치유 절제술을 받은 위암 환자에서의 3년 무병생존이 5년 전체생존을 대치할 수 있는가?

권성준,김형주,김미경,Kwon, Sung-Joon,Kim, Hyoung-Ju,Kim, Mi-Kyung 대한위암학회 2005 대한위암학회지 Vol.5 No.3

Purpose: The 5-year survival rate is the most useful parameter for evaluating the effect of management on most malignant tumors. Recurrence after a curative resection for gastric cancer occurs mostly within 3 years of the operation, which caused us to evaluate whether a 3-year disease-free survival (3DFS) can be substituted for a 5-year overall survival (5OS). Materials and Methods: We reviewed the medical records of 656 consecutive patients who had undergone a curative resection for gastric cancer To assess whether 3DFS represents 5OS, we used a simple linear regression with survival probability calculated by using the survival function. Results: Recurrence was found in 175 cases during the follow-up periods. The accumulative frequencies of recurrence at postoperative 1 year, 3 years, and 5 years were 46% (81 cases), 89% (156 cases), and 97% (170 cases), respectively. The correlation coefficient (r) and the coefficient of determination $(r^2)$ between 3DFS and 5OS were 0.87 and 0.76, respectively, and the regression equation was $5OS=0.18+(0.80{\times}3DFS)$. The r and $R^2$ according to the type of recurrence were 0.89 and 0.80 in peritoneal seeding, 0.88 and 0.78 in hematogeneous metastasis, and 0.86 and 0.73 in local recurrence, respectively. The r (0.77) and $r^2$ (0.60) were relatively lower in low stages (stage I and II) compared to r (0.88) and $r^2(0.77)$ in high stages (stage III and IV). Conclusion: The 3DFS is an excellent predictor of 5OS. Therefore, if we use the former as the treatment evaluating method, 2-year time reduction in assessing and reporting treatment results is expected.

위암 수술 시 절제연 암침윤의 임상적 의미

권성준,Kwon, Sung-Joon 대한위암학회 2001 대한위암학회지 Vol.1 No.1

Purpose: Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation. Materials and Methods: Seven hundred fifteen gastric cancer patients who were operated on at our hospital from 1992 to 1998 were included in this analysis. Various clinicopathological factors, including resection-line involvement, were ascertained from the surgical and histopathological records. Results: Of the 715 evaluable patients, 27 patients ($3.8\%$) had involvement of one or both resection lines; in 10 patients the proximal resection line only, in 16 the distal resection line only, and 1 both resection lines were involved. Presence of resection-line involvement was significantly associated with T3 and T4 stage, N (+) stage, M (+) stage, type of operation (total gastrectomy), tumor location (entire stomach), size$\geq$11 cm), and gross type of tumor (Borrmann 4 type). When performing a distal subtotal gastrectomy, no involvement was found when the cranial and caudal distances between the lesion and the line of transection was equal to or greater than 2 cm and 3 cm, respectively, for early cancer and 7 cm and 3 cm, respectively, for advanced cancer. When performing a total gastrectomy for upper 1/3 or middle 1/3 gastric cancer, no involvement was found when the cranial distances between the lesion and the line of transection were equal to or greater than 3 cm and 4 cm, respectively, without distinction of the presence of serosal invasion. Conclusions: The difference in survival between positive and negative margin patients is limited to the group of patients with curative surgery. An important principle of treatment is that the entire tumor must be removed with a 3 cm distal margin and a 2- to 7 cm margin depending on the location and the depth of wall invasion of the tumor, to provide histologically negative margins.

위전절제술 시 식도측 절제연 암 침윤의 예후적 가치

권성준,Kwon, Sung-Joon 대한위암학회 2001 대한위암학회지 Vol.1 No.3

Purpose: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. Materials and Methods: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. The Chisquare test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and independent prognostic significance was evaluated using the Cox regression method. Results: The prevalence of esophageal margin involvement was $3.6\%$ (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size ($\geq$5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. Conclusion: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.

원발성 위 림프종

권성준,대한위암연구동우회 회원,Kwon, Sung-Joon 대한위암학회 2001 대한위암학회지 Vol.1 No.4

Purpose: The aim of the study was to obtain data on the anatomic and histologic distributions, the clinical features, and the treatment results for patients with primary gastric non-Hodgkin's lymphoma. Materials and Methods: One hundred thirty-two patients who were treated at 8 university hospitals and 2 general hospitals between January 1991 and December 2000 were enrolled to evaluate clinico-pathologic features. Results: The lower one-third of the stomach was the most frequent site ($42\%$), and the most frequent chief complaint was epigastric pain ($54\%$). Gastric resection was performed in 114 cases. Pathologic findings of preoperative endoscopic biopsy specimens from the 114 patients that underwent surgery were a gastric lymphoma in 94 cases ($82\%$), a carcinoma in 15 cases ($13\%$), an ulcer in 4 cases ($4\%$), and a gastrointestinal stromal tumor in 1 case ($1\%$). The stage distributions by Musshoff's criteria were 71 cases ($54\%$) of stage IE, 36 cases ($27\%$) of stage $II_{1}E$, 8 cases ($6\%$) of stage $II_{2}E$, 2 cases ($2\%$) of stage IIIE, and 15 cases ($11\%$) of stage IVE. Histologic gradings by the Working Formulation in were 31 cases ($23\%$) of low grade, 96 cases ($73\%$) of intermediate grade, and 5 cases ($4\%$) of high grade. Chemotherapy-related complications occurred in 25 cases ($22\%$) while operation-related complications occurred in 6 cases ($5\%$). Seventeen patients ($13\%$) only underwent surgery, 19 ($14\%$) had chemotherapy (CTx) and/or radiotherapy (RTx) only, and 96 patients ($73\%$) received surgery and CTx and/or RTx. No substantial differences in survival were found in relation to the different histologic grades and different treatments. The five-year survival was $85\%$ in stage I or II and $47\%$ in stage III or IV (P=0.0000). Conclusion: Pathologic stage appears to be the single most important prognostic indicator. Survival differences according to treatment modalities were not statistically significant. However, the low number of patients treated with various approaches over a long period precludes a firm conclusion.

제4기 위암 환자 중 장기 생존 예의 검토

권성준,Kwon, Sung-Joon 대한위암학회 2002 대한위암학회지 Vol.2 No.3

Purpose: The prognosis of stage IV gastric cancer is very grave. However, some of these patients survive long periods after surgery. This study was undertaken to investigate various clinico-pathological profiles related to the prognosis for these long-term survivors. Materials and Methods: One hundred fifty-five patients with stage IV gastric cancer who underwent a gastric resection from 1992 to 1997 at Hanyang University Hospital were evaluated. Thirty-three patients who survived more than 5 years after surgery were designated as long-term survivors (LTS); on the other hand, one hundred twenty-two patients who died within 5 years after surgery were named as short-term survivors (STS). Results: The rate of the patients with T4, preoperative serum level of CA19-9 greater than 37 U/g protein, and peritoneal dissemination was lower for the LTS than in for the STS (P=0.002, P=0.045, and P=0.0000, respectively). Tumors were smaller (7.3 cm vs. 8.9 cm, P=0.030) and metastatic lymph node were fewer (19.7 vs. 28.8, P=0.019) for the LTS than for the STS. Curative surgery ($\76\%\;vs.\;\46\%$, P=0.002) and a subtotal gastrectomy ($\76\%\;vs.\;46\%$, P=0.026) were performed more frequently for the LTS than for the STS. From a univariate survival analysis, depth of invasion, distant metastasis, extent of gastric resection, postoperative chemotherapy, and curability were statistically significant factors. From a multivariate survival analysis, curability, depth of invasion, and extent of gastric resection were independent prognostic factors. Conclusions: If feasible, we have to exert our efforts to achieve curative surgery although the tumor is considered to be a stage IV gastric cancer. Thereafter, multi-modality treatments including chemotherapy can be considered to improve the prognosis.

A Study on the Operation and Function Improvement for apparel warehouse Using Fuzzy-AHP

권성준,차영두,여기태,Kwon, Sung-Joon,Cha, Young-Doo,Yeo, Gi-Tae The Society of Digital Policy and Management 2017 디지털융복합연구 Vol.15 No.9

국가 간 다양한 상품 무역에서 파생되는 물류업무를 처리하기 위해 세계 물류시장은 성장하고 있는 추세이다. 특히 의류물류는 매년 처리량이 증가하고 있으며, 세계 산업 중 손꼽히는 매출 기록을 나타내고 있다. 현재 의류품목은 고가의 제품으로 성장하였으며, 정교하고 알맞은 물류서비스가 요청되고 있다. 본 논문은 3PL 서비스를 제공하는 회사들이 앞으로 성장하고 있는 의류시장에 대한 서비스 및 오퍼레이션에 대응할 수 있도록 효과적인 운영방안을 제시하는 것에 연구목적이 있다. Fuzzy AHP방법을 사용하여 의류창고 운영에 대한 중요요인의 가중치를 산출하였다. 분석결과, 1위로는 인력교육(0.17) 2위로는 화재관리(0.169), 3위로 입출고 관리(0.142)로 나타났으며, 4위와 5위는 각각 Warehouse management system 및 바코드 시스템으로 확인되었다. 즉 '의류' 특성을 정확히 이해하고 이를 바탕으로 인력교육, 화재관리 그리고 입출고관리를 수행해야하며, 이를 통하여 의류물류 서비스의 질을 제고할 수 있다. Given the expansion of globalization and international trade, the number of apparel consumers is growing every year, making it difficult to estimate the amount of handling needed from the logistics industry. To determine which management factors are important and which ones require improvement, fuzzy AHP was used. Using this method, the factors were ranked in the final analysis as follows: The first and most important factor was training employees (0.17), while the second was fire hazard management (0.169); the third-highest factor was inbound and outbound goods (0.142), and the fourth was the warehouse management system. Barcode management was ranked fifth. By these results, we were able to analyze the processes of clothing warehouses, noting that although the factors appear independent, they are actually connected while proceeding with full management control. Moreover, because of the special characteristics of garments, employee management is crucial. Due to the vulnerability of these goods to fire hazards, this factor must be well managed.

표층 확장형 조기위암의 임상병리학적 특성

권성준,김형주,Kwon, Sung-Joon,Kim, Hyoung-Ju 대한위암학회 2005 대한위암학회지 Vol.5 No.4

Purpose: Superficially spreading (SS) early gastric cancer (EGC) is characterized by wide horizontal extension without deep vertical invasion. It is a relatively rare form of EGC, and it's clinicopathological (C-P) characteristics are not evident. This study aimed to clarify their C-P characteristics. Materials and Methods: We defined SS EGC as invading less than the submucosal layer that measured more than 60 mm in diameter or wider than $5{\times}5cm \;(25cm^2)$ in width. The C-P characteristics and prognosis were compared between 69 patients with SS EGC and 319 patients with the common type EGC (EGC except SS type). Results: For SS EGC lymph node metastases, Lauren's diffuse type, lymphatic invasion were significantly higher than in common type EGC. In patients with SS EGC, all of the metastatic lymph nodes were anatomically distributed within the paragastric region, with fewer along the left gastric artery and common hepatic artery. In 6 cases of SS EGC with resection marqins less than 10 mm, there was no death during the follow-up period (4 to 13 years after operation) if margins were not involved. Age (>58 yrs), tumor site (upper 1/3), lymph node metastasis, submucosal invasion were statistically significant poor prognostic factor in univariate survival analysis. In multivariate survival analysis, age and lymph node metastasis were independent prognostic factors. However, tumor diameter or width was not a significant prognostic factor. Conclusion: Although SS EGC has histologically distinct properties, gastrectomy with free surgical margins and appropriate lymph node dissection $(D1+{\beta})$ could be a suitable treatment.

위암 환자에 있어 혈소판 증가증의 예후적 중요성

권성준(Sung Joon Kwon) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.62 No.4

진행성 위암 수술시 시행한 지속적 온열 복막 관류요법에 대한 임상적 고찰

권성준(Sung Joon Kwon),김동우(Dong Woo Kim) 대한외과학회 1997 Annals of Surgical Treatment and Research Vol.52 No.2

점액성 위 선암의 임상병리학적 특성

권성준(Sung Joon Kwon),박재정(Jae Jung Park),백승삼(Seung Sam Paik) 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.66 No.6