Risk Factors for Recurrence in Completely Resected pT1/2N1 Non-small Cell Lung Cancer

Background: Complete surgical resection is the most effective treatment for pT1/2N1 non-small cell lung cancer, however 5 year survival rate of these patients is about 40% and the major cause of death is recurrent disease. We intended to clarify the risk factors of recurrence in completely resected pT1/2N1 non-small cell lung cancer. Material and Method: From Jan. 1990 to Jul. 2003, total of 117 patients were operated for pT1/2N1 non-small cell lung cancer. The risk of recurrence according to patients characteristics, histopathologic findings, type of resection, pattern of lymph node metastasis, postoperative adjuvant treatment were evaluated retrospectively. Result: Mean age of patients was 59.3 years. There were 14 patients with T1N1 and 103 patients with T2N1 disease. Median follow-up time was 27.5 months and overall 5 year survival rate was 41.3%. 5 year freedom-from recurrence rate was 54.1%. Recurrence was observed in 44 (37.6%) patients and distant recurrence developed in 40 patients. 5 year survival rate of patients with recurence was 3.3%, which was significantly lower than patients without recurrence (61.3%, p=0.000). In multi-variate analysis of risk factors for freedom-from recurrence rate, multi-station N1 (hazard ratio=1.997, p=0.047) was a poor prognostic factor. Conclusion: Multi-station N1 is the risk factor for recurrence in completely resected pT1/2N1 non-small cell lung cancer.ope

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts -Forty-two years report in a University Hospital-

Background : The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. Materials and Methods : This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985～2002) and compared them to the report of the previous 25-year result (1960～1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. Results : During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. 　The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. Conclusion : These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.ope

Mode of regional and mediastinal lymph node metastasis of bronchogenic carcinoma in accordance with the location, size and histology of primary tumor of lung

의학과/석사[영문] [한글] 흉곽내에서 임프의 유출경로는 Rudbeck(1653), Willis(1675),7ascagni(17()4), Sappey( 1885)등애 의해 연구가 시작되었으며 Rouviere(1929), Borrie(1952), Nohl(1956)등에 의 해서 급격히 발전되었다 . 폐암에 있어서 종격동 임프절의 암전이 유무 및 정도는 환자의 수술적응과 예후판정에 매우 중요한 인자로써 임프절 전이의 양상은 폐암의 조직학적 소견, 위치, 크기에 따른 정확한 분류를 함으로써 앞으로의 폐암 수술에 많은 도움이 되리라 생각되어 본 연구를 시작하였다. 1980년 1월부터 1989년 7월까지 폐암으로 수술한 환자중 흉곽내 모든 임프절 절제를 동 시에 시행한 178례를 대상으로 하였다. 남자가 145례, 여자는 33례이었고 연령분포는 25 세에서 78세 사이로 평균 55.4세 이었다. 세포형별로는 상피세포암이 115례로 64,6%이었 으며 선암이 42례, 23,7%로 대부분을 차지하였다. 연구결과에 의하면 암의 크기에 따른 종격동 임프절 전이율의 증가는 통계학적 의의가 없었으며, 상피세포암과 선암사이에서도 종격동 입프절 전이율의 차이는 통계학적으로 나 타나지 않았다. 폐암의 위치별 종격동 임프절로의 전이율을 보떤 우중엽과좌상엽에서 각 각 31.8%, 31.4%블 보여 높은 전이율을 나타냈고 전체적으로 종격동 임프절로의 전이율은 25,4%이었다. 이 중 Nl임프절 전이없이 오직 N2 임프절로의 전이만 있는 경우가 전체환 자의 13%나 되었으며 상면에서는 16.3%, 하엽에서는 8.2%의 전 이율을 보여 통계학적으로 하엽에서 보다 상엽에서 N2 임프절로의 직접적인 전이가 높음을 알 수 있었다. 좌상엽에 암이있는경우 임프절 전이에 있어서 N2 임프절로의 전이는 대부분 좌측 상부 기관기관지 임프유출로와 좌측 기관주위 임프유출로를 따라 전이됨을 볼 수 있고 직접적 인 유출로에 의해 대동맥하의 임프절, 대동맥주위 임프절, 하부 폐인대 임프절, 식도주위 임프절로 전이 되었다. 좌하엽에 암이 있는 경우 N2 임프절로의 전이는 대부분 좌측 기 관기관지 임프유출로에 의해 전이됨을 볼수 있고 좌하엽의 지역 임프절 -> 하부 폐인대 임프절 -> 분기즐하 임프절로의 유출로를 따라 식도주위 임프절로 전이됨을 볼수 있고 직 접적인 유출로에 의해 대동맥하의 임프절로의 전이도 볼수 있다. 우상엽에 암이 있는 경 우 N2 임프절로의 전이는 대부분 우측 기관주위 임프유출로에 의해 전이되고 반대편 기관 기관지 임프절로의 전이도 1례 있었다. 우중엽에 암이 있는 경우 N2 임프절로의 전이는 대부분 우측 기관주위 임프유출로에 의해 전이되고 직접적인 유출로에 의해 식도주위 임 프절로의 전이도 있었다. 우하엽에 암이 있는 경우 N2 임프절로의 전이는 대부분 우측 기 관주위 임프유출로에 의해 전이되고 우하엽의 지역임프절 -> 하부 폐인대 임프절 -> 분기 즐하 임프절로의 유출로를 따라 하부 폐인대 임프절과 식도주위 임프절로의 전이도 있었 다. Mode of regional and mediastinal lymph node metastasis of bronchogenic carcinoma in accordance with the location, size and histology of primary tumor of lung Kill Dong Kim Department of medical science, The Graduate School, Yonsei University (Directed by Professor Sung Nok Hong, M.D.) A total 178 patients with primary lung cancer who had undergone complete resection of the tumor in combination with complete mediastinal lymphadenectomy were reviewed at Yonsei University Medical Center from January 1980 through July 1989. Materials: There were 45 men and 33 women ranging of age from 25 to 78 years with a mean age of 55.4 years. Histological types were squamous carcinoma in 115 cases (64.6%) adenocarcinoma in 42 cases (23.6%), bronchioloalveolar carcinoma in 9 cases (5.1%), large cell carcinoma in 8 cases (4.5%) and small cell carcinoma in 4 cases (2.2%). Results were summarized as follows: 1. The size of primary tumor was not directly proportional to the frequency of mediastinal lymph node metastasis. (P=0.0567) 2. The histologic types of the primary tumor did net related to the incidence of mediastinal lymph node metastasis. (P>0.1) 3. The chance of mediastinal lymph node metastasis in the case with lung cancer located in right middle lobe (31.8%, N=22) and left lower lobe (31.4%, N=32) were the highest and the lowest was the one located in right lower lobe, while over all incidence of mediastinal lymph node metastasis in this series was 25.4%(N=55). 4. The rate of mediagtinal lymph node metastasis without evidence of regional hilar lymph node metastasis was 13%.(N=23) The chance of mediastinal lymph node involvement without N1 lymph node metastasis was 16.3%(N=17) in both upper lobes and 8.2%(N=6) in both lower lobes. It was statistically significant that the tumors in the upper lobes had greater chance of the mediastinal lymph node metastasis without N1 than the tumors in the lower lobes. 5. In this series majority of the patients with lung cancer the mediastinal lymph node metastasis from the tumor in each pulmonary lobes usually occurs via ipsilateral tracheobronchial and paratracheal lymphatic pathway. Especially the lung cancer located in lower lobes can metastasize to subcarinal, paraesophageal and inferior pulmonary ligamental lymph node through the lymphatic pathway of inferior pulmonary ligament ,It can be speculated that in some cases of this series otherwise mediastinal lymph node metastasis can also occur with direct invasion to the parietal pleura and to the mediastinal lymph node via direct subpleural lymphatic pathway.restrictio

A H/W & S/W Co-Design and Functional Co-Verification for PCI Express Controller

본 논문에서는 차세대 통신 플랫폼을 위한 PCI 익스프레스의 전송계층과 데이터 연결계층의 모든 기능을 지원하는 PCI 익스프레스 컨트롤러를 설계하였다. 설계된 컨트롤러를 효과적으로 제어하기 위해 8051 마이크로프로세서를 이용하였다. 또한, 본 논문에서는 PCI 익스프레스 컨트롤러와 8051 마이크로프로세서의 통합 검증을 위한 방법으로 벡터 생성 부분, 테스트 벤치, 그리고 메모리로 구성된 테스트 벤치를 하나의 가상 마이크로프로세서로 가정하였다. 그리고 PCI 익스프레스의 모든 프로토콜을 지원할 수 있는 어셈블리 수준의 명령어들을 테스트 벤치에 적용되도록 하였다. 특히 일반적인 기본 동작 검증과 설계 기반 검증에서 찾지 못한 특수 경우의 에러를 찾기 위한 검증을 위해 랜덤 검증 환경 및 테스트 파라미터를 정의 하였다. 제안된 검증 환경과 명령어를 통해 설계된 PCI 컨트롤러의 검증 결과 랜덤 테스트 검증을 통해 효과적으로 오류를 찾을 수 있었다.2

Fluorescent nucleic acid probes for the G-quadruplex-forming sequences

2

Nodal Station as a Prognostic Factor in Resected Stage IIIA N2 Non-Small Cell Lung Cancer

To clarify the prognostic implication of the location and number of the metastatic mediastinal nodes in resected stage IIIA N2 non-small cell lung cancer. Material and Method: One hundred and seventy-four patients with resected non-small cell lung cancer who eventually proved to have pathologic stage IIIA N2 disease were studied. Patients who received preoperative induction therapy, non-curative operation or defined as operative mortality were excluded from this study. Result: In upper lobe tumors, there was no difference in 5-year survival according to the involvement of lower mediastinal nodes (32.3% vs 25.6%, p＝0.86). In lower lobe tumors, no difference was found in 5-year survival according to the involvement of upper mediastinal nodes (25.1% vs 14.1%, p＝0.33). There was no significant difference in 5-year survival between patients with or without metastatic subcarinal node (20.9% vs 25.6%, p＝0.364). In terms of the number of metastatic mediastinal nodes, 5-year survival was better in single station group (26.3%) than multiple station group (18.3%) (p＝0.048). In multiple station N2 group, the patients who received postoperative chemotherapy and radiation therapy had better 5-year survival (34.2%) (p＝0.01). Cox's proportional hazards model revealed that the age ≥60 (O.R: 1.682, p＝.006), multiple station N2 (O.R: 1.503. p＝0.021), pneumonectomy (O.R: 1.562, p＝0.018), postoperative chemotherapy and radiation therapy (O.R: 0.625, p＝0.012) were the factors affecting the postoperative survival. Conclusion: Multiple station N2 disease was the important prognostic factor for postoperative survival in resected stage IIIA N2 non-small cell lung cancer. Postoperative chemotherapy and radiotherapy were thought to improve the survival in case of multiple station N2 disease.ope

Clinical Significance of the Aortic Node in Non-small Cell Lung Cancer of the Left Upper Lobe

Background: To clarify the clinical significance of the aortic nodes in resected non-small cell lung cancer of the left upper lobe. Material and Method: One hundred fifty six patients with resected non-small cell lung cancer of the left upper lobe were studied. Patients who received preoperative induction therapy, non-curative operation or defined as operative mortality were excluded from this study. Result: In N2 left upper lobe tumors, aortic nodes comprised 52.7% of the metastatic mediastinal lymph nodes. In single station N2 disease, a frequently metastasized station was aortic node (64.3%). 5-year actuarial survival according to the N status was 65.0% in N0, 30.4% in N1, and 17.9% in N2. There was no statistically significant difference in survival between N1 and N2 diseases (p=0.06). The patients with metastasis to aortic node alone had a comparatively good prognosis (5-year survival: 35.6%) than other N2 diseases (5-year survival: 4.6%) (p=0.01) and had a similar survival outcome as N1 diseases (p=0.97). Considering the aortic node as N1 node, 5-year survival according to the N status was 65.0% in N0, 31.2% in N1, 4.6% in N2 and significant survival difference was observed between N1 and N2 disease (p=0.00). In multivariate analysis, the male sex (hazard ratio 6.892, p=0.011) and the involvement to the aortic node alone (hazards ratio 2.799, p=0.009) were the significant factors affecting postoperative survival. Conclusion: According to the our data, involvement to the aortic node alone in left upper lobe tumors should be grouped with N1 disease because this combined category reflects the surgical outcome more accurately.ope

Basaloid carcinoma of the lung: a really dismal histologic variant?

BACKGROUND: Basaloid carcinoma of the lung has been reported as an uncommon and highly aggressive form of nonsmall cell lung cancers. Even in stage I and II of basaloid carcinoma, a 5-year survival rate of only 15% has been reported and it has been suggested that different treatment modalities for basaloid carcinoma should be considered. The aim of this study was to determine the prognostic implications of a basaloid carcinoma of the lung. METHODS: This study included a series of 291 surgically resected lung tumors, which were originally diagnosed as a poorly or undifferentiated carcinoma, a small cell carcinoma, or an atypical carcinoid. Of these, 35 basaloid carcinoma patients were identified and compared with 167 poorly differentiated squamous cell carcinoma (PDSC) patients in terms of the preoperative clinical data, the procedure performed, and the survival outcome. RESULTS: The overall incidence of basaloid carcinoma was 4.8%. The actuarial 5-year survival rate was 40.6% in patients with PDSC and 36.5% in those with basaloid carcinoma (p = 0.86). In stage I and II patients, the actuarial 5-year survival rate was 53.9% in the PDSC group and 57.2% in the basaloid group (p = 0.97). There were no differences in the recurrence rate and the relapse pattern (p = 0.584). Cox's proportional hazards model revealed that an age equal to 60 years old (hazard ratio 2.179, p = 0.000) and an advanced stage (hazard ratio 2.264, p = 0.000) were the risk factors for postoperative survival in both groups. CONCLUSIONS: Basaloid carcinoma of the lung does not have a worse prognosis than the other nonsmall cell lung cancers. Although it is obvious that a basaloid carcinoma is a unique histologic entity, it does not require a different treatment modality due to the similar clinical behavior with other nonsmall cell lung cancers.ope

Change in pulmonary function following empyemectomy and decortication in tuberculous and non-tuberculous chronic empyema thoracis

Chronic empyema thoracis results from various etiologies. Improvement in pulmonary function after empyemectomy and decortication has proved difficult to predict when the etiology of chronic empyema thoracis is tuberculosis. The purpose of this study was to confirm the changes in pulmonary function according to the etiology after an operation. Sixty-five patients were classified into two groups according to their etiology: Group A (tuberculous) and Group B (non-tuberculous), and they were retrospectively evaluated with regard to their forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), percentage of predicted normal value of FEV1 (% FEV1) and FVC (%FVC). Empyemectomy and decortication was performed for all the patients and the two groups were similar in age, gender and preoperative spirometric parameters. In Group A (n=41), the pre- and postoperative mean values were 2.31L and 2.88L in FEV1, 65.8% and 80.5% in %FEV1, 2.62L and 2.55 L in VC, 61.9% and 71.8% in %VC, respectively. In Group B (n=24), the pre- and postoperative mean values were 2.13L and 2.49L in FEV1, 66.4% and 73.8% in %FEV1, 2.55L and 2.95 L in FVC, 64.9% and 71.8% in %FVC, respectively. All the spirometric parameters improved significantly in both groups compared to their preoperative values. However, no significance was shown in the rate of increase of the spirometric parameters between the two groups. In conclusion, improvement of lung function is expected after empyemectomy and decortication, regardless of the etiology of the chronic empyema thoracis.ope