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Pathanasethpong P, Nawapun S, Chadbunchachai P, Somintara O, Apivatanasiri C, Boonrod A. The diagnostic accuracy of mammography and ultrasonography for recurrent breast cancer after breast conserving treatment. Eur J Radiol Open 2023; 11:100514. [PMID: 37609045 PMCID: PMC10440391 DOI: 10.1016/j.ejro.2023.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To evaluate the performance of mammography and breast ultrasonography to diagnose tumor recurrence in patients after breast conserving therapy. Material and Methods Imaging findings of 130 breast cancer patients treated by breast conserving therapy (BCT) who have followed up with mammography and ultrasonography at our center between 1 st January 2010 and 1st January 2016 were interpreted by two radiologists. The information of recurrent tumor and baseline data were blinded. Imaging interpretation followed the ACR Breast imaging-reporting and data system (BI-RADS) 5th edition guideline. Findings of mammography, breast ultrasonography, demographic data and histological data were recorded and analyzed. Results The presence of mass in mammography (P-value=0.025) and internal vascularity in mass in ultrasonography (P-value<0.001) were associated with recurrent tumor at the surgical bed. All the recurrent tumors were interpreted as BI-RADS 4 (71 patients) with sensitivity= 100%, specificity= 89.5%. BIRADS4 is significant in the diagnosis of recurrent breast cancer in BCT patients (AUC of the ROC curve = 0.742 and 95% CI=(0.7-0.79)). Conclusion The presence of mass in mammography and internal vascularity in the mass in ultrasonography are the imaging findings which were significantly related to recurrent tumor at surgical bed in patient with breast conserving treatment.
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Affiliation(s)
| | - Supajit Nawapun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Payia Chadbunchachai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | | | - Arunnit Boonrod
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 40002, Thailand
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Wittayapairoj A, Sinthuchao N, Somintara O, Thincheelong V, Somdee W. A randomized double-blind controlled study comparing erector spinae plane block and thoracic paravertebral block for postoperative analgesia after breast surgery. Anesth Pain Med (Seoul) 2022; 17:445-453. [DOI: 10.17085/apm.22157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Thoracic paravertebral block (PVB) is an effective regional block for pain control after breast surgery. However, accidentally puncturing adjacent vital structures may cause undesirable complications. Erector spinae plane block (ESPB) has been considered a safer proxy of PVB for beginners. This study aimed to evaluate the analgesic effects of ultrasound (US)-guidance PVB and ESPB after breast surgery. Methods: This randomized control trial was conducted in patients who underwent mastectomy. Forty-four women were randomly allocated into PVB group or ESPB group. All patients received a block with 20 ml of 0.5% levobupivacaine before general anesthesia. The primary outcome was the 24-h postoperative morphine requirements. The other outcomes of interest were postoperative pain scores, time to first analgesic request, dermatome of sensory blockade, block-related complications, and opioid adverse events.Results: The 24-h morphine requirements were significantly lower in PVB compared to the ESPB group (3.5 ± 3.3 vs. 8.6 ± 3.8 mg, P < 0.001). The overall pain scores were also lower in the PVB group (P < 0.001). Only 14 patients in the PVB group requested additional morphine, whereas all patients in the ESPB group requested it (P = 0.004). The dermatome of sensory blockade was wider in the PVB group (7 vs. 4 levels, P = 0.019). No serious complications occurred in either group. Conclusions: Compared to ESPB, PVB provided lower postoperative opioid requirements, lower pain scores, and wider sensory blockade after mastectomy.
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AsavachaIsuvikom A, Somintara O, Namuangchan Y, Aphivatanasiri C, Wongbuddha A. Long Term Clinical Outcome and Prognostic Factors after Treatment of Patients Diagnosed with Ductal Carcinoma in Situ of Breast. Asian Pac J Cancer Care 2022. [DOI: 10.31557/apjcc.2022.7.3.459-465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: The retrospective study evaluated the clinical outcome after treatment of patients diagnosed with ductal carcinoma in situ of breast and reanalyzed the prognostic factors related to recurrence rate and disease free survival(DFS) using long-term follow-up. Material & Methods: Between January 2008 and July 2021, 130 patients previously diagnosed ductal carcinoma in situ underwent surgery. We collected retrospective data characteristic data, radiology data, operative data, pathology data, clinical outcome and time to breast tumor recurrence. Median follow-up time was 51.5 months. Results: The 12-year cumulative incidence of tumor recurrence and re- excision in 130 patients were 6.92%(9 patients) and 12.31%(16 patients). Among 9 patients, 5 patients had locoregional recurrence, 3 patients had distant metastasis recurrence and 1 patient had both. Ki-67(OR, 1.06;95% CI 1.00 – 1.11); p-value = 0.045) was associated with an increase risk of recurrence tumor in multivariable analysis. Simple mastectomy(41.54%) and wide excision (38.46%) were the most surgery in this study. Conclusion: The retrospective study showed the 12-year cumulative incidence of recurrence tumor. Although Ki-67 increased risk of recurrence tumor.
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Koonmee S, Somintara O, Intarawichian P, Aphivatanasiri C, Sangkhamanon S, Laohawiriyakamol S, Panawattanakul R, Mahantassanapong P, Rattadilok C, Jeeravongpanich P, Krongyute W, Prachumrasee K, Alaghehbandan R. Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand. Cancer Manag Res 2021; 13:8737-8753. [PMID: 34849028 PMCID: PMC8627199 DOI: 10.2147/cmar.s335386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose Breast cancer is a growing public health challenge in Thailand. Pathum Raksa project was launched in 2015, as a result of higher than expected rate of triple-negative breast cancers in Thai women. The purpose of this project was to identify the cause(s) and address the issue(s), hence improving the quality of breast cancer biomarker testing in Thailand. Materials and Methods Nineteen hospitals across the country, with 902 breast cancer patients were enrolled in this study during 2015–2020. The pre- and post-data from Pathum Raksa initiative was only available for Khon Kaen University (KKU) and Udonthani hospitals in Northeast Thailand. We developed a resource-stratified strategic plan that included designing a unique specimen container, forming multidisciplinary teams from the Surgery and Pathology Departments, and employing locally developed innovative technologies to optimize the entire process of breast cancer diagnostics and biomarker testing. Results The rate of triple-negative breast cancers in KKU and Udonthani decreased 52.8% (p = 0.02) and 28.9% (p = 0.48), respectively. The rate of ER+ breast cancers in both hospitals increased 5% post-Pathum Raksa implementation. The rate of HER2-neu+ (score 3+) also increased in both hospitals (particularly an increased 65% rate in KKU). Luminal A/B cancers were the most common subtype in both KKU and Udonthani hospitals. Conclusion Pathum Raksa project has significantly improved breast cancer biomarker testing in Thailand. As a result of this national innovation, false-negative rates of breast biomarkers have significantly decreased, resulting in improving prognosis, treatment, and survival of breast cancer women in Thailand. ![]()
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Affiliation(s)
- Supinda Koonmee
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | | | | | | | - Wilart Krongyute
- Department of Surgery, Fort Suranari Hospital, Nakhon Ratchasima, Thailand
| | | | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada
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Tummanatsakun D, Proungvitaya T, Roytrakul S, Limpaiboon T, Wongkham S, Wongkham C, Silsirivanit A, Somintara O, Sangkhamanon S, Proungvitaya S. Serum Apurinic/Apyrimidinic Endodeoxyribonuclease 1 (APEX1) Level as a Potential Biomarker of Cholangiocarcinoma. Biomolecules 2019; 9:biom9090413. [PMID: 31454981 PMCID: PMC6770206 DOI: 10.3390/biom9090413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
Diagnostic and/or prognostic biomarkers for cholangiocarcinoma (CCA) are still insufficient with poor prognosis of patients. To discover a new CCA biomarker, we constructed our secretome database of three CCA cell lines and one control cholangiocyte cell line using GeLC-MS/MS. We selected candidate proteins by five bioinformatics tools for secretome analysis. The inclusion criteria were as follows: having predicted signal peptide or being predicted as non-classically secreted protein; together with having no transmembrane helix and being previously detected in plasma and having the highest number of signal peptide cleavage sites. Eventually, apurinic/apyrimidinic endodeoxyribonuclease 1 (APEX1) was selected for further analysis. To validate APEX1 as a bio-marker for CCA, serum APEX1 levels of 80, 39, and 40 samples collected from CCA, benign biliary diseases (BBD), and healthy control groups, respectively, were measured using dot blot analysis. The results showed that serum APEX1 level in CCA group was significantly higher than that in BBD or healthy control group. Among CCA patients, serum APEX1 level was significantly higher in patients having metastasis than in those without metastasis. The higher level of serum APEX1 was correlated with the shorter survival time of the patients. Serum APEX1 level might be a diagnostic and prognostic biomarker for CCA.
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Affiliation(s)
- Doungdean Tummanatsakun
- Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Tanakorn Proungvitaya
- Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sittiruk Roytrakul
- National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Pathumthani 12120, Thailand
| | - Temduang Limpaiboon
- Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sopit Wongkham
- Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chaisiri Wongkham
- Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Atit Silsirivanit
- Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Siriporn Proungvitaya
- Centre of Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
- Cholangiocarcinoma Research Institute (CARI), Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Sanmai S, Proungvitaya T, Limpaiboon T, Chua-On D, Seubwai W, Roytrakul S, Wongkham S, Wongkham C, Somintara O, Sangkhamanon S, Proungvitaya S. Serum pyruvate dehydrogenase kinase as a prognostic marker for cholangiocarcinoma. Oncol Lett 2019; 17:5275-5282. [PMID: 31186744 DOI: 10.3892/ol.2019.10185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/11/2019] [Indexed: 01/03/2023] Open
Abstract
Pyruvate dehydrogenase kinase (PDK) is a Ser/Thr kinase that inactivates mitochondrial pyruvate dehydrogenase and serves a key role in aerobic glycolysis, which is a hallmark of cancer cells. The present study determined the PDK expression in cholangiocarcinoma (CCA) tissues and sera to evaluate their applicability as a biomarker for CCA. Using proteomic analysis, PDK was revealed to be the most overexpressed mitochondrial protein in CCA tissues. Then, the expression of PDK isoforms in CCA tissues was examined in 15 CCA cases by immunohistochemistry. The PDK3 isoform levels in the sera were measured using a dot blot assay for 39 patients with CCA, 20 patients with benign biliary disease and 19 healthy volunteers. The results revealed a 27-fold overexpression of PDK3 in cancerous tissues when compared with adjacent non-cancerous tissues. The immunohistochemical results demonstrated that the PDK1, 2 and 3, but not the PDK4, isoforms were overexpressed in cancerous tissues. When the PDK3 levels in the sera were examined, they were significantly higher in CCA when compared with the BBD and healthy groups. The specificity and sensitivity of PDK3 as a marker for CCA were 97.5 and 33.0%, respectively, and high PDK3 levels in the sera were correlated with a short survival time for CCA. In conclusion, PDK3 can be used as a diagnostic/prognostic marker for CCA.
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Affiliation(s)
- Surangkana Sanmai
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Tanakorn Proungvitaya
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Temduang Limpaiboon
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Daraporn Chua-On
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wunchana Seubwai
- Department of Forensic Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sittiruk Roytrakul
- National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani 12120, Thailand
| | - Sopit Wongkham
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chaisiri Wongkham
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Siriporn Proungvitaya
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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7
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Virani S, Chindaprasirt J, Wirasorn K, Sookprasert A, Somintara O, Vachirodom D, Koonmee S, Srinakarin J, Kamsa-Ard S, Suwanrungruang K, Rozek LS, Sriplung H, Wiangnon S. Breast Cancer Incidence Trends and Projections in Northeastern Thailand. J Epidemiol 2018; 28:323-330. [PMID: 29760320 PMCID: PMC6004364 DOI: 10.2188/jea.je20170045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden. METHODS Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988-2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group. RESULTS Age-standardized rates (ASRs) increased significantly for all women from 1995-2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988-2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined. CONCLUSIONS Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.
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Affiliation(s)
- Shama Virani
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
| | - Jarin Chindaprasirt
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | - Kosin Wirasorn
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | - Aumkhae Sookprasert
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Khon Kaen University
| | | | | | - Supinda Koonmee
- Department of Pathology, Faculty of Medicine, Khon Kaen University
| | | | - Supot Kamsa-Ard
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University
| | | | | | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
| | - Surapon Wiangnon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University
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Chirappapha P, Somintara O, Lertsithichai P, Kongdan Y, Supsamutchai C, Sukpanich R. Complications and oncologic outcomes of pedicled transverse rectus abdominis myocutaneous flap in breast cancer patients. Gland Surg 2016; 5:405-15. [PMID: 27563562 DOI: 10.21037/gs.2016.07.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are several techniques for harvesting the pedicled transverse rectus abdominis myocutaneous (TRAM) flap after mastectomy in breast cancer patients. We examined the whole muscle with partial sheath sparing technique and determined factors associated with its complications and oncological outcomes. METHODS We retrospectively reviewed the results of 168 TRAM flaps performed between January 2003 and December 2010, focusing on complications and oncologic outcomes. RESULTS Among the 168 pedicled TRAM flap procedures in 158 patients, flap complications occurred in 34%. Most of the flap complications included some degree of fat necrosis. There was no total flap loss. Flap complications were associated with elderly patients and the presence of major donor site complications. Abdominal bulging and hernia occurred in 12% of patients. The bi-pedicled TRAM flap and higher body mass index (BMI) were significant factors associated with increased donor site complications. Seven patients (4%) developed loco-regional recurrence. Within a median follow-up of 27 months, distant metastasis and death occurred in 6% and 4% of patients, respectively. CONCLUSIONS The pedicled TRAM flap using the whole muscle with partial sheath sparing technique in the present study is consistent with the results from previous studies in flap complication rates and oncological outcomes.
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Affiliation(s)
- Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panuwat Lertsithichai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Youwanush Kongdan
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chairat Supsamutchai
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rupporn Sukpanich
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Titapun A, Pugkhem A, Luvira V, Srisuk T, Somintara O, Saeseow OT, Sripanuskul A, Nimboriboonporn A, Thinkhamrop B, Khuntikeo N. Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand. World J Gastrointest Oncol 2015; 7:503-512. [PMID: 26691730 PMCID: PMC4678397 DOI: 10.4251/wjgo.v7.i12.503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/27/2015] [Accepted: 10/27/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors.
METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011.
RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1.
CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.
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Aphinives P, Vachirodom D, Thanapaisal C, Rangsrikajee D, Somintara O. A comparison of letrozole and anastrozole followed by letrozole in breast cancer patients. Breast Cancer (Dove Med Press) 2015; 7:37-41. [PMID: 25653555 PMCID: PMC4309671 DOI: 10.2147/bctt.s73997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background We previously studied the noninferiority of anastrozole (ANZ) versus ANZ followed by letrozole (A-LTZ) due to reimbursement policy. We found that patients with A-LTZ had better overall survival (OS) than did patients with ANZ alone. This study aimed to prove that patients with A-LTZ also had better OS than patients with letrozole (LTZ) alone. Methods All medical records of the breast cancer patients taking LTZ with or without ANZ between 2004 and 2013 were reviewed. All patients were divided into two groups: the LTZ group included patients treated with LTZ alone, and the A-LTZ group included patients treated with ANZ who were automatically changed to LTZ due to change of the reimbursement policy. Results From 359 cases, there were 179 cases in the LTZ group and 180 cases in the A-LTZ group. The mean age of patients in the LTZ group was 53.7 years and in the A-LTZ group was 54.2 years. The distribution of clinical stages among the LTZ group versus the A-LTZ group was 21 versus 4 (stage 1), 86 versus 116 (stage 2), 55 versus 46 (stage 3), and 17 versus 14 (stage 4), respectively. Among the LTZ patients, 63.7% took aromatase inhibitor monotherapy and 36.3% had a switching strategy, while in the A-LTZ group, 53.9% took AI monotherapy and 46.1% had a switching strategy. OS of the A-LTZ group was longer than that of the LTZ group. Conclusion The patients in A-LTZ, taking ANZ followed by LTZ had better OS than those in LTZ, taking LTZ alone.
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Affiliation(s)
- Potchavit Aphinives
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Damnern Vachirodom
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chaiyut Thanapaisal
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dhanes Rangsrikajee
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Aphinives P, Vachirodom D, Thanapaisal C, Rangsrikajee D, Somintara O. Effects of switching from anastrozole to letrozole, due to reimbursement policy, on the outcome of breast cancer therapy. Breast Cancer (Dove Med Press) 2014; 6:145-50. [PMID: 25249759 PMCID: PMC4154879 DOI: 10.2147/bctt.s67553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Endocrine therapy is one of the standard treatments for estrogen-receptor-positive breast cancer patients. Letrozole is the only aromatase inhibitor (AI) included in Thailand’s essential drug list since the change of reimbursement policy in 2008, when patients had to change their AIs (other than letrozole) to letrozole. This study aimed to prove that the efficacy of anastrozole plus letrozole is not less than anastrozole alone. Methods All medical records of breast cancer patients taking anastrozole between 2004 and 2013 were reviewed. Some patients were initially treated with anastrozole and then changed to letrozole (A-LTZ group), whereas the other patients were continuously treated with anastrozole until completion of therapy (ANZ group). Results In a total of 180 (55.9%) out of the 322 cases, anastrozole was replaced with letrozole. The mean age of patients in the ANZ group was 54.9 years and that of those in the A-LTZ group was 54.2 years. Clinical stages (1–4) of the ANZ versus A-LTZ patients were four versus four, 76 versus 116, 46 versus 46, and 16 versus 14, respectively. ANZ patients took AI monotherapy (46.5%) and switching strategy (53.5%), while A-LTZ patients took AI monotherapy (53.9%) and switching strategy (46.1%). The overall survival (OS) of A-LTZ patients was longer than that of ANZ patients. Stage 2 and 4 patients in the A-LTZ group also had better OS than those in the ANZ group, but stage 3 patients had similar OS in both groups. Conclusion Anastrozole can be replaced by letrozole any time during endocrine therapy. The patients taking anastrozole plus letrozole surprisingly seemed to have better OS than patients taking anastrozole alone.
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Affiliation(s)
| | - Damnern Vachirodom
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand
| | | | | | - Ongart Somintara
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand
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