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Tenofovir disoproxil fumarate (TDF) monotherapy is recommended for the treatment of chronic hepatitis B (CHB) patients who are refractory to other drugs. Yet, little data are available for the effectiveness of TDF monotherapy compared with TDF‐based combination therapy on the risk of hepatocellular carcinoma (HCC) and death/transplantation. This nationwide population‐based cohort study included 11,289 CHB patients who initiated TDF rescue therapy after failure of preceding treatments between 2012 and 2014 in Korea. The risks of HCC and death/transplantation were compared between TDF combotherapy (n = 2,499) and TDF monotherapy (n = 8,790) groups. The findings were validated in a hospital cohort of 1,163 CHB patients. In the nationwide cohort, during 44.2 months of overall treatment duration, 529 patients developed HCC and 190 died or received transplantation. In the 2,499 propensity score‐matched pairs, compared with TDF combotherapy, TDF monotherapy showed no significantly different risks of HCC (1.11/100 person‐year [PY] vs. 1.32/100 PY; HR 1.23, 95% CI 0.95−1.60, p =.12) and death/transplant (0.43/100 PY vs. 0.42/100 PY; HR 1.04, 95% CI 0.67−1.60, p =.87). However, in the 469 propensity score‐matched pairs of cirrhosis subcohort, TDF monotherapy was associated with a higher risk of HCC than TDF combotherapy (HR 1.46, 95% CI 1.002−2.12, p =.049). In the validation hospital cohort, TDF monotherapy was not associated with significantly different risks of HCC and death/transplant in the entire cohort and cirrhosis subcohort. In CHB patients with failure to preceding treatments, TDF monotherapy showed no higher risks of HCC and death/transplantation compared with TDF combotherapy. However, the comparative effectiveness of rescue TDF monotherapy should be further clarified in cirrhotic patients since the findings were not consistent in the nationwide and hospital cohorts. [ABSTRACT FROM AUTHOR]

It is unclear whether suboptimal adherence contributes to adverse clinical outcomes in patients with chronic hepatitis B (CHB). Moreover, there is no consensus regarding the optimal level of drug adherence. This was a population‐based historical cohort study including 51 975 adult CHB patients treated with entecavir (0.5 mg/d orally). Data were obtained from the Korean national health insurance service claims database, which covers >99% of the entire population, between 2007 and 2015. Medication adherence was categorized as high (proportion of days covered [PDC], ≥90%; n = 32 089), intermediate (PDC, 80%‐89%; n = 10 197) and low (PDC, <80%; n = 9689). During a median 4.5 years (maximal 9 years) of follow‐up in 51 975 CHB patients treated with entecavir, multivariable analyses revealed that the risk of mortality/transplantation was significantly greater in the low‐adherers (adjusted hazard ratio [HR], 1.38; P <.001) and intermediate‐adherers (adjusted HR, 1.44; P <.001) than the high‐adherers (P for trend < 0.001). The risk of renal failure in the low‐ and intermediate‐adherence groups was also significantly higher than the high‐adherence group (P for trend < 0.001). By contrast, the risk of hepatocellular carcinoma (HCC) was not significantly different between groups (P for trend = 0.70). The higher risk of mortality/transplantation and renal failure but similar risk of HCC for low‐ and intermediate‐adherers compared with high‐adherers was consistent in inverse probability treatment weighting analysis of the entire cohort and subcohorts with or without cirrhosis. In conclusion, high medication adherence (≥90%) is required to significantly lower risk of mortality and renal failure in patients with CHB during long‐term treatment with entecavir. [ABSTRACT FROM AUTHOR]

Disease mapping is an area of epidemiology concerned with estimating the spatial pattern in disease risk over a geographical region. Typically, the study area is partitioned into spatial districts (small areas), with the disease map displaying the disease incidence associated with each district. We consider Bayesian nonparametric small-area models with a Dirichlet process and a simultaneous conditional autoregressive model for the spatial correlation between neighboring areas to estimate the standardized mortality ratio and mapping. The observed mortality rates are unstable for regions with rare events such as cancer. Bayesian methods, similar to the proposed small-area analysis method, provide mechanisms for smoothing the estimates of rates by region. We compare nonparametric Bayesian models using a Dirichlet process prior with the parametric Bayesian models using a gamma prior for small-area estimation. [ABSTRACT FROM AUTHOR]

In a wireless sensor network, data collection is relatively cheap whereas data transmission is relatively expensive. Thus, preserving battery life is critical. If the process of interest is sufficiently predictable, the suppression in transmission can be adopted to improve efficiency of sensor networks because the loss of information is not great. The prime interest lies in finding an inference-efficient way to support suppressed data collection application. In this paper, we present a suppression scheme for a multiple nodes setting with spatio-temporal processes, especially when process knowledge is insufficient. We also explore the impact of suppression schemes on the inference of the regional processes under various suppression levels. Finally, we formalize the hierarchical Bayesian model for these schemes. [ABSTRACT FROM AUTHOR]

Background: The National Liver Cancer Surveillance Program (NLCSP) targets patients with liver diseases that lead to liver cancer in South Korea. This study aimed to investigate the risk of liver disease leading to liver cancer using nationally representative data to establish an efficient NLCSP. Methods: This study used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) from 2002 to 2013. A retrospective matched cohort design was applied to compare the development of liver cancer in patients with and without liver disease. Cox- proportional hazard regression for liver cancer with competing risk of death was performed for all subjects or each group stratified according to age or income level. Results: A total of 66,192 patients with liver disease and matched subjects without liver disease were included in the study. The incidences of liver cancer among patients with and without liver disease within a median 8-year follow-up period were 2.68% (n = 1,772) and 0.34% (n = 210), respectively. Cox- regression analysis for liver cancer incidence indicated that cirrhosis had the highest risk (hazard ratio [HR]: 18.13, 95% confidence interval [CI]: 15.24–21.58), followed by hepatitis B (HR: 9.32, 95% CI: 8.00–10.85). Subgroup analysis showed that the presence of liver disease was an important risk factor in younger as well as elderly people, and a higher risk of liver disease was also observed in the patients with Medicaid. Conclusions: Attention should be paid to the development of liver cancer in young people under 50 years old and preventive efforts to decrease the incidence of liver cancer among Medicaid recipients is needed. [ABSTRACT FROM AUTHOR]

Background: Evaluate the impact of chest X-ray (CXR) screening on mortality and treatment adherence by comparing pulmonary tuberculosis (PTB) cases detected through screening and those routinely diagnosed at healthcare facilities., Methods: A retrospective analysis of 10% randomly sampled National Health Insurance Service claims data assessed PTB cases diagnosed during 2004-2020. Patients were categorized as 'screening-detected (ACF, active case finding)' or 'routinely detected (PCF, passive case finding)' based on CXR screening history. Cox proportional hazards model determined the association between screening and all-cause or tuberculosis (TB)-specific mortality. Treatment adherence was also measured., Results: Among 84,828 PTB patients, 18.76% were ACF (15,916), and 81.24% were PCF (68,912). ACF exhibited lower risks in all-cause mortality (adjusted hazard ratio [aHR], 0.70; 95% confidence interval [CI], 0.67-0.73) and TB-specific mortality (aHR, 0.38; 95% CI, 0.32-0.46) compared to PCF. In the ACF group, 91.39% initiated anti-TB treatment, with 45.99% adherence. For PCF, 92.87% initiated treatment, and only 45.44% were adherent., Conclusion: Individuals undergoing CXR screening have a lower risk of both all-cause and TB-specific mortality compared to PCF, but treatment adherence is similar between the two groups, emphasizing the need to improve the linkage between screening, diagnosis, and treatment for the screened population., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

Introduction: Gastric adenoma is a precursor lesion of gastric cancer. We investigated whether the removal of gastric adenoma prevented gastric cancer incidence and its mortality., Methods: Using the linkage of nationwide databases, we assessed gastric cancer incidence and mortality among patients who had gastric adenomas removed between 2011 and 2013 in Korea. These outcomes were compared primarily with those of the Korean general population by estimating the standardized incidence and mortality ratio and secondarily with internal control subjects who did not have gastric neoplasm after esophagogastroduodenoscopy and were matched for age, sex, and calendar year by calculating hazard ratios (HR) with the Cox proportional hazards model., Results: We identified 44,405 adenoma removal patients. During a median follow-up of 8.4 years, 1,038 (2.34%) of them were given a diagnosis of gastric cancer and a total of 524 gastric cancers were expected for a standard incidence ratio of 1.98 (95% confidence interval [CI], 1.84-2.13). A total of 199 deaths from gastric cancer were expected and 99 were observed for a standard mortality ratio of 0.50 (95% CI, 0.40-0.60). Compared with the nonadenoma cohort (n = 39,826), the adenoma removal patients had a higher risk of gastric cancer (HR, 2.84; 95% CI, 2.51-3.21) and associated mortality (HR, 1.66; 95% CI, 1.19-2.31)., Discussion: Removal of gastric adenoma resulted in lower-than-expected mortality but higher-than-expected incidence due to gastric cancer than that in the general population. Our analyses indicated the importance of follow-up strategy after removal of gastric adenoma., (Copyright © 2023 by The American College of Gastroenterology.)

Background/Aims: The National Liver Cancer Surveillance Program (NLCSP) was established in 2003 to reduce the socioeconomic burden imposed by liver cancer (LC). We aimed to investigate the effectiveness of the NLCSP in South Korea with respect to survival benefits and cost, after adjusting for various confounding factors. Methods: We used the National Health Insurance Service claims data linked with the NLCSP from 2004 to 2015. The Cox proportional hazard model and generalized linear model were used to determine the effects of the NLCSP on the early detection of LC, survival, and medical costs. Results: From 2006 to 2010, 66,632 patients (surveillance group: 10,527 and no surveillance group: 56,105) newly diagnosed with LC were included in the study. The odds of the early detection of LC was 1.82 (95% confidence interval [CI], 1.73 to 1.93) times higher among patients who participated in the NLCSP once within the 2-year period prior to the diagnosis of LC than among those who did not participate in the surveillance program. The mortality rate of patients who participated in the NLCSP was 22.0% lower (hazard ratio, 0.78; 95% CI, 0.76 to 0.80) than that of those who did not participate. When compared with the group who did not participate in surveillance, the group who participated in the NLCSP had higher total medical costs; however, their cost per day was lower after adjustment during the follow-up period. Conclusions: This study highlights the survival benefit in patients who participated in the NLCSP and the need for continuous improvements of the NLCSP in South Korea.

Background: High-dose melphalan (HDMEL) represents the standard conditioning regimen before autologous stem cell transplant (ASCT) in multiple myeloma (MM), but recent updates have suggested combination of melphalan with bulsulfan (BUMEL) is also associated with favorable outcomes. We performed the current study to address the lack of comparative studies between the two conditioning regimens in Asian populations., Methods: Using the Korean National Health Insurance and Korean Health Insurance Review and Assessment Service databases, 1,304 patients newly diagnosed with MM undergoing ASCT between January 2010 and December 2014 were identified. Patients were divided according to conditioning regimen (HDMEL vs. BUMEL), and after case matching, 428 patients undergoing HDMEL conditioning were compared to 107 patients undergoing BUMEL conditioning with respect to clinical course and treatment outcomes., Results: The 3-year progression-free survival (PFS) was 52.5% for the HDMEL conditioning group versus 70.3% for the BUMEL conditioning group ( P =0.043). The 3-year overall survival (OS) was 82.0% versus 83.5% ( P =0.525), respectively. Although not statistically significant, BUMEL conditioning was associated with more platelet transfusion, while HDMEL was associated with more granulocyte colony stimulating factor support. In multivariate analysis, BUMEL conditioning was not inferior to HDMEL conditioning in regard to both PFS and OS., Conclusion: Our study confirmed that BUMEL is an effective and well-tolerated alternative to HDMEL conditioning, with better PFS., Competing Interests: Authors' Disclosures of Potential Conflicts of Interest: No potential conflicts of interest relevant to this article were reported.

Objective: The purpose of this study is to evaluate the outcomes of hypovascular hypointense nodules in the hepatobiliary phase of gadoxetic acid-enhanced MRI and the risk factors for the hypervascular transformation of the nodules through a systematic review and meta-analysis., Materials and Methods: We searched the Ovid-MEDLINE and EMBASE databases for published studies of hypovascular hypointense nodules in patients with chronic liver disease. The pooled proportions of the overall and cumulative incidence rates at 1, 2, and 3 years for the transformation of hypovascular hypointense nodules into hypervascular hepatocellular carcinomas (HCCs) were assessed by using random-effects modeling. Metaregression analysis was performed., Results: Sixteen eligible studies with 944 patients and 1819 hypovascular hypointense nodules in total were included. The pooled overall rate of hypervascular transformation was 28.2% (95% CI, 22.7-33.6%; I 2 = 87.46%). The pooled 1-, 2-, and 3-year cumulative incidence rates were 18.3% (95% CI, 9.2-27.4%), 25.2% (95% CI, 12.2-38.2%), and 30.3% (95% CI, 18.8-41.9%), respectively. The metaregression analysis revealed that the mean initial nodule size (cutoff value, 9 mm) was a significant factor affecting the heterogeneity of malignant transformation., Conclusion: Hypovascular hypointense nodules detected in the hepatobiliary phase of gadoxetic acid-enhanced MRI carry a significant potential of transforming into hypervascular HCCs. The size of nodules is a significant risk factor for hypervascular transformation.