Sung Hoon Noh

Publications (157)494.13 Total impact

• Article: Clinical implication of FDG-PET in advanced gastric cancer with signet ring cell histology.

  Kyung Ho Pak, Mijin Yun, Jae-Ho Cheong, Woo Jin Hyung, Seung Ho Choi, Sung Hoon Noh
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  ABSTRACT: The purpose of this study was to investigate the role of the standardized uptake values (SUV), a semi-quantitative assessment of tumor FDG uptake, as a prognosticator for advanced signet ring cell carcinoma (SRC). We reviewed the files of 41 patients who underwent curative gastrectomy for advanced SRC and who had an FDG-PET at initial presentation between September 2003 and December 2007. The median follow-up period was 30.9 months (range: 4.0-70.3). We found a correlation between the SUVmax and TNM stage. When the patients were divided into two groups (low vs. high SUVmax) based on a median SUVmax of 3.80, the high-SUVmax group showed more aggressive tumor behavior than did the low SUVmax group. In addition, the high SUVmax group showed more postoperative recurrence (P = 0.028), shorter relapse-free survival (P = 0.004), and lower 30-month cancer-specific survival rates (40.0% vs. 69.3%, P = 0.008). However, in multivariate analysis, SUVmax failed to be an independent predictor of overall survival. Although SUVmax of initial PET scan was not an independent predictor of patient outcomes after curative surgery, higher SUVmax is associated with more advanced stage and indicates more aggressive tumor biology in advanced SRC.
  Journal of Surgical Oncology 06/2011; 104(6):566-70. · 2.10 Impact Factor
• Article: Minimizing hepatic trauma with a novel liver retraction method: a simple liver suspension using gauze suture.

  Yanghee Woo, Woo Jin Hyung, Hyoung-Il Kim, Kazutaka Obama, Taeil Son, Sung Hoon Noh
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  ABSTRACT: Prolonged liver retraction during radical gastrectomy for adequate exposure of the hepatogastric ligament may lead to hepatic trauma. The authors offer a new minimally traumatic liver retraction method using a simple liver suspension with a gauze suture and compare it with the modified liver-puncture method. This study retrospectively evaluated 92 patients who underwent the liver-suspension or liver-puncture method during gastric resections in 2010. Their clinical and operative characteristics were analyzed together with perioperative transaminases, and the two groups were compared. Patients with a history of liver disease, abnormal preoperative liver function test results, postoperative complications, or combined operations were excluded from the study. The liver-suspension method was performed using two 4 × 4-in. gauze pads threaded with a 2-0 Prolene suture, which were secured to the pars condensa with surgical clips and externally tied to suspend the liver toward the abdominal wall. Each liver retraction was completed without intraoperative complications. The patients in the liver-suspension group had more nonhepatic comorbidities than those in the liver-puncture group (P = 0.029). Other patient characteristics such as age, gender, and body mass index (BMI) did not differ between the two groups. No differences were found between the groups in terms of mean operative time (200.3 ± 66.9 vs 214.9 ± 74.4) or preoperative mean alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels. However, the patients in the liver-suspension group had significantly lower postoperative mean ALT levels (postoperative days 0, 1, 2, 3, and 5) and mean AST levels (postoperative days 0 and 1). Compared with the liver-puncture method, the authors' novel liver-suspension with suture-gauze technique is a safe and effective method for retracting the liver during laparoscopic and robotic upper abdominal surgeries.
  Surgical Endoscopy 06/2011; 25(12):3939-45. · 4.01 Impact Factor
• Article: Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers.

  Yanghee Woo, Woo Jin Hyung, Kyung-Ho Pak, Kazuki Inaba, Kazutaka Obama, Seung Ho Choi, Sung Hoon Noh
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  ABSTRACT: To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer. Retrospective analysis. Tertiary hospital. Eight hundred twenty-seven patients with gastric cancer. Between July 2005 and April 2009, 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed. We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality. The robotic group was younger than the laparoscopic group, but other preoperative patient characteristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P < .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P = .002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P > .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1+α (n = 5), D1+β (n = 126), and D2 (n = 105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins. Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.
  Archives of surgery (Chicago, Ill.: 1960) 05/2011; 146(9):1086-92. · 4.32 Impact Factor
• Article: A randomized phase 2 study of docetaxel and S-1 versus docetaxel and cisplatin in advanced gastric cancer with an evaluation of SPARC expression for personalized therapy.

  Hei-Cheul Jeung, Sun Young Rha, Chong Kun Im, Sang Joon Shin, Joong Bae Ahn, Woo Ick Yang, Jae Kyung Roh, Sung Hoon Noh, Hyun Cheol Chung
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  ABSTRACT: The purpose of this study was to compare 2 weekly docetaxel-based regimens as first-line treatments for advanced gastric cancer and to investigate the expression of secreted protein acidic and rich in cysteine (SPARC) and its abilities to predict treatment-related clinical outcomes. Patients were randomly selected to receive 3 weekly cycles of docetaxel (35 mg/m(2) on days 1 and 8) plus S-1 (35 mg/m(2) each twice daily on days 1-14) (DS), or docetaxel plus cisplatin (35 mg/m(2) each on days 1 and 8) (DC). Endpoints included overall response rate (primary), survival, toxicity, and quality of life (secondary). SPARC expression in prechemotherapy specimens of primary gastric tumors was evaluated via immunohistochemical analysis. Eighty patients were enrolled in the study. Confirmed overall response rates were 46% (95% confidence interval, 30%-62%) for DS and 24% (95% confidence interval, 11%-38%) for DC via intent-to-treat analysis. Median progression-free survival was 7.3 and 4.9 months and overall survival was 16.0 and 8.3 months for DS and DC, respectively. The most common grade ≥ 3 toxicity was neutropenia. Grade ≥ 3 mucositis (18%) and hand-foot syndrome (8%) were the toxicities most associated with DS, whereas anorexia (20%) and lethargy (20%) were more common with DC. High SPARC expression was related to early progression (hazard ratio, 3.67; P = .042) and poor overall survival (hazard ratio, 2.01; P = .010) in docetaxel chemotherapy on multivariate analysis. The outcomes in this study favored DS over DC for further phase 3 study. The findings suggest that split-dose weekly docetaxel alleviates hematological toxicity without compromising efficacy, and that SPARC expression may help individualize therapy in advanced gastric cancer.
  Cancer 05/2011; 117(10):2050-7. · 4.77 Impact Factor
• Article: Predictive values of 5-fluorouracil pathway genes for S-1 treatment in patients with advanced gastric cancer.

  Hei-Cheul Jeung, Sun Young Rha, Sang Joon Shin, Seung Joon Lim, Jae Kyung Roh, Sung Hoon Noh, Hyun Cheol Chung
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  ABSTRACT: Determination of significant associations between gene expression and predefined endpoints might improve treatment tailoring for advanced gastric cancer. We investigated the mRNA expression of 5-fluorouracil (5-FU) pathway genes in prechemotherapeutic tumor samples of primary gastric cancer to try to predict the treatment outcome of S-1 monotherapy. 5-FU pathway genes, dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), thymidylate synthase (TS), and thymidine phosphorylase (TP), were analyzed using quantitative real-time PCR of RNA extracted from archived formalin-fixed paraffin-embedded tissues. We selected the median value for each gene as a cutoff to separate patients into high and low gene expression groups. High OPRT gene expression was significantly associated with tumor response (P = 0.014). In a combined analysis including OPRT, patients with high OPRT and TP showed a higher overall response rate than did the remaining patients (40 vs. 10%, respectively; P = 0.002). For survival, patients with high OPRT and low TS levels showed prolonged survival in both progression-free survival (3.4 vs. 2.4 months, P = 0.024) and overall survival (11.0 vs. 8.2 months, P = 0.007). In a multivariate analysis, the combinations of OPRT and TP for response and OPRT and TS for both progression-free survival and overall survival were independent variables. To conclude, mRNA expression levels of molecular markers in formalin-fixed paraffin-embedded specimens of primary gastric tumors can be useful for identifying patients with advanced gastric cancer who would most likely benefit from S-1 treatment.
  Anti-cancer drugs 05/2011; 22(8):801-10. · 2.23 Impact Factor
• Article: Oral vitamin B12 replacement: an effective treatment for vitamin B12 deficiency after total gastrectomy in gastric cancer patients.

  Hyoung-Il Kim, Woo Jin Hyung, Ki Jun Song, Seung Ho Choi, Choong-Bai Kim, Sung Hoon Noh
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  ABSTRACT: Vitamin B12 deficiency is a common long-term sequelae after total gastrectomy. Intramuscular injection of vitamin B12 is the only known treatment. We investigated the efficacy and safety of oral vitamin B12 replacement for gastric cancer patients with vitamin B12 deficiency after total gastrectomy. We performed a single-arm, open-label, fixed-drug dosage, prospective study (NCT00699478) involving gastric cancer patients who underwent total gastrectomy. Vitamin B12-deficient (<200 pg/ml) patients (n = 30) received daily oral vitamin B12 (dosage: 1500 μg mecobalamin) administration for 3 months. The primary outcome measurement was serum vitamin B12. The secondary outcome measurements were improvement of neurologic symptoms and hematologic findings (serum folate, homocysteine, ferritin, iron, total iron binding capacity, transferrin, and mean corpuscular volume). For comparison, another group of vitamin B12 deficient patients (n = 30) received intramuscular vitamin B12 injections (dosage: 1000 μg cyanocobalamin) weekly for 5 weeks and monthly thereafter for a total of 3 months in a separate study period. In both groups, mean serum vitamin B12 increased after 30 days of treatment and was maintained up to 90 days. No adverse effects related to oral or intramuscular vitamin B12 replacements were noted. Both groups showed decreased homocysteine levels. Before treatment, 29 patients in the oral vitamin B12 group had neurologic symptoms related to vitamin B12 deficiency. After oral vitamin B12 treatment, 28 patients experienced symptom relief, and 16 patients were symptom free. Oral vitamin B12 replacement is an effective and safe treatment for vitamin B12 deficiency in gastric cancer patients after total gastrectomy.
  Annals of Surgical Oncology 05/2011; 18(13):3711-7. · 4.17 Impact Factor
• Article: Intrinsic subtypes of gastric cancer, based on gene expression pattern, predict survival and respond differently to chemotherapy.

  Iain Beehuat Tan, Tatiana Ivanova, Kiat Hon Lim, Chee Wee Ong, Niantao Deng, Julian Lee, Sze Huey Tan, Jeanie Wu, Ming Hui Lee, Chia Huey Ooi, [......], Heike Grabsch, Han Chong Toh, Steven Rozen, Jae Ho Cheong, Sung Hoon Noh, Wei Kiat Wan, Jaffer A Ajani, Ju-Seog Lee, Manuel Salto Tellez, Patrick Tan
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  ABSTRACT: Gastric cancer (GC) is a heterogeneous disease comprising multiple subtypes that have distinct biological properties and effects in patients. We sought to identify new, intrinsic subtypes of GC by gene expression analysis of a large panel of GC cell lines. We tested if these subtypes might be associated with differences in patient survival times and responses to various standard-of-care cytotoxic drugs. We analyzed gene expression profiles for 37 GC cell lines to identify intrinsic GC subtypes. These subtypes were validated in primary tumors from 521 patients in 4 independent cohorts, where the subtypes were determined by either expression profiling or subtype-specific immunohistochemical markers (LGALS4, CDH17). In vitro sensitivity to 3 chemotherapy drugs (5-fluorouracil, cisplatin, oxaliplatin) was also assessed. Unsupervised cell line analysis identified 2 major intrinsic genomic subtypes (G-INT and G-DIF) that had distinct patterns of gene expression. The intrinsic subtypes, but not subtypes based on Lauren's histopathologic classification, were prognostic of survival, based on univariate and multivariate analysis in multiple patient cohorts. The G-INT cell lines were significantly more sensitive to 5-fluorouracil and oxaliplatin, but more resistant to cisplatin, than the G-DIF cell lines. In patients, intrinsic subtypes were associated with survival time following adjuvant, 5-fluorouracil-based therapy. Intrinsic subtypes of GC, based on distinct patterns of expression, are associated with patient survival and response to chemotherapy. Classification of GC based on intrinsic subtypes might be used to determine prognosis and customize therapy.
  Gastroenterology 04/2011; 141(2):476-85, 485.e1-11. · 11.68 Impact Factor
• Article: Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions.

  Hee Man Kim, Kyung Ho Pak, Moon Jae Chung, Jae Hee Cho, Woo Jin Hyung, Sung Hoon Noh, Choong Bai Kim, Yong Chan Lee, Si Young Song, Sang Kil Lee
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  ABSTRACT: Recently, endoscopic submucosal dissection has been carefully applied in early gastric cancer (EGC) with undifferentiated type. However, there are no individual guidelines for endoscopic treatment of EGCs with poorly differentiated tubular adenocarcinoma or signet ring cell carcinoma. The aim of this study was to investigate and compare the clinicopathologic features of these two types of EGC to guide the application of endoscopic treatment. Patients to undergo radical gastrectomy for the treatment of EGC were selected for inclusion in this study. Histology was classified according to the Japanese Gastric Cancer Association. Between January 2005 and December 2008, 288 patients with poorly differentiated EGC and 419 patients with signet ring cell EGC were enrolled. Their medical records were reviewed retrospectively. Compared with signet ring cell EGC, poorly differentiated EGC had higher rates of male gender, old age (≥45 years), large tumor length (>20 mm), ulcer, submucosal invasion, lymphovascular invasion, and lymph node metastasis. In the multivariate analyses, poorly differentiated EGC was significantly associated with ulcer (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.5-3.8), submucosal invasion (OR: 3.6, 95% CI: 2.6-5.1) and lymphovascular invasion (OR: 2.0, 95% CI: 1.1-3.6) with a reference of signet ring cell EGC. The independent risk factors for lymph node metastasis were large tumor length, submucosal invasion, and lymphovascular invasion in both types of EGC. Young age was an independent risk factor of lymph node metastasis only in poorly differentiated EGC. Poorly differentiated EGC has clinicopathologic features that are less favorable to endoscopic treatment than are those of signet ring cell EGC. Therefore, these two types of EGC should be approached separately, not as a united type of undifferentiated histology, during the planning of endoscopic treatment.
  Surgical Endoscopy 04/2011; 25(9):3087-93. · 4.01 Impact Factor
• Article: Gene expression signature-based prognostic risk score in gastric cancer.

  Jae Yong Cho, Jae Yun Lim, Jae Ho Cheong, Yun-Yong Park, Se-Lyun Yoon, Soo Mi Kim, Sang-Bae Kim, Hoguen Kim, Soon Won Hong, Young Nyun Park, Sung Hoon Noh, Eun Sung Park, In-Sun Chu, Waun Ki Hong, Jaffer A Ajani, Ju-Seog Lee
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  ABSTRACT: Despite continual efforts to develop a prognostic model of gastric cancer by using clinical and pathologic parameters, a clinical test that can discriminate patients with good outcomes from those with poor outcomes after gastric cancer surgery has not been established. We aim to develop practical biomarker-based risk score that can predict relapse of gastric cancer after surgical treatment. Microarray technologies were used to generate and analyze gene expression profiling data from 65 gastric cancer patients to identify biomarker genes associated with relapse. The association of expression patterns of identified genes with relapse and overall survival was validated in independent gastric cancer patients. We uncovered two subgroups of gastric cancer that were strongly associated with the prognosis. For the easy translation of our findings into practice, we developed a scoring system based on the expression of six genes that predicted the likelihood of relapse after curative resection. In multivariate analysis, the risk score was an independent predictor of relapse in a cohort of 96 patients. We were able to validate the robustness of the six-gene signature in an additional independent cohort. The risk score derived from the six-gene set successfully prognosticated the relapse of gastric cancer patients after gastrectomy.
  Clinical Cancer Research 03/2011; 17(7):1850-7. · 7.74 Impact Factor
• Article: General perioperative management of gastric cancer patients at high-volume centers.

  Hye Seong Ahn, Jeong Hwan Yook, Cho Hyun Park, Young Kyu Park, Wansik Yu, Moon-Soo Lee, Han Sang-Uk, Keun Won Ryu, Tae Sung Sohn, Hyung-Ho Kim, Seung Ho Choi, Sung Hoon Noh, Naoki Hiki, Takeshi Sano, Han-Kwang Yang
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  ABSTRACT: Gastric cancer is very common in Korea and Japan, where many hospitals annually perform high numbers of gastrectomies for gastric cancer. The aim of this study was to compare the general management of gastric cancer in high-volume centers in Korea and Japan. We undertook a survey of the general management of gastric cancer at high-volume centers (over 200 cases/year) and analyzed the answers. In six of 14 hospitals surveyed, antimicrobial prophylaxis for elective gastrectomy was administered until postoperative day 3. A Levin tube and an abdominal drain were routinely inserted in seven and ten hospitals, respectively. Laboratory tests, such as complete blood cell count, liver function test, electrolytes, and blood urea nitrogen/creatinine were performed frequently on postoperative days 1, 2, 3, and 5. Sips of water after open distal gastrectomy were restarted up to postoperative day 3 in twelve hospitals. The surgical pathology was reported up to postoperative day 10 in thirteen hospitals. Twelve hospitals provided a regular patient education program and only one hospital provided an integrated education program which included the participation of a surgeon, an oncologist, a nurse, and a nutritionist. The general management of gastric cancer in 14 high-volume centers was not so different among the centers. The general management protocols noted here are expected to provide useful information for perioperative care.
  Gastric Cancer 03/2011; 14(2):178-82. · 2.42 Impact Factor
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  Available from: PubMed Central

  Article: Recent evolution of surgical treatment for gastric cancer in Korea.

  Ji Yeong An, Jae-Ho Cheong, Woo Jin Hyung, Sung Hoon Noh
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  ABSTRACT: Gastric cancer is the most common malignancy and the incidence is steadily increasing in Korea. The principal treatment modality for gastric cancer is surgical extirpation of tumor along with draining lymph nodes. Gastrectomy with D2 lymph node dissection has been well established as a standard of surgery and improved the survival of gastric cancer patients. Recently, technological advances are drastically reshaping the landscape of surgical treatment of gastric cancer. One of the most notable trends is that minimal access surgery becomes dominating the treatment of early stage diseases. For advanced diseases, the standard access surgery is considered a reference treatment. Although there is a pilot study underway to evaluate the feasibility of the application of minimal access surgery to advanced gastric cancer (AGC), the evidence for oncological safety is not yet provided sufficiently. Based on the recent randomized controlled trials, the extent of surgery for AGC has re-defined as para-aortic lymph node dissection dose not add any survival benefit while increasing surgery-related morbidities. In addition, it is now accepted as a standard operation omitting unnecessary procedures such as splenectomy and/or distal pancreatectomy for prophylactic lymph node dissection. Conceptual and technical innovation has contributed to decreasing morbidity and mortality without impairing oncological safety. All these recent advances in the field of gastric cancer surgery would be concluded in maximizing therapeutic index for gastric cancer while improving quality of life.
  Journal of gastric cancer. 03/2011; 11(1):1-6.
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  Available from: PubMed Central

  Article: Eupatilin Inhibits Gastric Cancer Cell Growth by Blocking STAT3-Mediated VEGF Expression.

  Jae-Ho Cheong, Sung Yi Hong, Yanjun Zheng, Sung Hoon Noh
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  ABSTRACT: Eupatilin is an antioxidative flavone and a phytopharmaceutical derived from Artemisia asiatica. It has been reported to possess anti-tumor activity in some types of cancer including gastric cancer. Eupatilin may modulate the angiogenesis pathway which is part of anti-inflammatory effect demonstrated in gastric mucosal injury models. Here we investigated the anti-tumor effects of eupatilin on gastric cancer cells and elucidated the potential underlying mechanism whereby eupatilin suppresses angiogenesis and tumor growth. The impact of eupatilin on the expression of angiogenesis pathway proteins was assessed using western blots in MKN45 cells. Using a chromatin immunoprecipitation assay, we tested whether eupatilin affects the recruitment of signal transducer and activator of transcription 3 (STAT3), aryl hydrocarbon receptor nuclear translocator (ARNT) and hypoxia-inducible factor-1α (HIF-1α) to the human VEGF promoter. To investigate the effect of eupatilin on vasculogenesis, tube formation assays were conducted using human umbilical vein endothelial cells (HUVECs). The effect of eupatilin on tumor suppression in mouse xenografts was assessed. Eupatilin significantly reduced VEGF, ARNT and STAT3 expression prominently under hypoxic conditions. The recruitment of STAT3, ARNT and HIF-1α to the VEGF promoter was inhibited by eupatilin treatment. HUVECs produced much foreshortened and severely broken tubes with eupatilin treatment. In addition, eupatilin effectively reduced tumor growth in a mouse xenograft model. Our results indicate that eupatilin inhibits angiogenesis in gastric cancer cells by blocking STAT3 and VEGF expression, suggesting its therapeutic potential in the treatment of gastric cancer.
  Journal of gastric cancer. 03/2011; 11(1):16-22.
• Article: Lymphovascular invasion is an important predictor of lymph node metastasis in endoscopically resected early gastric cancers.

  Hyunki Kim, Jie-Hyun Kim, Jun Chul Park, Yong Chan Lee, Sung Hoon Noh, Hoguen Kim
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  ABSTRACT: With an increased incidence of early gastric cancer (EGC) and advances in endoscopic technologies, endoscopic resection (ER) has become an important treatment modality for EGC. Therefore, precise assessment of the risk of lymph node (LN) metastasis in ER specimens has become essential. The widely accepted criteria for ER have been mostly obtained from surgical data. This study was performed to evaluate the adequacy of these criteria and re-evaluate the predictive power of the criteria for LN metastasis. We evaluated a series of pathologic factors in ER specimens from 79 gastric cancer patients treated with endoscopic mucosal resection (7) or endoscopic submucosal dissection (72) and underwent subsequent surgical resection due to the potential risk of LN metastasis. Of the 79 patients, 10 patients (12.7%) exhibited regional LN metastasis. Univariate analysis revealed that the presence of lymphovascular invasion (LVI) was significantly associated with LN metastasis (26/69, 37.7 vs. 9/10, 90%, P = 0.004). The number of LVI was significantly higher in the LN metastasis group (1.1 ± 2.3 vs. 7.7 ± 8.4, P<0.001). By multivariate analysis, the presence of LVI (odds ratio, 21.41; P = 0.010) and undifferentiated histology (odds ratio, 11.15; P = 0.016) were significantly correlated with LN metastasis. The presence of LVI, undifferentiated histology and the numbers of LVI were important risk factors for LN metastasis. Among these factors, the presence of LVI was the most important risk factor for LN metastasis in endoscopically resected early gastric cancer.
  Oncology Reports 03/2011; 25(6):1589-95. · 1.84 Impact Factor
• Article: Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy.

  Hyoung-Il Kim, Woo Jin Hyung, Cho Rok Lee, Joon Seok Lim, Ji Yeong An, Jae-Ho Cheong, Seung Ho Choi, Sung Hoon Noh
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  ABSTRACT: During laparoscopic gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is required. In this study, we evaluated a novel method of intraoperative portable abdominal radiograph for localization of EGC lesions after preoperative endoscopic clipping. A retrospective study of 80 patients who had undergone laparoscopic gastrectomies with our intraoperative abdominal radiographic method of tumor localization was performed. During preoperative endoscopy, endoscopic metal clips were applied just proximal to the tumor. A plain abdominal radiograph taken immediately after oral administration of effervescent agents was employed to select candidates for intraoperative localization. Intraoperative vessel clips were laparoscopically applied along the greater and lesser curvatures, and a portable abdominal radiograph was taken to identify the location of endoscopic clips relative to laparoscopic vessel clips. In all patients, endoscopic clips were applied proximal to the lesion without complications. Both intraluminally and extraluminally placed clips were successfully detected by intraoperative portable abdominal radiograph in all patients. Mean ± standard deviation (SD) proximal margin length was 34.2 ± 20.2 mm. All patients had tumor-free resection margin. Preoperative endoscopic clipping and intraoperative portable abdominal radiograph is an accurate and simple tumor localization method in laparoscopic gastrectomy.
  Surgical Endoscopy 03/2011; 25(3):958-63. · 4.01 Impact Factor
• Article: High microsatellite instability predicts good prognosis in intestinal-type gastric cancers.

  Hyunki Kim, Ji Yeong An, Sung Hoon Noh, Sung Kwan Shin, Yong Chan Lee, Hoguen Kim
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  ABSTRACT: A subset of gastric cancers showed high microsatellite instability (MSI-H). The reported clinicopathological features of MSI-H gastric cancers are heterogeneous, and specific factors associated with prognosis have not been identified. We analyzed the clinicopathological characteristics and prognostic factors in a large series (161 cases) of MSI-H gastric cancers, and compared the results to 315 cases of microsatellite-stable or low microsatellite-instable gastric cancers. The frequency of MSI-H gastric cancers was 9% (161/1786). MSI-H gastric cancers have distinct clinicopathological features, including female sex, older age, antral location, well-to-moderate differentiation, intestinal-type Lauren classification, expanding-type Ming classification, a non-signet-ring cell component, the presence of a mucinous component, a moderate-to-severe lymphoid stromal reaction, and a lower tumor stage. The MSI-H phenotype was associated with better prognosis (P = 0.044), and male sex (P = 0.035, hazard ratios [HR]: 0.23), intestinal-/mixed-type Lauren classification (P < 0.001, HR: 0.09) and lower tumor stages (1 and 2, P = 0.001, HR: 0.08) were independently-favorable prognostic factors. With unique clinicopathological features, intestinal-type MSI-H gastric cancers are associated with good prognosis and can be classified as a different subset of gastric cancers.
  Journal of Gastroenterology and Hepatology 03/2011; 26(3):585-92. · 2.87 Impact Factor
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  Available from: PubMed Central

  Article: Expression of Epstein-Barr Virus Gene and Clonality of Infiltrated T Lymphocytes in Epstein-Barr Virus-associated Gastric Carcinoma.

  Jae Myun Lee, Hoguen Kim, Sung Hoon Noh, Won-Young Lee, Se Jong Kim, Jeon Han Park
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  ABSTRACT: Epstein-Barr virus associated gastric lymphoepithelioma-like carcinoma (LELC) is characterized by the intensive infiltration of lymphoid cells, the presence of EBV, and the better prognosis over typical adenocarcinoma. Thus, it was assumable that viral latent proteins may be responsible for the recruitment of a certain T cell repertoire to EBV-associated gastric carcinoma. To examine above possibility, EBV gene expression in gastric carcinoma tissues and usage of TCR among the tumor infiltrating lymphocytes were analyzed. EBV specific DNA and EBERs RNA were detected in 4 out of 30 patients. RT-PCR analysis revealed that all 4 of EBV-positive tumor tissues expressed EBNA1 mRNA and BARTs and LMP2a was detected only one sample out of 4. However, the EBNA2 and LMP-1 transcripts were not detected in these tissues. CD8(+) T cells were the predominant population of infiltrating lymphocytes in the EBV-positive gastric carcinoma. According to spectra type analysis of infiltrating T cells, 10 predominant bands were detected by TCR Vβ CDR3 specific RT-PCR from 4 EBV-positive tumor tissues. Sequence analysis of these bands revealed oligoclonal expansion of T cells. These findings suggest that clonally expanded T cells in vivo might be a population of cytotoxic T cells reactive to EBV-associated gastric carcinoma.
  Immune Network 02/2011; 11(1):50-8.
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  Available from: PubMed Central

  Article: Salvage chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) in previously treated patients with advanced gastric cancer.

  Hong Jae Chon, Sun Young Rha, Hyung Soon Park, Sang Joon Shin, Hyo Song Kim, Jae Kyung Roh, Sung Hoon Noh, Hyun Cheol Chung, Hei-Cheul Jeung
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  ABSTRACT: This phase II trial first describes the combination chemotherapy of biweekly irinotecan plus S-1 (biweekly IRIS) for pretreated advanced gastric cancer (AGC) patients. Patients who had previously been treated with greater than or equal to one regimen were enrolled. They received S-1 35 mg/m(2) twice daily on days 1-14 and irinotecan 150 mg/m(2) on days 1 and 15, every 4 weeks. The primary endpoint was overall survival (OS). Among the 38 patients enrolled, 18 patients were treated as second line, and the remaining 20 patients were enrolled as third- or fourth line. A total of 208 cycles were administered with the median being four cycles (range 1-16). The median OS was 8.7 months [95% confidence interval (CI) 7.5-10.3], and the median progression-free survival was 6.3 months (95% CI 5.3-7.3). Low serum albumin (<3.5 mg/dL) was an independent adverse prognosticator for survival. Overall response rate was 17% (95% CI 4-30%). The major grade 3/4 toxicities were neutropenia (26%) and diarrhea (18%). Biweekly IRIS showed the moderate activity as salvage treatment in AGC. Considering high neutropenia and gastrointestinal toxicity, patient selection should be warranted; serum albumin may be a predictive factor for treatment decision.
  Cancer Chemotherapy and Pharmacology 02/2011; 68(4):991-9. · 2.83 Impact Factor
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  Available from: Seulkee Park

  Article: In vitro adenosine triphosphate based chemotherapy response assay in gastric cancer.

  Seulkee Park, Yanghee Woo, Hogeun Kim, Yong Chan Lee, Sungho Choi, Woo Jin Hyung, Sung Hoon Noh
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  ABSTRACT: The purpose of this study was to investigate the reliability and the clinical applicability of the adenosine-triphosphate-based chemotherapy response assay (ATP-CRA) as a method of determining in vitro chemosensitivity in patients with gastric cancer. A total of 243 gastric cancer tissue samples were obtained from gastrectomies performed between February 2007 and January 2010. We evaluated the effectiveness of the ATP-CRA assay in determining the chemosensitivity of gastric cancer specimens using eleven chemotherapeutic agents - etoposide, doxorubicin, epirubicin, mytomicin, 5-fluorouracil, oxaliplatin, irinotecan, docetaxel, paclitaxel, methotraxate, and cisplatin - for chemosensitivity studies using ATP-CRA. We assessed the failure rate, the cell death rate, and the chemosensitivity index. The failure rate of ATP-CRA was 1.6% (4/243). The mean coefficient of variation for triplicate ATP measurements was 6.5%. Etoposide showed the highest cell death rate (35.9%) while methotrexate showed the lowest (16.6%). The most active chemotherapeutic agent was etoposide, which most frequently ranked highest in the chemosensitivity test: 31.9% (51/160). Oxaliplatin was more active against early gastric cancers than advanced gastric cancers, whereas docetaxel was more active against advanced cancers. The lymph node negative group showed a significantly higher cell death rate than the lymph node positive group when treated with doxorubicin, epirubicin, and mitomycin. ATP-CRA is a stable and clinically applicable in vitro chemosensitivity test with a low failure rate. The clinical usefulness of ATP-CRA should be evaluated by prospective studies comparing the regimen guided by ATP-CRA with an empirical regimen.
  Journal of gastric cancer. 12/2010; 10(4):155-61.
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  Available from: Joon Seok Lim

  Article: Image-based Approach for Surgical Resection of Gastric Submucosal Tumors.

  Yoo-Min Kim, Joon Seok Lim, Jie-Hyun Kim, Woo Jin Hyung, Sung Hoon Noh
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  ABSTRACT: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.
  Journal of gastric cancer. 12/2010; 10(4):188-95.
• Article: CT colonography for postoperative surveillance after curative gastrectomy in patients with gastric cancer.

  Joon Seok Lim, Sang Kil Lee, Woo Jin Hyung, Jin-Young Choi, Myeong-Jin Kim, Sung Hoon Noh, Ki Whang Kim
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  ABSTRACT: The purpose was to evaluate the diagnostic role of contrast-enhanced CT colonography (CTC) for follow-up of colorectal cancer screening after curative gastrectomy in patients with gastric adenocarcinomas. Contrast-enhanced CTC was performed as a substitute for routine follow-up CT for the detection of recurrent lesions in 700 consecutive patients who underwent curative surgery for gastric adenocarcinomas. Prospectively, patients with polyps measuring 6 mm or larger on CTC were referred for optical colonoscopy. Clinical and radiologic follow-up with respect to detection of polyp and recurrent lesion was retrospectively assessed. Colorectal polyps measuring 6 mm or larger were identified by CTC in 104 (14.9%) of the 700 patients. Optical colonoscopy was recommended to these patients and was performed in 72 cases. True positive lesions were identified in 62 of the 72 patients (per-patient positive predictive value: 86.1%). The diagnostic yield for primary colonic malignancies was 1.6% (11/700). Recurrent lesions of gastric cancer were also detected in eight patients (1.1%). In patients who undergo gastrectomy due to gastric adenocarcinoma, contrast-enhanced CTC may offer a unique advantage by allowing simultaneous colorectal cancer screening in addition to its routine role of detecting recurrent lesions during follow-up.
  Journal of Surgical Oncology 11/2010; 102(6):593-8. · 2.10 Impact Factor