• Journal of Gastric Cancer
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• 제16권2호
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• pp.115-119
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• 2016

We report the case of a patient with gastric adenocarcinoma with multiple liver metastases. This patient showed complete remission for more than 68 months after S-1/cisplatin combination chemotherapy and radical total gastrectomy. The patient, a 63-year-old man, presented with dyspepsia and difficulty in swallowing. Endoscopic findings showed a huge ulcero-infiltrative mass at the lesser curvature of the mid-body, extending to the distal esophagus. Biopsy revealed a poorly differentiated tubular adenocarcinoma. An abdominal computed tomography scan demonstrated multiple hepatic metastases. S-1/cisplatin combination chemotherapy was initiated, and following completion of six cycles of chemotherapy, the gastric masses and hepatic metastatic lesions had disappeared on abdominal computed tomography. Radical total gastrectomy and D2 lymphadenectomy combined with splenectomy were performed. The patient underwent three cycles of S-1/cisplatin combination chemotherapy followed by tegafur-uracil therapy for 1 year. He remained in complete remission for more than 68 months after surgery.

• Journal of Gastric Cancer
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• 제23권3호
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• pp.410-427
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• 2023

Recent advances in artificial intelligence (AI) have provided novel tools for rapid and precise pathologic diagnosis. The introduction of digital pathology has enabled the acquisition of scanned slide images that are essential for the application of AI. The application of AI for improved pathologic diagnosis includes the error-free detection of potentially negligible lesions, such as a minute focus of metastatic tumor cells in lymph nodes, the accurate diagnosis of potentially controversial histologic findings, such as very well-differentiated carcinomas mimicking normal epithelial tissues, and the pathological subtyping of the cancers. Additionally, the utilization of AI algorithms enables the precise decision of the score of immunohistochemical markers for targeted therapies, such as human epidermal growth factor receptor 2 and programmed death-ligand 1. Studies have revealed that AI assistance can reduce the discordance of interpretation between pathologists and more accurately predict clinical outcomes. Several approaches have been employed to develop novel biomarkers from histologic images using AI. Moreover, AI-assisted analysis of the cancer microenvironment showed that the distribution of tumor-infiltrating lymphocytes was related to the response to the immune checkpoint inhibitor therapy, emphasizing its value as a biomarker. As numerous studies have demonstrated the significance of AI-assisted interpretation and biomarker development, the AI-based approach will advance diagnostic pathology.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.272-276
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• 2004

목적: 조기 위암의 경우 림프절 정이의 빈도가 $2\∼20\%$로 낮고 따라서 수술 범위를 최소화하려는 경향이 있다. 게다가 조기 위암의 경우 림프절 절제술의 적절한 범위 선택에 여러 의견들이 있는 상황이다. 본 연구는 위암의 경우 감시 림프절 및 하나의 림프절 전이가 있는 증례를 분석하여 림프절 절제술의 최소 범위를 찾고자 하는데에 있다. 대상 및 방법: 연세대학교 의과대학 외과학교실에서 2000년부터 2002년까지 치료적 위절제술 및 D2 림프절 절제술을 시행받은 78명의 환자를 대상으로 감시 림프절을 평가 하였다. 개복술후 25 mg의 indocyanine green을 5 ml의 생리 식염수에 혼합하여 원발 종양부위의 장막하층에 주입하여 5분 이내에 염색된 모든 림프절을 표시하였다. 또한 연세대학교 의과대학 외과학 교실에서 1997년부터 2001년까지 치료적 위절제술을 시행받은 환자중 하나의 림프절 전이를 보인 141명을 분석하였다. 결과: 감시 림프절을 평가한 78명의 환자 중 69명($88.5\%$)에서 감시 림프절이 확인되었고, 그중 60명($87\%$)의 환자에서 감시 림프절은 위주위 제1군 림프절에서 발견 되었으나 9명($13\%$)의 경우에서는 제2군 림프절에서 감시 림프절이 확인 되었다. 하나의 림프절 전이를 보인 141명의 전이 림프절의 해부학적 위치를 분석한 결과 125명($88.6\%$)에서는 위주위 제1군 림프절로 전이가 있었고 16명($11.4\%$)에서는 제2군 림프절로 전이를 하였다. 결론: 따라서 D1 림프절 절제술을 시행할 경우 위암에 있어서 조기 전이를 놓칠 수 있으며, 만약 림프절 절제술이 필요한 경우에 있어서는 D2 림프절 절제술이 최소 수술 범위라 할수 있겠다.

• 대한암한의학회지
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• 제19권1호
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• pp.33-41
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• 2014

This report is aimed to investigate the effect of Integrative Medicine Therapy (IMT) in treating metastasized ovary and endometrial cancer. A 51-year-old woman who was diagnosed double primary ovarian and endometrial cancer in 2009. The patient was treated with Laparoscopic Assisted Vaginal Hysterectomy (LAVH), Bilateral Salpingo Oophorectomy (BSO) Pelvic Lymph Node Dissection (PLND), adjuvant chemotherapy till Sep. in 2013. But metastases to Rt. External Iliac artery, Aortocaval area Lymph Nodes, Liver(caudate lobe), Rt. Buttock subcutaneous area, Lt. Gastric Area Lymph Nodes were found. Finally, the patient decided to be treated by IMT including Abnoba Viscum, Vitamin C, herbal medication and pharmacopuncture combined with chemotherapy. The efficacy was evaluated with Positron Emission Tomography and Computed Tomography (PET-CT) and Abdomen Computed Tomography (CT). The metastatic tumor in liver was disappeared and Rt. external iliac artery, aortocaval area Lymph Nodes, Rt. buttock subcutaneous area were also decreased after 6 months treatment. These results suggest that IMT may have a potential role for metastatic cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8661-8666
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• 2014

Background: Docetaxel and cisplatin in combination with fluorouracil (DCF) regimen is accepted to be one of the standard regimens in the treatment of advanced gastric cancer. However, substantial toxicity has limited its use in daily clinical practice. Therefore, modification of DCF regimens, including introduction of capecitabine has been investigated to improve the safety profiles. In the present study, the efficacy and toxicity of a regimen with a modified dose of docetaxel and cisplatin in combination with oral capecitabine (DCX) was evaluated in untreated patients with HER2-negative advanced gastric cancer. Materials and Methods: Fifty-four patients with HER2-negative locally advanced or metastatic gastric cancer were included in this cohort. Patients received docetaxel $60mg/m^2$ plus cisplatin $60mg/m^2$ (day 1) combined with capecitabine $1650mg/m^2$ (days 1-14) every 3 weeks. Treatment response, survival, and toxicity were retrospectively analyzed. Results: The median age was 54 years (range: 24-76). The majority of patients (70%) had metastatic disease, while 11 patients (21%) had recurrent disease and underwent curative gastrectomy, and 5 patients (9%) had locally advanced disease (LAD). The median number of DCX cycles was 4. There were 28 partial responses and 11 complete responses, with an overall response rate of 72%. Curative surgery could be performed in four patients among five with LAD. At the median follow-up of 10 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort of patients were 7.4 and 12.1 months, respectively. Dose modification was done in 12 patients due to toxicity in 8 and noncompliance in 4 patients. The most common hematological toxicity was neutropenia, which occurred at grade 3-4 intensity in 10 of 54 patients (27.7%). Febrile neutropenia was diagnosed only in two cases. Conclusions: DCX regimen offers prominent anti-tumor activity and considered to be effective first-line treatment with manageable toxicity for patients with HER2-negative advanced gastric cancer.

• Journal of Gastric Cancer
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• 제17권1호
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• pp.63-73
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• 2017

Purpose: Data on operable gastric cancer from India is sparse. The purpose of this study was to investigate the clinical details, histopathological demographics, and 5-year overall survival (OS) and disease free survival (DFS) associated with operable, non-metastatic gastric cancer in a dedicated upper gastrointestinal (GI) surgical unit in India. Materials and Methods: Data for patients diagnosed with operable gastric cancer between January 2006 and December 2014 were retrospectively analyzed. Data were collected from electronic hospital records in addition to mail and telephonic interviews when possible. Results: A total of 427 patients were included. The tumor was located in the pyloro-antral region in 263 patients (61.7%). Subtotal gastrectomy was performed in 291 patients and total gastrectomy in 136 patients. Tumor stage classification revealed 43 patients (10.0%) with stage I, 40 patients (9.4%) with stage IIA, 59 patients (13.9%) with stage IIB, 76 patients (17.8%) with stage IIIA, 96 patients (22.5%) with stage IIIB, and 113 patients (26.4%) with stage IIIC disease. Follow-up data were available for 71.6% of the patients with a mean duration of 32.4 months. Five-year DFS and OS were 39% and 59%, respectively. Conclusions: Despite presenting at an advanced stage, the 5-year DFS and OS of patients with operable gastric cancer treated at a dedicated upper GI unit of a tertiary care center in India was good.

• Journal of Gastric Cancer
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• 제23권1호
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• pp.224-249
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• 2023

Gastric cancer is heterogeneous in morphology, biology, genomics, and treatment response. Alterations in human epidermal growth factor receptor 2 (HER2) overexpression, microsatellite instability (MSI) status, programmed death-ligand 1 (PD-L1) levels, and fibroblast growth factor receptor 2 (FGFR2) can be used as biomarkers. Since the combination of fluoropyrimidine/platinum plus trastuzumab that was investigated in the ToGA trial was approved as a standard of care in HER2-positive patients in 2010, no other agents showed efficacy in the first- (HELOISE, LOGiC, JACOB trials) and second- (TyTAN, GATSBY, T-ACT trials) line treatments. Despite the success in treating breast cancer, various anti-HER2 agents, including a monoclonal antibody (pertuzumab), an antibody-drug conjugate (ADC; trastuzumab emtansine [T-DM1]), and a small molecule (lapatinib) failed to translate into clinical benefits until the KEYNOTE-811 (first-line) and DESTINY-Gastri01 (≥second-line) trials were conducted. The incorporation of HER2-directed treatment with immune checkpoint inhibitors in the form of a monoclonal antibody or ADC is now approved as a standard treatment. Despite the promising results of new agents (engineered monoclonal antibodies, bi-specific antibodies, fusion proteins, and small molecules) in the early phase of development, the management of HER2-positive gastric cancer requires further optimization to achieve precision medicine with a chemotherapeutic backbone. Treatment resistance is a complex process that can be overcome using a combination of chemotherapy, targeted agents, and immune checkpoint inhibitors, including novel agents. HER2 status must be reassessed in patients undergoing anti-HER2 treatment with disease progression after the first-line treatment. As a general guideline, patients who need systemic treatment should receive chemotherapy plus targeted agents, anti-angiogenic agents, immune checkpoint inhibitors, or their combinations.

• Journal of Gastric Cancer
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• 제21권3호
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• pp.268-278
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• 2021

Purpose: While several prognostic models for the stratification of death risk have been developed for patients with advanced gastric cancer receiving first-line chemotherapy, they have seldom been tested in the Chinese population. This study investigated the performance of these models and identified the optimal tools for Chinese patients. Materials and Methods: Patients diagnosed with metastatic or recurrent gastric adenocarcinoma who received first-line chemotherapy were eligible for inclusion in the validation cohort. Their clinical data and survival outcomes were retrieved and documented. Time-dependent receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive ability of the models. Kaplan-Meier curves were plotted for patients in different risk groups divided by 7 published stratification tools. Log-rank tests with pairwise comparisons were used to compare survival differences. Results: The analysis included a total of 346 patients with metastatic or recurrent disease. The median overall survival time was 11.9 months. The patients were different into different risk groups according to the prognostic stratification models, which showed variability in distinguishing mortality risk in these patients. The model proposed by Kim et al. showed relative higher predicting abilities compared to the other models, with the highest χ² (25.8) value in log-rank tests across subgroups, and areas under the curve values at 6, 12, and 24 months of 0.65 (95% confidence interval [CI]: 0.59-0.72), 0.60 (0.54-0.65), and 0.63 (0.56-0.69), respectively. Conclusions: Among existing prognostic tools, the models constructed by Kim et al., which incorporated performance status score, neutrophil-to-lymphocyte ratio, alkaline phosphatase, albumin, and tumor differentiation, were more effective in stratifying Chinese patients with gastric cancer receiving first-line chemotherapy.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.282-285
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• 2004

전 세계적으로 위암의 발생빈도와 사망률은 감소하고 있으나 우리나라에서는 가장 흔한 암르로 중요한 사망 원인 중 하나이다. 특히, 진행성 위암의 경우에는 아직도 예후가 불랴하며 예후에 dudgiddf 미치는 인자로는 원격전이, 림프절 전이, 불완전한 수술절제 등이 있다. 선행화학요법은 수술 전에 화학요법을 시행하여 종양의 크기를 줄인 다음 수술을 시행하는 방법으로 이는 절제 불가능한 진행성 위암에서 병소의 국소적인 종양을 감소시켜 절제율이 증가하는 경우는 많이 있었다. 그러나 혈행성 및 복막파종 등 가종 원격전이를 동반한 위암에서의 선행화학요법에 대한 연구는 아직 부족한 실정이다. 이에 본원에서 폐전이 및 좌측 쇄골상부 림프절 전이가 있는 환자에서 선행화학요법 시행 후 원격전이 부위의 완전 관해 후 위전절제술을 시행 후 원격전이 부위의 완전 관해 후 위전절제술을 시행한 1예를 문헌 고찰과 함께 보고하는 바이다. 증례: 47세 여자환자로 이학적 검사상 좌측 쇄골상부 림프절이 만져지고 흉부 방산선 소견 상 다발성 폐전이를 동반한 진행성 위암으로 진단 받았다. 술 전 항암요법으로서 Taxotere, CDDP와 5-FU를 투여하였다. 항암화학요범 4회 실시 후 좌측 쇄골상부 림프절과 흉부 방산선 소견 상 보이던 다발성 폐전이가 사라졌고, 복부 CT 소견 상 위병 변의 크기의 감소를 보였다. 이에 저자들은 위전절제술과 D2 림프절 곽청술을 시행하였다. 병리조직검사상 위암은 위근육층까지 도달했으며 62개의 절제된 림프절 중 42개에서 암세포가 발견되었다. 환자는 수술 후 2회의 항암요법을 추가로 시행 받은 후 퇴원하였다.

• Journal of Digestive Cancer Research
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• 제1권1호
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• pp.48-51
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• 2013

73세 남자 환자로 약 1개월 전부터 상복부 불편감 주소로 본원 내원 후 시행한 상부 내시경 검사상 하체부 전벽측의 조기위암으로 내시경 점막하 박리술을 시행하였다. 조직검사 결과 저분화도(poorly differentiated type)의 선암이 발견되었고, 절제면의 암세포 침범 소견은 없었으나, 점막하 2층(900 um)까지 침윤된 소견과 일부 림프선 전이 소견이 보여 위 절제 수술(subtotal gastrectomy)을 시행하였다. 조직검사 결과 점막층에 국한된 저분화도의 선암이 발견되었고, 그 외 림프절 전이 등의 소견은 보이지 않아 수술 후 병기 1기의 조기위암(T1N0M0, stage IA) 으로 진단 후 추가적인 항암치료 없이 추적관찰을 하였다. 이후 6개월 마다 복부 전산화단층촬영술과 상부 내시경 검사를 시행하였으며, 수술 후 2년째 시행한 복부 전산화단층촬영 결과 간의 다발성의 전이성암으로 의심되는 소견이 관찰되었다. 간 조직 검사를 시행하였고, 조직검사 결과 저분화도의 선암으로 발견되었으며, 원발 병소를 확인하기 위해 면역화학 검사를 시행한 결과 췌담도 계통의 암에서 특징적으로 보일 수 있는 CK7과 CK19이 강양성 소견을 보여 담도암의 간전이로 의심하였다. 이후 췌담도 MRI 및 PET 검사 등을 시행 하였으나, 담도암 등의 소견은 관찰되지 않았다. 위암은 특징적으로 발생 기전에서 다양한 내적 및 외적 원인들(nitrosamine, H. pylori, E-cadherin mutation 등)로 인해 면역 화학 조직검사 결과가 다양하게 나타날 수 있기 때문에(heterogeneous cytokeratin expression pattern) 면역화학 검사 결과만으로 위암 가능성을 배제할 수 없는 것으로 보고되고 있다. 따라서 위암의 간전이로 진단 후 항암치료를 시행하였으며, 면역화학 검사에서 췌담도 계통의 암으로 오인되었던 재발성 전이성 위암의 증례 1례를 문헌고찰과 함께 보고한다.