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양반석 ( Ban Seok Yang ),박세호 ( Se Ho Park ),이소희 ( So Hee Lee ),박형석 ( Hyung Seok Park ),황혜원 ( Hye Won Hwang ),이준상 ( Jun Sang Lee ),고시몬 ( Si Mon Ko ),김승일 ( Seung Il Kim ),박병우 ( Byeong Woo Park ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.2
목적: 본 연구는 임신성 유방암의 임상병리학적 특징과 예후를 조사하여 임신이 임신성 유방암에 미치는 영향을 평가하고자 하였다. 방법: 1987년부터 2007년 사이에 치료받은 14명의 임신성 유방암환자들의 임상병리적 특성, 치료방법, 생존율을 855명의 40세 미만침윤성 유방암 환자들과 chi-square 검정, Kaplan-Meier 방법, 그리고 Cox`s hazards 모델을 이용하여 비교하였다. 임신성 유방암은 임신기간중또는출산후1년이내에진단된유방암으로정의하였다. 결과: 14명의 임신성 유방암 환자 중, 7명은 임신 중에 진단되었으며, 7명은 산후 1년 내에 진단되었다. 평균 증상기간은 7.6개월이었고, 임신성 유방암과 40세 미만 유방암 환자들의 평균 나이는 각각 32.6세, 34.6세였다 (p=0.044). 임신성 유방암은 모두 유관암이었으며, 병기, 호르몬 수용체 발현, 치료방법은 임신성 유방암과 40세 미만 유방암 사이에 통계적 차이를 보이지 않았다. 임신성 유방암 환자의 5년 무병 생존율과 전체 생존률은 57.1%, 70.0% 였으며, 생존율은 두 그룹 사이에 통계적 차이는 없었다. 다변량 분석에서도 임신여부는 생존율에 영향을 주지 않았다. 임신성 유방암 환자 중 출산전과 후에 따른 생존율은 통계적으로 유의한 차이를 보이지 않았다. 결론: 젊은 유방암 환자와 비교하여 임신성 유방암은 임상병리학적 특성과 예후는 차이가 없었으며, 임신성 유방암 환자와 태아를 위해 적극적인 진단과 다학제적인 치료가 필요하다. Purpose: The aims of this study were to investigate clinicopathological characteristics and outcomes of pregnancy-associated breast cancer (PABC) and to determine the implications of pregnancy itself on the prognosis of PABC. Methods: Clinicopathological features, treatment patterns, and survival of 14 PABC patients were compared to those of 855 invasive ductal carcinoma (IDC) patients under 40 years of age, who were treated between 1987 and 2007, using a chi-square test, the Kaplan-Meier method, and Cox`s hazards models. PABC was defined as breast cancer diagnosed during pregnancy or within the first year after delivery. Results: Among 14 PABCs, 7 were diagnosed during pregnancy and 7, during the first postpartum year. The mean duration of the symptoms was 7.6 months. The mean age at diagnosis of PABC and IDC under 40 years was 32.6 and 34.6 years, respectively (p=0.044). All PABCs were ductal type. Hormone receptors, treatment modalities, and tumor and node stage were not statistically different between PABC and IDC under 40 years. Five-year disease-free, locoregional relapse-free, distant relapse-free, and overall survival of PABC was 57.1%, 71.3%, 56.4%, and 70.0%, respectively. Survival was not significantly different between two groups. In Cox°Øs models, PABC was not associated with survival outcomes. Among PABCs, there was no statistical difference in survival between patients diagnosed before and after delivery. Conclusion: Pregnancy itself does not increase the risk of poorer outcomes among young breast cancer patients. Vigilant diagnosis and multidisciplinary treatment should be recommended to best manage woman with PABC and her baby.
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배숭준,안성귀,윤창익,양반석,이학우,손은주,정준 한국유방암학회 2019 Journal of breast cancer Vol.22 No.3
Purpose: We evaluated the clinical value of breast magnetic resonance imaging (MRI) in patients who underwent breast-conserving surgery (BCS). The degree of correlation between pathology size and MRI or ultrasonography (US) size was compared based on breast cancer subtypes. In addition, we investigated the positive margin rates. Methods: Patients with invasive breast cancer who underwent preoperative breast MRI and US between 2011 and 2016 were included in the study. Lin's concordance correlation coefficient was used to measure the correlation between MRI or US andpathologic tumor extent. Tumor extent was defined as pathologic tumor size, including in situ carcinoma. Margin positivity was assessed based on frozen-section examination. Results: A total of 516 patients with a single tumor who underwent BCS were included in the study. The correlation between pathologic size and MRI was significantly higher than that of US (r = 0.6975 vs. 0.6211, p = 0.001). The superiority of MRI over US in measuring the pathologic extent was only observed in triple-negative breast cancer (TNBC; r = 0.8089 vs. 0.6014, p < 0.001). The agreement between MRI or US and tumor extent was low for the human epidermal growth factor receptor 2 (HER2)-positive subtype (MRI: 0.5243, US: 0.4898). Moreover, the positive margin rate was higher in the HER2-positive subtype than in the others (luminal/HER2-negative: 11.6%, HER2-positive: 23.2%, TNBC: 17.8%, p = 0.019). The post hoc analysis showed that the HER2-positive subtype was more likely to show positive margins than the luminal/HER2-negative subtype (p = 0.007). Conclusion: Breast MRI was superior to US in the preoperative assessment of the pathologic extent of tumor size; this was most evident in TNBC. For HER2-positive tumors, imaging-pathologic discordance resulted in higher positive margin rates than that with other subtypes.
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이승아,이학민,이학우,양반석,박종태,안성귀,정준,김승일 대한암학회 2018 Cancer Research and Treatment Vol.50 No.3
Purpose Although sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND). Materials and Methods We analyzed 1,886 patients who underwent ALND after negative results of SLNB, retrospectively. A logistic regression analysis was used to identify risk factors associated with a falsenegative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS). Results Tumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS. Conclusion In patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.
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