심해성 어류, 다랑어류, 새치류 및 어류가공품의 총수은 및 메틸수은 함량

강석호,김재관,정유정,허은선,조윤식,모아라,박광희,이명진 한국식품위생안전성학회 2017 한국식품위생안전성학회지 Vol.32 No.1

The aim of this study was to determine total mercury and methyl mercury level in fishes (Deepsea Fish, Tuna, Billfish) and fishery products. A total of 101 fishes and 44 fishery products samples collected from commercial market in Gyeonggi-do. Total mercury were analysed by mercury analyzer and methyl mercury were analyzed by gas chromatography with electron capture detector. In the fishes, total mercury was detected in all samples and methylmercury was detected in 92 samples of them. The detection rate of methylmercury was 91.1% in fishes. The mean concentration (mg/kg) of total mercury and methylmercury were 1.968 ± 0.505/0.496 ± 0.057 for Billfish, 0.665 ± 0.091/0.252 ± 0.033 for Deep-sea Fish and 0.577 ± 0.085/0.218 ± 0.025 for Tuna, respectively. The Swordfish contains the highest level of total mercury (1.968 mg/kg) and methylmercury (0.496 mg/kg). In Mabled rockfish, the ratio of methylmercury’s contents about total mercury’s contents was the highest as 66.5%. In case of fishery products, frozens made of 100% of raw material contained the highest level of total mercury and methyl mercury. The weekly intake of total mercury and methylmercury was calculated in 4.72% and 5.24% of Provisional Tolerable Weekly Intake (PTWI) respectively. This study showed that the weekly intake of methylmercury from Deep-sea Fish, Tuna and Billfish was less than the PTWI recommended by the Joint FAO/WHO expert committee on food additives.

Laparoscopy versus Open Nephroureterectomy in Prognostic Outcome of Patients with Advanced Upper Tract Urothelial Cancer: A Retrospective, Multicenter, Propensity-Score Matching Analysis

김성한,송미경,김정권,홍범식,강석호,구자현,정병창,서호경 대한암학회 2019 Cancer Research and Treatment Vol.51 No.3

Purpose The purpose of this study was to compare oncologic outcomes between open nephroureterectomy (ONU) and laparoscopic nephroureterectomy (LNU) in patients with upper tract urothelial carcinoma. Materials and Methods The medical records of consecutive ONU and LNU cases from five tertiary institutions were retrospectively analyzed between 2000 and 2012. The propensity-score matching methodology was used to compare the two surgical approaches in terms of age, body mass index, American Society of Anesthesiologists score, tumor location, grade, pathologic T and N categories, the presence of lymphovascular invasion, and follow-up duration. The Kaplan-Meier with log-rank tests and clustered Cox regression were used to compare the estimated rates of survival for each surgical approach and to investigate the effect of the surgical approach on each prognostic outcome. Results Six hundred thirty-eight propensity-score matching pairs (n=1,276) were compared; LNU was significantly better than ONU in all types of survival, including intravesical recurrencefree survival (IVRFS), disease-free survival, overall survival (OS), and cancer-specific survival (CSS) (p < 0.05). The 3-year OS and CSS rates were significantly higher with LNU than with ONU (p < 0.05). Compared with ONU, LNU had significantly better 3-year OS and CSS rates (82.9% and 86.2% vs. 78.3% and 81.8%); there were no differences at 5 years. In subgroup analysis of the early-staged group, advanced-stage group, lymph node–positive group, and lymph node–negative group, the two approaches did not significantly affect prognostic outcomes, except LNU improved the IVRFS in the lymph node–negative or no history of previous bladder cancer group. Conclusion LNU had a significantly better prognostic outcome than ONU after propensity-score matching.

Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea

심지성,서호경,구자현,정병창,홍범식,강석호 대한암학회 2019 Cancer Research and Treatment Vol.51 No.3

Purpose The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. Materials and Methods This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral period with consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. Results The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recently. Conclusion We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.

경기도내 유통 다소비 생선류의 중금속 및 셀레늄 함량

조윤식,김기철,김경아,강석호,정유정,곽신혜,이필석,이운형,모아라,용금찬,윤미혜 한국식품위생안전성학회 2017 한국식품위생안전성학회지 Vol.32 No.3

A total of 100 seafoods commonly consumed in Gyeonggi-do were investigated to determine the concentration of lead (Pb), total mercury (Hg), methyl mercury (MeHg), cadmium (Cd) and selenium (Se). Concentration of heavy metals and selenium was measured by using mercury analyzer, ICP-MS and GC-ECD. The average content (mg/kg) of heavy metals in the seafood samples was as follows; Pb 0.0915 (0.0021-0.4490), Cd 0.0084 (ND- 0.1773), and Hg 0.0412 (0.0013-0.3032). All the levels were below the recommended standards of the MFDS in Pb (0.5 mg/kg), Cd (0.2 mg/kg), Hg (0.5 mg/kg). The methylmercury was detected in the hairtail (0.0677 mg/kg) and cod (0.2941 mg/kg). After the average content of heavy metals in seafood was determined, the exposure assessment for heavy metals was conducted. Relative hazardous levels compared to PTWI were lower than the official standards of the JECFA for Pb (0.97%), Hg (3.42%) Cd (0.45%). In conclusion, the levels presented in this study are presumed to be safe for consumption.

The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study

김태헌,홍범식,서호경,강석호,구자현,정병창 대한암학회 2019 Cancer Research and Treatment Vol.51 No.1

Purpose We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU). Materials and Methods Consecutive cases of ONU and LNU between 2000 and 2012 at five participating institutions were included in this retrospective analysis. Clinical characteristics and pathologic outcomes were compared between the two surgical approaches. The influence of the type of surgical approach on intravesical recurrence-free survival (IVRFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan-Meier method and differences were assessed with the log-rank test. Predictors of IVRFS, PFS, CSS, and OS were also analyzed with a multivariable Cox regression model. Results A total of 1,521 patients with UTUC were eligible for the present study (ONU, 906; LNU, 615). The estimated 5-year IVRFS (57.8 vs. 51.0%, p=0.010), CSS (80.4 vs. 76.4%, p=0.032), and OS (75.8 vs. 71.4%, p=0.026) rates were significantly different between the two groups in favor of LNU. Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. Multivariable Cox regression analyses showed that type of surgical approach was independently associated with IVRFS, but was not related to PFS, CSS, and OS. Conclusion Our findings indicate that LNU provided better oncologic control of IVRFS, CSS, and OS compared with ONU for the management of patients with UTUC.

The Prognostic Impact of Angiolymphatic Invasion in Bladder Urothelial Carcinoma Patients Undergoing Radical Cystectomy

김진혁,고영휘,김종욱,강석호,정승일,박진성,서호경,김형준,정병창,김태환,최세영,남종길,구자윤,주관중,장원식,윤영은,윤석중,홍성후,오종진 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.1

Purpose: The aim of this study was to investigate the association between angiolymphatic invasion (ALI) and bladder cancer in patients who underwent radical cystectomy (RC). Materials and Methods: Multicenter retrospective data from 495 bladder cancer patients who underwent RC between 2007 and 2019 were enrolled in this study. Patients were stratified into 2 groups according to the presence of ALI. The effect of ALI was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). Results: The median age of the 495 patients in the study was 65 years, with median and mean follow-up durations of 23.3 months and 37.1 months, respectively. ALI was present in 182 patients (36.8%). ALI was significantly associated with worse RFS as well as CSS and OS (p<0.001, p=0.012, and p=0.01, respectively). Adjusting for significant variables, a multivariate analysis showed that tumor stage (over T2) and ALI were independent predictors for CSS, whereas lymph node (LN) metastasis was not. Meanwhile, the adjusted multivariate analysis showed that tumor stage over T2, ALI, LN metastasis, and positive surgical margin were independent predictors for RFS. Otherwise, tumor grade (over grade 2) was not a significant predictor. Conclusions: The presence of ALI was an independent predictor influencing both CSS and RFS.

TNM-Based Head-to-Head Comparison of Urachal Carcinoma and Urothelial Bladder Cancer : Stage-Matched Analysis of a Large Multicenter National Cohort

송상훈,이재원,고영휘,김종욱,정승일,강석호,박진성,서호경,김형준,정병창,김태환,최세영,남종길,구자윤,주관중,장원식,윤영은,윤석중,홍성후,오종진 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4

Purpose Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. Materials and Methods Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. Results UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

Oncologic Outcomes and Predictive Factors for Recurrence Following Robot-Assisted Radical Cystectomy for Urothelial Carcinoma: Multicenter Study from Korea

심지성,권태균,나군호,이영구,이지열,정병창,김재윤,편종현,강성구,강석호 대한의학회 2017 Journal of Korean medical science Vol.32 No.10

The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7–50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1–20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9–23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1–20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.

Gender-related outcomes in robot-assisted radical cystectomy: A multi-institutional study

진현중,심지성,권태균,김태환,전승현,이상협,강성구,남종길,김완석,정병창,오종진,이상철,이지열,홍성후,나군호,한웅규,함원식,이영구,이용성,박성열,윤영은,구자현,강석호 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.1

Purpose: Robot-assisted radical cystectomy (RARC) optimizes patient recovery and has outcomes comparable with those of open surgery. This study aimed to compare the perioperative and oncologic outcomes of RARC in female and male patients. Materials and Methods: A retrospective cohort study of the Korean Robot-Assisted Radical Cystectomy Study Group database from 2007 to 2019 identified 749 patients (111 females and 638 males). Female were matched 1:1 to male by propensity score matching using a logistic regression. We compared perioperative outcomes, oncologic outcomes, and complications between the two groups. Results: The female group had comparable perioperative outcomes to the male group in terms of operation time, lymph node yield, positive surgical margin, blood transfusion rate, and hospitalization days. Complication rate and grade were not significantly different between the two groups. The most common complication was infection in female and gastrointestinal complications in male. We compared the 5-year overall, disease-specific, and recurrence-free survival of female and male: 58.2% vs. 68.0% (p=0.495), 75.7% vs. 79.3% (p=0.645), and 40.8% vs. 53.5% (p=0.913), respectively. On multivariable analysis, T stage (>T2), postoperative complications, and positive surgical margin were prognostic factors of poor outcome. Sex was not an independent predictor of the three survivals. Conclusions: The current study suggests that RARC in female has comparable perioperative and oncologic outcomes to those in male. The complication rate of RARC in female was comparable to that in male, but the type of complications differed by sex.

Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea

김성한,서호경,신희철,장성자,윤수인,주정남,구자현,김형석,전황균,정병창,정인갑,강석호,홍범식 대한의학회 2015 Journal of Korean medical science Vol.30 No.8

We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle- invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study’s cut-off time for AC was three months after surgery, and the study’s timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.