신세포암에서 림프절절제술의 역할

유탁근(Tag Keun Yoo),조정만(Jung Man Cho) 대한비뇨기종양학회 2007 대한비뇨기종양학회지 Vol.5 No.2

국소 진행성 및 소수 먼 곳 전이가 있는 전립선암에서 수술적 치료의 근거

문경태(Kyong Tae Moon),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3

There is no clear consensus for the best treatment of men with locally advanced prostate cancer. As a first step, radiation therapy or primary hormone therapy or radical prostatectomy with extended pelvic lymph node dissection is used. But it seems impossible to have a good oncologic result with single treatment modality. Traditionally, external beam radiation therapy with adjuvant hormone therapy is most preferred treatment method in locally advanced prostate cancer and radical prostatectomy has not been routinely used because of high rates of margin positive and lymph node metastasis. But, recently published articles showed that surgery in multimodal setting is effective treatment modality and not inferior to radiation therapy in oncologic outcomes. Perioperative morbidities of surgery and incontinence rates are similar to surgery of organ confined diseases, and patients with primary radiotherapy seem to have high rate of lower urinary tract symptoms and radiation related complications compared with radical prostatectomy with adjuvant radiotherapy. There is still controversy in regard to performing surgery for locally advanced prostate cancer. We review the studies with surgery in locally advanced prostate cancer and compare with radiation therapy in multimodal setting, and review the studies with surgery in oligometastatic prostate cancer.

증례 : 신장 ; 과음 후 발생한 자발성 방광파열 1예

이명하 ( Myoung Ha Lee ),정준영 ( Jun Young Jung ),백대현 ( Dea Hyun Beak ),박영숙 ( Young Sook Park ),유탁근 ( Tag Keun Yoo ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

자연 방광파열은 매우 드물지만 조기에 진단하지 못하면 치명적인 합병증을 유발할 수 있으므로 알코올 섭취의 병력과 복통, 원인 불명의 복수, 핍뇨성 신부전의 양상을 보이는 환자에서 방광파열도 감별진단에 포함하여 복수 크레아티닌 검사를 시행하고 의심이 되면 확진 및 수술로 예후의 향상을 가져올 수 있겠다. Spontaneous urinary bladder rupture is uncommon, but is associated with significant morbidity and mortality because of delayed diagnosis. A 65-year-old man was admitted to the emergency room because of low abdominal pain and abdominal distention of sudden onset. The previous night, he had consumed a bottle of alcohol and fallen asleep. Diagnosed as peritonitis of unknown origin, he was prescribed antibiotics empirically. However, the ascites progressed and oliguric acute renal failure developed. On the fifth day, we measured the creatinine level in the ascitic fluid and performed retrograde cystography. He was diagnosed as idiopathic spontaneous bladder rupture and underwent a primary repair successfully. When a patient presents with acute abdominal pain, ascites, and oliguric acute renal failure without definite causes, physicians should consider idiopathic spontaneous bladder rupture, measure the creatinine level in the ascitic fluid immediately, and perform retrograde cystography to obtain an early diagnosis. (Korean J Med 76:370-373, 2009)

상부요로 요로상피암에서 Heat Shock Protein 27와 Cellular FLICE-like Inhibitory Protein의 발현

조정만(Jeong Man Cho),조희주(Hee Joo Cho),문경태(Kyong Tae Moon),민동석(Dong Suk Min),김은경(Eun Kyung Kim),김덕윤(Duk Yoon Kim),박재신(Jae Shin Park),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2011 대한비뇨기종양학회지 Vol.9 No.2

Purpose: We investigated the expressions of Heat shock protein 27 (HSP27) and Cellular FLICE-like inhibitory protein (c-FLIP) with urothelial carcinoma of the upper tract. Materials and Methods: The expressions of HSP27 and c-FLIP were quantified immunohistochemically form sixty one patients who underwent nephroureterectomy for urothelial carcinoma of the upper tract and 10 patient’s normal ureteral tissues who underwent nephrectomy. The overall percentage of cancer cells showing staining (0% to 100%) was indicated by visual scoring. Specimens were graded from 0 to +3 intensity representing the range of staining area, for which below 1% is 0 grade, 1-10% is+1 grade, 10-50% is +2 grade, over 50% is +3 grade. Results: HSP27 positive reaction was seen in 10 of 10 cases (100%) with a normal ureter, 59 of 61 cases (96.7%) with urothelial carcinoma of the upper tract. The mean HSP27 reaction scores were 2.67 with low grade, 2.27 with high grade (p=0.045). HSP27 expression was not statistically significant according to stage and lymph node metastasis. c-FLIP positive reaction was seen in 0 of 10 cases (0%) with normal ureter, 57 of 61 cases (93.4%) with urothelial carcinoma of the upper tract. c-FLIP expression was not statistically significant according to grade, stage and lymph node metastasis. Conclusions: This study suggests that the expression of HSP27 is reduced and the expression of c-FLIP is increased in patients with urothelial carcinoma of the upper tract. If these data are confirmed, HSP27 and c-FLIP may be usable as prognostic marker of urothelial carcinoma of the upper tract.

세포독성 항암화학요법을 받을 수 없는 환자에서의 Estramustine Phosphate 단독요법

류재현(Jae Hyun Ryu),김상진(Sang Jin Kim),김윤범(Yun Beom Kim),정태영(Tae Young Jung),문경태(Kyong Tae Moon),조정만(Jeong Man Cho),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2020 대한비뇨기종양학회지 Vol.18 No.2

Purpose: To investigate whether estramustine phosphate (EMP) monotherapy is applicable to castration-resistant prostate cancer (CRPC) patients who cannot receive cytotoxic chemotherapy. Materials and Methods: This retrospective single-arm study was conducted in CRPC patients who had not experienced cytotoxic chemotherapy and received EMP monotherapy (560 mg/day) at 2 institutions from 2008 to 2017. We analyzed prostate-specific antigen (PSA) responses, overall survival, and adverse effects of EMP treatment. Results: A total of 28 patients were analyzed. A reduction in serum PSA was observed in 11 patients (39.3%). Seven cases (25.9%) achieved more than 25% reduction of PSA, and 5 of them (18.5%) experienced more than 50% reduction. Median overall survival was 23 months (interquartile range, 10-60 months). Multivariable analyses demonstrated that low level of PSA at diagnosis of CRPC and long duration of prior androgen deprivation therapy were independent favorable factors predicting long-term overall survival. Adverse effects were edema (n=2; grade 2), nausea/vomiting (n=1; grade 2), gynecomastia (n=1; grade 2), and dyspnea (n=1; grade 1). Neither thromboembolic event nor grade 3-5 toxicity was observed. There was no discontinuation caused by side effects of EMP. Conclusions: EMP monotherapy could be considered as a safe treatment option with some effectiveness for CRPC patients who did not undergo cytotoxic chemotherapy. EMP is not generally recommended anticancer drug in the current guidelines for CRPC, but EMP monotherapy is thought to have an alternative role when a standard treatment cannot be selected due to patient"s age, health condition, or comorbidity.

근치적전립선절제술 후 발생한 절정요실금

김윤범(Yun Beom Kim),류재현(Jae Hyun Ryu),정태영(Tae Young Jung),김덕윤(Duk Yoon Kim),조희주(Hee Ju Cho),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2015 대한비뇨기종양학회지 Vol.13 No.2

Purpose: Climacturia is involuntary loss of urine during orgasm. The mechanism of climacturia in men who undergo radical prostatectomy (RP) is not fully understood, while deficiency in bladder neck coaptation during orgasm may be the cause. We evaluated the prevalence and risk factors of climacturia after RP. Materials and Methods: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from 2002 to 2013 and was able to have a vaginal intercourse postoperatively. RP was conducted using open or robot-assisted approach. We analysed the symptoms of climacturia, relationship between climacturia and several clinical factors. Also, we tried to find factors to predict the presence of climacturia. Results: Total of 123 patients were analyzed in this study. The median age of the men was 65 year and postoperative follow-up period for the interview was 37 months. Of the total 123 patients, 29 (23.6%) complained of the climacturia. In climacturia group, robot-assisted RP (p=0.018), nerve-sparing (p=0.046) and penile rehabilitation (p=0.012) were significantly less frequent, and more pad were comsumed (p=0.001) compared to non-climacturia group. On multivariable analysis, post-prostatectomy incontinence (PPI) (OR 6.49, p=0.004) and penile rehabilitation (OR 0.22, p=0.036) were significant factors to predict the presence of climacturia. Conclusions: Climacturia occurs in more than 20% patients who were potent enough after RP in our study. PPI and penile rehabilitation were positive and negative factor to predict an occurrence of climacturia, respectively. Therefore, in addition to PPI and erectile dysfunction, patients must be informed of this complication before undergoing RP.

로봇 보조 복강경 방광적출술 및 요로전환술의 초기 경험

조희주(Hee Ju Cho),신순철(Soon Cheol Shin),서도영(Do Young Seo),민동석(Dong Suk Min),조정만(Jeong Man Cho),강정윤(Jung Yoon Kang),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2012 대한비뇨기종양학회지 Vol.10 No.1

Purpose: Robot assisted laparoscopic radical cystectomy (RARC) is one of the options for minimal invasive treatment of muscle invasive bladder cancer or uncontrolled non muscle invasive bladder cancer. We detailed our operative techniques and initial experiences of robot assisted laparoscopic radical cystectomy with urinary diversion. Materials and Methods: From April 2010 to December 2011, 10 consecutive patients with bladder cancer who were performed robot assisted laparoscopic radical cystectomy with urinary diversion were enrolled. Patient’s demographics, intra-, perioperative data and oncologic outcome were analyzed. Urinary diversions including 9 ileal conduit and 1 ileal orthotopic neobladder were underwent extracoporeally. Results: Mean patient age was 65.1 years. The mean body mass index was 22.7kg/m². The mean operation time was 588.1min including 319.5min for robot assisted laparoscopic cystectomy (RARC), 165.0min for extracorporeal urinary diversion and 53.1min for lymph node dissection. The mean estimated blood loss was 244.7ml. The mean number of retrieved lymph node was 17.2. The pathologic report showed transitional cell carcinoma in all cases and adenocarcinoma of prostate in 2 male patients. No intra-operative complication was occurred. Conclusions: Robot assisted laparoscopic radical cystectomy could minimize surgery related complications without jeopardizing oncologic outcome. RARC may be effective treatment option for advanced bladder cancer.

전립선암종의 신생혈관 형성과 세포 증식능이 종양전이 및 예후에 미치는 영향에 대한 면역조직학적 연구

유탁근,이춘용 大韓泌尿器科學會 1997 Korean Journal of Urology Vol.38 No.12

전립선 암종의 신생혈관 형성과 세포 증식능 및 전립선특이항원 발현정도가 종양전이 및 예후에 미치는 영향

유탁근,이춘용,장세진,박문향 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.1

Prostate adenocarcinoma is a significant cause of morbidity and mortality in old men. Recently, with increased screening, there has been much interest in early detection and proper management of this cancer. The best predictors of prognosis in prostate cancer are the stage of disease and histologic differentiation of the cancer. But, preoperative prediction of pathologic stage in prostate cancer is currently limited and histologic differentiation may be somewhat subjective. Therefore, more accurate predictors of biological progression are needed. A number of markers including DNA ploidy, prostate specific antigen(PSA) level, oncogenes, tumor suppressor genes and expression of proteins related to proliferation have been suggested to aid the stage and histologic differentiation in predicting the malignant potential of prostate cancers. The authors designed this study to determine the prediction efficacies of neovascularity, proliferating cell nuclear antigen(PCNA) labeling index and intensity of PSA reaction using immunohistochemical staining, To evaluated above mentioned 3 markers, immunohistochemical stains in 48 cases of prostate cancers and 5 cases of benign prostatic hyperplasia(BPH) were performed and analysed. Microvessels were identified by immunostaining of endothelial cells for factor Ⅷ-related antigen. PCNA labeling indices were obtained in 200X field by counting more than 1,000 cells. The intensity of PSA staining was graded as 0, 1, 2, 3, based on its relationship to the control, and used as scores. The most outstanding staining was considered as 3. The results were as follows: 1. The mean microvessel count(MVC) in BPH group was 34.2±5.9 per 200X field and that of prostate cancer group was 63.5±38.6(p〈0.05). The mean MVC of Gleason grade I prostate cancer was 32.2(16-40). The MVCs were 38.3(23-58), 58.8(23-92), 78.1(18-182) and 86.8(22-180), from grade Ⅱ to V respectively. According to stage, the mean MVCs were 40.8, 48.5, 55.0 and 89.0 from A to D. Between the 2 groups with well differentiated(grade I-Ⅲ) and poorly differentiated(grade Ⅳ-Ⅴ) prostate cancer, there was significant difference in MVC(p〈0.05). And between localized and metastatic group, there was also significant difference. The mean survival of high MVC(MVC≥60) group was 57.4±15.9 months and that of low MVC group was 74.0±11.2 months. But the difference was not statistically significant. 2. The mean PCNA labeling indices were 14.6±8.0% in BPH group and 32.3±15.4% in prostate cancer group. According to Gleason grade, the mean PCNA labeling indices showed the distribution of 33.4(11-55)%, 30.8(19-41)%, 26.3(8-74)%, 38.0(22-55)% and 36.6(12-72)% from I to V respectively. According to stage, the mean value of stage A was 23.1(11-55)%. The mean values were 27.4(8-41)%, 30.4(21-51%) and 36.2(8-74)% in stage B, C and D. Between localized and metastatic group, the difference of PCNA labeling index was not statistically significant. The mean survival of high labeling index(≥30%) group was 66.0±12.2 months contrasted with 72.4±14.6 months of low labeling index group(p〉0.05). 3. The intensities of PSA staining were as follows: according to grade, from I to V, they were 2, 20, 2.75, 2.50, 1.73 and 1.20, respectively. In stage A, the mean PSA score was 2.67, and those of other stages were 2.62 in B, 2.60 in C and 1.58 in D. Between the 2 groups with well differentiated and poorly differentiated prostate cancer, there was significant differnce in PSA score(p〈0.05). And between localized and metastatic group, there was also significant difference. The mean survival of high intensity(2, 3) group was 74.1±11.6 months contrasted with 48.9±11.5 months in low intensity group(0, 1). But the difference was not statistically significant. These results suggest that microvessel density in prostate adenocarcinoma may be an another prognostic factor supporting clinical stage and histologic differentiation. In addition, the intensity of PSA immunostaining can be used as a predictor of malignant potential. But relatively negative results were obtained for PCNA labeling index from this study. To further define MVC and PSA staining intensity as predictors of prostate cancer, more enthusiastic and well designed studies are needed.

전립선암에서 세포고사억제유전자 bcl-2 및 종양유전자 c-erbB-2 발현에 대한 면역조직학적 연구

유탁근,김은경 凡石學術奬學財團 2000 凡石學術論文集 Vol.4 No.-