A prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal that the median survival is 2 to 4 months without treatment. Sorafenib, the standard regimen of advanced HCC, can prolong median survival only 1.5 months. A 50-year-old man with a history of chronic hepatitis B was diagnosed advanced HCC with PVTT. By a multidisciplinary medical team approach, the combination of 3-demensional conformal radiation therapy with sequential sorafenib was challenged. 4 months after initiation of treatment, he achieved partial response as modified response evaluation criteria in solid tumors criteria. Sorafenib was continued so far, and stable disease has been maintained up to now, without significant adverse effect.
Carcinoma, Hepatocellular ; Hepatitis B, Chronic ; Humans ; Middle Aged ; Portal Vein ; Prognosis ; Response Evaluation Criteria in Solid Tumors ; Thrombosis

BACKGROUND/AIMS: Advances in endoscopic submucosal dissection (ESD) techniques have led to the development of expanded criteria for endoscopic resection of early gastric cancer (EGC). The aim of this study was to evaluate the short- and long-term outcomes for ESD using indication criteria. METHODS: A total of 1,105 patients underwent ESD for EGC at six medical centers. The patients were classified into the following two groups based on the lesion size, presence of ulceration and pathological review: an absolute criteria group (n=517) and an expanded criteria group (n=588). RESULTS: The curative resection rates (91.1% vs 91.3%, p=0.896) were similar in the absolute criteria group and the expanded criteria group. The en bloc resection rates (93.4% and 92.3%, respectively; p=0.488) and complete resection rates (98.3% and 97.4%, respectively; p=0.357) did not differ between the groups. The cumulative disease-free survival rates and the overall survival rates were similar between the groups (p=0.778 and p=0.654, respectively). Independent factors for the curative resection of EGC included tumor location (upper vs middle and lower, 2.632 [1.128-6.144] vs 3.497 [1.560-7.842], respectively) and en bloc resection rate 12.576 [7.442-21.250]. CONCLUSIONS: The expanded criteria for ESD in cases of EGC is comparable with the widely accepted pre-existing criteria.
Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*methods ; Female ; Gastric Mucosa/*surgery ; Gastroscopy/*methods ; Humans ; Male ; Middle Aged ; *Response Evaluation Criteria in Solid Tumors ; Stomach Neoplasms/pathology/*surgery ; Survival Rate ; Treatment Outcome

Low grade lymphomas are malignancies of predominantly small lymphocytes that typically have long median survival periods due to low proliferative rates. It is considered an indolent disease, but patients with low grade lymphoma can almost never be cured with conventional treatment. New low-grade lymphoma entities have been classified by the International Lymphoma Study Group (ILSG) and are also categorized into the Revised European American Lymphoma (REAL) classification. The REAL classification utilizes a multiparameter definition of clinico-pathologic and biologic entities. According to this classification, we investigated the incidence, various clinical characteristics, treatment outcome and prognostic factors of low grade lymphoma. Many clinical characteristics of low grade lymphoma in Korea differed from those of Western countries, especially in the incidence, therapeutic outcome and prognostic factors. In Korea, although the general incidence of low grade lymphoma is relatively low, the relative number of mucosa-associated lymphoid tissue lymphoma (MALToma) is very high, and the overall survival rate is better than that reported of Western countries. Thus, further investigation on treatment outcome and prognosis of low grade lymphoma entities, other than mucosa-associated lymphoid tissue lymphoma, are warranted.
Adolescent ; Adult ; Aged ; Female ; Human ; Immunophenotyping ; Lymphoma, Low-Grade/mortality/pathology/*therapy ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Treatment Outcome

Prognosis of prostatic carcinoma can be cheefly influenced not by method of treatment, but histological differentiation and tumor stage. We reviewed histologic grade and survival of prostatic carcinoma retrospectively using the Gleason grade system based on gland differentiation and relation between gland and stroma in 25 patients from Jan, 1980 to Jan, 1987, Whom we had follow-up data about. The following results were obtained. 1. The average age of patients was 69 years with a range of 56 to 84 years. 2. We identified 1 patients as grade 2, 4 patients as grade 3, 9 patients as grade 4, 11 patients as grade 5 of total 25 patients. In 2 year survival, there were 100% for low combined Gleason(2-4), 90% for intermediate group(5-7), 80% for high grade. 3. There was close relationship between tumor grade and stage such that high grade is high stage, low grade is in low stage. 4. There were high mortality index(0.102) in high grade group, low mortality index(0.039 %) in low grade group in prostatic index combined Gleason grade with clinical tumor staging.
Adenocarcinoma ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Grading ; Neoplasm Staging ; Prognosis ; Prostatic Neoplasms ; Retrospective Studies

PURPOSE: With the use of combined-modality therapy, the survival of the patients with the rhabdomyosarcoma (RMS) has been improved during past 30 years. The reports on the therapeutic outcome of RMS in Korea during past 10 years, however, have been scarce. The authors reviewed the clinical characteristics and treatment outcome of pediatric RMS patients diagnosed in our institution during recent 11 years' period and compared this data with previous reports. METHODS: From January 1990 to December 2000, 29 patients were diagnosed with RMS by histopathology. Retrospective analysis of the medical records of these patients was performed. RESULTS: A male to female ratio was 1.4:1. Age at diagnosis ranged from 8 months to 19 years 5 months and the median age was 8 years 5 months. Head and neck region that included orbit and parameningeal areas was the most common primary site (44.8%) and other common sites were genitourinary tract, extremities and perianal areas. The two major pathologic types of RMS were embryonal (72.4%) and alveolar (17.2%). The patient distribution of Intergroup Rhabdomyosarcoma Study (IRS) clinical group was as follows: Group I 13.8%, Group II 24.1%, Group III 27.6% and Group IV 34.5%. Of the 29 patients, 4 patients were lost to follow up or received no treatment. Among 25 patients treated and followed, 3-year overall survival rate of these patients was 84% and 3-year event-free survival (EFS) was 60%. Three-year EFS of Group I was 100%, Group II 71%, Group III 83% and Group IV 22%. CONCLUSION: The clinical characteristics of RMS in our institution were similar to those reported by IRS. But there were higher proportion of Group IV patients than IRS suggesting the delayed diagnosis of RMS in Korean patients. The treatment outcome was comparable to that of current IRS trials. This results suggest that the treatment outcome of RMS patients in Korea has improved largely owing to the adoption of current IRS protocols.
Delayed Diagnosis ; Diagnosis ; Disease-Free Survival ; Extremities ; Female ; Head ; Humans ; Korea ; Lost to Follow-Up ; Male ; Medical Records ; Neck ; Neoplasm Staging ; Orbit ; Prognosis ; Retrospective Studies ; Rhabdomyosarcoma* ; Survival Rate ; Treatment Outcome

BACKGROUND: A retrospective study was conducted to review the overall survival and treatment outcomes of high grade melanoma in the extremity to explore the clinical features of malignant melanoma of the hand and foot, and the therapeutic efficacies and survival rate after amputation. METHODS: The clinical data of 30 patients with malignant melanoma of the hand and foot (confirmed by pathological examination), who were admitted and treated in our hospital between 2001 and 2010, were analyzed retrospectively. We analyzed variables affecting overall and disease-free survival. RESULTS: Thirty patients (18 men and 12 women) treated with an amputation procedure for malignant melanoma in the hand or foot constituted the study cohort. The average age of the patients at the time of diagnosis was 58.7 years. Univariate analysis for overall melanoma survival revealed that diagnosis at over 70 years of age, postoperative lymph node metastasis, and location of the tumor were significant prognostic factors. And on the Kaplan-Meier survival curve, old age, American Joint Committee on Cancer stage and postoperative lymph node metastasis showed statistically significant differences in the 5-year survival rate. Also, amputation with aggressive lymph node dissection showed improved long term survival in advanced stage melanoma. CONCLUSIONS: In Korean melanoma patients, for the treatment of high grade melanomas in the extremities after amputation, early diagnosis and postoperative follow-up for evaluation of lymph node metastasis are critical factors for long-term survival. And by performing lymph node dissection during amputation, we may improve the survival rate in advanced stage melanoma patients.
Aged ; *Amputation ; Analysis of Variance ; Disease-Free Survival ; Female ; Foot/*surgery ; Hand/*surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Melanoma/diagnosis/pathology/*surgery ; Middle Aged ; Neoplasm Staging ; Prognosis ; Republic of Korea ; Retrospective Studies ; Skin Neoplasms/diagnosis/pathology/*surgery ; Survival Rate ; Treatment Outcome

PURPOSE: This study was conducted to evaluate prognostic factors and cancer-specific survival (CSS) in a cohort of 41 patients with urachal carcinoma by use of a Bayesian model-averaging approach. MATERIALS AND METHODS: Our cohort included 41 patients with urachal carcinoma who underwent extended partial cystectomy, total cystectomy, transurethral resection, chemotherapy, or radiotherapy at a single institute. All patients were classified by both the Sheldon and the Mayo staging systems according to histopathologic reports and preoperative radiologic findings. Kaplan-Meier survival curves and Cox proportional-hazards regression models were carried out to investigate prognostic factors, and a Bayesian model-averaging approach was performed to confirm the significance of each variable by using posterior probabilities. RESULTS: The mean age of the patients was 49.88+/-13.80 years and the male-to-female ratio was 24:17. The median follow-up was 5.42 years (interquartile range, 2.8-8.4 years). Five- and 10-year CSS rates were 55.9% and 43.4%, respectively. Lower Sheldon (p=0.004) and Mayo (p<0.001) stage, mucinous adenocarcinoma (p=0.005), and larger tumor size (p=0.023) were significant predictors of high survival probability on the basis of a log-rank test. By use of the Bayesian model-averaging approach, higher Mayo stage and larger tumor size were significant predictors of cancer-specific mortality in urachal carcinoma. CONCLUSIONS: The Mayo staging system might be more effective than the Sheldon staging system. In addition, the multivariate analyses suggested that tumor size may be a prognostic factor for urachal carcinoma.
Adult ; Bayes Theorem ; Carcinoma/pathology ; Carcinoma/therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Treatment Outcome ; Urinary Bladder Neoplasms/pathology ; Urinary Bladder Neoplasms/therapy

PURPOSE: To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladder carcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma. MATERIALS AND METHODS: Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of 104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cell carcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumor cells was described as a high proliferation index. RESULTS: Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitional cell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%) (p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with higher tumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associated with advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariate analysis, altered survivin was an independent poor prognostic factor for recurrence. CONCLUSIONS: Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequently and is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinary bladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important question to be answered before approving the vaccine in management.
Carcinoma, Squamous Cell/genetics ; Carcinoma, Transitional Cell/genetics ; Female ; Humans ; Inhibitor of Apoptosis Proteins/genetics ; Inhibitor of Apoptosis Proteins/metabolism ; Ki-67 Antigen/metabolism ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Treatment Outcome ; Tumor Markers, Biological ; Urinary Bladder/pathology ; Urinary Bladder Neoplasms/genetics

OBJECTIVE: The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent. METHODS: One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy. RESULTS: The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001). CONCLUSION: Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.
Adenocarcinoma, Clear Cell/pathology/radiotherapy/*secondary/surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Endometrioid/pathology/radiotherapy/*secondary/surgery ; Cystadenocarcinoma, Papillary/pathology/radiotherapy/*secondary/surgery ; Endometrial Neoplasms/pathology/radiotherapy/*surgery ; Female ; Humans ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Radiotherapy, Adjuvant ; Salvage Therapy/methods ; Survival Analysis ; Treatment Failure ; Treatment Outcome

PURPOSE: Anorectal malignant melanomas (AMM) are rare and have poor survival. The study aims to evaluate the clinicopathologic characteristics and outcomes of patients with AMM, and to devise a staging system predictive of survival outcome. MATERIALS AND METHODS: This was a retrospective study of 28 patients diagnosed with, and treated for AMM. Patients classified by clinical staging of mucosal melanoma (MM) were reclassified via rectal and anal TNM staging. Survival outcomes were compared among patients grouped by the three different staging systems. RESULTS: The three staging systems were equated with similar figures for 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients diagnosed with stage I disease. Patients (n=19) diagnosed with MM stage II disease were reclassified by rectal TNM staging into three subgroups: IIIA, IIIB, and IIIC. For these patients, both 5-year OS and 5-year DFS differed significantly between the subgroups IIIA and IIIC (OS: IIIA vs. IIIC, 66.7% vs. 0%, p=0.002; DFS: IIIA vs. IIIC, 51.4% vs. 0%, p < 0.001). CONCLUSION: The accuracy of prognosis in patients diagnosed with AMM and lymph node metastasis has improved by using rectal TNM staging, which includes information regarding the number of lymph node metastases.
Disease-Free Survival ; Humans ; Lymph Nodes ; Melanoma* ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis* ; Rectum ; Retrospective Studies