• Journal of Chest Surgery
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• 제57권2호
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• pp.184-194
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• 2024

Background: Left ventricular assist devices (LVADs) are widely employed as a therapeutic option for end-stage heart failure. We evaluated the outcomes associated with centrifugal-flow LVAD implantation, comparing 2 device models: the Heartmate 3 (HM3) and the Heartware Ventricular Assist Device (HVAD). Methods: Data were collected from patients who underwent LVAD implantation between June 1, 2015 and December 31, 2022. We analyzed overall survival, first rehospitalization, and early, late, and LVAD-related complications. Results: In total, 74 patients underwent LVAD implantation, with 42 receiving the HM3 and 32 the HVAD. A mild Interagency Registry for Mechanically Assisted Circulatory Support score was more common among HM3 than HVAD recipients (p=0.006), and patients receiving the HM3 exhibited lower rates of preoperative ventilator use (p=0.010) and extracorporeal membrane oxygenation (p=0.039). The overall early mortality rate was 5.4% (4 of 74 patients), with no significant difference between groups. Regarding early right ventricular (RV) failure, HM3 implantation was associated with a lower rate (13 of 42 [31.0%]) than HVAD implantation (18 of 32 [56.2%], p=0.051). The median rehospitalization-free period was longer for HM3 recipients (16.9 months) than HVAD recipients (5.3 months, p=0.013). Furthermore, HM3 recipients displayed a lower incidence of late hemorrhagic stroke (p=0.016). In the multivariable analysis, preoperative use of continuous renal replacement therapy (odds ratio, 22.31; p=0.002) was the only significant predictor of postoperative RV failure. Conclusion: The LVAD models (HM3 and HVAD) demonstrated comparable overall survival rates. However, the HM3 was associated with a lower risk of late hemorrhagic stroke.

• Clinical Endoscopy
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• 제56권4호
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• pp.470-478
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• 2023

Background/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated. Methods: Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary's Hospital. Results: A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan-Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53-11.40) The histological types of MGN were not related to the primary histology types. Conclusions: MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.245-251
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• 2015

Objectives: Intrahepatic recurrence is the major cause of death among patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative surgical resection. Several approaches have been reported to decrease the recurrence rate. The objective of our study was to compare the clinical effects of transcatheter arterial chemoembolization (TACE) combined with interferon-alpha (IFN-${\alpha}$) therapy on recurrence after hepatic resection in patients with HBV-related HCC with that of TACE chemotherapy alone. Methods: We retrospectively analyzed the data from 228 patients who were diagnosed with HBV-related HCC and underwent curative resection between January 2001 to December 2008. The patients were divided into TACE (n = 126) and TACE-IFN-${\alpha}$ (n = 102) groups for postoperative chemotherapy. The TACE regimen consisted of 5-fluorouracil (5-FU), cisplatin (DDP), and the emulsion mixed with mitomycin C (MMC) and lipiodol. The recurrence rates, disease-free survival (DFS), overall survival (OS), and risk of recurrence were evaluated. Results: The clinicopathological parameters and adverse effects were similar between the 2 groups (P > 0.05). The median OS for the TACE-IFN-${\alpha}$ group (36.3 months) was significantly longer than that of the TACE group (24.5 months, P < 0.05). The 3-and 5-year OS for the TACE-IFN-${\alpha}$ group were significantly longer than those of the TACE group (P < 0.05) and the recurrence rate was significantly lower (P < 0.05). The TACE and IFN-${\alpha}$ combination therapy, active hepatitis HBV infection, the number of tumor nodules, microvascular invasion, liver cirrhosis, and the BCLC stage were independent predictors of OS and DFS. Conclusions: The use of the TACE and IFN-${\alpha}$ combination chemotherapy after curative hepatic resection safely and effectively improves OS and decreases recurrence in patients with HBV-related HCC who are at high risk. Our findings can serve as a guide for the selection of postoperative adjuvant chemotherapy for patients with HBV-related HCC who are at high risk of recurrence.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2993-2998
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• 2015

Background: Distance from anal verge and abdominoperineal resection are risk factors for circumferential resection margin (CRM) positivity in rectal cancer. Induction chemotherapy (IC) before concurrent chemoradiation (CRT) has emerged as a new treatment modification. Impact of IC before concurrent CRT on CRM positivity in low rectal cancer remains to be independently studied. The objective of this study was to determine CRM positivity in low rectal cancer, with and without prior IC, and to identify predictors of disease free and overall survival. Materials and Methods: Patients who underwent surgery for rectal cancer between 2005 and 2011 were retrospectively reviewed and divided into two groups. Group 1 received IC before CRT and Group 2 did not. Demographics, clinicopathological variables and CRM status were compared. Actuarial 5 year disease free survival (DFS), overall survival (OS) and independent predictors of survival were determined. Results: Patients in the IC group presented with advanced stage (Stage 3=89.2% versus 75.4%) (P=0.02) but a high rate of total mesorectal excision (TME) (100% versus 93.4%) (P=0.01) and sphincter preservation surgery (54.9 % versus 22.9%) (P=0.001). Patients with low rectal cancer who received IC had a significantly low positive CRM rate (9.2% versus 34%) (P=0.002). Actuarial 5 year DFS in IC and no IC groups were 39% and 43% (P=0.9) and 5 year OS were 70% and 47% (P=0.003). Pathological tumor size [HR: 2.2, CI: 1.1-4.5, P=0.01] and nodal involvement [HR: 2, CI: 1.08-4, P=0.02] were independent predictors of relapse while pathological nodal involvement [HR: 2.6, CI: 1.3-4.9, P=0.003] and IC [HR: 0.7, CI: 0.5-0.9, P=0.02] were independent predictors of death. Conclusions: In low rectal cancer, induction chemotherapy before CRT may significantly decrease CRM positivity and improve 5 year overall survival.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6935-6940
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• 2013

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamous cell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials and Methods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamous cell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. In addition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type of invasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also included in the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction of recurrence and decreased survival was selected. Results: The model with the best performance was composed of a combined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reaction and stromal desmoplasia (total score =10). Compared to those with score ${\leq}8$, the patients with score 9-10 had a significantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy (p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition, the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-free survival was significantly lower in the patients with score 9-10 than those with score ${\leq}8$ among the overall patients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy (p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristics of invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survival in patients with early-stage cervical squamous cell carcinoma.

• Journal of Chest Surgery
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• 제57권1호
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• pp.62-69
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• 2024

Background: Cervical esophageal cancer is a rare malignancy that requires specialized care. While definitive chemoradiation is the standard treatment approach, surgery remains a valuable option for certain patients. This study examined the surgical outcomes of patients with cervical esophageal cancer. Methods: The study involved a retrospective review and analysis of 24 patients with cervical esophageal cancer. These patients underwent surgical resection between September 1994 and December 2018. Results: The mean age of the patients was 61.0±10.2 years, and 22 (91.7%) of them were male. Furthermore, 21 patients (87.5%) had T3 or T4 tumors, and 11 (45.8%) exhibited lymph node metastasis. Gastric pull-up with esophagectomy was performed for 19 patients (79.2%), while 5 (20.8%) underwent free jejunal graft with cervical esophagectomy. The 30-day operative mortality rate was 8.3%. During the follow-up period, complications included leakage at the anastomotic site in 9 cases (37.5%) and graft necrosis of the gastric conduit in 1 case. Progression to oral feeding was achieved in 20 patients (83.3%). Fifteen patients (62.5%) displayed tumor recurrence. The median time from surgery to recurrence was 10.5 months, and the 1-year recurrence rate was 73.3%. The 1-year and 3-year survival rates were 75% and 33.3%, respectively, with a median survival period of 17 months. Conclusion: Patients with cervical esophageal cancer who underwent surgical resection faced unfavorable outcomes and relatively poor survival. The selection of cases and decision to proceed with surgery should be made cautiously, considering the risk of severe complications.

• Korean Journal of Radiology
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• 제23권1호
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• pp.68-76
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• 2022

Objective: Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. Materials and Methods: Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated. Results: The stent group finally included 100 patients (median age, 65 [interquartile range, 58-71] years; 64 male). The no-stent group included 22 patients (69 [61-75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion-free survival rate was 56% (95% confidence interval, 45%-69%) and 44% (32%-60%), respectively. The median stent occlusion-free survival time was 176 (interquartile range, 70-440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. Conclusion: Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.

• 생명과학회지
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• 제20권6호
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• pp.885-893
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• 2010

본 연구는 부산광역시에 거주하고 있는 비만중년여성(체지방률 30% 이상, BMI $25\;kg/m^2$ 이상) 16명을 대상으로 12주간 복합트레이닝 전 후에 나타나는 신체특성, 신체조성, 혈청지질과 심혈관질환 위험인자에 어떠한 변화가 나타나는지 규명하여 그 기초자료를 제시하는데 목적이 있다. 본 연구의 결과로는: 1) 12주 복합트레이닝 후 신체특성에서 체중, BMI, WHR는 각각 유의하게 감소한 것으로 나타났고, 수축기 확장기 혈압이 각각 증가하였으나 유의한 차이는 없는 것으로 나타났다. 2) 12주 복합트레이닝 후 신체조성에서 체지방량, 체지방률은 유의하게 감소하였으며, 제지방량은 유의하게 증가한 것으로 나타났다. 3) 12주 복합트레이닝 후 혈청지질에서 TC, TG, LDL-C는 유의하게 감소하였고 HDL-C 증가하였으나 통계적으로 유의한 차이는 나타나지 않았다. 4) 12주 복합트레이닝 후 심혈관질환 위험인자의 변화는 인슐린, 염증유발 인자인 TNF-$\alpha$가 각각 유의하게 감소한 것으로 나타났다. 본 연구의 결과를 종합해 볼 때 12주간의 복합트레이닝 적용이 중년비만여성들의 심혈관질환 위험인자의 변화에 긍정적인 변화를 보였으나, 비만으로 인해 나타나는 각종 현대병을 예방하기 위한 운동처방을 하기 위해서는 보다 더 구체적이고, 체계적인 연구가 계속 되어야 할 것으로 사료된다.

• KSBB Journal
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• 제21권4호
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• pp.248-254
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• 2006

본 연구에서는 CHO 세포를 이용해 세포를 별도의 적응기간 없이 무혈청 배지에서 배양했을 때 세포의 증식이 중단되는 원인을 찾고 배지 첨가 성분을 통해 이를 개선하고자 했다. 현재 개발된 무혈청 배지는 아직까지 혈청을 대체할 만한 성분을 포함하고 있지 않다. 때문에 무혈청 배지에 적응되지 않은 비적응 세포의 경우 계대 배양에 한계가 있다. 이런 한계가 나타나는 원인은 다양할 것으로 생각이 되지만 혈청의 부재로 인해 세포가 받게 되는 스트레스와 그로 인한 세포주기의 정지가 가장 근본적인 원인으로 생각된다. 무혈청 배지에서 세포가 받는 스트레스의 정도를 알아보고 배양 환경과 첨가물에 따른 ROS 농도의 변화를 측정하기 위해 배지와 세포의 ROS 농도를 측정하였다. ROS 농도를 측정한 결과 무혈청 상태에서 세포내 ROS가 엄청난 양으로 증가하는 것을 알 수 있었다. 이것은 혈청이 항산화능력을 갖고 있어서가 아니라 세포가 무혈청 환경에서 극심한 스트레스상태에 놓이기 때문인 것으로 생각된다. 이렇듯 증가한 ROS가 세포의 증식이 멈추게 되는 원인 중 하나로 생각되고, 항산화제를 첨가한 경우에도 증식력이나 ROS의 농도에 큰 차이가 없었던 것으로 미루어 보아 근본적으로 혈청과 같은 강력하게 증식을 촉진하는 성분을 배지에 첨가해야 할 것으로 여겨진다. ROS 이외에 세포의 증식이 멈추는 또 다른 원인으로 세포사멸의 여부를 확인했다. 무혈청 배지에서 배양한 적응세포와 비적응 세포 모두 특별한 세포사멸의 징후가 나타나지 않았다. 또한 무혈청 배지에서 증식이 멈춘 세포를 회수해 다시 혈청배지에서 배양한 경우 곧바로 증식력이 회복되기 때문에 대규모의 세포사멸은 발생하지 않는 것으로 생각된다. 위와 같은 현상들은 모두 혈청이 없기 때문에 발생하는 것으로 혈청을 대체할 수 있는 첨가물을 배지에 더해주면 세포의 증식이 개선될 것이다. 그래서 몇 가지 첨가물을 이용해 세포의 증식력에 변화가 나타나는지 알아보았다. 첨가물을 이용한 실험에서 IGF-I의 경우 장기간 배양에서 세포의 수를 안정적으로 유지하고 계대 횟수를 증가시키는 효과를 보였다. 이는 IGF-I이 어느정도 세포의 증식을 유지시켜주는 역할을 하기 때문인 것으로 생각된다. 무혈청 배지에서 비적응 CHO 세포의 계대 배양에 한계가 있는 것은 세포주기가 멈추기 때문인 것으로 생각된다. 세포주기가 멈추는 growth factor와 같이 세포의 증식을 지속적으로 유도할 수 있는 물질이 무혈청 배지에서는 부족하기 때문인 것으로 생각되고, IGF-I과 같은 첨가물을 통해 극복할 수 있는 문제라고 여겨진다.

• Journal of Chest Surgery
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• 제40권10호
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• pp.680-684
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• 2007

배경: IB기 비소세포폐암의 가장 효과적인 치료는 완전 절제이나, 수술 후 재발이 생기면 생존율이 떨어진다. 최근 IB기 비소세포폐암의 완전 절제 후 시행하는 보조 요법에 대해 관심이 높아지고 있다. 적절한 보조 요법을 사용하기 위해서는 재발의 위험 인자를 아는 것이 중요하다. 대상 및 방법: 114명을 대상으로 연구하였으며, 환자의 성별, 나이, 수술 방법, 조직학적 유형, 분화의 정도, 종양의 크기, 장측 흉막 침범 유무 등과 재발과의 관계를 분석하였다. 생존율과 무재발률은 Kaplan-Meier 방법으로 구하였으며, log rank test로 단변량 분석을, Cox's proportional hazard model을 이용하여 다변량 분석을 하였다. p값이 0.05 미만인 경우에 통계학적으로 유의하다고 판정하였다. 결과: 3년 생존율 및 무재발률은 각각 87.0%, 79.4%였다. 단변량 분석에서 분화도가 통계학적으로 의미가 있었으며, 다변량 분석에서도 저분화의 경우가 예후가 좋지 않았다. 결론: 완전 절제된 IB기 비소세포폐암 환자에서 저분화도가 재발과 연관된 인자이므로 수술 후 보조 요법이 필요할 것으로 기대된다.