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ABSTRACT: Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a noninvasive imaging technique capable of identifying primary
tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of
whole-body FDG-PET imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole-body FDG-PET imaging
was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patient
and lesion. FDG-PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patient-based
analysis, FDG-PET scans correctly identified 16 of 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence,
resulting in a sensitivity, specificity, and accuracy of 94%, 80%, and 89%, respectively. In a lesion-based analysis, FDG-PET
scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. The
overall sensitivity, specificity, and accuracy for all lesion sites were 96%, 85%, and 93%, respectively. FDG-PET scans revealed
unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In
13 patients treatment was altered by the outcome of the PET scan. We concluded that whole-body FDG-PET scan is a useful diagnostic
imaging modality for detecting recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease
after primary surgery.
On sait que le PET scan au FDG est une technique d’imagerie non-invasive capable d’identifier les tumeurs primitives et métastatiques
avec une sensibilité et une précision élevées. Le but de cette étude a été d’évaluer la précision diagnostique du PET-FDG
scan corps entier pour détecter une récidive ou des métastases du cancer du sein après intervention chirurgicale. Un PET-FDG
scan corps entier a été réalisé chez 27 patientes suspectées d’avoir une récidive de cancer du sein. Les images ont été évaluées
qualitativement pour chaque patiente et chaque lésion. L’analyse des images a montré 61 sites de lésions malignes ou bénignes
chez ces 27 patientes. En ce qui concerne l’analyse individualisée par patiente, le PET-scan a correctement identifié 16 des
17 patientes ayant une récidive ou des métastases et 8 des 10 patientes sans récidives, pour une sensibilité, une spécificité
et une précision respectivement de 94%, 80% et de 89%. En ce qui concerne l’analyse individualisée par lésions, le PET-FDG
scan a correctement identifié 46 des 48 sites de récidives ou de métastases et 11 des 13 lésions sans métastases pour une
sensibilité, une spécificité et une précision globales respectivement de 96%, 85% et de 93%. Le PET-FDG scan a révélé une
récidive ou des métastases non suspectées chez 8 des 27 (30%) patientes et chez 11 des 20 (55%) patientes ayant déjà une métastase à distance. Le plan thérapeutique a été modifié par les résultats du PET scan chez 134
patientes. Nous concluons que le PET-FDG scan corps entier est utile pour la détection de récidives ou de métastases chez
la patiente soupçonnée de récidive après chirurgie primitive pour cancer du sein.
La FDG-PET es una técnica no invasora de imágenes diagnósticas, capaz de identificar con alta sensibilidad y certeza tumores
primarios y metástasis. El propósito del presente estudio fue evaluar la certeza diagnóstica de la imagenología de cuerpo
entero por FDG-PET en la detección de carcinoma de seno recurrente o metastásico luego de tratamiento quirúrgico. La imagenología
de cuerpo entero con FDG-PET se practicó en 27 pacientes con sospecha de carcinoma mamario recurrente. Las imágenes fueron
evaluadas cualitativamente para cada paciente y cada lesión. Los estudios demonstraron 61 ubicaciones de lesiones malignas
o benignas en 27 pacientes. En el análisis basado en el paciente, los estudios con FDG-PET identificaron correctamente 16
de 17 pacientes con enfermedad recurrente o metastásica y 8 de 10 libres de recurrencia. lo cual significó sensibilidad, especificidad
y certeza de 94%, 80% y 89%, respectivamente. En el análisis basado en la lesión, las imágenes identificaron correctamente
46 de 48 ubicaciones de lesiones, con enfermedad recurrente o metastásica de 11 y 13 libres de recurrencia. Las tasas globales
de sensibilidad, la especificidad y la certeza para todas las ubicaciones fueron 96%, 85% y 93%, respectivamente. Los estudios
con FDG-PET revelaron enfermedad recurrente o metastásica no sospechada en 8 de 27 (30%) pacientes y lesiones metastásicas
distantes en 11 de 20 (55%). En 13 pacientes se modificó el tratamiento como resultado del estudio por PET. Nuestra conclusión
es que la escanografía de cuerpo entero por FDG-PET es una modalidad de imagenología diagnóstica útil en la detección de carcinoma
recurrente o metastásico en pacientes con sospecha de enfermedad recurrente luego de tratamiento quirúrgico primario.
World Journal of Surgery 04/2012; 25(7):829-834. · 2.36 Impact Factor
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Jin-Soo Kim,
Min-A Kim,
Do-Youn Oh,
Se-Hoon Lee,
Dong-Wan Kim,
Seock-Ah Im,
Woo Ho Kim,
Han-Kwang Yang,
Dae Seog Heo,
Yung-Jue Bang,
Kuhn-Uk Lee,
Tae-You Kim,
Tae-Min Kim,
Noe Kyung Kim, Kuk-Jin Choe
[show abstract]
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ABSTRACT: The aim of this study is to evaluate the efficacy of adjuvant chemotherapy with 5-fluorouracil and cisplatin in gastric cancer patients and to assess prognostic factors affecting relapse and survival.
We retrospectively reviewed the data of 153 patients with Stage III-IV (M0) gastric cancer. The patients were given adjuvant 5-fluorouracil/cisplatin chemotherapy after curative gastric resection with D2 dissection from November 1995 to November 2003. Chemotherapy consisted of cisplatin (60 mg/m(2) as 15 min i.v. infusion) and 5-fluorouracil (1200 mg/m(2) as 12 h continuous i.v. infusion for 4 days) in every 21 days up to six cycles.
During a median follow-up period of 72.9 months (range: 2.0-135.0 months), a total of 105 patients relapsed (locoregional 19.0% vs. systemic 81.0%). The median disease-free survival and overall survival were 19.8 and 32.2 months, respectively. Univariate analysis revealed T stage, TNM stage and lymph node ratio as prognostic factors for survival (P = 0.002, <0.0001 and <0.0001, respectively). After stepwise selection of the factors, multivariate analysis confirmed the impact of the lymph node ratio and T stage on overall survival and disease-free survival.
In patients with Stage III-IV (M0) gastric cancer, adjuvant 5-fluorouracil/cisplatin chemotherapy was tolerable, but did not seem to confer survival advantage. And the lymph node ratio was found as an independent prognostic factor in this population. This evidence suggests that the clinical trial using more active chemotherapeutic agents is mandatory.
Japanese Journal of Clinical Oncology 02/2011; 41(2):245-52. · 1.78 Impact Factor
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ABSTRACT: The excision of breast lesions using an ultrasound-guided vacuum-assisted biopsy device (VABD) is a widely used technique for the diagnosis and treatment of breast disease, but the results of long-term follow-up after VABD excision of benign breast tumours have not been reported. The purpose of this study was to evaluate the results of long-term follow-up after complete excision of benign breast tumours using an ultrasound-guided VABD.
This is a retrospective clinical study. Between January 2001 and December 2004, patients who had undergone VABD excision of benign breast tumours and been followed up by clinical examination and ultrasonography for 2 years or more were included.
One hundred eighty-four cases representing 153 patients were studied. The median follow-up period was 33 months (range, 24-67 months). All lesions were histologically benign. The mean size of the lesions was 1.09 +/- 0.57 cm (range, 0.3-3.03 cm). Within 2 years after VABD excision, residual lesions were detected in 10% of patients sonographically, but after 2 years or more, residual masses were found in 6.5% of patients. Scar changes also decreased from 36.0% to 15.8% during the period of follow-up. Finally, the benign breast tumours were completely excised without residual masses in 93.5% of the participant patients. Residual masses developed in two fibroadenoma cases (1.08%); one was re-excised and the other was followed serially.
Ultrasound-guided VABD excision is a minimally invasive technique for the complete removal of benign breast tumours. The results of this long-term follow-up of VABD excisions are comparable to conventional methods.
ANZ Journal of Surgery 11/2009; 79(11):794-8. · 1.25 Impact Factor
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ABSTRACT: This study was conducted to evaluate the clinical features and treatment outcome of gastric cancer associated with pregnancy.
Clinicopathologic characteristics of 15 patients who were diagnosed as having gastric cancer during pregnancy or within 1 year after delivery (the P-related group) were compared with those of 53 age-matched pregnancy-unrelated gastric cancer patients (the control group).
Significant differences were found in tumor stage and surgical curability; the numbers of stage IV disease were 12 (80%) and 21 (40%; p = 0.006), and those of curative resection were 4 (27%) and 20 (62%; p = 0.02) in the P-related and the control group, respectively. Three-year survival rate was significantly lower in the P-related group (23.3%) than in the control group (52.8%; p = 0.007). In the P-related group, only 3 patients, including one patient diagnosed using endoscopy, survived without recurrences. In the multivariate analysis, pregnancy was not identified as an independent risk factor associated with poor outcome.
Gastric cancer associated with pregnancy is discovered at its advanced stage and consequently shows a dismal prognosis. Considering that the patients who underwent curative resection have a favorable prognosis, primary efforts should be focused on early diagnosis.
Digestive surgery 02/2009; 26(1):31-6. · 1.37 Impact Factor
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Yu Jung Kim,
Min A Kim,
Seock-Ah Im,
Tae Min Kim,
Dong-Wan Kim,
Han-Kwang Yang,
Dae Seog Heo,
Kuhn-Uk Lee, Kuk Jin Choe,
Noe Kyeong Kim,
Tae-You Kim,
Woo Ho Kim,
Yung-Jue Bang
[show abstract]
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ABSTRACT: Pathologic stage is the most important predictive factor of relapse in gastric cancer after curative resection. However, patients with the same stage often have different risks of relapse. Here, we investigated whether the expressions of molecular markers can supplement the current staging system in terms of relapse prediction.
One hundred and nine stage III or IV (M0) patients who had received curative gastrectomy followed by adjuvant 5-fluorouracil and cisplatin chemotherapy were included in this study. The expressions of molecular markers including p53, p27, COX-2, HER-2, EGFR, maspin, S100A4, E-cadherin, Sp1, and p97 were analyzed by immunohistochemistry in cancer and paired normal tissues.
The overall relapse rate was 58.7%, and pathologic stage was a significant predictive factor of relapse (42% in stage IIIA, 48% in IIIB, 76% in IV, p = 0.005). Of the 10 markers examined, p53 and S100A4 were expressed only in tumor tissues, and S100A4 expression was significantly associated with a higher relapse rate (85% vs. 53%, p = 0.008). In multivariate analysis including tumor stage, S100A4 and p53 expression were independent predictive factors of relapse (relative risk, 6.98; 95% confidence interval [CI], 1.608-30.342, 3.49; 95% CI, 1.328-9.186, respectively). On comparing patients who expressed S100A4 or p53 with those who expressed neither, relapse rates were 58% vs. 25% in stage III (p = 0.011) and 95% vs. 59% in stage IV (M0) (p = 0.003).
In addition to staging system, the expressions of S100A4 and p53 were significant predictive factors of relapse in gastric cancer after curative resection and adjuvant chemotherapy.
Cancer Investigation 04/2008; 26(2):152-8. · 1.85 Impact Factor
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Hyun-Ah Kim,
Cha-Kyong Yom,
Byung-In Moon, Kuk-Jin Choe,
Sun-Hee Sung,
Woon-Sup Han,
Hye-Young Choi,
Hye-Kyoung Kim,
Heung-Kyu Park,
Sung-Ho Choi,
Eun-Jin Yoon,
Soo-Youn Oh
[show abstract]
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ABSTRACT: The adenosine triphosphate-based chemotherapy response assay (ATP-CRA) has the advantages of standardization, evaluability, reproducibility, and accuracy, and can be performed on relatively small numbers of tumor cells. A total of 43 patients were enrolled in the present study, and chemosensitivity tests were successfully performed in 40 (93.0%) of these patients. Twenty of the 40 received neoadjuvant chemotherapy or chemotherapy for metastatic breast cancer. The chemotherapy regimens used were doxorubicin plus docetaxel (n=9, 45.0%) or doxorubicin plus paclitaxel (n=11, 55.0%). Mean cell death rate, as determined by ATP-CRA, was lower in non-responders than in responders to therapy (P=0.012). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for ATP-CRA were 78.6%, 100%, 100%, 66.7%, and 85.0%, respectively. Diagnostic accuracy achieved by immunohistochemistry using estrogen receptor or progesterone receptor was lower than that achieved using ATP-CRA. Expression of p53, erb-B2, Ki67, Bcl-2, Bcl-xL, and annexin I was not significantly associated with response to chemotherapy. Our results show that ATP-CRA has high specificity and positive predictive value for predicting response to chemotherapy.
The Breast 03/2008; 17(1):19-26. · 2.49 Impact Factor
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ABSTRACT: Krüppel-like factor 5 (KLF5) is a zinc finger transcription factor, which has recently attracted attention because of its important regulatory activities linked to diverse functions such as cell growth, proliferation, differentiation, and tumorigenesis in a number of systems. However, its expression in human gastric cancer has not been described previously. In this study, we investigated the expression profile of KLF5 and the relationship between its clinicopathologic features and expression in gastric carcinomas.
Tissues were obtained from 247 gastric carcinoma patients who underwent curative gastrectomy (R0 resection) at the Department of Surgery, Seoul National University Hospital from January 1995 to June 1995, and these tissues were arranged in tissue array blocks. KLF5 expression was analyzed by immunohistochemical staining using anti-BTEB2 mouse monoclonal antibodies (Santa Cruz Biotechnology Inc., Santa Cruz, CA, USA).
Overall KLF5 was found to be expressed in 45.7% (113/247) of tumor tissues. Moreover, its expression rate was significantly high in early-staged gastric cancer (63.2 vs. 38.0%, p < 0.001), in gastric cancer without lymph node metastasis (54.0 vs. 40.1%, p = 0.04), and in tumors <5 cm in size (53.0 vs. 38.1%, p = 0.02). The 5-year survival rate of patients with KLF5-positive tumors was higher than those of patients with KLF5-negative tumors, although this was not statistically significant (74.7 vs. 62.2%, p = 0.057).
KLF5 expression rate was high in early-staged gastric cancer, in small gastric cancer tissues and in gastric cancer without lymph node metastasis. By univariate analysis, its expression was found to favor survival after surgery. Our study describes for the first time the expression profile of KLF5 in a large number of human gastric cancer tissues and suggests consistent results shown in many recent studies that reduction of KLF5 expression occurs in many types of human tumor.
Journal of Cancer Research and Clinical Oncology 03/2008; 134(2):163-7. · 2.56 Impact Factor
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ABSTRACT: We investigated prognostic differences according to nodal status in patients with pT2a and pT2b stage gastric cancers.
The clinicopathologic outcomes of 1118 patients who underwent curative resection and had 15 or more lymph nodes evaluated for pT2 stage gastric cancers between 1986 and 1996 were reviewed retrospectively. Of the study group, 442 (39.5%) patients had pT2a stage gastric cancers and 676 (60.5%) had pT2b stage gastric cancers.
The rates of lymph node metastasis for the pTa and pT2b groups were 53.8% and 71.0%, respectively (P < .001). The disease-specific 5-year survival rate of patients with pT2a cancers was significantly longer than for those with pT2b cancers (85.5% vs 55.7%, P < .001). The prognosis of patients with pT2a gastric cancers was significantly better than that of patients with pT2b cancers on any pN stage (P < .001). Multivariate analysis identified age, pT, and pN stages as independent prognostic factors for patients with pT2 gastric cancers. Patients with pT2aN0 (stage IB) cancers showed the best survival. Patents with pT2aN1 (stage II) and pT2bN0 (stage IB) cancers had similar survival rates, as did patients with pT2aN2 (stage IIIA) and pT2bN1 (stage II) cancers.
The subclassification of pT2 gastric cancers into pT2a or pT2b is necessary to demonstrate their different prognoses. We propose that the current stage grouping should be modified to better represent the prognosis for patients with stage pT2 gastric cancers.
Surgery 06/2007; 141(6):757-63. · 3.10 Impact Factor
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ABSTRACT: Endoscopic mucosal resection (EMR) is a relatively new treatment option for early gastric cancer (EGC). However, cases of incomplete EMR resulting in a positive lateral margin or submucosal invasion (positive vertical margin) have been reported. We conducted this study to evaluate the role of surgery after incomplete EMR for EGC.
We analyzed 19 patients who underwent gastrectomy as a result of an incomplete EMR. The patients were divided into three groups according to the type of incomplete EMR: a positive lateral margin (LM) group (n = 9), a positive vertical margin (VM) group (n = 4), and a positive lateral and vertical margin (LM + VM) group (n = 6).
The positive residual tumor rate and the positive lymph node rate were 44.4% (4/9) and 0% (0/9) in the LM group, 50.0% (2/4) and 25.0% (1/4) in the VM group, and 83.3% (5/6) and 16.7% (1/6), LM + VM group, respectively. Curative resection was performed in all patients and there was no recurrence in 30.8 months of follow-up.
Radical surgery is recommended for patients with a positive lateral resection margin or submucosal invasion, or both, after EMR for EGC, because of the possibility of residual tumor or lymph node metastasis.
Surgery Today 02/2007; 37(2):114-7. · 1.22 Impact Factor
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ABSTRACT: This study was conducted to evaluate the clinicopathologic characteristics and surgical outcome of perforated or bleeding gastric cancer patients.
Twenty-six gastric cancer patients undergoing emergency surgery for free perforation (n = 13) or severe bleeding (n = 13) were reviewed.
In the perforation group, tumors were mainly located in the greater curvature and anterior wall, but in the bleeding group, they were mainly in the lesser curvature. Three (23%) patients in the perforation group and 7 (54%) in the bleeding group received potentially curative resections (p = 0.11). The postoperative morbidity rate and mortality rate were 31 (8/26) and 8% (2/26), respectively. Median survival time after operation was 5.5 months. One patient in the perforation group and 3 patients in the bleeding group who underwent curative resection survived more than 30 months without recurrence. Three factors were found to be associated with improved survival after emergency surgery: potentially curative resection; TNM stage, and the absence of postoperative complications.
Emergency surgery for gastric cancer patients with perforation or severe bleeding is associated with a low curative resection rate and a high postoperative complication rate. However, long-term survival can be expected in those patients who underwent curative resection with earlier stage gastric cancer.
Digestive Surgery 02/2006; 23(4):217-23. · 1.22 Impact Factor
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ABSTRACT: Using the new 2003 American Joint Committee on Cancer (AJCC) staging system, the authors evaluated the usefulness of the staging bone scan in patients with primary breast carcinoma.
The authors examined 1939 patients with primary breast carcinoma for staging bone scan who were treated at a single institution. Pathologic stage was assigned retrospectively according to the 1988 and the 2003 AJCC staging systems.
Bone metastasis rates were 0.7% (4 of 586) for patients with Stage I disease, 0.7% (5 of 699) for patients with Stage IIA disease, 2.1% (10 of 479) for patients with Stage IIB disease, 4.5% (7 of 154) for patients with Stage IIIA disease, and 10.5% (2 of 19) for patients with Stage IIIB disease according to the 1988 AJCC staging system. The authors found a significant difference in the bone metastasis rate between patients with Stages IIA and IIB disease in the 1988 staging system (P = 0.039). Reevaluating the patients by the 2003 system resulted in significant upstaging, especially for patients with Stage II/III disease. According to the 2003 staging system, bone metastasis rates were 0.7% (4 of 586) for patients with Stage I disease, 0.6% (4 of 648) for patients with Stage IIA disease, 0.6% (2 of 310) for patients with Stage IIB disease, 4.0% (9 of 225) for patients with Stage IIIA disease, 16.7% (2 of 12) for patients with Stage IIIB disease, and 4.4% (7 of 158) for patients with Stage IIIC disease. It was noteworthy that there was a significant difference between Stages IIB and IIIA in the 2003 staging system (P = 0.010).
Stage reclassification using the new AJCC staging system resulted in upstaging of high-risk patients, as well as a significant decrease in the bone metastasis rate in patients with Stage IIB breast carcinoma. Considering the cost-effectiveness of staging bone scan, the data suggested that it was of little value for patients with Stage I and II breast carcinoma, but was highly recommended for patients with worse than Stage III disease by the new 2003 staging system.
Cancer 09/2005; 104(3):499-503. · 4.77 Impact Factor
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ABSTRACT: This study was aimed at investigating the effect of gastrin on the growth of gastric cancer and evaluating postoperative hypergastrinemia in patients that had received various types of gastrectomy for gastric cancer. RT-PCR for gastrin/CCKB receptor mRNA was performed in human gastric cancer cell lines and tissue. The effect of gastrin or glycine-extended gastrin on the growth of gastric cancer cell lines was determined by MTT assay. Serum gastrin levels were compared with respect to the resection type of gastric cancer surgery. Gastrin/CCKB receptor mRNA expression was detected in all 9 gastric cancer cell lines, and in 19 of 29 (62%) gastric cancer tissue samples. Growth of gastric cancer cell lines containing the gastrin/CCKB receptor was significantly enhanced by gastrin and glycine-extended gastrin. The proximal gastrectomy group had a significantly higher mean serum gastrin level than the distal subtotal gastrectomy, total gastrectomy, or preoperative groups (p<0.05). Our study confirms that a high proportion of gastric cancer tissue samples express the gastrin/CCKB receptor, which can stimulate the growth of gastrin/CCKB receptor-positive gastric cancer cells. In addition, we confirm that hypergastrinemia can be induced in about half of patients after proximal gastrectomy. More studies are needed to clarify the relationship between hypergastrinemia and tumor recurrence after proximal gastrectomy.
Oncology Reports 09/2005; 14(2):383-8. · 1.84 Impact Factor
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ABSTRACT: The role of hepatic resection for metastatic gastric cancer is less well defined due to the tendency of gastric cancer to widely metastasize. The purpose of this study is to examine the beneficial effect of hepatic resection in patients with metastatic gastric cancer. The clinicopathologic features and long-term results of 11 patients who underwent hepatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seoul National University Hospital were analyzed retrospectively. All resected hepatic metastases were solitary lesions. Among eight patients with synchronous hepatic metastases, one patient with early gastric cancer and lymph node metastases (T1N2M1) remained alive for 8 years 6 months after hepatic resection without recurrence. Among three patients with metachronous hepatic metastases, two patients with advanced gastric cancer and lymph node metastases (T3N2MO, T2N1MO at the initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival times of synchronous and metachronous hepatic metastases were 13.0 and 74.3 months, respectively. In solitary hepatic metastatic lesions from gastric cancer, surgical resection should be considered as one of the treatment options.
The American surgeon 03/2005; 71(2):95-9. · 1.28 Impact Factor
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ABSTRACT: Adjuvant chemotherapy for patients with lymph node-negative breast carcinoma is being recommended currently based on the St. Gallen classification. The prognostic importance of HER-2 status in patients with lymph node-negative breast carcinoma has been investigated extensively, with contradictory results. The authors investigated the clinical relevance of HER-2 overexpression when combined with the St. Gallen classification in lymph node-negative breast carcinoma.
The medical records of patients with breast carcinoma negative for lymph node involvement who underwent surgery between January 1995 and December 2000 at the Seoul National University College of Medicine (Seoul, Korea) were reviewed retrospectively. Risk groups based on the St. Gallen classification were categorized as average or minimal risk. The prognostic values of HER-2 in combination with the St. Gallen classification were analyzed with respect to disease-free survival (DFS) rates.
A total of 906 patients were eligible for analysis. The overall 7-year DFS rate was 87.5%. The 7-year DFS rates for patients with HER-2-positive and HER-2-negative tumors were, respectively, 77.9% and 91.2% (P = 0.002). The 7-year DFS rates for patients with average and minimal risk group were 85.0% and 97.9%, respectively. The authors found that HER-2 overexpression significantly predicted the risk of disease recurrence (odds ratio = 3.03 [95% confidence interval, 1.63-5.63]). Furthermore, when HER-2 status was combined with the St. Gallen classification, the DFS rate of the HER-2-positive average risk group was 73.3% compared with 88.4% for the HER-2-negative average risk group (P = 0.007).
The combination of HER-2 overexpression and the St. Gallen classification was more useful than either alone to predict the risk of disease recurrence in patients with lymph node-negative breast carcinoma.
Cancer 01/2005; 101(11):2516-22. · 4.77 Impact Factor
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ABSTRACT: To explore the feasibility of performing minimally invasive surgery (MIS) on subsets of submucosal gastric cancers that are unlikely to have regional lymph node metastasis.
A total of 105 patients underwent radical gastrectomy with lymph node dissection for submucosal gastric cancer at our hospital from January 1995 to December 1995. Besides investigating many clinicopathological features such as tumor size, gross appearance, and differentiation, we measured the depth of invasion into submucosa minutely and analyzed the clinicopathologic features of these patients regarding lymph node metastasis.
The rate of lymph node metastasis in cases where the depth of invasion was <500 microm, 500-2000 microm, or >2000 microm was 9% (2/23), 19% (7/36), and 33% (15/46), respectively (P<0.05). In univariate analysis, no significant correlation was found between lymph node metastasis and clinicopathological characteristics such as age, sex, tumor location, gross appearance, tumor differentiation, Lauren's classification, and lymphatic invasion. In multivariate analysis, tumor size (>4 cm vs <=2 cm, odds ratio = 4.80, P = 0.04) and depth of invasion (>2000 microm vs <=500 microm, odds ratio = 6.81, P = 0.02) were significantly correlated with lymph node metastasis. Combining the depth and size in cases where the depth of invasion was less than 500 microm, we found that lymph node metastasis occurred where the tumor size was greater than 4 cm. In cases where the tumor size was less than 2 cm, lymph node metastasis was found only where the depth of tumor invasion was more than 2000 microm.
MIS can be applied to submucosal gastric cancer that is less than 2 cm in size and 500 microm in depth.
World Journal of Gastroenterology 12/2004; 10(24):3549-52. · 2.47 Impact Factor
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ABSTRACT: The incidence of breast cancer in young women (age < 35) is low. The biology of the disease in this age group is poorly understood, and there are conflicting data regarding the prognosis for these women compared to older patients.
We retrospectively analyzed 2040 consecutive primary invasive breast cancer patients who underwent surgical procedures at our institution between 1990 and 1999. The younger age group was defined as patients aged <35 years at the time of diagnosis. The clinicopathological characteristics and treatment outcomes were compared between younger and older age groups.
A total of 256 (12.5%) patients were aged <35. There was a significantly higher incidence of nuclear grade 3 and medullary histological-type tumors in younger patients compared to older patients. Axillary lymph node status, T stage, histological grade, c-erbB2 expression and estrogen receptor status did not differ significantly between the two age groups. Younger patients had a greater probability of recurrence and death at all time periods. Although there was no significant difference in disease-free survival between the two age groups in lymph node-negative patients, the younger group showed worse prognosis among lymph node-positive patients (p < 0.001). In multivariate analysis, young age remained a significant predictor of recurrence (p = 0.010).
Young age (<35) is an independent risk factor for relapse in operable breast cancer patients.
BMC Cancer 11/2004; 4:82. · 3.01 Impact Factor
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Sue Kyung Park,
Dong-Seok Yim,
Kyung-Sik Yoon,
In-Mi Choi,
Ji-Yeob Choi,
Keun-Young Yoo,
Dong-Young Noh, Kuk-Jin Choe,
Sei-Hyun Ahn,
Ari Hirvonen,
Daehee Kang
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ABSTRACT: Our previous studies suggested that both catechol O-methyl transferase (COMT) and glutathione S-transferase (GST) M1 and T1 genotypes are associated with breast cancer risk. Here we extended the studies to evaluate the potential combined effect of these genotypes in individual breast cancer risk. Incident breast cancer cases (n = 202) and controls (n = 299) with no previous cancer were recruited from three teaching hospitals in Seoul in 1996-1999. Information on putative risk factors was collected by interviewed questionnaire. PCR-based methods were used for the genotyping analyses. Odds ratios (ORs) and 95% confidence (CIs) intervals were estimated by unconditional logistic regression after adjustment for known or suspected risk factors of breast cancer. Among pre-menopausal women the low activity associated (COMT *L) allele containing genotypes and the GSTM1 null genotype posed increased risks of breast cancer with ORs of 1.7 (95% CI = 1.0 - 2.8) and 1.7 (95% CI = 1.0-2.8), respectively. A marginally significant effect of GSTT1 null genotype was also observed when the total study population was considered (OR = 1.3, 95% CI = 1.0-2.1). When the combined genotype effects were examined, the concurrent lack of GSTM1 and GSTT1 genes posed a more than 2-fold risk of breast cancer (OR = 2.2, 95% CI = 1.2-3.9); this effect was mainly attributable in pre-menopausal women (OR = 3.2, 95% CI = 1.5-7.2). Moreover, the breast cancer risk increased in parallel with the number of COMT , GSTM1 , and GSTT1 at-risk genotypes (p for trend = 0.003). This association was particularly clear in pre-menopausal women among whom combination of all three high-risk genotypes posed a 4.1-fold breast cancer risk (95% CI = 1.4-12.7) compared with pre-menopausal women without at-risk genotypes (p for trend = 0.001). The trend was more pronounced in women with BMI greater than 22 kg/m2 (p for trend < 0.001) and high-risk status of parity factor (nulliparous or women with the first full term pregnancy at age of over 25-year-old) (p for trend = 0.013). These results suggest the combined effect between reproductive factors and GSTM1, GSTT1 and COMT genotypes in human breast carcinogenesis.
Breast Cancer Research and Treatment 11/2004; 88(1):55-62. · 4.43 Impact Factor
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Sue Kyung Park,
Dong-seok Yim,
Kyung-sik Yoon,
In-mi Choi,
Ji-yeob Choi,
Keun-young Yoo,
Dong-young Noh, Kuk-jin Choe,
Sei-hyun Ahn,
Ari Hirvonen,
Daehee Kang
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ABSTRACT: Our previous studies suggested that both catechol O-methyl transferase (COMT) and glutathione S-transferase (GST) M1 and T1 genotypes are associated with breast cancer risk. Here we extended the studies to evaluate the potential combined effect of these genotypes in individual breast cancer risk. Incident breast cancer cases (n = 202) and controls (n = 299) with no previous cancer were recruited from three teaching hospitals in Seoul in 1996-1999. Information on putative risk factors was collected by interviewed questionnaire. PCR-based methods were used for the genotyping analyses. Odds ratios (ORs) and 95% confidence (CIs) intervals were estimated by unconditional logistic regression after adjustment for known or suspected risk factors of breast cancer. Among pre-menopausal women the low activity associated (COMT *L) allele containing genotypes and the GSTM1 null genotype posed increased risks of breast cancer with ORs of 1.7 (95% CI = 1.0 - 2.8) and 1.7 (95% CI = 1.0-2.8), respectively. A marginally significant effect of GSTT1 null genotype was also observed when the total study population was considered (OR = 1.3, 95% CI = 1.0-2.1). When the combined genotype effects were examined, the concurrent lack of GSTM1 and GSTT1 genes posed a more than 2-fold risk of breast cancer (OR = 2.2, 95% CI = 1.2-3.9); this effect was mainly attributable in pre-menopausal women (OR = 3.2, 95% CI = 1.5-7.2). Moreover, the breast cancer risk increased in parallel with the number of COMT, GSTM1, and GSTT1 at-risk genotypes (p for trend = 0.003). This association was particularly clear in pre-menopausal women among whom combination of all three high-risk genotypes posed a 4.1-fold breast cancer risk (95% CI = 1.4-12.7) compared with pre-menopausal women without at-risk genotypes (p for trend = 0.001). The trend was more pronounced in women with BMI greater than 22 kg/m2 (p for trendp for trend = 0.013). These results suggest the combined effect between reproductive factors and GSTM1, GSTT1 andCOMT genotypes in human breast carcinogenesis.
Breast Cancer Research and Treatment 10/2004; 88(1):55-62. · 4.43 Impact Factor
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ABSTRACT: CHFR is a recently identified mitotic stress check-point gene. CHFR is ubiquitously expressed in normal human tissues, whereas loss of CHFR expression has been observed in human tumors. Silencing of CHFR has been associated with aberrant promoter methylation and histone deacetylation in several cancer types. In this study, we investigated epigenetic CHFR inactivation in human gastric cancers by examining CHFR expression and methylation status in gastric cancer cell lines with RT-PCR analysis, bisulfite PCR and sequencing. A series of primary gastric tumors were also analyzed for CHFR methylation. Eight of 12 (66.7%) gastric cancer cell lines and 19/43 (44.2%) primary gastric tumors showed CHFR methylation. In addition, CpG methylation status correlated well with CHFR expression in the human gastric cancer cell lines, in which treatment with 5-aza-dC resulted in de novo or enhanced expression of CHFR. Combination treatment of 5-aza-dC with trichostatin A showed a synergistic effect on CHFR expression in some cases. Our results indicate that aberrant promoter methylation of the CHFR gene was observed in a significant proportion of human gastric cancers and was responsible for the inactivation of the CHFR gene in gastric cancers.
Oncology Reports 08/2004; 12(1):129-33. · 1.84 Impact Factor
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ABSTRACT: To analyze the clinicopathologic characteristics of surgically resected gastric lymphoma patients.
We retrospectively analyzed 57 surgically resected gastric lymphoma patients, dividing them into 2 subgroups: Low grade MALToma (the LG group), High grade MALToma and Diffuse large B cell lymphoma (the HG group).
The numbers of patients were: 20 in the LG group, 37 in the HG group. The diagnostic rate of gastroscopy was 34.8% at primary diagnosis and 50% including differential diagnoses. The positive rates of H pylori were similar between the 2 groups (68% vs 77%). Multiple lesions were found in 19.3%. The proportion of mucosal and submucosal lesions was 80.0%(16/20) in the LG group, and 24.3%(9/37) in the HG group (P<0.001). Lymph node invasion rates were 10.5%(2/19) in the LG group and 44.1%(15/34) in the HG group (P=0.031). The numbers of recurred patients were none in the LG group, and 8 in the HG group. By univariant analysis, group (P=0.024) and TNM stage (stage I, II vs stages III, IV, P=0.002) were found to be the significant risk factors. There was a tendency of higher recurrence rate in the subtotal gastrectomy group than in the total gastrectomy group (P=0.05).
The HG groups had a more advanced stage and a higher recurrence rate than the LG group. Although there was no difference between subtotal and total gastrectomies, more careful assessments of multiplicities and radical resections with lymph node dissections seem to be needed because of multiplicity and LN invasion even in LG group.
World Journal of Gastroenterology 04/2004; 10(8):1103-9. · 2.47 Impact Factor
