관상동맥폐색질환에 따른 대장 종양의 유병률과 위험인자

석기태 ( Ki Tae Suk ),김현수 ( Hyun Soo Kim ),민현준 ( Hyun Jun Min ),박홍준 ( Hong Jun Park ),전효근 ( Hyo Keun Jeon ),김문영 ( Moon Young Kim ),김재우 ( Jae Woo Kim ),백순구 ( Soon Koo Baik ),권상옥 ( Sang Ok Kwon ) 대한장연구학회 2011 Intestinal Research Vol.9 No.2

Background/Aims: Both colorectal neoplasm (CN) and coronary artery obstructive disease (CAOD) are prevalent and major leading causes of death in Korea. Although CN and CAOD share similar risk factors such as male gender,smoking, hyperlipidemia, diabetes mellitus, and obesity, few studies of both CN and CAOD have been reported. In this study, we evaluated clinical correlations between CN and CAOD. Methods: Between June 2003 and December 2007, 176 patients (Male: 101, average age: 62.1±9.7 yr) who underwent colonoscopy after or before coronary angiography were retrospectively enrolled. The colonoscopic findings (normal, adenoma, or cancer) of patients as well as clinical and laboratory data according to the extent of CAOD (normal, minimal CAOD, or CAOD) were compared. Results: CAOD negative, minimal CAOD, and CAOD patients totaled 36, 40, and 100, respectively. The presence of CN (adenoma and adenocarcinoma) in CAOD negative, minimal CAOD, and CAOD cases was 42%,48%, and 63%, respectively, which was significantly different (P<0.05). In multivariate analysis, old age (≥60yr; P=0.03, odds ratio 2.47) and the presence of CAOD (P=0.02, odds ratio 4.11) were associated with the presence of CN. Conclusions: The prevalence of CN increased in proportion to the severity of CAOD. Colorectal cancer screening by fecal occult blood tests or colonoscopy should be a priority in patients with CAOD, particularly the elderly. (Intest Res 2011;9:112-116)

진료에서 중개 연구 아이디어 찾기

석기태 ( Ki Tae Suk ) 대한간학회 2022 임상연구방법론워크숍 Vol.2022 No.1

대장암에서의 “Omics” 연구-단백체학 연구를 중심으로

석기태 ( Ki Tae Suk ) 대한장연구학회 2011 Intestinal Research Vol.9 No.1

지난 20년간 대장암의 분자생물학적 기전에 관한 많은 연구가 진행되었음에도 불구하고 대장암의 진단과 예후, 예방, 치료, 병기결정에 맞는 신뢰성과 재현성이 있는 생물학적인 표지자는 부족한 실정이다. 현재까지 대장암의 진단과 치료는 기술적인 병기결정 체계와 형태학적 또는 조직학적인 소견에 의존되어 왔다. 그러나 질병을 연구하는데 있어 위와 같은 접근이나 한 가지 원인에 의한 발생한다는 단순한 접근은 복잡한 여러 인자가 관여한 암과 같은 질환의 이해에 많은 제약이 있다. 이러한 복잡한 기전을 연구하는 생물학적 분야로 전사체학, 단백체학, 대사체학, 그리고 유전체학이 있다. 비록 이러한 “omics”의 연구에서의 결과가 “Desire state” 와는 거리가 있지만, 이 분야에서 지난 10년 동안 기술적인 면에서 굉장한 진보를 이루었다. 현재까지의 “omics”을 이용한 대장암 연구 결과는 대장암의 진단과 예후에 일관된 생물학적 표지자를 밝혀내는데 미흡하지만, 대장암의 여러 분야의 이해에 도움을 주었다. 예를 들면 대장암의 서로 다른 병기에서 게놈, 전사, 단백질의 연구는 염색체의 평균 유전자 표현 수준과 연관되는 염색체 이수성을 발견하게 해 주었고, 이러한 염색체 변이/DNA복사 변화와 관련되는 유전자의 발현은 대장암에서만 한정되는 것이 아니라, 다른 고형암과 심지어는 효모에서도 발현되었다. 결국 이러한 연구는 대장암에서 새로운 후보 유전자(PLCG1 on20q, DBC1 on 8q21, NDGR1 on 8p24)를 발견하도록 해 주었다. 이 중 단백체학은 단백질의 성질을 발현, 중개연구 후 적용, 다른 단백질과의 결합에 초점을 두어 연구함으로써 세포 내 변형과정과 네트워크 형성을 질병의 진행 과정과 연계시켜 총괄적으로 이해할 수 있는 분야이다. 방법적으로 단백체학은 살아있는 시스템에서 단백질의 분석과 분리하는 방법 중 가장 효율적이라는데 기초를 두고 있다. 이러한 발전과 연구들에도 불구하고, 이 분야에는 자료수집, 해석, 진행과정의 분석, 발생 모델의 개발과 같은 수많은 rate-limiting step이 있다. 이러한 난관들은 현재의 기술과 전략들에 의해 빠르게 극복되고 있으며, 최근의 생물학에서의 암 관련 연구의 진보에 대한 EU-USA joint workshop에서, 연구 성공을 위해서 다음 분야의 향후 연구 의지를 발표하였다. “Cell-context specific molecular interaction maps in cancer (cancer interactomes, widely available experimental platforms for rapid biochemical validation, cellular network based contexts for the integration of orthogonal data modalities including gene expression, SNPs, gene copy number, epigenetic data, etc., information on pathway synergy for therapeutic intervention, assembly and validation of cell-context specific molecular interaction maps for cancer cells (genes, proteins, miRNA, lipids, metabolites, etc.)” 추후 “omics”를 이용하여 개인의 암세포에서 복잡한 발생 과정을 시각화하고 특별화된 개인적인 치료가 비기능적인 암 발생 과정을 교정하도록 하여 향후 미래에 적용될 개별화된 치료에서 혁명을 일으킬 것으로 판단된다.

간섬유화 및 문맥압항진증: 언제 어떻게 평가할 것인가?

석기태 ( Ki Tae Suk ) 대한간학회 2019 간학회 싱글토픽 심포지움 Vol.2019 No.2

현미부수체 불안정성에 따른 대장암의 임상-병리 특성

석기태 ( Ki Tae Suk ),김현수 ( Hyun Soo Kim ),이진형 ( Jin Hyung Lee ),김보라 ( Bo Ra Kim ),김문영 ( Moon Young Kim ),김재우 ( Jae Woo Kim ),백순구 ( Soon Koo Baik ),권상옥 ( Sang Ok Kwon ),정요셉 ( Yosep Chong ),조미연 ( Mee Yon 대한장연구학회 2009 Intestinal Research Vol.7 No.1

Background/Aims: Microsatellite instability (MSI) is associated with mutations in the DNA mismatch repair system and accounts for 10-15% of all cases of sporadic colorectal cancer (CRC). However, the characteristics and role of MSI as a marker for predicting the prognosis and therapeutic effect on CRC remain unclear. Methods: Between June 2003 and December 2007, 259 patients (males, 159 [61%]; age, 63 [±11] years) who underwent surgery for CRC were retrospectively enrolled. The clinicopathologic characteristics of patients with high-frequency MSI (MSI-H) CRC were reviewed and compared to patients with low-frequency MSI or microsatellite stable CRC. The patient characteristics and MSI-related data were recorded for the following variables: gender, age, clinicopathologic findings, chemotherapy response, recurrence, and survival. Results: MSI-H CRC was diagnosed in 30 patients (12%), low-frequency MSI CRC was diagnosed in 10 patients (4%), and microsatellite stable CRC in was diagnosed in 219 patients (84%). The MSI-H group exhibited the following characteristics: large size, right colon location, positive response to chemotherapy, low recurrence, longer survival, less neural invasion, poor differentiation, diffuse lymphoid reaction, and mucin pool formation. However, in the chemotherapy group (n=180), MSI-H was not a marker of longer survival. Based on Cox-regression analysis, stage IV CRC (OR=6.66; 95% CI, 2.24-53.00), MSI-H (OR=0.17; 95% CI, 0.04-0.73), and a positive response to chemotherapy (OR=0.02; 95% CI, 0.01-0.11) were related to mortality. Conclusions: MSI-H CRC had less neural invasion and diffuse lymphoid reaction. Further studies regarding the relationship between those pathologic findings and survival are needed. (Intest Res 2009;7:14-21)

간세포암 발생 예측에 있어서 문맥압 측정의 유용성

석기태 ( Ki Tae Suk ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2

Hepatocellular carcinoma (HCC) is the final stage of portal hypertension in chronic liver disease and the sixth most common neoplasm in the world. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis of fibrosis, risk stratification, identification of patients with HCC who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portalhypertension. In addition, HVPG may be a useful predictive factor for the development of HCC and HVPG ≥12 mmHg may be suggested a predictor of survival in cirrhotic patients with earlystage HCC. However, in the field of HCC, few data are available about the role of HVPG. In this review, we are going to introduce HVPG and overview its usefulness in the prediction of HCC. (J Liver Cancer 2014;14:73-79)

간질환에서 장내미생물총의 성차 이슈

석기태 ( Ki Tae Suk ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.1

Although sexual difference medicine is a relatively new concept, it is currently an important research area because different treatments may be required according to gender. Gender-related differences in the epidemiology, progression, and treatment strategies of chronic liver disease has been known for a long time, but there are few meaningful studies in most epidemiologic and clinical studies, but gender differences in pharmacological treatment have been associated with dose, administration timing, and incidence of drug side effects. Until now, the liver expresses androgen and estrogen receptors, so there are gender differences due to gene expression patterns, immune responses, and metabolism depending on sex hormones. (Korean J Gastroenterol 2021;78:24-26)

대장암 치료를 위한 생물학표지자

석기태 ( Ki Tae Suk ),김현수 ( Hyun Soo Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.2

Individualized tailored therapy is a currently pursuing direction for improving the outcome of patients with colorectal cancer. Targeted therapy is the potential strategy to reach this goal by evaluating status of the presumed targets and their related effector molecules and by maximizing the efficacy of chemotherapeutic agents with less toxicity in individual patient. Numerous hurdles should be overcome, however, because therapeutic outcome can be affected by multiple components; tumor characteristics such as somatic mutations at the DNA, RNA, and protein levels; patient characteristics like germline genetic polymorphisms in enzymes linked to drug metabolism; and environmental factors that include diet and physical activity. Currently, large numbers of potential biomarkers have been proposed but have not yet accomplished supporting evidences for their routine usage in clinics. Therefore, clinical trials driven by molecular targets and relevant biomarkers for the understanding of the conflicting data are needed to make markers available in clinical practice. (Korean J Gastroenterol 2009;53:68-75)

8번 삼염색체를 가진 골수이형성증을 동반한 장베체트병

석기태 ( Ki Tae Suk ),김현수 ( Hyun Soo Kim ),김정민 ( Jung Min Kim ),백순구 ( Soon Koo Baik ),이동기 ( Dong Ki Lee ),권상옥 ( Sang Ok Kwon ),어영 ( Young Uh ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

Behcet`s disease (BD) is a multisystem disorder with a wide variety of clinical presentation, but myelodysplastic syndrome (MDS) is rarely associated with this disease. Among 18 cases of BD-associated MDS previously reported, only 10 cases showed intestinal involvement. Furthermore, there is no case report of MDS combined with intestinal BD. Herein, we report a patient of intestinal BD who had MDS with chromosomal trisomy 8. (Korean J Gastroenterol 2003;41:229-233)

간섬유화와 Rifaximin

석기태 ( Ki Tae Suk ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.5