• Tuberculosis and Respiratory Diseases
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• v.63 no.1
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• pp.31-41
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• 2007

Background: In pathogenesis and prognosis of lung cancer, significance of enormous types of genetic expression were very compounding and undetermined. We performed this study to search association between clinical characteristics and expression of COX-2, MMP-9 and p53 in non-small cell lung cancer. Methods: Ninety-one patients with adenocarcinoma or squamous cell carcinoma were enrolled. We had searched clinical data retrospectively and performed immunohistochemical staining for COX-2, MMP-9 and p53. We had analyzed significance of these three genes in clinical features and prognosis for survival. Results: 1) In squamous cell carcinoma, male was predominant and was significantly correlated with smoking. 2) Major prognostic determinants for overall survival were curative resection. 3) Expression of COX-2 was more frequent in adenocarcinoma than in squamous cell carcinoma. 4) Negative staining of COX-2, MMP-9 and p53 was more frequent in squamous cell carcinoma than adenocarcinoma. 5) Survival duration was longer in the group with positive expression of p53 and negative for COX-2 and MMP-9 (median duration of survival = 165.6 weeks) than groups with the other expressional patterns. 6) Significant correlation was found between expression of MMP-9 and COX-2. In squamous cell carcinoma, expression of MMP-9, COX-2 and mutant p53 were mutually correlated. 7) COX-2 expression was significant prognostic factor for survival in resected cancer group. In unresected inoperable non-small cell lung cancer group, MMP-9 was statistically significant prognostic factor for overall survival. Conclusion: COX-2 and MMP-9 might have some roles for progression or prognosis in some selected patients with non-small cell lung cancer. COX-2 and MMP-9 may have some roles for disease progression or prognosis in selected patients with NSCLC.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.527-535
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• 1996

Background : Cell adhesion molecules knave been Implicated In the various stages of tumor progression and metastasis. ICAM-1 plays a important roles in cell-cell interactions in inflammatory and immune response of several diseases. Recently, elevated levels of sICAM-1 in circulation was reported as association with liver metastasis in gastric, Colonic, gall bladder and pancreatic cancer, with reduced survival in malignant melanoma. This study was performed to measure the sICAM-1 in patients with lung cancer and to evaluate the relations between staging of lung cancer and level of sICAM-1. Methods : Serum sICAM-1 was measured in 36 patients with lung cancer according to the pathologic types and clinical staging before therapy and in 8 controls with ICAM-1 ELISA kit. Results : Serum sICAM-1 levels were elevated in patients with lung cancer except small cell type. Also progression and metastasis of lung cancer associated with elevation of sICAM-1 levels. Conclusion : These results suggest that higher levels of serum ICAM-1 reflect the progression and metastasis of lung cancer and it may be used as a marker with diagnostic and prognostic significance.

• Radiation Oncology Journal
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• v.28 no.4
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• pp.205-210
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• 2010

Purpose: To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Materials and Methods: Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39~89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0~64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. Results: The median follow-up time was 62 months (2~202 months). The 5-year overall survival, loco regional relapse-free survival, disease-free survival, and colostomy-free survival rates were 86.0%, 71.7%, 71.7%, 78.2%, respectively. Regarding overall survival, the Eastern Cooperative Oncology Group (ECOG) performance status and complete response were found to be significant prognostic factors on univariate analysis. For multivariate analysis, only the ECOG performance status was significant. No significant factor was found for locoregional relapse-free survival or disease-free survival and similarly for treatment response, no significant factor was determined on logistic regression analysis. There were 7 patients who had local or regional recurrences and one patient with distant metastasis. The only evaluable toxicity in all patients was radiation dermatitis of perianal skin (grade 3), which developed in 4 patients (9.5%) and grade 2 in 22 patients (52.4%). Conclusion: This study revealed that patients with a performance score of ECOG 0-1 survived significantly longer than those with a poorer score. Finally, there was no significant predicting factors tested for treatment response.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.766-775
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• 1997

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

• Radiation Oncology Journal
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• v.24 no.4
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• pp.217-222
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• 2006

$\underline{Purpose}$: This study evaluated the results of definitive radiation therapy and the prognostic factors that affect survival rates for T2N0 glottic cancer patients. $\underline{Materials\;and\;Methods}$: Thirty patients with T2N0 glottic cancer who were treated with definitive radiation therapy at our institution between September 1986 and June 2004 were retrospectively reviewed. All patients were pathologically confirmed as having squamous cell carcinoma and were staged as AJCC T2N0. The age of the patients ranged from 39 to 79 (median 62) years and all were male. A total dose of $66{\sim}70\;Gy$ (median 66 Gy) was delivered with a 6-MV linear accelerator in $6.5{\sim}7$ weeks. The median follow-up period was 63 months. $\underline{Results}$: The actuarial disease-free survival rate for the entire group of the patients was 79% at 5 years. The five-year disease-free survival rates for patients without and with subglottic extension were 90% and 56%, respectively (p=0.03). However, anterior commissure involvement, supraglottic extension, and impaired cord mobility were not statistically significant prognostic factors. The five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). $\underline{Conclusion}$: Subglottic extension can be considered a poor prognostic factor for T2N0 glottic cancer.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.4
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• pp.306-323
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• 2001

종양발생에서 유전자 발현을 확인하고 profile 변화를 monitor하는 것은 병리학적 변화의 원인뿐 아니라 질병탐지와 진료의 새로운 목표를 확인하기 위한 새로운 기회를 제공해준다. cDNA microarray는 수천개의 유전자 발현을 동시에 연구할 수 있는 최신의 방법으로 피부, 유방, 간을 비롯한 다른 인체장기에서는 일부 이루어졌으나 array를 이용해 타액선 종양 연구에서는 전혀 이루어지지 않았다. 인간의 타액선 세포의 악성형질전환을 조절하는 분자적 상태를 연구하기 위해 본 연구는 약 2,000개의 유전자가 print된 cDNA microarray를 이용하여 인간 타액선 도관상피세포주(HSG)와 악하선에서 기원한 미분화 선암종(SGT)간에 비교연구를 하였다. Cy3와 Cy5 dye로 각각의 세포주에서 얻은 RNA와 reciprocal hybridize시키고 GenePix 4000 scanner로 스캔하고 GenePix Pro로 분석한 후 log2로 평균발현비율을 전환시켜 최소 2배이상의 발현을 보이는 유전자를 분석대상으로 하였다. 90%이상의 유전자가 비슷한 발현을 보였으며 2배이상의 발현을 보이는 경우 HSG가 SGT에 비해 72개 유전자가, SGT가 HSG에 비해 111개의 유전자 발현이 up-regulation되어 총 10%미만의 발현차이를 보였고 반복된 hybridization 으로부터 얻은 선택된 spot의 Pearson 상관계수는 -0.85이였다. HSG에서는 6번 p 염색체에서 과발현되는 유전자가 가장 많았고, SGT에서는 11번 q 염색체에서 가장 많았는데 HSG에서는 SGT에 비해 9, 13, 17, 18, 20, 21, 22염색체에서 과발현 되는 유전자 수가 많았고, SGT에서는 HSG에 비해 2, 7, 10, 15 염색체에서 유전자 발현 증가가 관찰되었다. HSG와 SGT간의 유전 발현을 기능별로 분석한 결과 몇 가지 주요 경로가 세포악성에 관련됨을 발견하였고, 타액선 도관상피세포에서 선암종을 구별하는데 기여하는 관련된 몇종의 과다 발현된 유전자를 찾았는데 전사인자, 성장인자 및 수용기, 세포골격 및 세포외기질 단백, 세포내 신호전달조절자 및 인자, 세포표면 항원등의 그룹으로 분류할 수 있었다. 따라서 이러한 microarray를 이용한 분자학적 표지자 연구가 악성 타액선 종양 발생과정에서 큰 도움을 줄 수 있을 뿐 아니라 유전자 조절에 의한 진단, 예후, 치료에서의 정확성을 개선시킬 수 있으리라 여겨진다.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.216-223
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• 2001

Purpose : We evaluated retrospectively the outcomes of inoperable squamous cell lung cancer patients treated with radiotherapy to find out prognostic factors affecting survival. Materials and methods : Four hundred and eleven patients diagnosed as squamous cell lung cancer between November 1988 and December 1997 were the basis of this analyses. The planned dose to the gross tumor volume was ranged from 30 to 70.2 Gy. Chemotherapy was combined in 72 patients $(17.5\%)$ with the variable schedule and drug combination regimens. Follow-up period ranged from 1 to 113 months with the median of 8 months and survival status was identified in 381 patients $(92.7\%)$. Overall survival rate was calculated using the Kaplan-Meier method. Results : Age ranged from 23 years to 83 years with the median 63 years. The male to female ratio was about 16:1. For all 411 patients, the median overall survival was 8 months and the 1-year survival rate (YSR), 2-YSR, and 5-YSR were $35.6\%,\;12.6\%,\;and\;3.7\%$, respectively. The median and 5-YSR were 29 months and $33.3\%$ for Stage IA, 13 months and $6.3\%$ for Stage IIIA, and 9 months and $3.4\%$ for Stage IIIB, respectively(p=0.00). The median survival by treatment aim was 11 months in radical intent group and 5 months in palliative, respectively (p=0.00). Of 344 patients treated with radical intent, median survival of patients (N=247) who received planned radiotherapy completely was 12 months while that of patients (N=97) who did not was 5 months (p=0.0006). In the analyses of the various prognostic factors affecting to the survival outcomes in 247 patients who completed the planned radiotherapy, tumor location, supraclavicular LAP, SVC syndrome, pleural effusion, total lung atelectasis and hoarseness were statistically significant prognostic factors both in the univariate and multivariate analyses while the addition of chemotherapy was statistically significant only in multivariate analyses. The acute radiation esophagitis requiring analgesics was appeared in 49 patients $(11.9\%)$ and severe radiation esophagitis requiring hospitalization was shown in 2 patients $(0.5\%)$. The radiation pneumonitis requiring steroid medication was shown in 62 patients $(15.1\%)$ and severe pneumonitis requiring hospitalization was occurred in 2 patients $(0.5\%)$. During follow-up, 114 patients $(27.7\%)$ had progression of local disease with 10 months of median time to recur (range : $1\~87\;months$) and 49 patients $(11.9\%)$ had distant failure with 7 months of median value (range : $1\~52\;months$). Second malignancy before or after the diagnosis of lung cancer was appeared in 11 patients Conclusion : The conventional radiotherapy in the patients with locally advanced squamous cell lung cancer has given small survival advantage over supportive care and it is very important to select the patient group who can obtain the maximal benefit and to select the radiotherapy technique that would not compromise the life quality in these patients.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.74-81
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• 2008

Background: Fascin is an actin-bundling protein that induces membrane protrusions and it increases cell motility in various transformed cells. Esophageal cancer is one of the most lethal malignancies, and it exhibits extensive local invasion or frequent regional lymph node metastasis even after curative surgery. We investigate the expression of fascin by performing immunohistochemistry to evaluate the clinical characteristics and prognostic significance of its expression in esophageal cancer patients. Material and Method: Immunochemistry for fascin was performed on 76 tumor samples from 76 patients who underwent esophageal cancer operations. The expression levels of fascin in the 76 esophageal cancer tissues were compared with those in the corresponding normal esophageal epithelium. The fascin-positive samples were defined as those showing more than 75% of fascin-positive cells. Result: Overall, a fascin positive expression was detected in 39 (51.3%) out of the total 76 cases. The tumors with positive fascin expression tended to more frequently show a higher stage (p=0.030), and a higher T-factor (p=0.031). The prognosis of the fascin negative group was significantly better than that of the fascin positive group (p=0.004). Multivariate analysis revealed that lymphovascular invasion and the fascin expression were independent prognostic factors. Conclusion: Fascin was expressed in 513% of the esophageal cancer tissues and a positive expression of fascin was associated with more advanced tumor progression and recurrence. Our study suggests that the fascin expression may be an independent prognostic factor for an unfavorable clinical course few those patients suffering with esophageal cancer.

• Radiation Oncology Journal
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• v.3 no.2
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• pp.123-129
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• 1985

A retrospective analysis was undertaken of 46 patients who were referred with squamous cell carcinoma of the esophagus during the period of March 1979 through October 1982, and who were treated by curative radiotherapy in the Department of Therapeutic Radiology Seoul National University Hospital. The overall two-year actuarial survival rate was $20\%$ Survival was analyzed with respect to the site of the cancer, its size, radiation dose, and degree of response. Patients with the best two-year survival rate are the ones who had the tumor no of more than 5cm in length $(39.3\%)$ or confined to the upper third of the esophagus $(29.5\%)$. An optimum radiation dose ranged from 1600 to 1700 rets. Patients to complete response had $42.4\%$ of two-year actuarial survival, but those to no response had $0\%$ of survival.