Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.
Colorectal Neoplasms ; Core Binding Factor Alpha 3 Subunit ; CpG Islands ; Epigenomics ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Methylation ; Polymerase Chain Reaction ; Prognosis ; RNA, Messenger ; Transcription Factor 3

Correction of funding statement in ACKNOWLEDGEMENTS section.

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.
Aromatase ; Asian Continental Ancestry Group ; Bone Density ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cholesterol ; Consent Forms ; Female ; Humans ; Observational Study ; Quality of Life*

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta-stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.
Adenocarcinoma ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Hemangioendothelioma ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis* ; Tomography, X-Ray Computed

PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p<0.01). Better outcome was found in patients younger than 12 years of age (p=0.024). Patients with moderate to severe AD showed better treatment outcomes (p=0.036). Patients sensitized only to HDM had the better response to treatment, but SIT was also effective in multi-sensitized groups (p=1.051). No significant differences in baseline laboratory results were observed between good and poor responders (p>0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.
Adolescent ; Adult ; Allergens/*immunology ; Animals ; Child ; Dermatitis, Atopic/*therapy ; Desensitization, Immunologic/*methods ; Dose-Response Relationship, Drug ; Female ; Humans ; Male ; Middle Aged ; Pyroglyphidae/*immunology ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; Young Adult

PURPOSE: This study aimed to establish a large-scale database of patients with gastric cancer to facilitate the development of a national-cancer management system and a comprehensive cancer control policy. MATERIALS AND METHODS: An observational prospective cohort study on gastric cancer was initiated in 2010. A total of 14 cancer centers throughout the country and 152 researchers were involved in this study. Patient enrollment began in January 2011, and data regarding clinicopathological characteristics, life style-related factors, quality of life, as well as diet diaries were collected. RESULTS: In total, 4,963 patients were enrolled until December 2014, and approximately 5% of all Korean patients with gastric cancer annually were included. The mean age was 58.2±11.5 years, and 68.2% were men. The number of patients in each stage was as follows: 3,394 patients (68.4%) were in stage IA/B; 514 patients (10.4%), in stage IIA/B; 469 patients (9.5%), in stage IIIA/B/C; and 127 patients (2.6%), in stage IV. Surgical treatment was performed in 3,958 patients (79.8%), endoscopic resection was performed in 700 patients (14.1%), and 167 patients (3.4%) received palliative chemotherapy. The response rate for the questionnaire on the quality of life was 95%; however, diet diaries were only collected for 27% of patients. CONCLUSIONS: To provide comprehensive information on gastric cancer for patients, physicians, and government officials, a large-scale database of Korean patients with gastric cancer was established. Based on the findings of this cohort study, an effective cancer management system and national cancer control policy could be developed.
Cohort Studies* ; Diet ; Drug Therapy ; Humans ; Korea ; Male ; Occupational Groups ; Prospective Studies* ; Quality of Life ; Stomach Neoplasms*

BACKGROUND: Attempts have been made to use the signal changes of fluid-attenuated inversion recovery (FLAIR) MRI as "a tissue clock," defined as a surrogate marker of the tissue damage resulting from acute ischemic stroke. The evolution of FLAIR signals after stroke onset has never been fully explained solely by time. The aim of this study was to determine whether cerebral small-vessel disease (SVD) affects FLAIR changes following acute ischemic stroke. METHODS: Based on data from a prospective stroke registry, consecutive patients who were hospitalized to the stroke center within 12 hours of stroke onset between January 2004 and May 2011 and had occlusion of the major cerebral arteries in the anterior circulation, as evidenced by MR angiography, were enrolled. Cases with FLAIR changes and controls without FLAIR changes were matched according to the time elapsed from stroke onset to MR study. RESULTS: Among the 130 patients who met the eligibility criteria, 62 (47.7%) had FLAIR changes. The time interval between stroke onset and MR study differed significantly between those with and without FLAIR changes (5.2 hours vs. 3.0 hours). FLAIR changes were more common among males and smokers. Comparisons between cases and controls matched on a one-to-one basis did not reveal any difference in the three signs of cerebral SVD: white-matter hyperintensities, lacunae, and cerebral microbleeds. CONCLUSIONS: This study failed to find any data supporting the hypothesis that cerebral SVD affects FLAIR changes after acute ischemic stroke.
Angiography ; Biomarkers ; Case-Control Studies ; Cerebral Arteries ; Glycosaminoglycans ; Humans ; Male ; Prospective Studies ; Stroke

BACKGROUND: Blood-brain equilibration rate constant (k(e0)) is derived from either pharmacokinetic and pharmacodynamic modeling (k(e0_model)) or a model-independent observed time to peak effect (k(e0_tpeak)). Performance in bispectral index (BIS) prediction was compared between k(e0_model) and k(e0_tpeak) for microemulsion or long chain triglyceride (LCT) propofol. METHODS: Time to peak effect (t(peak), time to a maximally reduced BIS value) of microemulsion propofol after an intravenous bolus (1 mg/kg) was measured in 100 patients (group A(micro)). An observed t(peak) of 1.6 min for LCT propofol was obtained from an earlier study. Another 40 patients received a target controlled infusions of microemulsion propofol (k(e0_model) = 0.187/min, group B(micro) = 20) or LCT propofol (k(e0_model) = 0.26/min, group B(LCT) = 20) and remifentanil. The k(e0_tpeak)'s in group B(micro) and B(LCT) were calculated using the observed t(peak) value obtained from group A(micro) and 1.6 min, respectively. Effect-site concentrations of propofol were recalculated using the amounts of propofol infused over time and k(e0_tpeak)'s. Predicted BIS values calculated by sigmoid Emax equations with k(e0_model) and k(e0_tpeak) were compared with observed BIS values during induction and emergence for both formulations of propofol. RESULTS: Observed t(peak) of microemulsion propofol was 1.68 min. The median performance errors of BIS in group B(micro) were -1.83% (-24.8 to 18.9, k(e0_model)) and -2.42% (-26.1 to 36.2, k(e0_tpeak)), while 8.01% (-20.5 to 30.1, k(e0_model)) and 7.37% (-27.0 to 49.1, k(e0_tpeak)) in group B(LCT). The median absolute performance errors of BIS in group B(micro) were 11.87% (2.2-31.1k(e0_model)) and 14.38% (-0.6 to 44.6, k(e0_tpeak)), while 17.31% (5.54-36.0, k(e0_model)) and 18.28% (-0.1 to 56.0, k(e0_tpeak)) in group B(LCT). CONCLUSIONS: The k(e0_model) showed better performance in BIS prediction than the k(e0_tpeak).
Colon, Sigmoid ; Humans ; Pharmacokinetic* ; Piperidines ; Propofol*