• 디지털융복합연구
• /
• 제17권7호
• /
• pp.179-186
• /
• 2019

본 연구는 건강신념모델(Health Belief Model, HBM)을 이론적 기틀로 대장암 조기검진행위에 영향을 미치는 요인을 규명하기 위한 서술적 조사연구이다. 만 50세 이상 성인 148명을 대상으로 인구사회학적 특성, 건강신념, 자기 효능감 및 행동의 계기 변수를 포함한 구조화된 설문지를 이용하여 조사하였다. 수집된 자료는 SPSS/WIN 25.0을 이용하여 기술통계, t-test, chi-square test 및 다중로지스틱 회귀분석을 시행하였다. 연구결과 대장암 조기검진행위에 영향을 미치는 요인은 지각된 민감성, 배우자 대장암 검진 경험 및 가족력이었다. 따라서 대장암 수검율 향상을 위해서는 대장암 조기검진의 중요성에 대한 체계적인 교육을 통해 지각된 민감성을 높이는 것이 필요하다. 또한 대상자의 가족력 및 가족단위 검진 주기를 사정하고, 부부의 파트너쉽을 활용한 교육 프로그램 개발이 이루어져야 할 것이다.

• Journal of Gynecologic Oncology
• /
• 제29권6호
• /
• pp.89.1-89.8
• /
• 2018

Objective: Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%-30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN. Methods: Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy. Results: The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission. Conclusions: Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%-30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.

• Journal of Chest Surgery
• /
• 제34권8호
• /
• pp.615-620
• /
• 2001

1998년 Ginsberg등은 전이성 폐암의 새로운 병기를 제시하였다. 이 병기 제안은 폐 전이 병소의 완전절제 여부, 무병생존기간, 폐 전이 병소의 개수를 예후 인자로 제시하여 이들을 기초로 병기를 나누었다. 우리는 세브란스 병원의 전이성 폐암 환자들을 분석하여 새로운 병기와 장기 생존율의 상관관계에 대하여 연구하였다. 대상 및 방법: 1990년부터 200년까지 전이성 폐암으로 수술적 치료를 받은 111명을 대상으로 하였다. 이둘 중 103명(92.8%)에서 완전절제가 가능하였다. 원발성 종양에 따라 분류하였을 때, 암종이 60명, 육종이 46명, 그 외의 질환이 5명이었다. 무병생존기간은 0에서 35개월까지가 79명, 36개월 이상이 32명이었다. 하나의 폐 전이 병소를 가진 환자가 53명, 여러 개의 폐 전이 병소를 가진 환자가 58명이었다. 평균 추적기간은 49개월이었다. 결과: 전이성 폐암이 완전절제 후 3년 생존율은 48.2%, 5년 생존율은 32.6%인 반면, 불완전절제한 경우에서 3년 생존율은 21.9%였다. 완전절제한 한자들 중에서 무병생존기간이 0에서 35개월까지의 환자군에서 3년 생존율은 40.5%, 5년 생존율은 30.4%였고 36개월 이상인 환자군에서 3년 생존율은 75.9%, 5년 생존율은 39.0%였다. 하나의 폐 전이 병소를 가진 환자군의 3년 생존율 45.8%, 5년 생존율 30.5%이었고 여러 개의 병소를 가진 환자군의 3년 생존율 50.0%, 5년 생존율 34.4%였다. 병기 1기인 환자군의 3년 생존율 58.5%, 5년 생존율 43.8%, 2기 54.0%, 37.4%, 3기 38.4%, 3기 38.2%, 27.9%, 그리고 4기의 3년 생존율은 21.9%였다. 결론: 새로운 전이성 폐암의 병기 모델에 따른 세브란스 병원 환자들의 분석 결과, 병기가 진행됨에 비례하여 생존율도 감소하였으나, 통계학적으로 유의한 차이는 아니었다. 전이성 폐암의 예후 인자를 규명하기 위해서는 보다 많은 경험과 오랜 기간 동안의 추적 조사가 필요하리라 생각된다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권2호
• /
• pp.559-562
• /
• 2012

Serum alpha-fetoprotein (AFP) is a significant marker for clinical diagnosis and prognosis evaluation in hepatocellular carcinoma (HCC) patients. However, some proportion of liver cancer patients are AFP-negative (AFP ${\leq}$20ng/ml). In order to study the differences between clinicopathological factors and prognosis of alpha-fetoprotein negative and positive patients, a total of 114 cases (41 AFP-negative and 73 AFP-positive) were selected for our research. By systematically statistical analysis, the results demonstrated that compared with AFP-negative patients, AFP-positive examples were more likely to feature cirrhosis nodules, non-complete neoplasm capsules, and a poor Edmondson-steiner grade. Furthermore, AFP-negative patients demonstrated a favorable long-term prognosis. By univariate analysis and multivariate analysis with Cox's proportional hazards model, multiple tumors were found to be independent risk factors for worse survival of AFP negative patients; however, less tumor-free margins, multiple tumors and Edmondson-steiner grades III/IV, proved to be independent risk factors leading to a poor prognosis of AFP positive cases. Finally, we can infer that high levels of AFP signify a highly malignant tumor and unfavorable prognosis.

• Journal of Chest Surgery
• /
• 제46권1호
• /
• pp.49-55
• /
• 2013

Background: The aim of this study was to determine the survival rate of patients with non-small cell lung cancer (NSCLC) who were preoperatively diagnosed with a negative N2 lymph node, but postoperatively confirmed as a positive N2 node based on a pathological evaluation. Materials and Methods: The hospital records of 248 patients from 1994 to 2009 with resected primary NSCLC who were preoperatively diagnosed with negative N2 lymph node, were retrospectively reviewed. Of these, after surgery, there were 148 (59.7%) patients with pathological N0, 54 (21.8%) with pathological N1 and 46 (18.5%) with pathological N2. Results: The median follow-up period was 24 months (range, 1 to 132 months). The 5-year disease free survival rates were 60% in pN0, 44% in pN1, and 29% in pN2. The 5-year overall survival rates were 63.1% in pN0, 51.9% in pN1, and 33.5% in pN2. There were no statistically significant differences between pN1 and pN2 (p=0.326 and p=0.106, respectively). Thirty-three (71.7%) of the 46 pN2 patients had single-zone metastasis, and 13 patients (28.3%) had multiple-zone metastases over the two nodal zone metastasis. There were no statistical differences in the 5-year disease free survival rate and the 5-year overall survival rates between the two groups. Conclusion: The 5-year disease free survival and the overall survival rate of the patients with unsuspected N2 disease were statistically similar with that of the patients with pathological N1 disease. There was no statistically significant difference between the patients with a single-zone metastasis and a multiple zone metastasis.

• Tuberculosis and Respiratory Diseases
• /
• 제70권5호
• /
• pp.423-427
• /
• 2011

Epithelioid sarcomas are rare soft tissue sarcomas with a high tumor grade and high local recurrence and metastasis rates. Although the lung is the most common site of metastasis, endobronchial metastasis hasn't been reported yet. We now report a case of epithelioid sarcoma with endobronchial metastasis. A 28-year-old man had recurrent pneumothorax and underwent wedge resection. He presented at our hospital with hemoptysis, dyspnea, and chest pain. Chest computed tomography revealed left pneumothorax, multiple lung nodules and endobronchial lesions at the right lower basal lobe. Bronchoscopy showed a hemorrhagic mass obstructing the bronchus of the right lower basal lobe. Magnetic resonance imaging revealed multiple nodular lesions in the left thigh muscles. The bronchoscopic biopsy of the endobronchial lesion and the muscle biopsy of the thigh showed the same feature epithelioid sarcoma. This is the first case report of an epithelioid sarcoma with endobronchial metastasis that was diagnosed by bronchoscopic biopsy.

• Journal of Chest Surgery
• /
• 제46권3호
• /
• pp.192-196
• /
• 2013

Background: This study focused on the association between preoperative serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) levels and pathologic parameters in patients with resected non-small-cell lung cancer (NSCLC). Materials and Methods: The records of 527 patients who underwent pulmonary resection of NSCLC were reviewed. The association between preoperative serum CEA and Cyfra 21-1 levels and variables that had p-values of less than 0.05 in a t-test or one-way analyses of variance was analyzed by multiple linear regression. Results: The mean serum CEA and Cyfra 21-1 levels prior to surgery were $6.8{\pm}23.1$ mg/dL (range, 0.01 to 390.8 mg/dL) and $5.4{\pm}12.3$ mg/dL (range, 0.65 to 140.2 mg/dL). The serum CEA levels were associated with tumor (T) and lymph node (N) stage and histology. The serum Cyfra 21-1 levels were associated with T stage, tumor size, and histology. Multiple linear regression indicated that serum CEA levels were associated with T (T3/4 vs. T1: ${\beta}$=8.463, p=0.010) and N stage (N2/3 vs. N0: ${\beta}$=9.208, p<0.001) and histology (adenocarcinoma vs. squamous cell: ${\beta}$=6.838, p=0.001), and serum Cyfra 21-1 levels were associated with tumor size (${\beta}$=2.579, p<0.001) and histology (squamous cell vs. adenocarcinoma: ${\beta}$=4.420, p=0.020). Conclusion: Serum CEA level was correlated with T and N stage, and Cyfra 21-1 with tumor size. CEA and Cyfra 21-1 showed histologic correlation. CEA is mainly elevated in adenocarcinoma and Cyfra 21-1 in squamous cell carcinoma. These results might be helpful for predicting pathologic status in preoperative NSCLC.

• 대한기관식도과학회지
• /
• 제16권2호
• /
• pp.145-148
• /
• 2010

Background: Laryngeal papillomatosis, which is cased by human papillomavirus, is the most common benign neoplasm of the larynx. However, the prognosis of this disease remains really unpredictable. The aim of this paper is to determine whether any clinical features at the time of diagnosis could predict its course. Material and Method: Eighty-six patients treated at our institution during the last 20 years were analyzed retrospectively. All patients had microsurgery under general anesthesia. All patients' follow-up period was more than 1 year. We divided the patients into 1) Juvenile versus adult group based on their age 20, 2) single surgical method with laser versus dual surgical method with laser and microdebrider group, and 3) single subsite versus multiple subsites group. And we compared the therapeutic outcome. Results: The recurrence rate was 100% (15 patients) in the JP group and 56% (40 patients) in the AP group. Juvenile versus adult group was the only independent prognostic factor by univariate, and multivariate analysis. Microdebrider resection technique and multiple subsites were not associated with treatment result. Time period from the first surgery to recurrence detection was different statistically only for the age group. The number of surgery in the JP group ranged from 1 to 31 (mean 8.8). In the AP group the number of surgery ranged from 1 to 25 (mean 3.7). It was statistically different. Conclusion: Prognosis for the laryngeal papillomatosis remains unpredictable. Only patients' age was the only independent prognostic factor.

• Journal of Korean Neurosurgical Society
• /
• 제61권3호
• /
• pp.363-375
• /
• 2018

Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

• Journal of Chest Surgery
• /
• 제35권10호
• /
• pp.750-754
• /
• 2002

원발성 심장 종양은 드물며 이들 중 20~25%에서 악성 종양이다. 더욱이 심장에서의 원발성 악성 간엽세포종은 극히 드문데, 최근 저자 등은 2례의 심장 악성 간엽세포종을 경험하였다. 첫 번째 예는 승모판 폐쇄부전증을 보인 61세의 여자환자로 승모판을 막고있는 좌심방의 후측벽에서 생긴 악성 간엽세포종이었다. 2.7$\times$3.7cm크기의 종괴는 승모판의 후내측 교련과 판륜까지 자라고 있었다. 좌심방의 벽측은 남긴채 종괴는 부분 절제하였다. 환자는 항암치료를 받고 30일 후에 별문제 없이 퇴원하였으며, 19개월 동안 외래 추적관찰 중이다. 두 번째 예는 좌측 하폐정맥에서 기원한 4$\times$5cm기의 약하고 연노란색의 다엽성의 종괴였다. 다른 작은 종양결절들이 좌심방의 벽과 승모판 후엽에서 발견되었다. 수술은 종양의 부분절제와 승모판막치환술을 시행하였다.