• BMB Reports
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• 제40권5호
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• pp.814-824
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• 2007

Liver cirrhosis (LC) is defined as comprising diffuse fibrosis and regenerating nodules of the liver. The biochemical and anatomical dysfunction in LC results from both reduced liver cell number and portal vascular derangement. Although several studies have investigated dysregulated genes in cirrhotic nodules, little is known about the genes implicated in the pathophysiologic change of LC or about their relationship with the degree of decompensation. Here, we applied cDNA microarray analysis using 38 HBsAg-positive LC specimens to identify the genes dysregulated in HBV-associated LC and to evaluate their relation to disease severity. Among 1063 known cancer- and apoptosis-related genes, we identified 104 genes that were significantly up- (44) or down- (60) regulated in LC. Interestingly, this subset of 104 genes was characteristically correlated with the degree of decompensation, called the Pugh-Child classification (20 Pugh-Child A, 10 Pugh-Child B, and 8 Pugh-Child C). Patient samples from Pugh-Child C exhibited a distinct pattern of gene expression relative to those of Pugh-Child A and B. Especially in Pugh-Child C, genes encoding hepatic proteins and metabolizing enzymes were significantly down-regulated, while genes encoding various molecules related to cell replication were up-regulated. Our results suggest that subsets of genes in liver cells correspond to the pathophysiologic change of LC according to disease severity and possibly to hepatocarcinogenesis.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.448-453
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• 2015

Objective : Recently, the survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and medical treatment modalities. Consequently, spine metastases from HCC are being diagnosed more frequently. The accurate prediction of prognosis plays a critical role in determining a patient's treatment plan, including surgery for patients with spinal metastases of HCC. We investigated the clinical features, surgical outcomes, and prognostic factors of HCC presenting with spine metastases, in patients who underwent surgery. Methods : A retrospective review was conducted on 33 HCC patients who underwent 36 operations (three patients underwent surgical treatment twice) from February 2006 to December 2013. The median age of the patients was 56 years old (range, 28 to 71; male : female=30 : 3). Results : Overall survival was not correlated with age, sex, level of metastases, preoperative Child-Pugh classification, preoperative ambulatory function, preoperative radiotherapy, type of operation, administration of Sorafenib, or the Tokuhashi scoring system. Only the Tomita scoring system was shown to be an independent prognostic factor for overall survival. Comparing the Child-Pugh classification and ambulatory ability, there were no statistically differences between patients pre- and post-operatively. Conclusion : The Tomita scoring system represents a practicable and highly predictive prognostic tool. Even though surgical intervention may not restore ambulatory function, it should be considered to prevent deterioration of the patient's overall condition. Additionally, aggressive management may be needed if there is any ambulatory ability remaining.

• Radiation Oncology Journal
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• 제29권2호
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• pp.63-70
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• 2011

목 적: 간세포암에 의한 뼈전이 환자의 방사선 조사선량에 따른 통증 감소 정도 및 전이성 병소의 영상학적 치료반응을 분석하고 고선량 방사선치료가 도움이 될 수 있는지 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2010년 6월까지 병리 혹은 임상적으로 간세포암에 의한 뼈전이로 진단받고 증상 완화 목적의 방사선치료를 받은 103명에서 뼈전이 병소 2237개 부위를 대상으로 연구하였다. 조사받은 생물학적 유효선량이 39 $Gy_{10}$이하인 경우 저선량군, 39 $Gy_{10}$를 초과하는 경우 고선량군으로 대상환자를 구분하였다. 통증 감소 정도는 숫자통증등급(numeric rating scale)을 이용하였고 통증이 감소한 경우, 통증 정도에 변화가 없는 경우, 통증이 증가한 경우로 나누었다. 영상학적 반응은 modified Response Evaluation Criteria In Solid Tumors (RECIST) 기준을 이용하였으며 환자의 생존율에 영향을 미치는 인자를 분석하였다. 결 과: 중앙추적 관찰기간은 6개월이었다(범위, 0~46개월). 저선량군에서는 67개 병소(66.3%) 부위에서, 고선량군 에서는 44개 병소(89.8%) 부위에서 영상학적 반응이 있었다 저선량군과 고선량군 사이에 영상학적 치료 반응 정도는 유의하게 차이를 보였다(p=0.02). 저선량군과 고선량군은 각각 65%와 75%의 통증 감소를 보였으나 통계적으로 유의한 차이는 없었다(p=0.24). 저선량군과 고선량군 사이에 급성 및 만성 치료 독성은 통계적으로 유의한 차이가 없었다(p>0.05). 뼈전이 진단 시부터 사망까지 생존기간은 0~46개월(중앙값, 11개월) 범위였고 1년 생존율은 41.6%였다. 잔존 간 기능(Child-Pugh 점수)이 생존율에 유의한 영향을 미치는 인자였고 Child-Pugh 점수에 따른 중앙생존기간은 A 14개월, 8와 C는 2개월로 나타났다. 결 론: 간세포암에 의한 뼈전이는 고선량군에서 영상학적 반응 정도가 더 높았다. 잔존 간 기능이 좋은 환자에게 고선량의 방사선치료 시 높은 치료 반응을 얻음으로써 삶의 질의 향상에 도움을 줄 수 있음을 알 수 있었다.

• 대한간호학회지
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• 제39권5호
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• pp.683-692
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• 2009

Purpose: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. Methods: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. Results: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. Conclusion: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

• Tuberculosis and Respiratory Diseases
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• 제44권3호
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• pp.639-648
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• 1997

배 경 : 환자에서 동맥혈 저산소증이 생길 수 있다는 보고가 있는데 기관지혈관 확장에 의해서 확산 장애에 의해 동맥혈 산소분압이 감소한다고 한다. Cabanes 등은 좌심실부전 환자에서 메타콜린에 기관지 반응이 증가함을 보고하면서 기관지혈관 확장이 한 기전이라고 주장하였다. 이에 저자들은 간경변증 환자에서 문맥고혈압에 의하여 메타콜린에 대한 기관지반응이 증가할 것이라는 가설하에 간경변증 환자에서 기관지수 축유발검사를 시행하고, 간경변증정도 및 식도 정맥류 정도와의 기관지반응과의 관계를 알아보기 위해 본 연구를 시행하였다. 방 법 : 임상적 문맥고혈압을 가진 간경변증 환자 22명에게 메타콜린 기관지수축유발검사를 시행하였고 또한 간경변 정도를 Pugh-Child 분류법에 따라 분류하고 식도내시경 검사를 시행하였다. 성적 : 총 22명의 임상적으로 문맥고혈압을 가진 간경변증 환자중 남자는 17명, 여자는 5명이었고, 연령분포는 19세에서68세 까지이며 평균연령은 48세였으며, 간경변증 원인은 알콜성 간염에 의한 경우가 9예, B형 바이러스성 간염에 의 한것이 12예였고 C형 바이러스성 간염에 의한것이 1예였다. 22명의 환자중 15예(68.2%)가 메타콜린 기관지 수축유발검사 양성이였고, 양성인 환자 15명의 $PC_{20}$은 $0.3mg/m{\ell}$에서 $16.6mg/m{\ell}$로 다양하였으며 평균값은 $6.5{\pm}5.1mg/m{\ell}$ 이다. 메타콜린 기관지 수축유발검사 $PC_{20}FEV_1$값과 Pugh-Child 분류법에 의한 간경변의 정도 사이에는 통계학적으로 상관관계가 없었다(p>0.05). 메타콜린 기관지 수축유발검사 $PC_{20}FEV_1$ 값과 식도 내시경상 식도정맥류의 심한 정도 사이에도 통계적으로 유의한 상관관계가 없었다(p>0.05). 결 론 : 이상의 결과에서 간경변증 환자에게서 메타콜린 기관지 반응이 증가(68.2%)함을 수 있었고 간경변증 정도나 식도정맥류 정도 사이에는 유의한 상관관계가 없었다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2923-2927
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• 2014

Background: Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. Materials and Methods: Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. Results: Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. Conclusions: According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.37-43
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• 2016

Objective : The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC). Methods : From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment. Results : The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment. Conclusion : Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.

• 대한방사선기술학회지:방사선기술과학
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• 제46권6호
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• pp.553-560
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• 2023

This study aimed to understand the correlations of prevalence and relevant variables of cholelithiasis with a group of cirrhosis patients and a control group targeting the subjects who received the abdomen ultrasonography from K university hospital in Daejeon Metropolitan City from January 1^st 2019 to December 31^st. And the results are as follows. First, the group of cirrhosis patients showed relatively higher prevalence of cholelithiasis than the control group as ordinary people, which showed statistically significant differences. Second, in the control group, there were statistically significant differences in the occurrence of cholelithiasis with respect to age. Conversely, in the cirrhosis patient, there was no statistically significant association observed with age; nonetheless, age itself exhibited statistical significance. Third, according to sex, the prevalence was not statistically significant in both group of cirrhosis patients and control group. Fourth, in each degree and cause of subdivided cirrhosis, the correlation was only shown in each degree. In the results of this study, the cirrhosis patients showed high correlation with the incidence of cholelithiasis, and the control group showed the high correlation with the incidence of cholelithiasis according to age.

• Radiation Oncology Journal
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• 제20권2호
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• pp.123-129
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• 2002

목적 : 수술적 절제가 불가능한 원발성 간암 환자들을 대상으로 삼차원적인 방사선치료계획 시스템을 이용한 입체조형 방사선치료를 전향적으로 실시하고 조기 임상 결과를 분석하였다. 또한, 이를 통해 원발성 간암의 비수술적 치료에서 입체조형 방사선치료의 잠재적인 역할과 가능성을 판단해 보고자 하였다. 대상 및 방법 : 1995년 1월부터 1997년 6월까지 원발성 간암으로 진단 후 입체조형 방사선치료의 기법을 적용하여 치료를 받은 17명의 환자가 본 연구 대상에 포함되었다. 대상 환자의 선정 기준은 방사선치료의 과거력이 없는 경우, 간외 전이가 없는 경우, 간경변증의 정도가 Child-Pugh classification A또는 B군인 경우, 종양이 전체 간 용적의 2/3를 넘지 않는 경우, 전신수행도가 European Cooperative Oncology Group (ECOG) 3기 이상으로 악화되지 않은 경우이었다. 15명의 환자에서 경동맥화학색전술과 입체조형 방사선치료의 병용요법이 시행되었다. 대상 환자는 In-ternational Union Against Cancer (UICC) 병기별로 II기 1명, III기 8명, IVA기 8명이었다. 4명의 환자에서 간문맥 혈전증이 동반되었으며, 종양의 평균 직경은 8 cm이었다. 조사영역은 종양과 주변 1.5 cm이었고 조사선량의 분포는 $36\~60\;Gy$로 중앙값은 59.4 Gy이었다. 종양의 반응은 치료 후 $4\~8$주에 시행한 영상 진단을 기준으로 평가하였다. 추적관찰기간의 중앙값은 15개월이었다. 결과 : 2년 생존율은 $21.2\%$였고 평균 생존 기간은 19개월이었다. 완전 반응과 부분 반응을 포함하여 11명의 환자에서 치료에 대한 반응을 보여 반응률은 $64.7\%$였다. 종양의 진행을 보인 환자는 3명으로 이 중 2명의 환자가 조사영역 밖에서 종양의 진행을 보였다. 추적 기간 중 6명의 환자에서 원격 전이가 나타났고 폐 전이와 뼈 전이가 각각 5명과 1명이었다. 삼차원 입체 조형 치료와 관련된 것으로 판단되는 방사선 간염은 발생하지 않았으며 Grade 2의 위염과 십이지장염이 각각 1명씩 발생했다. 치료로 인해 사망하였던 경우는 없었다. 결론 : 절제 불가능한 원발성 간암의 치료에 입체조형 방사선치료를 적용할 것은 비교적 안전하였고 실제적인 치료 효과를 나타내었다. 향후 원발성 간암의 비수술적 치료에 입체조형 방사선치료의 역할이 기대되며 이 치료법의 우수성을 입증하기 위한 제 3상 연구가 뒤따라야 할 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권17호
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• pp.7213-7218
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• 2014

Background: Egypt has one of the highest prevalences of hepatitis C virus (HCV) infection worldwide. Although the IL28B gene polymorphism has been shown to modify the course of chronic HCV infection, this has not been properly assessed in the Egyptian population. Materials and Methods: The IL28B rs12979860 single nucleotide polymorphism (SNP) was therefore examined in 256 HCV-infected Egyptian patients (group II) at different stages of disease progression and in 48 healthy volunteers (group I). Group II was subdivided into GII-A (chronic hepatitis patients, n=119), GII-B (post hepatitis cirrhosis, n=66) and GII-C (HCC on top of cirrhosis, n=71). Results: The C/T genotype was the commonest in all groups. It was more frequent in GI (52%) than in GII (48%). There was no significant difference in the frequency of C/T and C/C or T/T genotypes between groups and subgroups (p=0.82). Within the subgroups; the C/C genotype was more common in GII-B while C/T and T/T genotypes were more common in GII-C, though with no significant difference (p=0.59 and p=0.80). There was no significant association between IL28B rs12979860 SNP and viral load, ALT, AFP level, METAVIR scores for necro-inflammation and fibrosis, and Child-Pugh classification. Conclusions: 1) IL28Brs12979860 C/T genotype is the commonest genotype in HCV-associated CH and HCC in Egypt. 2) IL28Brs12979860 polymorphisms are not associated with disease progression or aggression (histological staging, severity of fibrosis in CH or the incidence of post-HCV HCC). 3) Differences in IL28Brs12979860 genotypes could be a consequence of environmental or ethnic variation.