• Journal of Chest Surgery
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• 제31권12호
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• pp.1195-1199
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• 1998

배경: 소세포폐암에 있어 수술의 적응은 제한적이었으며 수술의 결과에 대하여서도 논란이 많다. 대상 환자는 1992년 1월부터 1996년 12월까지 신촌세브란스 흉부외과에서 수술한 9명의 환자로서 남자가 8명, 여자가 1명이었으며 평균 연령은 57.2세(range; 35∼76세)이었다. 대상 및 방법: 수술전 소세포폐암으로 진단되었던 예는 5예이었으며 4예에서의 수술전 진단은 분화가 안된 편평상피세포암이었다. 수술은 전예에서 폐절제술 및 종격동림프절박리술을 시행하였고 폐단엽절제술이 5예, 폐단엽절제술과 분엽절제술 및 늑골을 포함한 En-block 절제 1예, 폐이엽절제술 2예, 전폐절제술 1예 등이었다. 결과: 수술사망 예는 없었으며 수술 후 합병증으로는 출혈 1예, 심부정맥 1예 등이 있었다. 수술 후 전예에서 소세포암이 확인되었고 수술 후 병기는 T1N0M0 1예, T2N0M0 4예, T3N0M0 1예, T3N1M0 1예, T2N2M0 1예, T4N0M0 1예이었다. 수술 후 5예에서는 항암화학요법을, 4예에서는 항암화학요법 및 방사선치료를 시행하였다. 전예에서 추적이 가능하여 평균 추적기간은 평균 33.0개월(1-63개월이었고 추적기간중 림프절로의 전이가 없는 경우 6예 중에서는 1예에서만 장골에 전이가 발견되었으나 생존해있고, 림프절로의 전이가 있거나 T4 병변인 3예에서는 2예는 국소 부위, 1예는 뇌에 재발이 있었으며 이중 2예는 사망하였다. 결론: 소세포폐암에서도 TNM 병기가 유용하며 종격동 또는 구역 림프절로의 전이가 없는 경우에는 수술 후 성적이 양호하여 초기 병기의 소세포폐암 환자에서는 항암화학요법과 함께 적극적인 수술 절제가 필요한 것으로 생각된다.

• Journal of Gastric Cancer
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• 제16권4호
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• pp.207-214
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• 2016

Purpose: The utility of N classification has been questioned after the 7th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) was published. We evaluated the correlation between ratio-based N (rN) classification with the overall survival of pathological T4 gastric cancer patients who underwent D2 lymphadenectomy. Materials and Methods: We reviewed 222 cases of advanced gastric cancer patients who underwent curative gastrectomy between January 2006 and December 2015. The T4 gastric cancer patents were classified into four groups according to the lymph node ratio (the number of metastatic lymph nodes divided by the retrieved lymph nodes): rN0, 0%; rN1, ${\leq}13.3%$; rN2, ${\leq}40.0%$; and rN3, >40.0%. Results: The rN stage showed a large down stage migration compared with pathological T4N3 (AJCC/UICC). There was a significant difference in overall survival between rN2 and rN3 groups in patients with pT4N3 (P=0.013). In contrast, the difference in metastatic lymph nodes was not significant in these patients (${\geq}16$ vs. <15; P=0.177). In addition, the rN staging system showed a more distinct difference in overall survival than the pN staging system for pathological T4 gastric cancer patients. Conclusions: Our results confirm that rN staging could be a good alternative for pathological T4 gastric cancer patients who undergo D2 lymphadenectomy. However, before applying this system to gastric cancer patients who undergo D2 lymphadenectomy, a larger sample size is required to further evaluate the usefulness of the rN staging system for all stages, including less advanced stages.

• Journal of Preventive Medicine and Public Health
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• 제46권2호
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• pp.74-81
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• 2013

Objectives: The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery. Methods: We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration. Results: The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1. Conclusions: The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

• Nuclear Medicine and Molecular Imaging
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• 제42권sup1호
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• pp.101-109
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• 2008

Cervix cancer is one of common gynecological cancers in the world, and staged with FIGO or TNM system. However, these clinical staging systems lack information about lymph node or distant metastases, thus imaging modalities are considered to make an appropriate therapeutic plan and enhance overall survival rate. In this context, FDG PET is recommended to pre-treatment stating and prognosis prediction, for it could noninvasively evaluate the status of lymph nodes, especially abdominal paraaortic nodes which are closely related with prognosis. Moreover, the degree of FDG uptake is correlated with prognosis. Although there is no consistent method for surveillance of cervix cancer, FDG PET seems a very important tool in detecting tumor recurrence because it is much more advantageous than conventional imaging modalities such as MRI for discerning recurrent tumor from fibrosis caused by radiation or surgery. Furthermore, FDG PET could be used to evaluate treatment response. On the other hand, recently introduced PET/CT is expected to play an ancillary role to FIGO staging by adding anatomical information, and enhance diagnostic performance of PET by decreasing false positive findings.

• 대한의사협회지
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• 제61권11호
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• pp.662-669
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• 2018

The cutaneous melanoma has been regarded as rare disease entity in Korea for long time but it shows a silent growth recently. Furthermore the management of cutaneous melanoma including staging system, surgical principle, sentinel lymph node biopsy and subsequent complete node dissection and, most importantly, immunotherapy and target therapy against cutaneous melanoma recently. The incidence of cutaneous melanoma is steadily increasing in Korea but its increase is rapid recent 2 decades to 4.3 times and should be greater soon according to the steeper increase of life expectancy. New staging system proposed by American Joint Committee on Cancer (2017) includes changes in individual TNM category and stage groups, particularly from a prognostic viewpoint. Dermoscopy has been successfully introduced in the differential diagnosis of pigmented skin lesion focusing on cutaneous melanoma by non-invasive simple diagnostic tool. Sentinel lymph node biopsy was a issue of long debate whether survival benefit is real or not. Temporary conclusion about this question is reached after two large scale studies and immediate complete node dissection should be performed in a certain situations. Most important change is drug therapy focusing on immunotherapy and target therapy. Braf- and MEK-inhibitor, immune checkpoint inhibitor and PD-1 blocker has been proved to be effective as a sole or combination regimen against advanced and/or high-risk adjuvant setting of cutaneous melanoma. In conclusion, these remarkable changes will be reviewed shortly here.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.159-166
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• 2009

목적: 제6판 UICC TNM 분류법과 비교하여 새로 개정될 제7판 분류법이 위암 환자들의 예후를 예측하는데 어떠한 차이점이 있는지를 그 유용성과 함께 비교 분석한다. 대상 및 방법: 1992년 6월부터 2006년 12월 사이에 한양대학교병원 외과에서 위암으로 수술 받은 1,633명을 대상으로 제6판 및 제7판(예정) UICC TNM 병기분류법에 따른 예후 예측과 관련된 사항들을 비교 분석하였다. 결과: 제7판 분류에 의한 T2와 T3 사이 생존율의 차이가 유의하지 않았으나 N0, N1, N2, N3a, N3b 사이 생존율은 모두 유의한 차이를 보였다. 제7판에 따른 병기 III와 병기 IV 사이의 생존율 차이는 유의하였으나 병기 Ia와 Ib사이, Ib와 IIa사이, IIa와 IIb사이, IIb와 IIIa 사이의 생존율 차이는 유의하지 않았다. 동일병기로 분류되었으나 구성요소의 차이에 따라 생존율의 동질성을 확보하지 못하는 경우가 병기 IV를 제외하면 제6판보다 제7판에서 더 많았다. 결론: 제7판 분류법은 제6판 분류법에 비하여 너무 복잡하게 구성되어 있으며, 서로 다른 병기 사이의 생존율의 차별화나 동일 병기를 이루고 있는 서로 다른 인자로 구성된 경우들 사이에서의 생존율의 동질성 평가에서 부족하였다. 그러나 근치 인자와 비근치 인자를 같은 병기로 구분한 제6판의 병기 IV 분류 기준을 수정하여 서로 다른 병기로 분리 해 놓은 제7판에서의 변화는 적절하다고 평가할 수 있겠다.

• Journal of Chest Surgery
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• 제31권4호
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• pp.362-368
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• 1998

편평세포폐암 환자 혈청내 SCC항원(squamous cell carcinoma antigen)의 암표지자로서의 유용성을 검정하고 암종이 성장함으로써 정상조직으로 침범하는 기전을 규명하기 위하여 폐암수술후 절제해 낸 폐암조직의 중심부와 말초부 그리고 암세포가 없는 정상 폐조직을 채취하여 SCC항원 농도와 DNA합성을 통해 세포성장과 분화에 관련이 있는 것으로 알려진 EGFr(epidermal growth factor receptor)의 농도를 측정하였다. 편평세포폐암종 조직내 SCC항원의 농도는 69＋25 ng/ml로 정상 폐조직 34＋7 ng/ml, 폐선암 35＋25 ng/ml보다 높았으며(p<0.05), EGFr의 농도는 폐암조직, 즉 편평세포암 47＋6 pmol/min, 선암 69＋20 pmol/min으로 정상 폐조직 34＋5 pmol/min, 39＋8 pmol/min보다 각각 높게는 나타났으나 유의성은 없었다. 암종의 크기에 따른 부위별 SCC항원의 농도는 암종이 직경이 3cm이하인 경우는 암종의 중심부(100＋82 ng/ml)가 말초부(55＋24 ng/ml)보다 높게 나타났으나(p>0.05), 5cm이상인 경우는 암종의 말초부(324＋92 ng/ml)가 중심부(34＋18 ng/ml)보다 현저히 높았다.(p<0.05) 그러나 부위별 EGFr의 농도는 암종의 크기에 따라 차이가 없었다. 암병기에 따른 부위별 SCC항원의 농도는 암중심부에서는 1, 2병기에서 3, 4병기로 암병기가 높아짐에 따라 감소하는 경향을 보였으나 통계적 유의성은 없었고(p>0.05), 암말초부에서는 1, 2병기 68＋37 ng/ml, 87＋35 ng/ml에서 3,4병기414＋87 ng/ml, 473＋226 ng/ml로 병기가 높아짐에 따라 현저하게 증가하였다.(p<0.05) 그러나 EGFr은 암중심부에서 1병기에서 2, 3, 4병기로 병기가 높아짐에 따라 증가하는 경향을 보였으나 통계적 유의성이 없었고(p<0.05), 암말초부에서는 병기에 따른 농도의 특이한 변화를 관찰할 수 없었다. 이상의 결과로 편평세포폐암종 조직내 SCC항원의 농도는 정상 폐조직이나 폐선암조직에서 보다 높게 나타나 혈청내 SCC항원의 농도가 편평세포폐암의 진단 및 치료효과를 예측하는데 유용한 암표지자로 생각되나, 암종내 부위별 SCC항원의 농도와 EGFr의 농도가 일치하지 않음으로써 암종이 성장함으로써 주위조직으로의 침범과 SCC항원의 농도와의 관계에 대해서는 보다 더 많은 연구가 필요할 것으로 사료된다.

• Journal of Gastric Cancer
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• 제17권4호
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• pp.319-330
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• 2017

Introduction: The extent of lymphadenectomy in the surgical treatment of gastric cancer is a topic of controversy among surgeons. This study was conducted to analyze the American National Cancer Database (NCDB) and conclude the optimal extent of lymphadenectomy for gastric adenocarcinoma. Methods: The NCDB for gastric cancer was utilized. Patients who received at least a partial gastrectomy were included. Patients with metastatic disease, unknown TNM stages, R1/R2 resection, or treated with a palliative intent were excluded. Joinpoint regression was used to identify the extent of lymphadenectomy that reflects the optimal survival. Cox regression analysis and Bayesian information criterion were used to identify significant survival predictors. Kaplan-Meier was applied to study overall survival and stage migration. Results: 40,281 patients of 168,377 met the inclusion criteria. Joinpoint analysis showed that dissection of 29 nodes provides the optimal median survival for the overall population. Regression analysis reported the cutoff ${\geq}29$ to have a better fit in the prognostic model than that of ${\geq}15$. Dissection of ${\geq}29$ nodes in the higher stages provides a comparable overall survival to the immediately lower stage. Nonetheless, the retrieval of ${\geq}15$ nodes proved to be adequate for staging without a significant stage migration compared to ${\geq}29$ nodes. Conclusion: The extent of lymphadenectomy in gastric adenocarcinoma is a marker of improved resection which reflects in a longer overall survival. Our analysis concludes that the dissection of ${\geq}15$ nodes is adequate for staging. However, the dissection of 29 nodes might be needed to provide a significantly improved survival.

• Journal of Gastric Cancer
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• 제1권1호
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• pp.32-37
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• 2001

Purpose: Three subgroups of stage II stomach cancer (T1N2M0, T2N1M0, T3N0M0) by UICC-TNM staging system show obvious survival difference to each other, which becomes the pitfall of the current staging system. We analyzed the survival and relapse pattern of stage II stomach cancer patients in three subgroups retrospectively to prove the need for change in staging system. Materials and Methods: From July 1989 to December 1995, curative gastric resection was performed in 1,037 patients with gastric adenocarcinoma, and among them 268 patients ($26\%$) were in stage II. The number in each of subgroups (T1N2M0, T2N1M0, and T3N0M0) were 17, 139 and 112 respectively. Survival and relapse pattern were analyzed and median follow up period was 46 months. Results: The 3-year cumulative survival rates of T1N2M0, T2N1M0, and T3N0M0 were $50\%,\;80\%,\;and\;76\%$ respectively (p=0.001). And the 3-year cumulative survival rates of T1N2M0 was comparable to those of 2 subgroups of stage IIIa (T2N2M0, T3N1M0), $47\%\;and\;45\%$ (p>0.05). Peritoneal recurrence was the most frequent in T3N0M0. And hematogenous spread was more frequent in T2N1M0 while nodal spread was more frequent in T1N2M0. Ten out of 17 cases of T1N2M0 died of recurrence. Most of them showed submucosal tumor with depressed lesion and mean tumor size was 3.3 cm. Conclusions: Up-staging of T1N2M0 should be considered because it has the lowest survival rate and the worst prognosis among the three subgroups of Stage II stomach cancer patients. In early gastric cancer patients with high-risk factors (large tumor size, invasion into the submucosal layer, and lymphatic vessel involvement), lymph node dissection and postoperative adjuvant therapy is recommended in an attempt to prevent recurrence in the form of lymph node metastasis.

• 동의생리병리학회지
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• 제23권3호
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• pp.710-714
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• 2009

Several studies showed that the survival rate of stage IIIB disease with malignant pleural effusion is worse than stage IIIB disease without malignant effusion. But, malignant pleural effusion was considered T4. To analyze changes the survival time for malignant pleural effusion, in the seventh revision of TNM classification for lung cancer. The records of all patients had to have either a histological or cytological diagnosis of non-small cell lung cancer (NSCLC), who were admitted to Wonkwang university hospital between January 2004 and December 2006 were reviewed retrospectively. We evaluated the survival time of 187 patients with advanced lung cancer with and without malignant pleural effusion. This included the pleural effusion or nodule M1 a (pleural dissemination, currently classified as T4), nodule(s) in the other lung M1 a (contralateral lung nodule, currently classified as M1), nodule(s) with the same lobe as the primary tumor T3 (currently classified as T4), other T4 factors T4 (T4 MO anyN), and extrathoracic sites of disease M1b (distant metastasis, currently classified M1). Among the 187 patients, T4anyNMO was 57 patients in the current TNM classification. In the next edition of the TNM classification, T4MOanyN-T4 (excluding same lobe nodules) was 12 patients, pleural dissemiantion-M1a was 45 patients, contralateral lung nodule(s)-M1a was 7 patients, and metastatic disease-M1b was 55 patients. We compared the survival time for these groups. Survival time was 11 months, 8 months, 11 months, and 4 months. The survival time of malignant pleural effusion was shorter than other T4 factors without pleural effusion. But, there was no remarkable difference in statistics due to small cases (p=0.23). We strongly suggest that malignant pleural effusion in advanced NSCLC will be categorized with metastatic disease.