• 대한핵의학회지
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• 제36권1호
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• pp.46-52
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• 2002

Whole-body positron emission tomography (PET) imaging with 18-F deoxyglucose (FDG) is a molecular imaging modality that detects metabolic alteration in tumor cells. In various human cancers, FDG-PET shows a potential clinical benefit in screening, tumor characterization, staging, therapeutic follow-up and detecting recurrence. In gynecologic cancers, FDG-PET is also known to be effective in characterization of adnexal masses, detection of recurrence, and lymph node invasion. This review discusses the clinical feasibility and future clinical application of this imaging modality in patients with cervical cancer, ovarian cancer, and other gynecologic cancers.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4143-4145
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• 2014

Background: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) Ewing sarcoma (ES) outcome data. The aim of this study was to identify and optimize ES-specific survival prediction models and sources of survival disparities. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for ES. 1844 patients diagnosed between 1973-2009 were used for this study. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome (bone and joint specific death, yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. Results: The mean follow up time (S.D.) was 74.48 (89.66) months. 36% of the patients were female. The mean (S.D.) age was 18.7 (12) years. The SEER staging has the highest ROC (S.D.) area of 0.616 (0.032) among the factors tested. We simplified the 4-layered risk levels (local, regional, distant, un-staged) to a simpler non-metastatic (I and II) versus metastatic (III) versus un-staged model. The ROC area (S.D.) of the 3-tiered model was 0.612 (0.008). Several other biologic factors were also predictive of ES-specific survival, but not the socio-economic factors tested here. Conclusions: ROC analysis measured and optimized the performance of ES survival prediction models. Optimized models will provide a more efficient way to stratify patients for clinical trials.

• Asian Pacific Journal of Cancer Prevention
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• 제17권1호
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• pp.347-352
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• 2016

Background: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) adenosquamous carcinoma data to identify predictive models and potential disparities in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for adenosquamous carcinoma. For the risk modeling, each factor was fitted by a generalized linear model to predict the cause specific survival. An area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. Results: A total of 20,712 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 54.2 (78.4) months. Some 2/3 of the patients were female. The mean (S.D.) age was 63 (13.8) years. SEER stage was the most predictive factor of outcome (ROC area of 0.71). 13.9% of the patients were un-staged and had risk of cause specific death of 61.3% that was higher than the 45.3% risk for the regional disease and lower than the 70.3% for metastatic disease. Sex, site, radiotherapy, and surgery had ROC areas of about 0.55-0.65. Rural residence and race contributed to socioeconomic disparity for treatment outcome. Radiotherapy was underused even with localized and regional stages when the intent was curative. This under use was most pronounced in older patients. Conclusions: Anatomic stage was predictive and useful in treatment selection. Under-staging may have contributed to poor outcome.

• Tuberculosis and Respiratory Diseases
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• 제47권3호
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• pp.339-346
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• 1999

배경: 비소세포폐암에서 비슷한 병기의 환자들도 생존 가망성은 상당한 차이를 보이는데 이러한 상황에서 보다 환자에게 효율적인 치료를 제공할 수 있게 도울 수 있는 새로운 예측인자의 필요성이 대두되었는데 보다 정확하고 재현성이 있는 폐암 병기 판정이 환자의 치료와 예후에 가장 큰 영향을 보인다고 생각된다. 비소세포폐암의 병기 판정은 1986년 Mountain 이 표명한 T(primary tumor), N(regional lymph nodes), M(distant metastasis) 시스템과 이에 각각의 병기를 따르고 있는데 이후 같은 병기내에서도 서로 다른 예후를 보이고 보다 세분화된 병기의 구분점이 있어야겠다는 공론속에서 1996년 American Joint Committee on Cancer과 Union Internationale Contre le Cancer에 의해 새로 개정된 비소세포 폐암의 병기 판정 시스템이 천명되었다. 본 연구에서는 비소세포폐암 환자에서 새로운 병기판정에 따른 생존율을 알아보고 이에 따라 술전, 술후 환자의 예후에 대한 의의를 알아 보기 위해 이 연구를 진행하였다. 방법: 연구 방법은 1981년부터 1995년까지 한양대학교 부속병원에서 비소세포폐암으로 진단된 환자중 술전에 방사선 또는 항암화학요법 치료를 받은 적이 없는 환자로서 치료적 목적으로 광범위 폐절제 및 림프절제술을 받은 환자중 사망여부의 추적이 가능한 총 84예의 환자를 대상으로 술후 얻어진 조직학적 병기를 과거의 병기판정과 새로운 TNM 병기를 기준으로 이의 생존의 관찰치와 더불어 병리조직학적 특정과 임상적 특징을 알아보았다. 결과: 환자의 median survival은 과거의 병기에 따른 결과는 stage I ; 79.1개월, stage II ; 47.3 개월, stage IIIa;22.77개월, stage IIIb; 16.1개월, stage IV;15.2개월이었고 새로운 병기에 따른 결과는 stage Ia;58.5개월, stage IIb;76.0개월, stage IIa;적용불능, stage IIIb;43.0개월, stage IIIa;22.5개월, stage IIIb;16.1개월, stage IV;15.2개월이었고 술후 36개월 뒤의 누적 백분율 생존율은 stage Ia;100%, stage Ib;80%, stage IIa; 적용불능, stage IIb;26%, stage IIIa;21%을 보였고 과거의 병기와 새로운 병기 판정에 따른 생존율에 따른 차이는 보이지 않았다. 결론: 폐암은 전세계적으로 암으로 인한 사망률 원인의 1위를 보이는 암종으로 비소세포폐암에서 비슷한 병기의 환자들도 생존 가망성은 상당한 차이를 보이는데 이러한 상황에서 보다 정확한 생존 가망성을 예측하고 각각의 환자에게 보다 효율적인 치료를 제공할 수 있게 도울 수 있는 새로운 예측 측도가 필요하게 되었다. 본 연구에서 결과는 통계학적으로 확연한 차이를 보이지 않았지만 새로 개정된 폐암 병기 판정 체계는 폐암 환자의 생존율을 높이고 비소세포폐암 환자의 예후를 보다 세분하여 정확하게 판정하는데 도움이 될 수 있으리라 사료되며 앞으로 보다 많은 추가적인 연구가 필요하다고 본다.

• Radiation Oncology Journal
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• 제9권2호
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• pp.271-276
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• 1991

요로조영술, 방광경검사, 직장내시경검사 등 자궁경부암에 있어서 병기결정을 위해 필요한 검사의 효용성을 평가하기 위하여 1979년 3월부터 1986년 12월까지 방사선 치료를 받은 510명의 자궁경부암환자를 대상으로 후향적 분석을 시행하였다. 요로조영술 및 방광경검사상 각각 $10.7\%$(49/456), $5.3\%$(24/452)가 이상소견을 보였으나 직장내시경검사에서는 $0.7\%$(3/413)만이 이상소견을 보였다. FIGO 병기결정에 필수적인 이러한 검사 결과로 26명의 환자 ($5.1\%$)가 골반내진 소견만으로 얻어진 병기보다 FIGO 병기가 상승하게 되었다. 각 병기의 환자에서 병기상승의 비율은 IB및 IIA병기에서는 $0\%$ (0/124), IIB 병기에서는 14명의 환자가 FIGO IIIB 병기로 또한 6명의 환자가 FIGO IVA 병기로 상승하여 $7.9\%$(20/252)로 나타났으며, IIIA 병기에서는 $0\%$(0/8), IIIB 병기에서는 6명이 FIGO IVA병기로 상승하여 $4.8\%$(6/126)로 나타났다. 병기결정을 위한 검사상 양성소견은 IIB 병기 이상의 진행된 병기에서만 나타났으며 초기에서는 나타나지 않았다. 보조적 검사로 337명이 전산화단층촬영을 시행받았으며 전산화단층촬영상 골반 임파절비대 소견이 $25.2\%$(85/337), 대동맥 임파절비대 소견이 $7.4\%$(25/337)에서 관찰되었다. 골반 임파절비대 소견의 빈도는 병기의 증가에 따라 증가하는 경향을 나타내었으나 대동맥 임파절비대 소견은 이러한 경향을 보이지 않았다. 자궁방결합 조직의 침윤소견에 있어서 전산화단층촬영 소견과 골반내진 소견은 $65.6\%$(442/674)에서 일치하였다. 또한 주위장기 침범소견에 있어서 전산화단층촬영은 내시경 검사를 기준으로 비교할 경우 음성예측치에 비하여 상당히 낮은 양성예측치를 나타내었다. 결론적으로, 병기결정을 위한 검사의 선택은 각 환자의 이학적 소견상의 진행정도를 고려하여 시행되어야 하며 그렇게 할 경우 적절한 FIGO 병기가 결정되면서 그 효용성을 증대시킬 수 있을 것이다.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.255-260
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• 2008

Purpose: Tongue cancer is the most common malignant tumor of the oral cavity and the ultimate goal in treatment of the cancer is not only complete excision and meticulous closure of the wound, but also, reconstruction of a demensional and functional tongue. Our study focuses on various factors, such as defect size, extent of tumor, age, application of mandibulectomy or radiotherapy, and their influences on postoperative speech and swallowing function. Methods: Our study was based on 59 patients who underwent tongue cancer operation and reconstruction of the tongue. Speech and swallowing were evaluated according to categories documented by Sultan and Teichgraeber. Patients were classified into 3 groups as partial glossectomy, hemiglossectomy and total glossectomy groups for evaluation. The average age of the patients were 51, and the mean follow-up period was 4 years 2 months. Results: The partial glossectomy group showed statistically relevant results for speech articulation and swallowing abilities compared to the total glossectomy group. In cases of defects involving the mouth floor, the group showed decreased results compared to the group without mouth floor involvement. Increased age showed decreased postoperative results with statistical significance, while mandibulectomy and radiotherapy revealed no statistically significant data. Analysis according to TNM staging resulted in decreased functional result with advanced staging without statistical significance. Conclusion: To summarize the factors influencing the functional outcome in tongue reconstruction, younger patients and early stage cancer with minimal surgical extent revealed more satisfying results while mandibulectomy and radiation did not have influence on our analysis. Addition of various influencing factors and studies with longer follow up periods on our patient groups may provide effective data for more satisfying functional outcomes in the future.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2541-2546
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• 2014

Background: Primary hepatic neuroendocrine carcinoma (PHNEC) is rarer than extrahepatic gastrointestinal neuroendocrine carcinoma (NEC). It is difficult to make a correct diagnosis and poses a challenge for management. Materials and Methods: Ten PHNEC patients were admitted to our hospital from June 2006 to June 2011. Laboratory tests and imaging scans were performed for diagnosis and exclusion of extrahepatic NEC. All patients were AFP - and CA199-. Seven patients had solid tumors with cystic changes on ultrasonography, CT and/or MRI. For the initial treatment, four patients received combined-therapy and six monotherapy. Considering overall treatment, six patients received combined-therapy and four patients monotherapy. Staging criteria of primary hepatocellular carcinoma (PHC, AJCC 7th edition) were used to differentiate the stage of all patients: 3 patients were stage I, 2 stageII, 4 patients stageIII and 1 stageIV. All patients were followed up and clinical data were gathered. Results: The median follow-up duration was 38.5 months. The 1-year, 2-year, 3-year and 6-year disease-free survival was 80.0%, 46.2% and 46.2% and 0% respectively. The overall survival rates were 100%, 67.1%, 67.1% and 33.6% respectively. Patients in early-stages (I/II) had similar disease-free and overall survival as those in advanced-stages (III/IV). Patients with monotherapy had significant shorter disease-free and overall survival than the patients with combination-therapy. Conclusions: PHNEC has a unique specificity during its occurrence and development. The staging criteria of PHC might not be suitable for the PHENT. More convenient and effective features need to be found in imaging and laboratory detection. Surgical resection, TACE, chemotherapy and radiofrequency ablation should be performed in combination and actively for patients with PHNEC or recurrence to get the best effectiveness; they might extend the disease-free and overall survival.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 2002년도 춘계학술대회 및 총회
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• pp.17-24
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• 2002

Recurrence of colorectal cancer after apparently curative resection remains common, with reported relapse rates of up to 40%. Because complete resection of solitary metastases or local recurrence may improve long-term survival, surgical management of such cases has become increasingly aggressive but has led to only modest survival benefit. The limitations of current approaches based on structural imaging are well documented, with over half of the patients who are thought suitable for curative surgery being found to have unresectable disease at operation. Therefore, better preoperative assessment is crucial. The increasing use of FDG-PET as an oncologic staging investigation has significantly improved the assessment of patients with suspected colorectal cancer recurrence. Several studios show that substantial and largely appropriate changes in patient management occur, often soaring patients the significant morbidity and mortality associated with aggressive but futile therapies while also saving scarce community resources. Nevertheless, the clinical relevance of these findings has still been questioned. The utility of PET in routine clinical practice will likely depend on its ability to provide incremental information compared with CT in selected patients rather than to serve as a replacement for CT. In conclusion, in patients with suspected recurrent or metastatic colorectal carcinoma, FDG-PET should be performed (1) when there is rising carcinoembryonic antigen levels in the absence of a known source, (2) to increase the specificity of structural imaging when there is an equivocal lesion, and (3) as a screening method for the entire body in the preoperative staging before curative resection of recurrent disease.

• 대한골관절종양학회지
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• 제4권1호
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• pp.30-36
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• 1998

Squamous cell carcinoma is a neglected disease entity in orthopedic oncology. The purpose of this study was to analyze overall survival and the role of surgery on survival and to evaluate the significance of possible prognostic factors. From Oct, 1986 to Aug, 1996, 57 patients were enlisted and 42 patients ere eligible. Inclusion criteria included more than one year follow-up and no distant metastasis at the first visit. Staging and survival followed AJC classification and Kaplan-Meier plot. Stage II included 17 cases and stage III, 25 cases. Thirty-eight patients underwent operations, chemotherapy, and/or radiotherapy, and the remaining four had operations only. The chemotherapeutic regimen was adriamycin-cisplatin. The average follow-up period was 45 months. The ten-year actuarial survival rate of whole patients was 65.4%. Location of primary lesion, stage, pathologic grading, and intensity of chemotherapy in the same stage showed a significant difference in survival. Nine out of 42 patients had local recurrence. Seven patients had inadequate wide margins and two had intralesional margins. Average period of recurrence from operation was 13(4-35)months. The operation itself had no impact on survival but a surgical margin of no less than 3cm from the lesion was important for local control. Pathological grade and staging were significant variables for long term survival. Acral lesion had a significantly higher chance of regional and distant metastasis but actual survival showed no difference. In stage II, aggressive chemotherapy could delay or reduce the chance of regional or distant metastasis.

• Tuberculosis and Respiratory Diseases
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• 제43권6호
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• pp.894-902
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• 1996

연구배경: Tumor angiogenesis란 종양 내에서 및 종양을 향한 새로운 혈관 증식을 말하는 것으로 암의 중식과 전이의 원인이 되며, 주로 유방암과 전립선암에서 암세포 조직 내에서의 angiogenesls와 전이의 상관관계가 보고되었으며, angiogenesls의 정도가 암의 독립적인 중요한 예후인자로 보고되었다. 본 연구는 폐암 조직에서 anglogenesls의 정도를 측정하여 예후인자로서의 가치를 평가하고자하였다. 방법: 1990년 1월 부터 1994년 12월 까지 이화여대 부속 동대문병원에서 원발성 폐암으로 진단받고 치료성적 및 생존여부를 알고 있는 비소세포폐암(non-small cell lung cancer) 환자의 기관지내시경 조직의 paraffin embedded block을 이용하여 CD31에 대한 antibody인 JC70을 사용하여 면역세포화학적 방법으로 endothelial cell을 염색하였다. 결과: 1) 전체 29예에서 microvessel의 수는 $32.7{\pm}20.8$(9-96)개 였다. 2) Microvessel의 수와 폐암의 조직학적 유형, T staging 간에는 유의한 상관관계가 없었으며, 임파선 전이 (N staging) 및 혈성 전이 (M staging) 와도 관계가 없었다(p>0.05). 3) 대상환자의 평균 추적기간은 15개월(2-46)로 microvessel의 수가 20개 이상인 군(20예)과 이하인(9예) 군으로 나누어 보았을때 1년 생존률 각각 50%, 46%, 2년 생존율 각각 30%, 0%로 유의한 차이가 없었다(p>0.05). 결론: Tumor angiogenesis는 임파선 및 원발 전이의 가능성을 시사하는 중요한 예후 예측인자일 것으로 생각되나 폐암의 기관지내시경 조직검사 조직을 이용하여서 angiogenesis의 정도를 측정하는 것은 조직이 적절하지 못하고 측정이 제한적이었으며, 아직까지는 우리나라에서 폐암에서의 angtogenesls에 관한 연구가 없는 상태로 수술조직을 이용한 더 많은 연구가 필요할 것으로 생각된다.