Publications by authors named "Chih-Chieh Yen"

6 Publications

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Comparing the Clinicopathological Characteristics of Combined Hepatocellular-Cholangiocarcinoma with Other Primary Liver Cancers Using the Updated WHO Classification.

Histopathology 2021 Apr 10. Epub 2021 Apr 10.

Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is an uncommon hepatic malignancy with a poor outcome. The 2019 WHO classification modified the definition and discarded the subtypes harboring stem cell features. However, the differences among cHCC-CCA, hepatocellular carcinoma (HCC), HCC with stem cell features (HCCscf) and intrahepatic cholangiocarcinoma (iCCA) remain undetermined. The aim of the study is to investigate the characteristics of cHCC-CCA in comparisons with other primary liver cancers utilizing the updated WHO classification.

Methods And Results: We retrospectively analyzed 64 cHCC-CCA and 55 HCCscf patients from Dec2007 to May2018. A propensity score matching was conducted to compare with HCC and iCCA patients. Clinicopathological characteristics, event-free (EFS) and overall survival (OS) were evaluated with multivariate Cox proportional hazard regression. In a median follow-up of 55.9 months, patients with cHCC-CCA had a significantly poor survival as compared with HCCscf and an intermediate survival outcome between HCC and iCCA. HBV infection and high tumor infiltrating lymphocytes (TILs) were associated with a favorable survival in cHCC-CCA. In the multivariate analysis, poor hepatic reserve, absence of HBV infection, stage IV disease and low TILs were significant negative prognostic factors in cHCC-CCA. After pooling with other primary liver cancers, tumor type of cHCC-CCA and iCCA predicted the worse survival results.

Conclusion: cHCC-CCA have an intermediate survival between HCC and iCCA and HBV infection and high TILs predict the favorable survival. Our study provides clinical correlations for the new 2019 WHO classification.
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http://dx.doi.org/10.1111/his.14384DOI Listing
April 2021

The Characteristics and Motivations of Taiwanese People toward Advance Care Planning in Outpatient Clinics at a Community Hospital.

Int J Environ Res Public Health 2021 03 10;18(6). Epub 2021 Mar 10.

Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan.

Advance care planning (ACP) provides access to complete advance decisions (ADs). Despite the legalization of ACP in Taiwan, it is underutilized in community settings. The objective of this study is to describe the service at a community hospital in Southern Taiwan. We retrospectively analyzed participants who were engaged in ACP consultations from January 2019 to January 2020. The characteristics, motivations, content, and satisfaction of participants are reported. Factors associated with refusing life-sustaining treatments (LST) or artificial nutrition/hydration (ANH) were analyzed using multivariate logistic regression. Of the 178 participants, 123 completed the ACP. The majority were female (64.2%), aged 61 on average and more than 80% had never signed a do-not-resuscitate order. In the ADs, most participants declined LST (97.2%) and ANH (96.6%). Family-related issues (48.9%) were the most prevalent motivations. Rural residence (OR 8.6, = 0.005), increased age (OR 7.2, = 0.025), and reluctance to consent to organ donation (OR 5.2, = 0.042) correlated with refusing LST or ANH. Participants provided a positive feedback regarding overall satisfaction (good, 83%) compared to service charge (fair/poor, 53%). The study demonstrated high AD completion when refusing LST or ANH. These findings may facilitate the development of ACP as a community-based service.
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http://dx.doi.org/10.3390/ijerph18062821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999986PMC
March 2021

Maternal survival of patients with pregnancy-associated cancers in Taiwan - A national population-based study.

Cancer Med 2020 12 25;9(24):9431-9444. Epub 2020 Oct 25.

Division of Hematology / Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Pregnancy-associated cancer (PAC), defined as cancers diagnosed during pregnancy or the first year after delivery, affects one to two in every 1000 pregnancies. Although PAC is expected to be a growing issue, information about PAC in the Asian population is still scarce. Women with cancer diagnosed at the age of 16-49 years between 2001 and 2015 were selected from the Taiwan Cancer Registry and linked with the National Birth Reporting Database to identify PAC patients. We compared the overall survival of patients with PAC to patients without pregnancy. Among 126,646 female cancer patients of childbearing age, 512 were diagnosed during pregnancy, and 2151 during the first postpartum year. Breast cancer was the most common PAC (N = 755, 28%). Compared with patients without pregnancy in the control group, patients with cancers diagnosed during pregnancy and the first postpartum year generally had more advanced stages (odds ratio 1.35 and 1.36, 95% confidence interval [CI] 1.02-1.77 and 1.18-1.57, respectively). For all cancer types combined and controlled for the stage, age, and year of diagnosis, patients with PAC had similar overall survival with those in the control group, with a hazard ratio (HR) of 1.07 (95% CI 0.80-1.41) for the pregnancy group and HR 1.02 (95% CI 0.88-1.18) for the postpartum group. The diagnosis of breast cancer during the first postpartum year was linked with shorter survival (HR 1.34, 95% CI 1.05-1.72). In contrast, patients with postpartum lymphoma (HR 0.11, 95% CI 0.02-0.79) and cervical cancer (HR 0.40, 95% CI 0.20-0.82) had better prognosis. In general, the diagnosis of cancer during pregnancy or the first postpartum year does not affect the survival of patients with most cancer types. Exceptions include the worse prognosis of postpartum breast cancer and the better outcome of postpartum lymphoma and cervical cancer.
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http://dx.doi.org/10.1002/cam4.3565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774740PMC
December 2020

Excellent treatment response with pembrolizumab in a lung cancer patient who developed immune-mediated acute motor/sensory axonal polyneuropathy.

Lung Cancer 2018 06 17;120:149-151. Epub 2018 Apr 17.

Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

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http://dx.doi.org/10.1016/j.lungcan.2018.04.014DOI Listing
June 2018

Organophosphate poisoning presenting as out-of-hospital cardiac arrest: A clinical challenge.

J Cardiol Cases 2017 Jul 22;16(1):18-21. Epub 2017 Apr 22.

Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Out-of-hospital cardiac arrest (OHCA) remains a challenge for physicians since effective management and definitive salvage depend upon correct determination of the etiology and the extent of injury. Definitive diagnosis of organophosphate poisoning (OP) requires physicians' clinical awareness of a typical toxidrome, that is, characteristic signs and symptoms of poisoning, and laboratory confirmation. Here we report a case of an OHCA patient with OP, which was initially misdiagnosed as an acute ST segment elevation myocardial infarction based on the patient's medical history and clinical manifestations. < Organophospate poisoning is associated with an increasing mortality with widely used pesticides in the developing world. Differential diagnosis of out-of-hospital cardiac arrest should include such etiology that can be reversed by early intervention.>.
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http://dx.doi.org/10.1016/j.jccase.2017.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149259PMC
July 2017