2021 대한비뇨기종양학회 신암연구회 Consensus Statement: 전이성 신세포암의 종양감축 신적출술

이찬호,강민용,곽철,김성한,김정권,박재영,서성일,서일영,서준교,송완,Song Cheryn,육형동,이상철,이형호,정진수,정창욱,조정기,최창일,추설호,한준현,Hwang Eu Chang,김미소,김찬(Chan Kim),최석환,홍성후 대한비뇨기종양학회 2022 대한비뇨기종양학회지 Vol.20 No.3

Purpose: The Korean Renal Cancer Study Group (KRoCS) provides consensus recommendations on the role of cytoreductive nephrectomy (CRN) in patients with metastatic renal cell carcinoma (mRCC).Materials and Methods: A group of mRCC experts from the Korean Urological Oncology Society convened at the 2021 KRoCS meeting on CRN for mRCC.Results: The consensus document was developed to address 4 questions related that were judged to be the most relevant to patient care: (1) Is there a role for CRN in patients planning targeted therapy? (2) Is there a role for CRN in patients planning immuno-oncology agents? (3) When is the optimal time of CRN in patients planning systemic treatment? (4) What is the ideal patient selection for CRN? The panelists have come up with following consensus. For mRCC patients, CRN should be considered only in those with IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) favorable and intermediate risk disease, regardless of the systemic treatment plans. Timing of CRN should consider the risk group as well as the number of risk factors, but is generally recommended for after assessing the degree of response to initial systemic treatment. Patients with good performance status, limited metastatic burden on top of resectable primary tumor are candidates recommended for CRN with or without metastasectomy with priority.Conclusions: In conclusion, there is still a role for CRN in the multimodality treatment of mRCC. Careful patient selection is of paramount importance. As the treatment landscape of mRCC continues to change, the role of CRN in the current immuno-oncology era will require more exploration.

Differences in Prostate Cancer between Korean Patients, the European Randomized Study of Screening for Prostate Cancer/Rotterdam Group, and a Dutch Clinical Cohort

심지성,김재헌,최훈,배재현,박홍석,문두건,천준,박재영 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.1

Purpose: We evaluated differences in biopsy-detected prostate cancer (PC) between a newly defined Korean clinical cohort (KCC) and two Western populations. Materials and Methods: The records of 723 Korean men aged 55 to 75 years who underwent an initial transrectal ultrasound-guided biopsy from 2004 to 2010 were retrospectively reviewed. Prostate biopsies were performed due to prostate-specific antigen (PSA) levels greater than 4.0ng/ml, or suspicious findings on rectal examination or transrectal ultrasonography. Characteristics of PC were compared between the KCC and Western groups (the Rotterdam group of the European Randomized Study of Screening for Prostate Cancer: ERSPC and Dutch Clinical Cohort: DCC). Results: The cancer detection rate was 26.4% (191/723) in the KCC, 20.9% (473/2268) in the ERSPC/Rotterdam group and 43.1% (138/320) in the DCC. The median PSA in patients with PC was 11.8ng/ml, 5.7ng/ml and 7.5ng/ml in the KCC, ERSPC/Rotterdam group, and DCC, respectively. The proportion of patients with a Gleason score of 7 or more was 57.1% (109/191) in the KCC, 37.5% (174/464) in the ERSPC/Rotterdam group and 37.0% (51/138) in the DCC. Conclusions: We found large differences in cancer detection rate, PSA, and Gleason score distribution between the KCC and Western cohorts. PC detected in Korean patients had more advanced clinical factors than in Western populations due to low availability of PSA screening programs.

Methylation Markers in Renal Cell Carcinoma

서성필,김용준 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.1

Many tumor markers in relation to renal cell carcinoma(RCC) have been evaluated for detecting and monitoring diseases outcomes. However, none of these biomarkers reported to date has shown sufficient sensitivity and specificity for as a detector and prognosticator of the whole spectrum of RCC in routine clinical practice. The limited value of the established prognostic markers requires analysis of new molecular parameters of interest in predicting the prognosis of RCC patients; in particular, the high-risk patient groups at risk of recurrence and progression. Abnormal methylation of CpG islands can efficiently repress transcription of the associated gene in a manner akin to mutations and deletions. Recent progress in the understanding of epigenetic modification and gene silencing has provided new opportunities for the detection, treatment, and prevention of cancer. Methylation is an important molecular mechanism in RCC and could be used as a diagnostic and prognostic marker. Aberrant patterns of epigenetic modification would be, in near future, crucial parameters in cancer diagnosis, prognosis and a good target for developing novel therapies while maintaining the quality of life. This review discusses the epigenetic issues involved in the detection and prediction of prognosis in RCC.

신종양에서 근치적 혹은 부분신절제술 후 절제연 양성의 치료

권태균(Tae Gyun Kwon) 대한비뇨기종양학회 2009 대한비뇨기종양학회지 Vol.7 No.2

고등급 전립선암에서의 근치적 전립선 절제술 시행 후 병리학적 등급 하향의 발생률과 치료 성적

나준필(Jun Phil Na),유재호(Jae Ho Yoo),김태헌(Tae Heon Kim),강민용(Min Yong Kang),성현환(Hyun Hwan Sung),전황균(Hwang Gyun Jeon),정병창(Byong Chang Jeong),서성일(Seong Il Seo),이현무(Hyun Moo Lee),최한용(Han Yong Choi),전성수(Seong S 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.2

Purpose: High Gleason score (8 to 10) is a poor prognostic factor regardless of treatment. Pathological downgrading sometimes occurs in high grade prostate cancer. The aim of this study is to evaluate treatment outcomes in patients with high grade prostate cancer on biopsy who were pathological downgrading after radical prostatectomy (RP). The impact on outcomes according to changes in the Gleason score after RP was evaluated. Materials and Methods: Of 3,236 men who underwent RP between September 1995 and December 2014, 541 patients with biopsy Gleason score 8 to 10 were retrospectively reviewed. We analyzed incidence and biochemical recurrence (BCR) free probability in this downgraded group according to the Gleason grade of cancer in the RP specimen. Results: Of 541 patients had a prostate biopsy Gleason score of 8 to 10. Two hundred ten patients showed pathological downgrading after RP (38.8%). Five-year BCR-free probability of patients who had Gleason score of 7 or less after RP was 46.8%. However, 5-year BCR-free probability of patients who remained Gleason scores 8 to 10 after RP was 28.5%. There was a significantly higher BCR-free probability in pathological downgrading group (p<0.001). On multivariate analysis, biopsy Gleason 8, lower PSA, clinical T2 stage was a significant predictor of downgrading. Conclusions: In this study, 38.8% of patients with high grade prostate cancer had a Gleason score of 7 or less in the RP specimen. Downgraded prostate cancer had more favorable treatment outcome. Serum PSA, clinical stage and biopsy Gleason score were the predictive factors for pathological downgrading.

전립선 재생검 방법

정현우(Hyunwoo Chung),송완(Wan Song),유재호(Jae Ho Yoo),강민용(Min Yong Kang),전황균(Hwang Gyun Jeon),정병창(Byong Chang Jeong),서성일(Seong Il Seo),전성수(Seong Soo Jeon),최한용(Han Yong Choi),김찬교(Chan Kyo Kim),박병관(Byung Kwan 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.2

Purpose: We compared biopsy results and surgical outcomes of magnetic resonance imaging (MRI)-guided biopsy with transrectal ultrasonography (TRUS)-guided biopsy to demonstrate efficacy of MRI-guided biopsy on previous biopsy negative patients. Materials and Methods: We retrospectively reviewed data of 120 patients who were categorized into MRI-guided biopsy groups (n=20) and TRUS-guided biopsy groups (n=100). All patients were diagnosed with prostate cancer (PCa) and had undergone radical prostatectomy (RP) after MRI-guided or TRUS-guided repeat biopsy between January 2010 and March 2016. Detection rate of significant cancer and Gleason score upgrading and downgrading were examined, in addition to biopsy results and subsequent RP outcomes. Results: Median values for prostate-specific antigen level of the TRUS-guided biopsy group and the MRI-guided biopsy group were 6.67 and 5.86 ng/mL (p=0.303), respectively. Median prostate volume of each group (34.1 mL vs. 23.5 mL, p=0.007), number of positive cores (2.0 vs. 3.0, p=0.001) and maximum cancer/core rate (30.0% vs. 60.0%, p<0.001) were statistically different. Positive core rates of each group were 21.9% and 87.1%, respectively. Pathologic T stage was the only variable that showed difference in surgical outcomes (p=0.002). Most of PCa was confirmed as clinically significant PCa after RP in MRI-guided biopsy group (95%). Conclusions: MRI-guided biopsy showed higher positive core rate and detection rate of clinically significant PCa than TRUS-guided biopsy in repeat biopsy setting. Prospective multicenter large-scale study and accumulation of data is expected to further define superiority of the MRI-guided biopsy.

조직 공학을 위한 신생 혈관의 역할

김명주(Myeong Joo Kim),지병훈(Byung Hoon Chi),조민지(Min Ji Cho),황영미(Young Mi Whang),장인호(In Ho Chang) 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.2

Tissue engineering is limited by our inability to adequately vascularize tissues post implantation because all tissue-engineered substitutes (with the exception of cornea and cartilage) require a vascular network to provide the nutrient and oxygen supply needed for their survival. This review gives a brief overview of the processes and factors involved in the vascularization and angiogenesis and summarizes the different strategies to overcome the issue of slow vascularization and angiogenesis in a range of tissue-engineered substitutes. Moreover, we will announce some potential future plans.

Clinical Significance of Positive Surgical Margin after Radical Prostatectomy according to Pathological Stage

이인제,오종진,김태진,송병도,이상철,홍성규,이상은,변석수 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3

Purpose: The purpose of this study was to investigate the positive surgical margin (PSM) as a predictive factor of biochemical recurrence (BCR) in prostate cancer (PCa) patients after radical prostatectomy (RP) according to each pathological stage. Materials and Methods: The records of 3,037 patients receiving RP were retrospectively reviewed. All patients were divided into 6 groups depending on pathological stage and presence of PSM. Cox proportional hazard analyses were performed to show the significance of PSM in all patients and in subgroup patients (T2, T3a, and T3b). The Kaplan-Meier analysis showed BCR-free survival rate of each group. Results: Among total 3.307 patients, the mean age was 65.89 years and PSM rate was 18.7%. During the 47.1 months, 550 patients had experienced BCR (26.2%). According to groups, prostate-specific antigen, Gleason score, and BCR were significantly different. Ten-year BCR-free survival rate was 87.1% (T2R0), 65.9% (T2R1), 60.1% (T3aR0), 43.0% (T3aR1), 20.8% (T3bR0), and 5.8% (T3bR1). Each group had statistical differences with BCR-free survival except T2R1 and T3aR0 (p=0.090). PSM was significant in multivariate Cox analyses in total patients (hazard ratio, 2.091; 95% confidence interval, 1.724–2.536; p<0.001) and in all subgroup with each stages. Conclusions: PSM is a significant predictor to BCR after RP in all PCa patients and in each stage. T2R1 PCa had a similar BCR-free survival rate to T3R0 patients during long-term follow-up, therefore careful management to T2R1 PCa as T3 should be necessary.

전립선암에서 발생한 맥락막 전이

이영(Young Lee),신용호(Yong Ho Shin),김영빈(Young Bin Kim),이동기(Dong-Gi Lee),이형래(Hyung-Lae Lee) 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3

Metastasis of choroid from prostate cancer is not common and has not been reported before in Korea. We report a case of decreased vision in a patient with prostate cancer. After external beam radiotherapy, patient had complete response in the choroidal metastasis. Metastasis of choroid secondary to prostate is not common. There have been only 8 cases reported. In this case, we demonstrated that external beam radiotherapy showed a therapeutic effect.

Comparison of Localized High Volume Tumor and Locally Advanced Low Volume Tumor after Radical Prostatectomy according to Risk Classification

김태진,이인제,송병도,이상철,홍성규,변석수,이상은,오종진 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3

Purpose: To investigate the percentage of pathologic tumor volume (pTPV) among patients who underwent radical prostatectomy (RP). Materials and Methods: We reviewed 3,080 patients who underwent RP between September 2003 and March 2015 and with a postoperative follow-up for more than 1 year. The patient population was stratified into 4 disease risk groups according to tumor stage and pTPV (T2 low volume [T2LV], T2 high volume [T2HV], T3 low volume [T3LV], and T3 high volume [T3HV]). Probability of biochemical recurrence (BCR)-free survival was determined using Kaplan-Meier curves. pTPV was evaluated by Multivariate Cox proportional hazard analysis for predicting BCR. Subgroup analyses were performed according to preoperative risk. Results: The median prostate-specific antigen (PSA) was 7.87 ng/mL, and pTPV was 10%. Among a total of 2,964 patients, T2LV had 1,473 (49.7%), T2HV was 598 (20.2%), T3LV with 199 (6.7%), and T3HV was 694 (23.4%). When comparing T2HV and T3LV, Gleason score and positive surgical margin rate was higher in T3LV. During a 50-month follow-up, BCR-free survival rate was higher in the T2HV group (p<0.001). pTPV was a significant factor to predict BCR in multivariate Cox analysis. In subgroup analyses, T2HV group had similar BCR-free survival rates to T3LV group in the preoperative high risk group while pTPV was significant in the high risk group. Conclusions: pTPV was a significant predictor of BCR among prostate cancer patients after RP, however T2HV had favorable BCR results. Among patients with a preoperative high PSA and Gleason score, T2HV had similar BCR results to T3LV.