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Combined Resection in Advanced Gastric Cancer.

Dong Woo SHIN ; Chang Hak YOO ; Sung Hoon NOH ; Jin Sik MIN

Journal of the Korean Cancer Association.1999;31(3):448-457.

PURPOSE: Prognosis of primary gastric cancer invading neighboring organs is very poor. However, with en bloc resection, a relatively favorable prognosis can be expected even in patients with such advanced cancer. But there has been controversy on the effectiveness of gastrectomy combined with en bloc resection of the invaded organs, and we conducted this study to evaluate the prognostic effects as well as the outcome of the combined resection. MATERIALS AND METHODS: Among 2,603 who underwent gastrectomy due to gastric carcinoma from January 1987 to December 1994 at the Department of Surgery, Yonsei University College of Medicine, 157 patients (6.0%) in whom curative combined resections of grossly invaded adjacent organs (cT4) were perfonned entered this study. Any case with distant metastasis was excluded. Comparisons and multivariate analysis between the invasion (pT3) group and the non-invasion (pT4) group were made for age, sex, tumor size, location, Borrmann type, depth of invasion, lymph node metastasis, histologic type and 5-year survival rate. RESULTS: One-organ combined resection was done in 60 (38.2%) patients; Two-organ, in 80 (51.0%) patients; and three-organ, in 17 (10.8%) patients. Most commonly combined organ was distal pancreas and transverse colon was the next. Histologic confirmation of invasion was made in 40.9%. 157 patients with T4 were divided into pT3 or pT4. Significant differences were found in type of operation, location of tumor, and TNM staging. Postoperative complications of combined resection were observed in 48 cases (30.6%) and the wound infection was the most frequent one. There were only 2 cases (1.3%) of immediate postoperative mortality in the combined group, and the causes of death were pulmonary complication and acute renal failure. Five-year survival rate (5-YSR) of pT3 group was 43.0% and that of pT4 was 26.2%. In comparison of 5-YSR according to TNM stages, no significant difference was found between pT3 and pT4 (45.0% vs. 66.7% in IIIa; 25.4% vs. 18.4% in IV). No difference of 5-YSR was observed in the groups categorized according to the number of resected organs. The comparison of 5-YSR between the 157 curatively-combined cases and the 63 palliatively-combined cases showed a significant difference (35.6% vs. 4.2%, p=0.000). Multivariate analysis showed that lymph node metastasis and microscopic tumor invasion served as significant parametets. CONCLUSION: En bloc combined resection of adjacent invaded organs along with systematic lymph node dissection would be beneficial to gastric cancer patients with neighboring organ invasion.
Acute Kidney Injury ; Cause of Death ; Colon, Transverse ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Pancreas ; Postoperative Complications ; Prognosis ; Stomach Neoplasms* ; Survival Rate ; Wound Infection

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Effectiveness of Gastrectomy in Stage 4 Gastric Cancer with Hepatic Metastasis.

Jeong Hwan YOOK ; Sung Joon KWON ; Byung Ki KIM ; Byung Jae KIM ; Sung KIM ; Seung Moon NOH ; Young Jae MOK ; Kyung Kyu PARK ; Byung Ju PARK ; Cho Hyun PARK ; Ho Yoon BANG ; Jae Moon BAE ; Young Jin SONG ; Du Hyun YANG ; Dae Hyun YANG ; Sung Tae OH ; Hyo Yung YUN ; Moo Son LEE ; Jong Inn LEE ; Yong Kwan CHO ; Dong Wook CHOI ; Sang Uk HAN

Journal of the Korean Cancer Association.1999;31(3):441-447.

PURPOSE: The prognosis for patients with stage IV gastric cancer is very poor. However, recently, some studies have reported benefits from a gastric resection for metastatic gastric cancer. This clinical study was performed to evaluate the effectiveness of a noncurative gastrectomy in treating stage IV gastric cancer with hepatic metastasis. MATERIALS AND METHODS: A retrospective analysis was performed on 98 gastric cancer patients who had undergone gastric resection, in spite of hepatic metastasis, between January 1990 and December 1996 at the Department of Surgery in 11 General Hospitals in Korea. RESULTS: The average age was 58 years old, and the male-to-female ratio was 69: 29. The laboratory tests were unable to predict hepatic metastasis. In 54 cases, hepatic metastasis was not identified before the surgery. The most common location of gastric cancer was antrum (72 cases). The most common gross type was Bonmann type III (78 cases). The serosa-exposed cases were 80. The peritoneal seeding was combined in 17 cases. A total gastrectomy was performed in 18 cases and a distal gastrectomy in 80. Lymph-node dissection was performed in 23 Dl, and 51 D2 cases. Hepatic resection was performed in 36 cases, The frequent histologic types were moderately differentiated and poorly differentiated tubular adenocarcinoma. Postoperative adjuvant chemotherapy was done in 70 cases. The complication rate (7%) was low. The median survival time was 15 months, with mean survival time of 18 months. The 2-year and 3-year survival rates were 23%, and 7%, respectively. In the univariate analysis, good survival was closely related to limitation of hepatic metastasis to one lobe, a few metastases to both lobes, negativity of peritoneal seeding and lymph node dissection more than D2 (p<0.05), CONCLUSIONS: An aggressive gastric resection for stage IV gastric cancer with hepatic metastasis might be beneficial in lengthening the survival period. A prospective study is needed, especiaUy one with an exact evaluation and analysis of the quality of life between the gastrectomy and nonresection groups.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Gastrectomy* ; Hospitals, General ; Humans ; Korea ; Lymph Node Excision ; Middle Aged ; Neoplasm Metastasis* ; Prognosis ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

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Expression of p53 Protein and Proliferating Cell Nuclear Antigen in Epstein - Barr Virus-associated Gastric Adenocarcinoma.

Jeong Hee KANG ; Chang Hoon LEE ; Kang Suek SUH

Journal of the Korean Cancer Association.1999;31(3):429-440.

PURPOSE: Recently, it has been reported that Epstein-Barr virus (EBV) is associated with some gastric cancers. But EBVs role in EBV-associated gastric carcinomas (EBVaGCs) has not been fully elucidated. This study was undertaken to evaluate the characteristics of EBVaGCs and to compare those with non-EBVaGCs. MATERIALS AND METHODS: EBV infection was studied using paraffin-embedded tissue blocks of 119 cases of gastric adenocarcinomas by in situ hybridization for EBV-encoded small RNAs (EBERs). In EBVaGCs and non-EBVaGCs, molecular characteristics were evaluated by immunohistochemical staining for latent membrane protein (LMP)-1, p53 protein, and proliferating cell nuclear antigen (PCNA). RESULTS: EBERs were detected in 12 cases (10.1%) of 119 gastric adenocarcinomas. LMP-1 was negative in all carcinomas tested, p53 protein was positive in 7 cases (58.3%) of 12 EBVaGCs and in 51 (47.7%) of 107 non-EBVaGCs, the difference between two groups being not significant. Mean PCNA index was 38.2+-26.1% in EBVaGCs and 22.8 +- 20.0% in non-EBVaGCs. The index was significantly higher in the former than in the latter. CONCLUSION: These results suggested that neoplastic progression in EBVaGCs was implicated with high expression of PCNA, but not consistently with overexpression of p53 protein or LMP-1.
Adenocarcinoma* ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; In Situ Hybridization ; Membrane Proteins ; Proliferating Cell Nuclear Antigen* ; RNA ; Stomach Neoplasms

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Lumpectomy with Axillary Dissection for Breast Cancer.

Eil Sung CHANG ; Jin Sung CHANG

Journal of the Korean Cancer Association.1997;29(6):1041-1048.

PURPOSE: The study was to evaluate the various risk factors related to local recurrence and distant metastasis in early breast cancer treated by lumpectomy with axillary dissection MATERIALS AND METHODS: Forty nine patients with early breast cancer were treated by lumpectomy with axillary dissection between January, 1990 and December, 1996. We analysed the risk factors such as age, tumor size, axillary lymph node metastasis, stage, pathologic classification and radiotherapy for local recurrence and distant metastasis RESULTS: The peak incidence was in the fifth decade (15 cases, 31%) and the average age was 47. The most common tumor size was 0~2 cm in 27 of 49 cases (55%). The preoperative chemotherapy was performed in 25 of 49 cases. The axillary lymph node metastasis was absent in 41 of 49 cases (84%). The most common pathologic type was invasive ductal carcinoma (29 cases, 60%). The breast skin incision was performed with curvilinear incision in 40 cases (85%), radial incision in 7 cases (15%). The axillary skin incision was performed with seperated incision in 45 cases (96%), nonseperated incision in 2 cases (4%). The most common complication was wound seroma (6 cases, 12%). By the time of follow-up, crude local recurrence rate was 10% (5 out of 49 cases) and crude distant metastasis rate was 6% (3 out of 49 cases). CONCLUSION: The factors such as age, tumor size, positive axillary nodes and stage were not statistically significantly related to local recurrence. Postoperative radiation therapy and preoperative chemotherapy were the significant factor related to local recurrence (2.6% for 39 cases with radiation therapy vs. 40.0% for 10 cases without radiation therapy, p<0.05; 0% for 25 cases with preoperative chemotherapy vs. 20.8% for 24 cases without preoperative chemotherapy, p<0.05).
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Risk Factors ; Seroma ; Skin ; Wounds and Injuries

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Increment of Telomerase Activity with Breast Cancer Progression.

Kyu Hyun PARK ; Sun Young RHA ; Tae Soo KIM ; Byung Chan LEE ; Sei Ho PARK ; Hyun Cheol CHUNG ; Won Young LEE ; Joo Hang KIM ; Jae Kyung ROH ; Kyong Sik LEE ; Jin Sik MIN ; Byung Soo KIM

Journal of the Korean Cancer Association.1997;29(6):1032-1040.

PURPOSE: We studied the telomerase activity in normal and cancer tissues of the breast and then compared it to the clinical parameters. MATERIALS AND METHODS: 36 paired normal and cancerous breast tissues were assayed for telomerase activity by PCR-based TRAP assay (telomeric repeat amplification protocol). In 17 cancer tissues, flow cytometric analysis for S-phase fraction was done. RESULTS: None of the normal breast tissue expressed telomerase activity while 23 out of 26 breast cancer tissue expressed telomerase activity (92%). Clinical parameters such as T-factor, tumor grade, hormone receptor expression, mitosis, S-phase fraction did not correlate with telomerase expression. However, telomerase acitvity increased with cancer progression such as; in a state of lymph node metastasis and in an advanced pathological stage. CONCLUSION: Telomerase activity was expressed only from cancer tissues. And this expression increased with cancer progression suggesting a possible therapeutic target in breast cancer.
Breast Neoplasms* ; Breast* ; Lymph Nodes ; Mitosis ; Neoplasm Metastasis ; Telomerase*

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TGF-beta-1 Expression and p53 Mutation in Non-small Cell Carcinomas of the Lung.

Han Kyeom KIM ; Seol Hee PARK ; Young Soon NA ; Yong Gu KANG ; Young Sik KIM ; Jung Ho HAN ; Mee Ja PARK ; Insun KIM

Journal of the Korean Cancer Association.1997;29(6):1022-1031.

PURPOSE: TGF-beta-1 is actually a major growth inhibitor for most cell types. We assumed that the loss of TGF-beta-1 would be occurred during carcinogenesis of the lung. Also, the mutation and expression of p53 have been known to be major moleclar change of non-small cell carcinoma of the lung. So, the relationship between the mutation of p53 and the expression of TGF-beta-1 in the non-small cell carcinomas were evaluated. MATERIALS AND METHODS: In 43 non-small cell carcinoma and normal tissue of the lung, their TGF-beta-1 mRNA were measured by RT-PCR and p53 was studied by SSCP and Western blotting assay. RESULTS: p53 mutation rate in non-small cell carcinomas of the lung (48.4%) was much more frequent than the normal control group (14.3%). The expression rate of TGF-beta-1 in lung carcinomas, especially squamous cell carcinoma (71.4%), was much higher than the normal control group (42.9%). p53 mutation and TGF-beta-1 mRNA in the lung carcinomas were not strongly correlated. CONCLUSION: It suggests that high expression rate of TGF-beta-1 and p53 mutation are associated with carcinogenesis of non-small cell carcinoma of the lung. High expression rate of TGF-beta-1 in the lung carcinomas can be partly explained by the fact that TGF-beta-1 have capacity to control the production of many components of the extracellular matrix and enhance angiogenesis in favor of tumor growth despite of their inhibitory effects of cell growth. However, additional research is required to determine the exact role of TGF-beta-1 in carcinogenesis of the lung.
Blotting, Western ; Carcinogenesis ; Carcinoma, Squamous Cell ; Extracellular Matrix ; Lung* ; Mutation Rate ; Polymorphism, Single-Stranded Conformational ; RNA, Messenger ; Transforming Growth Factor beta1*

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Combination Chemotherapy with Etoposide, Ifosfamide, and Cisplatin (VIP) in Small Cell Lung Cancer.

Mi Young PARK ; Joon Yeon WON ; Kyung Tae PARK

Journal of the Korean Cancer Association.1997;29(6):1011-1021.

PURPOSE: A prospective phase II trial was conducted in patients with small cell lung cancer (SCLC) to determine whether the response rate, duration of response, and overall survival can be improved by a combination chemotherapy with etoposide, ifosfamide, and cisplatin (VIP). MATERIALS AND METHODS: From May 1994 to April 1997, thirty-three previously untreated patients with SCLC received individualized treatment tailored to disease extent. Twenty-one patients with limited disease (LD) received six cycles of chemotherapy consisting of etoposide 120 mg/m2, ifosfamide 1,500 mg/m2, and cisplatin 25 mg/m2 all given intravenously on days 1, 3 and 5. Cycles were repeated every 3 weeks for six cycles. Thoracic radiotherapy was administered to 15 patients with LD of SCLC subsequently after initial two or three cycles of chemotherapy. Prophylactic cranial irradiation was given to complete responders of SCLC. Chemotherapy alone was administered to 12 patients with extensive disease (ED) of SCLC. RESULTS: Complete response (CR) rate was 51% (LD 67%, ED 25%) and overall response rate was 94% (LD 95%, ED 92, p=0.022). And the median duration of response of all patients was 8 months (11 months in LD, 6.5 months in ED, p=0.042). With a median follow-up period of 13 months (3+~36), the median survival of all patients was 12 months (16 months in LD, 9.5 months in ED, p=0.006), and the median disease-free survival (DFS) of 17 CR patients was 12 months. Stage and performance status score were important prognostic factor, but sex, age, and LDH level did not affect the outcome significantly. Among 21 patients with LD, 15 patients received radiotherapy and 6 did not. The overall response rate of patients who received radiotherapy was significantly higher than that of patients who did not (p=0.045). But there were no significant differences in duration of response and OS between them (p=0.055, p=0.068, respectively). The major side effects (greater than grade 2 of WHO criteria) of evaluable 154 cycles of chemotherapy were alopecia (76%), nausea/vomiting (54%), leukopenia (27%), anemia (19%), and thrombocytopenia (15%). CONCLUSION: VIP chemotherapy has produced a high complete remission rate and it is a safe and well-tolerated regimen in SCLC. However, compared to previous reports, it has not improved overall survival significantly. Further phase II and III studies are warranted to confirm the efficacy of VIP chemotherapy.
Alopecia ; Anemia ; Cisplatin* ; Cranial Irradiation ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide* ; Follow-Up Studies ; Humans ; Ifosfamide* ; Leukopenia ; Prospective Studies ; Radiotherapy ; Small Cell Lung Carcinoma* ; Thrombocytopenia

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Prognostic Factor Analysis of Small Cell Lung Cancer: Appropriateness of Two Staging System.

Jae Jin CHANG ; Tae You KIM ; Choon Taek LEE ; Seung Mo NAM ; Jae Hag KIM ; Eun Jeong SONG ; Seong Hwan KIM ; Bong Seog KIM ; Baek Yeol RYOO ; Young Hyuck IM ; Jhin Oh LEE ; Tae Woong KANG ; Yoon Koo KANG

Journal of the Korean Cancer Association.1997;29(6):1000-1010.

PURPOSE: The two staging system, which divides the tumors into limited disease (LD) and extensive disease (ED) has been widely accepted as a major prognostic determinant in small cell lung cancer (SCLC). However this system has provoked several controversial issues in defining stage categories, for instance, ipsilateral pleural effusion as LD or ED. Furthermore, identification of favorable subgroups in the same stage has been recognized as an important factor to determine appropriate treatment strategies. In this study, we performed a retrospective analysis in an attempt to resolve the controversial issues about staging and identify the patient group with favorable prognosis based on this two staging system. MATERIALS AND METHODS: The clinical data of 233 patients with SCLC treated from 1990 to 1996 at Korea Cancer Center Hospital were retrospectively analyzed for this study. All patients were treated with chemotherapy containing cisplatin and/or radiotherapy. The independent prognostic factors for survival were identified by multivariate analysis using Cox's proportional hazards model. RESULTS: Performance status (relative risk of death [RR]:2.89), number of metastasis (RR:2.2), response to treatment (RR:2.2) as well as stage (RR:1.77) were identified as independent prognostic factors for survival in patient with SCLC. The median survival of patients with ipsilateral pleural effusion (13 months) which was categorized as ED was similar to that of patients with contralateral mediastinal or supraclavicular lymph nodes (13.8 months) or other LD patients (13.7 months). This result suggests that ipsilateral pleural effusion should be categorized as LD. In LD, response to treatment was the only independent prognostic factor (RR:2.34) and thoracic radiotherapy moderately improved survival as compared with combination chemotherapy alone (17.7 months vs. 10.4 months, p=0.06). In ED, the patient group with a good performance status (ECOG 0-1), normal range of serum alkaline phophatase, and metastasis less than 2 sites showed significantly prolonged survival, comparing with other ED patients (11.2 months vs. 7.2 months, p=0.0001). CONCLUSION: As a result of survival analysis, we confirmed independent prognostic factors such as stage and performance status in SCLC. We could recommend that LD category include patients with ipsilateral pleural effusion as well as those with contralateral lymphadenopathy. In ED, the survival in patients with favorable prognostic factors was comparable to LD, suggesting this patient group may be a candidate for aggressive therapy.
Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Factor Analysis, Statistical* ; Humans ; Korea ; Lymph Nodes ; Lymphatic Diseases ; Multivariate Analysis ; Neoplasm Metastasis ; Pleural Effusion ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; Reference Values ; Retrospective Studies ; Small Cell Lung Carcinoma*

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Linear Accelerator-Based Stereotactic Radiosurgery for Acoustic Neurinomas.

Hong Seok JANG ; Sei Chul YOON ; Tae Suk SUH ; Mi Ryeong RYU ; Yeon Shil KIM ; Moon Chan KIM ; Jun Ki KANG ; Kyung Sub SHINN

Journal of the Korean Cancer Association.1997;29(6):992-999.

No abstract available
Acoustics* ; Neuroma, Acoustic* ; Particle Accelerators ; Radiosurgery*

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Prognostic Factors for Local Control and Survival in T1-T2 Glottic Cancer.

Charn Il PARK ; Kyung Hwan SHIN ; Suk Won PARK ; Seong Soo SHIN ; Kwang Hyun KIM

Journal of the Korean Cancer Association.1997;29(6):984-991.

PURPOSE: To evaluate the efficacy of radiotherapy as the first treatment of T1-T2 golttic cancers, we analyzed survival rates, local control rates, and voice preservation rates retrospectively. Furthermore, prognostic factors potentially influencing local control and incidence of second primary tumors were analyzed. MATERIALS AND METHODS: One hundred patients with T1-T2 glottic cancer were irradiated between February 1989 and July 1991. Median follow-up time was 80 months. 1) Factors analyzed for each patient included age, stage, anterior commissure involvement, fraction size, field size, total dose and treatment time. 2) Survival analysis methods were employed to assess the effects of these factors in local control and survival rates. All patients received Co-60 irradiation, one daily fraction of 1.75~2.0 Gy to doses of 60~72 Gy. RESULTS: The overall survival rate, disease free survival rate and cause specific survival rates for all patients at 5 year were 80.7%, 78.6% and 87.3%, respectively. The 5-year overall survival rates for patients with T1, 2 were 82.8% and 76.9%, respectively. Overall treatment time of 50 days or less was uniquely found to have superior impact on local control rate to that of more than 50 days in univariate prognostic factor analysis (p=0.0494), and showed statistical trend in multivariate analysis (p=0.0577). Fourteen patients who had showed relapse after radiotherapy underwent salvage operation, among whom nine patients were cured. The 5-year local control rate for all patients after radiotherapy was 79% and ultimate local control rate was 87%. Voice preservation rate after radiotherapy and salvage operation was 87.6%. The second primary cancer developed in 9 patients (9%). CONCLUSION: Radiotherapy which showed high survival rates and voice preservation rate proved to be the optimal initial treatment for patients with T1-T2 glottic cancer. Prolongation of overall treatment should be avoided as the overall treatment was found to have a significant impact on the local control of tumor. The close follow-up and prevention should be needed to decrease the death rate by second primary tumor.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Neoplasms, Second Primary ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Voice

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