유방암의 뇌 전이 : 임상 및 방사선학적 소견

안진경,오기근,오기근,정태섭 대한영상의학회 2001 대한영상의학회지 Vol.45 No.1

목적: 유방암의 뇌 전이에 대한 임상적 특징 및 방사선학적 소견에 대하여 알아보고자 하였다 대상과 방법 1983년부터 1999년까지 본원에서 유방암으로 치료를 받은 환자 1399명중 유방암의 뇌 전이로 진단을 받았던 환자는 61명이었다 전체 1379명의 유방암 환자의 병기는 stage IIA(n=508), stage I(n=366). stage IIB(n=247). stage IIIA(n=189), stage IIIB(n=45) , stage 0(n = 33) stage IV(n = 11)이었으며 이중 뇌 전이를 보였던 61명의 환자의 병기는 stage IIB(12.5%). stage IIA(3.9%), stage IIIA(3.1%), stage IIIB(2.2%). stage I(0.8%)이었다. 전체 유방암 환자의 연령별 분포는 40-49세(n=610). 50-59세(n=301) 30-39세 (n = 291) , 60-69세 (n = 124) 20-29세 (n =41) , 70-79세 (n= 28) , 80-89세 (n=4)였으며 이중 뇌 전이 환자의 연령별 분포는 20-29세 (14.6%) , 30-39세 (79%) . 50-59세 (4.6%) .40-49세(2.6%), 60-69세(1 6%)였다. 61명의 뇌 전이 환자 중 영상 분석이 가능하였던 환자는 35명 이었으며 이들을 대상으로 뇌 전이로 인한 증상, 유방암의 첫번째 원격 전이 장기, 유방암 진단후 뇌 전이가지의 기간, 뇌 전이 이후 사망가지의 기간, 뇌 이외의 장기로 선행 전이가 있은 후에 뇌 전이가 된 환자와 다른 장기로의 전이 없이 뇌로 첫번째 전이가 있었던 환자에서의 생존기간의 타이를 알아보았다. 영상 소견은 CT(29예) 및 MRl(8예)를 분석하였다 결과: 임상적으로 나타난 뇌 전이의 주증상은 두통과 구토였다. 유방암 진단 후 다른 장기로의 전이는 뇌 전이 이전에 타장기로 선행 전이가 있었던 예(n=22)와 타장기로 선행 전이 없이 처음부터 뇌로 전이가 된 예(n=13)로 분류하였다. 유방암 진단 후 뇌 전이가지의 기간은 1-2년 (8/35), 2-3년(8/35)이 가장 많았고, 26명이 뇌 전이가 진단된 후 1년 이내에 사망하였다. 생존기간은 뇌 전이 이전에 타장기로 선행 전이가 있었던 환자가 타장기 전이 없이 처음부터 뇌로 원격 전이가 된 환자보다 좀 더 긴 소견을 보였다. 뇌 전이의 영상 소견상 전이 위치는 상천막 전이 (n=23) , 하천막 전이 (n=2)와 양쪽 모두로의 전이(n=10)가 있었고, 다발성 전이는 24예였으며 단일 전이는 11예였다. Purpose: To analyse the clinical and radiologic findings of brain metastasis of breast cancer. Materiars and Methods: Sixty-one of 1399 patients in whom breast cancer was diagnosed between 1983 and 1999 were affected by brain metastasis. Among these 1399, the stage of the breast cancer, in descending order of frequency, was IIA (n=508),I(n=366), IIB (n=247), IIIA (n= 189), IIIB (n=45),0 (n=33) and IV(n= 11) The stage of the 61 brain metastases, similarly ordered, was IIB (12.5%), IIA (3.9%), IIIA (3.1%), IIIB (2.2%) and I (0.8%) In all confirmed breast cancers, the age distribution, in descending order of frequency, was 40-49years (n= 610), 50-59 (n= 301), 30-39 In=2911, 60-69 (n= 124), 20-29 (n=41), 70-79 (n=28), and 80-89 (n=4). The age distribution of brain metastasis was 20-29 (14.6%), 30-39 (7.9%),50-59 (4.6%),40-49 I(2.6%) and 60-69 (l.6%). Imaging findings were available for 35 of the 61 patients affected by brain metastasis, and symptoms from brain among the 35, analysis of the symptoms of this metastasis, the site of the first distant metastasis to an extracranial or cranial organ, the interval from the diagnosis of breast cancer to brain metastasis, the interval from brain metastasis to death, and the difference in survival time between patients with iiitial and succeeding brain metastasis was undertaken. Brain CT findings were analysed in 29 cases and MRI findings in eight. Results: The most common symptoms were headache and vomiting. Among the 35 brain metastasis patients for whom imaging findings were available, other systemic metastasis occurred in 22. Initial brain metastasis occurred in the remaining 13, and in seven of these there was also coincident organ metastasis, while six showed only brain metastasis. The most frequent intervals from the diagnosis of breast cancer to brain metastasis were 1-2 years(8/35) and 2-3years(8/35). Twenty-six of 35 patients died within one year of brain metastasis. Patients in whom this occurred later survived for longer than those in whom it occurred initially.

Risk Factors for Metachronous Gastric Neoplasms in Patients Who Underwent Endoscopic Resection of a Gastric Neoplasm

( Hyuk Yoon ),( Nayoung Kim ),( Cheol Min Shin ),( Hye Seung Lee ),( Bo Kyoung Kim ),( Gyeong Hoon Kang ),( Jung Mogg Kim ),( Joo Sung Kim ),( Dong Ho Lee ),( Hyun Chae Jung ) 대한소화기학회 2016 Gut and Liver Vol.10 No.2

Background/Aims: To identify the risk factors for metachronous gastric neoplasms in patients who underwent an endoscopic resection of a gastric neoplasm. Methods: We prospectively collected clinicopathologic data and measured the methylation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation-specific real-time polymerase chain reaction in patients who underwent endoscopic resection of gastric neoplasms. Results: A total of 257 patients with gastric neoplasms (113 low-grade dysplasias, 25 highgrade dysplasias, and 119 early gastric cancers) were enrolled. Metachronous gastric neoplasm developed in 7.4% of patients during a mean follow-up of 52 months. The 5-year cumulative incidence of metachronous gastric neoplasm was 4.8%. Multivariate analysis showed that moderate/severe corpus intestinal metaplasia and family history of gastric cancer were independent risk factors for metachronous gastric neoplasm development; the hazard ratios were 4.12 (95% confidence interval [CI], 1.23 to 13.87; p=0.022) and 3.52 (95% CI, 1.09 to 11.40; p=0.036), respectively. The methylation level of MOS was significantly elevated in patients with metachronous gastric neoplasms compared age- and sexmatched patients without metachronous gastric neoplasms (p=0.020). Conclusions: In patients who underwent endoscopic resection of gastric neoplasms, moderate/severe corpus intestinal metaplasia and a family history of gastric cancer were independent risk factors for metachronous gastric neoplasm, and MOS was significantly hypermethylated in patients with metachronous gastric neoplasms. (Gut Liver 2016;10:228-236)

Dissecting Tumor-Stromal Interactions in Breast Cancer Bone Metastasis

Yibin Kang 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.2

Bone metastasis is a frequent occurrence in breast cancer, affecting more than 70% of late stage cancer patients with severe complicationssuch as fracture, bone pain, and hypercalcemia. The pathogenesis of osteolytic bone metastasis depends on cross-communicationsbetween tumor cells and various stromal cells residing in the bone microenvironment. Several growth factor signalingpathways, secreted micro RNAs (miRNAs) and exosomes are functional mediators of tumor-stromal interactions in bone metastasis. We developed a functional genomic approach to systemically identified molecular pathways utilized by breast cancercells to engage the bone stroma in order to generate osteolytic bone metastasis. We showed that elevated expression of vascularcell adhesion molecule 1 (VCAM1) in disseminated breast tumor cells mediates the recruitment of pre-osteoclasts and promotestheir differentiation to mature osteoclasts during the bone metastasis formation. Transforming growth factor β (TGF-β) is releasedfrom bone matrix upon bone destruction, and signals to breast cancer to further enhance their malignancy in developing bone metastasis. We furthered identified Jagged1 as a TGF-β target genes in tumor cells that engaged bone stromal cells through the activationof Notch signaling to provide a positive feedback to promote tumor growth and to activate osteoclast differentiation. Substantiallychange in miRNA expression was observed in osteoclasts during their differentiation and maturation, which can be exploitedas circulating biomarkers of emerging bone metastasis and therapeutic targets for the treatment of bone metastasis. Furtherresearch in this direction may lead to improved diagnosis and treatment strategies for bone metastasis.

Metachronous liver metastasis after curative gastrectomy for gastric adenocarcinoma

Suk-Hyun Shin(신석현),Jong Man Kim(김종만),Su Mi Kim(김수미),Min-Gew Choi(최민규),Choon Hyuck David Kwon(권준혁),Jae-Won Joh(조재원),Sung Kim(김성),Suk-Koo Lee(이석구),Cheol Keun Park(박철근) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2

Purpose: The prognosis of patients with liver metastasis from gastric cancer is poor and the optimal treatment remains undetermined. This study identified prognostic factors for survival of patients with metachronous liver metastasis with no other metastatic site after gastrectomy for primary gastric cancer. We also evaluated the clinical impact of hepatic resection. Methods: Between 1997 and 2013, 19,588 curative gastrectomies for gastric adenocarcinoma were performed and 52 patients were diagnosed with metastasis to only the liver. We retrospectively analyzed the clinicopathologic factors of these patients. Results: The median time from gastrectomy to diagnosis of liver metastasis was 16 months (range, 1?65 months). Median survival time after the diagnosis of liver metastasis was 13 months (range, 3?64 months). The 1-year, 2-year, and 3-year patient survival rates after diagnosis of liver metastasis were 53.8%, 26.6%, and 19.9%, respectively. Twelve patients (23%) underwent liver resection for liver metastasis. The 1-year, 3-year, and 5-year overall survival rates were 92%, 42%, and 42% in the hepatic resection group and 43%, 13%, and 7% in the non-hepatic resection group (P=0.002). Multivariate analysis showed that hepatic resection, pathologic stage I and II of the primary tumor, and intestinal type in Lauren classification were predisposing factors for patient survival. Conclusion: Liver resection for resectable metachronous liver metastasis diagnosed after curative gastrectomy increases survival in patients with pathologic stage I or II and intestinal type in Lauren classification for the primary tumor.

Oncologic outcomes following metastasectomy in colorectal cancer patients developing distant metastases after initial treatment

Seung Yeop Oh,Do Yoon Kim,Kwang Wook Suh 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.88 No.5

Purpose: We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. Methods: Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. Results: The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. Conclusion: Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.

Bone Metastasis in Gastric Cancer Patients

Jae Bong Ahn,하태경,권성준 대한위암학회 2011 Journal of gastric cancer Vol.11 No.1

Purpose: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. Materials and Methods: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. Results: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average 14.9±17.3 months and the period until death after the diagnosis of bone metastasis was on average 3.8±2.6 months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. Conclusions: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis

Bone Metastasis in Gastric Cancer Patients

Ahn, Jae-Bong,Ha, Tae-Kyung,Kwon, Sung-Joon The Korean Gastric Cancer Association 2011 Journal of gastric cancer Vol.11 No.1

Purpose: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. Materials and Methods: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. Results: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average $14.9{\pm}17.3$ months and the period until death after the diagnosis of bone metastasis was on average $3.8{\pm}2.6$ months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. Conclusions: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis.

수술 후 보조적 방사선 치료를 포함한 근치적 치료를 받은 유방암 환자들의 뇌전이 발생률과 연관된 인자 분석

배선현,최두호,허승재,임도훈,박원,남희림,양정현,남석진,이정언,임영혁,안진석,박연희 한국유방암학회 2011 Journal of breast cancer Vol.14 No.-

Purpose: To assess the incidence of brain metastasis in patients with breast cancer receiving surgery and adjuvant radiotherapy (RT) and to evaluate subtypes associated with brain metastasis. Methods: We retrospectively reviewed the medical records of 1,000 patients with breast cancer who were treated with surgery and adjuvant RT for a cure between January 2001 and July 2005 at Samsung Medical Center. Seventy-one patients received neoadjuvant chemotherapy before surgery. The pathological stage was I in 430 patients, II in 327, and III in 243. We divided the patients into three subtypes according to immunohistochemistry: triple negative (TN, 245 patients), human epidermal growth factor 2 (HER2) enriched (HE, 166 patients) and positive estrogen receptor or progesterone receptor without HER2 overexpression (EP, 589 patients). The median follow up time was 72 months after surgery. Results: Locoregional failure-free survival rate and distant metastasis-free survival rate at 5 years were 92.8% and 86.1%, respectively. The disease free survival rate and overall survival rate at 5 years were 84.6% and 94.7%, respectively. Thirty-nine patients had brain metastasis, and the brain metastasis-free survival rate at 5 years was 97.2%. A univariate analysis showed that younger age, neoadjuvant chemotherapy, modified radical mastectomy, advanced pathological stage and the TN and HE subtypes were significant risk factors for brain metastasis. A multivariate analysis revealed that age, neoadjuvant chemotherapy, pathological stage and the TN and HE subtypes were statistically significant factors for brain metastasis. Conclusion: The cumulative incidence of brain metastasis was 3.9% after curative treatment. If patients have a clinically suspicious symptoms suggesting brain metastasis, clinicians should be aware that an early brain imaging work up and management are necessary. Because patients with the TN or HE subtypes accompanied by younger age and advanced pathological stage have increased brain metastasis (>10%), annual regular imaging follow-up may be recommended for these high risk patients.

Advances in diagnosis and treatment of metastatic cervical cancer

Haoran Li,Xiaohua Wu,Xi Cheng 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.4

Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

Clinical Outcomes in Patients with Triple-negative Breast Cancer and Brain Metastases

김효진,권혁찬,오성용,김성현,이수,권경아,이지현,이미리,조세현,최영진 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: Patients with triple-negative breast cancer (TNBC) are known to carry an increased risk of distant metastasis and poor survival. The principal objective of this study was to investigate survival after brain metastases in patients with TNBC. Methods: The authors retrospectively evaluated clinical data obtained from 66 patients who had been diagnosed with breast cancer and brain metastasis from 2003 to 2009. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor-2 (HER2) statuses were determined via immunohistochemical staining. TNBCs were defined as those that were ER-negative, PR-negative, and HER2-negative. The time interval from initial diagnosis to brain metastasis and overall survival after brain metastasis was evaluated via the Kaplan-Meier method. Results: Twenty four (40.0%) of 60 patients were diagnosed with TNBC. The clinicopathologic characteristics did not differ between the TNBC and non-TNBC patients. The disease-free survival durations of the TNBC and non-TNBC subjects were 17.9 and 25.6 months, respectively (p=0.135). The time intervals from initial diagnosis to brain metastasis were 25.5 and 43.7 months, respectively (p=0.027). The time intervals from distant metastasis to brain metastasis were 8.4 and 19.5 months, respectively (p=0.006). Overall survival durations from brain metastasis to death were 4.3 and 7.6 months, respectively (p=0.046). Conclusion: Patients with TNBC were more likely to develop brain metastasis earlier, and exhibit poor overall survival. Triple receptor status may be utilized as a prognostic marker for breast cancer patients with brain metastasis.