경부의 주정맥 침범과 암성 혈전을 보인 여포상 갑상선암 2예

안성귀,이잔디,임치영,남기현,장항석,정웅윤,박정수 대한외과학회 2006 대한외과학회 학술대회 초록집 Vol.2006 No.5

Current Issues and Clinical Evidence in Tumor-Infiltrating Lymphocytes in Breast Cancer

안성귀,정준,홍순원,정우희 대한병리학회 2015 Journal of Pathology and Translational Medicine Vol.49 No.5

With the advance in personalized therapeutic strategies in patients with breast cancer, there is an increasing need for biomarker-guided therapy. Although the immunogenicity of breast cancer has not been strongly considered in research or practice, tumor-infiltrating lymphocytes (TILs) are emerging as biomarkers mediating tumor response to treatments. Earlier studies have provided evidence that the level of TILs has prognostic value and the potential for predictive value, particularly in triple-negative and human epidermal growth factor receptor 2–positive breast cancer. Moreover, the level of TILs has been associated with treatment outcome in patients undergoing neoadjuvant chemotherapy. To date, no standardized methodology for measuring TILs has been established. In this article, we review current issues and clinical evidence for the use of TILs in breast cancer.

Survival Benefit of Zoledronic Acid in Postmenopausal Breast Cancer Patients Receiving Aromatase Inhibitors

안성귀,김성현,이학민,이승아,정준 한국유방암학회 2014 Journal of breast cancer Vol.17 No.4

Purpose: A growing body of evidence indicates that zoledronicacid (ZA) can improve the clinical outcome in patients withbreast cancer and low estrogen levels. In the present study, weaimed to investigate the survival benefit of ZA administration inpostmenopausal Korean women with breast cancer who werealso receiving aromatase inhibitors. Methods: Between January2004 and December 2010, 235 postmenopausal breast cancerpatients undergoing aromatase inhibitor therapy were investigated. All patients were postmenopausal, as confirmed by laboratorytests. Of these patients, 77 received adjuvant upfront ZA forat least 1 year in addition to conventional adjuvant treatment. The remaining 158 patients never received ZA and were treatedaccording to the St. Gallen guidelines. Results: The baselinecharacteristics for ZA treatment were not different between thetwo groups. The median follow-up time was 62 months, and thepatients who received ZA in addition to aromatase inhibitorsshowed a better recurrence-free survival compared to those whoreceived aromatase inhibitors alone (p=0.035). On multivariateanalysis, the patients who received ZA showed a better recurrence-free survival independent of the tumor size, nodal status,progesterone receptor, and histological grade. For this model,Harrel c index was 0.743. The hazard ratio of ZA use for recurrence-free survival was 0.12 (95% confidence interval, 0.01–0.99). Conclusion: Our findings suggest that upfront use of ZA aspart of adjuvant treatment can offer a survival benefit to postmenopausalbreast cancer patients receiving aromatase inhibitortreatment.

Prognostic Factors for Patients with Bone-Only Metastasis in Breast Cancer

안성귀,이학민,조상훈,이승아,황승현,이희대,정준 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.5

Purpose: Bone is the most frequent site of metastasis among breast cancer patients. We investigated prognostic factors affecting survival following bone-only metastasis in breast cancer patients. Materials and Methods: The medical records of breast cancer patients who were treated and followed at Gangnam Severance Hospital retrospectively reviewed to identify patients with bone-only metastasis. Results: The median time from the diagnosis of bone-only metastasis to the last follow-up or death was 55.2 [95% confidence interval (CI), 38.6-71.9] months. The Kaplan-Meier overall survival estimate at 10 years for all patients was 34.9%. In the multivariate Cox regression model, bisphosphonate treatment [hazard ratio=0.18; 95% CI, 0.07-0.43], estrogen receptor positivity (hazard ratio=0.51; 95% CI, 0.28-0.94), and solitary bone metastasis (hazard ratio=0.32; 95% CI, 0.14-0.72) were significantly associated with longer overall survival in the bone-only recurrence group. Among the treatment modalities, only bisphosphonate treatment was identified as a significant prognostic factor. Conclusion: Identifying the factors influencing breast cancer mortality after bone-only metastasis will help clarify the clinical course and improve the treatment outcome for patients with breast cancer and bone-only metastasis. Bisphosphonates, as a significant prognostic factor, warrant further investigation.

Molecular Classification of Triple-Negative Breast Cancer

안성귀,김승준,Cheungyeul Kim,정준 한국유방암학회 2016 Journal of breast cancer Vol.19 No.3

Tumor heterogeneity of triple-negative breast cancer (TNBC) has been the main barrier in conquering breast cancer. To dissect the molecular diversity of TNBC and discover therapeutic targets for TNBC, the molecular classification of TNBC is a prioritized issue in research area. Accordingly, recent studies have been successful in classifying TNBC into several distinct subtypes with specific biologic pathways. Despite the different methodologies used and varied number of final subtypes, these studies identically suggested that TNBC consists of four major subtypes: basallike, mesenchymal, luminal androgen receptor, and immune-enriched. By reviewing these methods of classifications of TNBC, we highlight the unmet need to develop a molecular classifier suited for TNBC.

Doxorubicin이 포함된 항암치료를 받은 2, 3기 유방암에서 ATP를 이용한 항암제 반응성 검사와 조기 전신 재발과의 관계

안성귀,정준,최석경,황승현,이승아,정우희,이희대 한국유방암학회 2011 Journal of breast cancer Vol.14 No.-

Purpose: An in vitro adenosine triphosphate-based chemotherapy response assay (ATP-CRA) was designed to require only a limited number of cells and shorten test turnaround time with a high success rate. This study investigated the correlation between in vitro doxorubicin sensitivity of tumor cells and early systemic recurrence, defined as recurrence within 2 years after surgery. Methods: From January 2004 to March 2007, the ATP-CRA for doxorubicin was tested in 128 patients among breast cancer patients treated at Gangnam Severance Hospital, Seoul, Korea. The American Joint Committee on Cancer stages for all patients were II and III. All patients received doxorubicin-based chemotherapy. Selected patients were divided into a chemosensitive group and a non-chemosensitive group, according to a 40% cell death rate as a cut-off value. We analyzed the relationship between chemosensitivity and early systemic recurrence in patients with breast cancer. Results: The meanage of the patients investigated was 44.6-years-old, the mean follow-up period was 39.9 months, and recurrence free survival was 38.6 months. Thirteen recurrences were observed during follow-up. Among 13 patients with a recurrence, eight had a recurrence within 2 years (early recurrence). All of the early recurring patients belonged to the non-sensitive group. Doxorubicin sensitivity results measured by ATP-CRA were related with early recurrence free survival in patients with breast cancer (p=0.030). The mean cell death rate derived from the ATP-CRA for the early recurrence group tended to be lower than that of the non-early recurrence group, but the difference was not statistically significant (p=0.05). Conclusion: Doxorubicin sensitivity measured by ATP-CRA was well correlated with in vivo drug responsibility to predict early recurrence against doxorubicinbased adjuvant chemotherapy in patients with breast cancer.

Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006)

안성귀,남석진,안세현,정용식,박형규,이수정,강성수,한원식,박경화,박용래,이지현,윤현조,김준현,유영범,송정윤,고병균,곽금희,정민성,김성용,조서현,김도일,장명철,문병인,김이수,김세중,박민호,김태현,조지형,임철완,배영태,공경엽,배영경,이아원,정준 한국유방암학회 2021 Journal of breast cancer Vol.24 No.2

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion: Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

포스터전시 : 간세포암의 근치적 절제술 후 조기 재발 예측을 위한 수술 전 FDG-PET의 역할 (초)

안성귀,김성훈,윤미진,이종두,김경식 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3(S)

Long-Term Survival Analysis of Korean Breast Cancer Patients at a Single Center: Improving Outcome Over Time

안성귀,정준,이학민,이승아,이희대 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: The prognosis of breast cancer has been consistently improving. We analyzedour cohort of breast cancer patients with a long-term follow up at a single center over time. Materials and Methods: A total of 1889 patients with known cancer stages were recruited and analyzed between January 1991 and December 2005. Patients were classified according to the time periods (1991--1995; 1996--2000; 2001--2005). To determine intrinsic subtypes, 858 patients whose human epidermal growth receptor-2 status and Ki67 were reported between April 2004 and December 2008 were also analyzed. Results: At a median follow up of 9.1 years, the 10-year overall survival (OS) rate was 80.5% for the entire cohort. On multivariate analysis for OS and recurrence-free survival (RFS), the time period was demonstrated to be a significant factor independent of conventional prognosticmarkers. In the survival analysis performed for each stage (I to III), OS and RFS significantly improved according to the time periods. Adoption of new agents in adjuvant chemotherapy and endocrine therapy was increased according to the elapsed time. In the patients with known subtypes, OS and RFS significantly differedamong the subtypes, and the triple-negative subtype showed the worst outcomein stages II and III. Conclusion: In the Korean breast cancer cohort with a long-term follow up, our data show an improved prognosis over the past decades, and harbor the contribution of advances in adjuvant treatment. Moreover, we providednew insight regarding comparison of the prognostic impact between the tumorburden and subtypes.

유방암 환자에서 골전이 및 골전이 후 생존율에 영향을 미치는 예후인자

안성귀,이경식,김승일 한국유방암학회 2008 Journal of breast cancer Vol.11 No.4

Purpose: Bone is the most common site of breast cancer metastasis. The aim of this study is to identify the subgroup of patients who have high risk of bone metastasis and we evaluate the prognostic factors of overall survival after bone relapse. Methods: A total 2,785 of primary breast cancer patients who were treated from January 1980 to December 2001 were included in this analysis. All the patients received radical surgery at the time of diagnosis. We retrospectively collected the clinico-pathologic data (age, tumor size, axillary lymph node status, histologic grade, steroid hormone receptor status, and disease-free interval after primary surgery). Definitive radiologic evidence of bone metastases by plain X-ray or whole body bone scan during follow-up was defined as bone metastases. We analyzed the relationship between the clinicopatholgic factors and the risk of bone metastases and the overall survival after bone relapse. Results: During follow-up, 256 patients (9.3%) experienced bone metastasis. By multivariate analysis using Cox’s model, age less than 35 years (p<0.001, risk ratio [RR]; 2.467, 95% confidence interval [CI]; 1.619-3.759), large primary tumor more than 2 cm (p=0.005, RR; 1.911, 95% CI; 1.222-2.988), positive axillary node (p<0.001, RR; 2.798, 95% CI; 1.867-4.195), and a high histologic grade (p=0.046, RR; 1.631, 95% CI; 1.008-2.640) were significantly associated with frequent bone metastases. The 10 years survival rate after bone metastasis was 26.9%. Disease free interval less than 2 years (p<0.001, RR; 3.453, 95% CI; 2.382-5.005) and hormone receptor status (p=0.003, RR; 1.791, 95% CI; 1.218-2.635) were independently associated with poor overall survival after bone relapse. Conclusion: We concluded that a shorter disease-free interval after definitive surgery and hormonal receptor status of the primary tumor are independent prognostic factors of overall survival after bone metastasis. These results show that a tailored strategy is needed for the treatment of patients with bone metastases.