• Radiation Oncology Journal
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• 제26권4호
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• pp.204-212
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• 2008

목 적: 유방 보존수술 후 방사선 치료를 받은 환자에서 치료의 성적과 무병 생존율 및 재발에 영향을 주는 위험인자에 대해 알아보고자 하였다. 대상 및 방법: 1997년 3월부터 2003년 12월 까지 유방 보존수술 시행 후 방사선 치료를 받은 환자 77명을 대상으로 후향적으로 분석하였다. 추적 관찰 기간의 중앙값은 58.4개월($43.8{\sim}129.4$개월)이었다. 전체 환자의 평균 연령은 41세, 중앙 연령은 40세이었다. 수술 후 조직학적 T 병기는 Tis가 7명, T1 38명(49.3%), T2 28명(36.3%), T3 3명, 미확인이 1명이었다. 액와 림프절 전이가 없는 경우가 52명(67.5%), $1{\sim}3$개 전이가 14명(18.1%), 4개 이상이 3명(0.03%)이었다. 절제연이 음성인 환자는 59명이었고, 2 mm 이내로 근접한 경우는 15명, 양성인 경우는 2명이었다. 방사선치료는 전체 유방에 접사면으로 조사한 후 원발 병소 부위에 전자선으로 추가조사 하여 총 59.4 Gy에서 66.4 Gy를 시행하였다. 액와 림프절의 개수가 4개 이상인 경우에는 액와 림프절과 쇄골 상 림프절을 포함하여 $41.4{\sim}60.4$ Gy를 조사하였다. 항암화학요법은 59명에서 시행되었고, 호르몬 치료로는 tamoxifen 또는 fareston을 사용하였으며 29명에서 시행하였다. 결 과: 5년 생존율은 98.1%이었으며, 5년 무병 생존율은 93.5%이었다. 총 77명의 환자 중 4명(5.2%)의 환자가 재발을 하였다. 1명은 쇄골 상 림프절 재발, 1명은 쇄골 상 림프절과 동시에 다발성 원격전이, 다른 2명은 원격전이가 발견되었다. 원발 병소 주위의 국소 재발은 추적 관찰 기간 중 발견되지 않았다. 림프절 전이 유무나 숫자는 재발이나(p=0.195)무병 생존율(p=0.30)에 영향을 미치지 않았다. 절제연이 양성인 2명 중 1명이 7개월 만에 재발을 하였고, 재발 기간까지 걸린 기간인 무병 생존기간이 통계적으로 의미 있게 짧은 것으로 나타났으며(p<0.0001), 재발 빈도도 절제연이 음성이거나 가까운 경우에 비해서 통계적으로 의미가 있는 것으로 나타났다(p=0.0507). 그러나 절제연이 근접한 경우에는 절제연 음성인 경우와 비교하여 통계적으로 재발 빈도에 차이가 없었다(p=1.000). 재발된 4명은 모두 40세 이하로 9.2%의 재발률을 보인 반면, 40세 이상에서는 재발이 없었으나 두 그룹 간에 통계적으로 유의한 차이는 없었다(p=0.1255). 수술 후 조직학적 T 병기는 T2의 경우 4명(14%)이 재발한 반면, T1에서는 재발이 발견되지 않았으며 통계적으로 유의한 차이를 보였다(p=0.0284). 무병 생존율도 T2 환자의 경우에 통계적으로 의미 있게 낮은 것으로 나타났다(p=0.0379). 무병 생존율에 영향을 미치는 단변량 분석에서 수술 후 조직학적 T 병기, 절제연의 상태, p53 수용체 변이가 통계적으로 의미 있게 나왔다. 결 론: 초기 유방암에서 유방 보존수술 후 방사선치료는 높은 국소제어율과 무병 생존율을 보이는 안전한 치료이다. 절제연 양성, 수술 후 조직학적 T병기, p53 수용체 변이 등은 통계적으로 유의하게 재발 위험이 높은 군에 속하였으며, 무병 생존율에 영향을 미치는 것으로 밝혀졌다.

• Radiation Oncology Journal
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• 제15권4호
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• pp.331-337
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• 1997

목적 : 연세의대 연세암센터에서는 1991년도부터 조기유방암에 대하여 유방보존술을 실시해오고 있으며 본원에서 사용하는 치료방법과 치료에 따르는 부작용 등에 대해서는 이미 보고한 바 있다. 아직 추적 관찰 기간이 짧기 때문에 치료결과를 평가하기는 어려운 시점이지만 치료 후 수년 이내에 재발하는 양상을 알아보고 그에 관련되는 위험인자를 알아봄으로써 본원에서 시행 되고 있는 유방보존술을 중간 점검해 보고자 하였다. 대상 및 방법 : 1991년 1월부터 1994년 12월까지 AJCC 병기 1기, 2기 유방암으로 유방 보존적 수술을 받은 후 연세암센터 방사선종양학과에서 근치적 방사선치료를 받았던 216명의 환자들을 대상으로 하였다. 환자들의 연령 분포는 23세에서 80세로 중앙값이 44세였으며, 40대가 86명$(39.8\%)$, 30대가 73명$(33.8\%)$, 50대가 38명$(17.6\%)$였다. T 병기 별로는 T1이 117명, T2가 99명이었으며 이 중 Tlc와 3cm 이하의 T2가 전체의 $79\%$를 차지하였다. 액와림프절은 73명에서 양성이었다. 따라서 stage 1이 89명$(41.2\%)$, 113가 81명$(37.5\%)$, llb가 46명$(21.3\%)$이었다. 모든 환자들은 유방부분절제술과 액와림프절 곽청술을 시행받은 후 방사선치료를 받았으며 96명의 환자들이 방사선치료 후, 또는 방사선치료 전후에 항암화학요법을 받았다. 추적 기간은 3-60개월로 정중앙 추적기간이 30개월이었다. 결과 : 추적 기간 동안에 19명이 재발하였는데 3명은 국소 재발(true recurrence;1, elsewhere; 1, skin;1)만 있었고 13명은 원격전이만 있었으며, 3명은 국소재발과 원격 전이가 동시에 있었다. 이 외 반대편 유방암이 1예에서 발생하였고, 3예에서 2차 원발암이 발생하였다. 국소 재발을 보인 예들 중, 유방의 피부에서 재발하였던 예는 곧 이어 원격전이를 보였지만, 나머지 2예는 유방전적출술을 받은 후 무병 생존중이다. 원격전이를 보인 예들은 대부분(12/16) 2년 이내에 재발하여 빠르게 진행되어 11명이 사망하였고 원격전이 후 정중앙 생존기간이 8개월이었다. 병기별 5년 생존율은 1기 $96.7\%$, IIa기 $95.2\%$, IIb기 $69.9\%$이었고, 5년 무병생존율은 I기, IIa기, IIb기가 각각 $97.1\%,\;91.7\%,\;59.9\%$이었다. 원격전이에 영향을 주는 인자로는 연령, 1병기, N병기,AJCC stage가 의미 있었으며, 병리학적 유형, 화학요법 여부, 수술절제연 침범 유무는 원격전이에 영향을 주지 못하였다. 결론 : 조기유방암의 유방보존술 후 수년 이내에는 유방내 국소재발은 적으나, 원격전이는 주로 3년이내에 발생하였는데 40세 이하의 젊은 연령층에서, 종양이 클수록, 침범된 액와림프절의 숫자가 많을수록 원격전이율이 높았다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3779-3784
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• 2013

Aims: To determine the clinical, pathological and prognostic features associated with triple-negative breast cancer (TNBC). Methods: Clinical and histologic data of 21,749 breast cancer patients who were treated at Tianjin Medical University Cancer Institute and Hospital between July 2002 and December 2011 were collected. Patients were divided into two groups: those with TNBC and those with other types of breast cancer. Patients and tumor characteristics were compared between the two groups using the Chi-square test. The prognostic results of 9,823 patients in the study population were also analyzed to determine long-term survival rates in the two groups of breast cancer patients. Results: Among the breast cancer patients treated in our hospital between 2003 and 2011, 10.4%-13.5% of them had triple-negative breast cancers. Data analyses revealed significant differences in disease onset age, family history of breast cancer, tumor size, tumor histologic grade, lymph note positivity and metastatic status between TNBC and non-TNBC patients. There were also significant differences in 5-year, 7-year and 9-year disease-free and 7-year and 9-year overall survival probability between the groups. Conclusions:TNBC are associated with younger disease onset age, larger tumor size, higher rate of axillary lymph node positivity, and higher tumor histologic grade. TNBC is also related to family history of breast cancer, increased metastatic risk and poor prognosis.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1197-1201
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• 2012

Objective: To study the relationship between clinical pathologic characteristics, treatment modalities and prognostic factors in HER-2 (Human Epidermal growth factor Receptor-2) overexpressed breast carcinoma. Materials and Methods: Major clinico-pathological factors including therapeutic modalities and survival status of 371 breast cancer patients with HER2 over-expression, teated at Yantai Yuhuangding Hospital from March of 2002 to December of 2010 were retrospectively studied, with special attention focused on survival-related factors. Results: The median age of the total 371 patients in this study was 48 years at time of diagnosis, among which, the leading pathological type was infiltrating ductal carcinoma (92.5%); 62.8% presented with a primary tomor larger than 2 cm in diameter at diagnosis, 51.0% had axillary lymph node (ALN) metastases; ER (Estrogen receptor)/PR (Progesterone receptor) double negative occured in 52.8% of cases, and PCNA (proliferation cell nuclear antigen) (+++) was found in 55.1%. HER-2 overexpressed patients were usually in advanced stage when the diagnosis was made (72.8% at stages IIA~IIIC). The prognosis and survival were assessed in 259 patients with complete follow-up data. 5-year DFS (disease-free survival) and OS (overall survival) rate was 68.0% and 78.0% respectively. Univariate analysis revealed that age, tumor size, ALN metastases, LVSI (lymph-vascular space involvement), PCNA status, hormonal therapy, chemotherapy cycles, and HER-2 overexpression, correlated closely with the prognosis. ALN metastases, LVSI, PCNA status and chemotherapy cycles were independent predictors of survival. Conclusions: HER-2 overexpressed breast cancer has special clinical and pathological characteristics, with advanced clinical stages and high rate of ER/PR double negative. Lymph node metastases, LVSI, PCNA and chemotherapy cycles are independent predictors of prognosis.

• Journal of Chest Surgery
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• 제12권4호
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• pp.424-428
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• 1979

Clinical observation were performed on 25 cases of Mediastinal tumors or Cyst, those were admitted and treated at the Department of Thoracic and Cardiovascular Surgery, Korea University Hospital, during the 6 years period from March 1973 to March 1979. The following results are obtained. Of 25 cases, 19 patients were males and 6 patients were females. Range of age varied widely from 2 years to 72 years. Approximately 28% were younger than 15 years of age at the time of diagnosis. The common subjective symptoms of the patients were anterior chest pain [36%], coughing [27%], dyspnea and a few incidence of hemoptysis. Diagnostic procedures were posteroanterior and lateral chest roentgenorgrams, Chest tomograms, Brochograms, Esophagograms, Mediastinoscopy, Scalene and Axillary Lymph node biopsy, and Needle aspiration biopsy. In the histological distribution on Mediastinal tumors in order of frequency, Neurogenic tumor 6 cases [25%], Lymphoma 5 cases [21%], Bronchogenic cyst 4 cases [17%], Pericardial cyst 2 cases [8.3%], Teratodermoid tumor 2 cases [8.3%], and each one case of Rhabdomyosarcoma, Seminoma, Cavernous hemangioma, Anthracosis, Tuberculoma were noted respectively. Of 24 cases of the histologically confirmed Mediastinal tumors, 6 cases [24%] were malignant. Thoracotomy for removal of tumor or cyst was performed on 17 cases and offered cure of all benign tumors. In 6 cases of malignant tumors, Chemotherapy with Vincristine, Cyclophosphamide and Prednisolone was given to 1 case Lymphoma. There was no case of postoperative mortality.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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• pp.4847-4849
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• 2014

A compariosn was made of survival outcomes of oncoplastic breast conserving therapy (oBCT) with nipple-areolar (NAC) preservation in women with centrally located breast cancer (CLBC) undergoing modified radical mastectomy (MRM) in China in a matched retrospective cohort study. We used a database including patients who received oBCT (n=91) or MRM (n=182) from 2003 to 2013 in our hospital. Matching was conducted according to five variables: age at diagnosis, axillary lymph node status, hormone receptor status, human epidermal growth factor-like receptor 2 status (HER-2) and tumor stage. The match ratio was 1:2. Median follow-up times for the oBCT and MRM groups were 83 and 81 months, respectively. There were no significant differences in 87-month overall, local, or distant recurrence-free survival between patients with oBCT and MRM (89%vs.90%; 93%vs.95%; 91%vs.92%;). For appropriate breast cancer patients, oBCT for CLBC is oncologically safe, oncoplastic techniques improving cosmetic outcomes.

• Radiation Oncology Journal
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• 제32권4호
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• pp.262-265
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• 2014

Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.

• BMB Reports
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• 제49권5호
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• pp.293-296
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• 2016

The immunoregulatory cytokine Interleukin 10 (IL-10) protein is produced by various cells during the course of inflammatory disorders. Mainly, it downregulates pro-inflammatory cytokines, antigen presentation, and helper T cell activation. In this study, we show that the ratio of IL-10-producing cells was significantly increased in lineage negative (i.e., not T, B, or leukocyte cell lineages) cells than in lineage positive cells in lymphoid and peripheral tissues. We further observed that IL-10-producing innate lymphoid cells (ILCs), here called firstly ILC10, were increased in number in oxazolone-induced contact hypersensitivity (CHS) mice. In detail, IL-10-producing lineage negative cells were elevated in the axillary, inguinal lymph node, and ear tissues of CHS mice. Notably, the cells expressed classical ILC marker proteins such as CD45, CD127, and Sca-1. Altogether, our findings suggest for the first time that ILC10s are present in various physiological settings and could be involved in numerous immune responses as regulatory cells.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.4-10
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• 2015

Mammary implants marketed by Poly Implant Proth$\grave{e}$se (PIP) were found to contain industrial grade silicone and this caused heightened anxiety and extensive publicity regarding their safety in humans. These implants were used in a large number of patients worldwide for augmentation or breast reconstruction. We reviewed articles identified by searches of Medline, PubMed, Embase, and Google Scholar databases up to May 2014 using the terms: "PIP", "Poly Implant Proth$\grave{e}$se", "breast implants" and "augmentation mammoplasty" "siloxanes" or "silicone". In addition the websites of regulating bodies in Europe, USA, and Australia were searched for reports related to PIP mammary implants. PIP mammary implants are more likely to rupture than other implants and can cause adverse effects in the short to the medium term related to the symptoms of rupture such as pain, lumps in the breast and axilla and anxiety. Based on peer-reviewed published studies we have calculated an overall rupture rate of 14.5% (383/2,635) for PIP implants. However, there is no evidence that PIP implant rupture causes long-term adverse health effects in humans so far. Silicone lymphadenopathy represents a foreign body reaction and should be treated conservatively. The long-term adverse effects usually arise from inappropriate extensive surgery, such as axillary lymph node dissection or extensive resection of breast tissue due to silicone leakage.

• Archives of Plastic Surgery
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• 제46권1호
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• pp.79-83
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• 2019

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.