Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006) / 한국유방암학회지

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006) / 한국유방암학회지

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

The Clinicopathological Characteristics of Palpable and Non-palpable Breast Cancer

Purpose@#Palpability is known to be a poor prognostic factor for breast cancer. The present study analyzed the clinicopathological characteristics and outcomes of palpable and nonpalpable breast cancers using big data. @*Methods@#Between January 2005 and May 2019, a total of 15,141 patients were enrolled. All patients were diagnosed with invasive ductal carcinomas. Patients with unclear medical records, multiple tumors, bilateral breast cancers, inflammatory breast cancers, inoperable breast cancers and distant metastasis were excluded. Patients were divided into the palpable and nonpalpable breast cancer groups based on physicians’ clinical examinations. The clinicopathological characteristics and disease-specific survivals (DSS) were analyzed. @*Results@#Patients with palpable breast cancers were younger, had larger tumors, and higher tumor-node-metastasis stage (p<0.001) than patients with nonpalpable breast cancers. Palpable breast cancer cases had higher rates of lympho-vascular invasion, higher histologic and nuclear grades than nonpalpable breast cancer cases (p<0.001). The positive proportion of hormone receptor was higher in the nonpalpable breast cancer group than in the palpable breast cancer group, but that of human epidermal growth factor receptor 2 was higher in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). The Ki-67 index was higher in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). Total mastectomy and axillary dissection were performed more frequently in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). Adjuvant chemotherapy was administered more frequently in the palpable breast cancer group than in the nonpalpable breast cancer group. However, radiotherapy and hormonal therapy were performed more frequently in nonpalpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). According to a multivariate analysis, younger age, lower body mass index, larger tumor size, tumor location, higher stage, higher histologic grade and higher Ki-67 index were associated with palpability (p<0.001). DSS was significantly lower in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). @*Conclusion@#Palpable breast cancers tend to be triple negative breast cancers and have higher histologic grade and, Ki-67 index and worse prognosis than nonpalpable breast cancers. Therefore, based on the results of the present study, treating palpable breast cancers requires careful attention.

The Clinicopathological Characteristics of Palpable and Non-palpable Breast Cancer

Purpose@#Palpability is known to be a poor prognostic factor for breast cancer. The present study analyzed the clinicopathological characteristics and outcomes of palpable and nonpalpable breast cancers using big data. @*Methods@#Between January 2005 and May 2019, a total of 15,141 patients were enrolled. All patients were diagnosed with invasive ductal carcinomas. Patients with unclear medical records, multiple tumors, bilateral breast cancers, inflammatory breast cancers, inoperable breast cancers and distant metastasis were excluded. Patients were divided into the palpable and nonpalpable breast cancer groups based on physicians’ clinical examinations. The clinicopathological characteristics and disease-specific survivals (DSS) were analyzed. @*Results@#Patients with palpable breast cancers were younger, had larger tumors, and higher tumor-node-metastasis stage (p<0.001) than patients with nonpalpable breast cancers. Palpable breast cancer cases had higher rates of lympho-vascular invasion, higher histologic and nuclear grades than nonpalpable breast cancer cases (p<0.001). The positive proportion of hormone receptor was higher in the nonpalpable breast cancer group than in the palpable breast cancer group, but that of human epidermal growth factor receptor 2 was higher in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). The Ki-67 index was higher in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). Total mastectomy and axillary dissection were performed more frequently in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). Adjuvant chemotherapy was administered more frequently in the palpable breast cancer group than in the nonpalpable breast cancer group. However, radiotherapy and hormonal therapy were performed more frequently in nonpalpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). According to a multivariate analysis, younger age, lower body mass index, larger tumor size, tumor location, higher stage, higher histologic grade and higher Ki-67 index were associated with palpability (p<0.001). DSS was significantly lower in the palpable breast cancer group than in the nonpalpable breast cancer group (p<0.001). @*Conclusion@#Palpable breast cancers tend to be triple negative breast cancers and have higher histologic grade and, Ki-67 index and worse prognosis than nonpalpable breast cancers. Therefore, based on the results of the present study, treating palpable breast cancers requires careful attention.

Spindle epithelial tumor with thymus-like differentiation of the thyroid in a 70-year-old man

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare tumor of the thyroid gland mostly occurring in young patients. The imaging findings of SETTLE tumors are yet to be defined. However, they are usually described as well-defined heterogeneously enhanced masses on CT scan. The current case has the potential growth as compared with a 2009 chest radiography. We took into account the possibility of SETTLE in the case of a bulky mass in patients over 70 years old, particularly in the lower neck. Herein, we report a case of the oldest patient so far. The patient underwent a right lobectomy of the thyroid and mass excision. Follow-up CT scans after 6 months revealed no local recurrence. Surgery is the gold standard treatment for SETTLE. Chemotherapy and radiotherapy could be another possible option for patients with advanced stage SETTLE.

Clinicopathologic Characteristics of Pregnancy-Associated Breast Cancer: Results of Analysis of a Nationwide Breast Cancer Registry Database / 한국유방암학회지

PURPOSE: This study aimed to evaluate the clinicopathological characteristics of pregnancy-associated breast cancer (PABC) in comparison with non-pregnancy associated breast cancer (non-PABC). METHODS: A total of 344 eligible patients with PABC were identified in the Korean Breast Cancer Society Registry database. PABC was defined as ductal carcinoma in situ, invasive ductal carcinoma, or invasive lobular carcinoma diagnosed during pregnancy or within 1 year after the birth of a child. Patients with non-PABC were selected from the same database using a 1:2 matching method. The matching variables were operation, age, and initial stage. RESULTS: Patients with PABC had significantly lower survival rates than patient with non-PABC (10-year survival rate: PABC, 76.4%; non-PABC, 85.1%; p=0.011). PABC patients had higher histologic grade and were more frequently hormone receptor negative than non-PABC patients. Being overweight (body mass index [BMI], ≥23 kg/m²), early menarche (≤13 years), late age at first childbirth (≥30 years), and a family history of breast cancer were more common in the PABC group than in the non-PABC group. Multivariate analysis showed the following factors to be significantly associated with PABC (vs. non-PABC): early menarche (odds ratio [OR], 2.165; 95% confidence interval [CI], 1.566–2.994; p<0.001), late age at first childbirth (OR, 2.446; 95% CI, 1.722–3.473; p<0.001), and being overweight (OR, 1.389; 95% CI, 1.007–1.917; p=0.045). CONCLUSION: Early menarche, late age at first childbirth, and BMI ≥23 kg/m² were more associated with PABC than non-PABC.

Incidence and Predictive Factors of Central Neck Node Metastasis in Patients with T1, T2 Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Thyroidectomy without prophylactic central neck dissection may be recommended for small (T1 or T2) papillary thyroid carcinoma (PTC). The aim of this study was to determine the incidence and predictive factors of central cervical lymph node metastasis in T1/2 papillary thyroid carcinoma. METHODS: A retrospective review of 877 patients with T1/2 PTC who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from March 2007 to February 2014 was performed. The clinicopathologic results were reviewed and the incidence and predictive factors of central cervical lymph node metastasis (LNM) were analyzed. RESULTS: The overall frequency of central LNM was 29.8%. In univariate analysis, male, younger age, bilaterality, multifocality, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were associated with central LNM. In multivariate analysis, younger age, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were independent variables of central LNM. CONCLUSION: Central LNM is associated with younger age, larger tumor, lymphovascular invasion, and lateral lymph node metastasis in small (T1/2) PTC patients. Prophylactic central lymph node dissection should be considered in patients with risk factors.

Complication after Total Thyroidectomy and Node Dissection for Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The typical complications after thyroidectomy are bleeding, hematoma, hoarseness, hypocalcemia, chylous fistula, etc. The aim of this study was to determine the incidence and to evaluate risk factors of complication after total thyroidectomy and lymph node dissection (ND) for thyroid cancer. METHODS: We performed a retrospective review of 623 patients with thyroid cancer and who underwent total thyroidectomy and ND and the patients were treated at our hospital from March 2007 to February 2010. The clinical features of complications were reviewed and the incidence and predisposing factors of the complication were analyzed. RESULTS: Postoperative bleeding occurred in 0.2% of the patients. The overall incidence of transient and permanent hypocalcemia was 8.5% and 0.6%, respectively. Graves disease, a decreased number of preserved parathyroid glands and an increased number of removed central lymph nodes constituted the risk factors for postoperative hypocalcemia. On multivariate logistic regression analysis, the presence of Graves disease and a decreased number of preserved parathyroid glands were the independent risk factors for postoperative hypocalcemia. Hoarseness occurred in 1.6% of the patients. The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.5% and 0.3%, respectively. CONCLUSION: Total thyroidectomy with ND is a safe procedure because the overall incidence of postoperative complications is low. Careful surgery is required for thyroid cancer patients with Graves disease. Parathyroid gland insufficiency is the important cause of hypocalcemia after total thyroidectomy and ND. To reduce voice change, careful dissection is required around the recurrent laryngeal nerve and excessive tracheal traction should be avoided.

Retroperitoneal Mucinous Cystadenoma

We present a case of a primary retroperitoneal mucinous cystadenoma, which is a relatively rare tumor found exclusively in women. This tumor is difficult to correctly diagnose preoperatively. Although there is little published information regarding the CEA levels in the cystic fluid of cystic tumors arising in the retroperitoneum, a high CEA level in the cystic fluid is a useful diagnostic marker for a primary retroperitoneal mucinous tumor. The appropriate management of retroperitoneal mucinous cystadenomas is the total removal of the cyst. The retroperitoneal approach for retroperitoneal cystic tumors is useful, has a lower risk of traumatizing the bowel than the intra-abdominal approach, and does not require compression of the other organs. We report the successful resection of a retroperitoneal mucinous cystadenoma through the retroperitoneal approach.

A case of jejuno-jejunal intussusception caused by a small intestinal lipoma / 대한내과학회지

Intussusception is a prolapse of a segment of the intestine into the lumen of the adjacent intestine. The majority of intussusceptions occur in infancy and early childhood. Intussusception arising in adulthood represents only about 5% of all intussusceptions and is usually caused by a malignant small bowel lesion acting as an apex for intussusception. Lipoma is not a common tumor in the gastrointestinal tract, and gastrointestinal lipomas may be submucosal or subserosal. Most of them are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. Intestinal intussusception caused by lipoma is uncommon and is particularly rare when the lipoma is located in the small intestine. We report an unusual case of intussusception in an adult male patient, which was caused by a lipomatous lesion located in the proximal jejunum acting as a lead point.

Combination Chemotherapy with 5-Fluorouracil and Heptaplatin as First-line Treatment in Patients with Advanced Gastric Cancer

Heptaplatin is a recently developed platinum derivative. This agent has been reported to have a response rate of 17% as a single agent, and tolerable toxicity in the treatment of advanced gastric cancer. The aim of this study was to evaluate the efficacy and toxicity of a combination of 5-fluorouracil (5-FU) and heptaplatin in patients with advanced gastric cancer. Forty-seven chemotherapy-naive patients with advanced or recurred gastric cancer were recruited. 5-FU was administered over 120 hr by continuous intravenous infusion from day 1 to 5, at a daily dose of 1,000 mg/m2 and heptaplatin was administered over 1 hr by intravenous infusion on day 1 at 400 mg/m2, and this cycle was repeated every 4 weeks. The response rate was 21%, median progression-free survival was 1.9 months (95% CI, 1.6 to 2.2 months). Median overall survival was 6.2 months (95% CI, 4 to 8.4 months) and the 1-yr survival rate was 29% for all patients. The most frequent toxicity was proteinuria. Toxicities were generally mild and reversible. This study demonstrates that the combination of 5-FU/heptaplatin combination is less active but tolerated in patients with advance gastric cancer.

Appendiceal Mucocele

PURPOSE: An appendiceal mucocele refers to an abnormal dilatation of the appendiceal lumen by mucus. It is a rare clinical entity with a reported prevalence rate of 0.2~0.3% of all appendectomies. The purpose of our study was to identify the clinical characteristics of and the proper surgical management for appendiceal mucoceles. METHODS: The hospital records of 24 eligible patients were reviewed. We analyzed demographic data, and pathological and clinical data. RESULTS: There was a significant difference in size (P<0.009) between simple mucoceles (mean, 1.95 cm) and cystadenomas (mean, 3.6 cm). While ultrasonography was the most commonly used test to establish the diagnosis (14 patients), computed tomography and colonoscopy also provided fundamental information in 5 and 2 patients, respectively. An appendectomy was performed in most cases (20 cases, 83%). A cecectomy was performed in 3 cases, and an ileocecal resection was performed in only one case. Among the cases requiring a cecectomy, a laparoscopic cecectomy was performed in one case. A synchronous tumor was present in 5 cases. Three patients had gastric cancer, 1 patient had gallbladder cancer, the other one had endometriosis. CONCLUSIONS: Our study shows that appendiceal mucoceles most frequently present as acute appendicitis and that preoperative diagnosis is difficult to make. All mucoceles should probably be removed to eliminate the chance of progression to malignancy. Also of note was the elevated incidence of associated neoplasms, especially gastrointestinal carcinomas. Some recommend surveillance colonoscopy in patients with a diagnosis of an appendiceal mucocele. We had three cases accompanied by gastric malignancy. Therefore, we suggest that surveillance gastrofiberscopy may be indicated.

Prevalence of BRCA1 and BRCA2 Mutations in Korean Breast Cancer Patients

The incidence of breast cancer in Korea has been increasing in recent years, such that it is now the most common female cancer. Breast cancer in Korea is characterized by an earlier age of onset than in Western countries, suggesting that it would be related with genetic background. We assayed germline mutations in the BRCA genes to evaluate their genetic pathology in Korean breast cancer patients. The study subjects consisted of 173 patients at clinically higher risk and 109 unselected patients. Germline mutations in the entire coding sequences of the BRCA1 and BRCA2 genes were analyzed by Conformation-Sensitive Gel Electrophoresis (CSGE), and any aberrantly-sized band was sequenced. BRCA mutations were present in 12.7% of the high risk patients, compared with 2.8% of the unselected patients. Among high risk patients, mutations were most prevalent in patients with a family history of breast or first-degree ovarian cancer (22.1%), followed by those with male breast cancer (20%), bilateral breast cancer (20%), multiple organ cancer including breast (13%) and younger breast cancer patients (aged<35 yr) (8.1%). Moreover, BRCA mutations were detected in 34.8% of patients having two highrisk factors. These findings suggest that BRCA gene mutation analysis should be performed on Korean patients with high-risk factors for breast cancer.

Bfl-1 Gene Expression in Breast Cancer: Its Relationship with other Prognostic Factors

The Bfl-1 gene, which was isolated from human fetal liver and only recently described, is a member of the Bcl-2 gene family. Reverse transcriptase-polymerase chain reaction was performed on RNA drawn from 30 breast cancer tissues to compare the expression of the Bfl-1 gene with other prognostic factors. The median relative ratio was 3.0 (range, 0.12-26.83) and the Bfl-1 gene expression rate was 36.7% (11/30). There was no statistically significant relationship between the clinicopathologic parameters of patients and the expression value of Bfl-1 gene. The level of Bfl-1 gene expression was higher in more advanced breast cancers than in early cancers. There was no significant relationship between the expression values and currently acknowledged prognostic factors, but a higher expression pattern was noticed in the groups of positive hormone receptors and negative p53 and negative c-erbB2, albeit statistically not significant. It seems that the increased expression of the Bfl-1 gene serves as a contributory factor in breast cancer, in the same way that another group of genes, the Bcl-2 family, contributes to apoptosis.

A Case of Small Bowel Obstruction Caused by Cytomegalovirus Infection

The human cytomegalovirus (CMV), a member of the herpes virus family, can cause a lifelong infection with episodes of endogenous reactivation. Almost the entire adult Korean population has been infected with CMV; they have serum CMV antibodies of IgG class. Reactivation is clinically silent in immunocompetent individuals. Symptomatic illness, such as pneumonitis, retinitis, hepatitis or gastroenteritis, is usually confined to immunocompromized patients. The colon, stomach and esophagus are the organs frequently infected with CMV in these patients. A CMV infection may also complicate an inflammatory bowel disease. CMV enteritis involving the small bowel, which makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation, but rarely evokes obstruction. The authors experienced a case of CMV enteritis of the terminal ileum, presenting as an intestinal obstruction, which developed in an immunocompetent individual with no underlying disease. This appears to be a world first.

Study of Capsaicin-induced Apoptosis in Human Colon Cancer Cell Lines

PURPOSE: Numerous investigations have been conducted in order to determine the potential carcinogenic or chemopreventive activity of capsaicin. The aim of this study is to characterize the effects of capsaicin on colon cancer cells, and provide valuable information concerning the application of capsaicin in chemoprevention as well as for therapeutic purposes. METHODS: CoLo320DM and LoVo cells (human colon cancer cell line) were treated with capsaicin. In order to access cell viability and altered morphology, an MTT assay was performed and the cells were microscopically examined. Decreasing DNA staining was accessed by FACS. The cells were stained with FITC labeled annexin V and analyzed by FACS to detect cellular membrane alteration during apoptosis. The cells were stained with DiOC6(3) and Hydroethidine and analyzed by FACS in order to access ROS and dleta psi m. RESULTS: Capsaicin decreased cell viability in a dose-dependent manner. Capsaicin produced a cell morphology corresponding to the apoptotic features including cell shrinkage and chromatic condensation. Capsaicin treated cells induced a loss of nuclear DNA leading to hypoploidy in a dose-dependent manner. Cells were excluded by double staining with PI and FITC labeled annexin v and detected by FACS. We show that treatment of CoLo320DM, L0Vo cells with increasing concentrations of capsaicin parallel an increase in the percentage of red fluorescent cells (HE-->Eth) that reflect ROS hypergeneration and a decrease in the percentage of green fluorescent cells that reflect delta psi m disruption. CONCLUSION: These results clearly demonstrate that capsaicin-induced colon cancer cell death is apoptotic.

Expression of a Novel 90 kDa Heat Shock Protein in Colorectal Tumor

PURPOSE: When cells are subjected to a wide variety of stressful stimuli, they respond by increasing the synthesis of specific stress proteins. Stresses include heat shock, nutrient deprivation, oxygen radicals, toxic metal and viral infection. Major stress proteins are Hsp 27, Hsp 60, Hsp 70 (9), Hsp 90 (3) and Hsp 100 (1). Previously a novel 90 kDa stress protein has been reported to be induced in fish cells by virus infection. The novel 90 kDa stress protein is different from well-known major stress protein in size, antigenicity, cellular localization. The novel 90 kDa stress protein was found to be present in various kinds of cells including human cells and its expression was increased in human carcinomas. The purpose of this study is to evaluate the expression of the novel 90 kDa stress protein in human colonic mucosa of normal tissue, adenoma and adenocarcinoma using immunohistochemical method. METHODS: 85 colon tissues were screened for the expression of the novel 90 kDa stress protein; 85 normal colonic mucosa, 20 colonic adenoma and 65 colonic adenocarcinoma. The tissues were stained with monoclonal antibody against the novel 90 kDa stress protein. In scoring system, tissue sections with immunostained area above 10 % were decided to be positive and, among the positive, the tissue sections were divided into three score, 1, 2, and 3, based on the staining intensity and positive area proportion. The tissue sections with immunostained area below 10% were decided to be negative and grouped into 0 score. Correlation of immunohistochemical expression was analysed by using SPSS version 10.0 statistically. RESULTS: The expression of the 90 kDa stress protein was significantly different among normal colonic mucosa, colonic adenoma, and colonic adenocarcinoma and the percentage of positive samples were 14.1%, 80.5%, and 95.4% respectively. This result suggests that the expression level of the novel 90 kDa stress protein was extremely low in normal tissue but increased significantly in adenocarcinomatous tissues. CONCLUSIONS: The expression of the novel 90 kDa stress protein was increased significantly with transformation of the normal colon tissue to malignancy. This suggests the possibility that this novel 90 kDa stress protein play some role in cancerous transformation of colon tissue.

Clinical Analysis of Breast Cancer Surgeries in Korea

PURPOSE: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION: This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.

Clinical Analysis of Breast Cancer Surgeries in Korea

PURPOSE: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION: This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.

The Cold Preservation of Mice Hepatocytes Induces Apoptosis but Not over Expression of MHC Class I Antigen / 대한이식학회지

Hepatocyte transplantation is a potential treatment modality for liver diseased patients. Purified hepatocytes stimulates allospecific cytotoxicity by expressing the MHC class I antigen. Also, during cold preservation, hepatocytes are damaged by lipid peroxidation with oxygen free radicals, which may induce apoptosis on cold preserved hepatocyte. For measuring the degree of antigenicity on cold- preserved mice hepatocytes with UW solution, we studied the expression of MHC class I antigen in various time period by FACS and RT-PCR. For analysis of apoptotic hepatocyte death, we studied morphological changes and DNA fragmentation. We used flow cytometry techniques with rhodamine 123,3,3'-dihexiloxadicarbocyanine (DiOC6 (3)) and propidium iodide (PI). DiOC6 (3) is mitochondrial probe to measure the mitochondrial transmembrane potential that drops early in apoptosis. The percentage of cells undergoing chromatinolysis (subdiploid cells) was determined by ethanol fixation followed by RNA digestion and PI staining. The cold preserved hepatocytes expressed MHC class I constitutively, but revealed no significant differences among various preservation period. However, apoptosis of hepatocytes occured progressively during cold preservation. These results provides that the cold preservation of mice hepatocyte induces apoptosis with involvement of an oxidative process, but does not stimulate over expression of MHC class I antigen.