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- 저자 : 송선교(Sun Kyo Song) (검색결과 43 건)
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송선교 ( Sun Kyo Song ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S
Curative surgery is the most common and desirable treatment for advanced gastric cancer (AGC), but macroscopically curative resection of AGC dose not always mean a curative outcome, For the tailored management of AGC, accurate preoperative stage are made by using abdominal CT, FDG PET and laparoscopy is necessary. In case of T3/T4 lesion, neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (NACR) are effective therapeutic approaches with acceptable toxicity without increasing surgical morbidity and mortality. I recommend the use of a multidisciplinary therapeutic strategy for treatment of AGC. Future applications of newer cytotoxic drugs such as oxaliplatin, capecitabine, irinotecan, and docetaxel or targeted therapies may help to improve the management of AGC.
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강상윤,김세원,송선교,김상운,Kang, Sang-Yoon,Kim, Se-Won,Song, Sun-Kyo,Kim, Sang-Woon 대한위암학회 2007 대한위암학회지 Vol.7 No.3
목적: 진행성 위암환자의 예후인자에서 림프절 전이와 침윤깊이 등이 중요한 예후인자로 여겨지고 있지만, 림프절 전이가 없는 진행성 위암환자의 침윤깊이에 따른 예후인자에 관해서는 정립이 되지 않고 있다. 본 연구에서는 림프절 전이가 없는 진행성 위암 환자의 생존율에 관계된 예후 인자를 확인하고 침윤깊이에 따른 예후 인자의 변화를 확인하고자 한다. 대상 및 방법: 본 교실에서 진행성 위암으로 1990년 1월부터 1999년 12월까지 수술 받은 1,761명 중 의무기록을 후향적으로 검토하여 림프절 전이 및 원격전이가 없는 진행성 위암 환자 268명을 대상으로 하였다. 나이, 성별, 종양의 위치, 종양의 크기, 종양의 위벽침윤도, 조직학적 분화도, 림프관 침윤, 신경침윤, 혈관 침윤 등을 토대로 생존율에 대한 단변량 및 다변량 분석을 시행하였고 침윤 깊이(T2, T3, T4)에 따라 대상 환자를 아그룹으로 분류하여 침윤 깊이에 따르는 예후인자를 조사 하였다. T4 군은 제한된 개체 수 때문에 분석에서 제외 시켰다. 결과: 생존율과 관계된 통계적으로 의미있는 예후 인자는 단변량 분석에서는 나이, 종양의 위벽침윤도, 조직학적 분화도, Borrmann 형, Lauren 분류이고 다변량 분석에서는 나이, 침윤도, Lauren 분류였다. 침윤 깊이에 따른 아그룹의 다변량 분석에서 의미있는 예후 인자는 T2 군에서는 나이와 Borrmann 형, Lauren 분류이며 T3 군에서는 나이와 Lauren 분류, 혈관 침윤이었다. 결론: 림프절 전이 없는 진행성 위암에서 나이와 Lauren 분류, 침윤 깊이가 생존율의 영향을 미치는 독립적인 예후 인자라고 볼 수 있다. 단 T2 군에서는 Borrmann 형 또한 생존율에 영향을 미치는 예후 인자로써 검토해 볼 필요가 있다. Purpose: This study was conducted to identify prognostic factors in gastric cancer without lymph node metastasis and to specifiy which prognostic factors can be available in detail according to the depth of invasion. Materials and Methods: This retrospective study was based on the medial records of 268 gastric cancer patients who received resectional therapy from 1990 to 1999. The patients who revealed pT2NOMO, pT3NOMO, pT4NOMO on postoperative pathologic reports were enrolled. The survival rate was analyzed according to clinicopathologic and therapeutic factors. Results: According to the depth of invasion, the number of patients with pT2a, pT2b, pT3 and pT4 were 86 (32.1%), 56 (20.9%), 108 (40.3%), and 18 (6.7%) respectively. Age, depth of invasion, histological type, Borrmann type, and Lauren classification were statistically significant in the univariate analysis, and the age, the depth of invasion, and Lauren classification were independent prognostic factors identified by multivariate analysis. On multivariate analysis of subgroups according to the depth of invasion, the independent prognostic factors were age, Borrmann type, and Lauren classification in pT2, and age, Lauren classification, and vascular invasion in pT3. The prognostic factors of pT4 patients could not be analyzed due to limited sample size. Conclusion: In advanced gastric cancer patients without lymph node metastasis, age, the depth of invasion, and Lauren classification should be checked to predict prognosis. In patients with pT2 lesion among the above patients, the Borrmann type should be added in check-list.
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박신영,배정민,김세원,김상운,송선교,Park, Shin-Young,Bae, Jung-Min,Kim, Se-Won,Kim, Sang-Woon,Song, Sun-Kyo 대한위암학회 2009 대한위암학회지 Vol.9 No.3
목적: 위암환자의 수술 전 병기 결정에 있어서 PET의 유용성을 알아보기 위해 본 연구를 시행하였다. 대상 및 방법: 2006년 2월부터 2008년 8월까지 본원에서 위암으로 진단받고 수술 전 병기 결정을 위해 복부 컴퓨터 단층촬영(CT) 및 PET-CT를 모두 시험한 환자 70명을 대상으로 복부 CT 및 PET-CT 영상 자료에 의한 림프절 전이 판정과 수술 후 병리 조직검사에 의한 림프절 전이판정으로 민감도, 특이도, 양성예측도, 음성예측도 및 정확도를 조사하였고 위암의 형태, 조직학적 분류, 크기 등과 FDG섭취 정도와의 차이 등을 알아보았다. 결과: 조기 위암 23예의 경우 복부 CT에서 병변이 진단된 경우는 4명(17.4%), PET-CT에서는 12명(52.1%)이었으며, 진행 위암 47예의 경우 CT에서 26명(56.5%), PET-CT에서 45명(95.7%)으로 PET-CT에서 진단율이 높게 나타났다. 병변의 크기에 따른 분류에서도 복부 CT보다 PET-CT에서 진단율이 높은 것으로 나타났으며, 조기 위암의 경우 진행 위암에 비해 FDG 섭취 정도가 낮았지만 3 cm 이상의 조기 위암의 경우 3 cm 미만의 조기 위암에 비해 FDG가 섭취되는 경우가 더 많았다. CT에서 림프절 병기 결정의 민감도는 40.0%, 특이도는 85.7%, 양성예측도는 85.7%, 그리고 음성예측도는 40.0%였으며, PET-CT에서는 각각 55.6%, 81.0%, 86.2%, 45.9%였다. PET-CT를 통해서만 발견된 전이 병소는 1예(간전이)였으며, 중복암은 직장암 1예와 췌장암 1예가 있었다. 또한 세포조직형에 따른 분류에서도 분화영, 미분화형 모두 PET-CT에서 진단율이 높은 것으로 나타났다. 결론: CT에 비해 PET-CT에서 원발 병소의 진단, 림프절 전이 모두 진단율이 높은 것으로 나타났으며 PET-CT는 전이 병소와 중복암의 발견 등 다른 영상 진단법에 비하여 유리한 점이 있다. Purpose: The aim of this study was to examine the usefulness of positron emission tomography (PET)-computed tomography (CT) in the pre-operative staging of gastric cancer. Materials and Methods: Between February 2006 and August 2008, PET-CT and CT were performed on 70 patients diagnosed with gastric cancer by gastrofiberscopic biopsy. The sensitivities, specificities, Positive predictive value (PPV), and negative predictive value (NPV) of PET-CT and CT imaging for the detection of gastric cancer TNM staging were compared. Results: The detection rates for the primary tumor were as follows: PET-CT, 81.4% (57/70); and CT, 42.9% (30/70). For both early gastric cancer (EGC) and advanced gastric cancer (AGC), PET-CT was more accurate than CT in detecting the lesions. As the size of the tumor exceeded 3 cm, the detection rate increased. The sensitivities, specificities, PPV, and NPV of PET-CT for lymph node staging were 55.6%, 81%, 86.2%, and 45.9%, while the sensitivities, specificities, PPV, and NPV of CT were 40.0%, 85.7%, 85.7% and 40%, respectively. One case of multiple liver metastasis and two cases of dual primary cancer (rectal and pancreatic cancers) were detected by PET-CT. PET-CT also had a higher detection rate for all histologic types of primary tumors. PET-CT was more accurate than CT in detecting primary gastric cancer lesions. The detection of nodal metastasis by PET-CT was similar to CT; small-sized tumors or EGC detection rates were not high. However, PET-CT provided additional information to detect distant metastases and dual primary cancers and reduced unnecessary laparotomies to detect peritoneal seeding or carcinomatosis. Conclusion: It would be useful to make a pre-operative diagnosis of gastric cancer and determine treatment if PET-CT were added to other routine pre-operative studies.
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장석원,김치호,김상운,송선교,Jang Seok-Won,Kim Chi-Ho,Kim Sang-Woon,Song Sun-Kyo 대한위암학회 2004 대한위암학회지 Vol.4 No.3
Purpose: There have been some controversies over the therapeutic principles of advanced gastric cancer, and the results of treatment have been variable, especially for stage III disease. This study was conducted to define the prognostic factors of stage III gastric cancer. Materials and Methods: This retrospective study was based on the medical records of 179 patients with stage III disease who received a gastrectomy from January 1990 to December 1994. The 5-year survival rate was analyzed according to the age, sex, tumor location, tumor size, Borrmann's type, depth of invasion, lymph-node metastasis, ratio of metastatic lymph nodes, type of surgical resection, extent of lymphnode dissection, curability of resection, postoperative chemotherapy, and pathological stage. The statistical analysis was done by using the Kaplan-Meier method, the log-rank test, and the Cox proportional hazards model. Results: The overall 5-year survival rate was $61.6\%$ the 5-year survival rates according to subgroup were $69.7\%$ for stage IIIa ($100\%$ for $T_{2}N_{2}$, $70.0\%$ for $T_{3}N_{1}$, $68.6\%$ for $T_{4}N_{0}$), and $54.1\%$ for stage IIIb ($T_{3}N_{2}$) (P<0.05). Among various clinicopathologic factors of stage III gastric cancer, the age of the patient, the tumor location, the gross type of tumor, the type of gastric resection, the extent of lymph-node dissection, the curability of resection, and the subgroups of stage III were statistically significant in the univariate survival analysis. The multivariate analysis defined the curability of resection, the extent of lymph-node dissection, the type of operation, the stage of disease, and the age of the patient as independent prognostic factors. Conclusion: A curative surgical resection and an extended lymph-node dissection are thought to be most important for improving the survival rate in stage III gastric cancer patients.
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T2 위암환자의 침윤깊이에 따른 병리소견 및 예후의 차이
김세원 ( Se Won Kim ),송선교 ( Sun Kyo Song ),김상운 ( Sang Woon Kim ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S
Purpose:A difference of a pathologic characteristic in proportion to depth of invasion analyzed in T2 gastric cancer and a difference of depth of invasion examined an influence to lymph node metastasis and prognosis. Materials and Methods:The clinicopathologic outcomes of 432 patients who underwent curative resection for pT2 stage gastric cancers from 1995 to 1999 were reviewed retrospectively. We are compared on lymphatic metastasis, stage distribution, histologic classification, Bormann`s classification, Lauren classification, vessel invasion, lymphatic invasion, neural invasion and 5-year survival rate of pT2 groups(mp vs. ss). 1) Results:pT2b(ss) group compare to pT2a(mp) in Lauren classification, ratio of diffused type was higher(p<0.05) and in Bormann classification, infiltration type was higher (p<0.01). Vessel and lymphatic invasion, neural invasion showed significant difference between pT2a(mp) and pT2b(ss) (p<0.01). Difference noted between pT2a(mp) and pT2b(ss) group in a lymph node metastatic rate, degree of a metastasis and stage distribution (p<0.01). On stratifying patients according to depth of invasion, 5-year suvival rate for those with pT2a(mp) group was significantly greater than those with pT2b(ss) group(82.4% vs. 47.4%, respectively: P<0.01). In this study, appeared with the significant prognostic factor in 5-year suvival rate which multivariate analysis, depth of invasion(P<0.05) and lymph node metastasis (P<0.01) that enforced the total gastric cancer patient who had T2 gastric cancer with the object noted, but for patients with accurately staged pN0 group, suvival characteristics were similar for pT2a (mp) and pT2b(ss) gastric cancer (P=0.97). Conclusion:The subclassification of pT2 gastric cancer into pT2a(mp) and pT2b(ss) is necessary to demonstrate their different prognosis.
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