• Journal of Gastric Cancer
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• v.20 no.3
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• pp.233-244
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• 2020

Purpose: For unresectable or initially metastatic gastric cancer, conversion surgery (CVS), after systemic chemotherapy, has received attention as a treatment strategy. This study evaluated the prognostic value of ypTNM stage and the oncologic outcomes in patients receiving CVS. Materials and Methods: A retrospective review of clinicopathologic findings and oncologic outcomes of 116 patients who underwent CVS with curative intent, after combination chemotherapy, between January 2000 and December 2015, has been reported here. Results: Twenty-six patients (22.4%) underwent combined resection of another organ and 12 patients received para-aortic lymphadenectomy (10.3%). Pathologic complete remission (CR) was confirmed in 11 cases (9.5%). The median overall survival (OS) and disease-free survival (DFS) times were 35.0 and 21.3 months, respectively. In multivariate analysis, ypTNM stage was the sole independent prognostic factor for DFS (P=0.042). Tumors invading an adjacent organ or involving distant lymph nodes showed better survival than those with peritoneal seeding or solid organ metastasis (P=0.084). Kaplan-Meier curves showed that the 3-year OS rate of patients with pathologic CR and those with CR of the primary tumor but residual node metastasis was 81.8% and 80.0%, respectively. OS was 65.8% for stage 1 patients, 49.8% for those at stage 2, and 36.3% for those at stage 3. Conclusions: The ypTNM staging is a significant prognostic factor in patients who underwent CVS for localized unresectable or stage IV gastric cancers. Patients with locally advanced but unresectable lesions or with tumors with distant nodal metastasis may be good candidates for CVS.

• Journal of Korean Traditional Oncology
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• v.24 no.2
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• pp.1-11
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• 2019

Objectives : We investigated whether a single center nutrition screening tool (Kyunghee Neo Nutrition Risk Screening, KNNRS) can predict survival in patients with metastatic cancer. Methods : We retrospectively reviewed data of inpatients with metastatic cancer from April 2016 to August 2019. Data on demographic and clinical parameters were collected from electronic medical records, and overall survival was estimated using the Kaplan-Meier method. Stepwise Cox regression analysis was used to determine factors associated with survival. Patients with a KNNRS score of 0 to 3 were classified as "no-risk", 4 to 10 as "low-risk", and 11 to 20 as "high-risk". Results : Total 105 patients were included in the study. According to nutritional screening at baseline, 25 patients (23.8%, median age 57.0) were classified as ""no risk"" group; 80 patients (76.2%, median age 68.5) as "low risk" group; No patients as "high risk" group. Predictors of survival were Eastern Cooperative Oncology Group Performance Status score of 3 or 4 (hazard ratio [HR] = 1.93; 95% confidence interval [CI] = 1.21-3.10), hemoglobin less than 10 g/dL (HR = 1.97; 95% CI = 1.25-3.10) and C-reactive protein more than 1.0 mg/dL (HR = 1.95; 95% CI = 1.21-3.13). Kaplan-Meier survival analysis showed significant differences in the survival between KNNRS groups: ""no risk"" group: 6.1 ± 1.4 months (95% CI = 3.37-8.83); ""low risk"" group: 3.4 ± 0.9 months (95% CI = 1.5-5.37). Conclusions : Nutritional status according to KNNRS wasn't significant predictor of survival for patients with metastatic cancer. Improvement of KNNRS score thresholds is needed.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.329-338
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• 2017

Background: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. Methods: A retrospective review of 77 patients with E SCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. Results: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p=0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Conclusion: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.95-99
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• 2007

Objective : The purpose of this reports is to describe the influence of continuous external ventricular drainage [EVD] on delayed ischemic neurologic deficit [DIND] after early surgery in ruptured aneurysmal patients. Methods : The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage [SAH] who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD [Group A] postoperatively, whereas 108 patients did not [Group B]. EVD was performed at ipsilateral Kocher's point and maintained 2 to 14 days postoperatively. Results : DIND occurred in 15.7% [19 cases] of patients in Group A, 25% [27 cases] from Group B [P value=0.112]. Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion [36.8%] and mild deterioration of mental state [26.3%], contrary to weakness of extremities [59.2%] in Group B. At discharge, Glasgow Outcome Scales [GOS] of Group A were : good recovery [63.2%], moderately disabled [21%], severely disabled [10.5%], dead [5.3%] and Group B : good recovery [48.1%], moderately disabled [37%], severely disabled [14.8%] and dead [0%]. Of 121 patients from group A, 35 patients [28.9%] suffered ventriculitis. Conclusion : Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.

• Journal of Environmental Health Sciences
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• v.32 no.3
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• pp.199-206
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• 2006

Various heavy metals have been known for causing ischemic stroke. In order to describe the causative relationship between the blood levels of various heavy metals and stroke patients, 116 patients with stroke and 111 patients without stroke were selected from one Oriental medical hospital in Wonju, Korea. Total of 9 kinds of metals such as As, Cd, Co, Cu, Hg, Mn, Ni, Pb, and Zn were analyzed in blood from patients with and without stroke. There were no significant differences in the means of metal concentrations between the stroke and nonstroke patients except for the mean of Co concentration. In the case of Co, the means for stroke and non-stroke patients were 0.44 ug/l and 0.40 ug/l showing a significant difference at the level of p-value=0.05. The odds ratios for each metal ranged from 0.96 to 2.86. Most odds ratios were not significant but the odds ratio for Co, $2.86{\pm}1.49$ was significant, indicating that Co increases the risk of stroke by 2.86 times. In order to identify the specific risk level of stroke increased by a multiple interaction of metals, regression coefficients and odds ratio for a pair or multiple pair of metals were reanalyzed. However, all of regression coefficients and odds ratios were not significant. In conclusion, Co showed the significant level in blood from patients with stroke. In addition, the odds ratio of stroke was significantly different from other metals. Thus, it is considered that Co among various metals analyzed in this study is the important metal for increasing the risk of stroke.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.321-327
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• 2015

Objective : To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. Methods : We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. Results : A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ${\geq}0.2$ and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR ${\geq}0.2$ showed a statistically significant association (p=0.019). In the group with CEAR ${\geq}0.2$, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR ${\geq}0.2$ (p=0.003) Conclusion : The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2559-2563
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• 2014

Purpose: We investigated the expression of epithelial $Ca^{2+}$ channel transient receptor potential vanilloid (TRPV) 5 and 6 in non-small-cell lung cancer (NSCLC) and assessed their prognostic role in patients after surgical resection. Materials and Methods: From January 2008 to January 2009, 145 patients who had undergone surgical resection of NSCLCs were enrolled in the study. Patient clinical characteristics were retrospectively reviewed. Fresh tumor samples as well as peritumor tissues were analyzed for TRPV5/6 expression using immune-histochemistry (IHC) and quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Patients were grouped based on their TRPV5 and TRPV6 levels in the tumor tissues, followed up after surgery, and statistically analyzed to examine the prognostic roles of TRPV5 and TRPV6 on patients' survival after surgical resection of NSCLCs. Results: Using IHC, among the 145 patients who had undergone surgical resection of NSCLCs, strong protein expression (grade${\geq}2$) of TRPV5 and TRPV6 was observed in a lower percentage of primary tumor tissues than in non-tumor tissues of same patients. Similar findigns were obtained with the RT-PCR test for mRNA levels. Decreased overall mRNA levels of TRPV5 and TRPV6 were associated with a worse overall survival rate (p=0.004 and p=0.003 respectively) and shorter recurrence-free survival (p<0.001 and p<0.001 respectively). The combining effect of TRPV5 and TRPV6 on survival was further investigated using multivariate analysis. The results showed that a combination of low expression of TRPV5 and TRPV6 could be an independent predictor of poor recurrence-free survival (p=0.002). Conclusions: Decreased expression of TRPV5/6 in tumor tissues was observed in NSCLC patients and was associated with shorter median survival time after surgical resection. Combined expression of TRPV5 and TRPV6 in tumor tissues demonstrated promising prognostic value in NSCLC patients.

• Journal of Gastric Cancer
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• v.16 no.3
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• pp.161-166
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• 2016

Purpose: Lymph node (LN) metastasis is the best prognostic indicator in non-distant metastatic advanced gastric cancer. This study aimed to assess the prognostic value of various clinicopathologic factors in node-negative advanced gastric cancer. Materials and Methods: We retrospectively analyzed the clinical records of 254 patients with primary node-negative stage T2~4 gastric cancer. These patients were selected from a pool of 1,890 patients who underwent radical resection at Memorial Jin-Pok Kim Korea Gastric Cancer Center, Inje University Seoul Paik Hospital between 1998 and 2008. Results: Of the 254 patients, 128 patients (50.4%), 88 patients (34.6%), 37 patients (14.6%), and 1 patient (0.4%) had T2, T3, T4a, and T4b tumors, respectively. In a univariate analysis, operation type, T-stage, venous invasion, tumor size, and less than 15 LNs significantly correlated with tumor recurrence and cumulative overall survival. In a multivariate logistic regression analysis, tumor size, venous invasion, and less than 15 LNs significantly and independently correlated with recurrence. In a multivariate Cox proportional hazards analysis, tumor size (hazard ratio [HR]: 2.926; 95% confidence interval [CI]: 1.173~7.300; P=0.021), venous invasion (HR: 3.985; 95% CI: 1.401~11.338; P=0.010), and less than 15 LNs (HR: 0.092; 95% CI: 0.029~0.290; P<0.001) significantly correlated with overall survival. Conclusions: Node-negative gastric cancers recurred in 8.3% of the patients in our study. Tumor size, venous invasion, and less than 15 LNs reliably predicted recurrence as well as survival. Aggressive postoperative treatments and timely follow-ups should be considered in cases with these characteristics.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3863-3868
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• 2012

In this study mitochondrial D-Loop variations in Iranian prostate cancer and benign prostatic hyperplasia (BPH) patients were investigated. Tumour samples and corresponding non-cancerous prostate tissue from 40 prostate cancer patients and 40 age-matched BPH patients were collected. The entire mtD-loop region (16024-576) was amplified using the PCR method and products were gel-purified and subjected to direct nucleotide sequencing. A total of 129 variations were found, the most frequent being 263A${\rightarrow}$G and 310T${\rightarrow}$C among both BPH and prostate cancer patients. Variation of 309 C${\rightarrow}$T was significantly more frequent in prostate cancer patients (P value<0.05). Four novel variations were observed on comparison with the MITOMAP database. Novel variations were np16154delT, np366G${\rightarrow}$A, np389G${\rightarrow}$A and 56insT. There was no correspondence between the different variations and the age of subjects. Considering that D-loop variations were frequent in both BPH and prostate cancer patients in our study, the fact that both groups had high average age can be a possible contributing factor. D-loop polymorphisms and microsatellite instability can influence cell physiology and result in a benign or malignant phenotype. Significantly higher frequency of 309 C${\rightarrow}$T variation in cancer patients is a notable finding and must be a focus of attention in future studies.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4433-4437
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• 2016

Background: Gastric cancer (GC) is the fifth most common cancer worldwide. Since development is usually asymptomatic, it is generally diagnosed at an advanced stage. The value of screening in patients with nonspecific symptoms for GC is controversial. Aim: The study aimed to evaluate whether hematological parameters (platelet count (PC), mean platelet volume (MPV), MPV/PC ratio, red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)) are useful markers to differentiate between gastric cancer patients and healthy individuals. Materials and Methods: Sixty-one patients with gastric cancer and sixty-one healthy individuals were enrolled to the survey and retrospective analysis of selected blood parameters were performed. Results: The mean values of PC, MPV, RDW, NLR, and PLR were significantly higher in GC patients compared to the control group. No statistical differences were observed in MPV/PC ratios. Likewise, no significant statistical differences were revealed in values of blood parameters among TNM stage groups. The RDW showed the highest diagnostic specificity and sensitivity. Conclusions: Hematological parameters: PC, MPV, RDW, NLR, PLR have diagnostic power and can discriminate patients with gastric cancer from patients without cancer. Blood parameters compared with clinical symptoms might alert physicians and patients and lead to performancce of upper gastrointestinal endoscopy, the gold standard in gastric cancer screening and therebly increase the early detection of cancer.