비강 및 부비동의 반전성 유두종에서 인형유두종 및 Ebstein-Barr 바이러스의 검출

조재식,임상철,백준,정형수,신명석,Cho, Jae-Shik,Lim, Sang-Chul,Baik, Jun,Jeong, Hyoung-Soo,Shin, Myoung-Seok 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.1

The etiology of inverted papilloma(IP) remains unknown, but several studies have reported that Human Papillomavirus(HPV) may play a role in the pathogensis of sinonasal inverted papilloma(IP). And recent reports demonstrate the possible etiologic role of Epstein-Barr virus (EBV) in sinonasal IP. The aim of this study is to detect HPV and EBV in sinonasal IP, to examine the relationship between HPV subtype and sinonasal IP, to investigate the relation between HPV and EBV. We reviewed 30 cases of sinonasal IP(simple IP 19 cases, IP with dysplasia 8 cases, IP with squamous cell carcinoma 3 cases). Paraffin embedded archival tissue was used in this study. Detection of HPV, EBV were examined by in situ hybridization(ISH) using HPV type 6/11, 16/18, 31/33/35 DNA probe and EBER probe. The HPV was detected in 6(20%) out of 30 cases. The HPV 6/11 was dectected in 4 out of 19 cases of simple IP, HPV 16/18 in 1, HPV 31/33/35 in 1 out of 8 cases of IP with dysplasia respectively. The EBV was not detected in 30 cases. HPV may play a role in the pathogensis of sinonasal inverted papilloma. But EBV is not a etiopathologic factor to be considered in the development of sinonasal IP.

측두하부와에 발생한 영아섬유종증 1례

조재식(Jae Shik Cho),백준(Jun Baik),이상철(Sang Chui Lee),임상철(Sang Chui Lim) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

The fibromatoses are defined as a group of non encapsulated, non metastasizing, fibrous tumors that have a tendency for infiltrative growth and local recurrence following surgical excision and can be divided into fascial and musculoaponeurotic fibromatoses. Infantile fibromatosis is childhood counterpart of musculoaponeurotic fibromatosis and is more common in the head and neck, the shoulder and upper arm and the thigh. Treatment includes excision, radiation, steroid and chemotheraphy, etc. Treatment of choice is complete excision but postoperative deformity and sequelae should be considered. Recently, we have experienced a case of infantile fibromatosis originating from infratemporal fossa and report this case with a review of literatures.

비강 및 부비동의 반전성 유두종에서 인유두종바이러스검출과 p53및 c-erbB-2의 발현

조재식(Jae Shik Cho),백준(Joon Baik),임상철(Sang Chul Lim),조연(Yeon Cho),윤제환(Je Hwan Yoon),서덕중(Duk Jung Seo),박창수(Chang Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2

Background: Inverted papilloma(IP) of the nasal cavity and paranasal sinuses is a benign neoplastic condition that can be associated with squamous cell carcinoma (SCC). Several studies have indicated an etiologic role for viruses in the development of inverted papilloma. And it is necessary to find out the significance of a biologic markers such as p53, c-erbB-2 to predict the malignant potential. The purposes of this study are to detect HPV in inverted papilloma of the nasal cavity and paranasal sinus, to examine role of HPV as an etiological agent, to examine the relationship between HPV subtype and malignant transformation of inverted papilloma, and to investigate the relation between expression rate of p53, c-erbB-2 and HPV in recurrent or malignant transformation cases. Material and Methods: Thirty two cases of inverted papilloma(IP) in the nasal cavity and paranasal sinuses were reviewed and classified into 3 groups; simple IP, IP with dysplasia group, IP with squamous cell carcinoma group. Paraffin embedded achival tissue was used in this study. The HPV was detected by in situ hybridzation (ISH) using HPV type 6/11, 16/18, 31/33/35 DNA probes. Expression of p53 and c-erbB-2 was examined by immunohistochemical staining. Results: 1) The HPV was detected in 6(19%) out of 32 cases. 2) The HPV 6/11 was dectected in 4 out of 21 cases of simple IP, HPV 16/18 in 1, HPV 31/33/35 in lout of 8 cases of IP with dysplasia respectively. 3) The positive expression of p53 was 13 cases out of 32 cases; 2 out of 21 cases of simple IP, all of 8 cases of IP with dysplasia and 3 cases of IP with squamous cell carcinoma 4) The positive expression of c-erbB-2 was in 24 out of 32 cases; 16 out of 21 cases of simple IP, 6 out of 8 cases of IP with dysplasia, 2 out of 3 cases of IP with squamous cell ca. 5) The recurrence of IP occurred in lout of 6 cases of positive for HPV, in 4 out of 26 cases negative for HPV. 6) The recurrence of IP occurred only in positive cases for p53. 7) The recurrence of IP occurred in 4(17%) out of 24 cases positive for c-erbB-2, in 1(13%) out of 8 cases negative for c-erbB-2. Conclusion: The p53 expression was associated with Inverted papillomas exhibiting evidence of malignant transformation. Also, there was a correlation between the p53 expression and recurrence.

구강 편평세포암에서 EGFR과 C-erb-B2 유전자 발현에 관한 면역조직화학적 연구

조원,조재식,이종원,김해송,박근재,Cho, Won,Cho, Jae-Shik,Lee, Chong-Won,Kim, Hae-Song,Park, Guen-Jae 대한기관식도과학회 1996 大韓氣管食道科學會誌 Vol.2 No.2

The clinical staging systems for oral squamous cell carcinoma is limited as a prognostic indicatior because of different biological characteristics of cancer in this region and variable microenvironment depending on subsites, there have been study to determine prognosis by evaluating malignancy, that is the nature of tumor cells. Many studies have been tried to determine prognostic indicator in various malignancies for the evaluation of differentiation capacity and the expression of oncogene product. EGF make a role in cellular growth and differentiation and to be essential in cellular survival. EGFR is an intergral membrane protein, stimulate cellular differentiation and hormonal secretion, and has structural homology with V-erb-B transforming protein. Recent reports have demonstrated that EGFR is overexpressed in stomach, breast, vagina, dermis, head and neck, genitourinary and lung tumors, and possibly used as a tumor marker. In head and neck region, most of studies were mainly carried out on laryngeal squamous cell carcinoma. In the present study, immunohistochemical study for EGFR and C-erb-B2 gene in paraffin sections of 45 squamous cell carcinoma in oral cavity was performed to evaluate the presense of EGFR and C- erb-B2 gene in this lesion, to evaluate them as a prognostic indicator by analysing the correlation between these expression and subsites, primary stages, clinical stages, pathologic grades, neck node metastasis, recurrences and treatment results, and to determine relation between EGFR and C-erb-B2 gene.

비인두암의 국소 종양 치유와 생존율에 관한 예후 인자 분석

정웅기(Woong-Ki Chung),조재식(Jae-Shik Cho),박승진(Seung Jin Park),이재홍(Jae-Hong Lee),안성자(Sung Ja Ahn),남택근(Taek Keun Nam),최찬(Chan Choi),노영희(Young Hee Noh),나병식(Byung Sik Nah) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.2

목 적 : 비인두암 환자에서 항암화학요법과 방사선치료 후 국소종양제어율, 생존율, 무병생존율에 미치는 예후 인자를 알아보고자 하였다. 대상 및 방법 : 1986년 7월부터 1996년 6월까지 약 10년간 전남대학교병원에서 비인두암으로 확진되어 근치적 목적으로 치료를 받은 47명의 환자를 대상으로 후향적 분석을 시행하였다. 대상 환자의 연령 분포는 16세에서 80세까지였고 중앙 값은 52세였다. 성별 분포는 남자가 33명(70%), 여자가 14명(30%)이었다. WHO의 기준에 의한 조직학적 유형은 제1형(케 라틴형성 편평세포암)이 3례(6%), 제2형(비케라틴형성 편평세포암)이 30례(64%), 제3형(미분화암)이 13례(28%)였고 나머 지 1례(2%)는 조직학적 유형이 알려지지 않았다. 미국암합동위원회(1997)의 병기분류법에 따라 후향적으로 다시 분류한 병기는 T1, T2a, T2b, T3, T4에서 각각 11례(23%), 6례(13%), 9례(19%), 7례(15%), 14례(30%)였다. 그리고 림프절 침범 상태는 N0, N1, N2, N3에서 각각 7례(15%), 14례(30%), 21례(45%), 5례(10%) 있었다. 병기군별 분포는 Stage I, IIA, IIB, III, IVA, IVB에서 각각 2례(4%), 2례(4%), 10례(21%), 14 례(30%), 14례(30%), 5례(11%) 있었다. 방사선치료 전에 항암제 치료를 받은 환자는 42례이며 5례는 항암제 치료가 시행되지 않았다. 방사선치료는 선형가속기의 6MV와 10MV X-ray 및 9 MeV 전자선을 사용하였으며 원발 병소에 조사된 총방사선량은 6120- 7920cGy(중앙값: 7020cGy)였다. 항암화학요법은 Cisplatin+5-Fluorouracil(25명), Cisplatin+Pepleomycin(17명)으로 1회에서 3회까지 시행하였다. 국소종양제어율, 생존율, 무병생존율을 Kaplan-Meier법에 의하여 산출하였으며 두 군간의 생존율의 차이는 Generalized Wilcoxon test를 이용하여 검증하였다. 영향을 주는 인자의 다변량분석에는 Cox 모델을 이용하였다. 결 과 : 국소종양 제어율은 2년에 89%, 5년에 81%이었다. 5년 생존율은 60%(범위; 6-132개월, 중앙값; 32개월)이었다. 예후에 영향을 미치는 위험 인자로 연령, 성별, 두개신경침범, 병리조직학적 유형, 병기군, 항암화학요법, 항암화학요법과 방사선치료 사이의 간격, 방사선량, 방사선치료기간을 다변량분석에 포함시켰다. 국소종양제어율에는 두개신경침범(P=0.004)만이 의의 있는 것으로 나타났다. 생존율과 무병생존율에는 병기군(P=0.006, P=0.003)과 총방사선량(P=0.012, P=0.008)이 의의 있는 것으로 나타났다. 치료 후 합병증은 구강건조증, 치아손상, 이증상 등이 많았으며 2례의 갑상선기능저하증이 있었다. 결 론 : 비인두암에서 예후에 영향을 미치는 인자로서 국소종양제어율은 두개신경침범 여부가, 생존율 및 무병생존율에는 총방사선량 과 병기군, 특히 N 병기가 의의 있는 것을 알 수 있었다. 사용된 항암화학요법과 방사선치료는 심각한 부작용이 없이 효과적으로 이용될 수 있음을 알 수 있었다. Purpose : This study was performed to find out the prognostic fac tors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. Materials and Methods : We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70%) patients was male. Histological types were composed of 3 (6%) of keratinizing, 30 (64%) of nonkeratinizing squamous cell carcinoma and 13 (28%) of undifferentiated carcinoma. Histological type was not known in 1 patient (2%). We restaged according to the staging system of 1997 American Joint Committee on Cancer. Forty seven patients we re recorded as follows: T1; 11 (23%), T2a; 6 (13%), T2b; 9 (19%), T3; 7 (15%), T4; 14 (30%), and N0; 7 (15%), N1; 14 (30%), N2; 21 (45%), N3; 5 (10%). Clinical staging was grouped as follows: Stage I; 2 (4%), IIA; 2 (4%), IIB; 10 (21%), III; 14 (30%), IVA ; 14 (30%) and IVB; 5 (11%). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the lymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was fro m 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin+5-fluorouracil (25 patients) or cisplatin +pepleomycin (17 patients) with one to three cycles. Five patients have not received chemotherapy. Local control rate, sur vival and disease free survival rate were calculated by Kaplan- Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. Multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. Results : Local control rate was 81% in 5 year. Five year survival rate was 60% (median survival; 32 months). We included age, sex, cranial nerve deficit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial nerve deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were sig nificant prognostic factors in survival (P=0.006, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. Conclusion : In our study, cranial nerve deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemothe rapy and radiotherapy used in our patients were effective without any serious complication.

두경부 편평상피암종에서 Matrix Metalloproteinase-2의 발현과 경부림프절 전이에 관한 연구 -임상병리학적 연구-

김승현,임상철,백준,박창수,Chang Soo Park 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.8

성문상부암의 방사선치료

남택근(Taek-Keun Nam),정웅기(Woong-Ki Chung),조재식(Jae-Shik Cho),안성자(Sung-Ja Ahn),나병식,(Byung-Sik Nah) 오윤경(Yoon-Kyeong Oh) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.2

Purpose : A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. Materials and Methods : From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2∼79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0∼93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage Ⅰ and ⅣB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0∼68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0∼59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (±lymph node dissection), three had a supraglottic horizontal laryngectomy (±lymph node dissection), and one had a primary excision alone. Results : The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage Ⅰ+Ⅱ, Ⅲ+Ⅳ were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+RT) vs radiotherapy alone (RT) in stage Ⅱ, Ⅲ, ⅣA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (p<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+RT vs RT in stage Ⅱ, Ⅲ, ⅣA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (p<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (p<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. Conclusion : In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted. 목 적 : 성문상부암에서 방사선 단독치료 또는 수술 후 방사선치료를 받은 환자를 대상으로 방사선치료의 역할을 국소종양제어율과 생존율을 중심으로 후향적으로 분석하고자 하였다. 대상 및 방법 : 1986년 1월부터 1996년 10월까지 134명이 성문상부암으로 진단되어 방사선단독 또는 수술 후 방사선치료가 시행되었고 이 중 계획된 방사선량을 조사 받은 117명의 환자를 대상으로 하였다. 1997년의 AJCC 병기분류체계에 의하여 재분류하였고 병기 Ⅰ, Ⅱ, Ⅲ,ⅣA, ⅣB의 환자 수는 각각 6 (5%), 16 (14%), 53 (45%), 32 (27%), 10 (9%)이었다. 전체 환자 중 80명은 근치적 목적의 방사선치료로 원발병소에 61.2∼79.2 Gy (평균 : 69.2 Gy), 경부림프절에 45.0∼93.6 Gy (평균 : 54.0 Gy)를 조사하였다. 전체 환자 중 병기 Ⅰ과 ⅣB 환자는 모두 방사선 단독치료를 시행하였다. 37명의 환자에서 수술 후 방사선치료를 받았고 원발병소 절제부위에 45.0∼68.4 Gy (평균 : 56.1 Gy), 경부 림프절에 45.0∼59.4 Gy (평균 : 47.2 Gy)를 조사하였다. 수술방법으로서 33명은 전후두적출술(±경부림프절 청소술), 3명은 부분후두적출술(±경부림프절 청소술), 나머지 1명은 원발병소만의 절제술이었다. 결 과 : 전체환자의 5년 생존율은 43%이었다. 병기 Ⅰ+Ⅱ와 Ⅲ+Ⅳ의 5년 생존율은 49.9%, 41.2%이었으나(p=0.27), 병기 I (n=6) 환자의 종양특성생존율은 100%이었다. 수술 후 방사선치료군(S+RT)과 방사선단독 치료군(RT)의 5년 생존율은 병기 Ⅱ에서 100% 대 43%, 병기 Ⅲ에서 62% 대 52%이었으나 유의한 차이는 없었고(p=0.17, p=0.32), 병기 ⅣA에서 58% 대 6%로 S+RT군의 생존율이 유의한 차이로 양호하였다(p<0.001). 전체 환자의 국소종양 제어율은 57%이었다. 병기별 국소종양제어율은 병기 Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB에서 각각 100, 74, 60, 44, 30%이었다(p=0.008). S+RT군과 RT군의 국소종양제어율은 병기 Ⅱ에서 100% 대 68%, 병기 Ⅲ에서 67% 대 55%로 유의한 차이는 없었으나(p=0.29, p=0.23), 병기 ⅣA에서는 81% 대 20%로 유의한 차이가 있었다(p<0.001). 방사선 단독치료를 받은 80명의 환자 중 방사선치료반응에 따른 국소종양제어율은 완전관해, 부분관해, 부분관해미만 군에서 각각 76, 20, 0%이었다(p<0.001). 전체환자에서 생존율에 영향을 미치는 예후인자는 다변량 분석을 시행한 결과 N 병기, 수술 여부, 나이였고 국소종양 제어율에 영향을 미치는 유의한 인자는 N 병기, 수술 여부, ECOG 활동도였다. 방사선 단독치료군에서 다변량 분석결과 생존율과 국소종양제어율 모두에 유의한 인자는 방사선치료 후 종양반응과 N 병기였다. 결 론 : 조기 병기의 성문상부암에서는 통상적인 방사선단독치료로 후두기능을 보존하면서 수술군과 대등한 종양제어율을 보여주었다. 그러나 진행된 병기의 경우에는 수술과 방사선치료의 병용요법 또는 후두기능의 보존적 측면에서의 동시적 항암화학방사선요법이 고려되어야 할 것으로 생각된다. 특히 진행된 림프절 병소에 대해서는 가능한 한 방사선치료 전 또는 유도화학요법 후 계획된 경부림프절 청소술을 고려해야 할 것으로 생각된다.

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