자궁경부암 진료권고안

임명철 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-

Allogeneic Blood Transfusion Given Before Radiotherapy Is Associated with the Poor Clinical Outcome in Patients with Cervical Cancer

임명철,김태현,박소희,공선영,윤정현,강석범,서상수,박상윤,김주영 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6

Purpose: To analyze the effect of allogeneic blood transfusion on clinical outcome in 119 patients with stage IIB cervical cancer who were treated with radiotherapy±chemotherapy. Patients and Methods: Medical records were examined for hemoglobin levels before and during radiotherapy, history of allogeneic blood transfusions and the time point when transfusions were given. These factors were retrospectively analyzed along with other clinical risk factors for influences on the patients’ clinical outcomes. Results: Thirty-two patients (26.9%) received packed red blood cell transfusion (mean, 3.4 units; range, 1-12 units) before or during radiotherapy. Median follow-up period was 39.3 months (range, 7.6-58.4 months). Patients with history of transfusion showed poorer metastasis- free survival and a trend toward poorer overall survival than non-transfused patients. When patients who received transfusions were sub-divided by the time of transfusion, those who received transfusions before radiotherapy had significantly poorer clinical outcome than those who received transfusions during radiotherapy. In a multivariable analysis, patients with pretreatment transfusion showed a higher risk of distant metastasis (HR=3.75, 95% CI: 1.28-12.15, p=0.017) and decreased overall survival rates (HR=4.62, 95% CI: 1.15-18.54, p=0.031) compared with those of other patients. Conclusion: Our results suggest that allogeneic blood transfusions given before radiotherapy may be associated with higher incidence of distant metastases and decreased survival in patients with stage IIB cervical cancer.

Incidence of cervical, endometrial, and ovarian cancer in Korea during 1999–2015

임명철,원영주,고문정,김미선,심승혁,서동훈,김재원 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objective: To investigate the incidence and trends of cervical (C53), endometrial (C54.1), and ovarian cancer (C56) among Korean females between 1999 and 2015. Methods: The incidence of the three major gynecological cancers between 1999 and 2015 was analyzed based on the data from the Korea Central Cancer Registry. The age-standardized rates (ASRs) and the annual percent changes (APCs) for each site were calculated. Results: The absolute incidence rates of the three major gynecological cancers increased from 6,394 in 1999 to 8,288 in 2015. ASR for gynecologic cancer decreased from 23.7 per 100,000 in 1999 to 21.1 in 2015. This was mainly due to a definitive decrease in the incidence of cervical cancer, which recorded an APC of −3.7%. The trends of APC for gynecologic cancer were variable, being −1.36% between 1999 and 2006 and −0.11% between 2006 and 2015. A definitive but variable increase was noted for endometrial cancer, and the APC for this cancer was 7.4% between 1999 and 2009 and 3.5% between 2009 and 2015. The incidence of ovarian cancer gradually increased, with an APC of 1.8% between 1999 and 2015. Conclusion: Overall, ASRs and APCs for the three major gynecological cancers are decreasing, with a recent reduction in the width of the change. However, there has been a progressive increase in the incidence of endometrial and ovarian cancers.

마음챙김 기반 인지치료(MBCT)가 부정적인 신체상을 가진 대학생의 신체상 만족도, 불안 및 자아존중감에 미치는 효과

임명철,손정락 한국건강심리학회 2012 한국심리학회지 건강 Vol.17 No.4

The purpose of this study is to explore the effects of Mindfulness-Based Cognitive Therapy (MBCT) on Body Image Satisfaction, Anxiety, and Self-Esteem in University Students with negative body image. Five hundred ten university students who lived in Chonbuk province completed the Body Esteem Test, Body Cathexis Scale, Beck Anxiety Inventory Scale and Self Esteem Scale. Eighteen patients who selected by those scales were randomly assigned to 9 in the MBCT group, and 9 in the waiting-list control group. All participants completed Body Esteem Test, Body Cathexis Scale, Beck Anxiety Inventory Scale and Self Esteem Scale at pretreatment, end of treatment, and at 4 weeks follow-up periods. MBCT program was administered for 8 sessions. The results of this study were as follows: Body Image Satisfaction(Body Esteem, Body Cathexis), Self-Esteem of therapy group were increased more than those of the waiting-list control group, and Anxiety was decreased in the therapy group. Finally, implications and limitations of this study and suggestions for future study are also discussed. 본 연구는 마음챙김 기반 인지치료(MBCT)프로그램이 대학생의 신체상 만족도, 불안 및 자아 존중감에 미치는 효과를 알아보았다. 사전 조사에서 신체 존중감 검사, 신체 만족 척도, Beck 불안 항목표, 자아 존중감 척도를 실시하여, 이를 토대로 24명을 선발하여 마음챙김 기반 인지치료 집단에 12명, 대기통제집단에 12명으로 무선할당 하였다. 치료집단에 대해 총 8회기에 걸쳐 마음챙김 기반 인지치료 프로그램을 실시하였다. 신체상 만족도(신체 존중감 검사, 신체 만족 척도), 불안 및 자아 존중감 수준은 사전, 사후 1개월 추적 기간 동안 검사를 통해 18명의 참가자(MBCT 프로그램 9명, 대기통제집단 9명)에 대한 평가가 이루어졌다. 본 연구의 결과, 마음챙김 기반 인지치료 프로그램에 참여한 집단이 대기통제집단보다 신체상 만족도와 자아 존중감이 증가되었고 불안이 감소되었으며 그 수준이 추적검사까지 유지되었다. 마지막으로 본 연구의 의의, 제한점 및 후속 연구를 위한 시사점이 논의되었다.

Identification of differentially expressed genes according to chemosensitivity in advanced ovarian serous adenocarcinomas: Expression of GRIA2 predicts better survival

임명철,유헌종,서상수,강석범,박상윤 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

To investigate the survival outcome of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced epithelial ovarian cancer. Intraoperative HIPEC (cisplatin [75 mg/m2], 41.5°C, 90 min) was performed in 30 patients with residual tumor < 1 cm after cytoreductive surgery between January 2007 and February 2008. All the patients received adjuvant chemotherapy with combination platinum and taxane. The stages of ovarian carcinoma were III (n = 25) and IV (n = 5). The histology of ovarian carcinoma was as follows: serous carcinoma (n = 24), mucinous carcinoma (n = 2),endometrioid carcinoma (n = 2), clear cell carcinoma (n = 1), and transitional cell carcinoma (n = 1). No mortality and grade IV morbidities were identified. Twenty-one grade III morbidity, requiring intervention, were identified. The most common mobidity is pleural effusion (19%) and pneumothorax (14%) at diaphragmatic stripping/resection site. Median progression free survival was 17.3 months (SE, 5.83; 95% CI 5.83-28.73). Median overall survival was 53 months (SE, 5.43; 95% CI 42.35-63-65). This is the first phase II study that concluded the efficasy and safety in ovarian cancer. Results from ongoing randomised trial (NCT01091636) of HIPEC for ovarian cancer is waited.

Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010

임명철,문은경,신애선,정규원,원영주,서상수,강석범,김재원,김주영,박상윤 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.4

Objective: To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females. Methods: Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated. Results: The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females ≥80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%). Conclusion: ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.

Different role of secondary cytoreductive surgery by surgeon's experience and hospital facility

임명철,박상윤,배재만 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.3

Endometrioid Adenocarcinoma in Urethrovaginal Septum: A Diagnostic Pitfall

임명철,이승미,이정윤,최혁재,이선,허주엽,박상윤 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.

Feasibility and Safety of Extensive Upper Abdominal Surgery in Elderly Patients with Advanced Epithelial Ovarian Cancer

임명철,강석범,송용중,박세현,박상윤 대한의학회 2010 Journal of Korean medical science Vol.25 No.7

We performed a retrospective study to evaluate the feasibility and safety of extensive upper abdominal surgery (EUAS) in elderly (≥65 yr) patients with advanced ovarian cancer. Records of patients with advanced epithelial ovarian cancer who received surgery at our institution between January 2001 and June 2005 were reviewed. A total of 137 patients including 32 (20.9%) elderly patients were identified. Co-morbidities were present in 37.5%of the elderly patients. Optimal cytoreduction was feasible in 87.5% of the elderly while 95.2% of young patients were optimally debulked (P=0.237). Among 77 patients who received one or more EUAS procedures, 16 (20.8%) were elderly. Within the cohort, the complication profile was not significantly different between the young and the elderly,except for pleural effusion and pneumothorax (P=0.028). Elderly patients who received 2or more EUAS procedures, when compared to those 1 or less EUAS procedure, had significantly longer operation times (P=0.009), greater blood loss (P=0.002) and more intraoperative transfusions (P=0.030). EUAS procedures are feasible in elderly patients with good general condition. However, cautious peri-operative care should be given to this group because of their vulnerability to pulmonary complications and multiple EUAS procedures.

Survival outcomes after extensive cytoreductive surgery and selective neoadjuvant chemotherapy according to institutional criteria in bulky stage IIIC and IV epithelial ovarian cancer

임명철,유형종,송용중,서상수,강석범,김선호,유종우,박상윤 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4

Objective: To investigate the survival outcomes in patients with bulky stage IIIC and IVovarian cancer, treated by primary debulking surgery (PDS) and selective use of neoadjuvantchemotherapy (NAC) according to institutional criteria. Methods: Medical records for advanced ovarian cancer patients who were treated at NationalCancer Center (NCC) between December 2000 and March 2009 were retrospectively reviewedin the comprehensive cancer center. Bulky stage IIIC and IV ovarian cancer cases wereincluded. Current NCC indication for NAC is determined based on patients' performancestatus and/or computerized tomography (CT) findings indicating difficult cytoreduction. After NAC, all traces of regressed metastatic ovarian cancer, potentially includingchemotherapy-resistant cancer cells, were surgically removed. Results: Of the 279 patients with bulky stage IIIC and IV, 143 (51%) underwent PDS and 136(49%) received NAC. No gross residual and residual tumor measuring ≤1 cm was achievedin 66% and 96% of the PDS group and 79% and 96% of the NAC group, respectively. Themedian progression-free survival (PFS) and overall survival (OS) time were 20 months andnot reached, but might be estimated more than 70 months in the PDS group and 15 and 70months in the NAC group, respectively. Conclusion: Extensive cytoreductive surgery to minimize residual tumor and selective useof NAC based on the institutional criteria could result in improved survival outcomes. Untilfurther studies can be done to define the selection criteria for NAC after surgery, institutionalcriteria for NAC should consider the ability of the surgeon and institutional capacity