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Lee J.H.,National Cancer Center | Choi I.J.,National Cancer Center | Kook M.C.,National Cancer Center | Nam B.-H.,Research Institute for National Cancer Control and Evaluation | And 2 more authors.
British Journal of Surgery | Year: 2010

Background: Early gastric cancer with signet ring cell histology has been reported as a favourable histological type. The aim of this study was to identify risk factors associated with lymph node metastasis in patients with this type of early gastric cancer. Methods: A cross-sectional study of patients with early gastric cancer with differentiated and signet ring cell histology undergoing surgery was conducted. Risk factors were evaluated using multiple logistic regression analysis with odds ratios and 95 per cent confidence intervals. Results: In 1362 patients undergoing gastrectomy for early gastric cancer, the rate of lymph node metastasis was similar for tumours with signet ring cell and differentiated histological findings (10.7 versus 9.0 per cent respectively; P = 0.307). Logistic regression analysis showed that depth of tumour invasion was predictive of lymph node metastasis in patients with signet ring cell histology (P < 0.001). Tumour size was not associated with lymph node metastasis in either univariable or multivariable analysis. Lesions smaller than 2 cm were not uncommon in patients with signet ring cell gastric tumours and lymph node metastases (six of 48; 13 per cent). Conclusion: Patients with early gastric cancer with signet ring cell-type histology are probably best treated by gastrectomy with lymph node dissection. Copyright © 2010 British Journal of Surgery Society Ltd.

Jung S.-Y.,Center for Breast Cancer | Kim H.Y.,Center for Breast Cancer | Nam B.-H.,Research Institute for National Cancer Control and Evaluation | Min S.Y.,Center for Breast Cancer | And 12 more authors.
Breast Cancer Research and Treatment | Year: 2010

The present study was designed to assess the clinical characteristics and outcomes of metaplastic breast cancer (MBC) compared to general invasive ductal carcinoma (IDC) and the triple-negative subtype (TN-IDC). The study population included 35 MBC and 2,839 IDC patients, including 473 TN-IDC diagnoses, from the National Cancer Center, Korea between 2001 and 2008. The clinicopathological characteristics and clinical outcomes were retrospectively reviewed. Mean age of patients was 47.4 years for the MBC group and 48.3 years for the IDC group. The MBC patients presented with a larger tumor size (>T2, 74.3% vs. 38.8%, P < 0.001), more distant metastasis at the first diagnosis (8.6% vs. 2.0%, P = 0.04), higher histologic grade (grade 3, 65.7% vs. 41.4%, P < 0.001), fewer estrogen receptor (ER), and progesterone receptor (PgR) positivity (ER+, 5.7% vs. 65.4%, P < 0.001; PgR+, 8.6% vs. 55.8%, P < 0.001), higher Ki-67 expression (35.5 ±26.2% vs. 20.6 ± 19.8%, P = 0.024), and more TN subtypes (80.0% vs. 16.7%, P < 0.001) compared to the IDC group. Fifteen (46.8%) MBC patients and 260 (9.3%) IDC patients experienced disease recurrence with a median follow-up of 47.2 months (range 4.9-100.6 months). MBC was a poor prognostic factor for disease recurrence and overall survival in univariate and multivariate analysis (HR 3.89 in recurrence, 95% CI: 1.36-11.14, P = 0.01; HR 5.29 in death, 95% CI: 2.15-13.01, P < 0.001). MBC patients also experienced more disease recurrence (HR 3.99, 95% CI: 1.31-12.19, P = 0.01) and poorer overall survival (HR 3.14, 95% CI: 1.19-8.29, P = 0.02) compared to the 473 TN-IDC patients, as reflected by aggressive pathological features. Patients with MBC appeared to have inherently aggressive tumor biology with poorer clinical outcomes than those with general IDC or TN-IDC.

Park J.Y.,Research Institute and Hospital | Ryu K.W.,Research Institute and Hospital | Eom B.W.,Research Institute and Hospital | Yoon H.M.,Research Institute and Hospital | And 8 more authors.
Annals of Surgical Oncology | Year: 2014

Background. There is no consensus on the optimal method of primary tumor control, determined by preoperative clinical factors, during sentinel node (SN) navigation surgery for early gastric cancer (EGC). In this study, we investigated the accuracy of clinical diagnosis based on preoperative examination in patients with EGC and proposed surgical options for primary tumor control during SN navigation surgery. Methods. We analyzed 815 patients with clinical stage IA gastric cancer who underwent gastrectomy at the National Cancer Center in Korea between March 2001 and February 2011. The clinical stage was determined by endoscopy, endoscopic ultrasonography, and abdominal computed tomography. Results. The preoperative assessment of tumor depth and tumor size was accurate in 57.5 and 70.8 % of patients, respectively. Tumor depth and size were underestimated in 8 and 25.3 % of patients. The overall accuracy of histologic diagnosis by endoscopic biopsy was 87.2 %. Of those tumors diagnosed preoperatively as differentiated, 20.5 % revealed mixed histology of undifferentiated type. Conclusions. The recommendation for SN biopsy may be limited to tumors sized 3 cm or smaller to avoid positive lateral margins and to minimize the risk of skip metastases. Endoscopic resection may safely be applied to small mucosal cancers, but other surgical options should be employed for undifferentiated large mucosal lesions, given their tendency for diffuse invasion. Full-thickness resection is preferable for submucosal cancers, to secure clear vertical margins. © 2013 Society of Surgical Oncology.

Lee D.-C.,University of South Carolina | Park I.,Seoul National University | Jun T.-W.,Seoul National University | Nam B.-H.,Research Institute for National Cancer Control and Evaluation | And 3 more authors.
American Journal of Epidemiology | Year: 2012

The authors examined the independent and combined associations of physical activity and obesity with incident type 2 diabetes among 675,496 Korean men from the database of the National Health Insurance Corporation. During an average follow-up of 7.5 years (1996-2005), 52,995 men developed type 2 diabetes. Men with overweight, obese I, and obese II classifications had 1.47, 2.05, and 3.69 times higher risk of type 2 diabetes, respectively, compared with normal weight men, and men with low, medium, and high activity had 5%, 10%, and 9% lower risk of type 2 diabetes, respectively, compared with inactive men after adjustment for confounders and physical activity or body mass index for each other. Overweight and obesity were detrimental within all activity categories, and meeting the activity recommendations (medium and high activity) was beneficial at all body mass index levels. Meeting the activity recommendations appeared to attenuate some negative effects of overweight or obesity, and the increased risk of type 2 diabetes due to inactivity was lower in normal weight men. Both preventing overweight or obesity and increasing physical activity are important to reduce the global epidemic of type 2 diabetes, regardless of body weight and activity levels. © The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.

Park I.H.,Center for Breast Cancer | Ro J.,Center for Breast Cancer | Lee K.S.,Center for Breast Cancer | Kim S.N.,Center for Clinical Trials | And 2 more authors.
Investigational New Drugs | Year: 2010

Summary: Background No clear data are available concerning the superiority of combination chemotherapy to sequential therapy using agents beyond 1st or 2nd line chemotherapy for treating patients with metastatic breast cancer. Methods Patients were randomized to receive a combination of gemcitabine and vinorelbine or gemcitabine until disease progression followed by vinorelbine monotherapy. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Results Forty-two patients were randomized to the combination arm and 40 were randomized to the sequential arm. Baseline characteristics were well balanced between the arms. The median number of chemotherapy cycles was 4 (range, 1-23) for the combination arm and 6 (range, 1-25) for the sequential arm. Patients receiving combination therapy had a higher composite response rate (26.8% vs. 12.5%; P=0.106) but a shorter median time to treatment failure (3.6 vs. 4.4 months, P=0.252) as compared to patients receiving sequential monotherapy. Median overall survival for the combination and sequential arms was 10.6 months and 8.9 months, respectively (P=0.436). Toxicities were manageable and similar in both arms. Quality of life measurements in global health, role, and social function were superior in the combination arm (P<0.05). Conclusions Combined gemcitabine and vinorelbine therapy appears comparable to sequential monotherapy for heavily pretreated patients with metastatic breast cancer as demonstrated by improved quality of life outcomes with similar therapeutic efficacies and incidences of adverse events. © 2009 Springer Science+Business Media, LLC.

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