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송명준 ( Myeong Jun Song ),박정화 ( Chung Hwa Park ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),천호종 ( Ho Jong Chun ) 대한간암연구회 2010 대한간암학회지 Vol.10 No.-
A 53-year-old man patient was admitted for evaluation of abdominal pain. Liver dynamic CT showed infiltrative type mass in right hepatic angle with arterial enhancement and rapid washout. Also low density tumor thrombus is filled with in right portal vein. He was diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class B). With the sixth cycle of metronomic hepatic artery infusion chemotherapy for infiltrative mass, HCC showed no stain in hepatic angiography and tumor marker are normalized at seven month from initial diagnosis.
송명준 ( Myeong Jun Song ) 대한내과학회 2021 대한내과학회지 Vol.96 No.2
Nonalcoholic fatty liver disease (NAFLD) is a major public health problem with comorbidities including obesity and dyslipidemia. Although the manifestations of NAFLD range from simple steatosis to non-alcoholic steatohepatitis, these may potentially give rise to liver cirrhosis and hepatocellular carcinoma. However, the mechanisms underlying NAFLD, and the factors that determine the individual risk of disease progression, remain poorly known. The most obvious clinicopathological characteristic of NAFLD is hepatic lipid accumulation and subsequent inflammation. In hepatocytes, the endoplasmic reticulum (ER) is a critical site of protein synthesis, detoxification, lipid and glucose metabolism, and Ca<sup>2+</sup> homeostasis; the ER is involved in NAFLD pathogenesis. Hepatic accumulation of lipids stresses the ER; this activates the unfolded protein response (UPR), which is classically viewed as an adaptive pathway that maintains ER homeostasis. Recent studies have revealed that UPR sensors regulate hepatic steatosis and the cellular response to lipotoxic stress. Therefore, the basic mechanisms of ER stress and UPR induction are of great interest for understanding the pathogenesis of NAFLD. The present review focuses on the roles played by ER stress and the UPR in NAFLD pathogenesis. (Korean J Med 2021;96:92-100)
Pros: Thromboprophylaxis in liver cirrhosis
송명준 ( Myeong Jun Song ) 대한간학회 2017 간학회 싱글토픽 심포지움 Vol.2017 No.2
Liver cirrhosis (LC) has long been considered in a clinical practice associated with a bleeding risk. LC is characterized by a defective synthesis of coagulation factors leading to prolonged conventional coagulation tests such as the prothrombin time (PT). The causal relationship between the abnormality of this test and the risk of bleeding has been for long time taken for granted, but this paradigm has been challenged because, apart from gastrointestinal bleeding, spontaneous bleeding is not frequent in LC. Furthermore, both spontaneous and provoked bleedings are unrelated to platelet and clotting changes. There are also evidences that patients with LC suffer also from thrombosis in the portal and systemic circulation. Portal vein thrombosis (PVT) occurs in approximately 20% of patients with LC, particularly in those with advanced cirrhosis, and it is considered a hallmark of poor outcomes. However, treating PVT with anticoagulants could be difficult to implement because the coexistence of a coagulopathy may be a potential barrier, and there is also the fact that the “coagulopathy” of patients with LC is difficult to be accurately assessed with standard laboratory indexes, such as prothrombin time. Despite this, there are a few studies for safety and efficacy of anticoagulants in patients with LC and PVT. Thus, it is necessary that definitive criteria for indication of prophylaxis or treatment of thrombosis in the portal and systemic circulation in patients with LC should be introduced for the optimal management.
송명준 ( Myeong Jun Song ),배시현 ( Si Hyun Bae ) 대한간암학회 2012 대한간암학회지 Vol.12 No.1
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Surgery, percutaneous ablation and liver transplantation are the only curative treatment modality for HCC. However, a majority of patients have unresectable disease at diagnosis. Despite radical treatment, high risk of tumor recurrence is the most common problem. Therefore, there is a need for effective treatment options for patients with advanced or recurrent HCC. For patients with advanced stage of HCC according to the Barcelona Clinic Liver Cancer staging system, the multikinase inhibitor sorafenib is the current standard of care. However, hepatic arterial infusion chemotherapy (HAIC) have been applied to advanced stage HCC with a view to improve the therapeutic indexes in Asia. HAIC provides direct drug delivery into tumor bed and a greater first-pass effect; also systemic side effects can be potentially minimized. However, the sample size of researches on HAIC was small and large randomized trials are still lacking. In this article, we describe the treatment efficacy of HAIC for advanced stage HCC and discuss future therapeutic possibilities.
절제불가능한 간세포암에서 간동맥화학색전술 치료반응 예측에 인터루킨17과 C-반응성 단백질 발현의 연관성
송명준 ( Myeong Jun Song ),이승원 ( Sung Won Lee ),오은지 ( Eun-jee Oh ),장보현 ( Bohyun Jang ),장정원 ( Jeong Won Jang ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ) 대한간암학회 2016 대한간암학회지 Vol.16 No.2
Background/Aims: Transarterial chemoembolization (TACE) is the standard locoregional treatment in patients with unresectable hepatocellular carcinoma (HCC). Angiogenesis and inflammation play important roles in tumor growth in HCC. In this study, we evaluated the associations between the levels of growth factors and inflammatory markers and clinical prognosis in patients with unresectable HCC treated with TACE. Methods: The clinical outcomes of 58 HCC patients treated with TACE at the Catholic Medical Centers from January, 2012 to February 2015 were evaluated. Baseline levels of the growth factors vascular endothelial growth factor, fibroblast growth factor, platelet-derived growth factor, and hepatocyte growth factor and the inflammatory cytokines interleukin (IL)-17 and high sensitivity C-reactive protein (hs-CRP) were compared with the treatment outcomes. The primary endpoint was time to progression (TTP); the secondary endpoint was overall survival (OS). Results: During the 20.8 months of follow-up, TTP was significantly delayed in patients with low levels of hs-CRP (≤0.15) and IL-17 (≤0.94) and a maximal tumor diameter ≤5 cm (P =0.010, P =0.015, and 0.048, respectively). Patients with HCC with low hs-CRP and IL-17 levels had a longer survival than that of those with high hs-CRP levels and IL-17 (35.1 vs. 22.5 months, P =0.000; 41 vs. 21.8 months, P =0.000, respectively). However, any baseline growth factors were not significantly correlated with TTP and OS. Conclusions: Elevated IL-17 and hs-CRP may be predictive of a poor outcome in patients with HCC treated with TACE. A better understanding of this relationship will require further investigation of the immune mechanisms underlying tumor progression. (J Liver Cancer 2016;16:108-117)
간세포암에 대한 약물 방출성 미세구를 이용한 간동맥화학색전술
송명준 ( Myeong Jun Song ) 대한간암학회 2012 대한간암학회지 Vol.12 No.2
Transarterial chemoembolization (TACE) has been widely used as a standard treatment for HCC patients who are not suitable candidates for curative treatments and as a bridge to liver transplantation. The rationale for TACE is that the intra-arterial chemotherapy using lipiodol and chemotherapeutic agents, followed by selective vascular embolization, will result in a strong cytotoxic effect combined with ischemia (conventional TACE). Recently, drug-eluting beads (DC Bead®) for the transcatheter treatment of HCC have been developed to deliver higher doses of chemotherapeutic agent and to prolong contact time with the tumor. DC Bead® has the ability to actively sequester doxorubicin hydrochloride from solution and release it in a controlled and sustained fashion. Treatment with DC Bead® has been shown to substantially diminish the amount of chemotherapeutic agent that reaches the systemic circulation compared with conventional, lipiodol-based regimens, significantly reducing drug-related adverse events. In this article, we describe the treatment efficacy and safety of TACE with the drug-eluting bead for the treatment of hepatocellular carcinoma and discuss future therapeutic possibilities.
Child B 등급 진행성 간세포암종 환자에서 메트로놈 항암주입술과 간동맥항암색전술과의 비교연구
양현 ( Hyun Yang ),송명준 ( Myeong Jun Song ),남희철 ( Hee Chul Nam ),이해림 ( Hae Lim Lee ),이승원 ( Sung Won Lee ),송도선 ( Do Seon Song ),장정원 ( Jeong Won Jang ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seu 대한간암학회 2015 대한간암학회지 Vol.15 No.2
Background/Aims: Metronomic (MET) chemotherapy is a treatment characterized by frequent infusion of low doses of chemotherapeutic agent without extended break. The aim of this study is to evaluate the efficacy of MET chemotherapy compared with transarterialchemoembolization (TACE) in patients with child B class advanced hepatocellular carcinoma (HCC). Methods: Seventy-three patients with child B class advanced HCC were analyzed between April, 2007 and August, 2013 according to two treatment groups: (i) MET chemotherapy group (n=43, Epirubicin 35 mg/body surface area [BSA] every 4 weeks, and cisplatin 15 mg/BSA and 5-fluorouracil 50 mg/BSA weekly for 3 weeks) via an implantable port system with 1 week break. (ii) TACE group (n=30, Adriamycin 20-50 mg) every 4 weeks. Primary endpoint was overall survival (OS). Results: The median survival times in the MET and TACE groups were 4.5 months and 3.1 months, respectively. The overall survival rate showed significantly better in the MET treatment group than in the TACE group (P=0.039). When the factors affecting patient OS were analyzed, MET chemotherapy (P=0.038, hazard ratio {HR} 0.538 [95% confidence interval {CI} 0.299-0.967]) was independently associated with OS. Larger maximal tumor size, extrahepatic metastasis and advanced stage also were significant factors for OS (P=0.009, HR 1.064 [95% CI 1.014-16.064]; P=0.014, HR 2.120 [95% CI 1.164-3.861]; P=0.019, HR 2.046 [95% CI 1.125-3.720], respectively). Conclusions: MET chemotherapy showed survival benefit than TACE in patients with child class B advanced HCC. Therefore, MET chemotherapy may be considered as a treatment option for advanced HCC with poor liver function. (J Liver Cancer 2015;15:92-99)