• Journal of Gastric Cancer
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• 제5권2호
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• pp.113-119
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• 2005

목적: 표준화된 술식으로 위절제술을 시행한 위암 환자를 대상으로 임상병리학적 특성, 특히 암세포의 림프관, 정맥 및 신경 침범 유무가 환자의 예후에 미치는 영향을 확인 하고자 하였다. 대상 및 방법: 1995년 1월부터 1999년 12월까진 만 5년간 영남대학교 의과대학 부속병원 외과에서 위암으로 진단되어 위절제를 시행받은 1,018명의 의무기록을 토대로 후향적 연구를 시행하였다. 통계는 chi-dquare test를 이용하고 예후 인자들은 Cox proportional hazards regression model을 사용한 다변량 분석을 통해 분석하였다. 생존율은 Kaplan-Meier 방법으로 5년 생존율을 구하고 log-rank test로 검정하였다. 유의 수준은 P < 0.05를 기준으로 하였다. 통계처리는 SPSS for Windows (Version 10.0, SPSS lnc, USA) 프로그램을 이용하였다. 결과: 각 임상병리학적 특성에 대한 단변량 분석 결과, 환자의 연령, 종양의 크기 및 위치, Borrmann형, 조직 분화도, 위절제술의 범위, 암의 위벽 침윤도, 림프절 전이 정도, 병기, 원격 전이 유무, 수술의 근치도 등이 유의하였으며, 이상의 유의한 인다들을 다변량 분석한 결과 암의 위벽 침윤도, 림프절 전이, 림프관 침범, 신경 침범 및 수술의 근치도가 독립적 예후 인자로서 유의하였다. 결론: 기존의 TNM 병기 분류법이 병의 진행 상태를 객관적으로 표현할 수 있고 기본적인 예후 인자로서 역할을 하지만, 병리조직학적 검사 소견에서 림프관 및 신경 침범 유무를 확인하는 것은 위암의 예후 판정에 추가적인 정보를 제공할 수 있을 것으로 기대한다.

• Journal of Gastric Cancer
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• 제12권4호
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• pp.210-216
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• 2012

Purpose: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph nodepositive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (${\geq}59$, hazard ratio, 2.882), and carcinoembryonic antigen level (${\geq}5$ ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.161-166
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• 2016

Purpose: Lymph node (LN) metastasis is the best prognostic indicator in non-distant metastatic advanced gastric cancer. This study aimed to assess the prognostic value of various clinicopathologic factors in node-negative advanced gastric cancer. Materials and Methods: We retrospectively analyzed the clinical records of 254 patients with primary node-negative stage T2~4 gastric cancer. These patients were selected from a pool of 1,890 patients who underwent radical resection at Memorial Jin-Pok Kim Korea Gastric Cancer Center, Inje University Seoul Paik Hospital between 1998 and 2008. Results: Of the 254 patients, 128 patients (50.4%), 88 patients (34.6%), 37 patients (14.6%), and 1 patient (0.4%) had T2, T3, T4a, and T4b tumors, respectively. In a univariate analysis, operation type, T-stage, venous invasion, tumor size, and less than 15 LNs significantly correlated with tumor recurrence and cumulative overall survival. In a multivariate logistic regression analysis, tumor size, venous invasion, and less than 15 LNs significantly and independently correlated with recurrence. In a multivariate Cox proportional hazards analysis, tumor size (hazard ratio [HR]: 2.926; 95% confidence interval [CI]: 1.173~7.300; P=0.021), venous invasion (HR: 3.985; 95% CI: 1.401~11.338; P=0.010), and less than 15 LNs (HR: 0.092; 95% CI: 0.029~0.290; P<0.001) significantly correlated with overall survival. Conclusions: Node-negative gastric cancers recurred in 8.3% of the patients in our study. Tumor size, venous invasion, and less than 15 LNs reliably predicted recurrence as well as survival. Aggressive postoperative treatments and timely follow-ups should be considered in cases with these characteristics.

• Molecules and Cells
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• 제40권5호
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• pp.346-354
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• 2017

Long interspersed nuclear element-1 (LINE-1) is a retrotransposon that contains a CpG island in its 5'-untranslated region. The CpG island of LINE-1 is often heavily methylated in normal somatic cells, which is associated with poor prognosis in various cancers. DNA methylation can differ between formalin-fixed paraffin-embedded (FFPE) and frozen tissues. Therefore, this study aimed to compare the LINE-1 methylation status between the two tissue-storage conditions in gastric cancer (GC) clinical samples and to evaluate whether LINE-1 can be used as an independent prognostic marker for each tissue-storage type. We analyzed four CpG sites of LINE-1 and examined the methylation levels at these sites in 25 FFPE and 41 frozen GC tissues by quantitative bisulfite pyrosequencing. The LINE-1 methylation status was significantly different between the FFPE and frozen GC tissues (p < 0.001). We further analyzed the clinicopathological features in the two groups separately. In the frozen GC tissues, LINE-1 was significantly hypomethylated in GC tissues compared to their corresponding normal gastric mucosa tissues (p < 0.001), and its methylation status was associated with gender, differentiation state, and lymphatic and venous invasion of GC. In the FFPE GC tissues, the methylation levels of LINE-1 differed according to tumor location and venous invasion of GC. In conclusion, LINE-1 can be used as a useful methylation marker for venous invasion in both FFPE and frozen tumor tissues of GC.

• Journal of Gastric Cancer
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• 제4권2호
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• pp.82-88
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• 2004

Purpose: E-cadherin and CD44H have been shown to play a role in the progression and the metastasis of tumors. This study evaluated the clinical correlations between expression of E-cadherin and CD44H and various clinicopathologic factors and the value of expressions of E-cadherin and CD44H as prognostic factors in Borrmann type IV gastric cancer. Materials and Methods: In 122 patients with Borrmann type IV gastric cancer, we performed the immunohistochemical stainings for E-cadherin and CD44H. We analyzed the correlation between the expressions of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, stage, and peritoneal dissemination, and survival. Results: There were no correlations between reduced expression of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, and stage. However, there was a significant correlation between lymph node metastasis and the lymphatic invasion (P=0.022). There was also a significant correlation between the peritoneal dissemination and CD44H expression (P=0.005). The 5-year survival rate was correlated with CD44H expression expression (P=0.026), peritoneal dissemination (P<0.01), depth of invasion (P<0.01), lymph node metastasis (P<0.01), stage of tumor (P<0.01), and lymphatic invasion (P<0.01). There was no correlation between expression of E-cadherin and survival rate. Conclusion: The expression of CD44H and peritoneal dissemination was correlated. The expression of CD44H was an independent prognostic factor in Borrmann type IV gastric cancer. Further prospective studies with a large number of cases are required.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.168-173
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• 2001

Purpose: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. Materials and Methods: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. The Chisquare test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and independent prognostic significance was evaluated using the Cox regression method. Results: The prevalence of esophageal margin involvement was $3.6\%$ (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size ($\geq$5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. Conclusion: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.

• Journal of Gastric Cancer
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• 제16권4호
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• pp.215-220
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• 2016

Purpose: This study aimed to evaluate the rate, patterns, and risk factors associated with tumor recurrence in patients with T1N0 gastric cancer. Materials and Methods: The medical records of 8,753 patients with pathological T1N0M0 gastric cancer who underwent gastrectomy between 1994 and 2014 at Sungkyunkwan University School of Medicine were examined. Results: Among the 8,753 patients, 95 patients (1.1%) experienced tumor recurrence; this included 31 remnant, 27 hematogenous, 9 lymph nodal, 5 peritoneal, and 23 multiple-site recurrences. When patients were divided into two groups according to the presence of tumor recurrence, the following characteristics were higher in the recurrence group than in the non-recurrence group: older age (${\geq}65years$), male gender, undifferentiated histology, submucosal invasion, and venous invasion. In multivariate analysis, older age, male gender, tumor depth (sm2 and sm3 invasion), and venous invasion were independent risk factors for tumor recurrence. The recurrence rates were 0.7% in patients with less than two risk factors, 1.7% in those with two risk factors, 3.0% in those with three risk factors, and 6.3% in those with four risk factors (P<0.001). Conclusions: Although tumor recurrence is rare in pT1N0M0 gastric cancer, some patients with certain risk factors demonstrate an increased rate of tumor recurrence. Careful follow-up is required for patients with three or four risk factors.

• Radiation Oncology Journal
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• 제24권4호
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• pp.255-262
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• 2006

목 적: 진행된 직장암의 수술 후 보조적 방사선 치료를 시행한 환자에서 국소 재발한 군의 병리학적 예후 인자를 규명함으로써 향후 치료 방침의 결정에 도움이 되고자 하였다. 대상 및 방법: 1993년 2월부터 2001년 12월까지 원자력의학원에서 수술을 시행한 후 병기 3기 이상으로 방사선치료 및 항암 요법을 시행 받은 직장암 환자 110명을 대상으로 검체를 모두 조사하여 면역조직화학검사가 가능한 총 54명을 대상으로 하였다. 이중 국소전이가 발견된 군이 14명, 발견되지 않은 군이 40명이었다. 이들의 조직 검체를 대상으로 종양의 침윤 깊이, 종양의 조직학적 등급, 임파절 침윤 여부, 혈관 침윤 여부, 신경 침윤 여부 등의 병리적인 특징 및 p53, Ki-67, c-erb, ezrin, c-met, phospho-S6K, S100A4, HIF-1 alpha의 다양한 암 유전자의 발현양상을 단변량 분석 및 다변량 분석, hierarchical clustering 분석 기법을 사용하여 치료 후 예후와 관련된 인자를 찾았다. 결 과: 병리학적 예후 인자 중 단변량 분석상 종양 침윤 깊이, 종양의 등급, 혈관 침범이 의미 있었고 다변량 분석상 침윤의 깊이가 5.5 mm 이하, 혈관 침윤이 없는 경우가 국소 재발이 낮은 군이었다. 면역조직화학검사 결과의 단변량 분석상 c-met 양성, HIF-1 alpha 양성이 국소 재발률이 높은 예후 인자였고 다변량 분석상 c-met이 의미 있는 예후 인자였다. Hierarchical clustering을 통해서 조사한 결과 HIF-1 alpha, c-met 및 종양 침윤 깊이가 국소재발과 관련된 인자로써 국소 재발을 한 군의 71.4%가 3가지 인자 중 2개 이상을 가지고 있는 반면 국소 재발을 하지 않은 군에서는 27.5%가 2개 이상을 가지고 있었다. 결 론: 국소적으로 진행되어 방사선 치료를 시행해야 하는 직장암 환자군 중에서 HIF-1 alpha 양성, c-met 양성, 종양 침윤 깊이 5.5 mm 이상의 병리학적 예후 인자를 두 개 이상 가지는 환자는 국소 재발의 가능성이 높다. 이러한 인자가 방사선치료 저항군의 지표로써 유용한지에 대한 전향적 연구가 향후 필요할 것이다.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.193-199
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• 2009

목적: 고려대학교 구로병원에서 14년간 위암으로 수술받은 예를 대상으로 임상병리학적 특성, 치료 결과 및 예후 인자를 분석하여 보고자 하였다. 대상 및 방법: 1993년부터 2006년까지 본 교실에서 수술받은 2,327명의 위암 환자를 대상으로 후향적 연구를 하였다 결과: 절제율은 92.8%였고 근치적 절제율은 90.8%였다. 5년 생존율은 절제 예 70.0%, 근치적 절제 예 79.2%, 비근치적 절제 예 3.7% 그리고 비절제 1.5%였으며, 절제 예에서 병기별 5년 생존율은 IA기 98.9%, IB기 94.4%, II기 77.3%, IIIA기 69.3%, IIIB기 38.9% 그리고 IV기 13.6%였다. 예후 인자의 단변량 분석결과 나이, 종양의 크기 및 위치, 육안적 형태, 위벽 침윤, 림프절 전이, 원격 전이가 통계적으로 유의하였고 다변량 분석 결과 독립적 예후 인자는 림프절 전이, 위벽의 침윤도, 정맥 침윤, 연령의 순으로 나타났다. 결론: 위암에서의 예후는 병기에 의해서 가장 많이 영향을 받으므로 예후 향상을 위해서는 조기발견이 가장 중요하고, 적극적이며 체계적인 외과적 치료가 위암의 생존율향상에 기여할 것으로 생각한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권7호
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• pp.3149-3152
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• 2012

Objective: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated but not clearly clarified. The objective of our study was to investigate the role of PNI as prognostic factor in patients undergoing curative surgical resection and without distant metastasis in comparison with other clinicopathological factors. Methods: Between 2001 and 2010, 287 cases of gastric adenocarcinoma underwent radical gastrectomy recorded in hospital based registries. PNI was assessed as positive when cancer cells were seen in the perinerium or neural fascicles intramurally. Categorical and continuous variables were summarized using descriptive statistics and compared using chi-square and Mann-Whitney U tests, respectively. Cancer related survival rates were estimated by the Kaplan-Meier method. Results: PNI was positive in 211 of 287 cancers (73%), with a positive relation to lymph node metastases and advanced stage (p=0.0001, p=0.0001, respectively), mural invasion, and lymphatic and blood vessel invasion (p=0.0001, p=0.0001, respectively). The median survival of the PNI positive patients was significantly shorter than that of their PNI negative counterparts (24.1 versus 38.2 months, p=0.008). In the multivariate analysis, we detected PNI was an independent prognostic factor (p=0.025, HR=1.21, 95% CL 1.08-2.3) along with classical clinicopathological variables such as lymph node involvement (p=0.001), pT stage (p=0.03), and LVI (p=0.017), but not age, gender, tumour localization, stage, histologic type, and surgery procedure. Conclusions: PNI positivity in gastric cancers was related mural invasion, lymph node involvement, advanced stage and lymphatic and venous blood vessels. The presence of PNI appeared as an independent prognostic factor on survival on multivariate analysis, not influenced by tumor stage, lymph node metastases and other classical factors.