• Journal of Gastric Cancer
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• v.8 no.2
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• pp.70-78
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• 2008

Purpose: VEGF-C and VEGF-D are angiogenetic factors, and abnormal expression of E-cadherin hasa role in the progression of gastric carcinoma. The aim of this study was to evaluate the relationship between the expression of E-cadherin, VEGF-C and VEGF-D with the presence of lymph node metastases (LNM) using cytokeratin 18 in early gastric cancer (EGC). Materials and Methods: Immunohistochemical staining for E-cadherin, VEGF-C and VEGF-D was performed in 49 EGC patients from March 1997 to December 2002. To evaluate the real extent of LNM, 1,562 lymph nodes from 49 patients were re-examined with the use of cytokeratin 18. Results: Eleven (0.7%) LNM were newly found in 12.2% (n=6) of patients. The real LNM rate was 3.6% in mucosal invasive (m) cancer and 38.1% in submucosal invasive (sm). Stage migration was seen in three patients (6.1%). Abnormal expression of E-cadherin was detected in 36.7% of the patients and expression of VEGF-C and VEGF-D was detected in 16.3% and 36.7% of the patients, respectively. Abnormal expression of E-cadherin was significantly correlated with tumor differentiation (P=0.0103) and Lauren classification (P<0.0001). There was no positive relationship of VEGF-C and VEGF-D expression with the clinicopathological findings for EGC including LNM. However, the frequency of lymph node metastases was significantly higher in patients that demonstrated abnormal expression of E-cadherin with positive immunoreactivity of VEGF-C or VEGF-D (P=0.031). Conclusion: In present study, we could not demonstrate a relationship between the presence of LNM and expression of VEGF-C and VEGF-D in EGC. However, VEGF-C or VEGF-D expression, in addition to the abnormal expression of E-cadherin, was correlated with the real extent of LNM in EGC.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.282-285
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• 2004

We report a case of advanced gastric cancer with Virchow's node and lung metastasis that responded remarkably to preoperative chemotherapy. A 47-year-old female patient was diagnosed as having incurable advanced gastric cancer with Virchow's node and multiple lung metastasis. Preoperative chemotherapy with Taxotere, CDDP and 5FU was carried out. After four courses of the regimen, the Virchow's node and the lung metastasis had disappeared, and a marked reduction of the gastric lesion was observed on the CT scan. Consequently, the patient underwent a total gastrectomy with D2 lymph node dissection. On histopathological examination, cancer cells were found to have infiltrated up to the muscle layer of the gastric wall, and 42 out of 60 resected lymph nodes were found to be metastatic. The patient received another two courses of chemotherapy after the operation. (J Korean Gastric Cancer Assoc 2004;4:282-285)

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.345-350
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• 2004

Background : To evaluate the frequency and clinical significance of lymph node micrometastasis in patients of non-small-cell lung cancer pathologically staged to be T1-2,N0. Method : From consecutive 29 patients of non-small-cell lung cancer who received curative operation and routine systemic nodal dissection, we immunohistochemically examined 806 lymph nodes from mediastinal, hilar and peribronchial lesion. All slides were stained with hematoxylin and eosin staining for one section and with cytokeratin AE1/AE3 antibody for another consecutive section of same lymph node to find out micrometastasis. Results : In 806 lymph nodes examined, no tumor cell was seen on hematoxylin and eosin staining and micrometastic foci were shown to be on 0.37%(3) of 806 lymph nodes, in which were upper paratracheal, interlobar and peribronchial lymph node. These three positive stains constitute 10.3%(3) of the 29 patients with non-small-cell lung cancer. Nine patients died from disease progression(4), postoperative complication(3) and concomitant diseases(2). The four patients with disease progression did not show evidence of micrometastasis on their lymph node examination. Conclusion : The frequency of lymph node micrometastasis was in 0.37% of 806 lymph nodes examined. The study results might suggested that routine analysis of micrometastasis on the lymph node didn't give any clinical implication on patients with non-small-cell lung cancer.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.284-290
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• 2006

Purpose: Many previous studies have suggested that cyclooxygenase-2 (COX-2) over expression is closely related to angiogenesis. However, few have reported the relationship between COX-2 and lymphangiogenesis which is still unclear, The aim of this study was to determine the relationship between COX-2 expression and lymphangiogenetic factor, VEGF-C, in human gastric cancer and to correlate COX-2 and VEGF-C expression with other clinocopathological features to investigate whether COX-2 contributes to lymphangiogenesis and enhances lymph node metastasis. Materials and Methods: One hundred patients who underwent curative radical surgery in Hanyang University hospital from July 1998 to June 2001 were selected. The expression of COX-2 and VEGF-C were detected by using immunohistochemistry, and the relationships between these two parameters and several clinicopathological factors (gender, stage, lymph node status, tumor location, Lauren classification and angioinvasion) were determined. Results: Increased COX-2 expression was found in 86 of 100 tumor samples (86%) and in 70 of 100 tumor samples (70%) with VEGF-C. A high correlation between VEGF-C expression and lymph node metastasis was observed (P=0.033) along as well as COX-2 expression (P=0.012). Also, there was a significant correlation between COX-2 and VEGF-C expression (P=0.026), yet no correlation were found between COX-2 and VEGF-C expression and other clinicopathological parameters. Conclusion: Our study suggests that COX-2 expression contributes to lymphangiogenesis by mediating VEGF-C and finally promoting lymph node metastasis.

• Journal of Gastric Cancer
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• v.2 no.4
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• pp.175-179
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• 2002

위암의 진단에서 CT스캔은 수술 전 병기결정이나 수술 후 추적검사에서 필수적인 검사방법으로 인정을 받고 있고, 보편적으로 가장 많이 유용되고 있다. 그러나 나선식 CT를 사용하고 여러 가지 스캔방법의 개선에도 불구하고, 인접장기로의 직접침윤, 작은 크기의 간전이의 발견, 정상 크기범위의 림프절에서 전이의 발견, 양성 림프절과 전이의 감별, 복막전이에 대한 평가에서 지금까지의 보고들은 만족스러운 결과를 얻지 못하고 있으며 CT의 한계점으로 남아 있다. 그러나 최근에는 나선식 CT보다 더 빠른 시간내 더 얇은 두께의 절편을 얻을 수 있고, 이를 이용하여 관상면 및 시상면으로 정밀하게 재구성하거나 3D영상을 얻을 수 있는 다검출식 나선식 CT가 개발되어 사용되고 있고, CT 진단의 정확도를 높일 것으로 기대한다.

• Radiation Oncology Journal
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• v.26 no.1
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• pp.1-9
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• 2008

Purpose: To evaluate the impact of postoperative radiotherapy on loco-regional failure in patients with vulvar carcinoma and to determine the treatment strategy for inguinal lymph nodes. Materials and Methods: Sixty-six patients who received treatment for primary vulvar carcinoma at Seoul National University Hospital, from October 1979 through June 2004, were retrospectively analyzed. Sixteen patients were excluded from the analysis due to the following reasons: distant metastases in two patients; palliative intent for six patients; previous radiotherapy given to the pelvis in three patients; follow-up loss after surgery for four patient; insufficient medical records for one patient. Of 50 eligible patients, 35 were treated with surgery alone(S), ten were treated with surgery followed by radiotherapy(S+RT), and five were treated with radiotherapy alone. Results: The 5-year overall survival(OS) and disease-free survival(DFS) rates of all patients were 91% and 78%, respectively. Twelve patients(26%) experienced treatment failures and the sites of initial failure were as follows: a primary site in eight patients; regional lymph nodes in three patients; the lung in one patient. Although risk factors for failure were more common in the S+RT group than the S group of patients(p<0.05), the DFS rates were similar for the two groups(5-year DFS rates, 78% vs. 83%, p=0.66). The incidences of occult lymph node metastases was 10%. Ten of 31 patients with clinically negative lymph nodes did not received inguinal lymph node dissection, but no patient experienced regional failure. Conclusion: Postoperative radiotherapy may have a potential benefit for patients with risk factors for failure. The omission of inguinal dissection or elective radiotherapy to the inguinal lymph nodes may be considered in low-risk patients with clinically negative lymph nodes.

• The Korean Journal of Nuclear Medicine
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• v.39 no.5
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• pp.269-277
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• 2005

Purpose: This study evaluated the diagnostic value of $^{18}F-FDG$ PET/CT in detecting cervical lymph node metastases in head and neck cancer patients. Materials & Methods: The patients were divided into two groups, 46 patients underwent PET/CT scan for initial staging before surgery, and 20 patients for restaging of recurrence after primary treatment. Increased FDG uptakes in cervical lymph nodes were evaluated retrospectively and correlated with the histopathologic results. Results: In the initial staging group, 21 lymph nodes were detected by PET/CT in 15 patients. 20 lymph nodes were confirmed as metastases with a mean peak SUV of 5.84, and the remaining one lymph node was an inflammatory lesion, with a peak SUV of 2.75. Seven metastatic lymph nodes were reported only by histopatholoay. The sensitivity, specificity, positive predictive value and negative predictive value were 74.0%, 99.6%, 95.2% and 97.3%, respectively. In the recurrence group, 11 lymph nodes were detected in 9 patients, and 8 nodes were true positive, with a mean peak SUV of 5.65. The other three were inflammatous lymph nodes, and the peak SUVs were 2.16, 2.94 and 3.53. One false negative lymph node was reported. The sensitivity, specificity, positive predictive value and negative predictive value were 88.8%, 97.7%, 72.7% and 92.9%, respectively. Conclusions: FDG-PET/CT shows higher positive predictive value in the initial staging group, and better sensitivity in the recurrence group. Therefore PET/CT could be useful for both initial staging and restaging of recurrent cervical lymph node metastases.

• Tuberculosis and Respiratory Diseases
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• v.56 no.5
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• pp.505-513
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• 2004

Background : In lung cancer patients, the presence of metastatic neck nodes is a crucial indicator of inoperabilty. So thorough physical examination of neck is always mandatory, but sometimes those are hardly palpable even by the skillful hand. Ultrasonography is a useful diagnostic method in detection of small impalpable lymph nodes and in guidance of fine needle aspiration biopsy. In this study we evaluated the clinical usefulness of ultrasonography(USG) and ultrasound-guided fine needle aspiration cytology(US-FNA) in lung cancer patients without palpable neck nodes. Methods and Materials : From Sep 2002 to Sep 2003, 36 non-small cell lung cancer patients (20 adenocarcinoma, 16 squamous cell cancer) and 10 small cell lung cancer patients without palpable neck nodes on physical examiation were enrolled. patients who had contralateral mediastinal nodal enlargement(>1cm) on chest CT were excluded. After the routine check of USG on the neck, US-FNA was done in cases with enlarged neck nodes (${\geq}5mm$ in the short axis). The presence of enlarged lymph node on USG, and of malignant cells on cytology were evaluated by the histological type and the patients' clinical stage of lung cancer. Results : Among 36 non-small lung cell cancer patients, 14 (38.8%) had enlarged neck nodes on USG, and 5 of 10 small cell lung carcinoma patients. The mean diameter of the neck nodes was 9.8 mm (range, 7-12 mm). US-FNA of 14 non-small cell lung cancer patients revealed tumor cells in eight patients (57.1%). In 5 small cell lung cancer pateints, tumor cells were found in all cases. By the result of US-FNA, the clinical stage of 8 out of 36 (22.2%) non-small cell lung cancer patients had changed, including two cases of shift from the operable IIIa to the inoperable IIIb. In small cell lung cancer patients their clinical stage was not changed after US-FNA, but their pathological diagnosis was easily done in two cases, in whom endobronchial lesions were not found on bronchoscopy. Conclusions : USG and US-FNA of neck node seem to be safe, sensitive and cost-effective diagnostic tools in the evaluation of lung cancer patients without palpable neck nodes.

• Journal of Gastric Cancer
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• v.9 no.3
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• pp.104-109
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• 2009

Purpose: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. Materials and Methods: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. Results: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. Conclusion: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.246-255
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• 2009

Purpose: The objectives of this study were to investigate the impact of the number of resected lymph nodes on the survival of gastric cancer patients who underwent curative resection, and to evaluate the cut-off values that can have an influence on survival on the tumor stage-stratified analysis. Materials and Methods: The subjects were 949 gastric cancer patients who underwent curative resection at Korea University Medical Center from 1992 to 2002. They were classified according to the depth of tumor invasion, and the influence of the number of resected lymph nodes on survival was investigated. The cut-off value for the number of resected lymph nodes was determined as the smallest value that showed a significant survival difference. Results: The tumor size, location, lymph node stage, the number of metastatic lymph nodes and the number of resected lymph nodes were significantly different according to the tumor stage. The average number of resected lymph nodes was about 39, and it showed linear correlation with the number of metastatic lymph nodes. On the Cox proportional hazard model, the cut-off values of the number of resected lymph nodes, as corrected by the number of metastatic lymph nodes, was 14 for all the patients, 15 for the pT1 patients, 28 for the pT2 patients and 37 for the pT3 patients, respectively. Conclusion: Retrieving a number of lymph nodes that is more than the cut-off value could improve the survival of gastric cancer patients. Surgeons should also make efforts to perform an exact and thorough D2 lymph node dissection. Therefore, we urge surgeons to perform D2 dissection and pathologists should examine an certain exact number of lymph nodes.