• 대한두경부종양학회지
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• 제19권2호
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• pp.121-126
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• 2003

Objectives: The c-kit gene encodes a transmembrane receptor-type tyrosine kinase, which is known to have a significant role in the normal migration and development of germ cells and melanocytes. In the previous studies of c-kit gene, c-kit expressions showed only in adenoid cystic carcinomas, lymphoepithelioma-like carcinomas and myoepithelial carcinomas, but not in others and mutation was not found in any types of salivary carcinoma. We investigate the c-kit expression which may be useful to differentiating adenoid cystic carcinomas from others, and mutation of the gene which may not be exist nor the mechanism of c-kit activation in salivary carcinomas. Material and Methods: The archival tissue samples from 42 salivary carcinomas of major and minor salivary glands were studied for c-kit expression by immunohistochemistry and gene mutation by polymerase chain reaction amplification and single strand conformational polymorphism. Results: The c-kit expressions were noted in 22/24 adenoid cystic carcinomas, 7/9 mucoepidermoid carcinomas, 2/3 acinic cell carcinomas, 3/4 malignant mixed tumors, and one undifferentiated carcinoma. The mutation of c-kit gene was found in 3/24 adenoid cystic carcinomas, 3/8 mucoepidermoid carcinomas, one acinic cell carcinoma, and 2/4 malignant mixed tumors. Conclusion: c-kit protein overexpression is seen in a variety of salivary gland carcinomas, and the mutation of the gene may be the mechanism of c-kit activation in these neoplasms.

• Journal of Hospice and Palliative Care
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• 제15권2호
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• pp.99-107
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• 2012

목적: 말기암환자의 여명 예측은 치료의 이득과 위해를 판단하는 잣대가 되고, 적절한 의료 중재 제공 및 환자의 자율성에 기초한 의사결정에 중요한 기준이 된다. 특히 많은 수의 말기암환자는 암성 식욕부진-악액질 증후군으로 사망에 이르기 때문에 본 연구에서는 이를 반영할 수 있는 혈장 렙틴 농도와 생존기간과의 연관성을 알아보고자 하였다. 방법: 2009년 7월부터 2010년 7월까지 13개월 동안, 만 20세 이상의 말기암환자 69명을 대상으로 혈장 렙틴 농도를 측정하고, 생존기간을 조사하였다. 나이, 성별, 원발암 부위, 암 치료 경력, 전이여부, 투약상황 및 활력증후, 백혈구 수, 혈색소, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), C-반응성 단백질, 총 빌리루빈, 총 콜레스테롤, 알부민, 렙틴 등의 혈액검사를 시행하였다. 결과: 혈장 렙틴 농도와 성별, 나이, 백혈구 수, 혈색소, AST, ALT, 총 빌리루빈, C-반응성 단백질, 통증강도 등의 상관 관계 분석 결과 렙틴과 생존기간에는 통계적으로 유의한 양의 상관 관계를 보였으며, 단변량 분석한 결과 혈장 렙틴 농도는 생존기간과 통계적으로 경계수준의 유의한 관계를 보였으나, 단변량 분석에서 생존 기간에 유의한 영향을 미치는 성별, 백혈구 수, AST, ALT, 총 빌리루빈, 알부민, C-반응성 단백질을 포함하여 시행한 다변량 분석에서 혈장 렙틴 농도는 생존기간과 통계적으로 유의한 관계가 없는 것으로 나타났다. 결론: 암성 식욕부진-악액질 증후군과 관련이 있는 혈장 렙틴 농도와 말기암환자의 생존기간과는 통계적으로 유의한 연관성을 보이지는 않았다. 그러나, 소화기계암환자에 있어서는 혈장 렙틴 농도가 생존기간 예측인자로서 쓰일 수 있는 가능성을 보여주었다.

• Journal of Hospice and Palliative Care
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• 제12권2호
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• pp.61-71
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• 2009

목적: 본 연구는 청소년 후기 말기 암 환자의 전반적인 경험을 이해하고 총체적인 고통을 경감하도록 돕는 정서적, 영적 돌봄 프로그램인 CD 프로그램을 개발하기 위한 것이다. 방법: 2006년 11월 1일부터 2007년 10월 30일까지 Keller와 Song의 ARCS이론과 Kang의 멀티미디어 코스웨어 설계 과정을 응용하여 플래쉬 도구를 활용한 CD 프로그램을 개발하였으며, 개발된 의미요법 프로그램명은 "청소년 후기 암 환자를 위한 "내 삶의 보물찾기""이었다. 프로그램 개발은 <계획>, <설계>, <개발>-CD프로그램, 사용자(간호사)용 교육지침서 및 학습자용 교육용 책자, <평가>의 4단계를 통해 이루어졌다. 결과: 본 연구에서 개발된 의미요법 CD 프로그램은 총 5개의 비밀을 찾는 과정으로 교육시간은 각 차시별로 $15{\sim}20$분으로 구성되었으며. "비밀"로 명명된 각 차시별 구성은 의미요법에 대한 프로그램의 제작목적을 알려주는 <처음>과 6컷 만화를 통한 동기유발을 유도하기 위한 <마음열기>, 각 차시별 교육목적과 의미요법 교육이 진행되는 영상물 상영 <알아보기>, 교육 내용에 대한 카타르시스를 위한 <웃음 송>, 교육내용을 자신에게 직접 적용해 보는 <경험하기>, 메인화면으로 돌아갈 수 있는 <끝>의 6단계로 이루어졌으며, 교육용 소책자(의미노트)를 제공하여 반복학습이 이루어질 수 있도록 하였다. 본 프로그램은 청소년 말기 암환자가 있는 임상현장인 병원학교 혹은 지역사회 어느 곳이든지 컴퓨터가 가능한 곳에서는 사용할 수 있도록 CD로 만들어졌으며, 프로그램은 신규 간호사도 사용하기 편리하게 자동과 수동 양방향의 기능을 가지고 매체조작이 용이하도록 제작되었다. 교육지침서는 전체 내용을 손쉽게 파악할 수 있도록 되어 있고, <웃음 송>에 대한 저작권 등록은 완료된 상태로 전국의 소아 청소년 종양병동에서 무료로 사용할 수 있도록 하였다. 결론: 본 프로그램은 간호사들이 교육에 대한 큰 부담없이 의미요법 프로그램을 쉽게 진행할 수 있도록 제작되어 있어 임상에서 청소년 후기 말기 암 환자의 정서적, 영적 간호중재 방법으로 유용하다고 판단된다. 또한 말기 암환자 뿐 아니라 청소년 후기에 만성 및 불치의 질병으로 고통을 받는 대상자에게도 적용할 수 있다고 생각된다.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.238-245
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• 2015

Purpose: This study aimed to identify time-dependent prognostic factors and demonstrate the time-dependent effects of important prognostic factors in patients with advanced gastric cancer (AGC). Materials and Methods: We retrospectively evaluated 3,653 patients with AGC who underwent curative standard gastrectomy between 1991 and 2005 at the Korea Cancer Center Hospital. Multivariate survival analysis with Cox proportional hazards regression was used in the analysis. A non-proportionality test based on the Schoenfeld residuals (also known as partial residuals) was performed, and scaled Schoenfeld residuals were plotted over time for each covariate. Results: The multivariate analysis revealed that sex, depth of invasion, metastatic lymph node (LN) ratio, tumor size, and chemotherapy were time-dependent covariates violating the proportional hazards assumption. The prognostic effects (i.e., log of hazard ratio [LHR]) of the time-dependent covariates changed over time during follow-up, and the effects generally diminished with low slope (e.g., depth of invasion and tumor size), with gentle slope (e.g., metastatic LN ratio), or with steep slope (e.g., chemotherapy). Meanwhile, the LHR functions of some covariates (e.g., sex) crossed the zero reference line from positive (i.e., bad prognosis) to negative (i.e., good prognosis). Conclusions: The time-dependent effects of the prognostic factors of AGC are clearly demonstrated in this study. We can suggest that time-dependent effects are not an uncommon phenomenon among prognostic factors of AGC.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.223-230
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• 2015

Purpose: The purpose of this pilot study was to evaluate the association between adenosine triphosphate-based chemotherapy response assays (ATP-CRAs) and subsets of tumor infiltrating lymphocytes (TILs) in gastric cancer. Materials and Methods: In total, 15 gastric cancer tissue samples were obtained from gastrectomies performed between February 2007 and January 2011. Chemotherapy response assays were performed on tumor cells from these samples using 11 chemotherapeutic agents, including etoposide, doxorubicin, epirubicin, mitomycin, 5-fluorouracil (5-FU), oxaliplatin, irinotecan, docetaxel, paclitaxel, methotrexate, and cisplatin. TILs in the tissue samples were evaluated using antibodies specific for CD3, CD4, CD8, Foxp3, and Granzyme B. Results: The highest cancer cell death rates were induced by etoposide (44.8%), 5-FU (43.1%), and mitomycin (39.9%). Samples from 10 patients who were treated with 5-FU were divided into 5-FU-sensitive and -insensitive groups according to median cell death rate. No difference was observed in survival between the two groups (P=0.216). Only two patients were treated with a chemotherapeutic agent determined by an ATP-CRA and there was no significant difference in overall survival compared with that of patients treated with their physician's choice of chemotherapeutic agent (P=0.105). However, a high number of CD3 TILs was a favorable prognostic factor (P=0.008). Pearson's correlation analyses showed no association between cancer cell death rates in response to chemotherapeutic agents and subsets of TILs. Conclusions: Cancer cell death rates in response to specific chemotherapeutic agents were not significantly associated with the distribution of TIL subsets.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.162-167
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• 2010

Purpose: The incidence of lymph node metastasis has been reported to range from 2.6 to 4.8% in early stage gastric cancer with mucosal invasion (T1a cancer). Lymph node metastasis in early stage gastric cancer is known as an important predictive factor. We analyzed the prediction factors of lymph node metastasis in T1a cancer. Materials and Methods: A total of 9,912 patients underwent radical gastrectomy due to gastric cancer from October 1994 to July 2006 in the Department Of Surgery at Samsung Medical Center. We did a retrospective analysis of 2,524 patients of these patients, ones for whom the cancer was confined within the mucosa. Results: Among the 2,524 patients, 57 (2.2%) were diagnosed with lymph node metastasis, and of these, cancer staging was as follows: 41 were N1, 8 were N2, and 8 were N3a. Univariate analysis of clinicopathological factors showed that the following factors were significant predictors of metastasis: tumor size larger than 4 cm, the presence of middle and lower stomach cancer, poorly differentiated adenocarcinoma and signet-ring cell carcinoma, diffuse type cancer (by the Lauren classification), and lymphatic invasion. Multivariate analysis showed that lymphatic invasion and tumor larger than 4 cm were significant factors with P<0.001 and P=0.024, respectively. Conclusions: The frequency of lymph node metastasis is extremely low in early gastric cancer with mucosal invasion. However, when lymphatic invasion is present or the tumor is larger than 4 cm, there is a greater likelihood of lymph node metastasis. In such cases, surgical treatments should be done to prevent disease recurrence.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.212-218
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• 2010

Purpose: The aim of this study was to determine proportions of upper third gastric cancer (UTG) among all gastric cancers and analyze clinicopathological features of the disease. Materials and Methods: The medical records of 12,300 patients who underwent gastric surgery between 1986 and 2006 at Seoul National University Hospital (SNUH) were retrospectively reviewed. Clinicopathological features of 1,260 patients with UTG and 9,929 patients with middle or lower third gastric cancer (MLG) were compared, and annual proportions of UTG were evaluated. Results: The proportion of patients with UTG rapidly increased from 2.6% in 1986 to 12.5% in 1992. However, linear regression analysis showed that the rate of increase was reduced (0.21%/year) after 1992 (12.5% to 14.2% from 1992 to 2006). Compared with the MLG group, the UTG group had a lower proportion of (22.3% vs. 39.7%, P<0.001) and a greater proportion of stage III/IV disease (39.4% vs. 31.7%, P<0.001). The UTG group also had larger tumors than the MLG group in stages I/II and III (3.5 cm/5.3 cm/6.5 cm vs. 3.2 cm/5.0 cm/5.8 cm, P=0.020/0.028 /<0.001), a higher proportion of undifferentiated cancer (63.1% vs. 53.7%, P<0.001), and less intestinal Lauren's type (38.8% vs. 47.4%, P<0.001). The 5-year survival rate of the UTG group was significantly lower than that of the MLG group in stages I/II and III (85.6%/63.1%/34.2% vs. 91.6%/ 69.2%/44.7%, P<0.001/0.028/0.006). Conclusions: The proportion of UTGs has increased over the last two decades at SNUH, but the rate of increase has been greatly reduced since 1992. The UTG group showed a poorer prognosis compared with the MLG group in stages I/II and III.

• Journal of Gastric Cancer
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• 제14권1호
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• pp.15-22
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• 2014

Purpose: To evaluate the prevalence of esophageal reflux-induced symptoms after gastrectomy owing to gastric cancer and assess the relationship between esophageal reflux-induced symptoms and quality of life. Materials and Methods: From January 2012 to May 2012, 332 patients were enrolled in this cross-sectional study. The patients had a history of curative resection for gastric cancer at least 6 months previously without recurrence, other malignancy, or ongoing chemotherapy. Esophageal reflux-induced symptoms were evaluated with the GerdQ questionnaire. The quality of life was evaluated with the European Organization for Research and Treatment QLQ-C30 and STO22 questionnaires. Results: Of the 332 patients, 275 had undergone subtotal gastrectomy and 57 had undergone total gastrectomy. The number of GerdQ(+) patients was 58 (21.1%) after subtotal gastrectomy, and 7 (12.3%) after total gastrectomy (P=0.127). GerdQ(+) patients showed significantly worse scores compared to those for GerdQ(-) patients in nearly all functional and symptom QLQ-C30 scales, with the difference in the mean score of global health status/quality of life and diarrhea symptoms being higher than in the minimal important difference. Additionally, in the QLQ STO22, GerdQ(+) patients had significantly worse scores in every symptom scale. The GerdQ score was negatively correlated with the global quality of life score (r=-0.170, P=0.002). Conclusions: Esophageal reflux-induced symptoms may develop at a similar rate or more frequently after subtotal gastrectomy compared to that after total gastrectomy, and decrease quality of life in gastric cancer patients. To improve quality of life after gastrectomy, new strategies are required to prevent or reduce esophageal reflux.

• Genomics & Informatics
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• 제10권3호
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• pp.175-183
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• 2012

Colorectal cancer (CRC) is among the leading causes of cancer deaths and can be caused by environmental factors as well as genetic factors. Therefore, we developed a prediction model of CRC using genetic risk scores (GRS) and evaluated the effects of conventional risk factors, including family history of CRC, in combination with GRS on the risk of CRC in Koreans. This study included 187 cases (men, 133; women, 54) and 976 controls (men, 554; women, 422). GRS were calculated with most significantly associated single-nucleotide polymorphism with CRC through a genomewide association study. The area under the curve (AUC) increased by 0.5% to 5.2% when either counted or weighted GRS was added to a prediction model consisting of age alone (AUC 0.687 for men, 0.598 for women) or age and family history of CRC (AUC 0.692 for men, 0.603 for women) for both men and women. Furthermore, the risk of CRC significantly increased for individuals with a family history of CRC in the highest quartile of GRS when compared to subjects without a family history of CRC in the lowest quartile of GRS (counted GRS odds ratio [OR], 47.9; 95% confidence interval [CI], 4.9 to 471.8 for men; OR, 22.3; 95% CI, 1.4 to 344.2 for women) (weighted GRS OR, 35.9; 95% CI, 5.9 to 218.2 for men; OR, 18.1, 95% CI, 3.7 to 88.1 for women). Our findings suggest that in Koreans, especially in Korean men, GRS improve the prediction of CRC when considered in conjunction with age and family history of CRC.

• Tuberculosis and Respiratory Diseases
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• 제53권3호
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• pp.285-293
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• 2002

배 경 : 폐는 악성 종양이 흔히 전이되는 장소로 흔히 폐실질, 흉막, 혹은 임파선으로 주로 전이되며, 기관지내 전이는 흔하지 않아 악성 종양의 기관지내 발생율은 2%정도로 알려져 있다. 저자들은 굴곡성 기관지경 검사로 확인된 증례들을 대상으로 기관지내 전이암에 대한 임상적 특징을 알아보고자 하였다. 연구방법 : 1991년 6월부터 2001년 5월까지 10년 동안 연세대학교 의과대학 세브란스병원에서 굴곡성 기관지경 검사로 폐외 악성 종양의 기관지내 전이가 확인된 27예를 대상으로 임상 양상, 치료, 경과 등을 조사하였다. 연구결과 : 평균연령은 53세이고, 남자가 17예, 여자가 10예이었다. 원발 종양은 대장암이 가장 많았으며, 자궁경부암, 위암, 유방암의 순서이었다. 원발 종양의 진단에서부터 기관지내 전이를 발견할 때까지의 기간은 평균 45.5개월이었으며, 유방암이 85.3개월로 다른 종양들에 비해 길었다. 임상 증상은 기침이 가장 많았고, 흉부 X-선 소견은 폐문부 종괴음영, 단일결절, 무기폐가 많았다. 치료는 수술, 항암 화학요법, 방사선치료 등을 시행하였고, 생존기은 평균 12.3개월이었다. 결 론 : 기관지내 전이암은 임상에서 흔한 질환이 아니며, 증상, 방사선 소견, 기관지경 소견 등이 원발성 폐암과 유사하다. 따라서 악성 종양의 병력이 있으면서 지속적인 증상이 있거나 비전형적인 병리소견을 보일 때에는 기관지내 전이암의 가능성을 염두에 두고 접근하여야 한다.