• Journal of Gastric Cancer
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• 제1권2호
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• pp.106-112
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• 2001

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.180-186
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• 2001

Purpose: The prognosis for early gastric cancer (EGC) is favorable, and the 10-year disease-specific survival rate is reported to be around $90\%$. The absolute number of recurred EGC is too small to assess the risk factors, so recruitment of a large number of cases for statistical analysis is very difficult. We carried out this study to analyze the incidence and the patterns of recurrence of EGC and to identify the clinicopathological risk factors for recurrence of EGC. Materials and Methods: The authors retrospectively investigated the follow-up records of 1418 patients who underwent a curative resection for EGC from Jan. 1984 to Dec. 1999 at the Korea Cancer Center Hospital and analyzed them with special reference to cancer recurrence. Results: In this retrospective study of 1418 cases, 43 patients died of a recurrence of gastric cancer, and 105 patients died of unrelated causes. The five-year and the ten-year overall survival rates were $89.6\%$ and $81.7\%$, respectively, while the five-year and the ten-year diseasespecific survival rates were $96.5\%$ and $94.3\%$, respectively. The recurrence patterns of the 45 recurred EGC were hematogenous metastasis (19 cases), lymph node (L/N) metastasis (8 cases), locoregional recurrence (2 cases), peritoneal seeding (3 cases), and combined form (13 cases). The mean time interval to recurrence was 38.6 months, and the number of delayed recurred cases after 5 years was 10 ($22.2\%$). Of the clinicopathologic factors, depth of invasion, L/N metastasis, macroscopic type, lymphatic invasion, and vessel invasion, were significant risk factors in the univariate analysis. However, in the multivariate analysis, only L/N metastasis was an independent prognostic factor. Conclusion: Based on the results of this study, L/N metastasis is an independent prognostic factor. Thus, in patients with node-positive disease, adjuvant therapy might be considered, and long-term close follow-up might facilitate early detection and treatment of recurrent disease due to delayed recurrence.

• Journal of Gastric Cancer
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• 제14권1호
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• pp.58-62
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• 2014

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.213-218
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• 2004

목적: 조기 위암 중 점막하층 침윤과 림프절 전이가 많은 표층 팽창형 조기위암(5cm 이상)은 다른 형태의 조기위암과 다른 임상병리학적 양상을 보인다. 이에 저자들은 조기 위암 중 표층 팽창형 조기위암에 대해 임상 병리학적 특성과 수술 방법 및 예후에 영향을 주는 요소들을 알아보고자 하였다. 대상 및 방법: 1995년부터 2002년까지 단국대학교 외과학교실과 울산대학교 서울 중앙병원 외과학교실에서 위암으로 수술을 시행한 환자들 중 조직 병리 검사상 조기 위암으로 보고된 환자를 대상으로 하였다. 1,875예의 조기위암 환자 중 표층 팽창형 조기위암 300예($16.0\%$), 소형 조기위암 739예($39.4\%$)를 대상으로 임상병리조직학적 소견, 수술방법, 생존율, 재발 양상 및 재발률 등을 후향적 방법으로 비교 분석하였다. 결과: 양 군에서 육안적 소견상 IIc형이 가장 많았으며, 융기형보다 침윤형이 더 많았다. 양 군에서 수술방법의 차이는 없었다. 점막하층 침윤정도는 표층팽창형군이 185예($61.7\%$)로 소형군 294예($39.8\%$)보다 많았으며 두 군간에 통계학적으로 유의한 차이를 보였다(P=0.005). 림프관 침범은 표층팽창형군에서 39예($13.0\%$). 소형군에서 34예($4.6\%$)에서 관찰되었고 통계학적으로 유의한 차이를 보였으며(P=0.009) 종양의 재발은 표층팽창형군 300예 중 11예($3.6\%$), 소형군 739예 중 10예($1.4\%$)로 두 군 간에 통계학 적으로 유의한 차이는 없었다(P=0.214). 전체 5년 생존율은 표층팽창형군 $84.8\%$, 소형군 $93.0\%$로 통계학적으로 유의한 차이는 없었고(P=0.052), 5년 무병 생존율은 표층팽창형군 $87.5\%$, 소형군은 $94.7\%$로 통계학적으로 유의한 차이는 없었다(P=0.053). 결론: 표층팽창형 조기위암은 점막하층 침범, 림프관 침범, 림프절 전이는 빈도가 유의하게 많았다. 따라서 축소 수술 등은 적응이 되지 않으며 충분한 절제연과 광범위의 림프절 곽청술을 시행하는 것이 적절하다고 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2639-2642
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• 2012

Background: The patterns of gastric cancer recurrence vary across societies. We designed the current study in an attempt to evaluate and reveal the outbreak of the recurrence patterns of gastric cancer and also prediction of time to recurrence and its effected factors in Iran. Materials and Methods: This research was performed from March 2003 to February 2007. Demographic characteristics, clinical and pathological diagnosis and classification including pathologic stage, tumor grade, tumor site and tumor size in of patients with GC recurrent were collected from patients' data files. To evaluate of factors affected on the relapse of the GC patients, gender, age at diagnosis, treatment type and Hgb were included in the research. Data were analyzed using Kaplan-Meier and logistic regression models. Results: After treatment, 82 patients suffered recurrence, 42, 33 and 17 by the ends of first, second and third years. The mean ( SD) and median ( IQR) time to recurrence in patients with GC were 25.5 (20.6-30.1) and 21.5 (15.6-27.1) months, respectively. The results of multivariate analysis logistic regression showed that only pathologic stage, tumor grade and tumor site significantly affected the recurrence. Conclusions: We found that pathologic stage, tumor grade and tumor site significantly affect on the recurrence of GC which has a high positive prognostic value and might be functional for better follow-up and selecting the patients at risk. We also showed time to recurrence to be an important factor for follow-up of patients.

• Journal of Gastric Cancer
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• 제2권2호
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• pp.91-95
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• 2002

Purpose: We compared the quality of life (QOL) and nutritional outcomes following both Billroth I (BI) and Billroth II (BII) reconstructions after a subtotal gastrectomy in order to identify which reconstruction would produce a better QOL and nutritional outcomes and to provide better follow-up management. Materials and Methods: We studied 273 patients without evidence of recurrent disease following a curative distal subtotal gastrectomy for gastric cancer. Among them, 135 underwent a BI reconstruction and 138 a BII reconstruction. The nutritional status was assessed by using levels of hemoglobin, serum albumin, iron, and vitamin B12 and by calculating the relative body weight, the body mass index, and the percentage of body fat. The QOL was measured by using the Troidl score and by treatment-specific symptoms based on the criteria, somewhat modified by the authors, of Korenaga and others. Results: There was no significant difference in QOL between the BI and the BII groups. More than half of the patients revealed anemia, regardless of the type of reconstruction. The serum vitamin $B_{12}$ level of the BII group was lower than that of the BI group. The BII group showed a tendency toward lower hemoglobin levels and serum iron concentrations than the BI group did. Conclusions: The quality of life was not impaired in most patients after either a BI or a BII reconstruction. However, both resulted in iron deficiency anemia, although the incidence was higher after a BII reconstruction. The patient's serum iron and vitamin B12 should be measured periodically and these must be administered if the measurements reveal a below normal range.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8661-8666
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• 2014

Background: Docetaxel and cisplatin in combination with fluorouracil (DCF) regimen is accepted to be one of the standard regimens in the treatment of advanced gastric cancer. However, substantial toxicity has limited its use in daily clinical practice. Therefore, modification of DCF regimens, including introduction of capecitabine has been investigated to improve the safety profiles. In the present study, the efficacy and toxicity of a regimen with a modified dose of docetaxel and cisplatin in combination with oral capecitabine (DCX) was evaluated in untreated patients with HER2-negative advanced gastric cancer. Materials and Methods: Fifty-four patients with HER2-negative locally advanced or metastatic gastric cancer were included in this cohort. Patients received docetaxel $60mg/m^2$ plus cisplatin $60mg/m^2$ (day 1) combined with capecitabine $1650mg/m^2$ (days 1-14) every 3 weeks. Treatment response, survival, and toxicity were retrospectively analyzed. Results: The median age was 54 years (range: 24-76). The majority of patients (70%) had metastatic disease, while 11 patients (21%) had recurrent disease and underwent curative gastrectomy, and 5 patients (9%) had locally advanced disease (LAD). The median number of DCX cycles was 4. There were 28 partial responses and 11 complete responses, with an overall response rate of 72%. Curative surgery could be performed in four patients among five with LAD. At the median follow-up of 10 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort of patients were 7.4 and 12.1 months, respectively. Dose modification was done in 12 patients due to toxicity in 8 and noncompliance in 4 patients. The most common hematological toxicity was neutropenia, which occurred at grade 3-4 intensity in 10 of 54 patients (27.7%). Febrile neutropenia was diagnosed only in two cases. Conclusions: DCX regimen offers prominent anti-tumor activity and considered to be effective first-line treatment with manageable toxicity for patients with HER2-negative advanced gastric cancer.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.219-224
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• 2004

목적: 활발히 운영되고 있는 위암관련 인터넷 홈페이지에서 이루어진 질의와 설문 조사를 통해 위암환자나 보호자들의 위암에 관한 정보 욕구와 관심사항을 조사하였다. 대상 및 방법: 2002년 6월부터 2003년 9월까지 인터넷 홈페이지(www.gastriccancer.co,kr)에 문의된 619예의 질의와 2003년 8월부터 2003년 10월까지 시행된 설문에 응답한 524예의 위암 환자나 보호자들의 답변을 토대로 분석하였다. 결과: 질의 분석 619예의 질의를 내용에 따라 빈도순으로 분류해 보면 치료, 예후, 병기, 증상, 병태, 진단방법, 위암에 이로운 음식, 위암의 원인, 추적관리, 기타의 순이다. 치료에 관련된 질의 가운데 가장 높은 빈도는 수술 전후의 합병증이나 음식에 대한 내용이었고, 다음으로 항암 치료에 관련된 내용이 많았다. 수술 전 상황에서는 수술의 가능성과 예후에 관한 질문이 많았고, 수술 후 상황에서는 가능한 합병증과 예후에 관한 질문이 많았다. 수술이 불가능한 경우나 재발 위암의 경우에는 말기치료나 항암치료에 대한 질문이 많았다. 설문 분석 위암 관련 정보의 습득경로는 인터넷을 통한다는 답변이 가장 많았다. 의사들의 설명에 만족하는 경우는 $6\%$에 불과하였고, 설문 응답자의 $89.9\%$는 민간요법이나 대체요법에 대해 관심을 나타내었으며 단지 $5\%$만이 관심이 없다고 응답하였다. 결론: 위암 환자와 가족들은 위암에 관련된 정보의 습득을 갈망하고 있으나 의사들의 설명은 부족하다고 느끼고 있다. 발달된 인터넷 통신매체를 통한 올바른 위암 관련 의료정보를 제공함으로써 환자들의 치료와 건강증진에 도움을 줄 필요가 있다.

• Journal of Gastric Cancer
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• 제5권4호
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• pp.222-227
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• 2005

목적: 위암과 관련하여 특이한 종양표지자가 없음에도 불구하고 위암의 재발과 관련하여 AFP, CEA, CA19-9등의 유용성에 대한 몇 가지 보고가 있었다. 하지만 이런 연구의 유용성에 대해서는 아직까지 논란의 여지가 있는 것이 사실인데 저자는 CEA, AFP, CA19-9 등 3 가지 종양표지자를 이용하여 단일검사, 병합검사의 양성률을 구하고, 특히 재발부위에 따른 특정 종양표지자의 양성률을 알아보았다. 대상 및 방법: 조직학적으로 위선 암으로 확진되어 근치적 절제술을 받은 환자로서 수술 전과 술 후에 CEA, CA19-9, AFP의 3가지 종양표지자의 검사가 추적 가능하였던 환자 중 재발한 환자 52명을 재발부위별로 종양표지자의 단일 및 병합양성률을 조사하였다. 혈 청 AFP, CEA, CA 19-9의 검사치가 각각 10 ng/ml, 5 ng/ml, 35 u/ml 이상일 때 양성으로 판정하였다. 추적 관찰 중 재발유무는 위내시경 및 생검, 전산화 단층촬영, 흉부 X선 촬영, 골주사 등으로 진단하였다. 결과: 재발된 환자 52명의 재발 당시의 종양표지자의 양성률은 AFP 31%, CEA 52%, CA 19-9 46%였다. 병합양성률은 AFP/CEA 67%, AFP/CA 19-9 60%, CEA/CA 19-9 73%이었다. 재발 시 병합검사의 양성율이 단일검사보다 유의하게 높았다. 재발부위에 따른 단일검사 양성률은 복막의 경우 CA 19-9가 79%, 간의 경우 CEA가 90%로 의미 있게 증가되었다. 결론: 술 전에 종양표지자가 상승된 경우에서는 재발율이 높았으며 재발부위와 관련하여 간의 경우 CEA,복막의 경우 CA 19-9가 의미 있는 양성률을 보였다.

• Journal of Chest Surgery
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• 제28권10호
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• pp.954-962
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• 1995

Extended lymph node dissection, which includes dissection of the cervical and superior mediastinal nodes[three-field dissection , has been performed to improve the long-term survival since 1982 in Japan. Recently, the 5-year survival rate after three-field dissection has been reported to be better than 40%. During the period, from April to June, 1995, 4 patients among 7 operable esophageal cancer patients underwent subtotal esophagectomy with systematic dissection of regional lymph nodes including superior mediastinal and cervical lymph nodes at St. Mary`s Hospital. The esophagogastric anastomoses were made in the neck and the ascending routes of gastric tube were posterior mediastinal route. The cancer stage of them were stage IIA & IIB and it was possible to operate on a curability II & III basis. The numbers of resected lymph nodes with the three field dissection were 40-55. Postoperative complications were transient recurrent laryngeal nerve paralysis and atelectasis in 2 patients respectively but there was no anastomotic leak nor stenosis.