Expression of LDH-5 in Colorectal Carcinomas: Correlation with Prognosis and Tumor Angiogenesis

PURPOSE: Lactate dehydrogenase-5 (LDH-5) is one of five isoenzymes and is the most important for anaerobic glycolysis. LDH-5 is transcriptionally regulated by hypoxia-inducible factor (HIF). HIF plays a role in the response to hypoxia by activating genes involved in vascular remodeling, cell proliferation, and erythropoiesis. In this study, we investigated the clinicopathologic significance and angiogenesis of LDH-5 expression in colorectal cancer. METHODS: We retrospectively reviewed the medical records of 83 patients with colorectal cancer who underwent a surgical resection at Soonchunhyang Cheonan Hospital from January 2001 to December 2003. LDH-5 and HIF-1alpha protein expressions were evaluated in 83 human colorectal cancer specimens. These factors were related to TNM stage, lymph node metastasis, vascular, neural, and lymphatic invasion, and prognosis. RESULTS: LDH-5 was positive in 66% (55 patients) of the tumors, and HIF-1alpha was positive in 66% (55 patients) of the tumors. LDH-5 expression was significantly associated with HIF-1alpha protein expression (P<0.001). Also, LDH-5 expression was significantly associated with TNM stage and lymph node metastasis (P<0.001) while HIF-1alpha expression was significantly associated with TNM stage (P<0.001), lymph node metastasis (P<0.001), vascular invasion (P=0.011), and lymphatic invasion (P=0.005). The survival of the patients with high LDH-5 expression was worse than that of patients with low LDH-5 expression (P=0.032). CONCLUSION: Our study shows a high expression of LDH-5 in colorectal cancer. The up-regulation of LDH-5 parallels an increase in HIF-1alpha expression. The immunohistochemical assessment of tissue LDH-5 and HIF-1alpha provides important prognostic information for colorectal carcinomas.

ERRATUM: Expression of LDH-5 in Colorectal Carcinomas: Correlation with Prognosis and Tumor Angiogenesis

No abstract available.

Expression of RhoA in Colorectal Cancers and Its Clinicopathological Significance

PURPOSE: The Rho family of GTPases are involved in actin cytoskeleton organization and are associated with carcinogenesis and progression of human cancers. The clinicopathological significance of RhoA is not yet well known in the case of colorectal cancer. To investigate the expression of RhoA protein in colorectal carcinoma and to evaluate the relationship between RhoA protein expression and invasion and metastasis of colorectal cancer, we examined the expression of RhoA protein by using Western blotting and immunohistochemistry. METHODS: The protein levels of RhoA in colorectal carcinomas of surgical specimens were analyzed in 71 consecutive patients with colorectal cancers by using immunohistochemistry and Western blotting. The relationships between the protein levels of RhoA in tumor tissues and the clinicopathological features of the patients were also assessed. RESULTS: RhoA was highly expressed in 48 colorectal carcinomas (67.6%). There was a significant association between RhoA expression and lymph nodal status. The expression of RhoA protein was related to lymph-node metastasis (P=0.032) and advanced TNM tumor staging (P=0.020). RhoA expression had a significant prognostic value for overall survival. Kaplan-Meier plots of survival in patients with high RhoA showed that high RhoA expression was associated with a shorter overall survival. However, no association was found between RhoA and other pathologic or clinical variables, including age, gender, degree of differentiation, and presence of perineural spread. CONCLUSIONS: The RhoA protein may be related to malignant transformation and development of colorectal caricinomas and may play an important role in the invasion and the metastasis of colorectal carcinomas.

Expression of HER-2/neu and Paxillin in Ductal Carcinoma in situ, Invasive Ductal Carcinoma with Ductal Carcinoma in situ and Mucinous Carcinoma / 한국유방암학회지

PURPOSE: We purpose to determine the correlation of HER-2/neu and paxillin expression in ductal carcinoma in situ (DCIS), invasive ductal carcinoma with ductal carcinoma in situ (IDC with DCIS) and mucinous carcinoma. METHODS: To evaluate the expression of HER-2/neu and paxillin, the immunohistochemical staining was performed for 13 cases of DCIS, 13 cases of IDC with DCIS and 6 cases of mucinous carcinoma. RESULTS: The DCIS and IDC were associated with infiltration of the inflammatory cells, especially in the comedo type and solid type of tumor. In cases with infiltration of the inflammatory cells, HER-2/neu and paxillin were strongly expressed. When comparing the expression level of HER-2/neu from adjacent normal tissue between DCIS and IDC with DCIS, expression of HER-2/neu was similar to that of normal tissue adjacent to DCIS. However, in the adjoining normal ductal epithelial cells, paxillin was highly expressed in cells of all of the tumor types, and especially for IDC with DCIS. HER-2/neu and paxillin were not expressed in mucinous carcinoma cells in all cases. CONCLUSION: HER-2/neu in the DCIS and IDC with infiltration of inflammatory cells shows higher expression than non-inflammatory DCIS and IDC. If normal duct epithelial cells show a high level of HER-2/neu expression, the epithelial cells have a high probability of transformation into anaplastic cells. However, paxillin appears to have no value as a prognostic factor. The difference of expression of HER-2/neu between IDC with DCIS and DCIS suggests a different origin of tumor cells. The growth pattern of mucinous carcinoma cell is different from the that of DCIS or IDC cell, which grow slowly.

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Colon Cancer: Relationship to the Prognosis and Tumor Markers

PURPOSE: Angiogenesis is one of the key steps in solid tumor growth and metastasis. We investigated the prognostic significance of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1alpha (HIF-1alpha) expressions as markers of angiogenesis in colon cancer. METHODS: We retrospectively reviewed the medical records of 78 patients with colon or rectal cancer who underwent a surgical resection at Soonchunhyang University Hospital from January 2000 to December 2001, and we evaluated the expression of VEGF and HIF-1alpha in archival tumor tissues by using immunohistochemistry. We recorded the clinical and the pathological characteristics of the patients and analyzed their survival outcomes. RESULTS: Thirty-four (34) patients were male, and the mean age of all the patients was 66.7 years. HIF-1alpha and VEGF were positive in 56% (44 patients) and 53% (42 patients) of the tumors, respectively. HIF-1alpha expression was significantly associated with several pathological parameters, such as TNM stage (P=0.001), lymph node metastasis (P=0.001). HIF-1alpha expression was also associated with VEGF expression (P=0.032). The survival of patients with HIF-1alpha expression was worse than that of patients with no HIF-1alpha expression (P=0.036). However, VEGF expression was not associated with other pathological characteristics. CONCLUSIONS: We suggest that, in cases of colorectal cancer, HIF-1alpha expression may be associated with expression of VEGF, progression of tumors, and poor prognosis.

Complications Following and Supplementary Procedures for a Pancreas-preserving Total Gastrectomy

PURPOSE: A pancreas-preserving total gastrectomy (PPTG) was introduced to decrease the postoperative complications due to pancreatic resection. However, some complications, such as leakage of pancreatic juice, are still reported. Thus, the purpose of this study was to propose a supplementary procedure based on the results of treatment for gastric cancer at our hospital. MATERIALS AND METHODS: From Jan. 1997 to Dec. 2004, the cases of 141 patients who underwent a PPTG for gastric cancer were reviewed retrospectively. The patients were divided into Group A (38 cases), patients who were treated using a conventional PPTG, and Group B (103 cases), patients who were treated using a new and improved PPTG. Their postoperative complications were compared. RESULTS: No statistically significant differences in clinicopathologic data were noted between the two groups. The comparison of complications showed for groups A and B, respectively, 4 and 0 cases of pancreatic fistula, 1 and 0 cases of intraabdominal abscess, 2 and 0 cases of intraoperative pancreatic necrosis, and 2 and 2 cases of minor leakage. The difference in the prevalence of complications between the two groups was statistically significant (P=0.0001). CONCLUSION: In order to reduce the risk of PPTG-related complications, we used vascular clamps to observe the necrosis of the pancreatic tail before dividing the splenic artery, and this method resulted in a significant decrease in postoperative complications. Thus, we conclude that our use of vascular clamps in a PPTG is a simple and useful method for preventing postoperative complications.

Prognostic Value of Apoptosis and the Survivin, bcl-2, and p53 Expressions in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Survivin is a member of the inhibitor of apoptosis (IAP) protein family, and it is involved in the regulation of cell division. The over-expression of survivin has been reported to be associated with the parameters for a poor prognosis in most human cancers, including lung, breast, colon, stomach, esophagus, pancreas, etc. In this study, we examined the expression of a member of a novel IAP protein family, survivin, in breast cancer and its association with tumor cell apoptosis and the overall prognosis. METHODS: 80 cases of formalin-fixed paraffin-embedded breast cancer tissue were immunostained with, using polyclonal survivin (Novus Biologicals, Littleton, USA), monoclonal bcl-2 (DAKO, Carpinteria, USA), and monoclonal p53 antibodies (DAKO, Carpinteria, USA). The histochemical method used for the analysis of apoptosis was based on ApopTag. Peroxidase In Situ OligoLigation (ISOL) Apoptosis Detection Kit (CHEMICON International Inc. Temecula, USA). RESULTS: Immunohistochemical analysis showed that cytoplasmic survivin expression was positive in 43 of 80 cases (53.8%) of breast carcinomas and it was positive for 70% of the cases that showed a bcl-2 expression tumors. Statistical analysis revealed that the survivin expression was correlated with lymph node metastasis, the tumor stage, and the histological grade. Although the survivin expression was not correlated with p53 mutations, the survivin positive cases were associated with a bcl-2 expression (p=0.015) and a reduced apoptotic index (p=0.024). On the Cox proportional hazard model analysis, the apoptotic index was not identified as a significant independent predictor of overall survival (p=0.072), although the patients with a low apoptotic index ( or =0.2%). CONCLUSION: The results suggest that apoptosis inhibition of apoptosis by survivin may be a prognostic parameter for a worse outcome in breast carcinoma patients.

Circular Stapled Billroth I Anastomosis after Distal Subtotal Gastrectomy : Anastomotic Complications and Prevention

PURPOSE: The circular stapled Billroth I gastrectomy has been gradually popularized because of several advantages. Thus, this study aims to identify what to be supplemented for the safety of this technique by examining the potential complication after the circular stapled Billroth I gastrectomy. MATERIALS AND METHODS: This study selected 594 patients who underwent the circular stapled Billroth I gastrectomy because of the gastric cancer in our department of surgery from Jan. 1998 to Dec. 2004 as the subjects. As of Jan. 2001 when the bleeding on the anastomosis site was visually checked through the small incision at the opposite curvature to the lesion of the stomach to be resected and so the operation was completed, the patients were divided into the Group I (n=219) and Group II (n=375), which were the patients before and after Jan. 2001, respectively. Then, the clinical characteristics and postoperative anastomotic complications of both groups were compared. RESULTS: For the comparison of complications between two groups, the anastomotic leakage was found in four cases in Group I and three cases in Group II (p=0.196). The stenosis on the anastomosis region was not observed in both groups. The bleeding on the anastomosis region illustrates the statistically significant difference between Group I and Group II, with 43 cases and 2 cases, respectively (P=0.019). CONCLUSION: The circular stapled Billroth I gastrectomy is recommended because of several advantages of this technique. However, the bleeding on the anastomosis site may be indicated as the critical issue. Accordingly, the visual check on the bleeding on the anastomosis site during the operation will improve the safety of circular stapler.

Surgical Management of Traumatic Liver Injury

PURPOSE: The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. Patients with liver injury can be treated by using nonoperative or operative management. The aim of this study was to study patients with traumatic liver injury who were treated by using operative management. METHODS: Ninety-eight patients with traumatic liver injury underwent surgical treatment from January 1995 to December 2004 at Soonchunhyang University Cheonan hospital. Medical records were reviewed retrospectively, and demographic, clinical, operative, and postoperative datas were collected and analyzed. RESULTS: Among the patients with operative management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 1.9:1. The most frequent injury mechanism was blunt trauma (85.7%). Abdominal computed tomography was the diagnostic modality used most frequently. Severe liver injury above Grade III was seen in 80.6% of all patients, and long bone fracture was the most common combined injury. Patients were managed by using various techniques, including simple closure, liver resection, and perihepatic packing. Pulmonary complications were the most common postoperative complications (35.7%). the overall mortality rate was 17.3%. Between the survival group and the expired group, the amount of transfusion for the expired group was statistically more than that for the survival group. CONCLUSION: Operative management is an effective treatment modality for hemodynamically unstable patients with severe traumatic liver injury. The amount of transfusion is a significant prognostic factor for survival.

A Case of Hungry Bone Syndrome after Parathyroidectomy in Patient with Tertiary Hyperparathyroidism and Hemodialysis Patient / 대한내분비외과학회지

Hyperparathyroidism is a common finding in patients with chronic renal failure. Among the hyperparathyroidism, tertiary hyperparathyroidism, which is secreting parathyroid hormone autonomously in spite of hypercalcemia. Sometimes it requires surgical intervention due to not only symptomatic hypercalcemia, but also longstanding asymptomatic hypercalcemia. Hungry bone syndrome was known to be developed due to extensive re-mineralization of skeleton after parathyroidectomy. It is characteristic of persistent hypocalcemia, hypophosphatemia and often with tetany. The patient's condition improved without complication after the calcium chloride and calcium carbonate administration. We report a case of hungry bone syndrome developed after parathyroidectomy in patient with tertiary hyperparathyroidism and chronic renal failure.

Expression of E-cadherin and Clinical Correlation in Patients with Breast Carcinoma / 한국유방암학회지

PURPOSE: E-cadherin is a Ca (2+)-dependent cell adhesion molecule that plays an important role in normal growth and development via the mediation of homotypic, homophilic cell-cell interactions. Recent studies suggest that E-cadherin may also be important in neoplastic progression, particularly as a suppressor of invasion. METHODS: To evaluate the expression of E-cadherin, according to the histopathological features and the relation between E-cadherin and prognosis in breast carcinoma, immunohistochemical staining, using mouse HECD-1 was performed for 66 cases of breast carcinoma. RESULTS: The breast carcinomas showed loss or marked reduction of E-cadherin expression in 42 (63.6%) of the 66 cases. In a multivariate analysis, E-cadherin expression had no independent prognostic value, while the axillary lymph node status, tumor diameter, and TNM stage were independent prognostic factors. The results indicate that E-cadherin expression was related to several histological features in breast cancer, but had no independent prognostic value over standard prognostic factors. No significant correlation was found between E-cadherin expression and tumor size, stage, nuclear grade, lymph node status, histologic type, or hormonal status. CONCLUSION: The loss or marked reduction of E-cadherin expression in breast carcinomas was not related to the prog nosis of the patients.

Clinical Correlation of HER-2/neu Overexpression in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer is a common malignant tumor for Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, and particularly for HER-2/neu; however, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the HER-2/neu antigenic protein in breast cancer patients to evaluate the expression rate of this antigenic protein, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 100 patients who were diagnosed with breast cancer and who were treated with mastectomy between January 1996 and December 1999 at Soonchunhyang University Cheonan Hospital were selected according to the tissue condition of the paraffin block fixations. The prognostic factors were then investigated. The immunohistochemical expression of HER-2/neu was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: One hundred patients were included in this study, had a mean (SD) age of 47.9 (plus or minus 10.5) years and a follow-up duration of 59.9 (plus or minus 13.3) moths The overall mortality was 35% (35/100) and the mean survival time (SD) was 64.4 (plus or minus 12.0) months. The overall 5-year survival rate was 77.0%. Among the study variables, the tumor stage was a significant predictor of survival, and it as associate with a significantly low survival rate for stage III tumor. Lymph node metastasis, hormonal receptor status, histologic grade and HER-2/neu overexpression were significantly associated with the survival rate for patients with breast cancer. CONCLUSION: HER-2/neu is a very useful prognostic factor, and statistical significance was achieved for this factor.

Expression of Survivin in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Survivin is a member of the inhibitor of apoptosis (IAP) family, which is also involved in the regulation of cell division and is also overexpressed and associated with parameters of poor prognosis in most human cancers, including carcinomas of the lung, breast, colon, stomach, esophagus and pancreas. This study examined the expression patterns of survivin in normal breast tissue, atypical hyperplasia, primary breast cancer and lymph node tissues involved with breast cancer and to determined whether the expression of survivin is associated with the characteristics and prognosis of breast cancer. METHODS: Formalin-fixed paraffin-embedded samples from 80 breast cancer, 20 atypical hyperplasia and 20 malignant lymph node tissue cases were immunostained using polyclonal survivin (Novus Biologicals, CO). The degree of immunostaining was recorded on a scale of 0-3 according to the percentages of staining and distributions within the cytoplasm & nucleus. RESULTS: Survivin was expressed in 52, 14 and 17 of the 80 breast cancer (65%), atypical hyperplasia (70%) and breast cancer lymphoid (85%) specimens respectively. Among those expressing cancer, 11.3, 31.3 and 22.5% demonstrated nuclear staining only, cytoplasmic staining only and both nuclear and cytoplasmic staining respectively. A statistical analysis revealed that cytoplasmic survivin expression was correlated with the stage, histological grade and L/N metastasis. In a Cox proportional hazard model analysis, the expression of survivin was not identified as a significant independent predictor of overall survival (P=0.168), although the decrease in the survival rate of survivin-positive patients did reach statistical significance (P=0.048). CONCLUSION: Our results show that survivin is frequently overexpressed in primary breast cancer and its expression gradually increased from normal breast tissue to malignant lymph nodes. The expression of cytoplasmic survivin was common in breast cancer and could be both a useful diagnostic marker and important source of prognostic information.

A Case of Malignant Melanoma Presenting as a Breast Mass / 한국유방암학회지

Malignant melanomas arising in the skin, buccal mucous membranes. and retina are encountered frequently. A malignant melanoma characteristically disseminates widely but infrequently metastasizes to the breast, and primary melanoma of the breast is even rarer. Primary melanomas can arise in the glandular tissue of the breast. We report a case of malignant melanoma either primary in the breast or metastatic from an unknown primary that presented initially as a left breast mass without a detectable cutaneous lesion.

Abnormal Fragile Histidine Triad Gene Expression in Gastric Cancer

PURPOSE: Genomic alterations and abnormal expression of the fragile histidine triad (FHIT) gene in gastric cancer were examined to determine whether the FHIT gene is actually a frequent target for alteration during gastric carcinogenesis. MATENRIALS AND METHODS: To correlate DNA and RNA lesions of the FHIT gene with the effect on FHIT protein expression, in 40 gastric cancers, we investigated the FHIT gene for loss of heterozygisity (LOH), aberrant transcripts, and protein expression. RESULTS: Allelic loss at D3S1300 was detected in 7 of 38 (19%) informative cases. Aberrant transcripts were observed in 20 of 40 (50%) cases. Significant reduction of FHIT protein expression was observed in 22 of 40 (55%) cases. Aberrant FHIT transcription was shown to be associated with loss of FHIT protein expression. However, aberrent FHIT transcripts themselves were not associated with any clinicopathological parameters, such as age, sex, tumor site, or clinical stage. Moreover, there was no association between the presence of LOH at D3S1300 and the expression of aberrant FHIT transcripts. CONCLUSION: The high frequency of aberrant FHIT transcripts, the significant rate of LOH at D3S1300, and the altered expression of the FHIT protein indicate that alterations of the FHIT gene can play an important role in gastric carcinogenesis.

Surgical Results for Perforated Gastric Cancer

PURPOSE: Perforated gastric cancer (PGC) is rare and occurs in 1~4% of all gastric cancers. Possible dissemination of tumor cells at the time of perforation of the gastric carcinoma has been a matter of concern. The intraoperative determination of what kind of operation should be done and how extensive the lymphnode dissection should be still remains controversial. The purpose of this study is to evaluate the factors influencing the survival and to determine the optimal treatment for PGC. MATENRIALS AND METHODS: A total of 42 patients were operated on for a perforated gastric carcinoma at Soonchunhyang University Chunan Hospital from 1983 to 2000. the age and the sexes of the patients, the location of perforation, the diameter of perforation, the histologic type of the tumor, the depth of wall invasion, the absence or presence of lymph node metastasis / distant metastasis, the stage of disease, the type of operation, and the outcomes were examined. Statistically significant differences were analyzed by using Fisher's exact test. RESULTS: The stage distributions according to the UICC classification were 1 case of stage I, 6 cases of stage II, 17 cases of stage III, and 11 cases of stage IV. An emergency gastrectomy was done in 26 patients (61.9%), with a 5-yr survival rate of 44%. The survival of patients was significantly influenced by the depth of wall invasion, the lymphnode metastasis, distant metastasis, the stage of disease, and the type of operation. CONCLUSION: an emergency gastrectomy is the treatment of choice for most patients with resectable PGC. Choosing more a optimistic surgical approach for potentially curative cases of PGC should be one way to increase the patient's survival rate.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

Clinical Results and Histologic Change on Animal Model with Modified Uncut Roux Reconstruction after Gastrectomy

PURPOSE: The uncut Roux operation prevents the Roux stasis syndrome by preserving neuromuscular continuity between the proximal jejunum and the Roux limb, but this technique has an unacceptably high incidence of dehiscence of the staple lines with subsequent reflux gastritis or esophagitis. The authors designed a modified uncut procedure to avoid dehiscence of the staple lines. The aim of this study was to review whether this technique might be useful by examining the histologic change on animal study and the postoperative radiologic study of patients with modified uncut reconstruction. METHODS: Between February 1997 and December 2000, the UGI study was reviewed in 213 patients undergoing the modified uncut Roux reconstruction at Soonchunhyang University Hospital, Chunan, Korea, at 2 and 8 weeks after operation, to evaluate the incidence of dehiscence and the leakage of staple lines. Animal study included ten pigs, 5 underwent conventional uncut Roux procedure with staple, while the other 5 received reinforcing whole layer suture with black silk on the staple lines. The animals then underwent a second operation at 15 days after operation to evaluate histologic change and dehiscence of staple lines. RESULTS: Dehiscence and leakage were not found in any of the 213 patients undergoing modified uncut Roux reconstruction. In the animal study, 2 of 5 cases (40%) receiving conventional uncut Roux reconstruction had dehiscence, whereas dehiscence was absent in all 5 cases receiving modified uncut Roux reconstruction and these 5 animals showed more marked infiltration of inflammatory cells, vascular formation and more severe fibrosis on histologic examination. CONCLUSION: The conventional uncut Roux procedure suffer dehiscence of the staple lines with subsequent reflux gastritis or esophagitis. Therefore, modified uncut Roux reconstruction might prevent a jejunal leakage in the case of staple line dehiscence and might prevent dehiscence of staple lines.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

Surgical Treatment and Prognosis for Gastric Cancer in the Elderly

PURPOSE: The number of elderly patients who undergo surgery for gastric cancer has increased in recent years due to a life expectancy. To prevent fatal complications and increase the survival rate in gastric cancer patients, this study endeavored to clarify the risk factors contributing to postoperative complications in elderly patients undergoing a radical gastrectomy. METHODS: Between January 1997 and December 1998, 176 patients underwent a gastrectomy for gastric cancer. For this review, the patients were divided into two groups; 30 patients over 70 years of age (older group) and 102 patients below 70 years of age (younger group), were prepared. A retrospective study was performed to examine the factors related to the high rate of complications and to compare the operative and general complications. RESULTS: The incidences of preoperative combined disease were 56.6% in the older group and 31.3% in the younger group (p<0.05), but no significant difference in the incidence of postoperative complications (36.6% versus 38.2%) was found between the two groups. The most common postoperative complications were wound infections, pulmonary disorders, and intraabdominal infections. CONCLUSION: Despite the increased rate of preoperative combined disease in older patients, patients over 70 years are able to tolerate a radical gastrectomy for gastric cancer when optimal perioperative management is provided and blood loss is reduced.