Kuhn Uk Lee

Seoul National University Hospital, Seoul, Seoul, South Korea

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Publications (115)347.78 Total impact

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    ABSTRACT: Background and Objectives Reoperation is recommended for resectable retroperitoneal sarcoma (RS) recurrence; however, the long-term overall survival (OS) benefit varies. Although histologic grade is an important OS predictor after primary tumor resection, its prognostic value tends to diminish with subsequent reoperations. The objective of this study was to identify prognostic factors of OS after reoperation for recurrent RS.Methods The medical records of 95 patients who underwent resection for RS at Seoul National University Hospital between January 1999 and July 2011 were retrospectively reviewed. Of the 95 patients, 50 patients underwent second resection for recurrence, and 26 of these patients underwent third resection. Prognostic factors were analyzed at each reoperation.ResultsHigher histologic grade and gross residual disease were poor prognostic factors of OS after first resection. After second resection, higher histologic grade and time since previous operation of within 1 year were poor prognostic factors. After third resection, only contiguous organ resection was a significant independent prognostic factor.Conclusions The significance of prognostic factors changes with repetitive reoperations for RS recurrence. The prognostic value of histologic grade diminishes after the third resection, whereas other clinical factors such as time since previous operation and contiguous organ resection achieve significance. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 09/2014; · 2.64 Impact Factor
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    ABSTRACT: The main cause of death for colorectal cancer (CRC) patients is the development of metastatic lesions at sites distant from the primary tumor. Therefore, it is important to find biomarkers that are related to the metastasis and to study the possible mechanisms. Recent data have shown that soluble attractant molecules called chemokines support the metastasis of certain cancers to certain organs. To identify molecular regulators that are differentially expressed in liver metastasis of CRC, PCR array analysis was performed and CC chemokine ligand 7 (CCL7) showed remarkable overexpression in liver metastatic tumor tissues. To validate the results of the PCR array, 30 patients with primary CRC and liver metastases were selected. Immunohistochemistry and real-time PCR analysis showed that CCL7 was expressed in normal colonic epithelium and the expression was higher in liver metastases compared to primary CRC (p<0.001). Real-time PCR showed that the expression of CCR1, CCR2 and CCR3 was also higher in liver metastases compared to primary CRC (p=0.001, p=0.033 and p<0.001, respectively). In conclusion, correlation of CCL7 overexpression and its receptor expression with colon cancer liver metastasis suggests that CCL7 as a novel target in liver metastasis of CRC may be of potential clinical value for the prevention of hepatic recurrences.
    Oncology Reports 05/2012; 28(2):689-94. · 2.30 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the adequacy of esophageal classification for adenocarcinoma of the esophagogastric junction (AEJ) of the seventh American Joint Committee on Cancer (AJCC) TNM classification. The seventh AJCC TNM classification proposed the new classification for AEJ as a part of esophageal cancer depending on the esophagogastric junction (EGJ) involvement. However, there are still many controversies over the classification system for AEJ. A review of pathologic reports and photographic findings at Seoul National University Hospital from 2003 to 2009 identified 4524 patients with single, primary adenocarcinoma of the EGJ (n = 497) and other regions of the stomach (GC, n = 4027) who underwent an operation with curative intent. We analyzed the clinicopathologic features and postoperative prognosis of AEJ using the Siewert classification and the seventh AJCC TNM classification. There was no Siewert type I (AEJ I) in this study. The prognosis of AEJ was similar to that of GC. There was no difference in clinicopathologic features between AEJ II and AEJ III. Even though AEJ extending into the EGJ (AEJe) showed more advanced pathologic features than AEJ not extending into the EGJ (AEJg), the prognosis of AEJe and AEJg was not significantly different when stratified by T stage. Compared with the classification of gastric cancer applied for AEJ, esophageal classification for AEJ from the seventh AJCC TNM classification showed a loss of distinctiveness at each TNM stage. To evaluate the postoperative prognosis of AEJ within the stomach, AEJ II and AEJ III should be considered a part of gastric cancer irrespective of EGJ involvement.
    Annals of surgery 05/2012; 255(5):908-15. · 7.90 Impact Factor
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    ABSTRACT: The clinical importance of intraductal papillary mucinous neoplasm of the pancreas (IPMN) has been increasing with a large number of newly diagnosed IPMN. This study was designed to explore the characteristics of resected IPMN and to determine the predictive factors for malignant and invasive IPMN. Retrospective review of a prospectively collected database was performed on 187 consecutive patients following IPMN surgery between 1994 and 2008 at a tertiary institute. The main duct type IPMN was radiologically defined as main pancreatic duct dilation >5 mm rather than previously defined ≥10 mm. The morphologic types of IPMN included 28 main duct (IPMN-M, 15.0%), 118 branch duct (IPMN-Br, 63.1%), and 41 mixed (IPMN-Mixed, 21.9%) IPMNs. There were 23 patients with adenoma, 106 borderline atypia, 15 carcinoma in situ, and 43 invasive carcinoma. Sixty-nine extrapancreatic malignancies were diagnosed in 61 (32.6%) patients. Based on multivariate analysis, IPMN-M was statistically significant predictor of malignancy/invasiveness (p = 0.013/p = 0.028). In patients with IPMN-Br, the presence of mural nodule was a predictive factor for malignancy/invasiveness (p = 0.005/p = 0.002). In patients with IPMN-Mixed, mural nodule (p = 0.038/p = 0.047) and wall thickening (>2 mm, p = 0.015/p = 0.046) were risk factor for malignancy/invasiveness and elevated CA19-9 (p = 0.046) for invasiveness. The main pancreatic duct diameter (>5 mm) is a significant predictor for malignancy and invasiveness. Therefore, IPMN patients with main pancreatic duct dilatation (>5 mm) should be considered surgical resection. Mural nodule is the indicator of surgery in IPMN-Br and IPMN-Mixed. In case of IPMN-Mixed with wall thickening or elevated serum CA19-9, surgical resection is recommended.
    Langenbeck s Archives of Surgery 01/2012; 397(1):93-102. · 1.89 Impact Factor
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    ABSTRACT: Advanced hepatocellular carcinoma with either an invasion of the inferior vena cava or thrombosis is rare, and its prognosis is extremely poor. There is no established treatment. The purpose of this study was to evaluate the efficacy of surgical resection and its prognosis in 5 recent cases. From January 2005 to December 2008, 5 patients diagnosed with advanced hepatocellular carcinoma with inferior vena cava invasion and/or thrombosis underwent surgical resection. These patients were retrospectively reviewed. The mean age at diagnosis was 54 years. There were 4 men and 1 woman. According to the Child-Pugh classification, all patients were class A. One case had 2 hepatic masses, and the others had a solitary hepatic mass. The mean tumor size was 5.53cm. All 5 patients underwent partial hepatectomy and inferior vena cava resection or thrombosis removal. Among these, 4 cases needed a cardiopulmonary bypass. Four patients survived and 1 patient expired at the point of analyzing. Four cases experienced recurrences. The mean disease-free survival time was 19.6 months. One patient has been followed-up for 43 months without any recurrences up to now. Concurrent en-bloc resection of the liver and inferior vena cava for progressive HCC accompanying IVC invasion or thrombosis can be considered as a curative treatment.
    Hepato-gastroenterology 07/2011; 58(110-111):1694-9. · 0.77 Impact Factor
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    ABSTRACT: The purpose of this study is to analyze the relationship between the number of examined lymph nodes (NexLN) and survival in gastric cancer and to determine whether the metastatic/examined lymph node ratio (LN ratio) system can compensate for the shortcomings of the UICC/AJCC staging. Prospective data of 8949 primary T1-T4a gastric cancer patients who underwent curative surgery were reviewed. The patients were stratified by T-stage and grouped according to NexLN; 1 to 14 exLN denoted the first group and every subsequent 10 LNs thereafter. Numbers of LN and 5-year survival rates were analyzed according to NexLN. "The NR-staging system" was generated using 0.2 and 0.5 as the cut-off values of LN ratio and then compared with UICC/AJCC stages. The proportion of advanced N-stage increased with NexLN. Survival and the LN ratio were constant regardless of NexLN when combining all N0-N3b patients, however, T2/3 and T4a patients showed an increasing tendency toward survival in N1/2 and N3a as NexLN increased, mainly due to a stage migration effect. The LN ratio system showed better patterns of distribution of the LN stage and survival graph. The power of the differential staging of the LN ratio system was fortified with higher NexLN. The relationship between NexLN and survival is probably affected by stage migration in a high-volume gastric cancer center. The LN ratio system could be a better option to compensate for this effect, and the value of the prognosis prediction in this system increases with a higher NexLN.
    Annals of surgery 05/2011; 255(1):50-8. · 7.90 Impact Factor
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    ABSTRACT: This study aimed to evaluate the technical feasibility and safety of laparoscopic partial full-thickness gastrectomy with extensive sentinel node basin (SB) dissection in a porcine model before its application to gastric cancer without lymph node metastasis. A series of 10 pigs (30-37 kg) were used for a survival study approved by an animal use committee. The imaginary lesions were located in the greater curvature (n = 2), lesser curvature (n = 2), anterior wall (n = 2), posterior wall (n = 2), cardia (n = 1), and angle of the stomach (n = 1). The SBs were assumed to be located around each lesion in question. Laparoscopic partial gastrectomy and SB dissection were performed. Upper gastrointestinal series (UGIS) studies were performed with gastrograffin 5 days after the operation to detect possible stricture, leakage, and passage problems. The pigs were kept alive for 3 weeks, then killed. The procedure was completed for all the pigs. Nine gastric wedge resections and one segmental resection of the stomach with several SB dissections were performed. The mean operation time was 102 min (70-150 min). The postoperative mean weight gain was 3.19 kg. There was no perioperative morbidity or mortality. The UGIS studies failed to detect leakage and stricture, but all the pigs exhibited delayed gastric emptying. Necropsies did not detect procedure-related complications. As shown by a pig model, laparoscopic limited gastrectomy with SB dissection appears to be safe and technically feasible.
    Surgical Endoscopy 04/2011; 25(4):1070-5. · 3.43 Impact Factor
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    ABSTRACT: This study was carried out to evaluate the safety and feasibility of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer patients with systemic comorbidity. Two hundred and seventy-six patients who had undergone LADG by a single surgeon were given a physical status classification as defined by the American Society of Anesthesiologists (ASA class) and then divided into 2 criteria groups: criteria I group (ASA 1 vs ASA 2,3,4) and criteria II group (ASA 1,2 vs ASA 3,4). The clinicopathologic data of each patient were reviewed retrospectively and grouped by criteria. The percentage of patients with a comorbid disease was 8.1% (11 cases) in ASA class 1, 71.7% (86 cases) in class 2, 95.0% (19 cases) in class 3, and 100% (1 case) in class 4. No statistical difference was found between criteria I and II in terms of operative and postoperative results, operative time, estimated blood loss, transfusion rate, tumor size, total and positive number of dissected lymph nodes, proximal resection margin from lesion, the rate of open conversion, the duration of hospital stay, the time required before resuming a liquid diet, and the rate of complications, except the distal resection margin in criteria II (all P >0.05). There were no cases of mortality in any criteria group. LADG would be a safe and feasible operation for patients with gastric cancer with systemic comorbidity, without reducing radicality, losing the advantages of minimally invasive surgery, or increasing operative risk.
    Surgical laparoscopy, endoscopy & percutaneous techniques 02/2011; 21(1):33-6. · 0.88 Impact Factor
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    ABSTRACT: According to the AJCC/UICC TNM classification, T mesocolon invasion in AGC is classified as T2b or T3 according to the presence or the absence of serosa invasion. However, many authors have considered T mesocolon invasion in AGC as T4. This study was performed to evaluate the appropriate T stage for T mesocolon invasion in AGC. From 1996 to 2008, 90 patients underwent curative gastrectomy with T mesocolon excision at the authors' institute under the suspicion of T mesocolon invasion based on surgical findings and without pathologic invasion to any other organ. Histopathologic findings were reviewed to determine whether tumors had invaded the T mesocolon. Survival data of AGC patients registered in the SNUH database (N = 9998, from 1986 to 2007) was used as reference data for comparative purposes. A total of 27 patients (30%) had proven histopathological invasion of the T mesocolon, and a significant difference in survival rates was found between these 27 and the remaining 63 (P = .012). As compared with the SNUH database population, the survival rate of T mesocolon invasion patients differed from those of T2b (P < .001) and T3 (P = .043) patients, but was similar to that of T4 patients (P = .218). Furthermore, for N1 stage patients, the survival rate differed from those of T2b (P = .001) and T3 (P = .046) patients, but was similar to that of T4 patients (P = .744). The T stage of T mesocolon invasion in AGC should be revised to AJCC/UICC stage T4, because the survival rate of T mesocolon invasion AGC is lower than that of stage T2b or T3.
    Annals of Surgical Oncology 01/2011; 18(5):1274-81. · 4.12 Impact Factor
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    ABSTRACT: BACKGROUND:The seventh TNM staging system for gastric cancer of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) had a more detailed classification than the sixth TNM staging system for both the tumor (T) and lymph nodes (N). The authors compared survival rates assessed by the seventh staging system with those by the sixth system.METHODS:The authors analyzed the prospectively collected database on patients with gastric cancer who underwent surgery at Seoul National University Hospital between 1986 and 2006, and calculated the survival rates of 9998 cases with primary cancer, R0 resection, and >14 retrieved lymph nodes.RESULTS:The 5-year cumulative survival rates (5YSR) according to the seventh edition T or N classifications were significantly different. The 5YSR according to seventh edition of the TNM staging system were 95.1% (stage IA), 88.4% (stage IB), 84.0% (stage IIA), 71.7% (stage IIB), 58.4% (stage IIIA), 41.3% (stage IIIB), and 26.1% (stage IIIC), which were significantly different from each other. The 5YSR of the seventh edition T2 and T3 classifications had significant differences in patients with every N classification, and the 5YSR of seventh edition N1 and N2 classifications had significant differences in T2 patients, T3 patients, and T4 patients. Each stage in the sixth edition was divided into the seventh edition stage with different survival rates. In addition, the number of homogenous groupings in seventh edition TNM stages was increased from 1 to 2.CONCLUSIONS:The seventh system provided a more detailed classification of prognosis than the sixth system, especially between T2 and T3 tumors and N1 and N2 tumors, although further studies were found to be needed for the N3a and N3b classification. Cancer 2010. © 2010 American Cancer Society.
    Cancer 12/2010; 116(24):5592 - 5598. · 5.20 Impact Factor
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    ABSTRACT: The aim of this study was to determine proportions of upper third gastric cancer (UTG) among all gastric cancers and analyze clinicopathological features of the disease. The medical records of 12,300 patients who underwent gastric surgery between 1986 and 2006 at Seoul National University Hospital (SNUH) were retrospectively reviewed. Clinicopathological features of 1,260 patients with UTG and 9,929 patients with middle or lower third gastric cancer (MLG) were compared, and annual proportions of UTG were evaluated. The proportion of patients with UTG rapidly increased from 2.6% in 1986 to 12.5% in 1992. However, linear regression analysis showed that the rate of increase was reduced (0.21%/year) after 1992 (12.5% to 14.2% from 1992 to 2006). Compared with the MLG group, the UTG group had a lower proportion of (22.3% vs. 39.7%, P<0.001) and a greater proportion of stage III/IV disease (39.4% vs. 31.7%, P<0.001). The UTG group also had larger tumors than the MLG group in stages I/II and III (3.5 cm/5.3 cm/6.5 cm vs. 3.2 cm/5.0 cm/5.8 cm, P=0.020/0.028 /<0.001), a higher proportion of undifferentiated cancer (63.1% vs. 53.7%, P<0.001), and less intestinal Lauren's type (38.8% vs. 47.4%, P<0.001). The 5-year survival rate of the UTG group was significantly lower than that of the MLG group in stages I/II and III (85.6%/63.1%/34.2% vs. 91.6%/ 69.2%/44.7%, P<0.001/0.028/0.006). The proportion of UTGs has increased over the last two decades at SNUH, but the rate of increase has been greatly reduced since 1992. The UTG group showed a poorer prognosis compared with the MLG group in stages I/II and III.
    Journal of gastric cancer. 12/2010; 10(4):212-8.
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    ABSTRACT: Proximal gastrectomy is a surgical option for proximally located early gastric cancer. We present a new double-stapling method for proximal gastrectomy and esophagogastrostomy. We examined the safety of proximal gastrectomy by analyzing the lymph node metastasis rate in 53 patients who underwent total gastrectomy due to proximally located early gastric cancer from January 2004 to December 2008. We applied the double-stapling method used in distal gastrectomy reversely to proximal gastrectomy and esophagogastrostomy in 15 patients. Retrospective analysis showed that proximal early gastric cancer metastasizes to only lymph node station 2, 3 and 7 which were completely removed during proximal gastrectomy. Fifteen patients underwent proximal gastrectomy using a new method which left no gastrostomy wound for the insertion of a circular stapler in the remaining stomach. The median operation time was 156.5 min and median postoperative hospital stay was 8.0 days. There were only 2 cases of wound complications during hospital stay. Two cases of anastomosis site strictures which developed after discharge were successfully treated with balloon dilatation. We presented a new 'reverse double-stapling method' for proximal gastrectomy, which seems to be a fast and feasible method that leaves no gastrostomy wound in the remaining stomach.
    Digestive surgery 08/2010; 27(3):170-4. · 1.37 Impact Factor
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    ABSTRACT: The embryologic and anatomic peculiarity of the uncinate process may result in distinct clinical features, but few studies have addressed the uncinate process cancer. The purpose of this study was to compare the clinicopathologic characteristics and identify the prognostic factors that affect the survival and recurrence of pancreatic head cancer by tumor location. Between January 2002 and December 2008, 453 patients (161 with uncinate and 292 with non-uncinate process cancer) were treated for pancreatic head cancer. Clinicopathologic variables were analyzed by tumor location. Invasion into the superior mesenteric artery (SMA) occurred more frequently (p < 0.001), and overall resectability (p = 0.003), curative resection (p < 0.001), and R0 resection rates (22.3% vs 35.6%; p = 0.003) were lower for uncinate process cancer. Furthermore, overall survival after R0 resection was lower for uncinate process cancer (median 21 vs 26 months; p = 0.018), and this was accompanied by more frequent (p = 0.038) and earlier (median 13 vs 52 months; p < 0.001) locoregional recurrence. Concurrent chemoradiation increased overall (median, 26 vs 13 months; p < 0.001) and disease-free survival (median, 15 vs 6 months; p < 0.001) of uncinate and non-uncinate process cancer, respectively, after curative-intended resection. In uncinate process cancer, frequent invasion into the SMA led to lower resectability. Furthermore, lower survival after R0 resection was accompanied with frequent and early locoregional recurrence. Strategies to improve surgical and perioperative locoregional control are required for uncinate process cancer.
    Langenbeck s Archives of Surgery 08/2010; 395(6):697-706. · 1.89 Impact Factor
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    ABSTRACT: Primary hematolymphoid malignancies of the extrahepatic biliary tract are rare tumors. We report five cases of primary hematolymphoid malignancies involving the extrahepatic biliary tract. One is a granulocytic sarcoma of the extrahepatic bile duct, another is an extramedullary plasmacytoma of the gallbladder, and the others are two non-Hodgkin lymphomas of the extrahepatic bile duct and one of the gallbladder. The clinical presentations, radiographic studies, and gross findings at surgery have not been a significant help in differential diagnosis. Although a preoperative diagnosis of primary hematolymphoid malignancy is very difficult to reach because of the rarity of this disease, it should be considered, because, if an accurate diagnosis is made before surgical intervention, chemotherapy is the most appropriate treatment. In limited cases mimicking cholangiocarcinoma and gallbladder cancer, surgical resection followed by chemotherapy has a valid role as reasonable treatment for patients.
    Leukemia & lymphoma 07/2010; 51(7):1278-87. · 2.61 Impact Factor
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    ABSTRACT: Reflux is one of the most common sequela after proximal gastrectomy (PG). The aim of this study was to find a predicting factor related to the character of esophageal reflux after PG. Wireless ambulatory 24-hr pH monitoring (for acid reflux, AR) and diisopropyliminodiacetic acid hepatobiliary scan (for bile reflux, BR) were performed on 24 patients who had reflux symptoms after PG with esophagogastrostomy from July 2008 to March 2009. Endoscopic examination was done and the length of remnant stomach (LoRS) was measure by postoperative UGI series. Eleven patients (45.8%) had only BR, 7 (29.2%) had AR only, Two patients (8.3%) had both acid and BR, and 3 (12.5%) had neither. The LoRS along greater curvature was significantly shorter in patients with only BR (16.11 +/- 2.87 cm) than in patients with only AR (23.69 +/- 6.15 cm, P = 0.003). Severity of symptoms or esophagitis was not significantly correlated with the content of acid or BR. Reflux symptom after PG is caused by either bile or acid rather than both. Character of reflux was related to the LoRS.
    Journal of Surgical Oncology 06/2010; 101(7):626-33. · 2.64 Impact Factor
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    ABSTRACT: The follow-up strategy after hepatectomy for hepatocellular carcinoma (HCC) usually depends on the experience of physician, resulting in frequent imaging studies, which leads to increased cost. Hence, we investigated the role of monitoring alpha-fetoprotein (AFP) levels after hepatectomy in patients with preoperative high AFP. From January 2000 to December 2004, 66 patients who underwent curative hepatectomy due to HCC with preoperative AFP level > 400 ng/mL were reviewed. Changes in AFP level after the operation were investigated. The recurrence was suspected in case of two consecutive increase of AFP over cut-off value. Cut-off value was determined by ROC curve. All patients were divided into 2 groups: patients who met the definition (Group S) and those who didn't (Group D). AFP level of 20 ng/ml was proposed as the cut-off value for diagnosis of recurrence by ROC curve. Thirty two patients who didn't have the AFP level decreased below 20 ng/ml after the resection had HCC recurred, whereas 16 out of 34 patients who had AFP decreased had tumor recurrence. The AFP level of patients without recurrence was kept below 20 ng/ml during the follow-up. The AFP level of 44 out of 48 recurred patients increased over 20 ng/ml upon recurrence. By definition, group D were 5 patients. In 4 patients of group D, the AFP level didn't increase above 20 ng/ml upon recurrence. These patients had HCC and they recurred 1 year after the surgery. In patients with preoperative AFP level > 400 ng/ml, the AFP level tended to increase above 20 ng/ml at recurrence mostly within 1 year. Hence, we proposed that these patients could be monitored by only AFP until 1 year after surgery.
    The Korean Journal of Hepatology 06/2010; 16(2):168-75.
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    ABSTRACT: Liver transplantation is regarded as an effective treatment for early hepatocellular carcinoma (HCC). However, some patients experience recurrence and subsequently rapid progression of the disease. We investigated prognostic factors affecting survival after recurrence in patients who underwent adult living donor liver transplantation (LDLT) for HCC. From October 1992 to December 2005, 138 adult patients underwent LDLT for HCC. Among these, 28 patients (20.3%) who suffered recurrence were retrospectively reviewed. Univariate and multivariate analyses were performed to analyze factors affecting survival after recurrence. The median time to recurrence was 7.9 months. The median survival time after recurrence was 11.7 months, and the 1- and 3-year survival rates after recurrence were 52.8% and 15.8%, respectively. Initially, 7 patients (25%) showed multiorgan involvement; however, in the follow-up, 21 patients (75%) had multiorgan involvement. On univariate analysis, a pretransplant alpha-fetoprotein level >1000 ng/mL, major vascular invasion, a poorly differentiated tumor, a time to recurrence < or =6 months, unresectable disease, and bony metastases were related to shorter survival after recurrence. The independent prognostic factors by multivariate analysis were major vascular invasion [hazard ratio (HR) = 7.6], a poorly differentiated tumor (HR = 4.3), unresectable disease (HR = 10.4), and bony metastases (HR = 3.2). Two patients survived more than 36 months. One of them underwent retransplantation and survived for 45 months without additional recurrences. In conclusion, after transplantation, recurrent HCC has a tendency to involve multiple organs, and the prognosis is very poor. However, some patients have a good prognosis, and the appropriate treatment can prolong their survival. If the recurrent lesion is locally controllable, surgical resection should be considered.
    Liver Transplantation 05/2010; 16(5):678-84. · 3.94 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the major adult liver cancers. The existence of combined hepatocellular-cholangiocarcinoma (CHC), a histopathologic intermediate form between HCC and CC, suggests phenotypic overlap between these tumors. Here, we applied an integrative oncogenomic approach to address the clinical and functional implications of the overlapping phenotype between these tumors. By performing gene expression profiling of human HCC, CHC, and CC, we identified a novel HCC subtype, i.e., cholangiocarcinoma-like HCC (CLHCC), which expressed cholangiocarcinoma-like traits (CC signature). Similar to CC and CHC, CLHCC showed an aggressive phenotype with shorter recurrence-free and overall survival. In addition, we found that CLHCC coexpressed embryonic stem cell-like expression traits (ES signature) suggesting its derivation from bipotent hepatic progenitor cells. By comparing the expression of CC signature with previous ES-like, hepatoblast-like, or proliferation-related traits, we observed that the prognostic value of the CC signatures was independent of the expression of those signatures. In conclusion, we suggest that the acquisition of cholangiocarcinoma-like expression traits plays a critical role in the heterogeneous progression of HCC.
    Cancer Research 04/2010; 70(8):3034-41. · 9.28 Impact Factor
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    ABSTRACT: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases. The aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC. We retrospectively reviewed preoperative diagnoses, overall characteristics and postoperative outcome of 20 BCTs and 19 cystadenoma-mimicking simple cysts that were pathologically confirmed. Comparing with atypical simple cysts, symptoms, left-lobe cyst, thick wall, septation, mural nodule, bile duct dilatation and an increase of serum alkaline phosphatase were associated with BCTs. However, on multivariate analysis, mural nodule, left-lobe cyst, and an increase of serum alkaline phosphatase were significantly frequent in BCTs with odds ratios of 75.5, 13.8, and 33.0, respectively. Among the 20 BCTs, seven BCACs were diagnosed. The characteristics of BCACs were mural nodule (P<0.01), intrahepatic cyst debris (P<0.01), and bile duct dilation (P=0.04). Cystic fluid analysis provided no significant differences between BCT and simple cyst. After fine needle aspiration cytology of BCTs, all except one BCAC with atypical cell showed nonspecific findings. After complete surgical excision (97.4% of patients), only one patient with BCAC had recurrence during 29 months of follow-up period. In hepatic cysts with mural nodule, left-lobe cyst or increment of serum alkaline phosphatase seem to be indicative of BCTs in the diagnosis of suspicious hepatic cyst. Intracystic debris, bile duct dilation, and mural nodule may be suggestive clinical features of malignancy in BCTs.
    European journal of gastroenterology & hepatology 03/2010; 22(8):989-96. · 1.66 Impact Factor
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    ABSTRACT: In this study, we attempted to evaluate the prognosis of combined hepatocellular and cholangiocarcinoma (cHCC-CC) with comparison to hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (CC). The prognosis of cHCC-CC has not been fully elucidated. In this study, we attempted to evaluate the prognosis of cHCC-CC with comparison to HCC and CC. Consecutive patients who underwent curative resection for cHCC-CC at a single tertiary care center in Korea and their age, sex, and Child-Turcotte-Pugh class matched HCC and CC patients were included. We evaluated time-to-recurrence (TTR) and overall survival (OS) of cHCC-CC cases and compared them with HCC and CC patients. Thirty cHCC-CC, 60 HCC, and 60 CC patients were included. For cHCC-CC group, the median TTR and OS were 5.4 and 18.0 months. After adjustment for confounding factors, the cHCC-CC group had a shorter TTR than did HCC group [relative risk (RR), 2.76; P<0.001] and CC group (RR, 2.00; P=0.013), and a shorter OS than HCC group (RR, 4.70; P<0.001). Compared with the each stage I diseases, cHCC-CC had shorter TTR than HCC (RR, 4.59; P=0.001) and CC (RR, 2.74, P=0.015) and shorter OS than HCC (RR, 9.35; P=0.001). The results of this study indicated that cHCC-CC had a significantly poorer prognosis than HCC and CC even after curative resection.
    Journal of clinical gastroenterology 02/2010; 45(1):69-75. · 2.21 Impact Factor

Publication Stats

2k Citations
347.78 Total Impact Points

Institutions

  • 1995–2012
    • Seoul National University Hospital
      • • Department of Internal Medicine
      • • Department of Surgery
      Seoul, Seoul, South Korea
  • 2011
    • Chung-Ang University
      Sŏul, Seoul, South Korea
  • 2009–2011
    • Seoul National University Bundang Hospital
      • Department of Surgery
      Seoul, Seoul, South Korea
  • 2010
    • Kyung Hee University Medical Center
      Sŏul, Seoul, South Korea
    • Chonnam National University
      • Department of Surgery
      Gwangju, Gwangju, South Korea
  • 2005–2010
    • Seoul National University
      • Department of Surgery
      Seoul, Seoul, South Korea
    • Ajou University
      • School of Medicine
      Seoul, Seoul, South Korea
  • 2004
    • Sungkyunkwan University
      • Department of Surgery
      Sŏul, Seoul, South Korea