• Journal of Gastric Cancer
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• 제19권1호
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• pp.62-71
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• 2019

Purpose: The laparoscopic transhiatal approach (LA) for adenocarcinoma of the esophagogastric junction (AEJ) is advantageous since it allows better visualization of the surgical field than the open approach (OA). We compared the surgical outcomes of the 2 approaches. Materials and Methods: We analyzed 108 patients with AEJ who underwent transhiatal distal esophagectomy and gastrectomy with curative intent between 2003 and 2015. Surgical outcomes were reviewed using electronic medical records. Results: The LA and OA were performed in 37 and 71 patients, respectively. Compared to the OA, the LA was associated with significantly shorter duration of postoperative hospital stay (9 vs. 11 days, P=0.001), shorter proximal resection margins (3 vs. 7 mm, P=0.004), and extended operative times (240 vs. 191 min, P=0.001). No significant difference was observed between the LA and OA for intraoperative blood loss (100 vs. 100 mL, P=0.392) or surgical morbidity rate ($grade{\geq}II$) for complications (8.1% vs. 23.9%, P=0.080). Two cases of anastomotic leakage occurred in the OA group. The number of harvested lymph nodes was not significantly different between the LA and OA groups (54 vs. 51, P=0.889). The 5-year overall and 3-year relapse-free survival rates were 81.8% and 50.7% (P=0.024) and 77.3% and 46.4% (P=0.009) for the LA and OA groups, respectively. Multivariable analyses revealed no independent factors associated with overall survival. Conclusions: The LA is feasible and safe with short- and long-term oncologic outcomes similar to those of the OA.

• Journal of Gastric Cancer
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• 제18권4호
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• pp.400-408
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• 2018

Purpose: This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection. Materials and Methods: We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017. Results: Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed. Conclusions: In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

• 대한종양외과학회지
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• 제14권2호
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• pp.120-127
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• 2018

Purpose: The purpose of this study was to determine the immunologic role of lymph node (LN) and stage migration by assessing LN count and metastatic LN count. Methods: A total of 2,117 patients with gastric adenocarcinoma located in the body and antrum who underwent distal/subtotal gastrectomy with D2 LN dissection between January 1, 1998 and December 31, 2008 were enrolled. LN count and number of metastases were determined in the N1 tier (area of D1 dissection) and N2 tier (area of D2 dissection). The lower and upper quartiles of LN counts in the same pN stage were grouped to compare the prognosis and LN positivity according to the LN tier. Results: Stage migration from N1 tier to N2 tier occurred in 3.2% of cases. The 5-year disease-specific survival rates of the upper and lower LN count groups within the N1 tier were 91.0% and 86.7% (P=0.01), respectively. LN positivity in the N2 tier of the lower LN count group was higher than that of the upper LN count group (14.1% vs. 8.2%, P<0.01). Stage migration in the N2 tier of the lower LN count group was also higher than that of the upper LN count group (4.6% vs. 1.8%, P<0.01). Conclusion: The lower LN count group had a decreased survival rate compared to that of the upper LN count group, suggesting that perigastric LN has an immunological defense role in weakening the disseminating power of metastatic tumor cells, as indicated by the LN count.

• Journal of Gastric Cancer
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• 제20권4호
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• pp.385-394
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• 2020

Purpose: Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. Materials and Methods: Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. Results: We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I-IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0-IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). Conclusions: The cStage is unreliable for prognosis, and ypStage is moderately reliable. Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

• Journal of Gastric Cancer
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• 제21권1호
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• pp.49-62
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• 2021

Purpose: This study aimed to investigate the prognostic value of lymph node ratio (LNR) in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy. Materials and Methods: We retrospectively enrolled gastric cancer patients treated with neoadjuvant chemotherapy and curative surgery at the First Affiliated Hospital of Zhejiang University from 2004 to 2015 as the study cohort. Patients with the same inclusion criteria treated in 2016-2017 were enrolled as the validation cohort. Kaplan-Meier curves were assessed using the log-rank test to analyze the differences in overall survival (OS). Multivariate survival analysis was performed using the Cox proportional hazards model. The areas under the receiver operating characteristic curve of ypN and LNR categories for predicting the actual 3-year OS were compared. Results: A total of 265 patients were included in the proposal cohort. The median number of retrieved lymph nodes (rLNs) was 32. The number of positive lymph nodes (pLNs) increased as rLN increased (P=0.037), but the LNR remained relatively constant (P=0.462). The LNR was categorized into 4 groups according to the prognosis: ypNr0, node-negative with rLN>25; ypNr1, node-negative with rLN≤25 or 00.3. In the validation cohort of 43 enrolled patients, there was a clear distinction in OS that significantly (P<0.001) varied depending on the LNR values and LNR was the only independent prognostic factor in multivariate analysis (P<0.001). Conclusions: LNR was an independent prognostic factor for survival of patients with gastric cancer after preoperative chemotherapy and might be an alternative predictor for ypN stage.

• Journal of Digestive Cancer Research
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• 제3권1호
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• pp.39-41
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• 2015

HER2 양성인 진행성 위암에서 어떤 치료 약제를 선택하는가에 대하여는 진료지침이 정립되어 있지만, 그 유지기간에 대하여는 아직 정립된 진료 지침은 없다. 저자들은 진행성 위암 환자에서 36개월 동안 trastuzumab을 기반으로 한 항암화학 요법을 하여 유지하고 있는 사례를 문헌 고찰과 함께 보고하는 바이다.

• Radiation Oncology Journal
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• 제16권1호
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• pp.17-25
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• 1998

목적 : 위암치료에 있어 완전절제수술후 임상적 국소재발이 $30-40\%$에 이르는 것으로 보고되고 있으나 수술 후 항암화학요법이나 방사선 치료의 시행은 아직 그 역할이 분명치 않다. 반면 완전절제가 이루어지지 않은 위암에서는 원발병소 부위의 국소발소 위험성이 매우 높아 추가적인 국소치료의 필요성이 제기되고 있으나 이에 대한 구체적인 연구는 아직 미미한 실정이다. 이에 저자 등은 불완전 절제된 위암에서 수술후 방사선치료가 국소재발을 줄일 수 있는지, 또한 생존율향상을 얻을 수 있는지 알기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1991년 7월부터 1996년 8월까지 울산의대 서울중앙병원에서 위암 진단하에 근치적 절제수술을 시행하였으나 불완전 절제된 25명의 환자에서 수술후 방사선 치료를 시행하였다. 전체 25명의 환자 중 선세포암이 23명, 평활근육종이 2명이었고, 수술은 위전절제수술(Total gastrectomy) 5명, 위부분절제술(Subtotal gastrectomy) 20명이었다. 병기별로는 I B 1명, II 2명, III A 11명, III B 10명, IV 1댕이었으며 불완전 절제부위는 원위절제면(dlstal resection margin) 17명, 근위절제면(proxlmal resection margin) 5명, 간 절제면 1명 및 기타 장기 절제면 2명이었다. 방사선 치료는 총 6회의 FP 항암화학요법중 회차와 동시에 시작되는 것을 원칙으로 하였으며 조사선량은 44.6Gy-59.4Gy 범위였고 중앙선량은 55.8Gy였다. 결과 : 1명을 제외한 모든 환자가 정해진 양의 방사선 치료를 마칠 수 있었으며, 3명의 환자에서 $15\%$ 이상의 체중감소가 있었고 중증도 3 이상의 혈액학적 독성은 5명에서 관찰되었다. 최소 추적관찰기간은 12개월이었다. 전체 25명중 12명에서 재발이 있었으며 조사야내 국소재발은 7명에서 발생하였고 이들은 문합부위재발 3명, 인접조직 3명, 임파절 1명이었다. 반면 원격전이는 10명에서 발생하였고 이들은 복막전이 6명, 간 전이 2명, 쇄골상임파절 및 대동맥 임파절등 원위임파절 전이가 3명이었다. 환자의 현 상태는 무병생존 11명, 위암과 관련 없는 사망 2명, 위암으로 인한 사망 10명, 재발상태의 생존 2명 등이다. 4년 무병생존율과 질병관련생존율(disease specific survival)은 각각 $48\%$와 $40\%$였으며 중앙생존값은 35개월, 중앙무병생존값은 26개월이었다. 원발병소 위치, T-stage, N-stage, Stage, 방사선량 등은 생존율에 별다른 영향을 미치지 못하였다. 결론 : 수술후 방사선치료와 항암화학요법은 큰 부작용 없이 시행되었으며 치료후 실패양상은 원격전이가 가장 많았고 국소재발은 7명($28\%$)에서 발생하여 문헌상 관찰된 완전절제수술후 국소재발수치과 비슷하거나 낮은 것으로 나타났다 추적관찰 기간이 짧고 환자 수가 적어 단정짓기는 어렵지만 불완전 절제수술 후 원발병소 부위에 잔류암세포가 존재하는 상태인 점을 고려할 때, 불완전 절제된 위암에서 방사선치료가 국소재발을 억제에 기여했을 가능성이 크다고 생각된다.

• Radiation Oncology Journal
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• 제15권2호
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• pp.113-119
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• 1997

목적 : 국소적으로 진행된 위암치료는 수술이 주 치료로 5년 생존율은 그리높지 않아 좀더 완치율을 높이기 위하여 화학요법이나 화학요법과 병용하여 방사선치료 등이 시행되고 있다 저자들은 위암환자에서 수술후 방사선치료를 받은 환자의 치료성적을 후향적으로 분석하였다. 방법 : 1985년 3월부터 1993년 6월까지 한양대학병원 치료방사선과에서 위절제수술후 방사선 치료를 3500cGy 이상 받고 병기 3및 4기인 68명을 대상으로 후향적인 분석을 하였다. 연령분포는 28세부터 66세였고 중앙연령은 50세였다. 추적기간은 3개월에서 133개월(3명이 36개월 미만)로 중앙값은 50개월이었다. 조직병리상 37명이 non signet ring adenocarclnoma였고 29명이 signet ring cell이었다. 병기로 IIIA가 19명, IIIB가 25명, IV가 24명이었다. 항암화학요법은 65명의 환자에게 투여되었으며 FAM계통의 치료가 28예 cispiatln, 5FU계통이 26예이었다. 결과 : 5년생존율은 36.6% 5년무병생존율은 33.6%였다. 예후인자로 병소침입 임파선개수, 조직세포 종류 등이 생존율에 통계적으로 유의하게 영향을 주었고 잔존세포의 유무, 병기, 나이, 세포분화도 및, 방사선치료 총 기간 등도 생존율에 영향을 주었으나 통계적인 유의성은 없었고 항암화학제의 종류에따른 생존율의 차이는 없었다. 37명환자에서 재발이 있었고 위치로는 장망(omentum) 및 복막에 23.5%로 가장 재발율이 놀았으며 남은 위나 봉합부위에 13.2%의 재발율을 보였다. 전체 국소재발은 20.7% 전체 원격전이는 39.7%였다. 방사선치료로 인한 부작용은 22.1%에서 grade 3의 백혈구감소가 있었고 1.5%에서 grade 4 부작용이 있었다. 치료중 10% 이상의 체중감소는 8.8%였다. 결론 : 본 연구결과 수술후 화학요법과 방사선치료요법은 큰 부작용이 없었으며 실패양상은 주로 장망 및 복막이었고 치료부위내 국소재발율이 다음으로 많았다. 국소재발은 원격전이에 비해 많이 낮아지는 추세를 보였다 방사선역할에 평가를 조금 더 명확하게 규명하기위해 향후 재발 위험이 큰 환자에서 수술후 화학요법만 한 군과 화학요법 및 방사선치료를 병용한 군과의 재발 양상 및 생존율 등의 전향적 비교 연구가 필요할 것으로 생각되며 더 나아가 수술후 항암화학요법 및 방사선 병용요법에 복강내 약물치료도 고려되어야 하겠다.

• Toxicological Research
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• 제21권2호
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• pp.107-113
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• 2005

[ $BARODON^{(R)}$ ] is a multi-purpose, high functional alkali solution made by mixing and liquid-ionizing silicon, calcium, sodium, borax, organic carbon chemicals and silver. In this study, we have investigated the apoptotic potential and mechanistic insights of $BARODON^{(R)}$ in human gastric cancer cell line (AGS cells). In MTT assay, $BARODON^{(R)}$ reduced cell viability in AGS cells. Morphological features of apoptosis with marked cytoplasmic vacuolation and appearance of apoptotic peaks in flow cytometry were observed in AGS cells with$BARODON^{(R)}$ treatment. In addition, $BARODON^{(R)}$ induced apoptosis of stomach cancer cell is related to bax up-regulation, caspase 7 protease activation and subsequent cleavage of poly (ADP-ribose) polymerase (PARP). These results suggest that BARODON can induce the apoptosis of AGS cells through modulation of bcl-2 family and the activation of intrinsic caspase cascades, indicating that it is potentially useful as a anti-cancer agent.

• 대한수의학회지
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• 제15권1호
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• pp.27-38
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• 1975

개에 자연발생(自然發生)한 다음과 같은 종양(腫瘍)을 수집(蒐集)하여, 그 육안적(肉眼的) 및 조직학적(組織學的) 소견(所見)을 검토(檢討)하고, 이에 관(關)한 간단한 고찰(考察)을 가(加)했다. 피부(皮膚) 및 피하직(皮下織)의 종양(腫瘍) : 섬유종(纖維腫), 지방종(脂肪腫), 표피성(表皮性) 낭종(囊腫), 흑색육종(黑色肉腫), 한선종(汗腺腫), 비만세포종(肥滿細胞腫)(2예(例)), 비만세포육종(肥滿細胞肉腫), 피지선암종(皮脂腺癌腫). 비장(脾臟) 및 임파절(淋巴節)의 종양(腫瘍) : 비피막(脾被膜)의 섬유육종(纖維肉腫), 비(脾)의 평활근육종(平滑筋肉腫), 임파절(淋巴節)의 임파육종(淋巴肉腫)(2예(例)). 폐장(肺臟)의 종양(腫瘍) : 기관지성암종(氣管枝性癌腫)(3예(例)), 각각(各各) 선암종형(腺癌腫型), 편평세포암종형(扁平細胞癌腫型) 및 미분화세포(未分化細胞)(원형(圓形))암종형(癌腫型). 소화관(消化管) 및 간장(肝臟)의 종양(腫瘍) : 위(胃)의 섬유종(纖維腫), 간(肝)의 혈관종(血管腫), 담관암종(膽管癌腫), 간세포암종(肝細胞癌腫), 간(肝)에 출현(出現)한 골수성백혈세포세포(骨髓性白血細胞細胞). 복막(腹膜)의 종양(腫瘍) : 섬유육종(纖維肉腫). 비뇨생식계(泌尿生殖系)의 종양(腫瘍) : 자궁(子宮)의 섬유종(纖維腫), 난소(卵巢)의 난포낭종(卵胞囊腫), 질(膣)의 전염성(傳染性) 성기종(性器腫)(6예(例)), 신암종(腎癌腫), 섭호선종(攝護腺腫)(2예(例)), 포피(包皮)의 섬유종(纖維腫), 고환(睾丸)의 정충종(精蟲腫). 유선(乳腺)의 종양(腫瘍) : 혼합종(混合腫)(2예(例)), 근상피종(筋上皮腫). 신경계(神經系)의 종양(腫瘍) : 대퇴부(大腿部)의 신경섬유육종(神經纖維肉腫).