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강기주,이준행 대한의사협회 2010 대한의사협회지 Vol.53 No.4
Gastric cancer is the most common malignancy and the second leading cause of cancerrelated death in Korea. Age-adjusted annual incidence of gastric cancer per 100,000persons is 62.8 for male and 25.7 for female. The proportion of early gastric cancer among surgically treated gastric cancer patients was 28.6% in 1995, 32.8% in 1999, and 47.4% in 2004. Screening upper endoscopy is quite commonly performed in Korea, and the proportion of early gastric cancer in the screened population is almost 75%. Gastric adenoma is considered to be a very important precancerous lesion. Gastric adenomas are actively treated in Korea, and at least 1/3 of the gastric adenomas with high grade dysplasia show cancerous focus when endoscopically resected. The prevalence of Helicobacter pylori is decreasing in Korean population, which may lead to the decreased incidence of gastric cancer in the near future. Paradigms of the diagnosis and treatment of gastric cancer are rapidly changing in Korea. Efforts to establish robust scientific data for new approaches are strongly required. The proportion of early gastric cancer among all gastric cancers has been and will be more increased in Korea.
자궁경부 편평상피암 환자에서 혈청 SCCA 와 CA 125의 임상적 의의
강기주,윤만수 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.1
To evaluate the efficacy and diagnostic and prognostic significance of two tumor markers (SCCA, CA 125) in patient with squamous cell carcinoma of uterine cervix, the authors studied 215 patients with squamous cell carcinoma in situ and invasive carcinoma from September 1993 to November 1996. Both tumor markers were measured coincidently in 215 patients preopera-tively and in 70 cases of benign gynecologic disease for control group. Serum SCCA level of 2.5 ng/㎖ and CA 125 level of 35.0 U/㎖ were determined as cut-off levels. The results were as follows: 1. The pretreatment positive rate of SCCA in patient group were 35.8 %(77/215) and 5.7 %(4/70) in control group. 2. The mean values and positive rates of SCCA according to clinical stage were 1.44 ± 3.59 ng/㎖(8.7 %) for stage 0, 3.81 ±10.22 ng/㎖(23 %) for stage I, 8.54 ±15.23 ng/㎖(51.3 %) for stage Ⅱ, 35.54 ±38.34 ng/㎖(70.0 %) for stage Ⅲ, 22.49 ±36.06 ng/㎖(75.0 %) for stage IV, 40.33 ±58.66 ng/㎖(66.7 %) for recurrent cancer, respectively. The CCA value and positive rate were significantly increased stepwise by clinical stage from stage I to stage Ⅲ (P <0.05). 3. The pretreatment positive rate of CA 125 in patient group were 21.9 %(47/215) and 17.1 %(12/70) in contrl group. 4. In pre-invasive and invasive groups, the mean value and positive rate of SCCA were 1.44 ±3.59 ng/㎖(8.7 %), 9.05 ±25.26 ng/㎖(43.2 %), respectively, and it was statistically significant between two groups (P <0.05). The mean values and positive rate of CA 125 were 24.36 ±16.14 U/㎖(10.9 %), 35.15 ±59.52 U/㎖(24.9 %), respectively, it was not statistically significant (P >0.05). 5. The result of preoperative serum levels of SCCA can be characterized by 35.8 % sensitivity, 94.3 % specificity, 95.1 % positive predictive value, 32.4 % negative predictive value, 49.5 % diagnostic efficiency, and with 21.9 %, 82.8 %, 79.7 %, 25.7 %, 36.8 % respectively for CA 125. Between these two tumor markers, the result of SCCA was more valuable than the other in sensitivity, positive ive value, negative predictive value and diagnostic efficiency. The results indicate that measurement of SCCA and/or CA 125, have little efficacy in the early detection of squamous cell carcinoma considering it' s low rate of positivity in preinvasive and early stage of invasive squamous cell carcinoma. However, in patients with advanced stage invasive carcinoma, measurement of serum SCCA is useful in prediction of prognosis and in early detection of recurrence, and concomitant measurements of SCCA and CA 125 may be more useful in determining prognosis, therapeutic response, and early detection of recurrence than measurement of SCCA alone.
난소의 경계성 종양 및 침윤성 암종에서 p53 , Rb 유전자 발현과 Apoptosis 에 관한 연구
강기주,윤만수,설미영,하명완,고형권 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.3
목적 : 난소의 악성 종양의 발생에서 종양억제 유전자인 p53과 Rb 단백의 발현과 apoptosis의 역할을 규명하고 이들 인자들이 경계성 종양의 악성화에 미치는 영향을 규명하고자 연구를 시행하였다. 연구 방법 : 30예의 양성, 경계성 및 악성 난소 종양에서 면역 조직화학적 염색을 이용하여 p53 및 Rb 단백의 발현을 조사하고 TUNNEL method를 이용하여 대상 조직에서의 apoptosis 형태를 관찰하였다. 결과 : 양성, 경계성 및 악성 난소 종양에서 p53의 발현은 각각 0, 28 및 94 %로 악성 종양에서 발현율이 높았으며, 항암제에 내성을 보였던 경우 (2/3)와 술 후 잔존 종양이 있었던 경우 (4/5) 및 재발의 경우 (2/2)에서도 고도의 발현을 보였다. Rb 단백은 양성 종양에서부터 소실을 보였으며, 경계성 종양과 악성 종양에서 Rb 단백의 소실은 차이를 보이지 않았다. Apoptosis는 양성 종양에 비하여 악성 종양에서 더욱 활발하게 일어남을 보였으며 p53에 의한 apoptosis의 유도 효과를 간접적으로 확인할 수 있었으나 Rb 단백과 apoptosis 사이의 연관성은 찾을 수 없었다. 결론 : p53 및 apoptosis는 난소의 악성 종양과 양성 종양을 구별하는 인자로 이용될 수 있으며, 또한 종양의 재발 등의 예후와 밀접한 관련이 있는 것으로 나타나 난소의 악성 종양의 진행 및 재발 등의 예후를 추측할 수 있는 인자로 유용하게 이용될 수 있을 것으로 생각된다. Objective: The aim of this study is to evaluate the role of tumor suppressor genes, p53 and Rb gene, as well as apoptosis in the carcinogenesis of ovarian epithelial tumors. And the value of these factors as prognostic markers to tell the transformation of borderline tumors to overt carcinomas is also studied. Method: Thirty cases of ovarian epithelial benign and borderline tumors and invasive carcinoma were used and the expression of the p53 protein and Rb gene protein were evaluated by immunohistochemical method. The apoptosis was evaluated by TUNNEL method. Results: Positive rate of p53 expression in benign, borderline and invasive tumors were 0, 28, and 94 %, respectively. And also, p53 was highly expressed in chemoresistant cases (2/3), in residual tumor (4/5) and in recurred cancer (2/2). Rb protein was partly lost in the borderline tumors, but the rate of Rb protein loss in both borderline tumors and invasive carcinomas were similar. Apoptosis were more active in overt carcinomas than in borderline and benign tumors. In borderline tumors, p53 protein was expressed as 28.6% positivity, and apoptosis was expressed as 28.6% negativity, which showed indirectly that there was apoptosis induction effect of p53. In ten cases of invasive carcinomas showing highly expressed p53, apoptosis revealed all positive reaction except 2 cases, and Rb protein revealed variously. This result supported the apoptosis imduction effect of p53, but it was difficult to find the association of expression degree between the two tumor supressor genes Conclusion: In conclusion, the values of p53 is a discriminating factor of malignancy from benign and the expression of p53 is related with clinical aggressivity such as recurrence and residual cancers. Apoptosis are more active in overt carcinoma than in benign & borderline tumor, and in borderline tumor the expression of p53 is related to apoptosis induction which results to carcinomatous change.