비소세포성 폐암으로 수술 후 방사선치료가 시행된 N2병기 환자들에서 다발 부위 종격동 림프절 전이 여부에 따른 N2병기 구분의 임상적 의미

윤홍인(Hong In Yoon),김용배(Yong Bae Kim),이창걸(Chang Geol Lee),이익재(Ik Jae Lee),김송이(Songyih Kim),김준원(Jun Won Kim),김주항(Joo Hang Kim),조병철(Byung Chul Cho),이진구(Jin Gu Lee),정경영(Kyung Young Chung) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.2

목 적: 비소세포성 폐암 림프절 병기 N2 환자에서 수술 후 방사선치료의 결과와 예후에 영향을 주는 인자에 대해 알아보고자 하였다. 대상 및 방법: 1999년부터 2008년 2월까지 비소세포성 폐암으로 진단받고 수술 후 병기 N2로 방사선치료를 시행받은 112명의 환자를 대상으로 하였다. 폐구간절제술(segmentectomy) 및 폐엽절제술(lobectomy)를 시행받은 환자는 75명(67%), 전폐절제술(pneumonectomy)을 시행 받은 환자는 37명(33%)였다. 절제연 음성인 환자는 94명(83.9%)이었고, 근접절제연 및 절제연 양성인 환자는 모두 18명(16.1%)이었다. 수술 후 보조적 요법으로 103명(92%)의 환자에서 항암치료가 시행되었다. 방사선치료의 분할선량은 1.8에서 2 Gy로 총선량은 45에서 66 Gy가(중앙값, 54 Gy) 시행되었다. 결 과: 전체환자의 2년 생존율과 무병생존율은 각각 60.2%와 44.7%였다. 예후 인자에 대한 단변량 분석을 하였을때 종격동 림프절 부위(nodal station)의 전이가 단일 부위(single-station)인 환자에 비해 다발 부위(multiple-station)일 때 생존율과 무병생존율이 통계학적으로 의미 있게 감소하였다(p=0.047, p=0.007). T병기가 3기 이상일 때 생존율과 무병생존율이 의미 있게 감소하였다(p<0.001, p=0.025). 종양크기가 5 cm 이상이거나 림프혈관침윤이 양성인 경우 의미 있는 생존율의 감소를 보였고(p=0.035, p=0.034), 무병생존율은 통계학적으로 의미 있는 차이가 없었다. Cox-regression을 이용한 다변량 분석상 전이된 종격동 림프절 부위의 다발 부위 여부와 T병기가(<T3 vs.≥T3) 생존율(p=0.046, p<0.001)과 무병생존율(p=0.005, p=0.033)에 통계학적으로 의미 있는 인자들이었다. 치료 후 재발한 환자는 71명(63.4%)이었고, 국소재발은 23명(20.5%), 원격전이는 62명(55.4%), 그리고 국소재발과 원격전이가 동시에 진단된 환자는 14명(12.5%)이었다. 결 론: 수술 후 방사선치료를 시행받은 절제된 N2 병기 비소세포성 폐암에서 전이된 종격동 림프절 부위의 수가 다발 부위인 경우는 중요한 예후 인자로 향후 N2 병기와 관련된 하위 분류 연구와 그에 적절한 보조 요법에 대한 임상 연구가 필요할 것으로 생각한다. Purpose: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103(92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8∼2 Gy. Results: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (≥T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (≥5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (≥T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. Conclusion: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

비소세포성 폐암으로 수술 후 방사선치료가 시행된 N2병기 환자들에서 다발 부위 종격동 림프절 전이 여부에 따른 N2병기 구분의 임상적 의미

윤홍인(Hong In Yoon),김용배(Yong Bae Kim),이창걸(Chang Geol Lee),이익재(Ik Jae Lee),김송이(Songyih Kim),김준원(Jun Won Kim),김주항(Joo Hang Kim),조병철(Byung Chul Cho),이진구(Jin Gu Lee),정경영(Kyung Young Chung) 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.3

목 적: 비소세포성 폐암 림프절 병기 N2 환자에서 수술 후 방사선치료의 결과와 예후에 영향을 주는 인자에 대해 알아보고자 하였다. 대상 및 방법: 1999년부터 2008년 2월까지 비소세포성 폐암으로 진단받고 수술 후 병기 N2로 방사선치료를 시행받은 112명의 환자를 대상으로 하였다. 폐구간절제술(segmentectomy) 및 폐엽절제술(lobectomy)를 시행받은 환자는 75명(67%), 전폐절제술(pneumonectomy)을 시행 받은 환자는 37명(33%)였다. 절제연 음성인 환자는 94명 (83.9%)이었고, 근접절제연 및 절제연 양성인 환자는 모두 18명(16.1%)이었다. 수술 후 보조적 요법으로 103명(92%)의 환자에서 항암치료가 시행되었다. 방사선치료의 분할선량은 1.8에서 2 Gy로 총선량은 45에서 66 Gy가(중앙값, 54 Gy) 시행되었다. 결 과: 전체환자의 2년 생존율과 무병생존율은 각각 60.2%와 44.7%였다. 예후 인자에 대한 단변량 분석을 하였을때 종격동 림프절 부위(nodal station)의 전이가 단일 부위(single-station)인 환자에 비해 다발 부위(multiple-station) 일 때 생존율과 무병생존율이 통계학적으로 의미 있게 감소하였다(p=0.047, p=0.007). T병기가 3기 이상일 때 생존율과 무병생존율이 의미 있게 감소하였다(p<0.001, p=0.025). 종양크기가 5 cm 이상이거나 림프혈관침윤이 양성인 경우 의미 있는 생존율의 감소를 보였고(p=0.035, p=0.034), 무병생존율은 통계학적으로 의미 있는 차이가 없었다. Cox-regression을 이용한 다변량 분석상 전이된 종격동 림프절 부위의 다발 부위 여부와 T병기가(<T3 vs.≥T3) 생존율(p=0.046, p<0.001)과 무병생존율(p=0.005, p=0.033)에 통계학적으로 의미 있는 인자들이었다. 치료후 재발한 환자는 71명(63.4%)이었고, 국소재발은 23명(20.5%), 원격전이는 62명(55.4%), 그리고 국소재발과 원격전이가 동시에 진단된 환자는 14명(12.5%)이었다. 결 론: 수술 후 방사선치료를 시행받은 절제된 N2 병기 비소세포성 폐암에서 전이된 종격동 림프절 부위의 수가 다발 부위인 경우는 중요한 예후 인자로 향후 N2 병기와 관련된 하위 분류 연구와 그에 적절한 보조 요법에 대한 임상 연구가 필요할 것으로 생각한다. Purpose: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8∼2 Gy. Results: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (≥T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (≥5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (≥T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. Conclusion: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

종격동에 거대 낭성 전이를 일으킨 갑상선의 잠재성 유두상 암종

제갈재기,송상윤,나국주,안병희,오상기,정인석,박민호 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.1

심한 호흡곤란을 주소로 내원한 67세 남자의 영상소견상 종격동의 거대 낭성 종양이 기관을 압박하여 편이시키는 소견이 보여 응급 개흉술을 통해 종양을 절제하였다. 조직 소견상 갑상선의 유두상 암종에 합당하였고 수술 후 시행한 갑상선 초음파 검사와 양성자 단층촬영상 잠재성 갑상선 암종에 합당한 소견을 보였다. 갑상선의 유두상 암종이 초기에 원격 전이를 보이는 경우는 드물며 대부분 단독 결절의 형태를 취하나, 잠재성 암종이 종격동에 거대 낭성 전이를 하는 경우는 극히 드물어 보고하는 바이다. The initial presentation of distant metastases in patients with papillary thyroid carcinoma is quite rare. Most distant metastases are solid nodular lesions. A 67-year-old man who complained of severe dyspnea underwent surgery due to a large mediastinal cystic mass compressing the trachea and great vessels. Pathologically, the cystic mass was a metastatic thyroid papillary carcinoma. The thyroid evaluations were compatible with a well differentiated thyroid carcinoma. An occult thyroid carcinoma presenting as a large mediastinal cystic lesion is extremely rare.

종격동 림프절 전이를 보이는 분화 갑상선 암의 치료

이잔디(Jandee Lee),임치영(Chi-Young Lim),남기현(Kee-Hyun Nam),장항석(Hang-Seok Chang),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.71 No.1

종격동 전이를 보이는 갑상선암 환자에서 Robot-assisted Lymph Node Dissection을 병행한 1예

정종주,이용상,강상욱,성태연,이승철,남기현,장항석,정웅윤,백효채<SUP>1<,SUP>,박정수,Jong Ju Jeong,Yong Sang Lee,Sang- Wook Kang,Tae-Yon Sung,Seung Chul Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,Hyo Chae Paik,<SUP>1<,SUP> and 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.2

전방 종격동에 전이된 갑상선 수질암

전경화,진형민,전정수,Kyong-hwa Jun,M,D,Hyung-min Chin,M,D,and Chung- soo Chun,M,D 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.1

Medullary thyroid cancer (MTC) accounts for 5% to 10% of all thyroid cancers, and originates from the parafollicular or C-cells of the thyroid gland. More than 50% of patients present with a thyroid mass and up to 75% of these patients have locoregional lymph node metastasis at the time of diagnosis. The neuroendocrine C-cells of the thyroid gland secrete calcitonin, a relatively accurate tumor marker for MTC. Plasma basal and stimulated calcitonin measurements have been used to screen patients who are at risk of developing MTC and indispensable for the detection of residual MTC after initial surgical treatment. The overall survival rate of patients with MTC is intermediate to that of patients with differentiated thyroid cancer and anaplastic thyroid cancer. Postoperative radioiodine ablation therapy, chemotherapy and radiation therapy are generally ineffective. Surgical resection, therefore, remains the only definite treatment for patients with MTC. Unfortunately, residual MTC as indicated by elevated plasma basal or stimulated calcitonin levels is common even after apparent complete initial surgical resection. We present a case of metastatic MTC in the anterior mediastinum with review of the literatures. (Korean J Endocrine Surg 2003;4:55-58)

흉벽 연부조직에 발생한 전이성 거대세포종 -1예 보고-

신덕섭,정태은,이장훈,최준혁 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.7

골조직에 발생하는 거대세포종은 국소적으로는 양성이지만 재발률이 매우 높고, 아주 드물게 원격전이를 일으킬 수 있다. 우측 요골에 발생한 거대세포종이 치료 후 재발되어, 요골을 제거한 후, 다시 동측 흉벽 연부조직에 전이된 29세의 남자환자를 보고하는 바이다. 종양은 흉벽의 골조직과는 연관이 없었다. 수술은 주위 연부조직과 함께 광범위 절제하였으며, 조직학적 검사상 악성 종양을 시사하는 소견은 없었다.

원발성 비소세포성 폐암의 폐엽에 따른 종격동 림프절 전이 양상

이교선,나국주,송상윤,류상우 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.1

Background: The presence of infiltrated mediastinal lymph nodes is a crucial factor for the prognosis of lung cancer. The aim of our study is to investigate the pattern of metastatic non-small cell lung cancer that spreads to the mediastinal lymph nodes, in relation to the primary tumor site, in patients who underwent major lung resection with complete mediastinal lymph node dissection. Material and Method: We retrospectively studies 293 consecutive patients [mean age 63.0±8.3 years (range 37∼88) and 220 males (75.1%)] who underwent major lung resection due to non-small cell lung cancer from January 1998 to December 2005. The primary tumor and lymph node status was classified according to the international TNM staging system reported by Mountain. The histologic type of the tumors was determined according to the WHO classification. Fisher's exact test was used; otherwise the chi-square test of independence was employed. A p-value <0.05 was considered significant. Result: Lobectomy was carried out in 180 patients, bilobectomy in 50, sleeve lobectomy in 10 and pnemonectomy in 53. The pathologic report revealed 124 adenocarcinomas, 138 squamous-cell tumors, 14 adenosquamous tumors, 1 carcinoid tumor, 8 large cell carcinomas, 1 carcinosarcoma, 2 mucoepidermoid carcinomas and 5 undifferentiated tumors. The TNM stage was IA in 51 patients, IB in 98, IIB in 41, IIIA in 71, IIIB in 61 and IV in 6. 25.9 % of the 79 patients had N2 tumor. Most common infiltrated mediastinal lymph node was level No.4 in the right upper lobe, level No. 4 and 5 in the left upper lobe and level No. 7 in the other lobes, but no statistically significant difference was observed. Thirty-six patients (12.3%) presented with skip metastasis to the mediastinum. Conclusion: Mediastinal lymph node dissection is necessary for accurately determining the pTNM stage. It seems that there is no definite way that non-small cell lung cancer spreads to the lymphatics, in relation to the location of the primary cancer. Further, skip metastasis to the mediastinal lymph nodes was present in 12.3% of our patients.

종격동 구조물을 침범한 T4 비소세포폐암의 수술적 치료

황은구,백희종,이해원,정진행,박종호,조재일,심영목 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.4

P-148 Mediastinal lymph node metastasis without liver or lung involvement after curative resection of colon cancer

( Dong Won Park ),( Ji Hee Min ),( Gun Woo Koo ),( Yeonkyung Park ),( Tai Sun Park ),( Ji-yong Moon ),( Sang-heon Kim ),( Tae-hyung Kim ),( Jang Won Sohn ),( Ho Joo Yoon ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Colon cancer usually spreads the regional lymph nodes, liver, lung, bone and brain. Metastasis to mediastinal lymph node without pulmonary and hepatic metastasis from colon cancer is very rare. Here, we report a case with multiple metastasis to mediastinal lymph nodes without any other organ involvement after curative resection of colon cancer. A 47 year-old man presented with abdominal pain, and colonoscopic biopsy were consistent with the diagnosis of colon adenocarcinoma. Subsequently, right hemicolectomy was performed, and histopathology revealed moderately to poorly differentiated adenocarcinoma of right colon with perineural and lymph vascular invasion, and metastatic involvement of 9 out of 22 regional lymph nodes. There was no distant metastasis on computed tomography scans of chest and abdomen, and the patient received chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX). Two and a half years later, multiple enlarged mediastinal lymph nodes without lung and liver metastasis were observed on chest and abdomen computed tomography, and were extirpated by video-assisted thoracoscopic surgery. Pathology was consistent with the diagnosis of metastatic colonic primary adenocarcinoma. This case report suggests that the mediastinum should be considered as a possible metastatic site from colon cancer, even without evidence of lung and liver metastasis.