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엄순호 ( Soon Ho Um ),류호상 ( Ho Sang Ryu ),박미라 ( Mi Ra Park ),이재원 ( Jea Won Lee ),진윤태 ( Yoon Tae Jeen ),전훈재 ( Hoon Jae Chun ),송치욱 ( Chi Wook song ),이상우 ( Sang Woo Lee ),김창덕 ( Chang Duck Kim ),현진해 ( Jin Ha 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6
Background/Aims: Well designed staging system of hepatocellular carcinoma(HCC) is needed for comparative therapeutic studies regarding HCC to be of value. The aim of study is to reevaluate prognostic factors affecting natural history of HCC and to devise a staging system according to prognostic index estimated mathematically Methods: One hundred eighty patients with HCC were analyzed retrospectively. All patients received only conservative treatments. Univariate and multivariate analysis were performed using clinical, biochemical and imaging data obtained at diagnosis. Results: The overall acturial survival rate at 1, 3, 6, 12, 24 months were 74%, 33%, 11%, 7%, 5%, respectively. For significant prognostic variables in the univariate analysis, multivariate survival analysis disclosed that tumor size(p=0.0039), ascites(p=0.0190), total serum bilirubin(p=0.001) were independent prognostic factors. Considering the contribution of each of these factors to prediction of survial, a pronostic index(PI) was defined as a following regression equation. PI=EXP(tumor size×0.1904+ascites×0.4114+Bilirubin×0.0504). According to PI, a new staging system was devised allowing division of patients into three groups with significantly different survival rates(p<0.01). Conclusions: The new staging system for HCC according to PI would be useful for the staratification of HCC patients in the comparative evaluation of various therapeutic modalities.(Korean J Gastroenterol 1997;29:786-796)
엄순호 ( Soon Ho Um ) 대한간암학회 2013 대한간암학회지 Vol.13 No.1
A well-designed staging system of cancer is an essential tool for assessing the prognosis of patients and establishing therapeutic plan, and for comparing the effect of various anti-cancer therapeutic modalities. To date, many (at least 15) staging schemes have been developed for hepatocellular carcinoma (HCC). It remains, however, which system fits best to stratify the patients with HCC according to the survival and therapeutic plan. In this review article, the staging systems for HCC were explained in detail and the results of many studies that had compared the predictive powers of staging systems of HCC were described, including the studies performed in our institution. In summary, TNM staging systems remains to be a mainstay of tumor staging for classifying the tumor extent and anatomic progression of HCC, although they are inferior to clinical staging systems in terms of predictive power. In the current clinical situations, in which TNM staging of HCC is generally determined by imaging studies because a majority of HCC patients are treated by nonsurgical treatment, the modified 5th UICC TNM system for HCC devised by liver cancer study group of Japan appears to be more competent than the AJCC TNM systems for HCC. Child-Pugh classification is still useful for evaluating the severity of liver dysfunction of patients with HCC. BCLC staging have the highest prognostic power among various clinical staging systems for HCC, especially in patients with early and intermediate stage of HCC that can be subject to curative or palliative treatment. In addition, BCLC staging can offer the general guideline for therapeutic plan. However, a more sophisticated staging system will be required for accurate prediction of survival and for proper planning of treatment.
아칼라지아 치료에서 풍선확장술과 보툴리늄 독소 주사요법의 비교연구
송치욱(Chi Wook song),엄순호(Soon Ho Um),현진해(Jin Hai Hyun) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4
N/A Background/Aims: Preliminary studies have suggested that intrasphincteric injection of the lower esophageal sphincter(LES) with botulinum toxin(BoTx) is a safe and effective alternative to pneumatic balloon dilation(BD) in the treatment of achalasia. We have compared the efficacy between BoTx and BD in an ongoing prospective study. Methods: In a randomized trial, 16 patients with achalasia received either intrasphincteric injection of BoTx(100 units) or BD(Rigiflex 3.0 cm in diameter). Among 8 patients treated with BoTx, 3 to them had been treated unsuccessfu]- ly beforehand with BD. After one month and after three months, Treatment responses were assessed on the basis of changes in the symptom scores and parameters of esophageal manometric study. Results: Both BoTx without prior BD(n=5) and BD group(n=8) showed a decreased symptom score, LES pressure and gastroesophageal pressure gradient(GEPG) at 1 month also decreased. LES pressure at 3 months increased in the BoTx group. No patient treated within the BD group failed at 3 months, but 1(20%)patient in the BoTx without previous BD did fail. The failed BoTx group with prior BD didnt show a decreased symptom score. LES pressure and GEPG also didnt decrease and 2(66.7%) patients failed at 3 months after treatment. No significant complications were seen in both the BoTx and the BD group. Conclusions: Both BoTx injection and BD were effective treatments for achalasia. BD may provide a more effective long term treatment, as compared to BoTx, for achalasia. However BoTx injection in patients who failed prior BD showed a poor response and a high failure rate. Long term evaluation of safety and efficacy will be required to fully understand the utility of BoTx injection vs BD for achalasia. (Korean J Gastroenterol 1997;29:423-429)
재발한 혼합 간세포 담관상피암종 및 저혈관성 간세포암종 동시 절제 1예
김태형 ( Tae Hyung Kim ),엄순호 ( Soon Ho Um ),박상정 ( Sang Jung Park ),박승운 ( Seung Woon Park ),이한아 ( Han Ah Lee ),서연석 ( Yeon Seok Seo ),유영동 ( Young Dong Yu ),김동식 ( Dong-sik Kim ),김주영 ( Joo Young Kim ) 대한간암학회 2017 대한간암학회지 Vol.17 No.1
Liver cancer is more complex to treat compared to cancers in other organs, since liver function should be considered. In addition, only a few patients can be applied curative treatment due to advanced stage at diagnosis. Therefore, early stage detection is important and has been increased through screening and surveillance programs using image modalities recently. However, it is still difficult to diagnose small or hypovascular hepatocellular carcinoma (HCC) even using advanced image modalties. In particular, hypovascular HCCs do not show arterial contrast enhancement which is a typical finding of HCC on computed tomography (CT) and magnetic resonance imaging (MRI). Those also account for a considerable portion of early HCC. We present 54 years-old man who had recurrent hypervascular and hypovascular nodules on three phase CT and gadoxetic acid-enhanced MRI. The nodules were removed by surgical resection and confirmed as combined hepatocellular-cholangiocarcinoma and well differentiated HCC respectively. (J Liver Cancer 2017;17:94-99)