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Lee HS, Park SH, Yang SK, Ye BD, Kim JH, Kim SO, Soh JS, Lee S, Bae JH, Lee HJ, Yang DH, Kim KJ, Byeon JS, Myung SJ, Yoon YS, Yu CS, Kim JH. The risk of colorectal cancer in inflammatory bowel disease: a hospital-based cohort study from Korea. Scand J Gastroenterol 2015; 50:188-96. [PMID: 25515241 DOI: 10.3109/00365521.2014.989538] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Limited data are available on the incidence and risk factors of colorectal cancer (CRC) in Asian patients with inflammatory bowel disease (IBD). MATERIAL AND METHODS Information on 5212 Korean patients with IBD (2414 with Crohn's disease [CD] and 2798 with ulcerative colitis [UC]) was retrieved from the IBD registry of Asan Medical Center. Data on CRC incidence for the entire Korean population were derived from the Korean Statistical Information Service. RESULTS During 39,951 person-years of follow-up (17,679 for CD and 22,272 for UC), 30 patients (12 with CD and 18 with UC) developed CRC. The standardized incidence ratio (SIR) of CRC was 6.0 (95% confidence interval [CI], 3.10-10.48) for CD and 1.68 (95% CI, 1.00-2.66) for UC; it was 9.69 (95% CI, 5.01-16.93) for CD with colonic involvement and 4.31 (95% CI, 2.46-7.00) for extensive UC. The SIR was also increased in patients diagnosed with IBD at younger than 30 years old. CRC location was the low rectum in 11 of 12 CD patients (91.7%). The cumulative probability of rectal cancer was higher in CD patients with a perianal fistula than in those without a perianal fistula (p = 0.02). CONCLUSIONS A high prevalence of perianal fistulas in Korean CD patients may be the cause of the predominance of low rectal cancer in this population and the higher SIR of CRC in Koreans than in Westerners. In contrast, the SIR of CRC in Korean UC patients may be similar to that in Western UC patients.
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Lee HS, Park SH, Yang SK, Lee J, Soh JS, Lee S, Bae JH, Lee HJ, Yang DH, Kim KJ, Yea BD, Byeon JS, Myung SJ, Yoon YS, Yu CS, Kim JH. Long-term prognosis of ulcerative colitis and its temporal change between 1977 and 2013: a hospital-based cohort study from Korea. J Crohns Colitis 2015; 9:147-55. [PMID: 25518059 DOI: 10.1093/ecco-jcc/jju017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS No previous large-scale studies have evaluated the prognosis of ulcerative colitis (UC) over a period of three decades in a non-Caucasian population. The aims of this study were to update the current information on the natural course of UC in a sizable cohort of Korean patients and to evaluate changes in the treatment paradigms and prognosis of UC over time. METHODS We retrospectively analyzed 2802 Korean UC patients who visited Asan Medical Center. We divided the study subjects into three groups based on the year of diagnosis (cohort 1: 1977–1999; cohort 2: 2000–2006; and cohort 3: 2007–2013). RESULTS Five-year cumulative probabilities of prescription of thiopurines (azathioprine or 6-mercaptopurine) and anti-tumor necrosis factor (anti-TNF) agents were 4.1% and 0.0%, respectively, in cohort 1 and 27.9% and 12.7%, respectively, in cohort 3 (P < 0.001). A total of 209 patients (7.5%) underwent colectomy, producing cumulative probabilities of colectomy at 10, 20 and 30 years after diagnosis of 7.8%, 14.2% and 21.3%, respectively. The cumulative probability of colectomy was especially low in patients first diagnosed at our center: 3.1% at 10 years and 4.5% at 20 years. Moreover, the cumulative probability of colectomy decreased significantly over the last 30 years (P = 0.039). CONCLUSION Thiopurines and anti-TNF agents are used increasingly more frequently and earlier, while the colectomy rate has decreased over the last 30 years in Korean patients with UC. Korean UC patients may have a better clinical course than Western cases, as indicated by a lower colectomy rate.
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Hwang K, Park IJ, Yu CS, Lim SB, Lee JL, Yoon YS, Kim CW, Kim JC. Impression of prognosis regarding pathologic stage after preoperative chemoradiotherapy in rectal cancer. World J Gastroenterol 2015; 21:563-570. [PMID: 25593475 PMCID: PMC4292289 DOI: 10.3748/wjg.v21.i2.563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/30/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To ascertain pathologic stage as a prognostic indicator for rectal cancer patients receiving preoperative chemoradiotherapy (PCRT).
METHODS: Patients with mid- and low rectal carcinoma (magnetic resonance imaging - based clinical stage II or III) between 2000 and 2009 and treated with curative radical resection were identified. Patients were divided into two groups: PCRT and No-PCRT. Recurrence-free survival (RFS) was examined according to pathologic stage and addition of adjuvant treatment.
RESULTS: Overall, 894 patients were identified. Of these, 500 patients received PCRT. Adjuvant chemotherapy was delivered to 81.5% of the No-PCRT and 94.8% of the PCRT patients. Adjuvant radiotherapy was given to 29.4% of the patients in the No PCRT group. The 5-year RFS for the No-PCRT group was 92.6% for Stage I, 83.3% for Stage II, and 72.9% for Stage III. The 5-year RFS for the PCRT group was 95.2% for yp Stage 0, 91.7% for yp Stage I, 73.9% for yp Stage II, and 50.7% for yp Stage III.
CONCLUSION: Pathologic stage can predict prognosis in PCRT patients. 5-year RFS is significantly lower among PCRT patients than No-PCRT patients in pathologic stage II and III. These results should be taken into account when considering adjuvant treatment for patients treated with PCRT.
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Park SJ, Kim SM, Hong YS, Lee JL, Kim JE, Kim KP, Hong SM, Jin DH, Kim CW, Yoon YS, Park IJ, Lim SB, Yu CS, Kim JC, Kim TW. TFAP2E methylation status and prognosis of patients with radically resected colorectal cancer. Oncology 2014; 88:122-32. [PMID: 25341849 DOI: 10.1159/000362820] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study investigates the clinical significance of the gene encoding AP-2ε (TFAP2E) in colorectal cancer (CRC) patients undergoing curative resection. METHODS A single-institution cohort of 248 patients who underwent curative resection of stage I/II/III CRCs between March and December 2004 was enrolled, and 193 patients whose tumors were available for the determination of the TFAP2E methylation status were included in the analysis. RESULTS TFAP2E hypermethylation was detected in 112 patients (58%) and was significantly associated with distally located CRCs, low pathologic T stage (T1/T2), and stage I tumors. After a median follow-up of 86.3 months, the patients with TFAP2E hypermethylation tended to show better relapse-free survival (RFS) and overall survival (OS) than the patients with TFAP2E hypomethylation (5-year RFS rate: 90 vs. 80%, p = 0.063; 6-year OS rate: 88 vs. 80%, p = 0.083). Multivariate analysis showed that the pathologic nodal stage and TFAP2E methylation status were independent prognostic factors for RFS and OS, and they remained significant factors in the subgroup analysis that included 154 patients with stage II/III CRCs who had received adjuvant chemotherapy. CONCLUSIONS TFAP2E hypermethylation is associated with good clinical outcomes and may be considered as an independent prognostic factor in patients with curatively resected CRCs.
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Kim HJ, Lee SS, Byun JH, Kim JC, Yu CS, Park SH, Kim AY, Ha HK. Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology 2014; 274:712-22. [PMID: 25286324 DOI: 10.1148/radiol.14140390] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To prospectively compare diagnostic performance of diffusion-weighted (DW) imaging, gadoxetic acid-enhanced magnetic resonance (MR) imaging, both techniques combined (combined MR imaging), and computed tomography (CT) for detecting colorectal hepatic metastases and evaluate incremental value of MR for patients with potentially curable colorectal hepatic metastases detected with CT. MATERIALS AND METHODS In this institutional review board-approved prospective study, with informed consent, 51 patients (39 men, 12 women; mean age, 62 years) with potentially resectable hepatic metastases detected with CT underwent liver MR, including DW imaging and gadoxetic acid-enhanced MR. Two independent readers reviewed DW, gadoxetic acid-enhanced, combined MR, and CT image sets to detect hepatic metastases. The figure-of-merit (FOM) value representing overall diagnostic performance, sensitivity, and positive predictive value (PPV) for each image set were analyzed by using free-response receiver operating characteristic analysis and generalized estimating equations. RESULTS There were 104 hepatic metastases in 47 patients. The pooled FOM values, sensitivities, and PPVs of combined MR (FOM value, 0.93; sensitivity, 98%; and PPV, 88%) and gadoxetic acid-enhanced MR (FOM value, 0.92; sensitivity, 95%; and PPV, 90%) were significantly higher than those of CT (FOM value, 0.82; sensitivity, 85%; and PPV, 73%) (P < .006). The pooled FOM value and sensitivity of combined MR (FOM value, 0.92; sensitivity, 95%) was also significantly higher than that of DW imaging (FOM value, 0.82; sensitivity, 79%) for metastases (≤1-cm diameter) (P ≤ .003). DW imaging showed significantly higher pooled sensitivity (79%) and PPV (60%) than CT (sensitivity, 50%; PPV, 33%) for the metastases (≤1-cm diameter) (P ≤ .004). In 47 patients with hepatic metastases, combined MR depicted more metastases than CT in 10 and 14 patients, respectively, according to both readers. CONCLUSION Gadoxetic acid-enhanced MR and combined MR are more accurate than CT in detecting colorectal hepatic metastases, have an incremental value when added to CT alone for detecting additional metastases, and can be routinely performed in patients with potentially curable hepatic metastases detected with CT.
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Yang DH, Yang SK, Song K, Hong M, Park SH, Lee HS, Kim JB, Lee HJ, Park SK, Jung KW, Kim KJ, Ye BD, Byeon JS, Myung SJ, Kim JH, Shin US, Yu CS, Lee I. TNFSF15 is an independent predictor for the development of Crohn's disease-related complications in Koreans. J Crohns Colitis 2014; 8:1315-26. [PMID: 24835165 DOI: 10.1016/j.crohns.2014.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/22/2014] [Accepted: 04/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic idiopathic inflammatory bowel disease involving the whole gastrointestinal tract. TNFSF15 has been proved as a susceptibility gene for CD, but there are few reports about the association between TNFSF15 single nucleotide polymorphisms (SNPs) and the clinical course of CD. AIM To investigate the association between TNFSF15 genotypes and the clinical course of CD in Koreans. METHODS A total of 906 CD patients having TNFSF15 genotype data and clinical information were recruited from CD registry database of a tertiary referral center. The association between five TNFSF15 SNPs (rs4574921, rs3810936, rs6478108, rs6478109, and rs7848647) and various clinical parameters including stricture, non-perianal penetrating complications, bowel resection, and reoperation was investigated. RESULTS Among the five SNPs, rs6478108 CC genotype was associated with the development of stricture and non-perianal penetrating complications during follow-up (HR for stricture=1.706, 95% confidence interval 1.178-2.471, P=0.005; HR for non-perianal penetrating complications=1.667, 95% confidence interval 1.127-2.466, P=0.010), and rs4574921 CC genotype was associated with the development of perianal fistula (HR=2.386, 95% confidence interval 1.204-4.727, P=0.013) by multivariate analysis. However, there was no significant association of cumulative operation and reoperation rate with 5 SNPs of TNFSF15. CONCLUSION In Korean patients with CD, non-risk allele homozygotes of TNFSF15 SNPs rs6478108 and rs4574921 are independent genetic predictive factors for the development of strictures/non-perianal penetrating complications and perianal fistula, respectively.
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Park SJ, Ryu MH, Ryoo BY, Park YS, Sohn BS, Kim HJ, Kim CW, Kim KH, Yu CS, Yook JH, Kim BS, Kang YK. The role of surgical resection following imatinib treatment in patients with recurrent or metastatic gastrointestinal stromal tumors: results of propensity score analyses. Ann Surg Oncol 2014; 21:4211-7. [PMID: 24980089 DOI: 10.1245/s10434-014-3866-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although benefits of surgical resection of residual gastrointestinal stromal tumors (GISTs) after imatinib therapy have been suggested, those benefits over imatinib alone have not been proven. We compared the clinical outcomes of surgical resection of residual lesions after imatinib treatment (S group) with imatinib treatment alone (NS group) in patients with recurrent or metastatic GISTs. METHODS A total of 134 patients (42 in the S group, 92 in the NS group) with recurrent or metastatic GIST who had stable disease for more than 6 months after responding to imatinib were included. RESULTS There were no statistically significant differences in the baseline characteristics of the S and NS groups except for age and number of peritoneal metastases. The median follow-up period was 58.9 months. Progression-free survival (PFS) and overall survival (OS) were significantly longer in the S group compared with the NS group (median PFS: 87.7 vs. 42.8 months, p = 0.001; median OS: not reached vs. 88.8 months, p = 0.001). Multivariate analysis revealed that S group, female sex, KIT exon 11 mutations, and low initial tumor burden were associated with longer PFS, and S group and low initial tumor burden were associated with a longer OS. Even after applying inverse probability of treatment weighting adjustment, the S group demonstrated significantly better outcomes in terms of PFS (HR 2.326; 95 % confidence interval [CI] 1.034-5.236; p = 0.0412) and OS (HR 5.464; 95 % CI 1.460-20.408; p = 0.0117). CONCLUSION Surgical resection of residual lesions after disease control with imatinib is likely to be beneficial to patients with recurrent or metastatic GISTs.
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Kim B, Park SH, Pickhardt PJ, Lee SS, Ahn S, Kim J, Kim JC, Yu CS, Yang SK, Kim AY, Ha HK. Adenomatous neoplasia: postsurgical incidence after normal preoperative CT colonography findings in the colon proximal to an occlusive cancer. Radiology 2014; 273:99-107. [PMID: 24918959 DOI: 10.1148/radiol.14132844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the postoperative incidence of adenomatous neoplasia in the colon proximal to an occlusive colorectal cancer where preoperative computed tomographic (CT) colonography findings were normal. MATERIALS AND METHODS Institutional review board approval, with a waiver of informed consent, was obtained. This observational study included patients with occlusive colorectal cancer who underwent preoperative CT colonography between April 2007 and March 2010 that revealed normal findings (ie, no lesions ≥ 6 mm) in the proximal colon and who underwent postoperative colonoscopy. The primary outcome was postoperative colonoscopic discovery of clinically relevant lesions (ie, nondiminutive [≥ 6 mm] adenomas, advanced adenomas, or cancers) in the proximal colon. The cumulative incidence of clinically relevant lesions in preoperatively normal proximal colon over the postsurgical follow-up time was analyzed by using the Kaplan-Meier method. RESULTS The final cohort included 204 patients (102 men and 102 women; mean age, 57.3 years ± 11.3 [standard deviation]). At a total of 435 postoperative colonoscopies performed over a median follow-up of 29 months (range, 1-74 months), clinically relevant lesions were detected in the proximal colon in 30 patients: Nonadvanced adenomas were detected in 23 patients, and advanced adenomas were detected in seven patients. The cumulative incidence of clinically relevant adenomatous lesions in the preoperatively normal proximal colon 12 and 18 months after preoperative CT colonography was 8.1% (95% confidence interval [CI]: 3.9%, 12.2%) and 9.6% (95% CI: 5%, 14%), respectively. Clinically relevant adenomatous lesions found in the proximal colon within 18 months of preoperative CT colonography were nonadvanced adenomas in 10 of 15 patients. CONCLUSION When the portion of the colon proximal to an occlusive cancer is devoid of nondiminutive lesions at preoperative CT colonography, colonoscopy of the proximal colon following cancer resection rarely finds clinically relevant lesions and is unlikely to reveal any lesions requiring immediate removal until routine 1-year postsurgical follow-up. Online supplemental material is available for this article .
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Lee JL, Yang SS, Park IJ, Yu CS, Kim JC. Comparison of abdominal and perineal procedures for complete rectal prolapse: an analysis of 104 patients. Ann Surg Treat Res 2014; 86:249-55. [PMID: 24851226 PMCID: PMC4024931 DOI: 10.4174/astr.2014.86.5.249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/06/2014] [Accepted: 02/04/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose Selecting the best surgical approach for treating complete rectal prolapse involves comparing the operative and functional outcomes of the procedures. The aims of this study were to evaluate and compare the operative and functional outcomes of abdominal and perineal surgical procedures for patients with complete rectal prolapse. Methods A retrospective study of patients with complete rectal prolapse who had operations at a tertiary referral hospital and a university hospital between March 1990 and May 2011 was conducted. Patients were classified according to the type of operation: abdominal procedure (AP) (n = 64) or perineal procedure (PP) (n = 40). The operative outcomes and functional results were assessed. Results The AP group had the younger and more men than the PP group. The AP group had longer operation times than the PP group (165 minutes vs. 70 minutes; P = 0.001) and longer hospital stays (10 days vs. 7 days; P = 0.001), but a lower overall recurrence rate (6.3% vs. 15.0%; P = 0.14). The overall rate of the major complication was similar in the both groups (10.9% vs. 6.8%; P = 0.47). The patients in the AP group complained more frequently of constipation than of incontinence, conversely, in the PP group of incontinence than of constipation. Conclusion The two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity, but the overall recurrence tended to occur frequently among patients in the PP group. Functional results after each surgical approach need to be considered for the selection of procedure.
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Park IJ, Yu CS. Current issues in locally advanced colorectal cancer treated by preoperative chemoradiotherapy. World J Gastroenterol 2014; 20:2023-2029. [PMID: 24587677 PMCID: PMC3934472 DOI: 10.3748/wjg.v20.i8.2023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/26/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
In patients with locally advanced rectal cancer, preoperative chemoradiotherapy has proven to significantly improve local control and cause lower treatment-related toxicity compared with postoperative adjuvant treatment. Preoperative chemoradiotherapy followed by total mesorectal excision or tumor specific mesorectal excision has evolved as the standard treatment for locally advanced rectal cancer. The paradigm shift from postoperative to preoperative therapy has raised a series of concerns however that have practical clinical implications. These include the method used to predict patients who will show good response, sphincter preservation, the application of conservative management such as local excision or “wait-and-watch” in patients obtaining a good response following preoperative chemoradiotherapy, and the role of adjuvant chemotherapy. This review addresses these current issues in patients with locally advanced rectal cancer treated by preoperative chemoradiotherapy.
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Lee HS, Kim HO, Hong YS, Kim TW, Kim JC, Yu CS, Kim JS. Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery. J Nucl Med 2014; 55:582-9. [DOI: 10.2967/jnumed.113.128629] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Kim JB, Ye BD, Lee JL, Lim SB, Yu CS, Kim JC, Kang YK, Byeon JS, Myung SJ, Yang SK, Kim JH. Rectal gastrointestinal stromal tumor: clinical features, endoscopic findings and prognosis. HEPATO-GASTROENTEROLOGY 2014; 61:70-75. [PMID: 24895796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS Rectal gastrointestinal stromal tumor (GIST) accounts for only a small portion of all GISTs, and reports regarding its clinical features and endoscopic findings are still lacking. METHODOLOGY Thirty-two patients diagnosed as rectal GIST at Asan Medical Center, a tertiary university hospital in Korea between May 2003 and January 2011 were enrolled. RESULTS The median age was 54 years (range, 31-79) with 18 males (56.2%). Common symptoms were hematochezia, anal pain, and defecation difficulty, although 11 patients were asymptomatic. The median size of tumor was 6.1 cm (range, 0.4-12.0 cm), and the median distance from the anal verge was 4 cm (range, 3 cm). The most common endoscopic finding was subepithelial tumor with normal overlying mucosa (63.1%), followed by subepithelial tumor with erosion, ulceration, or bleeding (31.6%). Preoperative imatinib was administered in eight patients (25.0%) that helped the downsizing the tumor and anal sphincter preserved. High-risk group by NIH risk classification and tumor size were associated with tumor recurrence, with the overall five-year recurrence-free survival of 67.2%. CONCLUSIONS Common endoscopic feature of rectal GIST was subepithelial tumor with normal mucosa. Patients treated by definite resection with or without imatinib for rectal GIST seem to show a favorable clinical course.
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Seol HS, Kang HJ, Kang H, Lee SI, Kim NE, Kim TI, Chun SM, Kim TW, Yu CS, Suh YA, Singh SR, Chang S, Jang SJ. Development and characterization of a colon PDX model that reproduces drug responsiveness and the mutation profiles of its original tumor. Cancer Lett 2013; 345:56-64. [PMID: 24333725 DOI: 10.1016/j.canlet.2013.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/17/2013] [Accepted: 11/21/2013] [Indexed: 12/16/2022]
Abstract
Cultures of primary tumors are very useful as a personalized screening system for effective therapeutic options. We here describe an effective method of reproducing human primary colon tumors through primary culture and a mouse xenograft model. A total of 199 primary colon tumor cultures were successfully established under optimized conditions to enrich for tumor cells and to expand it for long-term storage in liquid nitrogen. To examine whether these stored cultures retained original tumor properties, fifty primary cultures were xenografted into NOD-SCID mouse. Histological and tumor marker analysis of four representative tumor xenografts revealed that all of the xenograft retained its primary tumor characteristics. Oncomap analysis further showed no change in the major mutations in the xenografts, confirming that our method faithfully reproduced human colon tumors. A drug sensitivity assay revealed that two of the primary cultures were hypersensitive to oxaliplatin rather than 5-FU, which was used in the patients, suggesting it as an effective therapeutic option. We thus present an effective, reproducible preclinical model for testing various personalized therapeutic options in colon cancer patients.
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Lim SB, Yu CS, Kim CW, Yoon YS, Park SH, Kim TW, Kim JH, Kim JC. Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Int J Colorectal Dis 2013; 28:1667-74. [PMID: 23943283 DOI: 10.1007/s00384-013-1761-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify the indication and prognostic significance of lateral lymph node (LLN) excision in locally advanced rectal cancer patients underwent preoperative chemoradiotherapy. METHODS Included were 67 consecutive patients with suspicious LLN metastasis who underwent chemoradiotherapy and surgery including selective LLN excision (82 excisions). The excisions were grouped according to the presence of LLN metastasis and compared in terms of the clinicopathological findings and oncological results. The correlation between the largest short-axis diameter of LLN measured by imaging and metastasis rates was explored. RESULTS LLN metastases were identified in 32 excisions (40.0 %). The calculated short-axis LLN diameter predicting metastasis was 11.7 mm (before chemoradiotherapy) and 11.4 mm (before surgery). LLN metastasis was observed more frequently in the low rectum (p = 0.031) and associated with higher CEA levels (p = 0.048). The 3-year overall survival rates for patients with and without LLN metastasis were 60.3 % and 90.3 % (p = 0.048), while the 3-year disease-free survival rates were 31.4 % and 70.5 % (p = 0.009). The hazard ratio of LLN metastasis for recurrence was 2.938 (95 % CI = 1.258-6.863). CONCLUSIONS LLN metastasis in rectal cancer patients underwent chemoradiotherapy was a distinct poor prognostic factor. Selective LLN excision based on imaging studies may have a role for such patients.
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Park HC, Jung KW, Kim BW, Shin A, Won YJ, Oh JH, Jeong SY, Yu CS, Lee BH. Characteristics and survival of korean anal cancer from the Korea central cancer registry data. Ann Coloproctol 2013; 29:182-5. [PMID: 24278855 PMCID: PMC3837082 DOI: 10.3393/ac.2013.29.5.182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/09/2013] [Indexed: 01/27/2023] Open
Abstract
Purpose In Korea, anal cancer is rare disease entity with specific clinical characteristics. Therefore, no survival analysis with a sufficient patient population has been performed. The aim of this study was to evaluate the characteristics of Korean anal cancer, focusing on the survival according to tumor histologies, sex, and a specific age group, using the nationwide cancer registry. Methods Using the Korea Central Cancer Registry, we analyzed a total of 2,552 cases from 1993 to 2010. We assessed the 5-year relative survival by using tumor histology. In addition, survival differences of Surveillance Epidemiology and End Results (SEER) stage were analyzed for both sexes and for young-age cancer (younger than 40 years) and advanced-age cancer (older than 70 years). Results The 5-year relative survival among anal cancer patients increased from 38.9% for the period 1993-1995 to 65.6% for the period 2006-2010. The anal squamous cell carcinoma was the most common histology and showed better survival than other types of cancer. Females demonstrated better survival than males in all SEER stages. The 5-year survivals for patients in whom anal cancer developed before the age of 40 and at or after the age of 40 were 62.4% and 51.6%, respectively. The 5-year survival for patients in whom cancer developed at or after the age of 70 was much worse than that for patients in whom the cancer had developed prior to that age. Conclusion Korean anal cancer has certain distinctive characteristics of survival according to tumor histology, sex, and age. Despite limitations on available data, this study used the nationwide database to provide important information on the survival of Korean patients with anal cancer.
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Lee JL, Yu CS, Kim M, Hong SM, Lim SB, Kim JC. Prognostic impact of diagnosing colorectal neuroendocrine carcinoma using the World Health Organization 2010 classification. Surgery 2013; 155:650-8. [PMID: 24468036 DOI: 10.1016/j.surg.2013.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neuroendocrine carcinomas (NECs) arising in the large intestine are rare neoplasms with highly aggressive behavior. The aim of the study was to compare the 2000 and 2010 World Health Organization (WHO) classification of these colorectal NECs. METHODS We conducted a retrospective study of patients diagnosed with colorectal NECs according to the WHO 2000 classification who underwent surgery at the Asan Medical Center between May 2000 and December 2010. The data were reevaluated to assess their consistency with the WHO 2010 classification. RESULTS For 20 of the 34 patients (59%), the 2000 and 2010 WHO classifications yielded the same NEC diagnosis (NEC group), whereas for 14 of the 34 patients (41%), the WHO 2010 classification mandated a diagnosis of G1 or G2 neuroendocrine tumors (NETs) rather than NECs (G1/G2 NET group). The NEC group was older than the G1/G2 NET group (64 vs 55 years; P = .05). Tumor differentiation in the NEC group was poorer than in the G1/G2 NET group (percentage of poorly differentiated tumor, 70% vs 7%; P < .001). In both groups based on the 7th American Joint Committee on Cancer staging, most of the tumors were advanced at the time of diagnosis, reaching stage IIIB (6 NEC vs 10 NET) and stage IV (10 NEC vs 3 NET). The 5-year overall survival in the 2 groups was different (P = .02), but not the 5-year disease-free survival (P = .24). CONCLUSION These results indicate that the WHO 2010 classification of colorectal NEC is more accurate and has better prognostic value than the WHO 2000 classification.
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Lee WY, Park KJ, Cho YB, Yoon SN, Song KH, Kim DS, Jung SH, Kim M, Yoo HW, Kim I, Ha H, Yu CS. Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn's fistula. Stem Cells 2013; 31:2575-81. [DOI: 10.1002/stem.1357] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/29/2013] [Indexed: 12/14/2022]
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168
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Yoon YS, Kim CW, Lim SB, Yu CS, Kim SY, Kim TW, Kim MJ, Kim JC. Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis. J Surg Oncol 2013; 109:239-44. [DOI: 10.1002/jso.23480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 10/07/2013] [Indexed: 12/24/2022]
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169
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Lee JL, Yu CS, Kim CW, Yoon YS, Lim SB, Kim JC. Chronological improvement in survival following rectal cancer surgery: a large-scale, single-center study. World J Surg 2013; 38:2185. [PMID: 24149718 DOI: 10.1007/s00268-013-2295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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170
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An HJ, Ryu MH, Ryoo BY, Sohn BS, Kim KH, Oh ST, Yu CS, Yook JH, Kim BS, Kang YK. The effects of surgical cytoreduction prior to imatinib therapy on the prognosis of patients with advanced GIST. Ann Surg Oncol 2013; 20:4212-8. [PMID: 24052319 DOI: 10.1245/s10434-013-3279-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Baseline tumor size is one of important prognostic factors for imatinib therapy in patients with advanced gastrointestinal stromal tumor (GIST). The purpose of this study was to determine whether surgical cytoreduction before imatinib therapy can improve the prognosis. METHODS A total of 249 patients with advanced GIST were reviewed retrospectively. Patients were categorized into two groups according to the degree of initial cytoreduction: 35 patients with ≥75 % of initial tumor bulk removed (cytoreduction group) and the other 214 patients (no cytoreduction group). The median follow-up was 44.0 months. RESULTS Patients in the cytoreduction group were younger, in better performance, showed more initially metastatic disease, peritoneal metastases, but fewer liver metastases. The baseline tumor size when starting imatinib became significantly reduced in the cytoreduction group, which made significant difference between the two groups. By multivariate analyses, mutational status, tumor size, and granulocyte count at presentation were associated with progression-free survival. Age and tumor size were associated with overall survival. However, initial cytoreduction was not significantly related to the prognosis. CONCLUSIONS Cytoreduction before imatinib therapy appears not to improve the prognosis. Imatinib therapy should still represent the initial treatment for advanced GIST.
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Xiao H, Yoon YS, Hong SM, Roh SA, Cho DH, Yu CS, Kim JC. Poorly differentiated colorectal cancers: correlation of microsatellite instability with clinicopathologic features and survival. Am J Clin Pathol 2013; 140:341-7. [PMID: 23955452 DOI: 10.1309/ajcp8p2dynkgrbvi] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To evaluate the association of microsatellite instability (MSI) with clinicopathologic features and oncologic outcomes in patients with poorly differentiated colorectal cancer (PD). METHODS Study patients were divided into well-differentiated colorectal cancer (WD) and PD, which were compared according to histologic differentiation and MSI status. RESULTS Among 1,941 patients, PD was more frequent among microsatellite-unstable tumors (23.6%) than among microsatellite-stable (MSS) tumors (4.2%, P < .001). Patients with PD had worse 4-year overall survival rates than patients with WD (78.6% vs 88.2%, P = 0.010). Compared with MSS-PD tumors, MSI-PD tumors were characterized by right-colon predilection, larger size, and infrequent lymph node metastasis (P < .001 to P = .007). CONCLUSIONS The clinicopathologic characteristics of PD were closely associated with those of MSI. The outcomes of MSI-PD tumors were better than those of MSS-PD tumors, but this finding did not reach statistical significance.
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172
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Park HC, Shin A, Kim BW, Jung KW, Won YJ, Oh JH, Jeong SY, Yu CS, Lee BH. Data on the characteristics and the survival of korean patients with colorectal cancer from the Korea central cancer registry. Ann Coloproctol 2013; 29:144-9. [PMID: 24032114 PMCID: PMC3767863 DOI: 10.3393/ac.2013.29.4.144] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/02/2013] [Indexed: 12/14/2022] Open
Abstract
Purpose The incidence rates of colorectal cancer (CRC) in Korea have been increasing during the past decade. Therefore, it is important to understand the characteristics, including survival, of Korean CRC patients. The aim of this study was to use the nationwide cancer registry to evaluate the characteristics of Korean CRC, focusing on the survival, according to tumor location, sex, and specific age groups. Methods Using the Korea Central Cancer Registry (KCCR), we analyzed a total of 226,352 CRC cases diagnosed from 1993 to 2010. The five-year relative survivals were compared for the proximal colon, the distal colon, and the rectum. Survival rates were compared between men and women and between patients of young age (less than 40 years old) and patients of advanced age (70 years old or older). Results The 5-year survival rates were improved in all subsites between 1993 and 2010. Distal colon cancer showed favorable survival compared to proximal colon or rectal cancer. Females demonstrated worse survival for local or regional cancers, and this difference was significant in for patients in their seventies. Young patients (<40 years old) showed better survival rates for overall and proximal colon cancer comparable to those for older patients (≥40 years old), but advanced age patients (≥70 years old) had worse survivals for all tumor subsites compared to their younger counterparts (<70 years old). These trends were similar in distant CRC. Conclusion Korean CRC has certain distinct characteristics of survival according to tumor location, sex, and age. Despite the limitations of available data, this study contributes to a better understanding of survival differences in Korean CRC.
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Lee JL, Yu CS, Kim CW, Yoon YS, Lim SB, Kim JC. Chronological Improvement in Survival Following Rectal Cancer Surgery: A Large-Scale, Single-Center Study. World J Surg 2013; 37:2693-9. [DOI: 10.1007/s00268-013-2168-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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174
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Yu CS, Yun HR, Shin EJ, Lee KY, Kim NK, Lim SB, Oh ST, Kang SB, Choi WJ, Lee WY. Local excision after neoadjuvant chemoradiation therapy in advanced rectal cancer: a national multicenter analysis. Am J Surg 2013; 206:482-7. [PMID: 23849272 DOI: 10.1016/j.amjsurg.2013.01.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 01/17/2013] [Accepted: 01/24/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of the current study was to evaluate the clinical availability of local excision (LE) for advanced rectal cancer without lymph node metastasis after neoadjuvant chemoradiation therapy (nCRT) in Korea. METHODS From June 2000 to October 2009, 40 patients with cT2-3N0M0 rectal cancer underwent nCRT followed by LE according to a retrospective multicenter analysis. RESULTS Of the 40 patients, 22 were men and 18 were women. Eighteen patients were cT2, and 22 patients were cT3. The median follow-up duration was 38 months. Three patients (7.5%) had morbidity after LE. Four patients (10%) had recurrence (local recurrence [1 patient] and systemic metastasis [3 patients]). The 3-year disease-free survival rate was 85.9%. Only pCR was a recurrence-related prognostic factor (P = .040). CONCLUSIONS Although the current study was not a randomized controlled study, LE after nCRT in T2-3N0 rectal cancer patients appears to be a safe and effective treatment, especially in pCR patients.
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Ha HI, Kim AY, Yu CS, Park SH, Ha HK. Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy. Eur Radiol 2013; 23:3345-53. [PMID: 23812242 DOI: 10.1007/s00330-013-2936-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/07/2013] [Accepted: 05/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects. METHODS One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm(2)) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC150-1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis. RESULTS DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (Az = 0.910) was superior to that of T2-weighed MR tumour volumetry (Az = 0.792) and post-CRT ADC (Az = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively. CONCLUSION DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.
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