Moon-Sing Lee

Buddhist Tzu Chi General Hospital, T’ai-pei, Taipei, Taiwan

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Publications (48)87.52 Total impact

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    ABSTRACT: Modern radiation therapy strives to minimize injury to organs while increasing the anticancer effects. The present study aimed to investigate the radiosensitizing effects of everolimus and to examine the molecular mechanisms responsible for everolimus‑mediated radiosensitization. Radiation in combination with everolimus (30 nM) sensitized Ras-transformed cells to radiation in vitro. Radiation induced apoptotic markers (sub-G1 cell accumulation, membrane inversion and DNA fragmentation) and treatment with everolimus did not promote radiation-induced apoptosis. However, LC3-II expression increased following combination treatment with everolimus and radiation, and the radiosensitizing effects of everolimus were reversed following transfection with small interfering RNA (siRNA) targeting Beclin 1. In addition, the protein levels of activated S6 kinase 1 (S6K1) were significantly reduced following treatment with everolimus, and the phosphorylation of factor 4E binding protein 1 (4EBP1) was suppressed following combination treatment. Taken together, our data demonstrate that everolimus sensitizes Ras-transformed cells to radiation in vitro. Everolimus-mediated radiosensitization is associated with the autophagy pathway. Thus, everolimus is a novel radiosensitizing agent with potential for use in cancer radiotherapy.
    International Journal of Molecular Medicine 09/2014; · 1.96 Impact Factor
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    ABSTRACT: The utility of lymph node ratio (LNR) in predicting outcomes has been reported previously. In current study, we further subgroup by LNR in subjects with lymph nodes metastasis of colorectal cancer, breast cancer, and head and neck cancer.
    Journal of Cancer Research and Clinical Oncology 08/2014; · 2.91 Impact Factor
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    ABSTRACT: Background: Traditional Chinese medicine (CM) appears to be used worldwide, especially by cancer patients. The aim of the present study was to explore CM uses and CM non-users by patients with colorectal cancer (CRC). Materials and methods: A retrospective study was conducted using registration and claims data sets for 2007 from the National Health Insurance Research Database. Patients with colorectal cancer were identified from the Registry for Catastrophic illness Patients. Binary logistic regression was used to estimate odds ratios as the measure of association with the use of CM. Results: A total of 61,211 CRC patients diagnosed in 2007 were analysis. Most CM users preferred to visit private clinics (46.9%) with 306,599 visits. In contrast, the majority of CM non-users preferred to visit private hospitals (42.2%) with 538,769 visits. Among all 176,707 cancer-specific CM visit, there were 66.6% visits to CM outpatient department (OPD) of private hospitals, while in 477,612 non-cancer-specific CM visits, 62.0% was for private clinics. The proportion of expenses for diagnostic fees for CM user in CM visits was much less than that for WM visits and CM non-users (US$4.6 vs. 29.3 vs. 33.5). The average cost for CM user in CM was less than that for WM visits and CM non-users (US$6.3 vs. 25.9 vs. 30.3). Female patients, younger age, and patients not living in the northern region, with higher EC or more comorbidities were more likely to receive CM treatment. Conclusion: The prevalence and costs of insurance-covered CM among CRC patients were low. Further longer longitudinal study is needed to follow up this trend.
    African Journal of Traditional, Complementary and Alternative Medicines 02/2014; 11(2):343-349. · 0.52 Impact Factor
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    ABSTRACT: Objective Hepatocellular carcinoma (HCC) is a common cause of cancer mortality. Resection is the best choice for HCC. Our objective was to evaluate the impact of various factors that affected survival in patients with resectable HCC. Materials and methods Between January 1, 2007 and December 31, 2013, 107 patients with a diagnosis of HCC who underwent surgery were enrolled retrospectively. The analysis was carried using t tests, the Kaplan–Meier method, and Cox proportional hazard regression model to identify potential confounding and predicting variables. Results The 3-year overall survival rates in patients with surgical margins >1 mm and ≤1 mm were 79% and 59% (p = 0.02), respectively, and those in patients with and without vascular invasion were 57% and 93% (p < 0.001), respectively. Based on multivariate analysis, postoperative pathological vascular invasion (hazard ratio, 6.25; 95% confidence interval, 2.01–19.37) and surgical margin (hazard ratio, 0.37; 95% confidence interval, 0.14–0.96) remained independent predictors of an adverse long-term outcome. Conclusion Patients with vascular invasion combined with surgical margins ≤1 mm are at risk of poor survival and have a worse locoregional control rate. Further studies are warranted to identify the optimal strategy for the prevention and management of intrahepatic recurrence in order to further improve the prognosis of HCC after resection.
    Tzu Chi Medical Journal 01/2014;
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    ABSTRACT: A high risk of stroke occurrence has been reported in several types of irradiated cancer patients. However, clinical data are lacking in irradiated lung cancer patients. The present study intended to explore a risk level of ischemic stroke occurrence in irradiated lung cancer patients. A nationwide population-based database obtained from the Taiwan National Health Insurance was analyzed. Between 2003 and 2006, we recruited 560 resected lung cancer patients into two study groups: surgery-plus-irradiation (n = 112) and surgery-alone (n = 448). Patients treated with chemotherapy were excluded. Propensity score match was used for pairing cases with a ratio of 1∶4. Two-year ischemic-stroke-free survival was defined as the primary endpoint. Three observations supported a high risk of ischemic stroke occurrence in patients with postoperative irradiation when compared with those patients with surgery alone: first, a high incidence per 1,000 person-year (22.3 versus 11.2, 1.99 folds); second, a low two-year ischemic-stroke-free survival rate (92.2% versus 98.1%, P = 0.019); and third, a high adjusted hazard ratio (HR, 4.19; 95% CI, 1.44-12.22; P = 0.009). More notably, the highest risk of ischemic stroke occurrence was found in irradiated patients who had diabetes mellitus (HR, 34.74; 95% CI, 6.35->100; P<0.0001). A high incidence of ischemic stroke was observed in irradiated lung cancer patients, especially in those with diabetes mellitus. For these patients, close clinical surveillance and strict diabetes control should be considered. Further studies to define detail biological mechanisms are encouraged.
    PLoS ONE 01/2014; 9(4):e94377. · 3.53 Impact Factor
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    ABSTRACT: Radiotherapy (RT) or concurrent chemoradiation therapy has been suggested to increase the risk of coronary heart disease for cervical cancer patients, but the results of studies have been inconsistent. Therefore, we aimed to investigate the factors which influence the risk of developing myocardial infarction (MI) in cervical cancer patients with a large, nationwide cohort. The study analyzed data from the 1996 to 2010 National Health Insurance Research Database provided by the National Health Research Institutes in Taiwan. The assessed number of patients with cervical cancer with radiotherapy only, surgery with bilateral oophorectomy only, and with appendectomy were 308, 323 and 229, respectively. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the risk of myocardial infarction. The adjusted hazard ratio for cervical cancer in patients with MI was 1.97 (95% CI, 0.97 - 3.91; P = 0.05) for the group that received RT alone, and 2.13 (95% CI, 1.11 - 3.75; P = 0.01) for the surgery group when compared with controls. The more risk comorbidities they have, the higher the risk of myocardial infarction would be for the patients. The incidence of MI was significantly higher among cervical cancer patients with RT alone or surgery with bilateral oophorectomy alone than among general populations. RT might be as a factor to increase risk as bilateral oophorectomy. Whether RT itself triggers menopause or impairs the ovarian hormone production that increases the risk of MI needs to be further investigated.
    Journal of Clinical Medicine Research 12/2013; 5(6):467-74.
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    ABSTRACT: The association of hepatitis C virus (HCV) infection with chronic kidney disease (CKD) remains widely debated. Here we quantify this association by analysis of data from the Taiwan National Health Insurance Research Database and ICD-9 codes to identify 9430 adults with newly diagnosed HCV (years 1999-2006) and randomly selected 37,720 matched non-HCV control individuals. The incidence rate and risk of incident CKD were evaluated through the end of 2010. The frequency of CKD was 1.66-fold higher in the HCV than the non-HCV cohort (5.46 compared with 3.43 per 1000 person-years), and the adjusted hazard ratio remained significant at 1.28 (95% confidence interval, 1.12-1.46). A multivariate analysis was used to determine the influence of HCV on CKD risk with regard to age, gender, follow-up duration, and comorbidities. The risk for CKD in HCV-infected individuals was higher with diabetes, hyperlipidemia, and cirrhosis (8.44; 3.70-19.23), followed by men <50 years (2.32; 1.49-3.61), all individuals <50 years (1.90; 1.33-2.73), men overall (1.44; 1.22-1.71), and individuals followed for 6 years (1.35; 1.06-1.71); all with considerable significance. Thus, HCV infection is associated with an increased risk of CKD. Hence, high-risk HCV-infected individuals should be aggressively monitored for development of CKD.Kidney International advance online publication, 20 November 2013; doi:10.1038/ki.2013.455.
    Kidney International 11/2013; · 8.52 Impact Factor
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    ABSTRACT: Objectives The aim of this study was retrospectively to identify tumor characteristics or any other prognostic factors that influence disease survival after curative rectal cancer resection.Patients and Methods The records of 95 patients with Stages I, II, or III rectal cancer (TNM system) seen from August 2008 to June 2012 in one institution were reviewed. The patients underwent radical surgery (abdominoperineal resection or laparoanterior resection with lymph node dissection) as definitive therapy and then adjuvant treatment if pathology indicated T3 or T4 lesions, lymph node involvement, or positive margins. Radiation therapy (54 Gy) was delivered to the gross tumor volume and 45–50 Gy to the nodal region. The chemotherapy protocol consisted of 12 biweekly courses of oxaliplatin (85 mg/m2), 5-fluorouracil (FU) (400 mg/m2), and leucovorin (400 mg/m2) on Day 1, followed by continuous infusion of 5-FU (2400 mg/m2) for 48 hours.ResultsThe 3-year cumulative overall survival rates for Stages I, II, and III rectal cancer were 100%, 100%, and 75%, respectively. Univariate analysis for all 91 patients indicated that pN classification, stage, surgical margin ≤ 10 mm, and extracapsular spread (ECS) were significantly associated with overall survival. The pN classification and stage also significantly affected the disease-free survival and distant metastasis-free survival. Furthermore, univariate analysis indicated vascular permeation, neural invasion, and surgical margin ≤ 10 mm were significantly associated with disease-free survival. Vascular permeation also significantly affected distant metastasis-free survival. On multivariate analysis for all patients, pN classification and close surgical margin significantly affected disease-free survival.Conclusion The presence of lymph node involvement and close margins was associated with lower disease-free survival. More aggressive postoperative therapy is suggested for patients if these factors exist.
    Tzu Chi Medical Journal 03/2013; 25(1):47–50.
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    ABSTRACT: BACKGROUND: Increased risk of ischemic stroke has been validated for several cancers, but limited study evaluated this risk in cervical cancer patients. Our study aimed to evaluate the risk of ischemic stroke in cervical cancer patients. METHODS: The study analyzed data from the 2003 to 2008 National Health Insurance Research Database (NHIRD) provided by the National Health Research Institutes in Taiwan. Totally, 893 cervical cancer patients after radiotherapy and 1786 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the risk of ischemic stroke. RESULTS: The 5-year cumulative risk of ischemic stroke was significantly higher for the cervical cancer group than for the control group (7.8% vs 5.1%; p <0.005). The risk of stroke was higher in younger (age <51 years) than in older (age >=51 years) cervical cancer patients (HR = 2.73, p = 0.04; HR = 1.37, p = 0.07) and in patients with more than two comorbid risk factors (5 years cumulative stroke rate of two comorbidities: 15% compared to no comorbidities: 4%). CONCLUSIONS: These study demonstrated cervical cancer patients had a higher risk of ischemic stroke than the general population, especially in younger patients. Strategies to reduce this risk should be assessed.
    Radiation Oncology 02/2013; 8(1):41. · 2.11 Impact Factor
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    ABSTRACT: Oral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. Due to high recurrence rate, close follow-up is mandatory. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume. From the National Health Insurance Research Database published by the Taiwanese National Health Research Institute, the authors selected a total of 1300 oral cancer patients who underwent tumor resection and free flap reconstruction in 2008. Hierarchical linear regression analysis was subsequently performed to explore the relationship between provider volume and expenditures of oncological surgery and one-year follow-up period. Emergency department (ED) visits and 30-day readmission rates were also analyzed. The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up. For oncological surgery expenditure, oral cancer patients treated by low-volume surgeons had an additional $845 than those in high-volume surgeons in mixed model. For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons. Oral cancer patients treated in low-volume hospitals incurred higher risk of 30-day readmission rate (odds ratio, 6.6; 95% confidence interval, 1.6-27). After adjusting for physician, hospital, and patient characteristics, low-volume provider performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher expenditure for oncological surgery and one-year healthcare per patient than did others with higher volumes. Treatment strategies adapted by high-volume providers should be further analyzed.
    PLoS ONE 01/2013; 8(6):e65077. · 3.53 Impact Factor
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    ABSTRACT: Three-dimensional conformal radiation therapy (3DCRT) has emerged as a preferred treatment for gynecologic malignancies. Yet its superiority to conventional radiotherapy (2-dimensional radiotherapy (2DRT)) for gynecologic malignancies has not been well established. Data from the 2005 to 2010 National Health Insurance Research Database (NHIRD) provided by the National Research Institutes in Taiwan were analyzed to address this issue. Patients were initially diagnosed as having cervical cancer according to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 180, and this clinical diagnosis was confirmed histopathologically or cytologically. Kaplan-Meier method and Cox proportional hazards regression were used to analyze the reported data. Between January 2005 and December 2010, there were 776 patients with newly diagnosed cervical cancer without metastasis, local recurrence, or surgical treatment before RT and 132 and 644 patients, respectively, who received 2DRT and 3DCRT. After adjustment for age, diabetes mellitus, hypertension, coronary heart disease, hyperlipidemia, side effects, urbanization level, geographic region, and enrollee category in the 5-year follow-up period, the HR was 1.82 (95% CI, 1.16-2.85, P = 0.009). The 5-year survival rate in the 2DRT and 3DCRT groups was 73.0% and 82.3%, P = 0.007, respectively. Cervical cancer patients treated with 3DCRT had better overall survival.
    ISRN oncology. 01/2013; 2013:729819.
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    ABSTRACT: Many studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness. Using the National Health Insurance (NHI) database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis. Oral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30-1.93; P<0.001). After adjusting for patients' characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34-0.65; P<0.001). In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30-1.93; P<0.001). Oral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.
    PLoS ONE 01/2013; 8(8):e70883. · 3.53 Impact Factor
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    ABSTRACT: Lymph node yield is recommended as a benchmark of quality care in colorectal cancer. The objective of this study was to evaluate the impact of various factors upon lymph node yield and to identify independent factors associated with lymph node harvest. The records of 162 patients with Stage I to Stage III colorectal cancers seen in one institution were reviewed. These patients underwent radical surgery as definitive therapy; high-risk patients then received adjuvant treatment. Pathologic and demographic data were recorded and analyzed. The subgroup analysis of lymph node yields was determined using a t-test and analysis of variants. Linear regression model and multivariable analysis were used to perform potential confounding and predicting variables. Five variables had significant association with lymph node yield after adjustment for other factors in a multiple linear regression model. These variables were: tumor size, surgical method, specimen length, and individual surgeon and pathologist. The model with these five significant variables interpreted 44.4% of the variation. Patients, tumor characteristics and surgical variables all influence the number of lymph nodes retrieved. Physicians are the main gatekeepers. Adequate training and optimized guidelines could greatly improve the quality of lymph node yields.
    PLoS ONE 01/2013; 8(7):e68526. · 3.53 Impact Factor
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    ABSTRACT: OBJECTIVES: In resected buccal cancer patients, an unexpected close surgical margin has been observed to correlate with poor clinical outcomes. However, close surgical margin alone does not independently guide post-operative therapies, revealing a clinical debate. Hence, the present study intended to explore epigenetic-based bio-predictors for further stratifying this debating patient population. MATERIALS AND METHODS: Between 2000 and 2008, we retrospectively recruited 44 resected buccal cancer patients with a close surgical margin of⩽5mm. All patients had post-operative radiotherapy. Genomic DNA was extracted from tumor-enrich areas that contained cancer cells of>70%. Methylation-specific PCR was performed to detect promoter methylation of four tumor suppressor genes, including RASSF1A, DAPK, IRF8, and SFRP1. Post-irradiation locoregional control was defined as the primary end point. RESULTS: There were 40 males and 4 females, with a median age of 53.5years (range, 32-82years). Multivariate analysis identified two independent predictors for locoregional recurrence: very close margin of⩽1 mm (HR: 4.96; 95% CI, 1.63-15.09; P=0.018) and promoter hypermethylation of DAPK (HR: 2.83; 95% CI, 1.05-7.63; P=0.042). The highest risk of locoregional recurrence was observed in patients with both of the two factors (HR, 8.05; 95% CI, 2.56-25.82; P=0.002) when compared with patients with none. Shorter disease-free survival, but not overall survival, was also observed. CONCLUSION: More aggressive managements should be considered in resected buccal cancer patients with both very close margin and DAPK promoter hypermethylation rather than post-operative observation or radiotherapy alone.
    Oral Oncology 12/2012; · 2.70 Impact Factor
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    ABSTRACT: Venous thromboembolism (VTE) is a life-threatening condition that occurs as a complication of cervical cancer. The aim of this study was to evaluate the incidence of VTE in cervical cancer patients during a 5-year follow-up. The study analyzed data deposited between 2003 and 2008 in the National Health Insurance Research Database (NHIRD), provided by the National Health Research Institutes in Taiwan. Totally, 1013 cervical cancer patients after treatment and 2026 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the VTE risk. The 5-year cumulative risk for VTE was significantly higher in the cervical cancer group than in the control group (3.3% vs 0.3%, p < 0.001). The hazard ratio for VTE was 10.14 times higher in the cervical cancer group than in the controls. The combined presence of more comorbidities was associated with a higher risk for VTE. Furthermore, cervical cancer patients without VTE had a significantly higher survival (75.3% vs 30.3%, p < 0.001). The cumulative risk of VTE was significantly higher in cervical cancer patients, and these patients also had lower survival rates. Strategies to reduce these risks need to be examined.
    BMC Research Notes 06/2012; 5:316.
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    ABSTRACT: A 26-year-old man with a history of nasopharyngeal carcinoma (NPC) presented with bone metastasis. Bone scan revealed diffuse skeletal metastases with superscan appearance. Afterward, radiotherapy for bone lesions was arranged and the effects were evaluated. The bone scan flare phenomenon appeared within a short time after radiotherapy. Diffuse bone metastasis, which is common in NPC, were indeterminate on images showing superscan pattern or flare.
    Journal of Clinical Medicine Research 06/2012; 4(3):221-3.
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    ABSTRACT: The radiation dosimetric systems have been developed for more than 50 years and are applied in the measurement of clinical and environment radiation dose. However, most of dosimeters can not repeat reading again in single radiation exposure. According to our previous study, radiophotoluminescent glass dosimeter (RPLGD) has good physical characteristics of radiation detection and repeatedly readout. The aims of this study were to make RPLGD by ourselves (hereafter, homemade RPLGP) and investigate radiation characteristics of homemade RPLGD. Several chemical compounds (AlPO4, AgCl, AgNO3, B2O3, H3PO4, Na3PO4, and P2O5), high temperature oven, Pantak X-ray HF 420, 60Co radiation source, and FGD-1000 readout system were used. Based on this study, we found that the homemade RPLGD has wider radiation detection range, slight angular dependence, and good dose linearity. The development and clinical applications of our RPLGD will be continuously improved in our laboratory.
    Radiation Measurements - RADIAT MEAS. 12/2011;
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    ABSTRACT: Objectives: A close margin of ≤3 mm results in a high risk for locoregional recurrence but still is not an independent factor that helps to guide the use of aggressive post-operative therapies in patients with resected buccal mucosa carcinoma. This suggests there is a diversity of clinical outcomes in this group of patients. This study explores the predictors among this clinically debated group of patients.
    Tzu Chi Medical Journal 12/2011;
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    ABSTRACT: Chemo-radiotherapy-induced carotid stenosis and cerebrovascular events in head and neck cancer patients can cause severe disability and death. We aimed to estimate the risk of stroke in such patients over a six-year follow-up period. The study cohort consisted of head and neck cancer patients (n=10,172). Cox proportional hazard model was used to compare the stroke-free survival rate between the patients treated with radiotherapy or chemotherapy, surgery alone, and surgery with adjuvant therapy after adjusting for possible confounding factors. At the end of follow-up, 384 patients had strokes: 126 (4.3%) from the surgery alone group, 167 (3.8%) from the radiotherapy or chemotherapy group, and 91 (3.2%) from the surgery with adjuvant therapy (P=0.222). Head and neck cancer patients aged less than 55 years treated with radiotherapy or chemotherapy conferred a 1.8-fold higher risk for stroke (95% CI, 1.22-2.56; P=0.003) after adjusting for patient characteristics, co-morbidities, geographic region, urbanization level, and socio-economic status. There was no statistical difference in stroke risk between different treatment modalities in head and neck cancer patients aged 55 years and more. Young head and neck cancer patients treated with radiotherapy or chemotherapy have higher risks for stroke. Different treatment strategies should be considered in such patients.
    Oral Oncology 08/2011; 47(11):1092-7. · 2.70 Impact Factor
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    ABSTRACT: Positive correlation between caseload and outcome has previously been validated for several procedures and cancer treatments. However, there is no information linking caseload and outcome of nasopharyngeal carcinoma (NPC) treatment. We used nationwide population-based data to examine the association between physician case volume and survival rates of patients with NPC. Between 1998 and 2000, a total of 1225 patients were identified from the Taiwan National Health Insurance Research Database. Survival analysis, the Cox proportional hazards model, and propensity score were used to assess the relationship between 10-year survival rates and physician caseloads. As the caseload of individual physicians increased, unadjusted 10-year survival rates increased (p < 0.001). Using a Cox proportional hazard model, patients with NPC treated by high-volume physicians (caseload ≥ 35) had better survival rates (p = 0.001) after adjusting for comorbidities, hospital, and treatment modality. When analyzed by propensity score, the adjusted 10-year survival rate differed significantly between patients treated by high-volume physicians and patients treated by low/medium-volume physicians (75% vs. 61%; p < 0.001). Our data confirm a positive volume-outcome relationship for NPC. After adjusting for differences in the case mix, our analysis found treatment of NPC by high-volume physicians improved 10-year survival rate.
    Radiation Oncology 08/2011; 6:92. · 2.11 Impact Factor

Publication Stats

127 Citations
87.52 Total Impact Points

Institutions

  • 2007–2014
    • Buddhist Tzu Chi General Hospital
      T’ai-pei, Taipei, Taiwan
  • 2013
    • VGHKS Kaohsiung Veterans General Hospital
      • Department of Otolaryngology
      Kaohsiung, Kaohsiung, Taiwan
  • 2010–2013
    • Tzu Chi University
      • Department of Medicine
      Hua-lien, Taiwan, Taiwan
    • Chia-Yi Christian Hospital
      Chia-i-hsien, Taiwan, Taiwan
  • 2009–2013
    • National Yang Ming University
      • Institute of Public Health
      Taipei, Taipei, Taiwan
    • National Chung Cheng University
      • Institute of Molecular Biology
      Chia-i-hsien, Taiwan, Taiwan
  • 2011
    • China Medical University Hospital
      臺中市, Taiwan, Taiwan