• 고신대학교 의과대학 학술지
• /
• 제33권3호
• /
• pp.289-296
• /
• 2018

Objectives: In these days, patients with stage I breast cancer have increased by regular health examination and diagnostic tool development. The aim of this retrospective study is to identify systemic recurrence related factors after breast conserving surgery (BCS) for stage I breast cancer. Methods: In this study, we analyzed the correlation between systemic recurrence and pathologic factors. We reviewed 223 patients who underwent BCS for stage I breast cancer. Postoperative pathologic factors, recurrent rates and sites were studied. In addition, preoperative patients'data were also collected. Statistical analysis was done by using PASW 16.0 (SPSS Inc., Chicago, IL, USA). Results: Systemic recurrence was found in 16 patients (7.17%) within 5 years after primary surgery. 5 patients had lymphatic invasion and 6 patients had vascular invasion. Lymphatic and vascular invasion had statistical correlation with systemic recurrence (P = 0.004, P = 0.001). Conclusions: In this retrospective study, we can conclude that vascular invasion and lymphatic invasion are related systemic recurrence after BCS for stage I patients. Further studies with large cohort will be required to fully understand the risk factors of systemic recurrence for stage I breast cancer patients.

• Journal of Gastric Cancer
• /
• 제14권4호
• /
• pp.252-258
• /
• 2014

Purpose: The macroscopic diagnosis of tumor invasion through the serosa during surgery is not always distinct in patients with gastric cancer. The prognostic impact of the difference between macroscopic findings and pathological diagnosis of serosal invasion is not fully elucidated and needs to be re-evaluated. Materials and Methods: A total of 370 patients with locally advanced pT2 to pT4a gastric cancer who underwent curative surgery were enrolled in this study. Among them, 155 patients with pT3 were divided into three groups according to the intraoperative macroscopic diagnosis of serosal invasion, as follows: serosa exposure (SE)(-) (no invasion, 72 patients), SE(${\pm}$) (ambiguous, 47 patients), and SE(+) (definite invasion, 36 patients), and the clinicopathological features, surgical outcomes, and disease-free survival (DFS) were analyzed. Results: A comparison of the 5-year DFS between pT3_SE(-) and pT2 groups and between pT3_SE(+) and pT4a groups revealed that the differences were not statistically significant. In addition, in a subgroup analysis of pT3 patients, the 5-year DFS was 75.1% in SE(-), 68.5% in SE(${\pm}$), and 39.4% in SE(+) patients (P<0.05). In a multivariate analysis to evaluate risk factors for tumor recurrence, macroscopic diagnosis (hazard ratio [HR], SE(-) : SE(${\pm}$) : SE(+)=1 : 1.01 : 2.45, P=0.019) and lymph node metastasis (HR, N0 : N1 : N2 : N3=1 : 1.45 : 2.20 : 9.82, P<0.001) were independent risk factors for recurrence. Conclusions: Gross inspection of serosal invasion by the surgeon had a strong impact on tumor recurrence in gastric cancer patients. Consequently, the gross appearance of serosal invasion should be considered as a factor for predicting patients' prognosis.

• Journal of Gynecologic Oncology
• /
• 제29권6호
• /
• pp.97.1-97.12
• /
• 2018

Objective: Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods: The National Cancer Database was queried for patients ${\geq}70$ years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

• Journal of Gastric Cancer
• /
• 제6권2호
• /
• pp.84-90
• /
• 2006

목적: TNM 분류법의 임상적 분류법과 병리학적 분류법은 항상 일치하지는 않는다. 진행성 위암의 육안적 침윤정도 특히 육안적 장막침윤의 의의를 파악하고, 육안적 침윤정도와 병리학적 침윤정도의 일치율을 높일 수 있는 방안을 모색하고자 하였다. 대상 및 방법: 1995년부터 1999년까지 경북대학교병원 외과에서 진행성 위암으로 수술 받은 789명의 환자를 대상으로 하였다. 육안적 및 병리학적 장막침윤 여부에 따른 환자의 예후와 재발양상을 분석하고 육안적 장막침윤과 병리학적 장막침윤이 일치하지 않는 경우는 이에 영향을 주는 인자를 찾았다. 결과: 병리학적 장막침윤에 따른 예후뿐 아니라 육안적 장막침윤에 따른 예후도 유의한 차이를 나타내었다. 육안적 장막침윤이 있는 경우의 42.2%와 병리학적 장막침윤이 있는 경우의 41.4%에서 재발하였으며, 복막재발의 빈도는 19.8% 및 21.9%로 비슷하였다. 육안적 장막침윤 판정의 민감도는 70.3%, 특이도는 77.0%, 양성예측도는 56,4%, 음성 예측도는 86.5%이었다 cT3/ss cancer와 cT3/se cancer와의 비교에서 원격전이 유무 및 육안적 형태에 따라서 유의한 차이를 나타내었고, 다변량 분석에서 두 변수 모두 cT3 cancer가 병리학적으로 ss cancer로 판정될 위험 인자이었다. 결론: 종양이 Borrmann I형이나 II형인 경우와 원격 전이가 없는 경우에는 육안적으로 장막침윤이 있더라도 병리학적으로는 장막침윤이 없을 가능성이 있기 때문에 주의를 요하지만, 위암의 육안적 장막침윤 여부는 환자의 생존율과 근치적 수술 후의 재발양상을 잘 반영하기 때문에 종양학적 가치가 충분하다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권2호
• /
• pp.497-501
• /
• 2016

Aim: To evaluate the relationship between pre-operative CA-125 levels and myometrial invasion in patients with early-stage endometrioid-type endometrial cancer. Materials and Methods: Two-hundred and sixty patients were diagnosed with endometrial cancer between January 2007 and December 2012. Of these, 136 patients with stage 1 endometrioid histologic-type and documented pre-operative serum CA-125 levels were included in the study. Age, preoperative CA-125 level, histologic grade, surgical grade, and presence of deep myometrial invasion were recorded. Additionally, 16, 20, and 35 IU/ml cutoff values were used and compared to evaluate the relationship between pre-operative CA-125 levels and myometrial invasion. Results: The average serum CA-125 level was $35.4{\pm}36.7$ in patients with deep myometrial invasion, and $21.5{\pm}35.8$ in cases without deep myometrial invasion. The relationship between the presence of deep myometrial invasion and CA-125 cut-off values (16, 20, 35 IU/ml) was statistically significant, although the correlation was weak (p<0.05). When the relationship between 16, 20 and 35 IU/ml CA-125 cut-off values and the presence of deep myometrial invasion was studied, specifity and sensitivity values were identified as: 0.60-0.68 for 16 IU/ml; 0.73-0.48 for 20 IU/ml; and 0.89-0.33 for 35 IU/ml. The sensitivity of 16 IU/ml cut-off value was higher when compared to other values. Conclusions: This study demonstrates that preoperative serum CA-125 values maybe used as a predictive test in patients with early stage endometrioid-type endometrium cancer, and as a prognostic factor alone. Further studies should be conducted to identify different CA-125 cut-off values in patients with low risk endometrial cancer.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권3호
• /
• pp.1489-1492
• /
• 2016

Background: Although there are no biomarkers that are routinely used in endometrial cancer (EC) management, many studies have found that serum human epididymis protein 4 (HE4) is superior to cancer antigen 125 (CA125) in the detection of EC. The correlation of HE4 with two prognostic factors for EC, primary tumor diameter (PTD) and depth of myometrial invasion (DMI) may be useful in identifying EC patients at high risk of lymphatic dissemination. Objective: To evaluate the correlation of serum HE4 with PTD and DMI in patients with EC. Materials and Methods: A cross-sectional study was conducted on 70 EC patients who were scheduled for elective surgery at Rajavithi Hospital between 1st September 2013 and 30th May 2014. Preoperative serum levels of HE4 and CA125 were investigated, and then gross measurement of PTD was taken and postoperative pathologic slides were reviewed for DMI including histologic types, grading and staging. Results: Preoperative serum HE4 levels were strongly correlated with PTD (r=0.65, p<0.001) and moderately correlated with DMI (r=0.46, p<0.001). Moreover, serum HE4 levels were significantly elevated in EC patients with PTD >2 cm (p<0.001) and DMI > 50% (p=0.004). The performance of serum HE4 in identifying EC patients at low risk and high risk of lymph node metastasis was significantly better than that of CA125 (AUC 0.88 vs. 0.65, p=0.003). At an optimal cut-off value of 70 pM/L, serum HE4 had a sensitivity of 83.3% and a specificity of 80.0%. Conclusions: In EC patients, preoperative serum HE4 is significantly correlated with PTD and DMI. Serum HE4 levels could be useful in identifying endometrial cancer patients at high risk of lymphatic spread who would benefit from systemic lymphadenectomy at the cut-off value of 70 pM/L.

• 대한두경부종양학회지
• /
• 제25권2호
• /
• pp.132-137
• /
• 2009

Purpose : For the past 10 years, the incidence of thyroid cancer has been rapidly increased in female population showing current incidence of 12,000 new thyroid cancer patients annually in Korea. Though differentiated thyroid cancer is known to show favorable prognosis and excellent long-term survival from slow growth and late distant metastasis, we re-evaluated prognostic factors of recurrence and mortality following surgical procedures based on our cases. Material and Methods : 954 Patients of DTC surgically treated at Department of Surgery, Inje University Busan Paik Hospital between 1980 and 2004 were reviewed in the aspects of the surgical procedures, clinical staging, risk factors, recurrence and their outcome through median follow-up period of 10.5 years. Results : Recurrence in remnant thyroid, cervical nodes, and distant metastasis were observed in 84 paients(8.8%), and 31 patients were confirmed to be died of locoregional recurrence of cancer and distant metasasis. Regarding the risk factors to recurrence, tumor size, extrathyroidal extension, nodal metastasis, and capsular invasion were significant predictors(p<0.05). Local recurrence and distant metastasis had no statistical signiicance according to age, sex, pathology, surgery, and lymphovascular invasion. Overall 10-year survival rate was 92.4%, but low, intermediate, and high-risk patient showed 100%, 94.4%, and 70.5% respectively. Conclusion : The significant factors influencing local recurrence and distant metastasis were tumor size, extrathyroidal exension, LN metastasis, capsular invasion. In order to improve survival rate of high-risk group, appropriate and aggressive management should be recommended.

• Journal of Gastric Cancer
• /
• 제1권2호
• /
• pp.119-123
• /
• 2001

Purpose: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over $90\%$. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. Materials and Methods: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. Results: Lymph node metastasis was observed in 26 patients ($11.7\%$), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was $4.4\%$, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. Conclusion: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery. (J Korean Gastric Cancer Assoc 2001;1:119-123)

• 대한두경부종양학회지
• /
• 제23권2호
• /
• pp.138-141
• /
• 2007

Objectives : Well differentiated thyroid carcinoma(WDTC) has relatively good prognosis. But recurrence is associated with increased morbidity and mortality, and always results in reoperation. So it is important to evaluate the risk factors relative to the recurrence. The aim of this study is to evaluate the risk factors of recurrence. Materials and Method : Two hundred seventeen patients who had undergone thyroidectomy and proved as WDTC from January 1999 to December 2004 was included in the study. We reviewed patient-related and tumorrelated factors respectively and analyzed the correlation with tumor recurrence. Results : Fourteen patients from two hundreds seventeen had recurred. Recurrence rate was 6.5%, and average interval of recurrence was 28 month. Male, age over 45, multiple mass, and advanced TMN stage patient group show higher recurrence rate, but no statistical significance. However, the recurrence rate of lymph node metastasis, tumor size>1.5cm, and extracapsular invasion group were statistically high. Conclusion : Lymph node metastasis, tumor size and extracapsular invasion are significant risk factors related to the recurrence of WDTC.

• Journal of Gastric Cancer
• /
• 제24권2호
• /
• pp.172-184
• /
• 2024

Purpose: The original eCura system was designed to stratify the risk of lymph node metastasis (LNM) after endoscopic resection (ER) in patients with early gastric cancer (EGC). We assessed the effectiveness of a modified eCura system for reflecting the characteristics of undifferentiated-type (UD)-EGC. Materials and Methods: Six hundred thirty-four patients who underwent non-curative ER for UD-EGC and received either additional surgery (radical surgery group; n=270) or no further treatment (no additional treatment group; n=364) from 18 institutions between 2005 and 2015 were retrospectively included in this study. The eCuraU system assigned 1 point each for tumors >20 mm in size, ulceration, positive vertical margin, and submucosal invasion <500 ㎛; 2 points for submucosal invasion ≥500 ㎛; and 3 points for lymphovascular invasion. Results: LNM rates in the radical surgery group were 1.1%, 5.4%, and 13.3% for the low-(0-1 point), intermediate- (2-3 points), and high-risk (4-8 points), respectively (P-fortrend<0.001). The eCuraU system showed a significantly higher probability of identifying patients with LNM as high-risk than the eCura system (66.7% vs. 22.2%; McNemar P<0.001). In the no additional treatment group, overall survival (93.4%, 87.2%, and 67.6% at 5 years) and cancer-specific survival (99.6%, 98.9%, and 92.9% at 5 years) differed significantly among the low-, intermediate-, and high-risk categories, respectively (both P<0.001). In the high-risk category, surgery outperformed no treatment in terms of overall mortality (hazard ratio, 3.26; P=0.015). Conclusions: The eCuraU system stratified the risk of LNM in patients with UD-EGC after ER. It is strongly recommended that high-risk patients undergo additional surgery.