Breast cancer is the second most common cancer in Korean women and its incidence has increased. Among the various treatment methods for breast cancer, chemotherapy plays an important role. The use chemotherapy to treat breast cancer began at the mid 20th century and first combination chemotherapy was conducted in mid 1970s. This chemotherapy reduced breast cancer mortality up to 25~30%, anthracycline and taxane based chemotherapeutic regimens are widely used. Chemotherapy could be classified to neoadjuavnt, adjuvant and palliative setting according to its aim and role. In this review, various drug therapeutic options and their backgrounds are considered based on neoadjuvant, adjuvant and metastatic systemic therapies.
Breast Neoplasms* ; Drug Therapy* ; Drug Therapy, Combination ; Female ; Humans ; Incidence ; Mortality

No abstract available.
Acute Disease ; Amylases/blood ; Humans ; Hyperamylasemia/complications/*diagnosis ; Isoenzymes/analysis ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Pancreatitis/complications/*diagnosis/radiography ; Tomography, X-Ray Computed

PURPOSE: Common bile duct (CBD) stone is a relatively common disease in elderly patients. There have been many reports about the efficacy and safety of LCBDE. But for elderly patients, only a few studies about its efficacy and safety exist. The aim of this study is to evaluate the efficacy, safety and the surgical outcome of LCBDE in patients who are 70 years or older and compare the results with those of the younger group. METHODS: From January 2000 to November 2009, 132 patients underwent LCBDE. We divided these patients into two groups according to age and conducted a retrospective analysis. The elderly group included patients who were 70 years old or older (n = 64), and the younger group included those who were younger than 70 (n = 68). The elderly group was compared to the younger group with respect to their clinical characteristics, operation time, postoperative hospital stay, open conversion rate, first meal time, postoperative complication, recurrence rate and mortality. RESULTS: The elderly group showed high American Society of Anesthesiologists score (2.2 vs. 1.9) (P = 0.003), preoperative morbidity (47 vs. 29) (P < 0.001), and previous abdominal operation (18 vs. 14) (P = 0.046). There were no significant differences in mean operation time, postoperative hospital stay, first meal time, recurrence rate, remnant stone, complication rates or mortality in both groups (P > 0.05). CONCLUSION: LCDBE is a safe and effective treatment modality for CBD stones not only for younger patients but also for elderly patients.
Aged ; Common Bile Duct ; Humans ; Length of Stay ; Meals ; Postoperative Complications ; Recurrence ; Retrospective Studies

PURPOSE: The empirical use of a chemotherapy regimen shows different results in individual breast cancer patient treatment. Recent studies showed the effectiveness of the adenosine triphosphate-based chemotherapy response assay (ATP-CRA). However, little is known about the correlation between chemosensitivity and breast cancer molecular subtypes. Therefore, we investigated whether the result of ATP-CRA is associated with a molecular subtype of breast cancer. METHODS: Two hundred eighty-seven patients diagnosed with breast cancer and receiving ATP-CRA at Mokdong Hospital, Ewha Womans University between September 2007 and December 2010 were enrolled in this study. Hormone receptor status, HER2/neu expression, and results of chemosensitivity tests of the patients was analyzed. RESULTS: In all of four subtypes, the combination of two agents showed significant higher mean cell death rate than a single agent. Within the breast cancer cell lines in this study, the range of chemosensitivity response was very wide and varied for each patient. For this reason, the molecular subtype of breast cancer is inconclusive in choosing an effective chemotherapeutic agent and in vitro chemosensitivity test, prior to therapy, could be a useful method for planning chemotherapy for each patient. CONCLUSION: Chemosensitivity response to anticancer agents was found to vary depending on the individual breast cancer patients. The molecular subtype of breast cancer is inconclusive to choose the effective chemotherapeutic agent and the in vitro chemosensitivity test, prior to therapy, could be more useful for planning chemotherapy for each patient.
Adenosine ; Adenosine Triphosphate ; Antineoplastic Agents ; Breast ; Breast Neoplasms ; Cell Death ; Cell Line ; Chemotherapy, Adjuvant ; Female ; Humans

PURPOSE: The role of the host immunologic environment is crucial in cancer progression. Recent studies revealed that neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), are possible surrogate markers of outcome in various cancers. In breast cancer, the therapeutic effect of neoadjuvant chemotherapy (NAC) differs in patients, and higher response rate reflects better outcomes. This study aimed to determine the predictive value of peripheral blood NLR and PLR for NAC response along with their prognostic role in breast cancer. METHOD: A total of 105 patients with breast cancer treated with NAC between 2009 and 2017 were analyzed retrospectively. NAC response and prognosis (disease-free-survival [DFS], progression-free-survival [PFS] and overall survival [OS]) according to NLR and PLR were evaluated. According to the optimal cut-off values for NAC response obtained from receiver operating characteristic (ROC) curves, patients satisfying both low NLR and PLR levels (low-ratio group) were compared to those who did not (high-ratio group). RESULTS: The NLR cut-off value was ≤ 2.21 (area under the ROC curve [AUC], 0.617; 95% confidence interval [CI], 0.517–0.710; p=0.030) with 94.1% sensitivity and 38.0% specificity. The PLR cut-off value was ≤ 143.36 (AUC, 0.618; 95% CI, 0.518–0.711; p = 0.040) with 85.3% sensitivity and 39.4% specificity. The low-ratio group demonstrated a better NAC response (p = 0.006) in multivariate analysis than the high-ratio group. The low-ratio group showed better DFS and PFS (p = 0.046 and p = 0.040, respectively) and longer OS (p = 0.078) in univariate survival analysis than the high-ratio group. In multivariate analysis, the low-ratio group had significantly better PFS (p = 0.049) and higher DFS (p = 0.054) than the high-ratio group. CONCLUSIONS: The combination of NLR and PLR showed improved prediction of NAC response, revealing their potential as screening tools, significant prognostic role in breast cancer patients who receive NAC. Further studies with subgroup analysis, larger population and longer follow up duration are required.
Biomarkers ; Blood Cell Count ; Breast Neoplasms ; Breast ; Drug Therapy ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: For early detection of breast cancer, tests with high sensitivity and specificity are needed. Metabolomics, the study of chemical processes involving metabolites, can be used to identify diagnostic biomarkers for a variety of types of cancers. In this study we identified biomarkers of breast cancer by profiling urinary metabolites. METHODS: We performed metabolite profiling of 30 urine samples from 14 patients with breast cancer and 16 healthy controls by liquid chromatography–mass spectrometry. An orthogonal partial least squares-discriminant analysis (OPLS-DA), Student's t-test, and receiver operating characteristic (ROC) analysis were performed to identify metabolites that were potential diagnostic biomarkers for breast cancer. RESULTS: The OPLS-DA showed clear separation between the two groups. Of the 95 metabolites detected, 24 potential biomarkers were identified by Student's t-test. A ROC analysis showed that concentrations of N-(2-furoyl) glycine, histidine, and D-tagarose were significantly higher (area under the ROC curve [AUC] >0.7) and those of trigonellinamide, L-galacto-2-heptulose, creatinine, and xanthine were significantly lower (AUC ≥0.8) in the patients with breast cancer than in the healthy controls. CONCLUSION Measurement of the concentrations of urinary metabolites can be used to screen for early breast cancer. We plan to explore diagnostic biomarkers of breast cancer in blood and urine further in a larger study.

Hereditary breast cancer is known for its strong tendency of inheritance. Most hereditary breast cancers are related to BRCA1/BRCA2 pathogenic variants. The lifelong risk of breast cancer in pathogenic BRCA1 and BRCA2 variant carriers is approximately 65% and 45%, respectively, whereas that of ovarian cancer is estimated to be 39% and 11%, respectively. Therefore, understanding these variants and clinical knowledge on their occurrence in breast cancers and carriers are important. BRCA1 pathogenic variant breast cancer shows more aggressive clinicopathological features than the BRCA2 pathogenic variant breast cancer. Compared with sporadic breast cancer, their prognosis is still debated. Treatments of BRCA1/BRCA2 pathogenic variant breast cancer are similar to those for BRCA-negative breast cancer, mainly including surgery, radiotherapy, and chemotherapy. Recently, various clinical trials have investigated poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor treatment for advanced-stage BRCA1/BRCA2 pathogenic variant breast cancer. Among the various PARP inhibitors, olaparib and talazoparib, which reached phase III clinical trials, showed improvement of median progression-free survival around three months. Preventive and surveillance strategies for BRCA pathogenic variant breast cancer to reduce cancer recurrence and improve treatment outcomes have recently received increasing attention. In this review, we provide an information on the clinical features of BRCA1/BRCA2 pathogenic variant breast cancer and clinical recommendations for BRCA pathogenic variant carriers, with a focus on treatment and prevention strategies. With this knowledge, clinicians could manage the BRCA1/BRCA2 pathogenic variant breast cancer patients more effectively.

Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL.
Adipose Tissue ; Aged ; Breast ; Diagnosis ; Gynecomastia* ; Humans ; Lipomatosis ; Lipomatosis, Multiple Symmetrical* ; Male ; Mastectomy ; Pathology ; Rare Diseases ; Tobacco Products

PURPOSE: A chemotherapy response assay test is performed to evaluate the degree of tumor growth inhibition by a chemotherapeutic agent. Several studies have been done on its usefulness; however, to the best of our knowledge, only a few studies concerning the relationship between chemotherapy response assay test results and breast cancer patients' prognoses have been conducted. Thus, we performed this study to analyze this relationship. METHODS: Among breast cancer patients who underwent curative surgery and neoadjuvant or adjuvant chemotherapy between August 2004 and December 2009, 102 were enrolled in this study. Chemotherapeutic regimens for patients were doxorubicin plus taxane or doxorubicin plus cyclophosphamide followed by taxane. We divided these patients into two groups (sensitive group [n=19] and resistant group [n=83]) and analyzed the relationship between chemosensitivity results and patient prognosis. RESULTS: The sensitive group was associated with poor disease-free survival (DFS) (p=0.003) and overall survival (OS) (p<0.001). No significant differences were observed in tumor histology (p=0.548), tumor size (p=0.479), number of metastatic lymph nodes (p=0.326), histologic grade (p=0.077), or nuclear grade (p=0.216) between the two groups. However, in respect to molecular subtype, the HER2-positive type and triple negative breast cancer were more frequently observed in the sensitive group (p=0.001). In a univariate and multivariate analysis for DFS, doxorubicin sensitivity was significantly associated with a poor prognosis (p<0.05). CONCLUSION: Better chemosensitivity results are associated with a poor prognosis in breast cancer patients who have undergone anthracycline- and taxane-based chemotherapy, however, examination of additional cases and the use of a longer study period are needed.
Breast ; Breast Neoplasms ; Bridged Compounds ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Taxoids

PURPOSE: Endoscopic thyroidectomy has brought lots of advantages to the patients since its first introduction. The aim of this study is to evaluate the functional and cosmetic satisfaction of patients receiving endoscopic thyroidectomy with patients receiving conventional thyroidectomy. METHODS: From October 2009 to January 2010, 98 patients underwent with conventional (n=69) or endoscopic (n=22) thyroidectomy. Of these patients 91 who had responded to a questionnaire distributed during the visit outpatient clinic visit. The questionnaire responses were analyzed to compare the satisfaction and postoperative results of these patients. RESULTS: The patient mean age was 45.5±10.1 years and the male to female ratio was 1:8.1. Perceived cosmetic satisfaction was significantly greater in patients who received conventional thyroidectomy than in those who received endoscopic thyroidectomy (P=0.03). Otherwise, there were no significant differences concerning functional problems. The conventional surgery was significantly longer than the endoscopic surgery (P=0.001). However, there were no significant differences in estimated blood loss, postoperative hospital stayand complication rates (P>0.05). CONCLUSION: Endoscopic thyroidectomy might bring satisfactory cosmetic result compared to conventional thyroidectomy. However, further studies are necessary.
Ambulatory Care Facilities ; Female ; Humans ; Male ; Patient Satisfaction* ; Postoperative Hemorrhage ; Thyroidectomy*