• 생명과학회지
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• 제29권4호
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• pp.499-508
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• 2019

암줄기세포는 전이와 재발의 주요한 요인이 되는 자가재생능력, 분화할 수 있는 능력, 치료에 대한 저항성 및 암 형성 능력의 특성을 가진다. WNT/${\beta}$-catenin, Hedgehog, Notch, BMI1, BMP 및 TGF-${\beta}$와 같은 암줄기세포의 특성을 획득 및 유지할 수 있는 신호기전의 연구 결과가 존재하지만, 현재까지 선택적으로 암줄기세포를 표적할 수 있는 치료 전략은 미미하다. 최근, 면역관문억제제인 CTLA-4, PD-1/PD-L1 단일클론항체는 흑색종, 폐암, 췌장암 및 혈액암에 괄목할만한 임상 시험 결과를 나타냈으며, 긴 항암지속효과와 적은 부작용은 기존 항암제보다 개선 된 모습을 보였다. 또한 두경부편평상피암, 흑색종, 유방암 줄기세포를 선택적으로 제거 하였다. 위의 결과를 종합하면, 면역관문억제제는 이전 항암제에 비해 효과적인 항암전략이며, 동시에 암줄기세포를 선택적으로 제거할 수 있는 가능성을 시사한다. 따라서 본 리뷰에서는 암줄기세포와 면역관문억제제의 이해를 통해, 면역관문억제제의 암줄기세포 표적 가능성에 대해 고찰하고자 한다.

• 구강회복응용과학지
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• 제37권4호
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• pp.281-293
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• 2021

상악골 절제술을 받은 환자는 구개부의 결손으로 인해 연하, 저작, 발음 기능이 심각하게 손상되는데, 식사 시 비강과 코를 통한 누출이 있게 되고, 치아 및 치조제의 소실로 저작이 어려워지며, 구강과 비강이 분리되지 않아 과비음이 발생하는 등 삶의 질이 현저히 저하된다. 결손부를 보철적으로 재건하기 위해서는 폐색장치의 무게를 최대한 줄여 중력에 의한 탈락을 최소화하고, 폐색장치의 bulb를 결손부 내로 적절히 연장시켜 부가적인 유지, 안정을 얻도록 해야 한다. 본 증례는 종양의 재발로 인해 추가적인 상악골 절제를 받은 부분 무치악 환자에서 가철성 국소의치의 기본적인 설계 원칙을 적용하여 금속 구조물을 디자인하고, 기능 인상을 통해 유지, 안정, 지지를 향상시킨 폐색장치를 제작하였다. 환자는 개선된 안모 및 저작, 연하, 발음 기능 향상에 만족하였고, 경과관찰 기간 동안 안정적인 교합 및 구강위생관리를 보여 이를 보고하는 바이다.

• Journal of Digestive Cancer Research
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• 제2권2호
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• pp.75-77
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• 2014

전이성 십이지장 유두암에서 정립된 치료 지침은 아직 없다. 본 증례에서 간 전이 및 국소 림프절 전이가 있는 십이지장 유두암에 대해 단계적 치료를 시행하였다. 원발 부위 종양의 크기를 감소시키고 전이성 병변에 대한 치료를 위해 gemcitabine과 cisplatin 병합 항암화학요법을 시행하였다. 항암화학요법 후 시행한 반응 평가 상에서 원발 병소의 크기가 감소되었고, 추가적으로 전이성 병변이 발생하지 않았음을 확인하고, 내시경적 유두부 절제술로 원발 부위를 국소적으로 제거하였다. 진단 후 12개월 동안 항암화학요법 치료를 시행하였으며, 이 기간 동안 영상학적으로 완전 관해를 유지할 수 있었다. 이후 PPPD 및 Intraoperative RFA를 시행하였으며, 수술 후 병리 소견 상 11개의 국소 림프절 중 1개에서 암세포가 발견되었으나, 원발 부위에서 암은 발견되지 않았다. 환자는 수술 후 7개월째 재발 소견 없이 외래 추적 관찰 중이다. 본 증례의 경우 항암화학요법과 내시경적 유두부 절제술, 그리고 PPPD 및 intraoperative RFA를 통하여 완전 관해를 유도할 수 있었다. 이런 단계적 접근법이 전이성, 국소 진행성 십이지장 유두암에서 생존율 향상을 유도할 수 있을 것으로 사료되어, 이를 증례 보고한다.

• Korean Journal of Radiology
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• 제22권12호
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• pp.1974-1984
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• 2021

Objective: This study aimed to compare the efficacy between no-touch (NT) radiofrequency ablation (RFA) and conventional RFA using twin internally cooled wet (TICW) electrodes in the bipolar mode for the treatment of small hepatocellular carcinomas (HCC). Materials and Methods: In this single-center, two-arm, parallel-group, prospective randomized controlled study, we performed a 1:1 random allocation of eligible patients with HCCs to receive NT-RFA or conventional RFA between October 2016 and September 2018. The primary endpoint was the cumulative local tumor progression (LTP) rate after RFA. Secondary endpoints included technical conversion rates of NT-RFA, intrahepatic distance recurrence, extrahepatic metastasis, technical parameters, technical efficacy, and rates of complications. Cumulative LTP rates were analyzed using Kaplan-Meier analysis and the Cox proportional hazard regression model. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat and as-treated analyses were performed. Results: Enrolled patients were randomly assigned to the NT-RFA group (37 patients with 38 HCCs) or the conventional RFA group (36 patients with 38 HCCs). Among the NT-RFA group patients, conversion to conventional RFA occurred in four patients (10.8%, 4/37). According to intention-to-treat analysis, both 1- and 3-year cumulative LTP rates were 5.6%, in the NT-RFA group, and they were 11.8% and 21.3%, respectively, in the conventional RFA group (p = 0.073, log-rank). In the as-treated analysis, LTP rates at 1 year and 3 years were 0% and 0%, respectively, in the NT-RFA group sand 15.6% and 24.5%, respectively, in the conventional RFA group (p = 0.004, log-rank). In as-treated analysis using multivariable Cox regression analysis, RFA type was the only significant predictive factor for LTP (hazard ratio = 0.061 with conventional RFA as the reference, 95% confidence interval = 0.000-0.497; p = 0.004). There were no significant differences in the procedure characteristics between the two groups. No procedure-related deaths or major complications were observed. Conclusion: NT-RFA using TICW electrodes in bipolar mode demonstrated significantly lower cumulative LTP rates than conventional RFA for small HCCs, which warrants a larger study for further confirmation.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1786-1796
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• 2021

Objective: To evaluate the prognostic implications of preoperative magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) with a focus on those with targetoid appearance based on the Liver Imaging Reporting and Data System (LI-RADS), as well as known microvascular invasion (MVI) features. Materials and Methods: This retrospective study included 242 patients (190 male; mean age, 57.1 years) who underwent surgical resection of a single HCC (≤ 5 cm) as well as preoperative gadoxetic acid-enhanced MRI between January 2012 and March 2015. LI-RADS category was assigned, and the LR-M category was further classified into two groups according to rim arterial-phase hyperenhancement (APHE). The imaging features associated with MVI were also assessed. The overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated. Results: Among the 242 HCCs, 190 (78.5%), 25 (10.3%), and 27 (11.2%) were classified as LR-4/5, LR-M with rim APHE, and LR-M without rim APHE, respectively. LR-M with rim APHE (vs. LR-4/5; hazard ratio [HR] for OS, 5.48 [p = 0.002]; HR for RFS, 2.09 [p = 0.042]) and tumor size (per cm increase; HR for OS, 6.04 [p = 0.009]; HR for RFS, 1.77 [p = 0.014]) but not MVI imaging features (p > 0.05) were independent factors associated with OS and RFS. Compared to the 5-year OS and RFS rates in the LR-4/5 group (93.9% and 66.8%, respectively), the LR-M with rim APHE group had significantly lower rates (68.0% and 45.8%, respectively, both p < 0.05), while the LR-M without rim APHE group did not significantly differ in the survival rates (91.3% and 80.2%, respectively, both p > 0.05). Conclusion: Further classification of LR-M according to the presence of rim APHE may help predict the postoperative prognosis of patients with a single HCC.

• Korean Journal of Radiology
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• 제22권4호
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• pp.652-662
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• 2021

Objective: To investigate the association between CT imaging features and survival outcomes in patients with primary invasive mucinous adenocarcinoma (IMA). Materials and Methods: Preoperative CT image findings were consecutively evaluated in 317 patients with resected IMA from January 2011 to December 2015. The association between CT features and long-term survival were assessed by univariate analysis. The independent prognostic factors were identified by the multivariate Cox regression analyses. The survival comparison of IMA patients was investigated using the Kaplan-Meier method and propensity scores. Furthermore, the prognostic impact of CT features was assessed based on different imaging subtypes, and the results were adjusted using the Bonferroni method. Results: The median follow-up time was 52.8 months; the 5-year disease-free survival (DFS) and overall survival rates of resected IMAs were 68.5% and 77.6%, respectively. The univariate analyses of all IMA patients demonstrated that 15 CT imaging features, in addition to the clinicopathologic characteristics, significantly correlated with the recurrence or death of IMA patients. The multivariable analysis revealed that five of them, including imaging subtype (p = 0.002), spiculation (p < 0.001), tumor density (p = 0.008), air bronchogram (p < 0.001), emphysema (p < 0.001), and location (p = 0.029) were independent prognostic factors. The subgroup analysis demonstrated that pneumonic-type IMA had a significantly worse prognosis than solitary-type IMA. Moreover, for solitary-type IMAs, the most independent CT imaging biomarkers were air bronchogram and emphysema with an adjusted p value less than 0.05; for pneumonic-type IMA, the tumors with mixed consolidation and ground-glass opacity were associated with a longer DFS (adjusted p = 0.012). Conclusion: CT imaging features characteristic of IMA may provide prognostic information and individual risk assessment in addition to the recognized clinical predictors.

• Korean Journal of Radiology
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• 제22권2호
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• pp.159-167
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• 2021

Objective: The aim of this study was to compare the survival rates of Korean females aged 40 to 49 years with breast cancer detected by supplemental screening ultrasound (US) or screening mammography alone. Materials and Methods: This single-institution retrospective study included 240 patients with breast cancer (mean age, 45.1 ± 2.8 years) detected by US or mammography who had undergone breast surgery between 2003 and 2008. Medical records were reviewed for clinicopathologic characteristics and detection methods. Disease-free survival (DFS) and overall survival (OS) were compared between patients with breast cancer in the US and mammography groups using the log-rank test. Multivariable cox regression analysis was used to identify independent variables associated with DFS and OS. Results: Among the 240 cases of breast cancer, 43 were detected by supplemental screening US and 197 by screening mammography (mean follow-up: 7.4 years, 93.3% with dense breasts). There were 19 recurrences and 16 deaths, all occurring in the mammography group. While the US group did not differ from the mammography group in tumor stage, the patients in this group were more likely to undergo breast-conserving surgery and radiation therapy than the mammography group. The US group also showed better DFS (p = 0.016); however, OS did not differ between the two groups (p = 0.058). In the multivariable analysis, the US group showed a lower risk of recurrence (hazard ratio, 0.097; 95% confidence interval, 0.001-0.705) compared to the mammography group. Conclusion: Our study found that Korean females aged 40-49 years with US-detected breast cancer showed better DFS than those with mammography-detected breast cancer. However, there were no statistically significant differences in OS.

• Korean Journal of Radiology
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• 제22권2호
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• pp.179-188
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• 2021

Objective: This study aimed to prospectively compare the efficacy, safety, and mid-term outcomes of dual-switching monopolar (DSM) radiofrequency ablation (RFA) to those of conventional single-switching monopolar (SSM) RFA in the treatment of hepatocellular carcinoma (HCC). Materials and Methods: This single-center, two-arm, parallel-group, randomized controlled study was approved by the Institutional Review Board. Written informed consent was obtained from all patients upon enrollment. A total of 80 patients with 94 HCC nodules were randomized into either the DSM-RFA group or SSM-RFA group in a 1:1 ratio, using a blocked randomization method (block size 2). The primary endpoint was the minimum diameter of the ablation zone per unit time. The secondary endpoints included other technical parameters, complication rate, technique efficacy, and 2-year clinical outcomes. Results: Significantly higher ablation energy per unit time was delivered to the DSM-RFA group than to the SSM-RFA group (1.7 ± 0.2 kcal/min vs. 1.2 ± 0.3 kcal/min; p < 0.001). However, no significant differences were observed between the two groups for the analyzed variables, including primary endpoint, regarding size of the ablation zone and ablation time. Major complication rates were 4.9% in the DSM-RFA group and 2.6% in the SSM-RFA group (p = 1.000). The 2-year local tumor progression (LTP) rates of the HCC nodules treated using DSM-RFA and SSM-RFA were 8.5% and 4.7%, respectively (p = 0.316). The 2-year LTP-free survival rates of patients in the DSM-RFA and SSM-RFA groups were 90.0% and 94.4%, respectively (p = 0.331), and the 2-year recurrence-free survival rates were 54.9% and 75.7%, respectively (p = 0.265). Conclusion: Although DSM-RFA using a separable clustered electrode delivers higher ablation energy than SSM-RFA, its effectiveness failed to show superiority over SSM-RFA in the treatment of HCC.

• 대한영상의학회지
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• 제82권4호
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• pp.994-999
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• 2021

수술 이후 10년 이상이 경과된 후 발생하는 후발성 전이와 더불어 기관지 내 전이는 신세포암의 특징적인 소견이다. 본 증례 보고는 신절제술 20년 후에 세분절 기관지에서 발생한 신세포암의 단일성 기관지 내 전이의 사례를 보고하고 문헌을 고찰하고자 한다. 71세의 남자가 폐렴을 주소로 병원에 입원하였다. 흉부 단순촬영에서 우하폐야의 다발성 결절성 병변을 보여 흉부 컴퓨터단층사진을 촬영하였고 우폐의 염증성 침윤과 함께 우하엽에 4.3 cm 크기의 경계가 좋은 길쭉한 고형성 종괴를 발견하였다. 포함된 상복부에 우측 신절제술의 흔적으로 20년 전에 투명 신세포암으로 우측 신장 절제술을 받았던 기왕력을 확인하였다. 병변은 폐우하엽 절제술로 제거하였고, 병리학적으로 기관지 내 전이성 투명신세포암으로 진단되었다. 신세포암의 병력이 있다면 절제술 후 수십 년이 지난 후라도 기관지 내 종양에 대하여 신세포암의 기관지 내 전이 가능성을 고려하여야 한다.

• 대한영상의학회지
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• 제82권4호
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• pp.903-913
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• 2021

목적 악성 종양의 완전 관해 후 발생한 흉강 내 림프절병증 환자에서 사르코이드증 유사 반응을 시사할 수 있는 영상의학적 특징을 알아보고자 한다. 대상과 방법 이 연구는 악성 종양의 완전 관해 상태에서 발생한 조직병리학적으로 확인된 사르코이드증 유사 반응을 보인 5명의 환자의 임상적 특징과 CT 및 ¹⁸F-fluorodeoxyglucose(이하 FDG) PET/CT 소견을 분석하였다. 결과 기저 악성 종양으로는 유방암, 비인두암, 자궁내막암 및 림프종이 포함되며. 악성 종양의 완전 관해와 사르코이드증 유사 반응 진단 사이의 시간 간격은 6~78개월이었다. CT 소견으로는 양측 폐문 및 종격동 림프절병증(n = 5), 기관지혈관주위, 엽간열주위 또는 흉막하 폐결절(1~15 mm) 및 소엽내 간질비후가 포함되었다(n = 4). ¹⁸F-FDG PET/CT는 흉강 외 FDG 흡수 없이 양측 폐문 및 종격동 림프절의 대사항진을 나타냈다(n = 3). 모든 환자에서 코르티코스테로이드 치료 후 사르코이드증 유사 반응이 호전되었다. 결론 악성 종양의 완전 관해를 달성한 환자에서, 원발성 종양의 재발과 흉강 외 원격 전이 없는 상태에서 새로 발견된 양측 폐문 및 종격동 림프절병증은 림프관주위 폐결절의 유무에 관계없이 사르코이드증 유사 반응의 가능성을 시사할 수 있으며 불필요한 전신 화학요법을 예방하기 위해 림프절의 조직병리학적 확인이 필요하다.