• Journal of Korean Medical Science
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• 제33권51호
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• pp.325.1-325.10
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• 2018

Background: To evaluate survival outcomes and prognostic factors for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) who received sunitinib (SU) and pazopanib (PZ) as first-line therapy in real-world Korean clinical practice. Methods: Data of 554 patients with mRCC who received SU or PZ at eight institutions between 2012 and 2016 were retrospectively reviewed. Based on the targeted therapy, the patients were divided into SU (n = 293) or PZ (n = 261) groups, and the clinicopathological variables and survival rates of the two groups were compared. A multivariable Cox proportional hazard model was used to determine the prognostic factors for OS. Results: The median follow-up was 16.4 months (interquartile range, 8.3-31.3). Patients in the PZ group were older, and no significant difference was observed in the performance status (PS) between the two groups. In the SU group, the dose reduction rate was higher and the incidence of grade 3 toxicity was more frequent. The objective response rates were comparable between the two groups (SU, 32.1% vs. PZ, 36.4%). OS did not differ significantly between the two groups (SU, 36.5 months vs. PZ, 40.2 months; log-rank, P = 0.955). Body mass index, Eastern Cooperative Oncology Group PS > 2, synchronous metastasis, poor Heng risk criteria, and liver and bone metastases were associated with a shorter OS. Conclusion: Our real-world data of Korean patients with mRCC suggested that SU and PZ had similar efficacies as first-line therapy for mRCC. However, PZ was better tolerated than SU in Korean patients.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.118-125
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• 2019

Background: Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined. Methods: Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015. Results: The median age was 69 years (interquartile range, 60-74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis. Conclusion: Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.

• Korean Journal of Radiology
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• 제23권11호
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• pp.1055-1066
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• 2022

Objective: The clinical relevance of myosteatosis has not been well evaluated in patients with pancreatic ductal adenocarcinoma (PDAC), although sarcopenia has been extensively researched. Therefore, we evaluated the prognostic value of muscle quality, including myosteatosis, in patients with resectable PDAC treated surgically. Materials and Methods: We retrospectively evaluated 347 patients with resectable PDAC who underwent curative surgery (mean age ± standard deviation, 63.6 ± 9.6 years; 202 male). Automatic muscle segmentation was performed on preoperative computed tomography (CT) images using an artificial intelligence program. A single axial image of the portal phase at the inferior endplate level of the L3 vertebra was used for analysis in each patient. Sarcopenia was evaluated using the skeletal muscle index, calculated as the skeletal muscle area (SMA) divided by the height squared. The mean SMA attenuation was used to evaluate myosteatosis. Diagnostic cutoff values for sarcopenia and myosteatosis were devised using the Contal and O'Quigley methods, and patients were classified according to normal (nMT), sarcopenic (sMT), myosteatotic (mMT), or combined (cMT) muscle quality types. Multivariable Cox regression analyses were conducted to assess the effects of muscle type on the overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: Eighty-four (24.2%), 73 (21.0%), 75 (21.6%), and 115 (33.1%) patients were classified as having nMT, sMT, mMT, and cMT, respectively. Compared to nMT, mMT and cMT were significantly associated with poorer OS, with hazard ratios (HRs) of 1.49 (95% confidence interval, 1.00-2.22) and 1.68 (1.16-2.43), respectively, while sMT was not (HR of 1.40 [0.94-2.10]). Only mMT was significantly associated with poorer RFS, with an HR of 1.59 (1.07-2.35), while sMT and cMT were not. Conclusion: Myosteatosis was associated with poor OS and RFS in patients with resectable PDAC who underwent curative surgery.

• Journal of Chest Surgery
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• 제39권11호
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• pp.828-837
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• 2006

배경: 악성종양에서 신생혈관 생성 및 당분해의 증가는 저산소 상태의 미세환경을 나타내며, 이는 종양의 침습성, 전이 및 환자의 예후와 관련이 있는 것으로 알려져 있다. Hypoxia-inducible factor 1(HIF-1)는 당원 수송체, 당분해 효소, 혈관내피세포 성장인자 등의 유전자의 전사를 활성화한다고 알려져 있다. 그리고 HIF-1의 전사 활성도는 HIF-$1{\alpha}$ 아단위의 표현이 조절되는 정도에 의존한다. 비소세포 폐암에서 HIF-$1{\alpha}$의 발현이 혈관 생성능, 종양세포 증식능 및 이상형 p53의 축적 등 종양의 생물학적 특성에 미치는 영향과 환자의 수술 후 예후와의 관계를 규명하고자 한다. 대상 및 방법: 1997년부터 1999년까지 비소세포 폐암으로 진단받고 전폐절제술 혹은 폐엽절제술을 시행 받은 59명의 폐암 환자들에서 얻어진 파라핀 조직 블록을 대상으로 하였다. ABC(avidin-biotin complex) 방법에 기초한 면역조직화학검사를 이용하여 암조직과 정상조직에서 HIF-$1{\alpha}$, VEGF(vascular endothelial growth factor), p53 단백의 발현을 조사하고, Ki-67의 발현을 이용한 증식지수를 측정하였다. HIF-$1{\alpha}$ 발현과 환자의 생존기간을 포함한 임상적-병리학적 변수들과의 상관관계, VEGF, p53의 발현과 증식지수와의 상관관계를 분석하였다. 결과: HIF-$1{\alpha}$의 과발현은 40.7%(24예/59예)였다. HIF-$1{\alpha}$의 과발현은 병리학적 TNM병기(p=0.004), T병기(p=0.020), N병기(p=0.004), 림프관/혈관 침범(p=0.019) 등과 관련이 있었다. 또 혈관내피세포 성장인자의 발현(p<0.001) 및 이상형의 p53의 발현(p=0.040)과 관련성이 있었다. Kaplan-Meier 생존분석에서 HIF-$1{\alpha}$의 과발현이 있는 환자의 5년 생존울은 22%로 HIF-$1{\alpha}$의 저발현 환자의 5년 생존율 61%에 비해 불량한 생존율을 보였고, 단변량분석과 다변량분석에서 HIF-$1{\alpha}$의 발현은 불량한 예후를 나타내는 인자로 관찰되었다. 결론: 이상의 결과로 비소세포 폐암 환자에서 HIF-$1{\alpha}$의 과발현은 종양내 신생혈관의 생성과 림프절 전이와 관련이 있는 표지자로 여겨지며, 수술 후 불량한 예후를 나타내었다.

• Journal of Chest Surgery
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• 제40권2호
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• pp.114-121
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• 2007

배경: 종양 발생기전에 있어서 세포자멸사가 중요한 역할을 한다. 조직 내의 세포자멸사 측정은 TUNEL (terminal deoxyribonucleotidyl transferase mediated nick end lagbelling), ISEL (in situ nick end labelling) 등의 방법을 쓰지만, 반응 세포의 비특이성 및 결과 판독의 주관성 등이 논란의 대상이 되어왔다. 최근 이러한 단점을 보완할 수 있는 단클론항체 M30이 소개되어, 인체 조직의 대장암, 가슴 샘종, 유방암, 자궁내막암 등에서 M30 면역염색을 이용한 세포자멸사 연구가 있었으나 폐암에 대한 연구는 없었다. 저자들은 비소세포 폐암에서 M30 면역염색에 의해 발현되는 세포자멸사 양상이 세포주기 핵심조절자인 p53 면역염색 발현양상 및 임상양상과 갖는 연관성을 살펴보고자 하였다. 대상 및 방법: 비소세포 폐암으로 근치적 절제수술을 받은 환자 45명을 대상으로 하였다. M30과 P53 면역조직화학염색에 실시하여 각 항체의 발현양상과 임상 병리학적 특성을 비교 분석하였다. 술 후 생존기간과 무병 생존기간을 구하였고, 단변량 분석을 실시하여 생존기간에 영향을 미치는 인자를 알아보았다. 다변량 분석을 실시하여 M30과 p53 발현양상이 술 후 사망위험도 및 재발위험도에 미치는 영향을 알아보았다. 결과: M30 양성세포 수는 p53 양성군이 p53 음성군보다 유의하게 많았고(p53 양성군 $61.7{\pm}26.8$개 vs. p53 음성군 $45.6{\pm}29.6$개, p=0.005), 세포사멸사 지수가 1 이상(Apoptosis Index, $Al{\ge}1$)인 환자 수도 p53 양성군에서 유의하게 많았다(p53 양성군 52.4% (l1/21) vs. p53 음성군 16.7% (4/24), p=0.025). 단변량 분석에서는 흡연량, 활동도(Performance Status, PS), 그리고 AI가 술 후 생존기간에 유의한 차이를 보였다. 다변량 분석에서는 AI가 높은 군에서 수술 후 암사망 위험도(Relative risk, R.R 7.482; 95% Confidence Interval, CI $1.886{\sim}29.678$; p=0.004)와 재발 위험도(R.R 3.795; 95% CI $1.184{\sim}12.158$; p=0.025)가 유의하게 증가하였다. p53 발현양상은 수술 후 생존기간과 암사망 위험도 및 재발 위험도에 영향을 미치지 않았다. 결론: 이상의 연구에서 단클론 항체 M30을 이용한 면역조직화학염색이 비소세포 폐암의 세포자멸사를 관찰하는 데 매우 유용한 방법임을 확인하였으며, 환자의 예후를 예측하는 데에도 도움이 될 수 있음을 알 수 있었다.

• Nutrition Research and Practice
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• 제16권5호
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• pp.604-615
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• 2022

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1-77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01-1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08-2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49-3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27-3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36-3.87), ICU admission (HR = 1.97; 95% CI, 1.17-3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59-19.43; stage III: HR = 16.20; 95% CI, 4.99-52.59) were significantly associated with CSS. CONCLUSIONS: Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.143-149
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• 2006

Purpose: This study was done to evaluate the incidence, type of injury, medical consequences, mortality, and prognostic factors associated with stab wounds in patients who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. Methods: A retrospective analysis of the clinical data of 40 patients with abdominal stab wounds who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from January 1, 2000 to December 31, 2004. Results: 1) The most prevalent age group was patients in their the twenties to fourties (77.5% of all patients), and average age of the patients was 39.3 years. The male-to-female ratio was 2.07:1. 2) The external site of stab wounds was most commonly the periumbilcal area of the abdomen (14 cases, 33.3%). 3) The most commonly injured organs were the liver and the stomach (10 cases each, 16.9%). 4) Operations were performed on all 40 patients, with 9 (22.5%) negative operation findings. 5) Death occurred in 5 cases (12.5%). 6) The trauma indices of the death group were TRISS 51.9%, RTS 3.6 points, and APACHE II 23.0 points. 7) The average transfusion amount of the death group was 13.8 pints Conclusion: These data suggest that the transfusion amount and the trauma index of abdominal stab injuries may be statistically significant factors for predicting mortality.

• Asian Pacific Journal of Cancer Prevention
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• 제15권3호
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• pp.1187-1192
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• 2014

Background: To correlate breast cancer subtypes with prognostic factors, microvessel density (MVD), vascular endothelial growth factor (VEGF) expression and clinical features. Materials and Methods: One hundred cases of primary breast carcinoma were classified using biomarkers on tissue microarray as: luminal A [estrogen receptor (ER)+, HER2-, $Ki-67{\leq}14%$], luminal B [ER+, HER2+ or ER+, HER2-, Ki-67>14%], HER2, triple negative basal-like (TNB) [any basal cytokeratins (CKs, 5, 14, 17) and/or endothelial growth factor receptor (EGFR) expression], and TN without such markers [TNN, null], and assessed for p53, vimentin, VEGF and CD31 immunoperoxidase. Results: Of the 100 cases (mean age, 51 years; mean tumor size, 3.2cm; 56% with nodal metastasis; 89 invasive ductal carcinomas, not otherwise specified, 4 invasive lobular carcinomas, 3 metaplastic carcinomas, and 4 other types) there were 39 luminal A, 18 luminal B, 18 HER2, 15 TNB and 10 TNN. The positivities of basal-like markers in the basal-like subtype were 78.3% for CK5, 40% for CK14, 20% for CK17, 46.7% for EGFR. There was no significant difference in age distribution, tumor size, degree of tubular formation, pleomorphism, lymphovascular invasion, nodal metastasis, MVD, VEGF expression and survival among subgroups. TNs demonstrated significantly higher tumor grade, mitotic count, Ki-67 index, p53 and vimentin and decreased overall survival compared with nonTN. Conclusions: The distribution of breast cancer subtypes in this study was similar to other Asian countries with a high prevalence of TN. The high grade character of TN was confirmed and CK5 expression was found to be common in our basal-like subtype. No significant elevation of MVD or VEGF expression was apparent.

• 대한기관식도과학회지
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• 제16권1호
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• pp.39-46
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• 2010

Background and Objectives Various tumor markers have been studied in an attempt to evaluate and decide the optimal treatment of the patients with head and neek squamous cell carcinoma (HNSCC). A nuclear antigen Ki-67 is a proliferative marker of tumor cells in all phases of cell cycle except G0. c-met gene, the tyrosine kinase receptor for hepatocyte growth tactor, may play various roles in malignant transformation. The authors evaluated the prognostic significance of Ki-67 and c-Met in surgical specimens of HNSCC to determine the relationship with the various clinicopathological characteristics. Materials and Methods Formatin-fixed paraffin-embedded surgical specimens were obtained from 54 patients with HNSCC. Ki-67 and c-Met expressions were analyzed by immunohistochemical staning and were compared with the clinicopathological characteristics such as, pathologic differentiation, tumor stage, clinical stage and lymph node metastasis. Results Ki-67 and c-Met over-expression was detected in 66.7% and 90.7% in HNSCC. There was positive correlation of increased expression of Ki-67 with tumor stage. and clinical stage, increased expression of e-Met with tumor stage, clinical stage, and nodal status. The expression of c-Met had a significant positive relationship with Ki-67 index (p<0.05). Conclusion Therefore, Ki-67 and c-Met are useful markers of tumor progression, aggressiveness and prognosis in HNSCC.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2879-2881
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• 2015

There is paucity of data on non Hodgkin's lymphoma (NHL) from our population in North-East India. In this retrospective study, patients were consecutively followed-up to see the clinic-pathological pattern of NHL, various responses, and pattern of relapses to first line treatment with chemotherapy. All patients in the present study received standard regimen of cyclophosphamde, doxorubicin, vincristine, prednisolone (CHOP) with or without rituximab (R-CHOP) as per our institutional protocol as first line therapy. Our study has shown that, in our adult population, the majority of NHL cases present with stage II and stage III disease and extra nodal involvement, B-cell lymphomas and diffuse large cell lymphomas being the most common subtypes. International prognostic index was a significant factor for varied responses to treatment. The majority of relapses after complete remission occurred in the first year.