Prognosis of pN3 Stage Gastric Cancer

안정련,정민규,김찬,홍민희,전홍재,김혜련,정희철,형우진,이성숙,정현철,노성훈,라선영 대한암학회 2009 Cancer Research and Treatment Vol.41 No.2

Purpose : The aim of this study was to determine the prognosis of pN3 stage gastric cancer patients after they have undergone curative resection, and we also wanted to identify the prognostic factors according to the clinico-pathologic features. Materials and Methods : Between January 2000 and December 2004, we retrospectively reviewed the medical records of the patients with histologically confirmed pN3 stage gastric cancer. They underwent both gastrectomy and lymphadenectomy with a curative aim. We categorized the pN3 stage patients into 2 groups; one with pN3 only (pN3M0) and the other with pN3 combined with M1 stage (pN3M1) that included peritoneal seeding, hepatic metastasis or para-aortic LN metastasis. Results : Out of 467 patients with stage IV gastric adenocarcinoma who received surgery, 260 patients underwent curative resection and they were pathologically staged as N3. Among these 260 patients, 78 patients were classified as the pN3/M1 stage. For all the patients, the median follow-up period was 19 months (range: 1~108 months) and the median overall survival time was 16.2 months (95% CI, 14.1~18.3%). The 5-year survival rate of the pN3/M0 group was significantly higher than that of the pN3/M1 group (12.6% vs. 2.6%, respectively, p=0.0001). The identified predictor for a worse prognosis was an advanced T4 stage (HR: 3.38, 95% CI, 1.4~8.3, p=0.008) for the pN3 patients. Conclusion : The survival for the pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared to that of the pN3/M1 group. An advanced T stage was a predictor for a poor prognosis for the pN3 patients. Therefore, diverse treatment strategies for these heterogeneous pN3 gastric cancer patients are needed for improving their survival.

Clinical Value of Ezrin Expression in Primary Osteosarcoma

김찬,신은아,홍수정,전홍재,김혜련,안정련,홍민희,양우익,노재경,라선영 대한암학회 2009 Cancer Research and Treatment Vol.41 No.3

Purpose : Ezrin is a membrane cytoskeletal linker protein and it is known to be associated with metastasis of primary osteosarcoma. The aim of this study is to determine the relationship between an ezrin expression and several key clinical parameters and to elucidate its potential prognostic value for patients with osteosarcoma. Materials and Methods : Seventy patients with histologically confirmed osteosarcoma and who had no distant metastasis were enrolled between 1995 and 2005 at Yonsei Cancer Center, Severance Hospital, Korea. The clinical parameters were retrospectively reviewed and immunohistochemical staining (IHC) for ezrin was performed using the surgically resected specimens. Results : Of the 70 tumor specimens, 39 (55.7%) revealed an ezrin expression. More of an osteoblastic histology and an elevated initial ALP level were observed in the ezrin positive patients than in the ezrin negative patients (p=0.008 and 0.001, respectively). The proportion of patients who favorably responded to neoadjuvant chemotherapy (≥90% necrosis) was significantly higher in the group of ezrin positive patients than that in the group of ezrin negative patient (72.2% vs 45.2%, respectively, p=0.024). The ezrin positive patients showed more frequent recurrence than did the ezrin negative patients (64.1% vs 35.5%, respectively, p=0.017). The patients with an ezrin expression also demonstrated poorer survival than did those patients without ezrin expression (5-year EFS: 31.7% vs 61.3%, respectively, p=0.023, 5-year OS: 53.4% vs 71.0%, respectively, p=0.022). When comparing EFS according to both an ezrin expression and chemoresponsiveness, there were trends that the ezrin negative/chemoresponsive group showed the best 5-year EFS (71.4%), followed by the ezrin negative/chemoresistant group (52.9%), the ezrin positive/chemoresponsive group (38.1%) and the ezrin positive/chemoresistant group (13.6%). These trends were statistically significant (p=0.036). Conclusion : The expression of ezrin by IHC staining was found in 55.7% of the patients with metastasisfree osteosarcoma. Immunoreactivity to ezrin is a negative prognostic factor for survival for the patients suffering with osteosarcoma. Identifying an ezrin expression might offer a valuable piece of information when treating patients with primary osteosarcoma

결핵 환자에서 Rifampin에 의한 Henoch-Shönlein Purpura 1예

박무석,김혜련,박병훈,손지영,정지예,안정련,정윤숙,임주은,정주원,문지애,변민광,김영삼,김세규,장준,이광길 대한결핵및호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

Henoch-Shönlein 자반증은 신장, 피부, 관절, 소화기계 등의 전신을 침범하는 혈관염으로 임상적인 증상을 종합하여 진단하는 질환이며 피부나 신장에서의 조직학적 생검이 진단을 뒷받침해 주는 근거가 될 수 있다. 항결핵제 사용 중에 rifampin으로 인하여 신기능 저하, 관절 통증, 양하지 자반, 복통 등의 임상 양상이 발생하였으며 하지 피부 병변의 조직 검사로 백혈구파쇄성혈관염(leukocytoclastic vasculitis) 소견을 보여 임상적으로 Henoch- Shönlein 자반증으로 진단하였으며 rifampin 복용 중지 후 피부 자반 소실되고, 신장 기능이 회복된 예를 문헌 고찰과 함께 보고하는 바이다. Rifampin is one of the first line drugs for treating tuberculosis, but it might be associated with serious adverse effects, including renal failure. We report here on a case of a 57-year-old patient who developed Henoch-Shönlein purpura during antituberculosis therapy that included rifampin. The patient converted to negative on the AFB smear for tuberculosis two weeks after the initial administration of antituberculosis medication. After treatment for 60 days, this patient was diagnosed with Henoch-Shönlein purpura by the purpura lesion on the lower legs, the leukocytoclastic vasculitis, the renal impairment and the pathological examination. After stopping rifampin, the skin lesions disappeared in about 10 days and his renal function gradually improved. This case study showed that Henoch-Schönlein purpura can be caused by rifampin during antituberculosis therapy and we recommend that the use of rifampin should be restrained when clinical symptoms of Henoch-Shönlein purpura are observed.

Treatment Outcomes of Sunitinib Treatment in Advanced Renal Cell Carcinoma Patients: A Single Cancer Center Experience in Korea

홍민희,전홍재,신상준,안중배,정현철,라선영,김찬,안정련,김효송 대한암학회 2009 Cancer Research and Treatment Vol.41 No.2

Purpose : The retrospective study was performed to assess the efficacy and toxicity profiles of sunitinib in Korean patients with metastatic renal cell carcinoma (RCC). Materials and Methods : Between January 2005 and December 2008, 76 Korean patients with recurrent/metastatic RCC who received sunitinib were retrospectively reviewed. The primary end point was progression-free survival and the secondary end points were overall survival and response rate. We also assessed the toxicities associated with sunitinib treatment. Results : Of the 76 patients, 69 (90.1%) were diagnosed with clear cell RCC. The median progressionfree survival and overall survival were 7.2 and 22.8 months, respectively in overall patients. Sixty-two patients (81.6%) received 50 mg 4 week and 2 week off schedule, and 14 patients (18.4%) received 37.5 mg daily on a daily continuous schedule. The objective response rate and disease control rate were 27.6% and 84.2%, respectively. A dose reduction or reduction in dose due to adverse events occurred in 76% of the patients, whereas 11% of the patients had discontinued treatment. Other common laboratory abnormalities were increased serum creatinine (75.6%), elevated alanine aminotransferase (71.0%), neutropenia (61.8%), anemia (69.7%), and increased aspartate aminotrasferase (53.3%). Grade 3/4 toxicities occurred as follows: thrombocytopenia (38.2%), fatigue (10.5%), stomatitis (10.5%), and hand-foot syndrome (9.2%). Conclusion : Our results indicate that sunitinib treatment is effective and tolerable for ecurrent/metastatic RCC patients in Korea. Further studies with prognostic or biochemical factors are needed to clarify the different toxicity profiles of this study.

연구자가 스폰서 주도 임상 시험에 참여하는 이유

김준형,최원,백승호,박수정,박수연,손우연,김현호,김승수,이한규,안정련,김윤정,서정민,남정모,이일섭 대한임상약리학회 2011 Translational and Clinical Pharmacology Vol.19 No.1

Background: It is getting more difficult to involve appropriate investigators in clinical trials. Knowing what investigators want from sponsor initiated clinical trials would help industry cooperate with investigators more efficiently. This study aims to describe the incentives for investigators choosing to participate or not and perform well in sponsored clinical trials. Methods: Investigators who have participated in GSK sponsored clinical trials were interviewed face-to-face or through e-mail using the standardized questionnaire. Investigators were asked to choose five items and determine the ranking or those five items Results: Questionnaires answered by 122 investigators were collected. The top three incentives were "Academic merit" (108, 88.5 %), "Expectation of treatment potentially helpful to patient" (101, 82.8 %),and "Access to new treatments" (92, 75.4 %). The disincentives and the factors affecting an investigator’s performance were analyzed separately because of the different questionnaire between investigators for medicine and vaccine. Investigators for medicine choose as disincentives "Insufficient time" (43, 61.4 %), "Difficult protocol" (41, 58.6 %), and "Adverse event concerns" (41, 58.6 %). Vaccine investigators pointed out "Limited support staff" (41, 78.8 %), "Insufficient time" (40, 76.9 %), and "Difficult blood sampling" (333, 63.5 %) as disincentives. Factors adversely affecting an investigator’s performance showed similar results to those of disincentives. Conclusion: Investigators focused on academic curiosity and patients and insufficient time mostly inhibits them from participating and performing clinical trials. Our results would help industry cooperate with investigators more efficiently, finally making companies perform clinical trials more effectively.

Docetaxel versus Paclitaxel Combined with 5-FU and Leucovorin in Advanced Gastric Cancer: Combined Analysis of Two Phase II Trials

전홍재,라선영,김혜련,노성훈,정현철,정희철,임종근,김찬,홍민희,안정련 대한암학회 2009 Cancer Research and Treatment Vol.41 No.4

Purpose This is an ad hoc analysis of two phase II studies which compared the efficacy and safety of two taxanes (paclitaxel and docetaxel) combined with 5-fluorouracil (5-FU) and leucovorin (LV) in advanced gastric cancer. Materials and Methods Patients with advanced gastric adenocarcinoma who were untreated or had only received first-line chemotherapy, were treated with either paclitaxel (PFL; 175 mg/m2) or docetaxel (DFL; 75 mg/m2) on day 1, followed by a bolus of LV (20 mg/m2 days 1∼3) and a 24-hour infusion of 5-FU (1,000 mg/m2 days 1∼3) every 3 weeks. The primary endpoint was overall response rate (ORR) and the secondary endpoint included survival and toxicity. Results Sixty-six patients received DFL (first-line [n=38]; and second-line [n=28]) and 60 patients received PFL (first-line [n=37]; and second-line [n=23]). The ORRs were not significantly different between the 2 groups (DFL, 26%; PFL, 38%). With a median follow-up of 9.5 months, the progression free survival was 5.2 months (95% confidence interval [CI], 4.2∼6.5 months) for DFL and 3.3 months (95% CI, 1.3∼5.5 months) for PFL (p=0.17). The overall survival was also comparable between the patients who received DFL and PFL (10.0 months [95% CI, 7.2 ∼12.5 months] and 13.9 months [95% CI, 10.9∼19.2 months], respectively; p=0.37). The most frequent grade 3∼4 adverse event was neutropenia (DFL, 71%; PFL, 62%). DFL and PFL had different non-hematologic toxicities; specifically, grade ≥3 mucositis (5%) and diarrhea (3%) were common in DFL, while nausea/vomiting (15%) and peripheral neuropathy (5%) were common in PFL. Conclusion Thus, the two taxanes had similar efficacy in the treatment of advanced gastric cancer, but different toxicity profiles. Prospective comparative studies are required to further clarify the role of taxanes in the treatment of advanced gastric cancer.

증례 : 혈액종양 ; 가돌리늄 기반 조영제 주입 후에 발생한 신성 전신 섬유화증 1예

홍민희 ( Min Hee Hong ),구향모 ( Hyang Mo Koo ),최준정 ( Jun Jeong Choi ),안정련 ( Jung Ryun Ahn ),전홍재 ( Hong Jae Chon ),김찬 ( Chan Kim ),이승태 ( Seung Tae Lee ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1

신성 전신 섬유화증은 가돌리늄 제제에 노출된 신부전 환자에게서 나타날 수 있는 전신성 질환으로, 예후가 불량하며 특별한 치료방법이 없으므로 예방이 중요한 질환이다. 저자들은 국내에서 최초로 보고하는 바이다. Nephrogenic systemic fibrosis is a rare multisystemic disorder mainly affecting the skin and joints in patients with underlying renal insufficiency exposed to gadolinium-based contrast. We report a patient who had renal insufficiency caused by multiple myeloma and developed nephrogenic systemic fibrosis after exposure to gadolinium-based contrast for the first time in Korea. (Korean J Med 78:127-131, 2010)

결핵 환자에서 Rifampin에 의한 Henoch-Shonlein Purpura

김혜련 ( Hye Ryun Kim ),박병훈 ( Byung Hoon Park ),손지영 ( Ji Young Son ),정지예 ( Ji Ye Jung ),안정련 ( Jung Ryun Ahn ),정윤숙 ( Yoon Suk Jung ),임주은 ( Ju Eun Lim ),정주원 ( Ju Won Jung ),문지애 ( Ji Ae Moon ),변민광 ( Min Kwa 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

Rifampin is one of the first line drugs for treating tuberculosis, but it might be associated with serious adverse effects, including renal failure. We report here on a case of a 57-year-old patient who developed Henoch-Shonlein purpura during antituberculosis therapy that included rifampin. The patient converted to negative on the AFB smear for tuberculosis two weeks after the initial administration of antituberculosis medication. After treatment for 60 days, this patient was diagnosed with Henoch-Shonlein purpura by the purpura lesion on the lower legs, the leukocytoclastic vasculitis, the renal impairment and the pathological examination. After stopping rifampin, the skin lesions disappeared in about 10 days and his renal function gradually improved. This case study showed that Henoch-Schonlein purpura can be caused by rifampin during antituberculosis therapy and we recommend that the use of rifampin should be restrained when clinical symptoms of Henoch-Shonlein purpura are observed. (Tuberc Respir Dis 2008;65:116-120)