절제술를 시행한 4기 위암 환자의 예후 및 예후 인자

최새별,홍광대,조재승,김종한,박성수,민병욱,엄준원,송태진,손길수,김종석,목영재,김승주,Choi, Sae-Byeol,Hong, Kwang-Dae,Cho, Jae-Seung,Kim, Jong-Han,Park, Sung-Soo,Min, Byung-Wook,Um, Jun-Won,Song, Tae-Jin,Son, Gil-Soo,Kim, Chong-Suk,Mok, Y 대한위암학회 2006 대한위암학회지 Vol.6 No.1

목적: 4기 위암은 예후가 불량하여 5년 생존율은 10% 이하이며, 진행정도에 따라 임상에서 치료 방침을 선정하는데 어려움이 있다. 이에 절제술을 시행한 4기 위암환자를 대상으로 장기생존군의 특성을 분석하고, 예후인자를 확인하고자 하였다. 대상 및 방법: 1983년 9월부터 2000년 12월까지 고려대학교 의과대학 외과학교실에서 4기 위암으로 절제술을 시행한 383예를 대상으로 하였다. 생존기간 2년을 기준으로 2년 미만 생존한 306예(79.9%)와 2년 이상 생존한 77예 (20.1%)의 두 군으로 나누어 임상병리학적 인자를 비교 분석하였고, 절제술을 시행한 4기 위암환자의 단변량 및 다변량 생존분석을 시행하였다. 결과: 2년 이상 생존군과 2년 미만 생존군에서 종양의 육안형, 원격전이, 림프절 곽청도, 근치도, 조직형이 유의한 차이를 보였다. 절제술을 시행한 4기 위암 환자의 5년 생존율은 5.4%였으며, 단변량 생존분석 결과 종양의 육안형, 원격전이, 림프절 곽청도, 근치도, 조직형이 의미 있는 예후인자였다. 그러나 다변량 생존분석 결과 림프절 곽청도, 근치도, 조직형이 생존율에 영향을 미치는 독립적인 예후인자였다. 결론: 근치적 절제 대상이 되는 4기 위암에서 근치적 절제와 림프절 곽청을 통하여 생존율의 향상을 기대할 수 있다. Purpose: The prognosis of stage IV gastric cancer is poor with the 5-year survival rate still being about 10%. We investigated the prognostic factors of stage IV gastric cancer patients who underwent resection. Materials and Methods: A retrospective study of 383 patients with stage IV gastric cancer who underwent surgery in our department between September 1983 to December 2000 was conducted. We classified the 383 patients into two groups: patients surviving 2 years or more (n=77) and those surviving less than 2 years (n=306). Clinicopathologic differences were analyzed between the two groups. We also performed univariate and multivariate analyses of various clinicopathologic factors concerning survival. Results: Statistically significant clinicopathologic differences between the two groups were observed in regard to macroscopic type, distant metastasis, lymph node dissection, curability, and histology. Curability and histology were significant survival factors in 2-year survival. The 5-year survival rate was 5.4% in stage IV gastric cancer. Significant differences in survival among macroscopic type, distant metastasis, lymph node dissection, curability and histology were observed in the univariate analysis. In the Multivariate analysis, Curability, lymph node dissection, and histology were significantly beneficial factors for survival. Conclusion: Lymph node dissection, curability, and histology were independent prognostic factors in stage IV gastric cancer, and radical treatment is recommended to improve survival.

혈관침윤성 간세포암 간세포암의 혈관침습 2예

최새별 ( Sae Byeol Choi ),석재연 ( Jae Yeon Seok ),김경식 ( Kyung Sik Kim ),박영년 ( Young Nyun Park ),한광협 ( Kwang Hyub Han ),이종태 ( Jong Tae Lee ) 대한간암학회 2007 대한간암학회지 Vol.7 No.-

간암에서의 간절제술을 위한 병합치료

최새별 ( Sae Byeol Choi ),김경식 ( Kyung Sik Kim ) 대한간암학회 2008 대한간암학회지 Vol.8 No.-

간내 결석의 외과적 치료

최새별(Sae Byeol Choi),김경식(Kyung Sik Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1

Hepatolithiasis is characterized by its intractable nature and frequent recurrences that require multiple operative interventions. Intrahepatic stones consist of calcium bilirubinate in most cases, but these stones contain more cholesterol than the stones in the common bile duct. The pathogenesis of primary bile duct stones is based upon bile stasis and infection. Bile duct stricture and dilatation of the duct are usually present in cases with brown pigmented stones. In addition to cholangitis, liver abscess and longstanding sepsis, intrahepatic stones and strictures can cause secondary biliary cirrhosis and intrahepatic cholangiocarcinomas. Pyogenic cholangitis that’s due to strictures and hepatolithiasis tends to recur; therefore, operations such as stricturoplasty, hepaticojejunostomy and liver resection are inevitable. The primary goals of surgery are to eliminate stones and the atrophic liver tissue, and to correct the bile stasis. Recent advances have been made in noninvasive treatments, such as percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). Because postoperative residual stones and recurrent stones occur frequently, PTCSL and dilatation therapy will improve the outcomes of patients suffering with hepatolithiasis combined with bile duct stricture.

대장 직장암 간전이의 외과적 치료

최새별(Sae Byeol Choi),김경식(Kyung Sik Kim) 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.2

간문부암에 대한 외과적 치료의 최신 지견

최새별(Sae Byeol Choi),김경식(Kyung Sik Kim) 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.1

간암 등록을 위한 정보의 표준화

최새별(Sae Byeol Choi),김경식(Kyung Sik Kim),송경섭(Kyung Sup Song) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.1

Obtaining the basic statistical data on cancer diseases is essential to plan cancer research and to determine the proper tools to use for diagnosing and treating cancer. By using the national wide cancer registry, more accurate data has been collected and more informative cancerrelated statistical data can be calculated such as the occurrence rate, the death rate, the survival rate and so on. In Korea, the primary liver cancer registry has been active since 2003, and the clinical data from 10,886 patients has been collected. Unfortunately there are time and security limitations for recording and sharing this data and so a more convenient system is required. Therefore, we have revised the original primary hepatoma cancer registry to give a summary of research itself and an analysis of patients’ data for the government’s national wide evaluation and management of primary hepatoma.

위에 발생한 위장관 간질성 종양의 임상병리학적 특성과 치료성적

류제석,이성렬,최새별,박성수,이주한,김승주,김종석,채양석,목영재,Ryu Je-Seock,Lee Sung-Ryul,Choi Sae-Byeol,Park Sung-Soo,Lee Ju-Han,Kim Seung-Joo,Kim Chong-Suk,Chae Yang-Seok,Mok Young-Jae 대한위암학회 2005 대한위암학회지 Vol.5 No.1

배경: 위장관 간질성 종양(GISTs)은 위장관계에 발생하는 간엽성 종양이다. 위장관 간질성 종양은 면역조직화학 검사에서 c-kit 단백 발현의 양성을 나타내며 그 임상적 경과는 매우 다양하다. 저자들은 위장관 간질성 종양의 임상병리학적 특성을 고찰하고 예후 인자를 평가하기 위하여 후향적 연구를 시행하였다. 대상 및 방법: 본 연구는 고려대학교 의과대학 외과학교실에서 1996년부터 2003년까지 위장관 간질성 종양으로 수술적 절제를 시행한 40명의 환자를 대상으로 하였다. 종양의 크기와 핵분열 정도에 따라 저위험도 집단(23예), 고위험도 집단(17예)으로 분류하였으며 두 군간 임상병리학적 특성, 면역조직화학 검사 결과 및 예후를 비교 분석하였다. 결과: 환자의 평균 연령은 $61.3\pm11.1$세이었으며 남녀비는 1:1,1이었다. 임상병리학적 소견으로는 수술 전 임상 증상이 있었던 경우와 수술 전에 조직학적으로 진단이 되었던 경우, 종양의 크기가 클수록, 핵분열이 많을수록, 종양의 성상이 궤양을 동반하거나 괴사를 보일 때, 고위험군에 포함되는 빈도가 높았다. 단변량 분석 결과, 종양의 크기, 핵분열 정도, 궤양 및 괴사 소견 그리고 내시경적 초음파 이상소견이 통계학적으로 의미가 있는 인자들로 나타났으며, 다변량 분석을 시행한 결과 핵분열 정도가 생존율에 영향을 미치는 독립적인 예후 인자로 나타났다. 관찰 기간 중 8예에서 재발하였으며 STI-571(imatinib mesylate, $Gleeveo^{R}$)을 사용한 4예는 현재까지 생존하고 있으며 사용하지 않은 4예 중 2예는 질환이 진행하는 양상을 나타내었고, 나머지 2P는 사망하였다. 결론: 위에서 기원한 위장관 간질성 종양에서 종양의 크기, 궤양 및 괴사 소견은 생존율에 영향을 주는 임상병리학적 소견이며, 핵분열 정도는 유용한 예후 인자라고 할 수 있다. STI-571은 재발 혹은 전이 환자에 있어 치료 효과를 나타내므로 술후 치료에 적용하는 것이 예후 향상에 기여하리라 생각된다. Purpose: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. GISTs are positive for the expression of c-Kit protein at immunohistochemistry, and their clinical presentations vary. This retrospective study was performed to evaluate the clincopathologic characteristics of GISTs and to define the prognostic factors. Materials and Methods: 40 patients who underwent a complete resection of a GIST during the period $1996\~2003$ at the Department of Surgery, Korea University College of Medicine, were studied. We divided them into low- and high-risk. groups by using tumor size and mitotic count: 23 cases were low risk, and 17 were high risk. Clinicopathologic features, immunohistochemical findings, and prognoses were compared between the low- and the high-risk groups. Results: The mean age of the 40 patients was $61.3\pm11.1$years, and the male-to-female ratio was 1:1.1. There was no significant difference in age and sex between the groups. A comparative analysis revealed tumor size, mitotic count, clinical symptoms, preoperative pathologic diagnosis, ulceration, and necrosis to be variables that had statistically significant differences between the high- and the low-risk groups. In the univariate analysis, tumor size, mitotic count, ulceration, necrosis, and abnormal endoscopic ultrasound findings were associated with disease-free survival, but in the multivariate analysis, mitotic activity was the only independent factor associated with disease-free survival. 8 patients had recurrences during the follow-up period, and four of them were treated with STI-571 (imatinib mesylate, $Gleevec^{(R)}$). The treated patients have survived until now; however, two of non-treated patients died from disease progression. Conclusion: Based on this study, tumor size, ulceration, and necrosis are significant factors affecting survival, and mitotic activity may be a useful prognostic marker. STI-571 may be used in an adjuvant setting because the drug has shown anticancer activity in patients with recurrence or metastasis.

무증상의 부신 골수 지방종 1예

이형순(Hyung Soon Lee),최새별(Sae Byeol Choi),김경식(Kyung Sik Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4

Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable.

20대 이하 간세포암종의 증례 : 20대 여성에서 임신 중 발견된 간세포암

최강국 ( Kang Kook Choi ),홍영주 ( Young Ju Hong ),최새별 ( Sae Byeol Choi ),이남준 ( Nam Joon Yi ),황신 ( Shin Hwang ),박영년 ( Young Nyun Park ),최진섭 ( Jin Sub Choi ),서경석 ( Kyung Suk Suh ),전재윤 ( Chae Yoon Chon ),김경식 대한간암연구회 2009 대한간암학회지 Vol.9 No.-

Hepatocellular carcinoma (HCC) in pregnancy is very rare. The cirrhosis which is present in the majority of patients with HCC induces infertility. The diagnostic methods and treatment modalities in HCC during pregnancy are different from those of usual types of other HCC. A 26-year-old, 32th-gestational-week pregnant female was sent to our hospital because of abnormal liver function test. A 1.5cm sized mass was identified in segment 6 of liver which was compatible to AJCC stage I. She did not have any other medical history except Hepatitis B Virus carrier and the HBs Ag of her mother also was positive. At the 40th gestational week, the female baby was delivered uneventfully. And then she underwent the transarterial chemoembolization (TACE) following the Rt. Hemihepatectomy. Since she underwent a surgical resection, the tumors have been recurred in the remnant liver only. Whenever the tumors were founded, the aggressive surgical approaches were performed including 3 times of hepatic resection with TACE or TACI. She is still alive with good general condition and normal liver function for 9 years since the first diagnosis was made. Therefore an extremely rare case of hepatocellular carcinoma in pregnancy is treated successfully because of aggressive therapies.