   Published online December 31, 2021
DOI: https://doi.org/10.4143/crt.2021.1083
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We aimed to investigate manifestations and patterns of care for patients with brain metastasis (BM) from breast cancer (BC) and compared their overall survival (OS) from 2005 through 2014 in Korea.
Materials and Methods
We retrospectively reviewed 600 BC patients with BM diagnosed between 2005 and 2014. The median follow-up duration was 12.5 months. We categorized the patients into three groups according to the year when BM was initially diagnosed (group I [2005-2008], 98 patients; group II [2009-2011], 200 patients; and group III [2012-2014], 302 patients).
Results
Over time, the median age at BM diagnosis increased by 2.2 years (group I, 49.0 years; group II, 48.3 years; and group III, 51.2 years; p=0.008). The percentage of patients with extracranial metastasis was 73.5%, 83.5%, and 86.4% for group I, II, and III, respectively (p=0.011). The time interval between BC and BM was prolonged in patients with stage III primary BC (median, 2.4 to 3 years; p=0.029). As an initial brain-directed treatment, whole-brain radiotherapy alone decreased from 80.0% in 2005 to 41.1% in 2014. Meanwhile, stereotactic radiosurgery or fractionated stereotactic radiotherapy alone increased from 13.3% to 34.7% during the same period (p=0.005). The median OS for group I, II, and III was 15.6, 17.9, and 15.0 months, respectively, with no statistical significance.
Conclusion
The manifestations of BM from BC and the pattern of care have changed from 2005 to 2014 in Korea. However, the OS has remained relatively unchanged over the 10 years.

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  • Comparison of initial and sequential salvage brain-directed treatment in patients with 1–4 vs. 5–10 brain metastases from breast cancer (KROG 16–12)
    Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki C
    Breast Cancer Research and Treatment.2023; 200(1): 37.     CrossRef
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Postmastectomy Radiation Therapy for Node-Negative Breast Cancer of 5 cm or Larger Tumors: A Multicenter Retrospective Analysis (KROG 20-03)
Kyubo Kim, Jinhong Jung, Haeyoung Kim, Wonguen Jung, Kyung Hwan Shin, Ji Hyun Chang, Su Ssan Kim, Won Park, Jee Suk Chang, Yong Bae Kim, Sung Ja Ahn, Ik Jae Lee, Jong Hoon Lee, Hae Jin Park, Jihye Cha, Juree Kim, Jin Hwa Choi, Taeryool Koo, Jeanny Kwon, Jin Hee Kim, Mi Young Kim, Shin-Hyung Park, Yeon-Joo Kim
Cancer Res Treat. 2022;54(2):497-504.   Published online August 25, 2021
DOI: https://doi.org/10.4143/crt.2021.933
AbstractAbstract PDFPubReaderePub
Purpose
To evaluate the role of postmastectomy radiation therapy (PMRT) in patients with node-negative breast cancer of 5cm or larger tumors undergoing mastectomy
Materials and Methods
Medical records of 274 patients from 18 institutions treated with mastectomy between January 2000 and December 2016 were retrospectively reviewed. Among these, 202 patients underwent PMRT, while 72 did not. Two hundred and forty-one patients (88.0%) received systemic chemotherapy, and 172 (62.8%) received hormonal therapy. Patients receiving PMRT were younger, more likely to have progesterone receptor-positive tumors, and received adjuvant chemotherapy more frequently compared with those without PMRT (p <0.001, 0.018, and <0.001, respectively). Other characteristics were not significantly different between the two groups.
Results
With a median follow-up of 95 months (range, 1-249), there were 9 locoregional recurrences, and 20 distant metastases. The 8-year locoregional recurrence-free survival rates were 98.0% with PMRT and 91.3% without PMRT (p=0.133), and the 8-year disease-free survival (DFS) rates were 91.8% with PMRT and 73.9% without PMRT (p=0.008). On multivariate analysis incorporating age, histologic grade, lymphovascular invasion, hormonal therapy, chemotherapy, and PMRT, the absence of lymphovascular invasion and the receipt of PMRT were associated with improved DFS (p=0.025 and 0.009, respectively).
Conclusion
Locoregional recurrence rate was very low in node-negative breast cancer of 5cm or larger tumors treated with mastectomy regardless of the receipt of PMRT. However, PMRT was significantly associated with improved DFS. Further investigation is needed to confirm these findings.

Citations

Citations to this article as recorded by  
  • Outcomes with and without postmastectomy radiotherapy for pT3N0‐1M0 breast cancer: An institutional experience
    Xinxin Rao, Xuanyi Wang, Kairui Jin, Yilan Yang, Xu Zhao, Zhe Pan, Weiluo Lv, Zhen Zhang, Li Zhang, Xiaoli Yu, Xiaomao Guo
    Cancer Medicine.2024;[Epub]     CrossRef
  • The effect of radiotherapy on patients with pathological stage IIB breast cancer after breast-conserving surgery or mastectomy: A cohort study
    Yi-Ying Pan, Tzu-Yu Lai, Cheng-Ying Shiau, Ling-Ming Tseng, I-Chun Lai, Yu-Ming Liu, Pin-I Huang
    Journal of the Chinese Medical Association.2024; 87(2): 202.     CrossRef
  • Post-mastectomy radiation therapy after breast reconstruction: from historic dogmas to practical expert agreements based on a large literature review of surgical and radiation therapy considerations
    Yazid Belkacemi, Meena S. Moran, Burcu Celet Ozden, Yazan Masannat, Fady Geara, Mohamed Albashir, Nhu Hanh To, Kamel Debbi, Mahmoud El Tamer
    Critical Reviews in Oncology/Hematology.2024; 200: 104421.     CrossRef
  • Impact of the 21-gene recurrence score testing on chemotherapy selection and clinical outcomes in T3N0 luminal breast cancer
    Ke Liu, Jia-Yi Li, Guan-Qiao Li, Zhen-Yu He, San-Gang Wu
    Expert Review of Anticancer Therapy.2024; 24(12): 1283.     CrossRef
  • Post-Mastectomy Radiation Therapy: Applications and Advancements
    Jessica L. Thompson, Steven G. Allen, Cecilia Pesavento, Corey W. Speers, Jacqueline S. Jeruss
    Current Breast Cancer Reports.2022; 14(3): 75.     CrossRef
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Effect of Postoperative Radiotherapy after Primary Tumor Resection in De Novo Stage IV Breast Cancer: A Multicenter Retrospective Study (KROG 19-02)
Yeon Joo Kim, Yeon-Joo Kim, Yong Bae Kim, Ik Jae Lee, Jeanny Kwon, Kyubo Kim, Jihye Cha, Myungsoo Kim, In Young Jo, Jung Hoon Kim, Jaehyeon Park, Jin Hee Kim, Juree Kim, Kyung Hwan Shin, Su Ssan Kim
Cancer Res Treat. 2022;54(2):478-487.   Published online July 12, 2021
DOI: https://doi.org/10.4143/crt.2021.632
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT.
Materials and Methods
This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively.
Results
The median follow-up time was 53.7 months (range, 3.1 to 194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 category, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio, 0.64; 95% confidence interval, 0.50 to 0.82; p < 0.001), in addition to T1/2 category, ≤ 5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups (group 1, T1/2 and non-TNBC [n=193]; group 2, T3/4 and non-TNBC [n=171]; and group 3, TNBC [n=49]), and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regarding PFS in groups 1 and 2, not in group 3.
Conclusion
PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 category and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.

Citations

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  • Letter to the editor for the article“Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model”
    Yaping Miao, Lexin Wang, Ping Chen, Jiaan Lu, Guanhu Yang, Hao Chi
    World Journal of Urology.2024;[Epub]     CrossRef
  • The prognostic differences and the effect of postmastectomy radiotherapy between post‐chemotherapy ypT1‐2ypN1 and de novo pT1‐2N1 breast cancer
    Tian Yang, Xiaorong Zhong, Jun Wang, Zhongzheng Xiang, Yuanyuan Zeng, Siting Yu, Zelei Dai, Ningyue Xu, Ting Luo, Lei Liu
    Cancer Medicine.2023; 12(7): 8112.     CrossRef
  • Impact of high dose radiotherapy for breast tumor in locoregionally uncontrolled stage IV breast cancer: a need for a risk-stratified approach
    Nalee Kim, Haeyoung Kim, Won Park, Won Kyung Cho, Tae Gyu Kim, Young-Hyuck Im, Jin Seok Ahn, Yeon Hee Park, Ji-Yeon Kim
    Radiation Oncology.2023;[Epub]     CrossRef
  • Machine learning predicts the prognosis of breast cancer patients with initial bone metastases
    Chaofan Li, Mengjie Liu, Jia Li, Weiwei Wang, Cong Feng, Yifan Cai, Fei Wu, Xixi Zhao, Chong Du, Yinbin Zhang, Yusheng Wang, Shuqun Zhang, Jingkun Qu
    Frontiers in Public Health.2022;[Epub]     CrossRef
  • Factors Influencing Prognosis in Patients with De Novo Stage IV Breast Cancer: A Systematic Review and Meta-Analysis
    Meilin Zhang, Zining Jin, Yingying Xu, Bo Chen, Jian Song, Muyao Li, Feng Jin, Ang Zheng
    SSRN Electronic Journal .2022;[Epub]     CrossRef
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A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy
Yu Jin Lim, Sea-Won Lee, Noorie Choi, Jeanny Kwon, Keun-Yong Eom, Eunyoung Kang, Eun-Kyu Kim, Jee Hyun Kim, Yu Jung Kim, Se Hyun Kim, So Yeon Park, In Ah Kim
Cancer Res Treat. 2018;50(4):1140-1148.   Published online December 7, 2017
DOI: https://doi.org/10.4143/crt.2017.508
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer.
Materials and Methods
A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model.
Results
The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029).
Conclusion
The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

Citations

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  • Predicting Patterns of Distant Metastasis in Breast Cancer Patients following Local Regional Therapy Using Machine Learning
    Audrey Shiner, Alex Kiss, Khadijeh Saednia, Katarzyna J. Jerzak, Sonal Gandhi, Fang-I Lu, Urban Emmenegger, Lauren Fleshner, Andrew Lagree, Marie Angeli Alera, Mateusz Bielecki, Ethan Law, Brianna Law, Dylan Kam, Jonathan Klein, Christopher J. Pinard, Ale
    Genes.2023; 14(9): 1768.     CrossRef
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    Yuqian Feng, Yiting Zhang, Yuying Xiang, Kaibo Guo, Huimin Jin, Shanming Ruan, Zhuoya Guan
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • Cost-effectiveness of postmastectomy hypofractionated radiation therapy vs conventional fractionated radiation therapy for high-risk breast cancer
    Jing Yang, Shu-Nan Qi, Hui Fang, Yong-Wen Song, Jing Jin, Yue-Ping Liu, Wei-Hu Wang, Yong Yang, Yu Tang, Hua Ren, Bo Chen, Ning-Ning Lu, Yuan Tang, Ning Li, Hao Jing, Shu-Lian Wang, Ye-Xiong Li
    The Breast.2021; 58: 72.     CrossRef
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    Koji Takada, Shinichiro Kashiwagi, Yuka Asano, Wataru Goto, Rika Kouhashi, Akimichi Yabumoto, Sae Ishihara, Tamami Morisaki, Masatsune Shibutani, Hiroaki Tanaka, Kosei Hirakawa, Masaichi Ohira
    BMC Women's Health.2021;[Epub]     CrossRef
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    Inmaculada Beato Tortajada, Carlos Ferrer Albiach, Virginia Morillo Macias
    The Breast.2021; 60: 255.     CrossRef
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    Disease Markers.2019; 2019: 1.     CrossRef
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    Zhenchong Xiong, Guangzheng Deng, Xinjian Huang, Xing Li, Xinhua Xie, Jin Wang, Zeyu Shuang, Xi Wang
    Cancer Research and Treatment.2018; 50(4): 1260.     CrossRef
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The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04)
Jeanny Kwon, Keun-Young Eom, Young Seok Kim, Won Park, Mison Chun, Jihae Lee, Yong Bae Kim, Won Sup Yoon, Jin Hee Kim, Jin Hwa Choi, Sei Kyung Chang, Bae Kwon Jeong, Seok Ho Lee, Jihye Cha
Cancer Res Treat. 2018;50(3):964-974.   Published online October 24, 2017
DOI: https://doi.org/10.4143/crt.2017.346
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence.
Materials and Methods
A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)).
Results
In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ ‒0.58 vs. > ‒0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p < 0.001, p=0.020, and p=0.031, respectively) and DFS (p < 0.001, p=0.017, and p=0.001, respectively). A scoring system using these three factors predicts risk of recurrence with relatively high concordance index (DMFS, 0.69; DFS, 0.71).
Conclusion
mPLN > 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.

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    Elki Sze-Nga Cheung, Philip Yuguang Wu
    Cancers.2025; 17(2): 202.     CrossRef
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    Clinical & Experimental Metastasis.2025;[Epub]     CrossRef
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    Technology in Cancer Research & Treatment.2022;[Epub]     CrossRef
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    Yue Wang, Ruby Jean Chang, Rong-Zhen Luo, Jing Yu, Xiaofei Zhang, Xianghong Yang, M.R. Quddus, Li Li, Wentao Yang, Aijun Liu, Qingping Jiang, Ruijiao Zhao, Huiting Zhu, Feng Zhou, Yiying Wang, Xiujie Sheng, Li-Li Liu, Yan-Lin Wen, Natalie Banet, C.J. Sung
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    Seiji Mabuchi, Naoko Komura, Michiko Kodama, Michihide Maeda, Yuri Matsumoto, Shoji Kamiura
    Current Oncology.2022; 29(7): 4856.     CrossRef
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    Mengting Wang, Min Ma, Liju Yang, Chengtong Liang
    Frontiers in Oncology.2022;[Epub]     CrossRef
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    Can Zhang, Xinghua Zhu, Yong Li, Jia Shao, Haibo Xu, Lei Chen, Youli Dan, Hua Jin, Aiqin He
    Medicine.2022; 101(41): e31178.     CrossRef
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    Xiaojuan Lv, Huiting Rao, Tao Feng, Chufan Wu, Hanmei Lou
    Radiation Oncology.2022;[Epub]     CrossRef
  • Prognostic value of lymph node ratio in cervical cancer: A meta-analysis
    Haixia Cui, Yuan Huang, Weibo Wen, Xiangdan Li, Dongyuan Xu, Lan Liu
    Medicine.2022; 101(42): e30745.     CrossRef
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Close layer
Evaluation of the Benefit of Radiotherapy in Patients with Occult Breast Cancer: A Population-Based Analysis of the SEER Database
Byoung Hyuck Kim, Jeanny Kwon, Kyubo Kim
Cancer Res Treat. 2018;50(2):551-561.   Published online June 1, 2017
DOI: https://doi.org/10.4143/crt.2017.189
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Few studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data.
Materials and Methods
We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479).
Results
Patients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016).
Conclusion
RT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.

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Meta-Analysis
Impact of Resection Margin Distance on Survival of Pancreatic Cancer: A Systematic Review and Meta-Analysis
Kyung Su Kim, Jeanny Kwon, Kyubo Kim, Eui Kyu Chie
Cancer Res Treat. 2017;49(3):824-833.   Published online August 26, 2016
DOI: https://doi.org/10.4143/crt.2016.336
AbstractAbstract PDFPubReaderePub
Purpose
While curative resection is the only chance of cure in pancreatic cancer, controversies exist about the impact of surgical margin status on survival. Non-standardized pathologic report and different criteria on the R1 status made it difficult to implicate adjuvant therapy after resection based on the margin status. We evaluated the influence of resection margins on survival by meta-analysis.
Materials and Methods
We thoroughly searched electronic databases of PubMed, EMBASE, and Cochrane Library. We included studies reporting survival outcomeswith different margin status: involved margin (R0 mm), margin clearance with ≤ 1 mm (R0-1 mm), and margin with > 1 mm (R>1 mm). Hazard ratio (HR) for overall survival was extracted, and a random-effects model was used for pooled analysis.
Results
A total of eight retrospective studies involving 1,932 patients were included. Pooled HR for overall survival showed that patients with R>1 mm had reduced risk of death than those with R0-1 mm (HR, 0.74; 95% confidence interval [CI], 0.61 to 0.88; p=0.001). In addition, patients with R0-1 mm had reduced risk of death than those with R0 mm (HR, 0.81; 95% CI, 0.72 to 0.91; p < 0.001). There was no heterogeneity between the included studies (I 2 index, 42% and 0%; p=0.10 and p=0.82, respectively).
Conclusion
Our results suggest that stratification of the patients based on margin status is warranted in the clinical trials assessing the role of adjuvant treatment for pancreatic cancer.

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Original Articles
Long-Term Outcome of Distal Cholangiocarcinoma after Pancreaticoduodenectomy Followed by Adjuvant Chemoradiotherapy: A 15-Year Experience in a Single Institution
Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jeanny Kwon, Jin-Young Jang, Sun Whe Kim, Do-Youn Oh, Yung-Jue Bang
Cancer Res Treat. 2017;49(2):473-483.   Published online August 23, 2016
DOI: https://doi.org/10.4143/crt.2016.166
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study was conducted to evaluate the long-term outcome in patients undergoing pancreaticoduodenectomy (PD) followed by adjuvant chemoradiotherapy for distal cholangiocarcinoma (DCC) in a high-volume center and to identify the prognostic impact of clinicopathologic factors.
Materials and Methods
A total of 132 consecutive patients who met the inclusion criteria were retrieved from the institutional database from January 1995 to September 2009. All patients received adjuvant treatments at a median of 45 days after the surgery. Median follow-up duration was 57 months (range, 6 to 225 months) for all patients and 105 months for survivors (range, 13 to 225 months).
Results
The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 70.7%, 55.7%, 49.4%, and 48.1%, respectively. Univariate analysis revealed poorly differentiated (P/D) tumors and lymph node (LN) metastasis were significantly associated with DMFS and OS. Additionally, preoperative carbohydrate antigen 19-9 level was significantly correlated with DFS, LRRFS, and DMFS. Upon multivariate analysis for OS, P/D tumors (p=0.015) and LN metastasis (p=0.003) were significant prognosticators that predicted inferior OS. Grade 3 or higher late gastrointestinal toxicity occurred in only one patient (0.8%).
Conclusion
Adjuvant chemoradiotherapy after PD for DCC is an effective and tolerable strategy without significant side effects. During long-term follow-up, we found that prognosis of DCC was mainly influenced by histologic differentiation and LN metastasis. For patients with these risk factors, further research should focus on improving adjuvant strategies as well as other treatment approaches.

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Prognostic Value of Log Odds of Positive Lymph Nodes after Radical Surgery Followed by Adjuvant Treatment in High-Risk Cervical Cancer
Jeanny Kwon, Keun-Yong Eom, In Ah Kim, Jae-Sung Kim, Young-Beom Kim, Jae Hong No, Kidong Kim
Cancer Res Treat. 2016;48(2):632-640.   Published online July 14, 2015
DOI: https://doi.org/10.4143/crt.2015.085
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to compare the prognostic efficacy of the number and location of positive lymph nodes (LN), LN ratio (LNR), and log odds of positive LNs (LODDs) in highrisk cervical cancer treated with radical surgery and adjuvant treatment. Materials and Methods Fifty high-risk patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment were analyzed retrospectively. The patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIB. Upper LN is defined as common iliac or higher LN, and LNR is the ratio of positive LNs to harvested LNs. LODDs is log odds between positive LNs and negative LNs. Radiotherapy was delivered to the whole pelvis with median 50.4 Gy/28 Fx± to the para-aortic regions. Platinum-based chemotherapy was used in most patients (93%). The median follow-up duration was 80 months. Results The 5-year disease-free survival (DFS) rate was 76.1%, and the overall survival (OS) rate was 86.4%. Treatment failure occurred in 11 patients, and distant failure (DF) was the dominant pattern (90.9%). In univariate analysis, significantly lower DFSwas observed in patients with perineural invasion, ≥ 2 LN metastases, LNR ≥ 10%, upper LN metastasis, and ≥ –1.05 LODDs. In multivariate analysis, ≥ –1.05 LODDs was the only significant factor for DFS (p=0.011). Of patients with LODDs ≥ –1.05, 40.9% experienced DF. LODDs was the only significant prognostic factor for OS as well (p=0.006). Conclusion LODDs ≥ –1.05 was the only significant prognostic factor for both DFS and OS. In patients with LODDs ≥ –1.05, intensified chemotherapy might be required, considering the high rate of DF.

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Objective Measurement of Cosmetic Outcomes of Breast Conserving Therapy Using BCCT.core
Tosol Yu, Keun-Yong Eom, Na Young Jang, Kyung Su Kim, Tae Ryool Koo, Jeanny Kwon, Byoung Hyuck Kim, Eunyoung Kang, Sung-Won Kim, Jae-Sung Kim, In Ah Kim
Cancer Res Treat. 2016;48(2):491-498.   Published online June 22, 2015
DOI: https://doi.org/10.4143/crt.2015.088
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study is to evaluate objective cosmetic outcomes and factors related to breast-conserving therapy (BCT) using the BCCT.core software.
Materials and Methods
Fifty-one patients who received BCT with informed consent were evaluated using the BCCT.core software. Patients were divided into two groups based on the BCCT score: excellent or good (n=42) vs. fair or poor (n=9). Analysis of clinical factors was performed to determine factors affecting cosmetic outcomes.
Results
The objective cosmetic outcome of BCT measured using the BCCT.core software was excellent in 10% of patients, good in 72%, and fair in 18%. None of the patients were classified as poor outcome. Tumor characteristics, systemic adjuvant therapy (chemotherapy and hormonal therapy), and radiation dose or energy of electron boost did not show correlation with the score measured by the BCCT.core program (p > 0.05). In univariate analysis, maximum dose within the breast (Dmax), width of tangential field, and excised tumor volume were smaller in patients with excellent or good by the BCCT.core compared to those with fair or poor (Dmax, 110.2±1.5% vs. 111.6±1.7%, p=0.019; width of tangential field, 8.0±1.1 cm vs. 8.6±0.7 cm, p=0.034; excised tumor volume, 64.0±35.8 cm3 vs. 95.3±54.4 cm3, p=0.067). In multivariate analysis, only Dmax was a significant factor for breast cosmetic outcome with a risk ratio of 1.697 (95% confidence interval, 1.006 to 2.863; p=0.047).
Conclusion
Objective measurement of cosmetic outcome of BCT using the BCCT.core software was feasible. The cosmetic outcome of BCT may be affected by the maximum dose within the breast.

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