• Journal of Chest Surgery
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• 제55권1호
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• pp.20-29
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• 2022

Background: Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients. Methods: In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification. Results: The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients. Conclusion: The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.

• 대한세포병리학회지
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• 제8권2호
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• pp.109-114
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• 1997

Transbronchial fine needle aspiration(TBNA) is one of the cytologic methods in diagnosing lung cancers. TBNA can be used in cases of hilar, mediastinal or lung masses adjacent to the bronchi. We analyzed and compaired the findings of 27 cases of TBNA and bronchial washing and brushing(BW/BB) in lung cancers confirmed by either biopsy or surgical resection between Jun, 1996 and May, 1997 in Asan Medical Center. They were 18 cases of non-small cell carcinomas(eight squamous cell carcinomas, nine adenocarcinomas, and one large cell undifferentiated carcinoma), eight cases of small cell carcinomas, and one case of metastatic hepatocellular carcinoma. The sensitivity of TBNA was 37%(10/27) and false negative was 63%(17/27). Although the sensitivity of BW/BB w3s 56%(15/27), it was not different statistically from that of TBNA(Chi square, p=0.38). Overall sensitivity of TBNA and BW/BB in this series was 70%(19/27). Forty-seven percent of false negative TBNA(8/17) were positive in BW/BB. The findings suggest that the addition of TBNA to the standard BW/BB increases diagnostic yield in cytologic diagnosis of lung cancer.

• 대한본초학회지
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• 제35권6호
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• pp.35-41
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• 2020

Objectives : The object of this study was to observe anticancer and immunomodulatory effects of Formosa plum aqueous extracts (PLe) on non-small cell lung carcinoma (squamous epithelial carcinoma), NCI-H520, xenograft Balb/c nu-nu nude mice. Method : Three different dosages of PLe, 50, 100 and 200 mg/kg were orally administered once a day for 28 days from 11 days after tumor cell inoculation. Five groups, each of seven mice per group were used in the present study as follows. Tumor volume and weights, serum interferon (IFN)-γ levels, serum IL-6 were observed with tumor mass and lymphatic organ histopathology to detect anticancer and immunomodulatory effects. Result : Although no meaningful changes on the tumor weights and volumes were observed after treatment of all three different dosages of PLe, decreases of tumor cell volumes in tumor masses were dose-dependently decreased mediated by increases of apoptosis among tumor cells by treatment of PLe 100 and 200 mg/kg as compared with tumor-bearing control. In addition, decreases on the body weight and gains were also demonstrated in tumor-bearing control with increases of serum IL-6 levels. Conclusion : The results obtained in this study suggest that over 50 mg/kg of PLe showed favorable immunomodulatory and anticachexic effects with anticancer effects in 100 and 200 mg/kg of PLe treated groups on the NCI-H520 cell xenograft. However, detail mechanism studies should be conducted in future with the screening of the biological active compounds in this herb.

• Radiation Oncology Journal
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• 제8권1호
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• pp.73-77
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• 1990

1981년부터 1989년까지 경희대학 부속병원 치료방사선과에서 무기폐를 동반한 폐암으로 방사선 치료를 받은 환자중, 과거력상 폐절제술, 항암요법, 방사선치료등의 기왕력이 있는 환자를 제외한 42명을 대상으로 치료성적을 분석하였다. 1. 비소세포성 폐암은 $62\%$ (21/34), 소세포성 폐암은 $75\%$ (6/8)에서 각각 무기폐가 방사선 치료 후 재팽창 되었으며, 전체 환자의 $64\%$ (27/42)에서 부분 또는 완전반응(reexpansion)을 나타내었다. 2. 방사선 총선량이 40 Gy (1297 ret) 이하와 40 Gy (1337 ret) 이상인 군에서 반응은 각각 $50\%$ (6/12)와 $70\%$ (21/30)이 었으며, 총선량과 무기폐 반응사이에는 유의한 관계가 있었다(p<0.01). 3. 분할조사선량에 따른 반응율은 소선량($180\~200$ cGy)에서는 $53\%$ (14/22), 대선량(300 cGy)에서는 $65\%$ (13/20)이었다. 4. 이상의 성적으로 보아 무기폐를 동반한 폐암 환자중에서, 특히 수술과 항암요법으로 치료가 곤란하고 조속한 처치를 요하는 비소세포성 폐암에서 방사선 치료의 중요한 역할이 확인되었다.

• Tuberculosis and Respiratory Diseases
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• 제39권6호
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• pp.502-510
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• 1992

연구배경 : Neuron specific enolase (NSE)는 뇌조직의 신경원에서 처음 발견된 당분해 효소이며, APUD 세포 및 신경내분비계에도 존재하는 것으로 알려졌다. 소폐포폐암은 신경내분비세포 및 APUD 세포와 많은 공통점을 가지고 있다. 따라서 NSE 항체를 사용하는 면역조직화학 염색과 혈청내 NSE 농도측정은 신경내분비 분화를 하는 폐종양의 표지자로서 사용될 수 있으며 소세포폐암의 진단에 유용할 수 있다. 방법 : 소세포폐암으로 진단받은 22명과 대조군으로는 비소세포폐암환자 21명을 대상으로 하였으며 생검조직에서 NSE 항체를 이용한 면역조직화학염색을 시행하고 환자의 혈청에서 방사면역측정법으로 NSE 농도를 측정하였다. 결과: 1) NSE 항체를 이용한 면역조직화학염색 NSE 항체를 이용한 면역조직화학영색에서 소세포폐암군 환자는 18명중 9명에서 양성 반응을 보였으며, 비소세포폐암 환자중 면역조직화학염색을 시행한 16명중 5명에서 양성 반응을 보였다. 2) 방사면역 측정법에 의한 혈청 NSE농도 측정 비소세포폐암군의 혈청 NSE평균치는 $11.79{\pm}4.47\;ng/ml$이었으며 소세포폐암군의 혈청 NSE치는 개인차가 심하기는 하였으나(6.01~361.4 ng/ml) 그 평균치는 $59.30{\pm}77.88\;ng/ml$으로 두 군 사이에는 유의한 차이가 있었다. 소세포폐암환자중 limited disease군의 혈청 NSE 평균치는 $20.19{\pm}12.91\;ng/ml$이었으며, extended disease군의 혈청 NSE치는 역시 개인차가 심하기는 하였으나(17.15~361.44 ng/ml) 그 평균치는 $91.9{\pm}94.2\;ng/ml$로 두 군 사이에 유의한 차이를 보였다. 정상인에서의 혈청 NES 농도는 측정하지 않았으나 대조군인 비소세포폐암군환자 평균+2x표준편차인 20 ng/ml을 기준으로 할 때 소세포폐암환자 22명중 16명(73%)에서 증가된 소견을 보였고 이중 limited disease는 50%(5/10), extended disease는 92% (11/12)에서 증가되었으며, 비소세포암 환자중에서는 1명(1/21)만이 증가된 소견을 보였다. NSE 혈청농도와 면역조직화학염색 정도를 비교시 소세포폐암군과 비소세포폐암군 모두에서 유의한 상관관계를 보이지 않았다. 결론 : 혈청 NSE농도측정은 소세포폐암환자에서 암표지자로서 유용한 방법이 될 수 있을 것으로 사료되며 항 NSE 항체를 이용한 생검조직의 면역조직화학염색은 분화가 나빠 고식적인 현미경적 소견만으로는 소세포암과 비소세포암과의 강벌이 어려운 경우 정확한 조직유형 결정과 신경내분비 기원을 뵈이는 폐암의 진단에 도움을 줄 수 있을 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제41권6호
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• pp.616-623
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• 1994

연구목적: 수술전 전산화 단층촬영상 임파절종대의 소견이 없는 $T_{1-3}N_0M_0$비소세포폐암 환자들을 대상으로 수술전 후 병기의 차이를 비교하여 이들에 있어 수술전 관혈적인 병기판정의 필요성에 대하여 검토하였다. 방법: 경북대학교병원에서 비소세포폐암으로 개흉절제술을 받았던 환자들 가운데 수술전 병기가 $T_{1-3}N_0M_0$인 41명을 대상으로 수술전과 수술후의 병기의 차이를 비교하였다. 결과: 1) 수술전 병기는 I기의 경우 $T_1N_0M_0$ 3예, $T_2N_0M_0$ 32예로 모두 35예였고 IIIa기 ($T_3N_0M_0$)는 6예였다. 종양의 위치는 중심형 폐암 24예, 말초형 폐암 17예였는데 IIIa기는 모두 중심형 폐암이었다. 2) 수술후 병기는 I기의 경우 $T_1N_0M_0$ 2예, $T_2N_0M_0$ 25예로 모두 27예였고 II기의 경우 $T_1N_1M_0$ 1예, $T_2N_1M_0$ 3예로 모두 4예였으며 IIIa기는 $T_3N_0M_0$ 1예, $T_3N_1M_0$ 2예, $T_3N_2M_0$ 4예, $T_2N_2M_0$ 2예로 모두 9예였고 IIIb기($T_4N_1M_0$)는 1예였다. 3) 수술후 T의 변화가 있은 경우는 $T_2$ 32예 가운데 2예는 $T_3$로 $T_3$ 6예중 1예는 $T_4$로 판명되었다. 4) 수술후 $N_1$으로 판명된 경우는 7예였고 $N_2$로 판명된 경우는 6예였다. 5) 수술전 T에 따른 임파절전이는 $T_{1-2}$인 경우는 35예 중 8예($N_1$ 5예, $N_2$ 3예)였고 $T_3$인 경우는 6예중 5예($N_1$ 2예, $N_2$ 3예)로 $T_{1-2}$에 비해 $T_3$에서 임파절 전이빈도가 높았고 $N_2/N_1$비도 높았다 그러나 수술전 $T_{1-2}$경우 종양의 위치에 따른 임파절전이의 차이는 없었다. 6) 41예의 대상환자중 $N_2$ 6예와 $T_4$ 1예를 제외한 34예에서 완전 절제가 가능하였다. 결론: 이상의 결과로 전산화 단층촬영상 임파절종대가 없는 비소세포암의 수술전 병기판정시 수술전 $T_3$에서는 종격동경 검사 등의 관혈적인 병기판정방법이 필요하리라 생각된다.

• Journal of Chest Surgery
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• 제30권3호
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• pp.308-314
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• 1997

고대안암병원에서 1988년 1월부터 1995년 7월까지 병리학적으로 진단된 원발성 폐암 환자 541명을 대상으로 최근 다발하는 폐암의 종류 및 발생빈도의 변화,흡연과의 관계를 검토하였다. 전체 541명의 환자 중 남성 이 423명(78.2%), 여성이 118명(21.8%)이 었다. 임상병 기는 띠가 41례(7.6%), 1띠가 33례 (6.1 %), olla기가 113례(20.9%), lIIb기가 163례(30.1%), IV기가 150례(27.7%)였으며 병기를 정하지 못한 경우가 41명이 었다. 땅리조직분류 상 편평상피암이 245례(45.3%)로 가장 많았고 선암이 150례(27.7%), 소세포암이 107례(19.8%)의 순이 었으며, 남자에서 가장 많은 조직형은 편평상피암으로 223례(52.7%)였 고, 여자에서는 선암이 64례(54.2%)로 가장 빈발하였다. 선암의 경우 최근 점차 발생빈도가 증가하였고 (P=0.02), 편평상피암과 소세포암의 경우 발생빈도 변화는 통계적으로 유의하지 않았다. 흡연자 388명 에서는 편평상퍼암 204례(52.6%), 소세포암 82례(21.1%), 선암 74례(19.1%)의 순으로 다발하였고, 비흡 연자 81명에서는 선암 43례(53.1%), 편평상퍼암 17례(30.0%), 소세포암 13례(16. 0%)의 순으로 다발하 였다. 40세 미만의 군은 22\ulcorner으로 전체의 4%를 차지하였고 선암과 소세포암이 각각 7례(32%)로 가장 빈발하였고 40세 이상 군에서는 편평상퍼암이 가장 빈발한 조직형이 었다. 연령별 조직형 발생비율을 보면, 편평상피암은 고령자일 수록 발생비율이 높아졌고(P=0.0005), 선암은 감소하는 경향을 보였으나 통계적인 의미는 없었고(P=0.11),소세포암은 차이가 없었다. 저자등은 이 결과를 원발성 폐암치료의 기초자료로 제시하고자 한다.

• Radiation Oncology Journal
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• 제35권1호
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• pp.55-64
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• 2017

Purpose: The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era. Materials and Methods: Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy. Results: Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients. Conclusion: Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.

• Radiation Oncology Journal
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• 제31권1호
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• pp.34-40
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• 2013

Purpose: To evaluate the predictive factors of radiation pneumonitis (RP) and associated changes in pulmonary function after definitive concurrent chemoradiotherapy (CCRT) in patients with non-small cell lung cancer (NSCLC). Materials and Methods: Medical records of 60 patients with NSCLC who received definitive CCRT were retrospectively reviewed. Dose volumetric (DV) parameters, clinical factors, and pulmonary function test (PFT) data were analyzed. RP was graded according to the CTCAE ver. 4.0. Percentage of lung volume that received a dose of threshold (Vdose) and mean lung dose (MLD) were analyzed for potential DV predictors. PFT changes were calculated as the difference between pre-RT and post-RT values at 3, 6, and 12 months after RT. Results: Twenty-two patients (37%) developed grade ${\geq}2$ RP. Among clinical factors, tumor location in lower lobe was associated with RP. Among the DV parameters, only MLD >15 Gy was associated with grade ${\geq}2$ RP. There were statistically significant decreases in PFT at all points compared with pre-RT values in grade ${\geq}2$ RP group. MLD was associated with forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) changes at 6 and 12 months. V10 was associated with FVC changes at 12 months. V20 and V30 were associated with FEV1 changes at 6 months and FVC changes at 12 months. Conclusion: After definitive CCRT in patients with NSCLC, MLD >15 Gy and lower lobe tumor location were predictors of grade ${\geq}2$ RP. Pulmonary functions were decreased after CCRT and the magnitude of changes was associated with DV parameters.

• Journal of Chest Surgery
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• 제52권3호
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• pp.131-140
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• 2019

Background: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.