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Purpose: The aim of this study is to analyze the oncological outcomes of squamous cell carcinoma (SCC) of the anal canal after chemoradiation therapy (CRT) in a single institution. Methods: Fifty-one patients with anal SCC who had been treated with CRT between January 2000 and December 2010 were analyze data single center in Korea. Results: Forty-eight patients exhibited clinical complete response. After a median follow-up of 42.1 months, 13 patients (25.5%) showed recurrence. The disease-free survival (DFS) rate was 63.4% at 5 and 10 years. The overall survival (OS) rates were 83.6% (5 years) and 75.2% (10 years). Stage I: DFS, 100%; OS, 100%; stage II: DFS, 85.7%; OS, 100%; stage IIIA: DFS, 68.6%; OS, 87.5%; stage IIIB: DFS, 34.7%; OS, 48.4%; and stage IV: DFS and OS, 0%. The local recurrence patterns were as follows: pelvic node (n=4, 7.8%), inguinal node (n=1, 2.0%), and inguinal and pelvic node (n=1, 2.0%). The systemic recurrence patterns were as follows: lung (n=2, 3.9%), para-aortic node (n=1, 2.0%), and extrapelvic site (n=2, 3.9%). N-stage represented a single independent prognostic factor for recurrence (P<0.05). Conclusion: CRT for SCC of the anal canal is effective for oncological outcomes and sphincter preservation. The initial nodal status may affect the oncological outcome.
Duplicated inferior vena cava (IVC) is a congenital anomaly seen rarely in the general population. Patients with IVC variants usually do not present any symptoms and are found incidentally in many cases. However, physicians are urged to recognize the presence of such anomalies during diagnostic or invasive procedures as these variants of blood vessel systems can impose substantial implications in certain clinical situations. Subsequently, information about IVC variants may become critical if surgical injuries or predisposing conditions act as life-threatening risks to patients during medical procedures. We present a case of duplicated IVC in a 68?year?old female patient with rectal cancer where an IVC anomaly was found during surgical resection of her tumor. From our experience, we emphasize the importance of having the knowledge of IVC variations in patients undergoing invasive surgical procedures which may involve large vessels.
목적 : 본 연구는 침생검을 통해 진단 받은 경화성 선증에 대해 추가적인 수술 없이 경과 관찰했을 때의 잠재적 안정성을 알아보고자 하였다. 방법 : 1996년 1월부터 2010년 5월까지 침생검을 통해 경화성 선증으로 진단된 143명의 환자의 145개 병변을 대상으로 (core-needle biopsies 118례, vacuum-assisted biopsies 27례) 의무기록 검토를 토대로 한 후향적 고찰이다. 결과 : 환자들의 BI-RADS(The American College of Radiology Breast Imaging Reporting and Data System) 분류는 다음과 같다: C3(n=8), C4a(n=123), C4b(n=11), C4c(n=e), C5(n=1). 그 중 14명은 조직검사를 재시행하였고 BI-RADS 분류 C5이면서 영상의학적 소견과 병리학적 소견의 불일치를 보인 1명의 환자가 침윤성 유방암으로 진단되어 수술을 시행하였다. 나머지 환자들은 정기적인 초음파 검사 및 유방촬영술을 통해 경과 관찰하였고, 평균 추적관찰 기간 40개월 동안 144개의 병변의 최종 BI-RADS 분류는 다음과 같다: C1(n=5), C2(n=107), C3(n=32), 경과 관찰기간 동안 142명의 환자에서 악성 유방질환이 발견된 환자는 없었다. 결론 : 침생검을 통해 경화성 선증으로 진단된 환자에 있어서 추가적인 수술 없이 정기적인 검진을 통하여 경과 관찰하는 것은 잠재적 안전성을 가지고 있다. 하지만 조직검사와 영상검사 결과의 불일치 소견을 보이는 경우 수술적 생검을 통한 최종 진단이 필요하다. Background : The aim of this study was to assess the potential safety of follow up for patients diagnosed with sclerosing adenosis through needle biopsies without additional surgery. Patients and Methods : From January 1996 to May 2010, 145 lesions in 143 sclerosing adenosis patients who underwent core-needle biopsies (n=118), vacuum-assisted biopsies (n=27) in our institution were followed. Results : The American College of Radiology Breast Imaging Reporting and Data System (BI-BADS) classification in these patients was as follows : C3(n=8), C4a(n=123), C4b(n=11), C4c(n=e) and C5(n=1). After sclerosing adenosis was diagnosed by needle biopsy, 14 patients underwent re-biopsy. Only 1 patient who had BIRAD C5 sonographic features was diagnosed with invasive ductal carcinoma and surrounding ductal carcinoma in situ. The remaining 142 patients received regular medical exam with ultrasonography and/or mammography. 144 lesions' BI-RADS category were C1(n=5), C2(n=107) and C3(n=32). With the median follow-up period of 40 months, none of the patients developed breast malignancy. Conclusions : Our study suggest that patients with sclerosing adenosis diagnosed by needle biopsies can be safely followed without additional surgery. However, in case of discordance with images and biopsy result, surgical excision for definite diagnosis is recommended.
Background : Rectal gastrointestinal tumor is not usually found in rectum and form 0.3% of all rectal malignancy. The aim of this study is to analyze patients who underwent surgical resection for rectal GIST. Methods : We retrospectively reviewed 10 patients who had been underwent curative operation for rectal GIST from 2006 to 2012. Patients were diagnosed with GIST by Abdomino-pelvic CT scan, MRI, or endoscopic ultrasound. Results were analyzed to identify patients characteristics, method and complication of operation, pathologic feature, hospital day, follow-up including neoadjuvent and adjuvant imatinib mesylate (IM). Results : Male and female patients were six and four. The mean age was 62 years (range, 49~81 years) The median follow-up period was 24 month(range, 1~68 months). Except routine checkups, most common chief complaints were constipation (30%). All patients underwent R0 resection (trans-anal surgery (n=2), minimally invasive surgery (n=5), open surgery(n=3)). One laparoscopic operation case was converted to laparotomy due to severe tumor adhesion. The mean size of tumor was 5.4cm (range, 1~8cm). The mitotic count shown >5 in 50 high power fields(HPF) was four cases, near total necrosis was two cases and that shown <5 in HPF was three cases. Five (50%) patients received neoadjuvant imatinib therapy following surgery. Adjuvant imatinib therapy was given to four patients based on size and mitotic counts. One local recurrence cases was found at 4 year 2 month after surgery. Conclusion : We can conclude that curative resection of rectal GIST with imatinib given to neoadjuvant and adjuvant setting is safe. And there are many various surgical options at rectal GIST management, and another study with more cases and logn term follow-up data is indispensable.
류제규 ( Je Gyu Ryu ), 김영완 ( Young Wan Kim ), 김남규 ( Nam Kyu Kim ), 허혁 ( Hyuk Huh ), 민병소 ( Byung Soh Min ), 이강영 ( Kang Young Lee ), 손승국 ( Seung Kuk Sohn ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2
목표: 본 연구의 목적은 수술 전 항암방사선 치료를 받은 직장암의 진단에 있어서 3차원 경항문 직장초음파가 2차원 경항문 직장초음파 및 CT, MRI 와 비교하여 가지는 정확도의 차이를 확인하는 데 있다. 대상 및 방법: 99명의 직장암 환자를 대상으로 하였고 이 중 58명은 2차원 경항문 직장초음파와 CT, MRI를 통해 병기결정을 하였고, 41명의 환자는 3차원 경항문 직장초음파와 CT, MRI로 병기결정을 하였다. 종양의 침습정도(T)와 임파절 전이(N)의 진단에 있어서 각 영상 검사 방법의 정확도는 조직병리 검사 결과와의 비교를 통해 판단하였다. 결과: 종양의 침습 정도를 진단함에 있어서는 2차원 경항문 직장초음파, 3차원 경항문 직장초음파, CT, MRI는 각각 68.9%, 76%, 68.6% 그리고 84.3%의 정확도를 보였다. 병기 상향 평가율은 각각 24.1%, 20%, 21.6%, 9.6%였고, 병기 하향 평가율은 각각 6.8%, 4%, 9.6%, 6%이었다. 수술 전 항암방사선 치료를 시행받은 환자군에 있어서는 종양의 침습 정도의 진단에서 2차원 경항문 직장초음파, 3차원 경항문 직장초음파, CT, MRI는 각각 57.1%, 66.6%, 56.3%, 62.5%의 정확도를 보였고, 병기 상향 평가율은 28.5%, 33.3%, 43.7%, 37.5%였으며, 병기 하향평가율은 14.2%, 0%, 0%, 0%였다. 임파절 전이를 진단함에 있어서는 2차원 경항문직장초음파, 3차원 경항문 직장초음파, CT, MRI 의 정확도는 각각 58.62%, 64%, 67.47%, 73.49%였으며, 수술 전 항암방사선 치료를 시행받은 환자의 경우는 57.1%, 55.5%, 68.75%, 68.7%였다. 결론: 초기 경험이라는 한계가 있지만, 수술 전 항암방사선 치료를 시행받은 직장암의 진단에 있어서 전반적인 정확도는 2차원 경항문 직장초음파에 비해서 3차원 경항문 직장초음파가 높은 것으로 나타났다. 시행 경험이 축적되면 3차원 직장초음파는 MRI와 함께 직장암의 수술 전 진단에 있어서 유용한 검사 방법이 될 것이다. Purpose: This study was designed to evaluate the accuracy of three dimensional transrectal ultrasonography (3D TRUS) when compared to those of two dimensional transrectal ultrasonography, CT and MRI for preoperative chemoradiated rectal cancer. Material and methods: Ninety-nine rectal cancer patients were enrolled. Among them, 58 patients were staged by 2D TRUS, CT and MRI and 41 patients were staged by 3D TRUS, CT and MRI. Depth of tumor invasion (T) and nodal involvement (N) assessed by imaging modalities were compared with pathologic results. Results: When assessing depth of invasion, the accuracy of 2D and 3D TRUS, CT and MRI was 68.9%, 76%, 68.6%, and 84.3%, respectively. Overstaging rates were 24.1%, 20%, 21.6%, and 9.6%, and understaging rates were 6.8%, 4%, 9.6% and 6%, respectively. In patients undergoing preoperative chemoradiation, accuracy of depth of invasion was 57.1%, 66.6%, 56.3%, and 62.5%, and overstaging rates were 28.5%, 33.3%, 43.7%, and 37.5%, and understaging rates were 14.2%,0%,0%, and 0%, respectively. When assessing nodal involvement, accuracy of 2D and 3D TRUS, CT and MRI was 58.62%, 64%, 67.47%, and 73.49%, respectively. In patients undergoing preoperative chemoradiation, accuracy of nodal involvement was 57.1%, 55.5%, 68.75%, and 68.7%, respectively. Conclusion: Although early experience, overall diagnostic accuracy of 3D TRUS was superior to conventional 2D TRUS. As accumulation of experiences, 3D TRUS as well as MRI could be used as a useful tool for preoperative imaging for rectal cancer.
Purpose: Ultralow anterior resection and coloanal anastomosis (hand-sewn) has commonly been used for preserving the anal sphincter in patients with low-lying distal rectal cancer. Preoperative chemoradiation therapy is a contributing factor to preserve the anal sphincter. Intersphincteric resection has been introduced and has begun to be applied to distal rectal cancer for anal sphincter preservation. The aim of this study was to report on patients who underwent intersphincteric resection and coloanal anastomosis for very low-lying rectal cancer. Methods: Intersphincteric resection was performed in 21 patients with very low-lying rectal cancer (within 4 cm from the anal verge) between December 2004 and May 2008. All patients received colonic J pouch anal anastomosis and loop ileostomy. The patients were selected prospectively and followed up for the function of bowel movement and recurrence. Results: Mean tumor distance from anal verge was 2.8 cm (range 2∼4 cm). No postoperative mortality was encountered. One patient developed ischemic colitis of colonic J-pouch after high doses of tomotherapy. Subsequently he received abdominoperineal resection and permanent colostomy. One patient underwent diverting colostomy for severe incontinence after ileostomy takedown. The other cases reported good anorectal function such as frequency of bowel movement and fecal incontinence. There were two local recurrences during a mean follow-up period of 11.6 months. Conclusion: Based on a single surgeon's experiences, postoperative morbidity and anorectal function after intersphincteric resection with coloanal anastomosis seems acceptable.
심홍진 ( Hong Jin Shim ), 강정현 ( Jeong Hyun Kang ), 이형순 ( Hyung Soon Lee ), 허혁 ( Hyuk Hur ), 민병소 ( Byung Soh Min ), 이강영 ( Kang Young Lee ), 김남규 ( Nam Kyu Kim ), 김영완 ( Young Wan Kim ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.1
목적 : 본 연구는 수술 전 화학방사선요법을 시행 받고 수술을 시행한 직장암 환자에서 조직학적 반응도와 혈청 암종배아항원의 상관관계를 알아보기 위해 시행되었다. 방법 : 2005년 8월부터 2007년 12월까지 연세대학교 세브란스 병원에서 직장암으로 진단 받고 수술 전 화학방사선요법을 시행받은 후 전직장간막 절제술을 시행한 85명의 환자를 대상으로 하였다. 화학요법은 5-Fluorouracil에 기초하였고 방사선주사는 총 5,040 cGy 를 조사하였다. 암종배아항원은 화학 방사선요법전(pre-CRT)과 직후(post-CRT), 수술 후 7일째(post-TME)에 각각 측정을 하였다. 조직학적 반응도는 TNM 병기에 따라 반응군(Favorable response : pCR 과ypStage1, 28명)과 비반응군(Unfavorable response : ypStage2와 ypStage3, 57명)으로 구분하였다. 결과 : 환자의 나이, 성별, 암의 위치, 림프혈관의 침범, 신경주위침범 등에서 반응군과 비반응군의 차이는 없었다. 반응군에서 low grade 의 조직학적 분화를 보이는 비율이 높았고(92% vs.70.2%, p=0.018) 항문보존술식을 시행한 비율이 더 높았다(92.9% vs. 71.9%, p=0.026). pre-CRT CEA수치는 반응군에서 유의하게 낮았으나(p<0.001) post-CRT, post-TME CEA값은 두 군간의 차이는 없었다. 다변량 분석에서 낮은 pre-CRT CEA(<5ng/ml) 값과 항문보존술식의 시행여부가 조직학적 반응군과 관련된 독립적인 인자로 확인되었다. 결론 : 직장암 환자에서 화학방사선치료 전 CEA 수치는 수술 후 조직학적 반응정도와 상관관계를 보였으나 화학방사선치료 후나 수술 후의 CEA값은 조직학적 반응정도와 상관 관계가 없었다. 이러한 결과를 바탕으로 CEA가 조직학적 반응정도를 예측하는 인자로서의 역할을 할 수 있는지에 대한 향후 전향적인 연구가 필요하다. Purpose: This study was designed to assess whether serum CEA is associated with pathological tumor response in rectal cancer patients who underwent preoperative chemoradiation therapy (CRT) with total mesorectal excision (TME). Methods: Eighty-five patients with rectal cancer who were treated by preoperative CRT followed by TME were enrolled between August 2005 and December 2007. 5-FU based chemotherapy and 5040 cGy of radiation were delivered. Serum CEA was measured pre-CRT, post-CRT, and post-TME period. Among 85 patients, 29 patients did not have post-CRT CEA level. Pathological tumor response (ypTNM stage) was categorized into two groups as follows; favorable response group (group A: n=28, pathological complete response and ypTNM I) vs unfavorable response group (group B: n=57, ypTNM II and III). Median follow-up period was 29.2 months (range 1.1-50.2 months). Results: There were no differences between favorable and unfavorable response group with respect to age, gender, tumor location, lymphovascular invasion, and perineural invasion (Table 1). Anal sphincter preservation surgery was more commonly performed in the group A when compared with group B (26 (92.9%) vs. 41 (71.9%)) (p=0.026). Well and moderately differentiated histology were more commonly found in the group A (26(92.9%) vs. 40(70.2%) (p=0.018). Low level of pre-CRT CEA (<5ng/ml) was more commonly found in the group A (26(92.9%) vs. 30 (52.6%) (p=0.000). However, there was no difference between group A and B with regard to post-CRT CEA and post-TME CEA. Logistic regression analyses showed that pre-CRT CEA (<5ng/ml) and sphincter preservation surgery were associated with favorable pathological tumor response. Conclusions: Low level of pre-CRT CEA (<5ng/ml) is predictive of favorable pathological tumor response but serum level of post-CRT and post-TME CEA did not have significant association with tumor response. This result should be validated in larger prospective randomized study near future.
Purpose: We evaluated the clinical significance of the tumor growth factor, midkine (MK), in paired gastric cancer and normal tissues. Materials and Methods: Twenty paired normal and cancer tissues were tested for MK mRNA expression by Northern blot analysis. Vessel staining was done by immunohistochemical staining using CD-31 monoclonal antibody (Dako). Results: MK mRNA was mainly expressed in cancer tissues (11 versus 1). Lymph node metastasis, pathological stage and tumor differentiation did not correlate with MK expression. However, MK expression rate increased with increment in tumor size (p=0.05). Microvascular density did not correlate with tumor invasion, lymph node metastasis, and pathological stages. However, there was a tendency of vascular density increment with MK expression in Tl-T2 stage. Conclusion: MK was mainly expressed in larger gastric cancer tissues suggesting its role in cancer growth in vivo. But no definite correlation between MK expression and tumor microvascular density was found.
Purpose: It has been theorized that p53 may be involved in the sensitivity to chemotherapeutic agents. We evaluated the chemosensitivity of wild p53 after transduction into gastric cancer cell lines with mutant p53. Materials and Methods: YCC-3(parent cell line with mutant p53), YCC-3v(parent cell line transduced with vector alone) and YCC-3C₃(clone with wild p53) cell lines were used in this study. p53 protein expression was measured by ELISA assay. Tumorigenicity and drug sensitivity were evaluated by soft agar and proliferation assay, respectively. Cell cycle analysis was performed by flowcytometry. Telomerase activity was measured by TRAP assay and terminal restriction fragment(TRF) length was measured after Southern blot analysis. Results: Even though p53 production hom the YCC-3C₃ cell line was three times higher than those of YCC-3 and YCC-3v cell lines, the cell cycle was the same in these three cell lines. In the YCC-3C₃ cell line, drug sensitivity to etoposide and cisplatin was increased when we compared it to those of the YCC-3v cell line(etoposide, 50% versus 83%; cisplatin, 67% versus 83%). However, there was no chemo-sensitization effect with vincristine, vinblastine and carboplatin. After exposure to cisplatin, a G0/G1 check-point effect was found in the YCC-3C₃ cell line, but not in the YCC-3v cell line. No differences were found in telomerase activity, TRFs length or DNA fragmentation between the YCC-3v and YCC-3C₃ cell lines after cisplatin treatment. Conclusion: Wild-type p53 gene transduction in the gastric cancer cell line induced sensitization to the cytotoxicity of etoposide and cisplatin. This suggests the possible application of combined chemo-gene therapy with an EP regimen and wild-type p53 in gastric cancer patients with p53 mutation.