• 제목/요약/키워드: stage IV

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절제 불가능한 4기 대장암에서 고식적 수술의 임상적 효과 (Clinical Impact of Palliative Surgery in Unresectable Stage IV Colorectal Cancer)

  • 이윤석
    • Journal of Digestive Cancer Research
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    • 제5권1호
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    • pp.32-36
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    • 2017
  • In unresectable stage IV colorectal cancer, the role of palliative surgery is not defined clearly. The palliative surgery can be categorized into two surgeries; first, palliative primary tumor resection; second, palliative metastatectomy. Several retrospective studies reported initial palliative systemic chemotherapy in unresectable stage IV colorectal cancer did not increase primary tumor related complications such as obstruction, perforation and hemorrhage, so they insisted that primary tumor resection in asymptomatic stage IV colorectal cancer should be preserved. However, in terms of overall survival and cancer-specific or progression-free survival, several retrospective studies, especially using population-based big data, reported favored survivals in palliative primary tumor resection group. And also several studies reported that palliative metastatectomy such as liver resection without resection of lung metastasis showed better overall survivals. But those results from those studies came from retrospective studies and are likely to be affected by selection bias. Prospective randomized studies are needed to define the benefit of palliative primary tumor resection and metastatectomy in unresectable stage IV colorectal cancer. However, based on the updated evidences, the dogma that palliative primary tumor resection should be preserved in asymptomatic unresectable stage IV colorectal cancer should be questioned.

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원격전이를 동반하지 않은 4기 위암 환자의 예후 (The Prognosis of Patients with Stage IV Gastric Carcinoma without Distant Metastasis)

  • 이준호;노성훈;최승호;민진식
    • Journal of Gastric Cancer
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    • 제1권2호
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    • pp.100-105
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    • 2001
  • Purpose: In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients without distant metastasis after curative resection. Materials and Methods: 190 stage IV gastric carcinoma patients without distant metastasis were reviewed after curative resection. Results: Male sex, distal third location, Borrmann type III, IV and histologically undifferentiated type were common. 5 year survival rate of the 190 patients was $22.2\%$. Depth of invasion and lymph node metastasis did not influence survival. The lymph node ratio (positive lymph node / retrieved lymph node) and combined resection affected survival by univariate and multivariate analysis. Conclusion: Combined resection and positive lymph node ratio were the independent prognostic factors in the patients with stage IV gastric carcinoma who underwent curative resection.

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간 전이가 동반된 Stage IV-S 신경모세포종에서 부신절제 후 간 전이의 자연소실 - 1예보고 - (Spontaneous Regression of Liver Metastasis in Stage IV-S Neuroblastoma after Adrenalectomy - Case Report -)

  • 서학준;정재희;송영택
    • Advances in pediatric surgery
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    • 제7권1호
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    • pp.68-72
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    • 2001
  • Prenatally diagnosed neuroblastomas have been reported in increasing numbers over the past several years. The vast majority are in favorable stages of the disease (stage I, II, IV-S). The authors experienced one case of stage IV-S neuroblastoma of the adrenal gland with liver metastasis, which regressed spontaneously after removal by adrenalectomy. This patient was noticed to have an abdominal mass at prenatal ultrasonography performed at 36weeks of gestation. This tumor was a neuroblastoma of the left adrenal gland with multiple liver metastases. Left adrenalectomy and liver biopsy were performed at 3 months of age. Thirty-eight months after surgery, an MRI demonstrated that the hepatic metastatic lesions had completely regressed without chemotherapy or radiation.

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원격 전이 여부에 따른 4기 위암의 세분류(IVa 및 IVb) (Subclassification of Stage IV Gastric Cancer According to the Presence of Distant Metastasis (IVa and IVb))

  • 하태경;권성준
    • Journal of Gastric Cancer
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    • 제6권3호
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    • pp.173-180
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    • 2006
  • 목적: 위암 병기 4기는 다른 병기에서와 같이 여러 T인자 및 N인자로 구성되어 있으며, 특히 원격 전이가 존재하는 경우가 포함되어 있다. 4기에 속하는 위암 중 원격 전이군(M1)의 경우는 근치적 절제가 불가능한 경우로서 비 원격 전이군(M0)과 함께 동일 병기로 분류되어 있어 원격 전이 유무에 따라 환자의 생존율에 의미있는 차이가 있을 수 있다는 가능성을 가지고 비교 분석하였다. 대상 및 방법: 1992년 6월부터 2005년 12월까지 본원에서 위암으로 수술한 1,630명 가운데 위절제술이 가능했던 4기 환자 308명을 대상으로 원격 전이 유무에 따른 여러 임상병리학적 인자들의 특성과 생존율을 비교 분석하였으며 추적기간의 중앙값은 43개월(범위, $1{\sim}154$개월)이었다. 결과: M0군의 5년 생존율은 35%, M1군은 16%로 M0군의 생존율은 M1군에 비해 의미 있게 높았으며(P=0.0000), M0군 중 T1-3N3M0군과 T4N1-2M0군간의 생존율은 통계학적으로 유의한 차이를 보이지 않았다. 결론: 현재의 TNM 분류법상 4기로 구분되는 예들을 비교 분석한 결과 M0군은 M1군에 비해서 통계적으로 유의하게 예후가 좋으므로 M0군은 stage IVa로, M1군은 stage IVb로 세분류하는 것이 타당하겠다.

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신경모세포종: 20년 치료 경험의 분석 (Neuroblastoma: Review of 20-year Experiences)

  • 문석배;이성철;박귀원;정성은
    • Advances in pediatric surgery
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    • 제15권1호
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    • pp.27-37
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    • 2009
  • Neuroblastoma is the most common extracranial solid tumor in children. We retrospectively analyzed the results of neuroblastoma treatment of 191 patients (116 males and 75 females) treated between January 1986 and December 2005 at the Department of Pediatric Surgery and the Department of Pediatrics, Seoul National University Children's Hospital. The mean age at diagnosis was 3.1 years (0.1 yrs - 13.5 yrs). Forty-seven patients were under 1 year of age. The mean follow-up period was 57.3 months (24 days - 19.1 yrs). Patients were classified into two groups according to the completeness of resection of the primary tumor; (1) gross total resection (GTR) and (2) incomplete resection (IR). The number of patients in stages I, II, III, IV, IV-S were 17 (8.9 %), 12 (6.3 %), 43 (22.5 %), 114 (59.7 %), 4 (2.1 %), respectively. GTR was achieved in 120 patients and IR in 71 (22 stage III, 47 stage IV, 1 stage IV-S, 1 brain). Overall survival (OS) was 65.2 % and event-free survival (EFS) was 48.6 %. EFS were 100 %, 75 %, 66.8 %, 31.3 %, 75 % at stage I, II, III, IV, IV-S, respectively. There was no significant difference in EFS according to the completeness of resection. EFS was improved in GTR group (p=ns) of stage III, but by contrast, stage IV patients showed worse EFS in GTR group. EFS was improved significantly after the introduction of autologous stem cell transplantation (ASCT) (58.1% vs. 40.6%, p=.029). The EFS improved significantly after the introduction of ASCT in IR group (p=.009) rather than GTR group (p=ns). The EFS of the patients under 1 year of age (N=47) was better than the patients over 1 year of age (N=144) significantly (75.5 % vs. 39.4 %, p=.0034). The prognosis of neuroblastoma was related to the INSS stage and age at diagnosis. The survival of IR group significantly improved after ASCT.

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Risk Factors for Stage IV Breast Cancer at the Time of Presentation in Turkey

  • Uyeturk, Ummugul;Tatli, Ali Murat;Gucuk, Sebahat;Oksuzoglu, Berna;Ulas, Arife;Avci, Nilufer;Ozbay, Mehmet Fatih;Gunduz, Seyda;Akinci, Muhammed Bulent;Salim, Derya Kivrak;Sonmez, Ozlem Uysal;Akdag, Fatma;Ergenc, Hasan
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권12호
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    • pp.7445-7449
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    • 2013
  • Background: Breast cancer (BC) is the one of the most common cancers in women. It is also a leading cause of death. Unfortunately, some patients initially present with distant metastases and are diagnosed with stage IV disease that is nearly always, by then, incurable. This retrospective analysis investigated the risk factors for stage IV BC that may underlie such late presentation. Materials and Methods: In all, 916 patients with BC who visited the medical oncology polyclinic of eight different centres in Turkeybetween December 2011 and January 2013 were analysed. Results: A total of 115 patients (12.6%) presented with stage IV disease. In univariate analysis; to comparing these with patients at other stages, no statistical difference was found for median diagnosis age or age at menarche (p=0.611 and p=0.820), whereas age at menopause and age at first live birth were significant (p=0.018 and p=0.003). No difference was detected in terms of accompanying diseases, use of oral contraceptives and hormone replacement therapy, smoking, alcohol consumption and the rate of family history of BC between the patients (p=0.655, p=0.389, p=0.762, p=0.813, p=0.229, p=0.737). However, screening methods were employed less often, the rate of illiteracy was higher, and the rate of other cancers was higher in patients with stage IV BC (p=0.022, p=0.022, p=0.018). No statistical difference was observed between the patients in terms of tumour histopathology, and status of oestrogen receptor, progesterone receptor, or human epidermal growth factor-2 receptor (p=0.389, p=0.326, p=0.949, p=0.326). Grade 3 tumours were more frequent in patients with stage IV disease (p<0.001). On multivariate analysis, risk factors for stage IV breast cancer at the time of presentation were found to be age at first live birth and educational level (p=0.003 and p=0.047). Conclusions: Efforts should be made to perform mammography scans, in particular, at regular intervals through national training programs for all women, particularly those with family histories of breast and other types of cancer, and to establish early diagnosis of BC long before it proceeds to stage IV. Additionally, women's education had better be upgraded. In order to make women aware of BC, national education-programmes must be organised.

Proposal of a New TNM Classification for Gastric Cancer: Focusing on pN3b and Cytology-Positive (CY1) Disease

  • Kim, Sa-Hong;Lee, Hyuk-Joon;Park, Ji-Hyeon;Choi, Jong-Ho;Park, Shin-Hoo;Choe, Hwi-Nyeong;Oh, Seung-Young;Suh, Yun-Suhk;Kong, Seong-Ho;Park, Do-Joong;Yang, Han-Kwang
    • Journal of Gastric Cancer
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    • 제19권3호
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    • pp.329-343
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    • 2019
  • Purpose: Gastric cancer with lymph node metastasis (LNM) more than 15 (N3b) was defined as stage IV until the 6th AJCC system. However, it has been reclassified as a localized disease (stage IIb or III) since the 7th system. The aim of this study is to demonstrate that the survival of N3b is comparable to cytology-only positive (CY1-only) stage IV and to propose a new TNM system interpreting N3b as an eligibility criterion for receiving more intensive chemotherapy regimens. Materials and Methods: 1,430 patients who underwent gastric cancer surgery at Seoul National University Hospital from 2007 to 2012 were retrospectively analyzed. The 5-year survival rate (5YSR) and 3-year recurrence-free survival (RFS) were evaluated according to the 7th and 8th systems, as well as a new categorization based on N-classification; N0-2 (LNM<7), N3a (LNM 7-15), or N3b (LNM>15). Results: The survival of N3b is comparable to that of CY1-only stage IV (log rank test, P=0.671) and is distinct from that of grossly stage IV (log rank test, P<0.001). The survival of the remaining stage IIIc (T4bN3a) was comparable to those of N3b and CY1-only stage IV. Most N3b patients had significantly shorter 3-year RFS and mean RFS than those with IIb-IIIc, as if N3b itself was a higher TNM stage. Conclusions: In terms of survival, T4bN3a, N3b, and CY1-only stage IV were unified as stage IVa, while grossly stage IV was defined as stage IVb. N3b can be regarded as an eligibility criterion for undergoing more intensive chemotherapy regimens.

Surgical Outcomes and Survival Prognostic Factors for Palliative Gastrectomies in Stage IV Resectable Gastric Cancer Outlet Obstruction Patients

  • Choi, Won Yong;Kim, Hyun Il;Park, Seong Ho;Yeom, Jong Hoon;Jeon, Woo Jae;Kim, Min Gyu
    • Journal of Gastric Cancer
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    • 제20권4호
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    • pp.421-430
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    • 2020
  • Purpose: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. Materials and Methods: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. Results: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. Conclusions: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

The Impact of Preoperative Low Body Mass Index on Postoperative Complications and Long-term Survival Outcomes in Gastric Cancer Patients

  • Kim, Chang Hyun;Park, Seung-Man;Kim, Jin-Jo
    • Journal of Gastric Cancer
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    • 제18권3호
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    • pp.274-286
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    • 2018
  • Purpose: The aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer. Materials and Methods: A total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (${\leq}18.5kg/m^2$, n=51), normal BMI group ($18.6-24.9kg/m^2$, n=308), and high BMI group (${\geq}25.0kg/m^2$, n=151). Results: There were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P<0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186-154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644-16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383-212.940; P=0.027). Conclusions: Preoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.

부신 기원의 선천성 신경모세포종의 치료 경험 (Clinical Features and Surgical Outcome of Congenital Neuroblastoma of Adrenal Gland)

  • 박효준;문석배;서정민;이석구
    • Advances in pediatric surgery
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    • 제15권1호
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    • pp.38-43
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    • 2009
  • With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass becomes more common. Most of these masses prove to be congenital neuroblastomas (CNB) postnatally. However, the diagnosis is often confused with other benign lesions and the post-natal management remains controversial. The medical records of 13 patients that underwent primary surgical excision for an antenatally detected adrenal CNB, between January 1995 and April 2009, were reviewed retrospectively. The clinical, radiological, surgical, and pathological data on the suprarenal mass were collected. Staging evaluation was performed after histological confirmation of the CNB. Most of the CNBs were stage I (N=11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had N-myc gene amplification. The stage I patients were cured by surgery alone, and stage IV patients underwent 9 cycles of adjuvant chemotherapy and currently have no evidence of disease after 39 months of follow-up. The patient with stage IV-S is currently receiving chemotherapy. There were no post-operative complications. For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an adrenal CNB detected before birth. The surgery can be safely performed during the neonatal period and provides a cure in most cases. Surgical diagnosis and treatment of CNB is recommended in neonatal period.

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