Non-Spine Bone Metastasis as an Initial Manifestation of Cancer in Korea

김완림,한일규,강승철,이상아,김한수 대한의학회 2014 Journal of Korean medical science Vol.29 No.3

Non-spine bone metastasis accounts for approximately 20% of all skeletal metastases, butlittle data have been published that focused on bone metastasis to the pelvis andextremities as an initial manifestation of cancer. We determined 1) clinicopathologiccharacteristics of patients who presented with non-spine bone metastasis of unknownprimary malignancy, and 2) process by which the diagnosis of primary cancer was made. We retrospectively reviewed 84 patients with bone metastasis of unknown primary cancersite at the time of presentation. The study population consisted of 56 men and 28 women,with a mean age of 59.1 yr (17.5-85.6 yr). The average follow-up period was 20.8 months(1-120 mo). Primary cancer site was identified in 79 patients (94.0%), and was determinedto be the lung (46.4%), kidney (13.1%), liver (9.5%), thyroid (8.3%), and prostate (4.8%). Five-year overall survival rate was 28.0%. Multiple bone metastases, distant organmetastasis, and multiple bone with organ metastases were the significant prognosticfactors in univariate analysis. Multiple bone metastases remained significant aftermultivariate analysis (P = 0.008). Lung cancer is the most common site of primary cancer,and patients with multiple bone metastases have a poor prognosis, possibly due todisseminated cancer and a greater tumor burden.

Survey of Preferences in Patients Scheduled for Carpal Tunnel Release Using Conjoint Analysis

김완림,김진삼,이준범,김선화,민동욱,박윤호 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.1

Background: This study aimed to investigate the preferences of patients scheduled for carpal tunnel release using conjoint analysis and also introduce an example of how to apply a conjoint analysis to the medical field. The use of conjoint analysis in this study is new to the field of orthopedic surgery. Methods: A total of 97 patients scheduled for carpal tunnel release completed the survey. The following four attributes were predefined: board certification status, distance from the patient's residency, medical costs, and waiting time for surgery. Two plausible levels for each attribute were assigned. Based on these attributes and levels, 16 scenarios were generated (2 × 2 × 2 × 2). We employed 8 scenarios using a fractional factorial design (orthogonal plan). Preferences for scenarios were then evaluated by ranking: patients were asked to list the 8 scenarios in their order of preference. Outcomes consisted of two results: the average importance of each attribute and the utility score. Results: The most important attribute was the physician's board certificate, followed by distance from the patient's residency to the hospital, waiting time, and costs. Utility estimate findings revealed that patients had a greater preference for a hand specialist than a general orthopedic surgeon. Conclusions: Patients considered the physician's expertise as the most important factor when choosing a hospital for carpal tunnel release. This suggests that patients are increasingly seeking safety without complications as interest in medical malpractice has increased.

인공고관절 전치환술에서 보편적 측방 도달법과 단일 절개 최소 침습적 측방 도달법과의 비교 분석

김완림 ( Wan Lim Kim ),장작 ( Jak Jang ),강승백 ( Seung Baik Kang ),이지호 ( Ji Ho Lee ),윤강섭 ( Kang Sup Yoon ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.3

목적: 인공고관절 전치환술 시 기존의 직접 측방 절개법(15~20 cm)과 최소 침습적 측방 절개법(<8 cm)으로 시행한 술례를 비교 분석하였다. 대상 및 방법: 직접 측방 접근법으로 시행된 총 80예의 인공고관절 전치환술을 대상으로 최소 침습 절개 군과 기존의 절개 군을 40명씩 무작위으로 구분하였으며 기존 절개 군은 Hardinge 접근법을 사용하였으며 최소 침습 절개 군은 대전자부 첨단을 중심으로 전상방에서 후하방으로 8 cm 정도의 피부절개를 하였다. 결과: 피부 절개에서 봉합까지 수술 시간은 최소 침습 군이 짧았으며(p=0.03) 흡입 배액관을 통한 배액량도 최소 침습 군이 적었다(p=0.02). 실혈양, 대퇴 스템 정렬, 비구 컵 경사도, 술 후 통증과 파행, Harris Hip Score, 감염률 등에서는 차이가 없었다. 최소 침습 군에서 고관절 아탈구 1예, 비구 골절 1예 등 2예의 합병증(5.0%)이 발생되었고, 1예의 대퇴 스템 내반 삽입이 있었다. 결론: 최소 침습법은 수술 시간과 실혈량의 의미있는 감소와 같은 장점이 있지만 기존 인공 고관절 전 치환술이 장기 생존률과 안정성에서 이미 검증되었고 최소 침습법은 좁은 수술 시야로 인해 문제 발생 가능성이 있으므로 충분한 수술 술기의 숙련 후 시행하는 것이 바람직할 것으로 사료되었다. Purpose: We compared the outcomes of primary consecutive THAs performed via the direct lateral approach through minimally invasive incisions (<8 cm) and through standard incisions (15~20 cm). Materials and Methods: Eighty primary consecutive THAs were performed via direct lateral approach through minimally invasive incisions or through standard size incisions. The standard incision is Hardinges direct lateral approach. For the MIS group, an approximately 8 cm long oblique skin incision was made centered at the tip of the greater trochanter and running anterosuperiorly to posteroinferiorly. Results: The surgical time was shorter (p=0.03) and the average amount of Hemovac drainage was smaller (p =0.02) in the MIS group. Alignment of the femoral stem and acetabular cup, post-operative pain and limping, HHS, and infection rate were no different between the two groups. In the MIS group, two complications (5.0%) occurred (one lateral positioning of the acetabular cup, one intra-operative acetabular fracture), and one varus stem insertion occurred. Conclusion: Minimization of the skin incision length for primary THAs performed via the direct lateral approach appears to have benefits with regard to shortening the wound closing time and decreasing the amount of postoperative Hemovac suction drainage. However, the minimally exposed operative field raises technical problems, so sufficient surgical experience and training are required.

Comorbidity is Independently Associated with Poor Outcome in Extremity Soft Tissue Sarcoma

강승철,김한수,김완림,김준호,강소현,한일규 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1

Background: Comorbidity has not been examined as an independent prognostic factor in soft tissue sarcoma (STS). We examinedthe prognostic impact of comorbidity on oncologic outcome in STS with an adjustment for possible confounding factors. Methods: A retrospective review was performed on 349 patients who had undergone surgery for high-grade localized STS ofextremity at our institute. Conditions known to alter the risk of mortality, as defined in the Charlson comorbidity index, were classifiedas comorbidities and 43 patients (12%) had at least one comorbidity at the time of surgery. The association of comorbidity andoncologic outcomes of local recurrence-free survival (LRFS) and disease-specific survival (DSS) were tested with adjustment forconfounding factors. Results: Comorbidity was associated with old age, high tumor grade, and large tumor size. The presence of comorbidity was independentlyassociated with poor LRFS and DSS, even after adjusting for confounding factors including age and treatment variables. Conclusions: Our data suggest that the presence of comorbidity is an independent prognostic factor for extremity STS.

Clinicopathologic Characteristics and Clinical Outcome of Localized Liposarcoma: A Single-Center Experience over 25 Years and Evaluation of PD-L1 Expression

채희정,김정은,김완림,이종석,송시열,이민희,정혜원,조경자,송준선,안진희 대한암학회 2022 Cancer Research and Treatment Vol.54 No.2

Purpose For liposarcoma (LPS), clinical course and proper treatment strategies have not been well-established. Recently, immune-checkpoint inhibitors have shown potential efficacy in LPS. We aimed to describe the clinical course of LPS and evaluate the clinical impact of programmed death-ligand 1 (PD-L1). Materials and Methods We reviewed all consecutive patients (n=332) who underwent curative-intent surgery for localized LPS at Asan Medical Center between 1989 and 2017. PD-L1 testing was performed in well-differentiated and dedifferentiated LPS. Results The median age was 56 years with males comprising 60.8%. Abdomen-pelvis (47.6%) and well-differentiated (37.7%) were the most frequent primary site and histologic subtype, respectively. During a median follow-up of 81.2 months, recurrence was observed in 135 (40.7%), and 86.7% (117/135) were loco-regional. Well-differentiated subtype (hazard ratio [HR], 0.38), abdomen-pelvis origin (HR, 2.43), tumor size larger than 5 cm (HR, 1.83), positive resection margin (HR, 2.58), and postoperative radiotherapy (HR, 0.36) were significantly related with recurrence-free survival as well as visceral involvement (HR, 1.84) and multifocality (HR, 3.79) in abdomen-pelvis LPS. PD-L1 was positive in 31.5% (23/73) and 51.3% (39/76) of well-differentiated and dedifferentiated LPS, respectively, but had no impact on survival outcomes. Conclusion Clinical course of LPS was heterogeneous according to histology and anatomic location. Clear resection margin was important to lower recurrence and postoperative radiotherapy might have additional benefit. A decent portion of well-differentiated and dedifferentiated LPS were positive for PD-L1, but its prognostic role was unclear. Further research is needed to determine clinical implications of PD-L1, especially for advanced-stage LPS with unmet needs for effective systemic treatment. Purpose For liposarcoma (LPS), clinical course and proper treatment strategies have not been well-established. Recently, immune-checkpoint inhibitors have shown potential efficacy in LPS. We aimed to describe the clinical course of LPS and evaluate the clinical impact of programmed death-ligand 1 (PD-L1).Materials and Methods We reviewed all consecutive patients (n=332) who underwent curative-intent surgery for localized LPS at Asan Medical Center between 1989 and 2017. PD-L1 testing was performed in well-differentiated and dedifferentiated LPS.Results The median age was 56 years with males comprising 60.8%. Abdomen-pelvis (47.6%) and well-differentiated (37.7%) were the most frequent primary site and histologic subtype, respectively. During a median follow-up of 81.2 months, recurrence was observed in 135 (40.7%), and 86.7% (117/135) were loco-regional. Well-differentiated subtype (hazard ratio [HR], 0.38), abdomen-pelvis origin (HR, 2.43), tumor size larger than 5 cm (HR, 1.83), positive resection margin (HR, 2.58), and postoperative radiotherapy (HR, 0.36) were significantly related with recurrence-free survival as well as visceral involvement (HR, 1.84) and multifocality (HR, 3.79) in abdomen-pelvis LPS. PD-L1 was positive in 31.5% (23/73) and 51.3% (39/76) of well-differentiated and dedifferentiated LPS, respectively, but had no impact on survival outcomes.Conclusion Clinical course of LPS was heterogeneous according to histology and anatomic location. Clear resection margin was important to lower recurrence and postoperative radiotherapy might have additional benefit. A decent portion of well-differentiated and dedifferentiated LPS were positive for PD-L1, but its prognostic role was unclear. Further research is needed to determine clinical implications of PD-L1, especially for advanced-stage LPS with unmet needs for effective systemic treatment.

구연 : 혈액종양 ; 진행기/말기 암환자의 치료결정 과정에 대한 연구

오도연,고은실,김완림,김효진,권정혜,김동완,이재진,조요한,김태유,허대석,방영주,김노경 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

Twenty-eight-year experience of soft-tissue and bone sarcomas at a tertiary care hospital in Korea

임현수,정재호,김정은,김완림,이종석,조경자,송준선,송시열,정혜원,이민희,안진희 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.1

고관절의 수술적 도달법: 측방 도달법

김동옥 ( Dong Ok Kim ),김완림 ( Wan Lim Kim ),윤강섭 ( Kang Sup Yoon ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.4

The direct lateral approach was first described and named the transgluteal approach by Bauer in 1979 and was popularized by Hardinge K in 1982. In total hip arthroplasty, the direct lateral approach offers distinct advantages for the orientation of implants, access to both the acetabulum and proximal femur, and the preservation of soft tissue continuity between the gluteus medius and vastus lateralis muscle group. It can also be quite versatile, even in cases requiring extensive exposure, such as revision arthroplasty. The disadvantages include a risk of superior gluteal nerve injury, disruption of the repaired abductor mechanism, and postoperative heterotopic ossification. This review describes the surgical exposure of the direct lateral approach as well as the advantages and potential complications of the direct lateral approach.

노년층 고관절부 골절과 골다공증의 상관 관계

장작 ( Jak Jang ),김완림 ( Wan Lim Kim ),강승백 ( Seung Baik Kang ),이지호 ( Ji Ho Lee ),윤강섭 ( Kang Sup Yoon ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.4

목적: 노년층 고관절부 골절 환자의 골 밀도를 측정하여 골다공증과 노년층 고관절부 골절의 상관 관계를 알아보고 골절 예방을 위한 골다공증 약물 치료 기준점을 제시하고자 하였다. 대상 및 방법: 2004년 2월부터 2007년 4월까지 고관절부 골절로 내원한 환자 중 65세 이하와 대사성 질환이나 병적 골절 등을 제외한 172예를 대상으로 대퇴 근위부와 요추부의 골밀도를 측정하여 골절과의 상관관계 및 골절 위험 한계치를 산출하였다. 결과: 평균 골 밀도는 대퇴부 T-score -2.63, 요추부 -2.95로 정상인에 비해 저하되었고 경부 골절 군의 요추부 T-score는 -2.86, 전자간 골절 군 -3.22로 전자간 골절에서 낮게 나타났다(p=0.04). 경부 골절 군에서 비전위 골절과 전위 골절의 요추부 T-score는 -2.21, -3.10 (p=0.041), 대퇴부 -2.29, -2.76 (p=0.012)로 각각 전위골절에서 낮았다. 안정성 및 불안정성 대퇴 전자간 골절사이에는 유의한 차이가 없었다. 고관절부 골절 위험 한계치는 요추부 T-score -1.29, 대퇴 근위부 -1.15였다. 결론: 노년층 고관절부 골절 예방을 위해서는 T-score가 -1.5 이하부터 골다공증의 적극적인 치료가 요할 것으로 사료되었다. Purpose: We measured the BMD (bone mineral density) of elderly patients with hip fracture in order to understand the relationship between osteoporosis and hip fracture, and also to suggest a reference point for starting an osteoporosis treatment program. Materials and Methods: From February 2004 to April 2007, we investigated 172 elderly hip fracture patients. Their BMD was checked by DEXA (Hologic QDR-4500w, S/N 49492) at the proximal femur and at the 1st to 4th lumbar vertebrae. The average T-score of the hip fracture patients and the fracture threshold was calculated. Results: The average BMD of the patients with hip fracture was -2.63 of the T-score in the proximal femur and -2.95 of that in the lumbar vertebrae. The BMD in the patients with intertrochanteric fracture was significantly decreased compared to that of femur neck fracture (p=0.04, 0.19). For the femur neck fracture patients, the BMD of the displaced group was decreased compared to that of the undisplaced group (p=0.04, 0.01). The fracture threshold was -1.29 of the T-score in lumbar vertebrae, and the fracture threshold was -1.15 in the proximal femur. Conclusion: The BMD in elderly patients with hip fracture was significantly decreased compared that of normal people. For the prevention of hip fracture in elderly patients, we propose that the aggressive treatment of osteoporosis should be started for patients with a T-score less than -1.5.

Integrin αvβ3 Induces HSP90 Inhibitor Resistance via FAK Activation in KRAS-Mutant Non-Small Cell Lung Cancer

윤신교,양한나,류현민,이은진,조유진,서세영,김덕훈,이창훈,김완림,정경해,박숙련,최은경,김상위,박강서,이대호 대한암학회 2022 Cancer Research and Treatment Vol.54 No.3

PurposeHeat shock protein-90 (HSP90) remains an important cancer target because of its involvement in multiple oncogenic protein pathways and biologic processes. Although many HSP90 inhibitors have been tested in the treatment of KRAS-mutant non–small cell lung cancer (NSCLC), most, including AUY922, have failed due to toxic effects and resistance generation, even though a modest efficacy has been observed for these drugs in clinical trials. In our present study, we investigated the novel mechanism of resistance to AUY922 to explore possible avenues of overcoming and want to provide some insights that may assist with the future development of successful next-generation HSP90 inhibitors.Materials and MethodsWe established two AUY922-resistant KRAS-mutated NSCLC cells and conducted RNA sequencing to identify novel resistance biomarker.ResultsWe identified novel two resistance biomarkers. We observed that both integrin Av (ITGAv) and β3 (ITGB3) induce AUY922-resistance via focal adhesion kinase (FAK) activation, as well as an epithelial-mesenchymal transition, in both <i>in vitro</i> and <i>in vivo</i> xenograft model. mRNAs of both ITGAv and ITGB3 were also found to be elevated in a patient who had shown acquired resistance in a clinical trial of AUY922. ITGAv was induced by miR-142 downregulation, and ITGB3 was increased by miR-150 downregulation during the development of AUY922-resistance. Therefore, miR-150 and miR-142 overexpression effectively inhibited ITGAvB3-dependent FAK activation, restoring sensitivity to AUY922.ConclusionThe synergistic co-targeting of FAK and HSP90 attenuated the growth of ITGAvB3-induced AUY922-resistant KRAS-mutated NSCLC cells <i>in vitro</i> and <i>in vivo</i>, suggesting that this combination may overcome acquired AUY922-resistance in KRAS-mutant NSCLC.