• Archives of Reconstructive Microsurgery
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• 제21권2호
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• pp.118-130
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• 2012

Background: Women receiving mastectomy usually prefer a single-stage surgical procedure without the need for additional surgery. Hence, nipple sparing mastectomy was introduced, and the follow-up data on the aesthetic outcome and recurrence of breast cancer were investigated in this study. Materials and Methods: The study subjects comprised 22 patients who received nipple-sparing mastectomy and immediate breast reconstruction using the free transverse abdominal rectus abdominis myocutaneous flap between June of 2007 and June of 2012. The patients' aesthetic outcomes were measured with 2 methods for the objective result: Breast size measurements and breast volume calculation both at preoperative phase and postoperative 1 years phase. Also, the patients' satisfaction was evaluated at postoperative 1 year with the self-assessment questionnaire. Follow up check for assessing cancer recurrence was performed for an average period of postoperative 1063 days. Results: First, in objective aesthetic outcome, there were no significant differences between the preoperative and postoperative results on both the breast size and the volume. Second, the patient satisfaction analysis scores were graded as very good in 15 patients (68.2%), and as good in 6 patient (27.3%). Most of the patients were very satisfied with our surgery method. Last, there was no local or distant recurrence in these 22 patients during the follow-up period. Conclusion: In this study, the nipple-sparing mastectomy achieved satisfactory results for the breast scar and shape with a single-stage surgical procedure, and the cancer recurrence rate was not significantly different from that of the conventional mastectomy. Besides, the nipple-sparing mastectomy is more cost-effective than the conventional mastectomy since it reduces the need for additional procedures. However, we think that it is necessary to determine the long-term outcomes about the recurrence rate.

• Journal of Chest Surgery
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• 제24권6호
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• pp.570-578
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• 1991

The spontaneous pneumothorax is the sudden collapse of the lung usually by air leakage from the ruptured sub-pleural bleb and has high recurrence rate. For prevention against recurrence, many drugs such as tetracycline, talcum powder, quinacrine, etc. have been used but the effects are not satisfactory. We reduced the recurrence rate successfully by the fibrin glue instillation through the chest tube. From the January 1989 to September 1990, we have managed 65 patients of spontaneous pneumothorax with closed thoracostomy and fibrin glue[fibrinogen 1gm/50ml with approtinin 3, 000kIU /ml, thrombin 5, 000IU /ml in 3% each 10ml] instillation through the chest tube. And we compared the results with those of 106 patients of spontaneous pneumothorax who were managed only by the closed thoracostomy from January 1985 to December 1988. Only the patients who visited our hospital with recurrence were considered as the recurred cases but the others were considered as not recurred. And the removal of chest tubes usually done 3 days after cessation of air leakage or 2 days after fibrin glue instillation Statistical analysis was done by X2-test. The results were as followings: 1. The recurrence rate of fibrin glue instillation group was lower than that of non-instillation group[1st attack: 15.1% versus 27.6% p<0, 05, the 2nd attack: 33.3% versus 73.7% p<0.01, the total 18.5% versus 35.8% p<0.01]. 2. The mean duration of chest tube drainage in the fibrin glue instillation group was shorter than non-instillation group[4.24$\pm$1.36 days versus 4.48$\pm$1.73 days p<0.05]. 3. The mean duration of hospitalization was shorter in the instillation group [8.12$\pm$3.5 days versus 10.8$\pm$3.8 days p<0.05] The complications were transient mild fever, chest pain, pleural effusion in 46 cases of 65 patients, but those didn`t make any problem. We concluded that the fibrin glue is effective in the reduction of recurrence rate, obliteration of air leakage and duration of hospitalization.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4717-4721
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• 2013

Complete surgical resection of the primary tumour is a crucial predictive step for head and neck squamous cell carcinoma (HNSCC), because incomplete resection may lead to increase in the recurrence rate. Molecular cancer markers have been investigated as potential predictors of prognosis marker, to identify patients who are at high risk of local recurrence. This retrospective study aimed to determine the prognostic correlation between p53 and eIF4E expression and clinical characteristics, recurrence and overall survival. Forty eight HNSCC patients were selected between 2006 and 2009 diagnosed at the Royal Darwin Hospital, Darwin, Northern Territory, Australia. Out of 48, only those 24 with negative surgical margins with hematoxylin and eosin (HandE) were chosedn for further analysis. A total of 77 surgical margins were obtained and subsequently analysed by immunohistochemical (IHC) staining with monoclonal p53 and polyclonal eIF4E antibodies. Contingency table and ${\chi}^2$-test were used to investigate the correlation between p53 and eIF4E expression and clinical characteristics, recurrence and overall survival of the HNSCC patients. The follow up period was 74 months (range 1-74 months). The Kaplan-Meier method was used to generate recurrence and survival curves. This is a first retrospective study of Northern Territory patients, including Indigenous and non-Indigenous Australians. Molecular study of surgical margins could help to identify patients with and without clear margins after surgery and help in choice of the most appropriate adjuvant treatment for HNSCC patients.

• Journal of Gastric Cancer
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• 제14권1호
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• pp.23-31
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• 2014

Purpose: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. Materials and Methods: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. Results: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). Conclusions: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.

• Korean Journal of Radiology
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• 제21권7호
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• pp.829-837
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• 2020

Objective: The aim of this study was to investigate the prognostic value of the maximum standardized uptake value (SUV_max) measured while restaging with F-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) to predict the 3-year post-recurrence survival (PRS) in patients with recurrent gastric cancer after curative surgical resection. Materials and Methods: In total, 47 patients with recurrent gastric cancer after curative resection who underwent restaging with ¹⁸F-FDG PET/CT were included. For the semiquantitative analysis, SUV_max was measured over the visually discernable ¹⁸F-FDG-avid recurrent lesions. Cox proportional-hazards regression models were used to predict the 3-year PRS. Differences in 3-year PRS were assessed with the Kaplan-Meier analysis. Results: Thirty-nine of the 47 patients (83%) expired within 3 years after recurrence in the median follow-up period of 30.3 months. In the multivariate analysis, SUV_max (p = 0.012), weight loss (p = 0.025), and neutrophil count (p = 0.006) were significant prognostic factors for 3-year PRS. The Kaplan-Meier curves demonstrated significantly poor 3-year PRS in patients with SUV_max > 5.1 than in those with SUV_max ≤ 5.1 (3-year PRS rate, 3.5% vs. 38.9%, p < 0.001). Conclusion: High SUV_max on restaging with ¹⁸F-FDG PET/CT is a poor prognostic factor for 3-year PRS. It may strengthen the role of ¹⁸F-FDG PET/CT in further stratifying the prognosis of recurrent gastric cancer.

• 대한영상의학회지
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• 제81권5호
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• pp.1164-1174
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• 2020

목적 수술 전 초음파 검사에서 갑상선 종양의 재발을 예측할 수 있는 심층 학습 모델을 개발하고자 한다. 대상과 방법 수술 전 초음파에서 병리학적으로 확진된 갑상선 수술을 받은 229명의 환자(남성:여성 = 42:187, 평균 연령, 49.6세)의 대표적인 초음파 이미지를 포함시켰다. 각각 대표적인 횡축 또는 종축 초음파 이미지가 선택되었다. 신경 네트워크용 Python 2.7.6 및 Keras 2.1.5, convolutional neural network을 사용한 심층 학습이 사용되었다. 재발한 환자와 재발이 없는 환자의 임상 및 조직학적 특징을 비교하였다. 그룹 간의 심층 학습 모델의 receiver operating characteristic curve 곡선 아래의 영역은 재발 갑상선암을 예측하기 위한 심층 학습 모델의 예측에 사용되었다. 결과 전체 환자 229명 중 49명이 종양 재발(21.4%)을 보였다. 종양의 크기, 다원성은 재발이 없는 군과 재발 군에서 유의한 차이가 있었다(p < 0.05). 재발성 갑상선암 예측을 위한 심층 학습 모델의 전반적인 평균 area under the curve (이하 AUC) 값은 0.9 ± 0.06이었다. 평균 AUC는 macrocarcinoma에서 0.87 ± 0.03, microcarcinoma에서 0.79 ± 0.16이었다. 결론 갑상선암의 초음파 이미지를 이용한 심층 학습 모델로 갑상선암 재발의 예측 모델 구축의 가능성을 보여주었다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7101-7106
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• 2013

Background: The prognosis of patients with hepatocellular carcinoma (HCC) after curative resection varies greatly. Few studies had investigated the risk factors for early recurrence (recurrence-free time ${\leq}$ 1 year) of hepatitis B virus (HBV)-related HCCs meeting Milan criteria. Methods: A retrospective analysis was performed on the 224 patients with HCC meeting Milan criteria who underwent curative liver resection in our center between February 2007 and March 2012. The overall survival (OS) rate, recurrence-free survival (RFS) rate and risk factors for early recurrence were analyzed. Results: After a median follow-up of 33.3 months, HCC reoccurred in 105 of 224 patients and 32 died during the period. The 1-, 3- and 5-year OS rates were 97.3%, 81.6% and 75.6% respectively, and the 1-, 3- and 5-year RFS rates were 73.2%, 53.7% and 41.6%. Cox regression showed alpha-fetoprotein (AFP) > 800 ng/ml (HR 2.538, 95% CI 1.464-4.401, P=0.001), multiple tumors (HR 2.286, 95% CI 1.123-4.246, P=0.009) and microvascular invasion (HR 2.518, 95% CI 1.475-4.298, P=0.001) to be associated with early recurrence (recurrence-free time ${\leq}$ 1-year) of HCC meeting Milan criteria. Conclusions: AFP > 800 ng/ml, multiple tumors and microvascular invasion are independent risk factors affecting early postoperative recurrence of HCC. In addition resection appears capable of replacing liver transplantation in some situations with safety and a better outcome.

• Radiation Oncology Journal
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• 제29권3호
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• pp.191-198
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• 2011

Purpose: Although the role of squamous cell carcinoma antigen (SCC-Ag) as a predictive and prognostic factor for uterine cervical cancer has been identified in previous studies, 1) the effective patient group of screening for recurrence with SCC-Ag, 2) the relationship between SCC-Ag and recurrence site, and 3) the relationship between the change of SCC-Ag and treatment outcome or recurrence have not been described. Materials and Methods: The study included 506 patients with histologically proven uterine cervical cancer between January 1994 and December 2010. We determining the serum SCC-Ag level before treatment and after treatment, and conducted a retrospective review of the patients' records. We evaluated the sensitivity and specificity of SCC-Ag for the detection of tumor recurrence by comparing biochemical recurrence with clinical recurrence. Results: The pretreatment SCC-Ag level and the proportion of patients over 1.5 ng/mL were higher in poor prognostic patient group. In the univariate and multivariate analysis, pretreatment SCC-Ag showed a statistically significant correlation with tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology. In patients with biochemical recurrence vs. those without, 5-year DFS and OS were 27.6 vs. 92.7% (p ${\leq}$ 0.001) and 53.7 vs. 92.5% (p ${\leq}$ 0.001), respectively. Conclusion: Our study reconfirmed the known function of pretreatment SCC-Ag, but could not confirm the function of biochemical response as a predictive factor for treatment and as a prognostic factor. There was no statistically significant relationship between SCC-Ag level and recurrence site. We confirmed the role of SCC-Ag as a follow-up tool for recurrence of disease and which patient groups SCC-Ag was more useful for.

• Journal of Gastric Cancer
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• 제5권4호
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• pp.266-272
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• 2005

목적: 위암의 근치적 절제술 후에 재발은 여러 형태로 발생한다. 특히 현행성 재발은 간 부위에서 주로 나타나는데 이러한 간계발의 임상병리학적 위험인자를 예측하기 위해 본 연구를 시행하였다. 대상 및 방법: 1992년 1월부터 1999년 12월까지 전북대학교병원에서 위암으로 근치적 수술치료를 받았던 838명의 환자 중 201명의 재발환자를 대상으로 간 재발과 관련된 임상병리학적 위험인자를 찾기 위해 후향적 연구를 하였다. 결과: 201명의 재발환자 중 59명이 간재발을 보였다. 로지스틱 회귀분석을 통한 다변량분석에서 간재발의 독립적인 위험인자로는 Lauren의 분류에서 장형인 경우(OR, 6.66; 95% Cl, 1.53 to 28.9; P=0.011), 근위부 절제연의 길이가 6cm 미만인 경우(OR, 3.76; 95% Cl, 1.03 to 13.67; P=0.045)가 관련되어 있었다. 결론: 위암의 수술 치료 후 간재발의 임상병리학적 위험인자들의 다양한 연구 조사와 더불어 분자생물학적인 연구가 더해진다면 간 재발에 대한 예측이 가능할 것이며 고위험 환자에게 적절한 치료법의 개발에도 도움이 될 수 있을 것이다.

• 대한골관절종양학회지
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• 제16권2호
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• pp.51-54
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• 2010

목적: 골 거대세포종 환자들의 치료결과 및 재발률을 평가하여 보고하고자 하였다. 대상 및 방법: 1980년 3월부터 2008년 12월까지 본원에서 치료 받은 거대세포종 환자 중 최소 12개월 이상 추적관찰이 가능하였던 54예에 대하여 후향적으로 조사하였다. 54예 중 남자 27예, 여자 27예로 평균 나이는 33.1세(13-67세)였다. 평균 추시 기간은 67개월(12-104개월)이었다. 결과: 54예 중 21예(38.9%)에서 국소재발이 발생하였으며 술 후 재발까지의 기간은 평균 21.5개월이었다. 국소재발에 통계적으로 유의한 영향을 가진 인자로는 해부학적 위치와 임상적 병기로 하지에서 상지보다 낮은 재발률을 보였으며(p=0.032), Campanacci 분류 grade I이 grade II와 grade III보다 재발률이 낮았다. 소파술 후 골시멘트 충진을 시행한 군(28예)과 동종골 이식을 시행한 군(18예) 사이에도 국소 재발률에 대해 통계적으로 유의한 차이를 보이지 않았고, 소파술 후 국소 보조요법으로 냉동을 시행한 군과 시행하지 않은 군에서도 통계적 유의성은 없었다. 결론: 골 거대세포종의 국소 재발을 방지하기 위해서는 종양세포의 철저한 제거가 여러 부가적인 처치보다 더 중요하다고 판단된다.