포스터발표논문초록 / 식품 천연물 분야 ( FN : Food & Natural Compounds ) : FN17 - 대파내 벼생장 촉진물질에 대한 연구

구교철,안형근,최상태,송경식 한국토양비료학회 1998 한국토양비료학회 학술발표회 초록집 Vol.- No.-

Prognostic Impacts of Metastatic Site and Pain on Progression to Castrate Resistance and Mortality in Patients with Metastatic Prostate Cancer

구교철,정병하,박상언,김기홍,나군호,홍성준,양승철 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Purpose: To investigate predictors of progression to castration-resistant prostate cancer (CRPC) and cancer-specific mortality (CSM) in patients with metastatic prostate cancer (mPCa). Materials and Methods: A retrospective analysis was performed on 440 consecutive treatment-naïve patients initially diagnosed with mPCa between August 2000 and June 2012. Patient age, body mass index (BMI), Gleason score, prostate-specific antigen (PSA), PSA nadir, American Joint Committee on Cancer stage, Visual Analogue Scale pain score, Eastern Cooperative Oncology Group performancescore (ECOG PS), PSA response to hormone therapy, and metastatic sites were assessed. Cox-proportional hazards regressionanalyses were used to evaluate survivals and predictive variables of men with bone metastasis stratified according to the presenceof pain, compared to men with visceral metastasis. Results: Metastases were most often found in bone (75.4%), followed by lung (16.3%) and liver (8.3%) tissues. Bone metastasis, pain, and high BMI were associated with increased risks of progression to CRPC, and bone metastasis, pain, PSA nadir, and ECOG PS≥1 were significant predictors of CSM. During the median follow-up of 32.0 (interquartile range 14.7–55.9) months, patients with bone metastasis with pain and patients with both bone and visceral metastases showed the worst median progression to CRPC-free and cancer-specific survivals, followed by men with bone metastasis without pain. Patients with visceral metastasis had the best median survivals. Conclusion: Metastatic spread and pain patterns confer different prognosis in patients with mPCa. Bone may serve as a crucial microenvironment in the development of CRPC and disease progression.

Trends of Presentation and Clinical Outcome of Treated Renal Angiomyolipoma

구교철,김원태,함원식,이진선,주희정,최영득 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.5

Purpose: The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality. Materials and Methods: Between March 1998and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria,suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed. Results: Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%)radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions. Conclusion: Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.

전립선 건강검진을 받은 60세 이상의 남성에서 대사증후군과 전립선용적의 연관성

구교철,조강수,강은민,권성원,홍성준 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Purpose: To evaluate the relationship between factors of metabolic syndrome(MS) to prostate volume and lower urinary tract symptom in men over sixties.Materials and Methods: A total of 624 male subjects aged 60 to 90 years were enrolled. Prostate volume, urinary flow rate, voided volume, post void residual urine volume, voiding symptoms and MS-related parameters were investigated. Patients were divided into two groups; those with MS (n=223) and those without(n=401). Prostate volume, urodynamic factors and voiding symptoms were compared based upon MS categories.Results: The MS and control group showed no significant differences with respect to age(74.8±5.6 vs. 74.0±5.4, respectively, p=0.083) and prostate specific antigen levels(1.8±1.5 vs. 1.7±1.5, respectively, p=0.248). However, the MS group had significantly greater waist circumference, blood pressure, fasting blood sugar level, hypertriglyceridemia and lower high density lipoprotein(HDL) cholesterol than the control group(p<0.05). Patients with MS showed significantly larger total prostate volume(p=0.008) and transitional zone volume(p=0.012). There were no differences between two groups respect to maximum flow rate, voided volume and residual volume (p>0.05). There was a significant relationship between prostate volume and obesity(p=0.016), however other MS factors such as low HDL, hypertension, non-insulin dependent diabetes mellitus and hypertriglyceridemia were not associated with prostate volume(p>0.05).Conclusions: Metabolic syndrome is associated with prostate volume related factors, but not to voiding dysfunction in Korean men over sixties. Among subcategories of MS, obesity is the most strongly related factor to prostate volume.

Cancer-Specific Mortality among Korean Men with Localized or Locally Advanced Prostate Cancer Treated with Radical Prostatectomy Versus Radiotherapy: A Multi-center Study Using Propensity Scoring and Competing Risk Regression Analyses

구교철,조진선,방우진,이승환,조성용,김선일,김세중,나군호,홍성준,정병하 대한암학회 2018 Cancer Research and Treatment Vol.50 No.1

Purpose Studies comparing radical prostatectomy (RP) outcomes with those of radiotherapy with or without androgen deprivation therapy (RT±ADT) for prostate cancer (PCa) have yielded conflicting results. Therefore, we used propensity score-matched analysis and competing risk regression analysis to compare cancer-specific mortality (CSM) and other-cause mortality (OCM) between these two treatments. Materials and Methods The multi-center, Severance Urological Oncology Group registry was utilized to identify 3,028 patients with clinically localized or locally advanced PCa treated by RP (n=2,521) or RT±ADT (n=507) between 2000 and 2016. RT±ADT cases (n=339) were matched with an equal number of RP cases by propensity scoring based on age, preoperative prostate-specific antigen, clinical tumor stage, biopsy Gleason score, and Charlson Comorbidity Index (CCI). CSM and OCM were co-primary endpoints. Results Median follow-up was 65.0 months. Five-year overall survival rates for patients treated with RP and RT±ADT were 94.7% and 92.0%, respectively (p=0.105). Cumulative incidence estimates revealed comparable CSM rates following both treatments within all National Comprehensive Cancer Network risk groups. Gleason score ! 8 was associated with higher risk of CSM (p=0.009). OCM rates were comparable between both groups in the low- and intermediate-risk categories (p=0.354 and p=0.643, respectively). For high-risk patients, RT±ADT resulted in higher OCM rates than RP (p=0.011). Predictors of OCM were age ! 75 years (p=0.002) and CCI ! 2 (p < 0.001). Conclusion RP and RT±ADT provide comparable CSM outcomes in patients with localized or locally advanced PCa. The risk of OCM may be higher for older high-risk patients with significant comorbidities.

Unrecognized Kinetics of Serum Testosterone: Impact on Short-Term Androgen Deprivation Therapy for Prostate Cancer

구교철,정병하,이동훈,김규현,이승환,홍창희,홍성준 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3

Purpose: To evaluate the kinetics of serum testosterone (T) recovery following short-term androgen deprivation therapy (ADT), as the understanding thereof is essential for the proper management of prostate cancer (PCa), especially intermittentADT. Materials and Methods: This prospective analysis included male sex offenders who voluntarily received leuprolide acetate in order to alleviate sexual aberrance. Thirty-three and 25 patients who received 3 and 6 months of ADT were assigned to Group A and Group B, respectively. Serum T levels were obtained everyweek during the on-cycle period, then monthly during the off-cycle period for at least 12 months. Results: The kinetics of serum T during the on-cycle period were similar in both groups. After flare reaction at week 2, a nadir of 0.45±0.29 ng/mL was achieved. In Group A, an abrupt rebound-upsurge was observed during the first 2 month off-cycle period, which surpassed the baseline level and reached a plateau level of 8.74±2.11 ng/mL during the flare (p<0.001). This upsurge was followed by a gradual decline back to baseline over the following 10 months. In Group B, a gradual increase was observed, and a baseline level of 7.26±1.73 ng/mL was reached at 5 months. Thereafter, an ongoing upsurge that surpassed baselinelevels was observed until 12 months (8.81±1.92 ng/mL; p=0.002). Conclusion:The kinetics of serum T recovery during the off-cycle period varied accordingto the duration of ADT. Serum T should be monitored beyond normalization, as an excessive rebound may improve quality-of-life, but hamper the treatment efficacyof PCa.

Treatment of Oligometastatic Hormone-Sensitive Prostate Cancer: A Comprehensive Review

구교철,Prokar Dasgupta 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.5

With advancements in diagnostic techniques, including molecular and clinical imaging, that directly target cancer cells, oligometastaticprostate cancer (PCa) is being diagnosed in patients who were, in the past, considered to have localized disease. Withaccumulating evidence, there has been a paradigm shift in considering aggressive treatments targeted at both the primary tumorand metastatic lesions in an aim to avoid and delay the need for palliative treatments and, ultimately, to achieve survival benefits. However, many questions still remain unanswered regarding the understanding of oligometastatic PCa, from its definition to optimaltreatment strategies for each individual. Limited retrospective studies have suggested that interventions, including localand/or metastasis-directed therapy using surgery and radiation therapy (RT), can improve survival outcomes with minimal riskof adverse effects. Such treatments have been shown to decrease the risks of subsequent palliative interventions and to delay thestart of androgen-deprivation therapy. Nevertheless, available data are insufficient to draw a reliable conclusion regarding theireffect on quality of life measures and overall survival. This comprehensive review overviews data from contemporary literaturethat have investigated treatments, including surgery and RT, for patients with oligometastatic PCa, namely pelvic lymph nodepositive disease and limited distant metastases, and summarizes ongoing trials that are evaluating the feasibility of aggressivemultimodal treatments.

Video-Assisted Minilaparotomy Surgery (VAMS): Challenging Cases of Nephron-Sparing Surgery in a Solitary Kidney

구교철,한웅규,양승철 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.3

Although radical nephrectomy is the mainstay in the surgical management of renal cell carcinoma (RCC), a solitary kidney with RCC is an imperative indication for nephron-sparing surgery (NSS). In this rare setting, radical nephrectomy can potentially render the patient anephric, leading to dialysis or renal transplantation. Although open surgery is still the gold standard for NSS, there has been an upsurge in the number of minimally invasive NSS procedures that have demonstrated excellent long-term oncologic, surgical, and functional outcomes. Complex renal tumors in the setting of a solitary kidney add an additional challenge to minimally invasive NSS. Here we describe 3 complex cases of RCC in a solitary kidney treated successfully by video-assisted minilaparotomy surgery-NSS.

Analgesic Opioid Dose Is an Important Indicator of Postoperative Ileus Following Radical Cystectomy with Ileal Conduit: Experience in the Robotic Surgery Era

구교철,나군호,윤영은,정병하,홍성준 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: Postoperative ileus (POI) is common following bowel resection for radicalcystectomy with ileal conduit (RCIC). We investigated perioperative factors associatedwith prolonged POI following RCIC, with specific focus on opioid-based analgesic dosage. Materials and Methods: From March 2007 to January 2013, 78 open RCICs and 26 robot-assisted RCICs performed for bladder carcinoma were identified with adjustment for age, gender, American Society of Anesthesiologists grade, and body mass index (BMI). Perioperative records including operative time, intraoperative fluid excess, estimated blood loss, lymph node yield, and opioid analgesicdose were obtained to assess their associations with time to passage of flatus, tolerable oral diet, and length of hospital stay (LOS). Prior to general anaesthesia, patients received epidural patient-controlled analgesia (PCA) consisted of fentanyl with its dose adjusted for BMI. Postoperatively, single intravenous injections of tramadolwere applied according to patient desire. Results: Multivariate analyses revealedcumulative dosages of both PCA fentanyl and tramadol injections as independentpredictors of POI. According to surgical modality, linear regression analyses revealed cumulative dosages of PCA fentanyl and tramadol injections to be positively associated with time to first passage of flatus, tolerable diet, and LOS in the open RCIC group. In the robot-assisted RCIC group, only tramadol dose was associated with time to flatus and tolerable diet. Compared to open RCIC, robot-assistedRCIC yielded shorter days to diet and LOS; however, it failed to shorten days to first flatus. Conclusion: Reducing opioid-based analgesics shortens the duration of POI. The utilization of the robotic system may confer additional benefit.

한국인 비뇨기 암의 역학과 치료 경향

구교철(Kyo Chul Koo),정병하(Byung Ha Chung) 대한비뇨기종양학회 2015 대한비뇨기종양학회지 Vol.13 No.2

Prostate, kidney, and bladder cancers are the three most prevalent urologic cancers in the Korean population. Throughout the last decade, there has been an upsurge in the incidence and prevalence of prostate and kidney cancers, along with a marked improvement in survival. A stage migration has been observed towards early detection of localized cancers, and accordingly, the landscape of urologic cancer treatment in Korea has been characterized by an exponential increase in the number of patients receiving surgery with curative intent. Herein, a substantial proportion of surgeries were performed using minimally-invasive methods, especially robot-assisted surgery. Current management strategies of urologic cancers in Korea are mostly based on evidences provided by international guidelines. There is prompt adoption and clinical application of novel systemic agents for advanced stage cancer, and surgical and oncological outcomes are comparable to those of Western reports. Multidisciplinary treatment options are available for various cancers at different stages. At the same time, treatment decisions are influenced by the availability of health-care resources, which is regulated by the National Health Insurance policy guidelines. Accumulating information on characteristics of urologic cancers in Korean patients demonstrates that Korean patients harbor more aggressive prostate cancer features compared to Western men. Due to the racial disparity in features of certain cancers, the optimal management strategy specific for the Korean population is yet to be validated. A comprehensive national cancer database may help to identify risk factors, select sequential strategies, and to assess survival outcome of Korean urologic cancer patients.