Progression-directed therapy in patients with oligoprogressive castration-resistant prostate cancer

이준녕,김미영,강재훈,강준구,정재욱,하윤석,최석환,김범수,김현태,김태환,유은상,김시형,권태균 대한비뇨의학회 2024 Investigative and Clinical Urology Vol.65 No.2

Purpose: Oligoprogressive lesions are observed in a subset of patients who progress to castration-resistant prostate cancer (CRPC), while other lesions remain controlled by systemic therapy. This study evaluates the impact of progression-directed therapy (PDT) on these oligoprogressive lesions. Materials and Methods: This retrospective study included 40 patients diagnosed with oligoprogressive CRPC. PDT was performed for treating all progressive sites using radiotherapy. Fifteen patients received PDT using radiotherapy for all progressive sites (PDT group) while 25 had additional first-line systemic treatments (non-PDT group). In PDT group, 7 patients underwent PDT and unchanged systemic therapy (PDT-A group) and 8 patients underwent PDT with additional new line of systemic therapy on CRPC (PDT-B group). The Kaplan–Meier method was used to assess treatment outcomes. Results: The prostate specific antigen (PSA) nadir was significantly lower in PDT group compare to non-PDT group (p=0.007). A 50% PSA decline and complete PSA decline were observed in 13 patients (86.7%) and 10 patients (66.7%) of PDT group and in 18 patients (72.0%) and 11 patients (44.0%) of non-PDT group, respectively. The PSA-progression free survival of PDT-B group was significantly longer than non-PDT group. The median time to failure of first-line systemic therapy on CRPC was 30.2 months in patients in PDT group and 14.9 months in non-PDT group (p=0.014). PDT-B group showed a significantly longer time to progression than non-PDT group (p=0.025). Minimal PDT-related adverse events were observed. Conclusions PDT can delay progression of disease and enhance treatment efficacy with acceptable tolerability in oligoprogressive CRPC.

용적이 큰 전립선비대증에서 경요도전립선절제술: 관혈적전립선적출술과의 비교

이준녕,예석준,김재수,유은상,박윤규 대한남성과학회 2007 The World Journal of Men's Health Vol.25 No.2

Target Molecule Expression Profiles in Metastatic Renal Cell Carcinoma: Development of Individual Targeted Therapy

이준녕,전소영,하윤석,최경희,윤길숙,김현태,김태환,유은상,김법완,권태균 한국조직공학과 재생의학회 2016 조직공학과 재생의학 Vol.13 No.4

The aim of this study is to analyze the level of target molecule expression in metastatic renal cell carcinoma (RCC) to determine whether there is a correlation between molecular marker expression and clinical response. Ten patients with metastatic RCC, who received receptor tyrosine kinase (RTK) targeted therapy after cytoreductive or radical nephrectomy, were included. The expression of target molecules relating to the RTK, mammalian target of rapamycin, hypoxia inducible factor, mitogen activated protein kinase, and adenosine monophosphate- activated protein kinase pathways were analyzed using real-time polymerase chain reaction and immunohistochemistry. We correlated the level of target molecule expression with clinical response, including efficacy and adverse events experience during RTK targeted therapy. All patients showed similar histological subtype and grade on pathological examination; however, the expression of RCC target molecules was very different among the patients. The expression of molecules related to the RTK pathway in RCC tissue as well as relative expression of molecules in RCC tissue compared to normal kidney tissue, were higher in patients who showed a good response to RTK targeted therapy compared to those that showed a poor response. Target molecule expression in normal kidney tissue was higher in patients who experienced high-grade adverse events than in patients who experienced low-grade events. Target molecule expression in metastatic RCC correlates with targeted therapy clinical response including efficacy and adverse events. Personalized target molecule expression profiles could be used to predict clinical response to different targeted therapies, thus helping optimization of targeted therapies for patients with metastatic RCC.

상부요로 이행세포암에 대한 경복막강경 신요관적출술: 관혈적 수술과의 비교

이준녕,김현태,권태균 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.4

Median Raphe Cysts of the Scrotum and Perineum Presenting with Recurrent Infection

이준녕,김현태,정성광 대한요로생식기감염학회 2014 Urogenital Tract Infection Vol.9 No.2

Median raphe cysts of the perineum are rare congenital anomalies of the male genitalia, which form during embryological development, and can be found in the midline from the distal penis to the perineum. However, the incidence of median raphe cyst is likely under-reported and under-recognized. We report on the case of a median raphe cyst extending from the scrotum to the perineum with recurrent infection and purulent discharge in a 28-year-old man, which first developed at the age of 5 years. We believe it is important that urologists recognize median raphe cysts and have knowledge of their management in order to provide appropriate information to patients.

요도에 발생한 원발성 신경내분비암

이준녕,이동우,김영수,윤길숙,김재수,유은상,김법완 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.3

Primary neuroendocrine carcinomas are uncommon highly malignant tumors of the genitourinary tract, and they have a poor prognosis. We report here on a case of a primary neuroendocrine carcinoma of the urethra that developed after radical cystectomy and ileal conduit diversion for treating transitional cell carcinoma of the urinary bladder. (Korean J Urol 2008;49:284-286)

Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis

이준녕,변경현,우명진,백희선,조민현,정신영,이소미,함지연,하윤석,김현태,유은상,권태균,정성광 대한의학회 2019 Journal of Korean medical science Vol.34 No.21

Background: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. Methods: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. Results: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI Conclusion: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.

Human Urine-derived Stem Cells Seeded Surface Modified Composite Scaffold Grafts for Bladder Reconstruction in a Rat Model

이준녕,전소영,이효정,장유진,최석환,김대환,오세행,송필현,이진호,김종건,권태균 대한의학회 2015 Journal of Korean medical science Vol.30 No.12

We conducted this study to investigate the synergistic effect of human urine-derived stem cells (USCs) and surface modified composite scaffold for bladder reconstruction in a rat model. The composite scaffold (Polycaprolactone/Pluronic F127/3 wt% bladder submucosa matrix) was fabricated using an immersion precipitation method, and heparin was immobilized on the surface via covalent conjugation. Basic fibroblast growth factor (bFGF) was loaded onto the heparin-immobilized scaffold by a simple dipping method. In maximal bladder capacity and compliance analysis at 8 weeks post operation, the USCsscaffoldheparin- bFGF group showed significant functional improvement (2.34 ± 0.25 mL and 55.09 ± 11.81 μL/cm H2O) compared to the other groups (2.60 ± 0.23 mL and 56.14 ± 9.00 μL/cm H2O for the control group, 1.46 ± 0.18 mL and 34.27 ± 4.42 μL/cm H2O for the partial cystectomy group, 1.76 ± 0.22 mL and 35.62 ± 6.69 μL/cm H2O for the scaffold group, and 1.92 ± 0.29 mL and 40.74 ± 7.88 μL/cm H2O for the scaffoldheparin-bFGF group, respectively). In histological and immunohistochemical analysis, the USC-scaffoldheparin-bFGF group showed pronounced, well-differentiated, and organized smooth muscle bundle formation, a multi-layered and pan-cytokeratin-positive urothelium, and high condensation of submucosal area. The USCs seeded scaffoldheparin-bFGF exhibits significantly increased bladder capacity, compliance, regeneration of smooth muscle tissue, multi-layered urothelium, and condensed submucosa layers at the in vivo study.

A Case of Duplicated Vas Deferens Found Incidentally during Varicocelectomy

이준녕,김범수,김현태,정성광 대한남성과학회 2013 The World Journal of Men's Health Vol.31 No.3

Duplication of the vas deferens is a very rare congenital anomaly in which two vasa deferentia coexist within the spermatic cord. Duplication of the vas deferens can be found during herniorrhaphy, vasectomy, and varicocelectomy performed on the spermatic cord or around the spermatic cord. However, it is estimated that the incidence of duplication of the vas deferens is under-reported and under-recognized. Unless anomalies of the vas deferens such as duplication of the vas deferens are recognized by surgeons, it will be difficult to reduce vas deferens injuries and achieve a satisfactory surgical outcome. In addition, care should be taken in cases of duplication of the vas deferens because it can be complicated by non-testicular genitourinary anomalies. We report a case of duplication of the vas deferens discovered during routine varicocelectomy.

High Notch1 Expression Correlates with Tumor Stage and Size in Clear Cell Renal Cell Carcinoma

이준녕,전소영,이효정,하윤석,김현태,유은상,권태균,김태환 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3

Purpose: Although the influence of Notch signaling on several types of malignancies has been studied, the role of Notch signaling in clear cell renal cell carcinoma (ccRCC) remains unclear. In this study, we evaluated the levels of Notch1 and Jagged1 and their significance in ccRCC. Materials and Methods: Tumor tissue and matched normal adjacent kidney tissue from 49 ccRCC cases were obtained. The expression of Notch1 and Jagged1 was analyzed using real-time polymerase chain reaction (PCR) and Western blotting. Tissue samples were divided into several groups according to clinicopathological features, and the relative expression of Notch1 and Jagged1 was assessed. Results: Real-time PCR revealed increased Notch1 expression in tumor tissues compared with that in adjacent normal tissues (p=0.044). Based on the pathological stage, a significant difference in Notch1 expression was observed between tumor and normal kidney tissues in pT2 and pT3 ccRCC (pT2, p=0.041; pT3, p=0.001). Notch1 expression in ccRCC relative to that in normal tissue was higher in later-stage ccRCC and larger ccRCC. Notch1 expression showed significant positive correlation with the maximal diameter of the primary renal tumor (mRNA, p<0.001; protein, p=0.001). High Notch1 expression was associated with recurrence and disease-specific death, although the difference was not significant. Jagged1 level was not significantly correlated with any of the factors examined. Conclusions: Notch1 may play a significant role in the tumorigenesis and progression of ccRCC. Notch signaling may be a potential target for chemopreventive or adjuvant therapeutics for ccRCC.