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)

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.

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.

Activin and Hepatocyte Growth Factor Promotes Colorectal Cancer Stemness and Metastasis through FOXM1/SOX2/CXCR4 Signaling

( Hong Peng ),( Ting Ye ),( Lei Deng ),( Xiaofang Yang ),( Qingling Li ),( Jin Tong ),( Jinjun Guo ) 대한소화기기능성질환·운동학회 2024 Gut and Liver Vol.18 No.3

Background/Aims: Cancer stem cells (CSCs) are believed to drive tumor development and metastasis. Activin and hepatocyte growth factor (HGF) are important cytokines with the ability to induce cancer stemness. However, the effect of activin and HGF combination treatment on CSCs is still unclear. Methods: In this study, we sequentially treated colorectal cancer cells with activin and HGF and examined CSC marker expression, self-renewal, tumorigenesis, and metastasis. The roles of forkhead box M1 (FOXM1) and sex-determining region Y-box 2 (SOX2), two stemness-related transcription factors, in activin/HGF-induced aggressive phenotype were explored. Results: Activin and HGF treatment increased the expression of CSC markers and enhanced sphere formation in colorectal cancer cells. The tumorigenic and metastatic capacities of colorectal cancer cells were enhanced upon activin and HGF treatment. Activin and HGF treatment preferentially promoted stemness and metastasis of CD133⁺ subpopulations sorted from colorectal cancer cells. FOXM1 was upregulated by activin and HGF treatment, and the knockdown of FOXM1 blocked activin/HGF-induced stemness, tumorigenesis, and metastasis of colorectal cancer cells. Similarly, SOX2 was silencing impaired sphere formation of activin/HGF-treated colorectal cancers. Overexpression of SOX2 rescued the stem cell-like phenotype in FOXM1-depleted colorectal cancer cells with activin and HGF treatment. Additionally, the inhibition of FOXM1 via thiostrepton suppressed activin/HGF-induced stemness, tumorigenesis and metastasis. Conclusions: Sequential treatment with activin and HGF promotes colorectal cancer stemness and metastasis through activation of the FOXM1/SOX2 signaling. FOXM1 could be a potential target for the treatment of colorectal cancer metastasis. (Gut Liver 2024;18:476-488)

Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis

Yukiharu Todo,Sho Takeshita,Kazuhira Okamoto,Katsushige Yamashiro,Hidenori Kato 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5

Objective: The aim of this study was to confirm the incidence and implications of a lymphaticspread pattern involving para-aortic lymph node (PAN) metastasis in the absence of pelviclymph node (PLN) metastasis in patients with endometrial cancer. Methods: We carried out a retrospective chart review of 380 patients with endometrial cancertreated by surgery including PLN dissection and PAN dissection at Hokkaido Cancer Centerbetween 2003 and 2016. We determined the probability of PAN metastasis in patients withoutPLN metastasis and investigated survival outcomes of PLN−PAN+ patients. Results: The median numbers of PLN and PAN removed at surgery were 41 (range: 11–107)and 16 (range: 1–65), respectively. Sixty-four patients (16.8%) had lymph node metastasis,including 39 (10.3%) with PAN metastasis. The most frequent lymphatic spread pattern wasPLN+PAN+ (7.9%), followed by PLN+PAN− (6.6%), and PLN−PAN+ (2.4%). The probabilityof PAN metastasis in patients without PLN metastasis was 2.8% (9/325). The 5-year overallsurvival rates were 96.5% in PLN−PAN−, 77.6% in PLN+PAN−, 63.4% in PLN+PAN+, and53.6% in PLN−PAN+ patients. Conclusion: The likelihood of PAN metastasis in endometrial cancer patients withoutPLN metastasis is not negligible, and the prognosis of PLN−PAN+ is likely to be poor. The implications of a PLN−PAN+ lymphatic spread pattern should thus be taken intoconsideration when determining patient management strategies

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.

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.

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

원격전이가 발생한 폐경전 여성 유방암 환자에서의 예후인자

성정호,유재민,남석진,이정언,유종한,이세경,채병주,김석원 한국유방암학회 2020 Journal of Breast Disease Vol.8 No.1

Purpose: Several studies have reported that the survival after distant metastasis in younger patients with breast cancer was similar to that in elderly patients. Moreover, few studies have observed better survival outcome after distant metastasis in younger patients with breast cancer. Here, we have identified the factors that affect the prognosis after distant metastasis in these patients. Methods: We reviewed 7,157 patients that underwent primary breast cancer surgery between January 2003 and December 2013 at the Samsung Medical Center. Three hundred and thirty two premenopausal patients aged <50 years showed distant metastasis and were included in the analysis. For further analysis, the patients older or younger than 40 years were divided into 2 groups. Results: There were no demographic differences in the patient characteristics such as clinical stage, nuclear grade, lymphovascular invasion, distant metastasis site, distant metastasis free interval (DMFI), except the estrogen receptor (ER) and progesterone receptor (PR) statuses, histopathology, and molecular subtype in both the groups (p-value=0.023, 0.035, 0.016, 0.046, respectively). The median follow-up period was 79.4 months. Next, we did not observe significant difference in the overall survival (OS) between the two groups (Log rank p-value=0.975). However, patients in the luminal A and luminal B group showed better OS than those in human epidermal growth factor receptor-2 (HER-2) positive, and triple-negative breast cancer (TNBC) group (Log-rank p-value<0.001). Furthermore, patients showed worse OS when they developed distant metastases within 36 months post-surgery (Log-rank p-value<0.001). In overall, age did not affect the survival outcome (p-value=0.547); however, the molecular subtype, DMFI, and distant metastasis sites showed significant differences in the patient outcome (p-value<0.001, respectively). Conclusion: Our analysis suggests that the molecular subtype, DMFI, and distant metastasis site serve as useful predictors for prognosis in younger breast cancer patients with distant metastasis. However, age in these patients did not correlate well with mortality.