The relationship between hospital volume and outcome of gastrointestinal cancer surgery in Korea.

OBJECTIVES: To assess the relationship between hospital volume and in-hospital mortality of patients undergoing four surgical procedures for gastrointestinal cancers in Korea. METHODS: Using the database of the Health Insurance Review and Assessment Service, we identified 66,201 patients who underwent the four types of gastrointestinal resection during the period 2005-2006. Participating hospitals were divided into five groups according to their surgical volume. The primary outcome was in-hospital mortality, defined as death from any cause before discharge. Multivariate logistic regression analysis was performed to determine the effect of hospital volume on risk-adjusted in-hospital mortality. RESULTS: We observed a significant relationship between hospital volume and in-hospital mortality rate for patients undergoing the four types of cancer-related gastrointestinal surgeries. The in-hospital mortality rate was lower for high-volume than for low-volume hospitals after adjusting for patient characteristics. The differences between very-high-volume and very-low-volume hospitals ranged from 0.94% to 2.77% for the four procedures, with the largest difference observed for pancreatic resection (3.75% vs. 0.98%). CONCLUSION: High-volume hospitals had better short-term surgical outcome than low-volume hospitals. We confirmed the volume-outcome relationship for four cancer-related gastrointestinal resections in Korea.

Lymphoepithelioma-like carcinoma of the urinary bladder.

A 78-yr-old woman presented with gross hematuria for 2 weeks. On cystoscopy, a frond-like mass was observed at the bladder trigone. Transurethral resection of bladder tumor was performed for the mass. Histopathological findings showed that 90% of lesions were lymphoepithelioma-like carcinoma (LELCA) and a few lesions were non-invasive transitional cell carcinoma. On microscopy, syncytial growth pattern and indistinct cytoplasmic borders were observed with the severe infiltration of lymphoid cells. The case was followed-up for 8 months without recurrence. This is the first report of a LELCA case in Korea.

Menopause Knowledge, Attitude, Symptom and Management among Midlife Employed Women.

OBJECTIVES: Midlife women's knowledge, positive attitudes and management toward menopause may improve the quality of peri and post-menopause life. This study was to identify correlations of the knowledge, attitude, symptoms and management toward menopause in middle-aged women. METHODS: We used a cross-sectional questionnaire study applying to 231 perimenopausal and menopausal women aged from 40 to 59 years old. The completed data of 189 perimenopausal and menopausal women were analyzed through t-test, ANOVA and pearson's correlation coefficient using the SPSS statistical programme. RESULTS: The menopausal women showed significantly higher physical symptoms than perimenopausal women. The menopausal women showed significantly higher psychosomatic symptom than perimenopausal women. There was a significant correlation between the menopausal attitude and management. CONCLUSION: This study suggests that the fundamental data of developing midlife women's symptom index (MSI) and providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women.

Clinical role of Bcl-2, Bax, or p53 overexpression in peripheral T-cell lymphomas.

Apoptosis pathways are known to be involved in the pathogenesis of peripheral T-cell lymphomas (PTCLs). As such, the current study attempted to investigate the overexpression of Bcl-2, Bax, or p53 with respect to the progression of PTCL. Paraffin-embedded specimens from 74 patients were analyzed immunohistochemically for Bcl-2, Bax, or p53 overexpression including PTCL-unspecified (n=45), extranodal natural killer cell/T-cell lymphoma (n=10), angioimmunoblastic T-cell lymphoma (n=7), anaplastic large cell lymphoma (n=7), and cutaneous T-cell lymphoma (n=5). The Bcl-2 overexpression was exhibited in 33 (45%), Bax, 17 (23%), and p53, 33 patients (45%). Bcl-2 overexpression was strongly associated with advanced stage (p=0.021) and higher international prognostic indices (IPI) (p=0.038). Bcl-2(+)/p53(+) group was found to be associated with advanced stage (p=0.008) and higher IPI (p=0.001), compared with the other groups. The independent expression of Bcl-2 or p53 was not correlated with survival. Meanwhile, when confined to Bcl-2 overexpressing groups, p53 overexpression was significantly associated with poor survival (p=0.05), as the 3-year OS rate was 82.5% for Bcl-2(+)/p53- cases, yet only 32.9% for Bcl-2(+)/p53(+) cases. Multivariate analyses for OS found the Bcl-2/p53 co-expression (p=0.004) as independent prognostic factor, together with advanced stage (p<0.001) and higher prognostic index for PTCL (p=0.008). Bcl-2 overexpression seemed to correlate with the progression of PTCL interacting with a p53-dependent pathway.

DNA hypermethylation of tumor-related genes in gastric carcinoma.

The hypermethylation of the CpG islands is a common mechanism for the inactivation of tumor-related genes. In the present study, we analyzed the methylation status of genes for cell repair such as hMLH1, MGMT, and GSTP1, and a gastric cancer-specifically methylated DNA fragment, MINT 25 in gastric cancer cases and control groups. The study population consisted of 100 gastric cancer patients (50 distal and 50 proximal carcinomas), and 238 healthy controls. All genes showed more frequent hypermethylation in the cases than in the control group (p<0.0001). We investigated the association between promoter hypermethylation and relevant parameters including age, gender, alcohol consumption, smoking, and family history. There was a common hypermethylation of hMLH1 (p=0.008), MGMT (p= 0.0001), and GSTP1 (p=0.0003) in females. This study also demonstrates that hypermethylation was strongly associated with non-drinkers (MGMT, p=0.046 and MINT 25, p=0.049) and non-smokers (hMLH1, p=0.044; MGMT, p=0.0003; MINT 25, p=0.029). Moreover, the frequency of MINT 25 hypermethylation increased with age (p=0.037), and MGMT methylation was frequently detected in distal gastric cancer than in proximal type (p=0.038). Our study suggested that promoter hypermethylation of the genes involved in cell repair system and MINT 25 is associated strongly with some subgroups of primary gastric carcinoma.

Prognostic significance of bcl-2, bax, and p53 expression in diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma (DLCL) exhibits heterogeneous clinical features and varies markedly in response to treatment and prognosis. Because apoptosis-related proteins may play an important role in predicting the prognosis of DLCL, the current study investigated the prognostic significance of a high level of bcl-2, bax, and p53 expression in relation to clinical characteristics in patients with DLCL. Paraffin-embedded specimens from 94 patients with de novo DLCL were analyzed immunohistochemically for bcl-2, bax, and p53 gene expression. Cases with a positive immunohistological stain in more than 50% of the tumor cells were considered to have DLCL-positive expression. Patients were treated optimally, i.e., with radiotherapy including brief cycles of CHOP or CHOP-like regimens for patients with stage 1-2A diseases and with at least 6 cycles of CHOP or CHOP-like regimens for stage 2B-4 diseases. The responses to therapy and survival were then analyzed in 94 uniformly staged patients. bcl-2 expression was identified in 24 patients (26.4%), bax expression in 35 patients (37.6 %), and p53 expression in 21 patients (22.6%). bax expression proved to be a statistically significant prognostic factor in predicting the overall survival (OS) (P = 0.0015) and disease-free survival (DFS) (P = 0.0052), regardless of other clinical factors or immunohistological results. There was no significant difference in the OS (P = 0.0682) or DFS (P = 0.088) between the bcl-2-positive (n = 24) and bcl-2-negative (n = 67) groups. However, bcl-2 expression was found to be unfavorably associated with the OS (P = 0.0054) in a confined group with low (n = 51) or low intermediate (n = 22) IPI scores. The expression of p53 exhibited no statistical correlation with the OS or DFS. A multivariate analysis revealed that IPI score, bulky mass, and bax expression were all significantly associated with the DFS or OS. bax and bcl-2 should be considered as independent biologic prognostic parameters in DLCL, thereby aiding in the identification of patient risk groups. As such, bcl-2-positive patients with a low or low intermediate IPI score, or without a high level of bax expression could be candidates for more intensive therapy or alternative therapeutic approaches.