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우상명,주정남,이우진,박상재,한성식,김태현,고영환,김현범,홍은경 대한의학회 2013 Journal of Korean medical science Vol.28 No.2
Several studies have reported that ABO blood group, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection contribute to the development of pancreatic cancer. The aim of this study was to evaluate the association between these factors and pancreatic cancer in the Korean population. We retrospectively recruited 753 patients with pancreatic cancer and 3,012 healthy controls, matched 4 to 1 with cancer patients for age and sex, between 2001 and 2011, at the National Cancer Center, Korea. A multivariate logistic regression analysis was employed to estimate adjusted odds ratios (AORs). The AOR for pancreatic cancer in subjects with non-O blood types (A, AB, and B), compared to blood type O, was 1.29 (95% CI, 1.05-1.58; P = 0.01). Seropositivity for hepatitis B virus surface antigen was not significantly related to pancreatic cancer, either in univariate (odds ratio 1.03;95% CI, 0.69-1.53; P = 0.91) or multivariate analysis (AOR, 1.02; 95% CI, 0.67-1.56;P = 0.93). The AOR for pancreatic cancer in subjects displaying seropositivity for anti-HCV was 2.30 (95% CI, 1.30-4.08; P < 0.01). Our results suggest that the non-O blood types and anti-HCV seropositivity, but not HBV infection, may increase the risk of developing pancreatic cancer in Korea, where HBV is endemic.
우상명,민병훈,최기돈,강정묵,김세중,황진혁,정지봉,김용태,윤용범,박인애 대한소화기학회 2002 대한소화기학회지 Vol.40 No.6
목적: 췌장 낭성종양 중 점액성 낭성종양은 악성화의 가능성이 있는 반면 장액성 낭선종은 대부분 양성 질환이어서 이들 질환의 감별진단은 매우 중요하다. 그러나 임상상이나 방사선학적 방법만으로 이들을 감별하는 것은 매우 어렵다. 본 연구에서는 췌장 낭종의 감별진단에 있어서 낭종액 천자검사의 임상적 유용성을 평가하였다. 대상 및 방법: 췌장 낭종으로 입원하여 감별진단을 위해서 세침흡인술을 시행한 89명의 환자를 대상으로 하였다. 세침흡인 술을 시행한 89명의 환자 중에서 78명(87.6%)의 환자에서 세침흡인술로 분석 가능한 검체를 얻을 수 있었다. 78명 환자의 최종 진단은 점액성 낭성종양이 17예, 장액성 낭선종이 13예, 고형성 가유두상 종양이 5예, 췌관내 유두상 점액성 종양이 8예, 낭성 변화한 선암이 6예, 가성낭이 29예이었다. 낭종액에서 세포학적 검사와 점소 염색을 시행하였고, CEA, CA19-9과 아밀라제치 등을 측정하였다. 이들의 진단 기준치는 ROC 곡선을 이용하여 도출하였다. 결과: 세침흡인술의 성공률은 낭종의 크기가 1.5 ㎝ 이하면 떨어졌으나 낭종의 위치와는 관계가 없었다. 세포학적 검사로는 점액성 낭성종양 16예 중 5예(31.3%)에서 진단적 가치가 있었으나 다른 낭종에서는 진단에 도움이 되지 못하였다. 그러나 점소 특수 염색을 시행하면 점액성 낭성종양 9예 중 5예 (55.5%)에서 양성을 보였던 반면 가성낭 12예와 장액성 낭 선종 6예는 모두 점소 염색 음성이었다. 낭종내 CEA 농도 466 ng/mL을 기준으로 하였을 때 예민도 86.7%, 특이도 97.6%로 점액성 낭성종양을 다른 낭종과 감별진단할 수 있었다. 낭종액 아밀라제 진단 기준치를 479 U/dL로 하면 예민도 72.7%, 특이도 89.5%로 가성낭을 다른 낭종과 감별진단할 수 있었다. CA19-9는 별다른 의미가 없었다. 천자에 따른 합병증이나 복강내 파종 등은 관찰되지 않았다. 결론: 췌장 낭종에 대한 세침흡인검사는 성공률도 높고, 감별진 단에 유용하며 비교적 안전한 검사 방법이다. Background/Aims: Pancreatic cystic neoplasms (PCNs) comprise a pathologically heterogeneous group with many shared clinical features. Diagnostic methods to distinguish mucinous cystic tumors (MCTs) from other cysts are limited. We assessed the reliability of the cystic fluid analysis measuring CEA, CA19-9, and amylase, cytological analysis and mucin staining in the differential diagnosis of PCNs. Methods: Cystic fluid was obtained from 78 pancreatic cysts using fine needle aspiration. These lesions include 17 MCTs, 13 serous cystadenomas (SCAs), 5 solid pseudopapillary tumors (SPTs), 8 intraductal papillary mucinous tumors (IPMTs), 6 ductal carcinomas with cystic degeneration, and 29 pseudocysts. Results: Epithelial cells were observed in 27 (81%) of 33 PCNs, and cytological diagnosis was possible in 5 (31%) of 16 MCTs. Mucicarmine staining was positive only in 5 MCTs, one cystic adenocarcinoma and one IPMT but not in any cases of other cysts. CEA levels of cystic fluid more than 466 ng/mL had 86.7% sensitivity and 97.6% specificity for detecting MCTs. On the other hand, amylase levels over 479 U/dL had 72.7% sensitivity and 89.5% specificity for detecting pseudocysts. Conclusions: Cystic fluid analysis measuring cytology, mucin staining, CEA and amylase levels is useful in the differential diagnosis of pancreatic cysts.
우상명 ( Sang Myung Woo ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.3
The term of biliary tract cancer (BTC) refers to all tumors that arise from the biliary tract or the biliary drainage system, including the intra- and extra-hepatic bile ducts as well as the gallbladder. BTCs are aggressive tumors with limited treatment options and poor overall survival. Currently, surgery remains to be the only potentially curative treatment, and most patients develop recurrence. For advanced tumors, only limited effective treatment modalities exist today. Gemcitabine plus cisplatin is considered as a standard option for advanced biliary cancer. A randomized phase III trial (ABC-02 trial) showed superiority of gemcitabine plus cisplatin over gemcitabine alone. In that study, they showed that after a median follow-up of 8.2 months, the median overall survival was 8.1 months in the gemcitabine-only group and 11.7 months in the gemcitabine plus cisplatin group (p<0.001). However, while this is a definite advancement, a 3-month survival extension among patients with BTC is modest at best. Moreover, this regimen has not been compared head-to-head with other gemcitabine based combinations. Gemcitabine monotherapy, 5-fluorouracil plus leucovorin, and single- agent capecitabine are all reasonable options for patients with a borderline performance status. Recent advancements have provided new insight into the genomic landscape of BTCs, and thus, it remains unclear whether combined treatment with molecular targeted agents or other cytotoxic chemotherapeutic agents may also be effective against advanced BTC. (Korean J Gastroenterol 2017;69:172-176)