• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.362-368
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• 2008

Background: LKB1(STK11) is a serine/threonine kinase that functions as a tumor growth suppressor. The functions of LKB1 in lung cancer are not completely understood. This study evaluated the relationship between LKB1 protein expression and the clinicopathological features in lung cancer tissues. Methods: The expression of LKB1 was studied in paraffin-embedded tumor blocks, which were obtained from 77 patients who had undergone surgery at Wonkwang University Hospital. The expression of the LKB1 protein was considered positive if the staining intensity in the tumor tissue adjacent to the normal airway epithelium was >30%. Results: The LKB1 expression was positive in 31 (40%) of samples. Loss of LKB1 expression was significantly associated with being male, smoking history, and squamous cell carcinoma. In the peripheral sites, the loss of LKB1 expression was strongly associated with a smoking history. A loss of LKB1 expression was more frequently associated with progression according to TNM staging, particularly more than T2, N progression. Conclusion: There was a significant relationship between the loss of the LKB1 protein and gender, smoking history, and histological type in primary lung cancer. Although LKB1 expression was not found to be a significant prognostic factor, further studies with a larger cohort of patient's lung cancer tissue samples will be needed to confirm this.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.113-119
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• 1998

Purpose : Because adenocarcinomas of the uterine cervix have lower 5-year survival rate than squamous cell carcinomas due to early lymph node metastasis and local extension, scrutiny of lymph node metastasis and local extension by radiologic examination is necessary in case of clinically diagnosed or suspected adenocarcinomas. The purpose of this study is to evaluate whether there are specific findings of these tumors, compared with squamous cell carcinomas, through the analysis of magnetic resonance (MR) imaging findings. Materials and Methods : Of 21 pathologically proven cervical adenocarcinomas, MR imaging findings of 18 tumors (histologic staging : two Ib, four IIa, two IIb, one IIIa, and one IIIb) were retrospectively analyzed and compared with those of 40 wquamous cell carcinoma in consecutive patients as a control group. T1-wetighted and fast spin echo T2-weighted images were obtained on the axial and sagittal planes, using a 1.5-T MR scanner. The largest diameter, location, signal intensity and degree of contrast enhancement contour, shape and longitudinal extent of the tumor and associated findings on MR image were analyzed. Results : The largest diameters of cervical adenocarcinomas ranged from 0.8 to 4.1 cm(mean, 2.2 cm). Of 18 adenocarcinomas, nine were of endocervical type. All adenocarcinomas were isointense to surrounding cervical stroma on T1-weighted images and hyperintense(homogeneous in ten, inhomogeneous in eight) on fast spin echo T2-weighted images. Adenocarcinomas enhanced on contrast study in all patients (homogeneous in six, inhomogeneous in 12 with hyperintese enhnacing rim in two). Eight adenocarcinomas had smooth contours and ten had irregular ones. The shape of adenocarcinoma was irregular in eight patients, barrel shape in six, papillary/polypod in three, and nodular in one. All adenocarcinomas involved lower half of the uterine cervix and six tumors extended up to the upper half. Pelvic lymph nodes of more than 1.5cm in diameter in two adenocarcinomas pateints and no detectable small pelvic lymph nodes on MR imaging in one patient were pathologically positive. Hydrometra was associated in two adenocarcinomas patients, and hematometra in one patient. Compared with squamous cell carcinomas, more frequent MR findings of endocervical type and barrel shape in cervical adenocarcinomas were statistically significant. Conclusion : Cervical adenocarcinomas had more frequent MR findings of endocervical type and barrel shape, compared with wquamous cell carcinomas. Adenocarcinoma of the uterine cervix may be suspected on MR imaging, when a cervical carcinoma is of barrel shape along the endocervical canal and tends to involve lymth nodes in earlier stages.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.250-256
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• 2006

Purpose: Recently, interest in peroxisome-proliferator-activated receptors (PPAR) has increased, although clinical studies of the effect of $PPAR-{\gamma}$ expression on gastric cancer have not been reported yet. In this study, we investigated the role of $PPAR-{\gamma}$ expression in gastric cancer patients. Materials and Methods: One hundred twenty-eight (128) samples of both gastric cancer and normal tissues were obtained from 128 patients who had undergone at a curative gastrectomy at Seoul Medical Center from Jan. 2001 to Dec. 2005. $PPAR-{\gamma}$ expression was determined by using immunohistochemical staining, and the results were analyzed. The statistical analysis was based on clinicopathological findings and the differences in survival rates. Results: The mean age of the patients was 6n, and the male : female ratio was 1.9 : 1. $PPAR-{\gamma}$ expression was significantly higher in cancer tissues than in normal tissue (81.3% vs. 57.0%, p<0.001). There was insignificant difference between well and moderately differentiated types and poorly differentiated types in terms of the expression of $PPAR-{\gamma}$ (87.0% vs. 74.6%, P=0.074). In the univariate analysis the survival rate was significantly increased when $PPAR-{\gamma}$ was expressed in normal tissue (P=0.003). In the multivariate analysis, only the UICC TNM staging had significance related to the survival rate. Conclusion: The rate of $PPAR-{\gamma}$ expression was higher in cancer tissue than it was in normal tissue from gastric cancer patients. In the univariate analysis, $PPAR-{\gamma}$ expression in normal tissue had significance with respect to survival, but the multivariate analysis showed no such significance. Thus, we should further evaluate more cases to determine whether or not such a significance exists.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.189-197
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• 2008

Purpose: Peritoneal lavage cytology is regarded as a useful diagnostic test for detecting intraperitoneal micrometastsis. However, there are currently no reports about cytological examination with $ThinPrep^{(R)}$ (CY), a newly introduced fluid-based diagnostic system, in patients with advanced gastric cancer (AGC). This study was performed to analyze the clinical significance of intraoperative peritoneal lavage for CY in AGC patients. Materials and Methods: 424 AGC patients were suspected to have serosal exposure macroscopically during surgery and they underwent intraoperative peritoneal lavage for CY between 2001 and 2006 at Korea Cancer Center Hospital. The clinical data, pathological data and CY results were collected and analyzed retrospectively. Results: The percentage of cytology positive results was 31.1%, and this was well correlated with the T-stage, N-stage and P-stage. The 3-year survival rates of CY0 and CY1 were 68.1% and 25.9%, respectively. According to the P-stage and CY, the 3-year survival rates were 71.1% in P0CY0, 38.9% in P0CY1, 38.5% in P1/2/3CY0 and 11.0% in P1/2/3CY1. Interestingly, both the P0CY1 and P1/2/3CY0 survival curves were similar figures, but they were significantly different from those of the other groups. Multivariate analysis indicated that CY was an independent, strong prognostic factor for survival, as well as sex, the T-stage, N-stage, P-stage, other metastasis and the serum CEA. CY1 was revealed as a risk factor for peritoneal recurrence in the curative resection group. Conclusion: The results certify indirectly that cytological examination using $ThinPrep^{(R)}$ is a very reliable diagnostic method for detecting intraperitoneal micrometastasis from the fact that it is not only a strong prognostic factor, but it is also a risk factor for peritoneal recurrence in AGC patients. Therefore intraoperative peritoneal lavage should be included in the routine intraoperative staging workup for AGC, and its result will provide a good target for the treatment of peritoneal micrometastasis.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.6
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• pp.546-552
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• 2007

Purpose: In the breast cancer patient, lymphatic mapping and sentinel lymph node biopsy are the most important procedure for axillary lymph node staging. We aimed to compare the three radiocolloids [$^{99m}Tc$-antimony trisulfide colloid (ASC), $^{99m}Tc$-tin colloid (TC), and $^{99m}Tc$-human serum albumin (HSA)] for sentinel lymph node mapping. Subjects and Methods: Totally, 397 patients with clinically N0 stage were enrolled. $^{99m}Tc$-ASC was injected in 202 out of 397 patients, $^{99m}Tc$-TC was injected in 120 patients, and $^{99m}Tc$-HSA was injected in the remaining 75 patients. The sentinel lymph nodes were localized by lymphoscintigraphy and selected using intraoperative gamma probe. All sentinel lymph nodes were investigated by intraoperative pathologic consultation. The axillary lymph nodes which were harvested by the lymph node dissection were also investigated. Results: The patients of each group showed similar clinical characteristics. There were no significant differences (p>0.05) in the identification rate of sentinel lymph nodes (IR), false negative rate (FNR), and negative predictive value (NPV). The axillary lymphadenectomy revealed axillary lymph node metastases in those three groups (ASC-33.2%, TC-31.7%, HSA-22.7%). The IR, FNR, and NPV were not significantly different among those groups. Conclusion: Those three $^{99m}Tc$-labeled radiocolloids showed equivalent results in sentinel lymph node mapping of breast cancer.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.6
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• pp.538-545
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• 2007

Purpose: We evaluated correlation of $^{18}F$-FDG uptakes, therapeutic response and relapse in pre-treatment $^{18}F$-FDG PET/CT in patients with SCLC. Materials and methods: We included 26 patients with pathologically proven small cell lung cancer. Total 102 lesions (26 lungs, 69 lymph nodes and 8 metastatic lesions) were evaluated. All patients underwent $^{18}F$-FDG PET/CT for staging. The maxSUV was used as a parameter of $^{18}F$-FDG uptake. The patients were divided into responders and non-responders according to response criteria on chest CT scan after 3 cycles of chemotherapy. We compared maxSUV between two groups by using independent t-test. To access correlation with $^{18}F$-FDG uptake and relapse, maxSUV and interval time to relapse was analyzed by correlation analysis. The cutoff value of maxSUV was evaluated by ROC curve. Results: Twelve-one patients (81%) were responders and five patients were non-responders on follow-up chest CT scan. The mean maxSUV of main lung lesions in responders and non-responders were $14.15{\pm}3.72$ and $9.17{\pm}2.15$, respectively. The maxSUV in the responders was significantly lower than that in non-responders (p<0.05). According to ROC curve, point of cut that predicts therapeutic response was 8.98 with 100% sensitivity and 57% specificity. The correlation analysis between $^{18}F$-FDG uptakes and interval time to relapse showed a significant negative correlation (p<0.05, r=-0.757). Conclusion: The pre-treatment $^{18}F$-FDG uptake of responders was significantly lower than that of non-responders. Patients with high $^{18}F$-FDG uptake in pre-treatment $^{18}F$-FDG PET/CT relapse earlier.

• Journal of Chest Surgery
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• v.38 no.6 s.251
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• pp.421-427
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• 2005

Complete surgical resection is the most effective treatment for pT1/2N1 non-small cell lung cancer, however 5 year survival rate of these patients is about $40\%$ and the major cause of death is recurrent disease. We intended to clarify the risk factors of recurrence in completely resected pT1/2N1 non-small cell lung cancer. Material and Method: From Jan. f990 to Jul. 2003, total of 117 patients were operated for pT1/2N1 non-small cell lung cancer. The risk of recurrence according to patients characteristics, histopathologic findings, type of resection, pattern of lymph node metastasis, postoperative adjuvant treatment were evaluated retrospectively. Result: Mean age of patients was 59.3 years. There were 14 patients with T1N1 and 103 patients with T2N1 disease. Median follow-up time was 27.5 months and overall 5 year suwival rate was $41.3\%$. 5 year freedom-from recurrence rate was $54.1\%$. Recurrence was observed in $44 (37.6\%)$ patients and distant recurrence developed in 40 patients. 5 year survival rate of patients with recurence was $3.3\%$, which was significantly lower than patients without recurrence $(61.3\%,\;p=0.000).$ In multi-variate analysis of risk factors for freedom-from recurrence rate, multi-station N1 $(hazard\;ratio=1.997,\;p=0.047)$ was a poor prognostic factor. Conclusion: Multi-station N1 is the risk factor for recurrence in completely resected pT1/2N1 non-small cell lung cancer.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.806-812
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• 1999

Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

• Radiation Oncology Journal
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• v.23 no.2
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• pp.71-77
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• 2005

Purpose: This retrospective study was conduced to analyze the treatment results and to evaluate the prognostic factors affecting the survival of nasopharyngeal carcinoma patients. Materials and Methods: From 1987 to 2002, we analyzed 43 patients who had nasopharyngeal carcinomas that were histologically confirmed and who had also completed the planned radiation therapy course at Keimyung University Dongsan Medical Center According to the 6th edition of American Joint Committee on Cancer staging system, 12 patients ($27.9\%$) were at Stage 11, 13 ($30.2\%$) were at Stage III and 18 ($41.9\%$) were at Stage IV Histopathologically, there were 15 ($34.9\%$) squamous cell carcinomas, 8 ($18.5\%$) nonkeratinizing carcinomas, 17 ($39.5\%$) undifferentiated carcinomas, and 3 ($7.0\%$) lymphoepitheliomas. Among the total 43 patients, 31 patients ($72.1\%$) were treated with only radiation therapy. Neoadjuvant chemotherapy was peformed on 7 patients ($16.3\%$) and concurrent chemoradiotherapy was performed on S patients ($11.6\%$). Cisplatin and 5-Fluorouracil were administered to 11 patients for 4 cycles, and Cisplatin and Taxotere were administered to 1 patient for 6 cycles. The range of the total radiation dose delivered to the primary tumor was from 61.2 to 84 Gy (median 70.4 Gy), The follow-up period ranged from 2 to 197 months with median follow-up of 84 months. Results: The local control rate at 6 months after radiation therapy was $90.7\%$. The five year overall survival and disease free survival rates were $50.7\%$ and $48.9\%$, respectively. On the multivariate analysis, the age, T-stage ($T_{1-3}\;vs\;T_4$), N-stage and AJCC stage were the statistically significant prognostic factors affecting survival (p<0.05). The patterns of failure were as follows: local failure only in 3 patients ($7.0\%$), local and systemic failure in 1 patient ($2.3\%$), and distant metastasis only in 11 patients ($25.6\%$). Conclusion: The prognostic factors affecting the outcome of nasopharyngeal carcinoma were age, T-stage (7$T_{1-3}\;vs\;T_4$), N-stage and stage. Because systemic metastasis was the main failure pattern noted for nasopharyngeal carcinoma, systemic chemotherapy is needed to decrease the rate of distant metastasis for nasopharyngeal carcinoma. In audition, research for more effective chemotherapeutical regimens and schedules is also needed.

• Radiation Oncology Journal
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• v.13 no.3
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• pp.215-223
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• 1995

Purpose : The aim of this study was to assess the effectiveness, survival rate and complication of radiation in nasopharyngeal cancer. Materials and Methods : From January 1980 to May 1989. Fifty patients who had nasopharyngeal carcinoma treated with curative radiation therapy at Kosin Medical Center were retrospectively studied. Thirty seven patients($74{\%}$) were treated with radiation therapy alone(Group I) and 13 patients ($26{\%}$) treated with combination of chemotherapy and radiation (Group II). Age distribution was 16-75 years(median : 45.8 years). In histologic type, squamous cell carcinoma was in 30 patients($60{\%}$), undifferentiated carcinoma in 17 patients($34{\%}$), and lymphoepithelioma in 3 patients($6{\%}$). According t AJCC staging system. 4 patients($8{\%}$) were in $T_1$, 13 patients($26{\%}$) in $T_2$. 20 patients($40{\%}$) in $T_3$, 13 patients($26{\%}$) in $T_4$ and 7 patients($14{\%}$) in $N_0$, 6 patients($12{\%}$) $N_1$, 23 patients($46{\%}$) in $N_2$, 14 patients($28{\%}$) in $N_3$. Total radiation dose ranges were 5250-9200cGy(median : 7355 cGy) in Group I and 5360-8400cGy(median : 6758cGy) in Group II Radiotherapy on 4-6MV linear accelerator and/or 6-12MeV electron in boost radiation was given with conventional technique to 26 patients($52{\%}$), with hyperfractionation(115-120cGy/fr., 2times/day) to 16 patients($32{\%}$), with accelerated fractionation(160cGy/fr., 2 times/day) to 8 patients($16{\%}$). In chemotherapy, 5 FU 1000mg daily for 5 consecutive days, pepleomycin 10mg on days 1 and 3, and cisplatin 100mg on day 1 were administered with 3weeks interval, total 1 to 3 cycles(average 1.8cycles) prior to radiation therapy. Follow up duration was 6-140 months(mean : 58 months). Statistics was calculated with Chi-square and Fisher's exact test. Results : Complete local control rates in Group I and II were $75.7{\%},\;69.2{\%} Overall 5 year survival rates in Group I and II were $56.8{\%},\;30.8{\%}$. Five year survival rates by histologic type in Group I and II were $52.2{\%},\;14.3{\%}$ is squamous cell carcinoma and $54.5{\%},\;50{\%}$ in undifferentiated carcinoma. Survival rates in Group I were superior to those of Group II though there were not statistically significant. In both group, survival rates seem to be increased according to increasing total dose of radiation up to 7500cGy, but not increased beyond it. There were not statistically significant differences in survival rates by age, stage, and radiation techniques in both group. Twenty four patients($48{\%}$) experienced treatment failures. Complications were found in 12 patients($24{\%}$). The most common one was osteomyelitis(4 patients, $33.3{\%}$) involving mandible (3 patients) and maxilla(1 patient). Conclusion : Chemotherapy in combination with radiotherapy was found to be not effective to nasopharyngeal cancer and the survival rate was also inferior to that of radiation alone group though it was statistically not significant due to small population in chemotherapy combined group.