• Journal of Gastric Cancer
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• v.6 no.3
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• pp.173-180
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• 2006

Purpose: The TNM staging system showed limitation in stratifying patients into different prognostic groups with gastric cancer Since the treatment for stage IV gastric cancer with distant metastasis (M1) is defined as non-curative one, we hypothesized that the survival rate of stage IV gastric cancer with M1 is different to that of stage IV gastric cancer with no distant metastasis (M0), which will provide a rationale to subdivide stage IV into IVa and IVb. Materials and Methods: From June 1992 to December 2005, of 1,630 gastric cancer patients who underwent surgery, 308 patients with stage IV gastric cancer were selected and analyzed. The clinicopathologic characteristics and survival of the patients, according to distant metastasis, were determined retrospectively. Median follow-up period was 13 months (range: $1{\sim}154$ month). Results: 5 year survival rate of M0 and M1 group was 35% and 16% respectively with statistic significance (P=0.0000). When the survival rate of M0 group was analyzed according to the difference of T and M factor, T1-3N3M0 and T4N1-2M0 group showed no significant statistical difference (P=0.1898). Conclusion: Given the result in this study, we suggest that the stage IV gastric cancer be subclassified into stage IVa and IVb according to M factor.

• Korean Journal of Head & Neck Oncology
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• v.30 no.1
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• pp.1-4
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• 2014

배경 및 목적 타액선 선양낭성암종은 느린 성장 속도와 늦은 원격 전이를 특징으로 하는 드문 상피성종양이다. 본 연구는 다양한 임상 병리학적 변수를 통해 선양낭성암종의 원격 전이에 영향을 주는 인자를 조사하고자 하였다. 대상 및 방법 1999년 10월부터 2011년 12월까지 본원 이비인후과에서 타액선 선양낭성암종으로 진단되어 치료 받은 44명(남자 19명, 여자 25명)을 대상으로 원격전이를 유발하는 위험 인자를 조사하였다. 8명의 환자는 배제 기준에 따라 제외하였다. 환자의 평균 연령은 54세였다. 환자의 병리 보고서, 종양의 크기, T 병기, 수술 절제연의 종양 존재 유무, 신경 조직 침습, 림프절 전이가 조사되었다. 결 과 15명의 환자가 원격전이가 있었으며 21명은 원격 전이가 없었다. 원격 전이를 유발할 수 있는 여러 인자들을 비교하였을 때, 원격 전이는 수술 절제연의 종양 세포 잔존(p=0.014), 종양의 크기(p=0.038), 진행된 T 병기(p=0.024)가 통계적으로 유의하게 연관성이 있었다. 림프절 전이와 신경 조직 침습은 원격 전이와 연관이 없었다. 결 론 종양의 크기, 진행된 T 병기, 수술 후 절제연의 종양 세포 잔존은 원격 전이의 예측 인자로 생각된다. 따라서 이에 해당하는 환자의 경우 더욱 철저한 관리 및 경과 관찰을 요한다.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.298-314
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• 2021

Owing to the anatomic complexity of the hepatic hilum, it has been considered difficult to diagnose and treat peri-hilar cholangiocarcinoma. Currently, imaging studies, including contrast-enhanced CT and MRI, play a crucial role in the detection, characterization, staging, and resectability assessment of peri-hilar cholangiocarcinoma. In this review, the classification of perihilar cholangiocarcinoma and proposed imaging protocol for the evaluation will be discussed. The typical imaging finding of peri-hilar cholangiocarcinoma, evaluation of longitudinal tumor extent, adjacent vascular invasion, and distant metastasis will also be mentioned. Finally, traditional concepts and recent updates for the resectability assessment of peri-hilar cholangiocarcinoma will be introduced.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.789-793
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• 2003

Primary pulmonary angiosarcomas are extremely rare tumors. The diagnosis is often delayed due to nonspecific symptoms, mimicking pulmonary embolism and require careful clinical evaluation to exclude metastasis from the heart, pericardium, and distant extrathoracic sites. Most diagnosis are made postmortem. We report a case of primary pulmonary angiosarcoma histopathologically confirmed postoperatively, which was clinically suspected endobronchial carcinoma with endobronchial obstruction with relavant literature review.

• Radiation Oncology Journal
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• v.13 no.1
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• pp.41-48
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• 1995

Purpose : The adjuvant postoperative radiotherapy has been usually applied to the patients with unfavorable prognostic factors after radical operation in early cervical cancer. We focused on the evaluation of the survival status and failure patterns of the patients with postoperative radiotherapy. Materials and Methods : We retrospectively analyzed ninety patients with FIGO stage IB and IIA cervix cancer who received postoperative pelvic irradiation at Chonnam University Hospital between August 1985 and December 1988, Seventy-eight patients had adequate follow-up information for survival analysis. Median follow-up time of these patients was 64 months. Results : The 5 year overall and disease free survival rate of ninety patients was $80.0\%$ and $80.2\%$, respectively. The prognostic significance to the survival was determined by multivariate analysis. Adequacy of resection margin(p=0.005) and lymph node status(p=0.005) appeared to be independent prognostic factors. Recurrence occurred in 13 patients, 5 in the pelvis and 8 at distant sites. The median time to recurrence was 19 months(range:3-39 months). The pelvic recurrence was more prevalent in the group of patients with adenocarcinoma, depth of stromal invasion more than 10mm and use of chemotherapy. The distant failure was more prevalent in the group of positive resection margin or positive lymph node with statistical significance. Conclusion : Patients with pelvic lymph node or surgical margin involvement clearly constitute a high risk group in this analysis and should be considered as candidates for some form of adjuvant therapy.

• Korean Journal of Head & Neck Oncology
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• v.7 no.2
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• pp.104-113
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• 1991

선양낭암은 타액선종양중 비교적 드문 악성종양으로 병리조직학적 및 임상적으로 독특한 양상을 보인다. 병리조직학상 종양세포가 신경주변으로 침범하여 수술당시 적절한 수술연을 얻기 어렵고 이에 따른 국소재발이 거듭되고 임파선전이 및 예측치 않는 원격전이가 생기기도 한다. 지금까지 선양낭암환자의 예후에 영향을 미치는 여러 요인들에 대한 연구들이 이루워지고 있는데 그중 조직학적 분화도, 원발부위, 종양의 크기, 수술연의 상태와 임상적 병기들이 중요시되고 있다. 이에 저자들은 1960년부터 1980년 까지 텍사스대학 M.D. Anderson 암센터에서 치료받은 이하선 및 악하선 선양낭암 각각 13례와 26례를 대상으로 원발부위가 환자의 생존 및 치료에 미치는 영향을 알고자 다른 예후인자로 알려진 조직병리학적 소견들과 함께 통계학적 분석을 실시하였다. 이하선과 악하선에 생긴 선양낭암을 비교한 결과 이하선에 생긴 경우 조직학적 분화도가 더 낮았고 악하선 종양에서 수술연에 종양침범율이 더 적었다. 경부 임파절 전이는 악하선 종양에서 많았으나 반면 원격전이는 이하선 종양에서 더 많이 발생하였다. 그러나 종양의 크기, 선경주위침범 유무, 국소재발과 환자의 생존율사이에는 의의있는 상관 관계는 없었다. 이하선과 악하선에 생긴 선양낭암의 여러 특성들과 생존률간의 univariate 분석결과 악하선에 생긴 선양낭암 환자에서 종양이 크거나 조직학상 분화가 나쁘거나(solid pattern), 경부임파절 전이와 원격전이가 생기면 예후에 나쁜 영향을 끼침이 밝혀졌다. 그러나 이하선에 생긴 경우 분석례가 너무 적어 결론을 내리기에 불충분하였다. 원발부위에 따른 선양낭암 환자들의 특성을 chi-square 검정법을 이용하여 통계학적으로 분석한 결과 이 두군간에는 의의있는 통계학적 차이는 발견할 수 없었다.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.291-297
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• 1996

Purpose : This study was performed to evaluate survival, failure patterns, and prognostic factors of MMR patients after radiation therapy. We also discussed the need for chemotherapy. Materials and Methods : A retrospective analysis was done for 23 patients with MMR who were treated with radiation therapy from June 1985 to November 1992. There were 19 male and 4 female patients, The patients' age ranged from 17 to 71 years (median 39 years). Systemic symptoms including fever, weight loss, or malaise were found in $30\%$ of the patients. The nasal cavity was most frequently involved No patients had nodal involvement at diagnosis. There were 2 patients with distant metastasis at presentation. Radiation therapy was delivered five times a week, 1.8 Gy daily, total $45\~54$ Gy (median 50.4 Gy) using 6 MV X-ray No patients received chemotherapy as initial treatment. Results : Overall 5-year and 10-year survival rates were $52.4\%$ and $44.1\%$, respectively. Seventy Percent(12/17) of the patients achieved complete response to radiotherapy, and $29.4\%$ (5/17) achieved partial response. The Patients with complete response showed a better 5-year survival rate than those with partial response ($66.9\%$ vs. $20\%$. p=0.004). Symptom duration before diagnosis, the presence of systemic symptom, and the number of primary sites had no influence on survival. The patterns of failure were as follows: local failure(1), failure in adjacent site(1), local and distant failure(1) distant metastasis(2). and conversion to malignant lymphoma(1). We could not find factors associated with the patterns of failure. Conclusion : The most important facto associated with survival was the response to radiotherapy. Seventeen percent of the patients had distant metastasis, and the salvage after distant metastasis was not successful. However. about $50\%$ of the patients could achieve long-term survival with local radiation therapy alone. Therefore, chemotherapy of MMR should be done after a prospective randomized study for the factors associated with distant metastasis.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.113-119
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• 2005

Purpose: Some controversies exist over the prognostic values of lymphatic, venous, and neural invasion in patients with gastric cancer. This study was conducted to confirm the prognostic values of these histopathologic factors in gastric cancer patients who received a gastrectomy. Materials and Methods: Data for clinicopathologic factors and clinical outcomes were collected retrospectively from the medical records of 1,018 gastric cancer patients who received a gastrectomy at Yeungnam University Medical Center between January 1995 and December 1999. A statistical analysis was done using the SPSS program for Windows (Version 10.0, SPSS Inc., USA). The Kaplan-Meier method was used for the survival analysis. Prognostic factors were analyzed by using a multivariate analysis with Cox proportional hazard regression model. Results: Ages ranged from 21 to 79 (median age, 56). A univariate analysis revealed that age, tumor size, location, gross type, depth of invasion, extent of gastrectomy or lymph node dissection, lymph node metastasis, distant metastasis, lymphatic invasion, venous invasion, neural invasion, pathologic stage, histologic type, and curability of surgery had statistical significance. Among these factors, lymph node metastasis, curability of surgery, neural invasion, lymphatic invasion, and depth of invasion were found to be independent prognostic factors by using a multivariate analysis. Venous invasion showed no prognostic value in the multivariate analysis. Conclusion: Neural invasion and lymphatic invasion are useful parameters in determining a prognosis for gastric cancer patients.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.379-388
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• 2002

Background : Although patients with stage IV non-small cell lung cancer are known to have a poor prognosis, the prognostic factors for survival have not been well evaluated. Such factors may be different from those for overall survival. This study was performed to analyze the prognostic factors for survuval and the variation of survival according to metastatic organ, in patients with stage IV non-small cell lung cancer. Materials and Methods : From January 1997 to December 2000, 151 patients with confirmed stage IV non-small cell lung cancer were enrolled into this study retrospectively. The clinical and laboratory data were analyzed using univareate Kaplan-Meied and Multivariate Cox regression models. Results : On univariate analysis, age, performance status, serum albumin level, weight loss, forced expiratory volume in one second (FEV1), systemic chemotherapy, the number of metastatic organs and serum lactate dehydrogenase (LDH) level were significant factors (p<0.05). In multivariate analysis, important factors for survival were ECOG performance (relative risk of death [RR]: 2.709), systemic chemotherapy (RR: 1.944), serum LDH level (RR: 1.819) and FEV1 (RR: 1.774) (p<0.05), Metastasis to the brain and liver was also a significant factor on univariate analysis). The presence of single lung metastasis was associated with better survival than that of other metastatic organs (p=0.000). Conclusion : We confirmed that performance status and systemic chemotherapy were independent prognostic factors, as has been recognized. The survival of stage IV non-small cell lung cancer patients was different according to the metastatic organs. Among the metastatic sites, only patients with metastasis to the lung showed bettrer survival than that of other sites, while metastasis of the brain or liver was associated with worse survival than that of other sites.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.27-34
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• 2003

Purpose : To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy Materials and Methods : Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500$\~$6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20$\~$81 months, with a median of 57.5 months. Results : The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3$\%$, and 41.6 and 29.7$\%$, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, 7 and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p<0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1$\%$), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1 Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management. Conclusion : Postoperative radiotherapy is feasigbls in extrah데atic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.