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이승아,배자성,김기환,김지일,안창혁,박우찬,송병주,정상설,김정수,Seung Ah Lee,M.D.,Ja Seong Bae,M.D.,Kee Hwan Kim,M.D.,Ji Il Kim,M.D.,Chang Hyuck An,M.D.,Ph.D.,Woo Chan Park,M.D.,Ph.D.,Byung Joo Song,M.D.,Ph.D.,Sang Seol Jung,M.D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2
Purpose: Endoscopic surgery to treat thyroid neoplasm was developed to solve the aesthetic problems that resulted from conventional open surgery. Although endoscopic thyroidectomy was initially performed in patients with benign thyroid neoplasm, its use has recently been extended to patients with Graves's disease and early cases of thyroid cancer.The purpose of this study was to determine whether this surgical approach is feasible and safe for the treatment of thyroid cancer. Methods: Between December 1999 and April 2006, 132 thyroid cancer patients at our institution were treated by either conventional thyroidectomy or endoscopic thyroidectomy. Endoscopic thyroidectomy was conducted using a gasless anterior neck skin lifting method. The inclusion criteria for endoscopic thyroidectomy in thyroid cancer patients included a tumor size of less than 2cm, absence of extrathyroidal extension, absence of cervical lymph node metastasis, and well differentiated cancers. Results: We performed endoscopic thyroidectomy in 29 thyroid cancer patients. There were no significant differences in operative time, the amount of drainage and the number of retrieved lymph nodes between conventional thyroidectomy and endoscopic thyroidectomy. In addition, although endoscopic thyroidectomy was associated with more complications, it was also associated with a shorter hospital stay. Conclusion: The completeness of surgical resection conducted via an endoscopic thyroidectomy may be comparable to that of conventional surgery, however, a larger series and longer follow-up evaluation are necessary for definitive conclusions to be drawn about its oncologic validity. (Korean J Endocrine Surg 2007;7:103-106)
이남섭(Nam Seop Lee),배자성(Ja Seong Bae),정소령(So-Ryeong Jeong),정찬권(Chan Kwon Jung),임동준(Dong Jun Lim),박우찬(Woo Chan Park),김정수(Jeong Soo Kim),김승남(Seung Nam Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.2
Purpose: Despite the overall excellent prognosis for patients with papillary thyroid microcarcinoma (PTMC), these tumors are also associated with a 5% relatively high lymph node (LN) recurrence rate and the optimal surgical extent of papillary thyroid microcarcinoma has been controversial. Cervical LN metastases (LNMs) are found in about 40∼65% of patients with PTMC. The aim of this study is to identify the factors affecting lymph node metastases (LNMs) in patients with PTMC. Methods: We performed a retrospective study of 335 patients with PTMC who underwent total thyroidectomy or lobectomy with elective central lymph node dissection (CLND) at Kangnam St. Mary’s Hospital between Jan. 2006 and Dec. 2008. We investigated the association of LNMs and clinicopathologic factors such as sex, age, multiplicity, extrathyroidal extension, and tumor size. Results: LNMs were present in 88 patients (26.3%). Univariate analysis showed that less than 45 years of age, male, multiplicity, a tumor size of greater than 5 mm, thyroid capsular invasion and extrathyroidal extension were predictive factors for LNMs (P<0.05). Of these, the age, male, tumor size and extrathyroidal extension were independent predictive factors for LNMs on multivariate analysis. Conclusion: A tumor size (>5 ㎜), male, age (<45) and extrathyroidal extension were determined as the predictive factors for LNMs, which occurred in about one fourth of the patients with PTMC. Therefore, elective CLND should be considered in patients with PTMC who have these factors through a thorough investigation before surgery.
갑상선 미세유두암에서 MMP-2, MMP-9과 HIF-1α 발현의 임상적 의의
최재영(Jae Young Choi),배자성(Ja Seong Bae),김영애(Young Ae Kim),장은덕(Eun Deok Chang),조항주(Hang Joo Cho),김기환(Ki Hwan Kim),안창혁(Chang Hyeok Ahn),박우찬(Woo Chan Park),김정수(Jeong Soo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.3
Purpose: Papillary Thyroid Microcarcinoma (PTMC) is rapidly increasing due to increased interests in the public health care system and improvements in ultrasonographic instruments and fine-needle-aspiration technique. The aim of this study is to investigate relationships between clinicopathologic features and molecular markers of PTMC and to help in developing therapeutic strategies in PTMC. Methods: Tissue samples from patients with 38 PTMC and 21 benign thyroid tumors that were operated on from Jan. 2006 to Nov. 2008 were used to make microarrays and immunohistochemical staining for ER-α, E-CD, VEGF, MMP-2, MMP-9, and HIF-1α were performed. Clinicopathologic features of each immunohistochemical staining group were analyzed retrospectively. Results: There is no immunohistochemistry staining in cases with benign thyroid lesions. The expression rate of ER-α, E-CD, VEGF, MMP-2, MMP-9, and HIF-1α in PTMC group was 66%, 58%, 82%, 66%, 71% and 63%, respectively. Bilateral tumor was statistically significant (48.0% vs 7.7%, P=0.015) related to MMP-2(+) PTMC group than in MMP-2(?) group. Bilateral tumor (44.4% vs 9.1%, P=0.060) and lymphovascular invasion (25.9% vs 0%, P=0.084) seemed to have greater relation to MMP-9(+) PTMC group than to MMP-9(?) group, but there is no statistically significant difference. Bilateral tumor (50.0% vs 7.1%, P=0.012), lymph node metastasis (45.8% vs 0%, P=0.003) and lymphovascular invasion (29.2% vs 0%, P=0.033) were significantly related to HIF-1α (+) PTMC group compared to HIF-1α(?) group. Conclusion: Our findings suggest that MMP-2, MMP-9 and HIF-1α expression could be used as a prognostic marker in PTMC. Larger studies are needed to assess its prognostic value in PTMC.
김지훈(Ji Hoon Kim),배자성(Ja-Seong Bae),김기환(Kee Hwan Kim),김지일(Ji Il Kim),안창혁(Chang Hyeok Ahn),박우찬(Woo Chan Park),송병주(Byung-Joo Song),정상설(Sang-Seol Jung),김정수(Jeong Soo Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.5
Purpose: Endoscopic thyroidectomy has become a widely used operative method due to the recent advances in the operative technique and instruments and its cosmetic superiority. The aim of this study is to evaluate the technical feasibility and potential role of endoscopic thyroidectomy. Methods: Between December 1999 and December 2006, 300 patients with benign thyroid disease or thyroid cancer were treated by gasless endoscopic thyroidectomy with using the anterior chest wall approach at Uijongbu St. Mary’s Hospital. We analyzed that clinicopathological features, the operative time, the operative method and the complications. Results: There were 261 cases of benign disease and 39 cases of malignant tumor. We generally performed lobectomy for benign thyroid disease. For malignant tumor, we performed 14 lobectomies, 6 total (or near total) thyroidectomies, 17 total (or near total) thyroidectomies with central lymph node dissection and 2 total (or near total) thyroidectomies with lateral lymph node dissection. The most frequent pathology in benign disease was nodular hyperplasia, and in malignant disease it was papillary carcinoma. The mean operative time was 122.2 minutes. For the patients with thyroid cancer, the mean operative time for thyroid cancer surgery without lymph node dissection (20 cases) and thyroid cancer surgery with lymph node dissection (19 cases) was 144 and 177 minutes, respectively. There were 34 cases of complication (11.33%) with 11 cases of transient hoarseness, 9 cases of transient hypocalcemia and 1 case of permanent hypocalcemia. Conclusion: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign disease. In patients with thyroid cancer, we suggest that that endoscopic thyroidectomy can be a good alternative to conventional thyroid surgery in highly selected cases. Larger series and longer follow-up evaluation are necessary to confirm our findings.
술 전 화학요법을 받은 유방암 환자에서 WHO와 RECIST 기준에 따른 반응성
이재청(Jae-Cheong Lee),배자성(Ja-Seong Bae),김미라(Mi-Ra Kim),박우찬(Woo Chan Park),송병주(Byong-Ju Song),김정수(Jeong Soo Kim),정상설(Sang-Seol Jung) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.2
Purpose: This study compared the response evaluation using the WHO (World Health Organization) criteria for patients with breast cancer with that of the RECIST (Response Evaluation Criteria In Solid Tumor) criteria in order to determine the significance of the RECIST criteria in breast cancer. Methods: Between 2001 and 2005, 42 patients with measurable lesions radiologically receiving neoadjuvant chemotherapy for a breast carcinoma were enrolled in this study. The results were compared using a kappa test as a concordance measure between the two response criteria. Results: With the WHO criteria, the overall response and progression rate were 35.7% (CR 0, PR 15) and 16.6% (PD 7) respectively. On the other hand, the overall response and progression rate using the RECIST criteria were 38.0% (CR 0, PR 16) and 7% (PD 3) respectively. The kappa value as a concordance measure between two response criteria was 0.718. Conclusion: The RECIST criteria are comparable to the WHO criteria in evaluating the response of breast cancer patients who have undergone neoadjuvant chemotherapy. A comparison of these results with other studies of more common tumor types supports the implementation of RECIST as the standard criteria for evaluating the treatment response but also for monitoring progression.
엽절제술을 시행한 갑상선 유두암 환자에서 완결 갑상선 절제술이 필요한지에 대한 연구
강일구(Il Ku Kang),김광순(Kwangsoon Kim),배자성(Ja Seong Bae),김정수(Jeong Soo Kim) 대한두경부종양학회 2021 대한두경부 종양학회지 Vol.37 No.2
Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC. Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months. Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092) Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.
소아청소년 갑상선암의 임상적 특징들 : 단일 기관에서의 20년간의 연구
문기윤(Ki Yoon Moon),김광순(Kwangsoon Kim),배자성(Ja Seong Bae),김정수(Jeong Soo Kim) 대한두경부종양학회 2020 대한두경부 종양학회지 Vol.36 No.2
Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC). Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups(23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; P=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; P=0.008) and bilaterality (HR, 11.477; P=0.022) as significant risk factors for DFS. Conclusion: Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.
수술 전 갑상선 암의 측경부 림프절전이 예측을 위한 지수화된 전산화 단층촬영 소견의 임상적 의의
김영중,김지영<SUP>1<.SUP>,김용석,이관주,이동호,배자성,성기영,김정수,박우찬,Young Joong Kim,Jee Young Kim,Ph.D.<SUP>1<.SUP>,Young Suk Kim,Ph.D.,Kwan Ju Lee,Ph.D.,Dong Ho Lee,Ph.D.,Ja-Seong Bae,Ph.D.,Ki Young Sung,Ph.D.,Jeong Soo 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.2