수술 후 재발한 유두상 갑상선 암의 경부 재발 위험인자에 대한 연구

하태권,유성목,김상효,Tae Kwun Ha,M.D.,Sung Mock Ryu,M.D. and Sang Hyo Kim,M.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. Methods: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. Results: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. Conclusion: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence. (Korean J Endocrine Surg 2010;10:261-265)

다발성 유두상 갑상선암의 임상병리학적 특성 분석

이민욱,하태권,유성목,김상효,Min Wuk Lee,Tae Kwun Ha,Sung Mock Ryu,and Sang Hyo Kim 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.1

담낭염, 담낭선종 및 담낭암 조직의 MUC 유전자 단백 발현

김재홍(Jae Hong Kim),유성목(Sung Mock Ryu),최창수(Chang Soo Choi),윤혜경(Hye Kyung Yoon),최영길(Young Kil Choi) 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.69 No.2

갑상선 미세유두암에서 경부림프절 전이의 예측인자에 대한 연구

유혜미(Hye-Mi Yu),하태권(Tae-Kwun Ha),유성목(Sung-Mock Ryu),김운원(Woon-Won Kim),김상효(Sang-Hyo Kim) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.1

Background :Though papillary microcarcinoma(PMC) of thyroid gland is known to have very favorable long-term prognosis, the recurrence in the neck and distant metastasis have been often reported. The predictive factors of node metastasis and tumor recurrence in clinical course were investigated to define surgical decision or guidelines in surgery of papillary microcarcinoma. Methods :The authors conducted a retrospective an-alysis of 216 patients of PMC treated with surgery at Department of Surgery, Busan Paik Hospital for the period from 1997 to 2007. Of these patients, 58 cases showing cervical lymph node metastasis at initial sur-gery were studied. Results :In overall 216 patients, the sex ratio of male to female was 1:9.3(male 21, female 195 cases), the mean age at the time of diagnosis was 44.7 years and the median tumor size was 6.61mm. Neck lymph node metastasis was found in 58 patients(26.9%), thyroid capsular invasion was 56 cases(25.9%), multifocality and bilaterality were found in 32(14.8%) and 29 cases(13.4%), respectively. Through statistical analysis, sex, capsular invasion, ETE, and tumor size(>5mm) were considered to be predictive factors of cer-vical lymph nodes metastasis. Of them, capsular invasion was the most predictive indicator of cervical lymph node metastasis on multivariate analysis. Nodal recurrence was observed in 6 of 58 patients of node positive at initial surgery. Conclusion :The cervical lymph node metastasis is known to be a risk factor of prognosis in PMC of thyroid gland. The results of this study showed four statistically significant independent predictive factors of cervical lymph node metastasis in PMC:capsular invasion, tumor size(>5mm), ETE, and sex. On multivariate analysis, capsular invasion was a great influencing factor in prediction of lymph node metastasis. Basically, patients who has predictive factors of cervical lymph node metastasis should have a thorough investigation, and close surveillance for nodal status is required in follow-up.

림프절 전이가 발견되지 않은(cN0) 유두상 갑상선 암의 중앙 경부 림프절 분석

김윤정(Yun Jung Kim),하태권(Tae Kwun Ha),유성목(Sung Mock Ryu),김상효(Sang Hyo Kim) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.2

Purpose :Papillary thyroid carcinoma (PTC) is known for malignant tumor which has a favorable prognosis and long-term survival. Although the prognosis for patients with PTC is generally good, PTC tends to have highly metastatic property. The purpose of this study was to analyze the central compartment lymph node in papillary thyroid cancer with no lymph node metastasis clinically and to assess the significance of prophylactic node dissection. Methods :A retrospective review was carried out in 394 patients with PTC who underwent sur-gery for the period from January 2004 to December 2006. The positive rate of the lymph node metastasis was analyzed. The relations between the central compartment lymph nodes and the patients’ age, gender, tumor size, exrathyroidal extension(ETE), multifocality, and bilaterality were comparatively analyzed in PTC patients with preoperative no lymph node metastasis. Results :The enrolled patients were 40 male and 354 female cases. The 118 cases of them were found to have cervical lymph node metastasis. The mean age was 46 years(range, 15-77years). Tumor size(p=0.000), ETE(p=0.001), multifocality(p=0.014), and bilaterality(p=0.001) were significantly related factors for cervical lymph node metastasis clinically in papillary thyroid cancer. However, age and gender were not significantly related with lymph node metastasis. Conclusion :Although no lymph node metastasis clinically, prophylactic neck node dissection can be performed to avoid risks of local recurrence and reoperation in the light of PTC nature. The pathological status and high positive rate of central compartment lymph node relate to tumor size and extrathyroidal extension. Close surveillance for nodal status is required in follow-up.

분화 갑상선암의 수술 및 예후에 대한 고찰

변경도(Kyung-Do Byun),하태권(Tae-Kwun Ha),유성목(Sung-Mock Ryu),김태현(Tae-Hyun Kim),김상효(Sang-Hyo Kim) 대한두경부종양학회 2009 대한두경부 종양학회지 Vol.25 No.2

Purpose :For the past 10 years, the incidence of thyroid cancer has been rapidly increased in female popula-ion showing current incidence of 12,000 new thyroid cancer patients annually in Korea. Though differentiated thyroid cancer is known to show favorable prognosis and excellent long-term survival from slow growth and late distant metastasis, we re-evaluated prognostic factors of recurrence and mortality following surgical procedures based on our cases. Material and Methods :954 Patients of DTC surgically treated at Department of Surgery, Inje University Busan Paik Hospital between 1980 and 2004 were reviewed in the aspects of the surgical procedures, clinical staging, risk factors, recurrence and their outcome through median follow-up period of 10.5 years. Results :Recurrence in remnant thyroid, cervical nodes, and distant metastasis were observed in 84 pa-ients(8.8%), and 31 patients were confirmed to be died of locoregional recurrence of cancer and distant metas-asis. Regarding the risk factors to recurrence, tumor size, extrathyroidal extension, nodal metastasis, and capsular invasion were significant predictors(p<0.05). Local recurrence and distant metastasis had no statistical signi-icance according to age, sex, pathology, surgery, and lymphovascular invasion. Overall 10-year survival rate was 92.4%, but low, intermediate, and high-risk patient showed 100%, 94.4%, and 70.5% respectively. Conclusion :The significant factors influencing local recurrence and distant metastasis were tumor size, extrathyroidal ex-ension, LN metastasis, capsular invasion. In order to improve survival rate of high-risk group, appropriate and aggressive management should be recommended.