Jung Ho Park

Background: The association between female reproductive factors and laryngopharyngeal reflux (LPR) remains poorly understood. This study investigated the relationship between reproductive history and LPR risk in women using a large nationally representative cohort. Methods: We conducted a nested case–control study using linked data from the Korean National Health and Nutrition Examination Survey and the National Health Insurance Service database (2007–2017). Among 57,559 participants, 1347 women diagnosed with LPR were matched 1:1 with 1347 controls without reflux disease using propensity score matching based on age, income, and education level. Multivariable logistic regression analyses were performed to evaluate the associations between reproductive factors and LPR risk after adjustment for metabolic and lifestyle variables. Results: Women with a first childbirth at age ≥27 years had a significantly higher risk of LPR than those with earlier childbirth (adjusted odds ratio [aOR] 1.33, 95% confidence interval [CI] 1.08–1.63; p = 0.007). A menarche-to-first-birth interval of ≥17 years was also associated with an increased risk of LPR (aOR 1.56, 95% CI 1.15–2.15; p = 0.005). In addition, breastfeeding for p = 0.019). These associations remained significant after adjustment for potential confounders. Conclusions: Female reproductive factors potentially reflecting cumulative hormonal exposure were independently associated with LPR risk in this nationally representative cohort. First delivery at age ≥27 years, a menarche-to-first-birth interval ≥17 years, and breastfeeding <12 months were associated with LPR, suggesting that reproductive history should be considered when evaluating women with reflux-related symptoms.

Purpose: Atypical hyperplasia (AH) management remains controversial due to variable malignant disease progression rates. While Western studies report 10% to 25% upgrade rates, data from Asian populations, particularly from referral academic centers, are limited. We aimed to identify predictive factors for malignant upgrade in Korean women with AH at academic hospitals.Methods: This retrospective multi-institutional study analyzed 340 patients diagnosed with AH on initial biopsy who underwent subsequent excision at five Korean academic hospitals from 2000 to 2022. Malignant upgrade was defined as ductal carcinoma in situ or invasive cancer on the final pathology. Multivariate logistic regression was used to identify independent predictors of upgrades.Results: Among 340 patients (319 atypical ductal hyperplasia, 20 atypical lobular hyperplasia, and 1 mixed), 128 (37.6%) experienced a malignant upgrade, 98 (76.6%) to ductal carcinoma in situ, and 30 (23.4%) to invasive cancer. In multivariate analysis, multifocal atypia (odds ratio [OR], 25.61; 95% confidence interval [CI], 11.20–58.55; P<0.001) and Breast Imaging-Reporting and Data System 4c-5 lesions (OR, 11.02; 95% CI, 1.43–84.86; P=0.021) were significant predictors. Multifocal atypia showed an 84.4% upgrade rate. Core needle biopsy had higher upgrade rates than vacuum-assisted biopsy (45.2% vs. 20.0%; P<0.001). The upgrade rates decreased from 50% to 25% over the study period (P<0.05).Conclusion: The 37.6% upgrade rate in this tertiary referral cohort exceeded that in Western reports, with multifocal atypia emerging as the strongest predictor. These findings support immediate excision for multifocal atypia while allowing individualized management for unifocal lesions with favorable imaging in Korean tertiary care settings.

Background/Objectives: Over the past two decades, the incidence of breast cancer has been increasing in Korea, which is potentially attributable to longer life expectancies, Westernized lifestyles, and declining fertility rates. However, the contributions of modifiable metabolic and behavioral risk factors in Asian populations remain underexplored. This study aimed to assess the associations between health-related factors and incidence of breast cancer in a large Korean cohort. Methods: We analyzed data from the Korean National Health Insurance Service and included women who underwent health screening in 2009. Cases of breast cancer diagnosed between 2010 and 2021 were identified using medical claims and registration codes. The breast cancer cases were matched to controls in a 1:4 ratio based on age, income, and region of residence. Conditional logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for key exposures. Results: In total, 52,869 breast cancer cases and 211,476 matched controls were included. The peak age group at diagnosis was 50–54 years. Dyslipidemia was associated with a 12% increase in the risk of breast cancer across all age groups (95% CI, 1.10–1.14). In women ≥ 50 years of age, a dose–response relationship was observed between body mass index (BMI) and breast cancer risk: aORs were 1.04 (95% CI, 1.01–1.08) for overweight, 1.14 (95% CI, 1.11–1.17) for obesity class I (BMI ≥ 25 to < 30 kg/m²), and 1.33 (95% CI, 1.26–1.41) for obesity class II (BMI ≥ 30 kg/m²). Conversely, being underweight was associated with a decreased risk (aOR, 0.81; 95% CI, 0.74–0.89). No consistent associations were observed with alcohol consumption, cigarette smoking, or the presence of diabetes mellitus. Conclusions: Postmenopausal obesity and dyslipidemia contribute to the risk of breast cancer among Korean women. Promoting healthy behaviors throughout life may support long-term risk reduction.

Background: Radiomics is a non-invasive and cost-effective method for predicting the biological characteristics of tumors. In this study, we explored the association between radiomic features derived from magnetic resonance imaging (MRI) and genetic alterations in patients with breast cancer. Methods: We reviewed electronic medical records of patients with breast cancer patients with available targeted next-generation sequencing data available between August 2018 and May 2021. Substraction imaging of T1-weighted sequences was utilized. The tumor area on MRI was segmented semi-automatically, based on a seeded region growing algorithm. Radiomic features were extracted using the open-source software 3D slicer (version 5.6.1) with PyRadiomics extension. The association between genetic alterations and radiomic features was examined. Results: In total, 166 patients were included in this study. Among the 50 panel genes analyzed, only TP53 mutations were significantly associated with radiomic features. Compared with TP53 wild-type tumors, TP53 mutations were associated with larger tumor size, advanced stage, negative hormonal receptor status, and HER2 positivity. Tumors with TP53 mutations exhibited higher values for Gray Level Non-Uniformity, Dependence Non-Uniformity, and Run Length Non-Uniformity, and lower values for Sphericity, Low Gray Level Emphasis, and Small Dependence Low Gray Level emphasis compared to TP53 wild-type tumors. Six radiomic features were selected to develop a composite radiomics score. Receiver operating characteristic curve analysis showed an area under the curve of 0.786 (95% confidence interval, 0.719–0.854; p < 0.001). Conclusions: TP53 mutations in breast cancer can be predicted using MRI-derived radiomic analysis. Further research is needed to assess whether radiomics can help guide treatment decisions in clinical practice.

Background/Objectives: There is limited evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on the epidemiology of thoracic and cardiovascular diseases. This study aimed to investigate changes in medical visits for these conditions during the COVID-19 pandemic. Methods: We analyzed the entire Korean population (~50 million) for monthly medical visits for 15 common thoracic and cardiovascular conditions, including pneumothorax, large bullae, lung cancer, esophageal cancer, thymoma, empyema, mediastinitis, esophageal rupture, multiple rib fractures, hemothorax, rib mass, varicose vein, pectus excavatum, aortic dissection, aortic aneurysm, and valve disease from January 2019 to December 2021. Data were obtained from the Korean National Health Insurance Service using the International Classification of Disease (ICD)-10 codes. Variations in the mean monthly medical visits of 15 frequent thoracic and cardiovascular diseases before and during the COVID-19 pandemic were compared using the Mann–Whitney U test, while changes in variance were assessed using Levene’s test. Results: The mean monthly number of medical visits for pneumothorax and large bullae significantly decreased during the COVID-19 pandemic compared to before the pandemic (by 10.1% and 12.8%; both p < 0.001). On the contrary, there was a significant increase in the mean monthly counts of medical visits for lung cancer, esophageal cancer, thymoma, and valve disease diagnosis (by 6.6%, 5.3%, 8.8%, and 5.0%, respectively; all p < 0.05). Conclusions: In Korea, the number of diagnosed cases of pneumothorax significantly decreased during the COVID-19 pandemic compared to before COVID-19, while diagnoses of thoracic cancers and valve disease increased.

The trastuzumab biosimilar CT-P6 is approved for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC), metastatic breast cancer (MBC), and metastatic gastric cancer (MGC). The objective of this post-marketing surveillance (PMS) study was to evaluate the real-world safety and effectiveness of CT-P6 in patients with HER2-positive cancers. This open-label, observational, prospective, PMS study collected data via investigator surveys from 35 centers in the Republic of Korea (5 October 2018-4 October 2022). Eligible patients with HER2-positive EBC, MBC, or MGC started CT-P6 treatment during routine clinical practice, followed by 1-year observation. Evaluations included adverse events (AEs), adverse drug reactions (ADRs), and effectiveness. Safety was analyzed in 642 patients (494 EBC, 94 MBC, 54 MGC). Overall, 325 (50.6%) patients experienced 1316 AEs, and 550 ADRs occurred in 199 (31.0%) patients. Unexpected ADRs occurred in 62 (9.7%) patients. Unexpected ADRs and ADRs of special interest did not raise any new safety signals. Among trastuzumab-naïve patients, 34/106 (32.1%) with EBC achieved pathological complete response; 30/74 (40.5%) MBC and 24/49 (49.0%) MGC patients achieved complete or partial response. In a real-world setting, CT-P6 demonstrated safety and efficacy findings consistent with previous CT-P6 studies.

임정현, et al. J Korean Soc Radiol. 2024 Oct;85:e78. https://doi.org/10.3348/jksr.2024.0053

Purpose: This study aimed to compare the complication rates of non-absorbable suture (NAS) and n-butyl-2-cyanoacrylate (NBCA) skin adhesive for skin closure during totally implantable venous access devices (TIVADs) implantation. Methods: Between March 2020 and February 2021, 586 consecutive patients who underwent TIVAD implantation were retrospectively analyzed. Two groups of patients suture with NAS ( n = 299) or NBCA ( n = 287) were followed up for 18 months to compare the occurrence of infection, thrombosis, and non-thrombotic malfunction. A total of 364 cases were extracted using propensity score matching in a 1:1 ratio. Mean TIVADs maintenance days were analyzed using Kaplan-Meier survival analysis. Results: Nineteen cases of complications occurred (0.294/1000 catheter-days) in the NAS group and 17 cases (0.210/1000 catheter-days) in the NBCA group. The difference in the complication rates between the two groups was not statistically significant ( p = 0.725) after propensity score matching. Mean TIVADs maintenance days were 627.3 days in NAS group and 697.6 days in NBCA group. There was no statistically significant difference in the number of TIVADs maintenance days between the two groups ( p = 0.081). Conclusion: In TIVADs implantation, skin closure using NBCA showed no difference in the occurrence of infectious complications compared with conventional non-absorbable skin suture.

The relationship between cancer and venous thromboembolism (VTE) has long been described. The risk of VTE in Asian patients with breast cancer remains largely unknown. This study described the incidence and risk factors of VTE in Korean patients with breast cancer. Data were collected from a retrospective database of patients who underwent breast cancer surgery between 2011 and 2020 at a single institution. The Cox proportional-hazards model was used to identify factors associated with VTE occurrences. Among the 2246 patients with breast cancer, 48 (2.1%) developed VTE during a median follow-up period of 53 months. The average incidence of VTE was 459 per 100,000 person-years. Age ≥ 60 years, male sex, chronic kidney disease, reconstructive procedures, and stage II or higher were independent predictive factors for VTE. VTE was associated with poor disease-free survival (hazard ratio (HR), 6.140; 95% confidence interval (CI), 3.480–10.835), and overall survival (HR, 8.842; 95% CI 4.386–17.824). Most VTE events were manageable with anticoagulation; three (6.3%) patients died of VTE, despite intensive care. The incidence of VTE was significantly elevated in Korean patients with breast cancer. Since VTE has a negative effect on oncologic outcomes of breast cancer, clinicians should manage its risk throughout their lifetime.