• Radiation Oncology Journal
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• 제31권4호
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• pp.222-227
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• 2013

Purpose: This study was performed to evaluate prognostic factors for survival from first relapse (SFFR) in stage I-III breast cancer patients. Materials and Methods: From June 1994 to June 2008, 3,835 patients were treated with surgery plus postoperative radiotherapy and adjuvant chemotherapy for stage I-III breast cancer at Samsung Medical Center. Among them, a total of 224 patients died by June 2009, and 175 deaths were of breast cancer. Retrospective review was performed on medical records of 165 patients who met the inclusion criteria of this study. Univariate and multivariate analysis were done on survivals according to variables, such as age, stage, hormone status of tumor, disease-free interval (DFI), sites of first failure, number of organs involved by recurrent disease (NOR), application of salvage treatments, and existence of brain or liver metastasis (visceral metastasis). Results: Patients' median overall survival time was 38 months (range, 8 to 123 months). Median SFFR was 17 months (range, 5 to 87 months). Ninety percent of deaths occurred within 40 months after first recurrence. The patients with SFFR ${\leq}1$ year had tendency of triple-negativity, shorter DFI (${\leq}2$ years), larger NOR (>3), visceral metastasis for first relapse than the patients with SFFR >1 year. In multivariate analysis, longer DFI (>2 vs. ${\leq}2$ years), absence of visceral metastasis, and application of salvage treatments were statistically significant prognosticators for longer SFFR. Conclusion: The DFI, application of salvage treatments, and visceral metastasis were significant prognostic factors for SFFR in breast cancer patients.

• Journal of Gastric Cancer
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• 제13권4호
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• pp.226-231
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• 2013

Purpose: The role of metastasectomy has been debatable and unclear in the treatment for patients with metastatic gastric cancer. Therefore, this study was designed to evaluate the role of metastasectomy on the overall survival of these patients. Materials and Methods: In 2,406 patients who underwent gastrectomy for gastric cancer between 1998 and 2010, 188 (7.8%) patients had their first surgery for metastatic gastric cancer. To minimize the bias of systemic chemotherapy, 99 patients who received postoperative chemotherapy (fewer than 2 cycles) were excluded. The primary gastrectomy or metastasectomy had not been enforced in the following cases. Patients with far advanced peritoneal dissemination, multiple liver and lung metastasis (more than 2), and a poor general condition (Eastern Cooperative Oncology Group>2) were excluded. Based on the metastasectomy, the patients were classified into two groups, gastrectomy with metastasectomy and gastrectomy only group. Results: There was no significant difference between both groups in clinicopathological characteristics except for the mean age (P=0.047). The univariate analysis for overall survival show statistical significances in metastasectomy (P=0.026), distal gastrectomy (P=0.047), and combined resection of another organ (P=0.047) group. With a multivariate analysis, metastasectomy was a significant factor in patient survival after surgery (odds ratio 1.679; P=0.034). Conclusions: Based on our results, we assume that a detailed strategy for surgery is needed to improve the overall survival of patients with metastatic gastric cancer. Therefore, we suggest that a metastasectomy can help prolong overall survival in some patients with metastatic gastric cancer.

• 대한두경부종양학회지
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• 제15권2호
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• pp.232-234
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• 1999

두경부 영역에서 발생하는 악성종양은 원격전이가 흔하지 않으나 최근 들어 국소전이에 대한 치료효과가 향상됨에 따라 원격전이가 재발과 사망의 주된 원인이 되고 있다. 원격전이중 뇌전이는 빈도는 적으나 이환시 높은 사망률을 보이므로 뇌전이를 의심하는 증상이 있을 때는 조기발견을 위한 적극적인 진단적 접근과 이에 대한 적절한 치료가 중요하다. 본 증례와 같이 고식적 수술후 국소전이에 대한 조절이 잘 되고 있는 환자에서 지속적인 두통 및 체중감소 등의 증상이 나타나는 경우 뇌전이를 의심하여 적절한 진단 방법을 통한 조기 진단과 치료가 중요하다고 생각된다.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.234-238
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• 2011

A 67 year old male at a regular checkup underwent esophagogastroduodenoscopy. On performing esophagogastroduodenoscopy, a lesion about 1.2 cm depressed was noted at the gastric angle. The pathology of the biopsy specimen revealed a well-differentiated adenocarcinoma. On performing an abdominal computed tomography (CT) scan & positron emission tomography-computed tomography (PET-CT) scan, no definite evidence of gastric wall thickening or mass lesion was found. However, lymph node enlargement was found in the left gastric and prepancreatic spaces. This patient underwent laparoscopic assisted distal gastrectomy and D2 lymph node dissection. On final examination, it was found out that the tumor had invaded the mucosal layer. The lymph node was a metastasized large cell neuroendocrine carcinoma with an unknown primary site. The patient refused chemotherapy. He opted to undergo a close followup. At the postoperative month 27, he had a focal hypermetabolic lesion in the left lobe of the liver that suggested metastasis on PET-CT scan. He refused to undergo an operation. He underwent a radiofrequency ablation.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.67-72
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• 1986

저자들은 17명의 환자에 19예의 골반 CT를 시행하여 다음과 같은 결과를 얻었다. 1. 수술전 CT 병기와 수술 및 병리학적 병기를 비교하였던 바 12예중 9예(75%)에서 일치하였으며, 2예는 병기가 낮게, 1예는 병기가 높게 판명되었다. 2. 치료는 10예에서 복회음 절제술을, 1예는 하위 전방 절제술을, 나머지 1예는 단순 대장 조루술을 시행하였다. 3. 수술전 CT가 큰 도움이 된 것은 방광침윤이 있는 2예와 골반 조직 동결로 방사선 치료후 2차 수술을 시행한 1예였다. 4. 수술전 간 전이는 1예(50%)에서 발견되었다. 5. 수술전 CT로써는 임파선 침윤 및 전이 정도를 알기가 힘들며, 직장 주위 조직의 염증 변화 경우에도 암 침윤과 구별이 어려웠다. 6. 수술후 CT는 암의 재발 및 원거리 전이의 발견에 유용했다. 따라서 수술전 혹은 후의 골반 CT는 치료 방향 설정 및 암의 국소재발과 전이조기발견에 큰 도움이 되므로 골반 CT의 많은 임상적 이용이 기대된다.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.136-143
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• 2001

Purpose: The prognosis for gastric cancer with peritoneal seeding is very poor, and the role of surgical intervention is limited. We evaluated the effect of radical removal of primary and metastatic lesions on survival in gastric cancer with peritoneal seeding. Materials and Methods: From May 1989 to March 1999 at Kosin University Gospel Hospital, 115 patients revealed gastric cancer with peritoneal seeding but without liver or lung metastasis and without follow-up loss. The study group included 86 patients who underwent surgery for radical removal of primary gastric and metastatic peritoneal lesions. The control group included 29 patients who experienced incomplete removal of primary or metastatic lesions. Both groups received intraoperative intraperitoneal chemotherapy using mytomycin or cisplatin, and 25 patients underwent postoperative intravenous chemotherapy. Results: The median survival times in the study and the control groups were 13 months and 4 months, respectively (p<0.0001). The 1-year, 2-year, and 5-year survival rates were, respectively, $50.6\%,\;18.1\%$, and $11.3\%$ in the study group and $14.8\%,\;3.7\%$ and $0\%$ in the control group (p<0.0001). In the study group, neither postoperative intravenous chemotherapy nor microscopic invasion of the resection margin had any effect on survival, but intraoperative intraperitoneal chemotherapy and degree of peri-toneal seeding, especially the amount of peritoneal seeding, had an effect on survival. In the control group, neither intraperitoneal nor intravenous chemotherapy had any effect on survival, but resection of the primary gastric lesion improved survival. Conclusion: Radical removal of primary gastric and metastatic peritoneal lesions improved the survival rate for gastric cancer with peritoneal seeding. However, a randomized prospective study is needed to correctly evaluate the effect of intraperitoneal or intravenous chemotherapy.

• Journal of Chest Surgery
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• 제36권6호
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• pp.397-403
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• 2003

폐의 다형성 암종은 일반적으로 드문 폐암종의 아형으로 알려져 있다. 1999년 WHO 폐암분류의 기준을 적용하여 계명대학교 동산의료원에서 진단된 42예의 다형성 암종에 대한 임상적 특징에 대해 알아보고자 하였다. 대상 및 방법: 1992년 1월부터 2001년 12월까지 본원에서 폐암으로 폐 절제술을 시행한 256예 중, 광학현미경적 재검색과 면역조직화학염색을 실시하여 다형성 암종으로 진단한 42예를 대상으로, 연구를 시행하였다. 결과: 42예 중 남자는 31예, 여자는 11예였고, 나이는 26세부터 77세까지였다. 임상증상은 기침, 객혈, 객담이 주로 나타났으며, 진단 시 병기는 Ia 3예, (7%), Ib 16예(38%), IIa 1예 (2%), IIb 8예(19%), IIIa 15예(35%), IIIb 1예(2%)였고, 이 중 림프절 전이가 없는 N0 경우는 23예(54%), 림프절 전이가 있는 N1과 N2인 경우는 19예(46%)로 나타났다. 원격전이가 발생한 환자는 총 19예로 뇌 5예(26%),뼈 4예(21%),근육 4예(21%), 림프절 2예(10%), 간, 난소, 편측 폐, 부신이 각 1예씩 발생하였다. 종양의 크기는 1 cm부터 11 cm까지 분포하였고 평균 5.85 cm이었다. 42예의 환자에서 조사 기간 중 생존자는 11예(26%), 사망자는 31예(74%)이었다. Kaplan-Meier method에 의한 이들의 전체 2년, 5년 생존율은 각각 26%와 13%로 조사대상 256예에서 다형성암종을 제외한 증례의 2년생존율 44%와 5년 생존율 34%에 비해서 유의하게 낮은 것으로 조사되었다(p<0.002). 나이와 종양의 크기, 병기 I과 병기 II 이상, N0 N1 이상의 생존율 비교에서는 유의한 차이는 없었다. 술 후 원격전이가 발생한 증례는 모두 사망하였고 이들은 원격전이가 없는 증례에 비하여 생존율이 유의하게 낮게 나타났다(p<0.002). 걸론: 1999년 WHO 폐암분류에 따른 새로운 진단 기준을 적용할 경우 다형성 암종은 이전의 WHO 폐암분류에서보다 높은 발생률을 보이며, 술 후 이들의 생존율은 다른 비소세포암종의 유형보다 유의하게 낮은 것을 확인할 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.876-882
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• 2001

Objectives : Meningeal hemangiopericytoma is a rare tumor. Clinical and radiological features are similar to those of an ordinary meningioma. But its biological behavior is quite different from those of a meningioma as it brings profuse bleeding in the operation field, frequent recurrence and metastasis to other systemic organs even in the case of gross total resection. In order to find out the prognostic factors and to compare longterm outcome after various treatment modalities, the authors reviewed consecutive 20 operated cases of meningeal hemangiopericytoma to characterize their clinical features, surgical outcomes and effectiveness of the radiation therapy. Methods : Twenty patients with a hemangiopericytoma were treated between 1982 and 1999 in our department. They are composed of 13 patients of hemangiopericytoma and 7 patients who were initially diagnosed as angioblastic type meningioma and then confirmed as a hemangiopericytoma after review of their previous histopathology slides. The mean follow-up period was 99 months(1-256 months). The long-term outcomes after various treatment modalities were evaluated according to recurrence-free survival and image follow-up. Recurrence-free survival curves are compared between the patient groups according to the extent of removal and radiation therapy. Results : There were 10 cases of recurrence and 4 cases of distant metastases ; lung, liver and femur(2 cases) respectively. The 5-year recurrence rate was 37%, while the 10-year recurrence rose to 77%. There was also statistically significant difference of median recurrence-free survival between the completely-resected group(Simpson grade 1 or 2) and partially-resected group(Simpson grade 3 or 4 or 5) ; 137 months compared to 47 months, respectively(p=0.009). The median recurrence-free period after subtotal resection of tumor and postoperative radiotherapy was 47 months compared to 117 months of the patients who underwent gross total resection of tumor and did not receive radiotherapy. But radiation therapy alone did not show significant difference in recurrence-free survival. Marked tumor volume reduction and easy removal of tumors without bleeding were found in 2 recurred cases. Conclusion : The extent of tumor resection and presence of metastasis are the most important factors related to long-term outcome of the patients with hemangiopericytoma. Radiation therapy after the first operation did not have a role in extending the recurrence-free survival, but it affected favorably to decrease the size of residual mass and intraoperative bleeding during the second operation.

• Radiation Oncology Journal
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• 제26권3호
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• pp.135-141
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• 2008

목 적: 수술 후 방사선 치료를 받은 후복막 연조직 육종 환자들의 치료 성적과 예후 인자를 분석해 보고자 하였다. 대상 및 방법: 1985년부터 2003년까지 수술 후 방사선 치료를 받은 후복막 연조직 육종 환자 23명의 자료를 분석하였다. 추적 관찰 기간은 8개월에서 240개월까지로 중앙값은 77개월이었다. 전체 환자 중 21명이 원발성 종양이었고, 두명은 재발성 이었다. 지방육종과 평활근육종이 전체 종양의 78%를 차지하였고 17명의 환자가 조직학적으로 고등급(2또는 3등급)이었다. 종양의 크기는 3에서 50 cm까지 분포하였으며 중앙값은 13 cm이었다. 65%의 환자에서 종양의 완전절제가 이루어졌다. 방사선치료는 일일 1.8에서 2.0 Gy를 주 5회 조사하여 총 45에서 59.4 Gy를 조사하였으며 중앙값은 50.4 Gy였다. 결 과: 환자들의 5년 전체생존율, 국소무재발생존율, 무전이생존율은 각각 68%, 58%, 71%였다. 11명의 환자에서 국소 재발이 일어났으며, 9명에서는 원격전이가 발생했다. 원격전이는 간에서 가장 많이 발생했다. 예후인자 분석 중 일변량 분석에서는 주변장기를 침윤한 경우와 60세를 초과한 나이가 생존율에 나쁜 영향을 주는 인자로 분석되었고 이중 주변장기를 침윤한 것은 다변량 분석에서도 유의한 인자로 분석되었다. 60세를 초과한 경우는 일변량과 다변량 분석 모두에서 국소재발에 유의한 영향을 미치는 인자였다. 한 명의 3등급의 설사를 제외하고는 3등급 이상의 치료에 의한 부작용은 보고되지 않았다. 결 론: 본 연구 결과 이전에 보고 되었던 다른 연구들의 결과와 비슷한 정도의 치료성적이 분석되었으며 주변 장기를 침범한 경우와 60세를 초과한 경우가 환자의 생존과 재발에 나쁜 영향을 미치는 유의한 인자였다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권2호
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• pp.1107-1110
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• 2013

Intrahepatic cholangiocarcinoma (ICC), one of the primary liver cancers, is frequent in the northeastern part of Thailand. Surgical resection remains the best method of treatment, but patients suffering from ICC usually present at a late stage of the disease. Studies of survival and prognostic factors after surgery remain rare. The aim here was to evaluate the survival rate and factors affecting the survival of patients with intrahepatic cholangiocarcinoma after surgery. The study used a retrospective cohort design. The subjects were 73 consecutive patients with ICC, who were admitted for surgery to Srinagarind Hospital, Khon Kaen University, during the period 2005-2009. The censoring date was 31 December, 2011, data being evaluated using uni- and multivariate analyses. Postoperative survival analysis was performed by the Kaplan-Meier method, and the Cox proportional hazard model was used to identify independent prognostic factors. The total follow-up time was 99 person-years. The total number of deaths was 59, giving a mortality rate of 59 per 100 person-years. The cumulative 1-, 3-, and 5-year survival rates were 52.1%, 21.7%, and 11.2%, respectively. The median duration of survival after resection was 12.4 months. Univariate analysis revealed stage of disease, lymph node metastasis, histological type, histological grade and macroscopic classification to be statistically significant (p-value<0.05) prognostic factors. In the multivariate analysis, only macroscopic classification was statistically significant (p-value<0.05). In conclusion, macroscopic classification was the only independent factor found to be significantly associated with survival following surgical treatment of ICC.