Clinical value of an adenosine triphosphate-based chemotherapy response assay in resectable stage III colorectal cancer

PURPOSE: ATP-based chemotherapy response assay (ATP-CRA) is a well-documented and validated technology that can individualize chemotherapy. This study was undertaken to assess the usefulness of ATP-CRA in advanced colorectal cancer (CRC) patients receiving adjuvant chemotherapy. METHODS: A total of 136 patients with curative resection between January 2006 and April 2014 were evaluated using ATP-CRA. Patients received either the FOLFOX or Mayo clinic regimen chemotherapy following assay results. The sensitive-group (S-group) was defined as a drug-producing ≥ 40% reduction in ATP, and the resistant-group (R-group) as an ATP reduction of < 40%. These 2 groups were further subdivided to produce 4 subgroups: the FOLFOX sensitive subgroup (the FS subgroup [n = 65]), the Mayo sensitive subgroup (the MS subgroup [n = 40]), the FOLFOX resistant subgroup (the FR subgroup [n = 10]), and the Mayo resistant subgroup (the MR subgroup [n = 21]). Clinical responses and survival results were compared for both treatment regimens. RESULTS: The FS and MS subgroups showed a better disease-free survival rate (29% vs. 40%, 35% vs. 47.6%) and overall survival rate (92.3% vs. 80.0%, 87.5% vs. 76.2%) than FR and MR subgroups. The FS and MS subgroups showed a longer time to relapse (20.2 months vs. 9.5 months, 17.6 months vs. 16.4 months) than the FR and MR subgroups. CONCLUSION: ATP-CRA tailored-chemotherapy has the potential to provide a survival benefit in resectable advanced CRC.

Anticancer Effects of IP6 in a Human Colon Carcinoma Cell Line in Nude Mice Xenografts

PURPOSE: Inositol hexaphosphate (IP6) is a naturally occurring polyphosphorylated carbohydrate that has been shown to suppress the growth of epithelial cancer. Because IP6 is a dietary phytochemical present in cereals, soy, legumens, and fiber-rich foods, we evaluated the efficacy of IP6 against colon cancer formation. METHODS: HT-29 cells were injected into nude mice. The animals were fed a normal diet (group 1), a low IP6 diet (group 2), and a high IP6 diet (group 3) for 4 wk. Body weight, tumor volume, tumor growth rate, growth inhibition rate, and therapeutic ratio were monitored after injection of HT-29 cells. RESULTS: HT-29-cell human-colon-carcinoma xenograft mice treated with IP6 showed a significant reduction in tumor growth rate, irrespective of the IP6 dose compared to normal diet group. Compared with the control group, group 3 showed a significant reduction (45%) in tumor volume. In the therapeutic ratio gain profiles, IP6 diet groups showed a significant alteration of therapeutic ratio when compared with the normal diet group (0% vs. 11%, P=0.014). In the body weight gain profiles, group 3 showed a significant reduction of body weight compared with the other two groups (20.25 g vs. 21.6 g, 21.7 g, P=0.009). Groups 1 and 2 showed similar changes in body weight. Tumor xenografts from IP6-fed mice showed significantly decreased cancer formation and growth, but increased toxicity was noted for high doses of IP6. CONCLUSION: These results indicate that in the future, IP6 could be an effective chemopreventive or chemotherapeutic agent for use in the treatment of colon cancer.

Expression of the Insulin-like Growth Factor Binding Proteins (IGFBPs) in Colon Cancer

PURPOSE: The purpose of this study was to demonstrate the hypothesis that tussue IGFBP-2,-3, and -4 levels would differ between colon cancer tissue and adjacent normal tissue and to determine whether these factors could affect the clinicopathologic characteristics such as age, tumor stage, differentiation, serosal invasion, and CEA in patients with colon cancer. METHODS: This study group consisted of 102 patients with colorectal cancer who under went operations between January 2004 and December 2006. Postoperative colon cancer specimens and adjacent normal colon tissues were obtained immediately. Histopathologic examinations were made by on pathologist for each specimen. The gene expressions of IGFBP-2,-3,-4 in cancer and normal tissues were measured using a reverse transcriptase-polymerase chain reaction (RT-PCR). In additional, the various clinic-opathologic factors were evaluated for both tissues by comparing the IGFBP-2, -3, -4 expression densities. RESULTS: No significant difference was found in the expression of IGFBP-3, -4 between colon cancer and normal colon tissues. A statistically significant expression of IGFBP-2 was detected in the cancer specimens compared with the normal colon tissues. IGFBP-3 was significantly associated with pathologic N stage. CONCLUSIONS: This is a rare report comparing colon cancer with normal colon tissue for IGFBP expression by means of a systemical evaluation of colon cancer patients. Our data suggest that IGFBP-2 may be intimately associated with malignant phenotypes, and may confer some growth advantage on tumor cells, which means that IGFBP-2 shows a high sensitivity for colorectal cancer. Interestingly, IGFBP-3 was strongly associated with the pathologic N stage. We think further studies are needed to understand this phenomenon.

Factors Influencing Recurrence after Curative Resection for Advanced Gastric Cancer

PURPOSE: Despite radical lymph node dissection and combined resection, the operative results of treating advanced gastric cancer remains inadequate. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the pattern of recurrence after curative resection for advanced gastric cancer. METHODS: Out of 220 patients who underwent curative resection for advanced gastric cancer from 1990 to 2000, 50 whose recurrence was confirmed by clinical, radiological, endoscopic or reoperative findings were studied retrospectively. We undertook a detailed analysis of the pattern of recurrence based on the morphologic and histopathologic characteristics of the initial tumor. RESULTS: The mean time to recurrence was 19.0 months. Early recurrence was found in 38 patients (76.0%), intermediate recurrence was found in 11 patients (22.0%), and late recurrence was found in 1 patient (2.0%). The patterns of recurrence were as follows: hepatic recurrence was found in 14 cases, peritoneal recurrence in 19 cases, local recurrence in 10 cases, extraperitoneal recurrence in 6 cases. In univariate analysis, the depth of invasion, extent of lymph node metastasis, TNM stage, and combined resection were important for recurrence. In multivariate analysis, depth of invasion and lymph node metastasis were important for recurrence. CONCLUSION: The peritoneal recurrence was the most frequently encountered pattern of recurrence. The two years following surgery was the most important period for recurrence. Depth of invasion and lymph node metastasis were related to recurrence with statistical significance. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.

Huge Exophytic Atypical Medullary Breast Cancer

A medullary carcinoma of the breast is an uncommon breast cancer subtype, but has a fair prognosis. The histopathological criteria for a medullary carcinoma were delineated by Ridolfi et al. in 1977, and most pathologists use these criteria. The authors experienced a huge carcinoma of the breast, which was diagnosed as an atypical medullary carcinoma. A 47-year old female visited our clinic due to a breast mass of six months duration. The mass was 16 cm in size and exophytic in the left lower breast. There had been necrosis, with a foul odor in most of the mass. A large fixed axillary lymph node was noted, but there was no evidence of distant metastasis. A radical mastectomy was performed due to invasion of the pectoralis major. On pathological examination, the tumor was diagnosed as an atypical medullary carcinoma.

Huge Exophytic Atypical Medullary Breast Cancer

A medullary carcinoma of the breast is an uncommon breast cancer subtype, but has a fair prognosis. The histopathological criteria for a medullary carcinoma were delineated by Ridolfi et al. in 1977, and most pathologists use these criteria. The authors experienced a huge carcinoma of the breast, which was diagnosed as an atypical medullary carcinoma. A 47-year old female visited our clinic due to a breast mass of six months duration. The mass was 16 cm in size and exophytic in the left lower breast. There had been necrosis, with a foul odor in most of the mass. A large fixed axillary lymph node was noted, but there was no evidence of distant metastasis. A radical mastectomy was performed due to invasion of the pectoralis major. On pathological examination, the tumor was diagnosed as an atypical medullary carcinoma.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

Detection of Breast Mass in Mammogram Using Computer-Aided Diagnosis System / 한국유방암학회지

PURPOSE: Computer-aided diagnosis system was developed to improve the accuracy and the efficacy of the image interpretation. This article is to provide a possibility of computer- aided diagnosis for detection of masses in mammograms. METHODS: The craniocaudal and mediolateral images of 120 mammograms from 30 patients that were histologically proven to be malignant and 30 patients that were histologically proven to be benign were analysed using the mammography softwere. The contralateral mammograms were used as control images. Correct marks of the lesions were scored as a true positive and marks not at the location of the lesions were scored as a false negative. Any marks of the normal images were scored as a false positive and no mark of normal images were scored as a true negative. RESULTS: It took approximately 2 min to scan and 1 min to process 24 by 18-cm mammograms. There was an average of 1.4, 2.0 and 2.1 marks per image in normal, benign and malignant mammograms respectively. Mass detection rate of malignant lesion was 90.0% (27 of 30) and that of benign lesion was 63.6% (21 of 33). Mass detection rate of dense breasts was 68.8% (22 of 32) and that of fatty breasts was 83.9% (26 of 31). Mass detection rate of BI-RADS category 4, 5 and 0 was 85.7% (42 of 49) and that of category 1, 2 and 3 was 42.9% (6 of 14). The overall sensitivity was 76.2% and specificity was 28.1%. CONCLUSION: In this study, mass detection rate for malignant lesions was higher than that of benign lesions and dense breast has lower detection rate than fatty breast. According to the BI-RADS category, mass detection rate was higher in the more malignant category. Computer-aided diagnosis system for this study had limited specificity but acceptable sensitivity.

Analysis of Surgical Websites in Korea

PURPOSE: Recent advances in the internet have enabled us to search for large amounts of medical information. In Korea there are many websites providing medical information, but the quality and quantity of these websites relating to surgery remains to be clarified. Therefore, through the analysis of the surgical websites in Korea, the characteristics and future directions are presented. METHODS: Two hundred and thirteen websites were retrieved using three search engines: Yahoo, Lycos and Naver. We reviewed these websites, and they were classified according to their administrator, subject and content. We also recorded the presence or absence of e-mail addresses, the section on medical counseling and internet reservation. RESULTS: One hundred and sixty-eight websites (78.9%) were administrated by the local clinics. In relation to the main subjects, 94.4% of websites targeted the general public. The main contents of the websites were colorectal and anal disease (83.1%). Of the 168 websites administrated by local clinics, online medical counseling was available in 142 (84.5%) and internet reservation was possible in 39 (23.2%). Most of the local clinics' websites were located in urban area. CONCLUSION: Our study showed surgical websites were led by local clinics, which specialized in colorectal and anal disease. It is emphasized that efforts to informationalization are needed by medical schools, affiliated hospitals and medical associations, and the guidelines enabling validity of medical counseling should be put in place.

Prospective Clinical Study of Prophylactic Antibiotic Therapy in Nonperforated Appendicitis

PURPOSE: Prophylactic antibiotics have been used in nonperforated appendicitis for preventing infection after an appendectomy. However, the duration of antibiotic administration for surgical prophylaxis in Korea has been noted to be longer than those recommended in other countries. PURPOSE: The objective of this study was to identify the appropriate duration of prophylactic antibiotic therapy in nonperforated appendicitis by comparing the wound infection rates of two different antibiotic regimens, 24 hours of cephalosporin (cefoxitin) alone and 72 hours of cephalosporin (cefoxitin) with aminoglycoside (sissomicin). METHODS: One hundred thirty-four (134) patients of nonperforated appendicitis were enrolled in this prospective, randomized, open trial and were assigned to one of two antibiotic regimens: 1) cefoxitin 1 g every 8 hours given intravenously for 24 hours and 2) cefoxitin 1 g every 8 hours given intravenously plus sissomicin 75 mg every 12 hours given intramuscularly for 72 hours. First doses were given just prior to the induction of anesthesia. RESULTS: Postoperative wound infections were detected in 3 cases (4.5%) of the 72-hour-treated group (n=66) whereas none occurred in the 24-hour-treated group (n=68). However, the difference in the rates of wound infections between the two groups was not statistically significant. Cost analysis identified a saving of 43,470 won per patient in the 24-hour-treated group. CONCLUSION: In nonperforated appendicitis cefoxitin administration alone for 24 hours is sufficient as a surgical prophylaxis.

Comparison of Clinical Outcome in Para-aortic Lymph Node Dissection (PALD) and D2 for Advanced Gastric Cancer / 대한암학회지

PURPOSE: We compared the clinical results of paraaortic lymph node dissection (PALD) with those of D2 to evaluate the survival gain and disadvantage of paraaortic lymph node dissection for advanced gastric cancer. MATERIALS AND METHODS: We analysed the clinical data of 196 patients who underwent curative resection and D2 with or without paraaortic lymph node dissection (PALD or D2) for advanced gastric cancer from May 1990 to June 1999. The operative factors (operative time, the amounts of intraoperative transfusion and hospital stay), operative morbidity and mortality and 5 year survival rates were compared between D2 and PALD groups. RESULTS: The operative time of subtotal gastrectomy was significantly longer in PALD group than D2 group. The operative morbidity rates were 9.2% in D2 group and 10.3% in PALD group. There were 3 operative mortalities in D2 group and none in PALD group. The 5 year survival rates (5YSR's) of stage IB, II, IIIA, IIIB, IV were 88.9%, 92.3%, 30.2%, 24.2%, 28.9% in D2 group and 93.3%, 75.5%, 61.0%, 0%, 0% in PALD group. CONCLUSION: The paraaortic lymph node dissection was a rather safe procedure without significant increase of morbidity and mortality. There was no statistically significant difference in survival in any stage of this retrospective study with limited cases and follow-ups.