췌장암 항암화학요법의 최신 지견

성민제,Min Je Sung 대한소화기암연구학회 2023 Journal of digestive cancer reports Vol.11 No.3

Pancreatic cancer is one of the most aggressive cancers, and it is expected to become the second-leading cause of cancer-related death in the United States by 2030. Its 5-year survival rate is <10% and approximately 15% of cases are eligible for surgical treatment during diagnosis. Furthermore, the risk of recurrence within 1 year postoperative is as high as 50%. Therefore, chemotherapy plays a crucial role in pancreatic cancer treatment. Survival rates are speculated to have improved since the introduction of FOLFIRINOX and gemcitabine/nab-paclitaxel combination therapy for metastatic pancreatic cancer in the 2010s. Additionally, the implementation of both neoadjuvant and adjuvant treatments in resectable and borderline resectable pancreatic cancer caused better outcomes compared to upfront surgery. Recently, not only have these medications advanced in development, but so have PARP inhibitors and KRAS inhibitors, contributing to the treatment landscape. This study aimed to explore the latest insights into chemotherapy for pancreatic cancer.

대도시와 중도시의 국민학교 아동의 우식성식품 섭취 및 구강건강관리 실태에 관한 비교 조사연구

성민제,신승철 ( Min Jae Sung,Seung Chul Shin ) 대한예방치과·구강보건학회 1992 大韓口腔保健學會誌 Vol.16 No.1

계층적 베이지안 혼합 효과 모델을 사용한 비동차 마코프 체인의 분석

성민제,Sung, Minje 한국통계학회 2014 응용통계연구 Vol.27 No.2

본 연구에서는 비동차 마코프 체인에서 개체들의 전이 행태를 분석하기 위한 계층적 베이지안 방법론을 사용하여 혼합 효과 모델을 소개 하였다. 모델의 모수들에 대한 사후분포가 분석적으로 구해질 수 없는 형태를 가지기 때문에 깁스(Gibbs) 샘플링 시뮬레이션 방법을 사용하여 조건부 사후확률로부터 샘플이 추출되었고, 실제 자료분석을 예를 사용하였다. The present study used a hierarchical Bayesian approach was used to develop a mixed effect model to describe the transitional behavior of subjects in time nonhomogeneous Markov chains. The posterior distributions of model parameters were not in analytically tractable forms; subsequently, a Gibbs sampling method was used to draw samples from full conditional posterior distributions. The proposed model was implemented with real data.

Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus

성민제,Tae Seop Lim,Mi Young Jeon,Hye Won Lee,Beom Kyung Kim,Do Young Kim,Sang Hoon Ahn,Kwang-Hyub Han,Jun Yong Park,Seung Up Kim 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5

Background/Aims: Sarcopenia is associated with liver fibrosis in patients with nonalcoholic fatty liver disease and chronic hepatitis B. We investigated the association between sarcopenia and hepatic fibrotic burden in patients with type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM who had received a comprehensive medical health checkup were recruited. Muscle mass was assessed using computed tomography. Fibrotic burden was assessed using the fibrosis-4 index (FIB-4). The study population was divided by quartile stratification of the lumbar skeletal muscle index (LSMI). Results: Among 309 patients with T2DM, 75 (24.3%) had sarcopenia. These patients were significantly older and had higher FIB-4, whereas they had significantly lower body mass index (BMI) and LSMI than patients without sarcopenia (all p<0.05). The LSMI showed a significant negative correlation with the FIB-4 when analyzed in terms of quartile stratification (p=0.003). Multivariate analysis showed that female sex and higher BMI were independently associated with a reduced risk of sarcopenia (odds ratio [OR], 0.388; 95% confidence interval [CI], 0.199 to 0.755 and OR, 0.704; 95% CI, 0.618 to 0.801; all p<0.05), whereas a higher FIB- 4 was independently associated with an increased risk of sarcopenia (OR, 1.817; 95% CI, 1.180 to 2.797; p=0.007). Among patients with a BMI <25 kg/m2 (n=165), those with sarcopenia (n=54, 32.7%) had a significantly higher FIB-4 than those without (n=111, 67.3%; 1.66 vs 1.38, p=0.004). Conclusions: Sarcopenia is independently associated with fibrotic burden in patients with T2DM. Further studies should investigate whether the improvement of sarcopenia can ameliorate liver fibrosis in patients with T2DM.

췌장신경내분비종양의 내과적 치료

성민제 ( Min Je Sung ),정문재 ( Moon Jae Chung ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.1

췌장신경내분비종양은 랑게르한스 소도에서 기원한 종양을 의미하며, 호르몬 분비에 의한 증상 발현 유무, Ki-67 분열 지수 및 세포분화도를 기준으로 한 분류 외에도, Tumor-Node-Metastasis (TNM) 병기 분류를 통한 병의 진행 정도에 따라 다양한 예후를 보인다. 췌장신경내분비종양의 내과적 치료목표는 증상을 조절하거나, 종양의 성장을 억제하는 것이다. 내과적 치료 약제 중 하나인 소마토스타틴 유사체는 호르몬 분비와 연관된 증상 조절 목적뿐만 아니라 항암 효과를 위해서도 사용되고 있으며, Ki-67 분열 지수가 20% 미만인 WHO 분류기준 Grade 1/Grade 2 (G1/G2) 종양의 진행을 억제하는 데에 효과적인 약물로 받아들여지고 있다. 분자표적치료제 중 everolimus와 sunitinib은 소마토스타틴 유사체 치료 후 진행된 WHO G1/G2 췌장신경내분비종양 환자에서 고려될 수 있다. 항암화학요법은 주로 Ki-67 분열지수가 높거나 급속히 진행하는 종양 또는 타 장기로 전이가 동반된 경우, 다른 치료에 실패하였거나 소마토스타틴 수용체 음성인 신경내분비 암종에 우선적으로 사용이 고려되며, 주로 etoposide/cisplatin 병합 요법이 표준 치료제로 받아들여지고 있다. 하지만 Grade 3 췌장신경내분비종양(well differentiated, high grade) 환자군에 대해서는 아직까지 표준 치료에 대한 가이드라인이 확립되어 있지 않으며, 기존의 전신 항암제에 치료 반응률이 상대적으로 저조한 것으로 보고되고 있어, G1/G2 종양에서 사용되는 소마토스타틴 유사체나 분자표적치료제 등의 치료 반응률을 평가할 연구가 필요한 상황이다. 췌장신경내분비종양은 다양한 임상 경과를 보이는 만큼 다양한 치료의 선택이 필요하며, 내과적 치료뿐만 아니라 원발 부위 및 전이성 병소에 대한 근치적 절제술, 간동맥 색전술과 고주파 소작술 등의 국소 치료, 방사선 동위 원소를 이용한 방사선표적치료(PRRT) 등 모든 가능한 치료 방법을 고려하는 다학제적 접근이 중요하다고 하겠다. Pancreatic neuroendocrine tumor (PNET) refer to tumors originating from the islet of Langerhans and shows various prognosis based on the presence or absence of symptoms due to hormone secretion, the Ki-67 cell proliferation index, and the histologic grade, and according to the degree of disease progression defined by the tumor-node-metastasis (TNM) stage classification. The purpose of medical treatment for PNET is to control symptoms or inhibit tumor growth. Somatostatin analogues can be administered for the purpose of controlling symptoms caused by the secretion of specific hormones, and are accepted as effective drugs for inhibiting the progression of G1/G2 tumors based on World Health Organization (WHO) classification with a Ki- 67 cell proliferation index less than 20%. Among the molecularly targeted agents, everolimus and sunitinib can be considered in patients with WHO G1/G2 PNET showing progression after somatostatin analog therapy. Cytotoxic chemotherapy is generally administered to patients with large tumor volume and rapidly progressing metastatic NET, and etoposide/cisplatin combination therapy has been considered as a standard treatment. For the patient group of Grade 3 PNET (well differentiated) newly classified by the WHO 2017 classification, guidelines for standard treatment have not yet been established. As it has been reported, studies are needed to evaluate the treatment response rate of somatostatin analogues or molecularly targeted therapies for the patient with Grade 3 PNET. It is important to consider a multidisciplinary approach with all possible treatment options including medical treatment, radical resection of primary or metastatic lesions, liver-directed therapies, and peptide receptor radionuclide therapy for the patients with PNET. Korean J Pancreas Biliary Tract 2021;26(1):24-32

췌장암의 항암치료와 방사선 치료 최신 지견

성민제 ( Min Je Sung ),방승민 ( Seungmin Bang ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.2

췌장암은 현재 가장 위협적인 악성종양 중 하나로, 5년 생존율이 10%밖에 되지 않는다. 이렇게 췌장암의 예후가 불량한 데에는, 항암화학요법에 반응이 저조한 것과 조기발견을 위한 효과적인 방법의 부재가 주요한 이유로 생각된다. 여러 치료 방법 중에서 수술적 절제만이 췌장암의 완치를 기대할 수 있다. 그러나 수술 후 재발률은 여전히 50% 이상으로 높고, 절제 가능한 단계로 진단되는 환자의 비율은 췌장암 환자 중 15% 미만으로 현저히 낮다. 그래서 항암화학요법과 방사선 치료는 췌장암 치료에서 중요한 역할을 하게 된다. 췌장암 치료 중에서, 전이성 췌장암에 폴피리녹스(F O L F I R I N O X )와 젬시타빈 / 냅 - 파클리탁셀(Gemcitabine/nab-paclitaxel)을 도입한 후에야 두 자릿수 생존율을 기대할 수 있게 되었다. 또한 경계 절제 가능 췌장암과 절제 가능 췌장암에서 동시 항암화학방사선요법을 포함한 선행 항암치료법이 수술을 먼저 시행하는 치료 방법보다 우수하다고 보고되었다. 최근에는 폴리아데노신 디프인산-리보오스 중합효소(PARP) 억제제, 면역항암제 등 여러 표적제들이 췌장암에 시도되고 있다. 이제 췌장암 치료에서 중요한 위치에 있는 항암화학요법과 방사선 치료의 현황에 대하여 설명하고자 한다. Pancreatic cancer is still one of the most aggressive malignancy, showing 10% of 5-year survival. Among the several reasons of the grave prognosis, the poor response to chemotherapeutic agents and the absence of effective tool for early detection are the most important. Regarding treatments, surgical resection is still positioned as the only one for expecting the cure of pancreatic cancer. However, the rate of recurrence after surgery is still high as more than 50%. And the portion of patients who are diagnosed at the resectable stage is still less than 15% of all cases. So, chemotherapy and radiotherapy are the main players for combating with pancreatic cancer. After the introduction of outcomes of FOLFIRINOX, and gemcitabine/nabpaclitaxel for metastatic pancreatic cancer, two-digit overall survival can be expected. And, neoadjuvant treatments including concurrent chemoradiation therapy for borderline resectable pancreatic cancer and/or resectable pancreatic cancer are reported as superior to upfront surgery. More recently, several target agents including polyadenosine diphosphate-ribose polymerase inhibitors and immunologic drugs are under evaluation for pancreatic cancer. So, herein, current status of chemotherapy and radiation therapy for pancreatic cancer will be addressed.

유기랭킨사이클(ORC)을 위한 주전열면 열교환기의 채널주름비에 따른 유동 및 열전달 특성

성민제(M.J. Sung),안준(J. Ahn) 한국전산유체공학회 2013 한국전산유체공학회 학술대회논문집 Vol.2013 No.10

A series of numerical simulation has been carried out to study thermo-hydraulic characteristics of a primary surface type heat exchanger, which is designed for the evaporator and condenser of a geothermal ORC. Working fluid is geothermal water at hot side and R-245fa, which is a refrigerant designed for ORC, at cold side. Amplitude ratio of the channel and Reynolds number are considered as design parameters. Nusselt number is presented for the Reynolds number ranging from 50 to 150 and compared to existing correlations. The result shows that higher amplitude ratio channel gives better heat transfer performance within the range of investigation.

Primary surface type 열교환기의 형상 변화에 따른 열전달 특성

성민제(M.J. Sung),안준(J. Ahn) 한국전산유체공학회 2013 한국전산유체공학회 학술대회논문집 Vol.2013 No.5

A series of numerical simulation has been carried out to study thermo-hydraulic characteristics of a primary surface type heat exchanger. Effects of aspect ratio and amplitude are considered. Working fluid is geothermal water at hot side. R-245fa is used at cold side which is for ORC(Organic Rankine Cycle). Nusselt number is presented for the Reynolds number(50≤Re≤150). The result shows that the higher aspect ratio channel gives better heat transfer efficiency.

100kWe급 ORC저온 지열원 발전기술개발

성민제(M.J. Sung),안준(J. Ahn) 한국전산유체공학회 2012 한국전산유체공학회 학술대회논문집 Vol.2012 No.11

유기랭킨사이클(ORC)을 위한 주전열면 열교환기의 채널 종횡비에 따른 유동 및 열전달 특성

성민제(M.J. Sung),안준(J. Ahn) 한국전산유체공학회 2013 한국전산유체공학회지 Vol.18 No.4

A series of numerical simulation has been carried out to study thermo-hydraulic characteristics of a primary surface type heat exchanger, which is designed for the evaporator and condenser of a geothermal ORC. Working fluid is geothermal water at hot side and R-245fa, which is a refrigerant designed for ORC, at cold side. Aspect ratio of the channel and Reynolds number are considered as design parameters. Nusselt number is presented for the Reynolds number ranging from 50 to 150 and compared to existing correlations. The result shows that higher aspect ratio channel gives better heat transfer performance within the range of investigation.