Cancer Research and Treatment

Nam Sun Paik

28 Articles

Displacement of Surgical Clips in Patients with Human Acellular Dermal Matrix in the Excision Cavity during Whole Breast Irradiation Following Breast-Conserving Surgery: Wonguen Jung, Kyubo Kim, Nam Sun Paik; Cancer Res Treat. 2020;52(2):388-395. Published online August 13, 2019; DOI: https://doi.org/10.4143/crt.2019.213

Purpose
The purpose of this study was to investigate the displacement of surgical clips in the excision cavity during whole breast irradiation following breast-conserving surgery (BCS) with or without acellular dermal matrix (ADM) insertion, and to analyze clinicopathologic factors associated with the displacement of surgical clips.
Materials and Methods
From 2016 to 2017, 100 consecutive breast cancer patients who underwent BCS with the placement of surgical clips (superior, inferior, medial, lateral, and deep sides) in the tumor bed were included in this study. All patients took first planning computed tomography (CT) scan (CT 1) before whole breast irradiation and second CT scan (CT 2) before boost irradiation. Between two sets of planning CT, the displacement of surgical clips was calculated from the ΔX (lateral–medial), ΔY (anterior–posterior), ΔZ (superior–inferior), and three-dimensional (3D) directions. Patients were divided into two groups according to the breast volume replacement with ADM: group A with ADM and group B without ADM.
Results
The means and 1 standard deviations of 3D displacement for superior, inferior, medial, lateral and deep clips were 5.2±2.9, 5.2±3.2, 5.6±4.5, 5.6±4.3, and 4.9±4.9 mm in entire cohort (n=100); 5.6±2.6, 6.0±3.5, 6.7±5.8, 6.7±5.7, and 6.1±7.4 mm in group A (n=38); 4.9±3.1, 4.8±3.0, 5.0±3.5, 5.0±2.9, and 4.3±2.8 mm in group B (n=62), respectively. The 3D displacements of group A were longer than those of group B, but only significant difference was observed in lateral clip (p=0.047).
Conclusion
This study demonstrated displacement of surgical clips during whole breast irradiation in patients with ADM insertion. For patients who had breast volume replacement using ADM, adaptive boost planning should be considered.

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Interobserver variability of clinical target volume delineation in patients undergoing breast-conserving surgery without surgical clips: a pilot study on preoperative magnetic resonance simulation
Shuning Jiao, Yiqing Wang, Jiabin Ma, Jing Shen, Xi-Qian Zhang, Bing Zhou, Xiansong Sun, Haoran Xu, Xia Liu, Ke Hu, Fuquan Zhang, Xiaorong Hou, Jie Qiu
BMC Cancer.2024;[Epub] CrossRef
What Should We Know in Postoperative Surveillance Imaging After Oncoplastic Breast-Conserving Surgery with Pellet-Type Acellular Dermal Matrix?
Yeong Yi An, Hyejung Hwang, Young Jin Suh
Academic Radiology.2023; 30: S16. CrossRef
Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography
Mi Young Kim, Young Jin Suh, Yeong Yi An
World Journal of Surgical Oncology.2021;[Epub] CrossRef

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Sarcoma and Sarcomatous Metaplastic Carcinoma of the Breast: Sang Han Yu, Woo Chul Noh, Ho Yoon Bang, Dae Yong Hwang, Dong Wook Choi, Jong Inn Lee, Nam Sun Paik, Nan Mo Moon, Jin Haeng Jung; Cancer Res Treat. 2001;33(6):463-468. Published online December 31, 2001; DOI: https://doi.org/10.4143/crt.2001.33.6.463

Abstract PDF

PURPOSE
Primary sarcoma and SMC (sarcomatous metaplastic carcinoma) of the breast are very rare tumors, accounting for less than 1% of all breast malignancies. There are many controversies concerning the biological characteristics, prognosis and optimal treatment of these tumors owing to the rarity of incidence. The aims of this study were to elucidate the clinicopathologic characteristics of these tumors and to assist in elucidating the optimal treatment plan for the disease.
MATERIALS AND METHODS
13 cases of primary sarcoma and 10 cases of SMC that had been treated at KCCH between 1984 and 2001 were retrospectively reviewed. Phyllodes tumors were excluded from our study.
RESULTS
Among the 13 cases of primary sarcoma included, stromal sarcoma occurred in 5 cases, osteosarcoma in 3 cases, angiosarcoma in 3 cases and spindle cell sarcoma in 2 cases. The mean age of the patients with primary sarcoma and SMC was 39.7 years and 55.1 years respectively (p=0.002). When survival rates were compared according to histologic types, size of tumor, histologic grade, type of surgery and use of adjuvant therapy, both size of tumor (p=0.0256) and histologic grade (p=0.0197) were shown to be prognostic factors.
CONCLUSION
There were no significantly different features between primary sarcoma and SMC in terms of biologic characteristics or survival rates, with the exception that patients with SMC were older than those with primary sarcoma. Histologic grade and size of tumor were significant prognostic factors of these tumors.

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Primary breast osteosarcoma: A case report and review of the literature
Ramesh Omranipour, Fereshteh Ensani, Maryam Hassanesfahani
Clinical Case Reports.2021;[Epub] CrossRef

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Secretory Carcinoma of the Breast in Three Year-old Girl: A Case report: Woo Chul Noh, Nam Sun Paik, Kyung Ja Cho, Jin Haeng Chung, Seung Kon Nam, Doo Hwan Choe, Nan Mo Moon; J Korean Cancer Assoc. 2000;32(4):822-826.

Abstract PDF: Secretory carcinoma is one of the least common forms of breast cancer and demonstrates distinctive clinical and pathological characteristics. We herein report a case of secretory carcinoma of the breast in 3 year and 1 month-old girl. At presentation, the patient had a 2.5cm sized mass on her left breast which was firmly attached to the overlying nipple. The aspiration cytologic findings of the tumor were consistent with a secretory carcinoma. After confirming malignancy by frozen section diagnosis, a modified radical mastectomy was performed and secretory carcinoma was finally diagnosed. To our knowledge, secretory breast carcinoma in children has not been reported previously in Korea and this seems to be the youngest case of secretory carcinoma of the breast which had been reported in English literature.

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The Role of bcl-2 and p53 in Tamoxifen-Induced Apoptosis of Human Breast Cancer Cell Lines: Woo Chul Noh, Dong Young Noh, Yong Ho Ham, Chang Min Kim, Nam Sun Paik, Nan Mo Moon, Kuk Jin Choe; J Korean Cancer Assoc. 2000;32(3):531-538.

Abstract PDF: PURPOSE
Tamoxifen has been well known as an effective anti-tumor agent against breast cancer. The important role of bcl-2 and p53 proteins in tamoxifen-induced apoptosis of breast cancer cells has been suggested. However, the paradoxical fact that bcl-2 over-expression is assdegrees Ciated with better prognosis in clinic has not yet been clearly explained. To investigate this paradox, we analyzed the effect and dynamics of bcl-2 and p53 on the apoptosis after treatment of breast cancer cells with tamoxifen.
MATERIALS AND METHODS
The human breast cancer cell lines MCF-7 and MB MDA-468 were treated with 17-betaestradiol (E2) and tamoxifen.
RESULTS
Following tamoxifen treatment, MCF-7 cells underwent apoptosis accompanied by reduced bcl-2 expression. E2 pre-treatment led to the inhibition of tamoxifen-mediated apoptosis and bcl-2 down-regulation. When MB MDA-468 cells were treated with E2 or tamoxifen, bcl-2 and p53 protein expression did not change and apoptosis did not develop.
CONCLUSION
We observed that the down-regulation of bcl-2 by tamoxifen treatment can facilitate the apoptosis of breast cancer cells without p53 mutations. This finding was consistent with clinical experiences in which bcl-2 positive tumors were assdegrees Ciated with more indolent phenotypes in breast cancer.

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Clinical Analysis of Operative treatment of Remnant Gastric Cancer: Kwang Ho Lee, Jong Inn Lee, Ho Yoon Bang, Woo Chul Noh, Dae Yong Hwang, Dong Wook Choi, Nam Sun Paik, Nan Mo Moon; J Korean Cancer Assoc. 1999;31(5):964-971.

Abstract PDF: PURPOSE
Authors analyzed the clinico-pathologic parameters of 34 remnant gastric cancers to know the general behavior and prognosis of remnant gastric cancer.
MATERIALS AND METHODS
Medical records of 34 patients were reviewed retrospectively, who were diagnosed as remnant gastric adenocarcinoma and underwent operation in Korea Cancer Center Hospital from February of 1988 to March of 1998.
RESULTS
The incidence of remnant gastric cancer was 0.7% (34/4,904 cases). Sex ratio, male to female, was 2.8: 1. Mean age was 55 years of age. Diagnoses of primary lesion were 10 cases of benign lesion, 24 cases of malignant lesion. The operation for the remnant gastric cancer is total gastrectomy or extended total gastrectomy. The most common extended-resected organ was spleen (21 cases). The morbidity following operation of remnant gastric cancer were quite rare and treated conservatively. The overall five year survival rate was 11.3%.
CONCLUSION
Authors concluded that aggressive operation of remnant gastric cancer is warranted, as it is proved relatively safe and is the only option to lengthen patients survival and to alleviate their QOL (quality of life).

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Free Cancer Cell Detection in Peritoneal Cavitr of Gastric Cancer Patients by RT-PCR for CEA: See Young Kim, Jong Inn Lee, Nan Mo Moon, Nam Sun Paik, Dong Wook Choi, Ho Yoon Bang, Woo Chul Noh; J Korean Cancer Assoc. 1999;31(1):24-30.

Abstract PDF: PURPOSE
This study is aimed to evaluate the efficacy of a novel method (RT-PCR for CEA) to diagnose free cancer cells in peritoneal cavity of gastric cancer patients, which can be used as a indication of prophylactic treatment to prevent peritoneal recurrence after curative resection of gastric cancer.
MATERIALS AND METHODS
114 gastric adenocarcinoma patients were included for this study. With pellet of peritoneal washing fluid, cytology and RT-PCR for CEA were performed with specific primers.
RESULTS
Positive rate of PCR as a whole was 55.3% (63 cases); however, that of cytology was 15.8% (18 cases). Positive rate of PCR increased with depth of invasion of the lesion (p=0.026); however, that of cytology didn't (p=0.233). In early gastric cancer and seeding cases, PCR was not more sensitive than cytologic examination in detection of free cancer cell, but in pm, ss and si cancers, PCR was much more sensitive than cytology (p<0.001).
CONCLUSION
PCR was more sensitive to diagnose free cancer cells in peritoneal cavity of gastric cancer patients especially in pm, ss and si cancers than conventional cytologic examination, and it can be a good candidate of indication of prophylactic treatment to prevent peritoneal recurrence after curative resection.

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Intraperitoneal and Retroperitoneal Sarcomas: Young Wook Jung, Woo Chul Noh, Nan Mo Moon, Nam Sun Paik, Jong Inn Lee, Dong Wook Choi, Ho Yoon Bang; J Korean Cancer Assoc. 1999;31(1):173-179.

Abstract PDF: PURPOSE
Sarcomas arising in intraperitaneal cavity and retroperitoneal space are relatively uncommon. Thus, studies characterizing the results of long-term follow-up are limited. The purpose of this study was to identify the clinicopathologic features and prognostic factors of intraperitoneal and retroperitoneal sarcomas. Materials and Method: Thirtyeight patients with intraperitaneal or retroperitoneal sarcoma who had been treated at Department of Surgery, Korea Cancer Center Hospital during the period from January 1987 to December 1997 were reviewed retrospectively.
RESULTS
The ratio between male to female was 0.9: 1. The mean age of the patients was 48.3 (32-75) years. The most common symptom was abdominal pain or discomfort (61%), followed by palpable mass (55%), GI bleeding (34%), weight loss (26%), and change of bowel habits (21%). The most comman histologic type was leiomyosarcoma (73.7%), followed by liposarcoma (23.7%), and malignant fibrous histiocytoma (2.6%). The mean tumor size was 15.5 x12.1 x 8.7 cm. Among 38 cases, 25 cases developed in intraperitoneal cavity and 13 cases arose in retroperitoneal space. Overall, 44 operations were performed in 31 patients. Among them, complete surgical resection constituted 73%. In 20 cases, combined resection of adjacent organ was performed to accomplish complete surgical resection of tumors. During the median follow up period of 23 months (3~116 months), the overall 5-year survival rate was 34.7%. The patients who had been treated by complete surgical resection showed better survival than those in whom palliative resection or biopsy only was performed (38.6% vs 0% of 5 YSR, P=0.015). Liposarcoma showed better prognosis than leiomyosarcoma (41.7% vs 34.2% of 5 YSR, P=0.0000). The size of tumor (10 cm>vs 10 cm< or =) was not a statistically significant prognostic factor.
CONCLUSION
In this series, The histologic type and complete surgical resection were important factors that can affect the survival of the patients. Aggressive surgical resections are therefore wananted to obtain better outcome of the patients with intraperitoneal and retroperitoneal sarcomas.

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Comparision between New Version of UICC-TNM Classification with Old Versions Including Japanese Classifications of Gastric Cancer Patientw: Sung Sik Bae, Jong Inn Lee, Nan Mo Moon, Nam Sun Paik, Dong Wook Choi, Dae Yong Hwang, Ho Yoon Bang, Woo Chul Noh; J Korean Cancer Assoc. 1999;31(1):43-53.

Abstract PDF: PURPOSE
This study was designed to examine the reliability and easy applicability of new version of UICC-TNM classification (UICC, 1997) compared with old version of UICC-TNM classification (UICC, 1992) and JRSGC (Japanese Research Society for Gastric Cancer) classification of gastric cancer.
MATERIALS AND METHODS
For 1043 patients who underwent curative resection from Jan. 1992 to Dec. 1996 in Korea Cancer Center (KCCH), old version of UICC-TMN classification and JRSGC classification were compared with the new version of UICC-TNM classification.
RESULTS
Correlation coefficient between topographic classification (old UICC-TNM, JRSGC) of lymph node and numeric classification was 0.9 (p<0.05). 5-year survival rates according to old UICC, TRSGC, new UICC classification were 94.9% at stage Ia; 96.6, 96.5, 97.1% at stage Ib; 73.8, 73.8, 73.0% at stage II; 54.1, 55.8, 58.0% at stage IIIa; 35.5, 42.0, 36.0% at stage IIlb; 25.9, 22.3, 23.9% at stage IV. 5-year survival rates of each classification had significant difference among stages (p<0.0001), but there was no significant difference among each classification.
CONCLUSION
The new version of UICC-TNM classification based on the number of involved lymph nodes allows a staging system as reliable as the old version of UICC-TNM and JRSGC classification. In addition, the new version of UICC-TNM classification can be applied without methodologic problems and seems more convenient and reproducible.

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Clinical Analysis of the Favorable Type of Breast Cancer - Medullary , Mucinous , Papillary and Tubular Carcinoma: Chang Wan Jeon, Woo Chul Noh, Nan Mo Moon, Nam Sun Paik, Jong Inn Lee, Dong Wook Choi, Ho Yoon Bang; J Korean Cancer Assoc. 1999;31(1):82-89.

Abstract PDF: PURPOSE
The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer.
MATERIALS AND METHODS
To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively.
RESULTS
The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors.
CONCLUSION
Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.

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Germline Mutation of BRCA2 Gene in Korean Breast / Ovarian Cancer Families: Yong Jin Won, Jae Hwan Oh, Ji Hyun Kim, Dong Young Noh, Kuk Jin Choe, Soon Beom Kang, Lee Su Kim, Man Su Ro, Nam Sun Paik, Dae Hyun Yang, Se Min Oh, Soon Nam Lee, Kyung Kook Kim, Jae Gahb Park; J Korean Cancer Assoc. 1998;30(2):242-252.

Abstract PDF: PURPOSE
Recent discovery of BRCA1 and BRCA2 genes has made it possible to perform presymptomatic diagnosis in hereditary breast/ovarian cancer families. We have previously reported germline mutations of the BRCA1 gene in Korean hereditary breast/ovarian cancer families. In that study two out of 13 families were found to have germline mutations in BRCA1 gene. One was a nonsense mutation in codon 1815, and the other was a frameshift mutation due to 2 base-pair deletion in codon 1701 of BRCA1 gene. This study was intended to identify germline mutations of the BRCA2 gene in Korean breast/ovarian cancer families.
MATERIALS AND METHODS
Peripheral blood DNA was obtained from 10 breast cancer patients registered at the Korean Hereditary Tumor Registry with positive family history of breast and/or ovarian cancer. Exons 11 and 27 of the BRCA2 gene(together accounting for 50% of the coding region of the BRCA2 gene) were amplified by polymerase chain reaction(PCR) and screened for mutations by in vitro transcription/translation method. For confirmation of the mutations, automatic sequencing of the PCR products displaying abnormal truncated protein bands was perfomed.
RESULT
We identified an abnormal truncated protein in the exon 11 of the BRCA2 gene from a member of hereditary breast cancer family, SNU-B4. Sequencing analysis revealed a 4 bp deletion in codons 1248-49 of the exon 11, resulting in frameshift that led to premature stop codon and truncation of the protein product.
CONCLUSION
We have identified a germline mutation from a Korean hereditary breast cancer family. So far only one case of the same mutation has been registered in Database of BRCA2 mutation (BIC) by a commercial genetic diagnosis company, Myriad Genetics, Inc. Identification of the germline mutation in BRCA2 gene should aid in the accurate presymptomatic diagnosis of the at-risk members in this family.

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Clinical Analysis of 329 Cases of Total Gastrectomy: Woo Sung Lee, Nam Sun Paik, Seon Mi Moon, Woo Chul Noh, Ho Yoon Bang, Dong Wook Choi, Jong Inn Lee, Nan Mo Moon; J Korean Cancer Assoc. 1998;30(1):63-71.

Abstract PDF: PURPOSE
This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively.
RESULTS
The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors.
CONCLUSION
The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.

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Clinical Analysis of Typical Medullary Carcinoma of the Breast: Kyu Hwan Choi, Woo Chul Noh, Nam Sun Paik, Nan Mo Moon, Ho Yoon Bang, Dong Wook Choi, Jong Inn Lee, Seon Mi Moon; J Korean Cancer Assoc. 1998;30(1):113-118.

Abstract PDF: PURPOSE
Medullary carcinoma of the breast is an uncommon subtype of infiltrating ductal carcinoma and its incidence in different series ranges between 2% and 8% of all breast canoers. The histopathologic criteria for medullary carcinoma of the breast used by most pathologists today were delineated by Ridolfi et al. in 1977. The criteria of typical medullary carcinoma include all of followings: 75% or more of syncytial growth pattern, microscopically completely circumscribed, no intraductal component, moderate to marked diffuse mononuclear stromal invasion, nuclear grade 1 or 2. Medullary carcinoma has a more favorable prognosis than usual invasive breast cancer. MATERIALS & METHODS: To determine clinical characteristics of this tumor, the medical records of 15 women with typical medullary carcinoma treated at KCCH between 1985 and 1996 were reviewed retrospectively.
RESULTS
The incidence of typical medullary carcinoma in KCCH was 0.51%(15/2946) of all breast cancers. Age ranged from 27 to 56 years and mean age was 40.1 years. The peak age group was 4th decade(46.6%), followed by 5 th decade(40%). Most of the patients were premenopausal status(14/15). The major clinical manifestation of all patients was a palpable mass. Twelve patients were investigated for ER status, but all were negative. Preoperative fine needle aspiration cytology was checked in 6 patients, all cases showed positive findings for malignancy. The mean size of tumor was 3.01 cm in diameter and the rate of lymph node positivity was 40%(6/15). There was one case of systemic recurrence at 38 months after operation and the patient expired at 3 months after detection of recurrence. The others were alive without evidence of disease for mean follow-up period of 64.7 months.
CONCLUSIONS
The mean age of the patients of medullary carcinoma was relatively younger than that of the patients with other usual invasive breast cancer. The incidence of medullary carcinoma in this study was slightly lower than western series. Medullary carcinoma showed good prognosis, even if estrogen receptors were negative, but to determine clinical characteristics of Korean medullary carcinoma of the breast, multicenter data should be collected.

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Clinical Analysis of Surgically Treated Primary Gastric Lymphoma: Choong Sik Kim, Nam Sun Paik, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Ho Yoon Bang, Woo Cheol Noh, Seon Mi Moon, Seung Sook Lee; J Korean Cancer Assoc. 1998;30(1):150-157.

Abstract PDF: PURPOSE
The incidence of primary gastric lymphoma is a relatively rare and is 2~5% of all gastric malignant lesion. Because of its rarity, there are few report in Korea. Therefore, to elucidste the clinicopathological characteristics and prognosis of primary gastric lymphoma and to investigate MALT(Mucosa-associated lymphoid tissue) lymphoma, we studied in primary gastric lymphoma. MATERIALS & METHODS: we evaluated retrospectively primary gastric lymphoma patients who underwent gastric resection from Jan. 1990 to Dec. 1994 in KCCH.
RESULTS
There were 20 patients with primary gastric lymphoma and the incidence is 0.54% of all gastric malignant lesion. Abdominal pain, primarily epigastric, was the most common presenting complaint and the most common location was the distal third of the stomach. The overall 5-year survival rate was 71%. Factor significantly influencing 5-year survival rate was the serosal invasion. Age, gender, tumor size, histologic grade, nodal status and Ann-Arbor staging system did not influence survival.
CONCLUSION
So,we suggest that the depth of invasion should be included in staging system of gastric lymphoma because Ann Arbor staging system might be inadequate when applied to primary gastric lymphoma. Also, we suggest that the multicenter study should be performed to elucidate the characteristics of Korean gastric lymphoma because of its low incidence.

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Germline Mutations of BRCA1 Gene in Korean Breast and/or Ovarian Cancer Families: Yong Jin Won, Jae Hwan Oh, Xiao Hong Huang, Dong Young Noh, Kuk Jin Choe, Soon Beom Kang, Lee Su Kim, Man Su Noh, Nam Sun Paik, Dae Hyun Yang, Se Min Oh, Soon Nam Lee, Jae Gahb Park; J Korean Cancer Assoc. 1997;29(5):713-723.

Abstract PDF: PURPOSE
To understand the involvement of BRCA1 gene in Korean breast and/or ovarian cancer families.
MATERIALS AND METHODS
Germline mutations of BRCA1 gene were analyzed in 13 families which included 3 hereditary site-specific breast cancer families, 6 suspected breast cancer families, and 3 suspected breast-ovarian cancer family, and one Li-Fraumeni family by screening BRCA1 gene using single strand conformation polymorphism (SSCP) analysis on polymerase chain reaction (PCR) amplified genomic DNA and confirmed the results by sequencing.
RESULTS
Including one family with previously reported nonsense mutation of BRCA1 gene, we detected two mutations in unrelated families. One newly identified mutation was frame shift mutation resulting from TG deletion in codon 1701, which results in a truncated BRCA1 protein, at codon 1714.
CONCLUSION
The proportion of families who inherit the mutated BRCA1 gene seems to be small among Korean breast and/or ovarian cancer families.

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Clinical Analysis of Invasive Papillary Carcinoma of the Breast: Seon Mi Moon, Nam Sun Paik, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Woo Chul Noh, Shin Kwang Khang; J Korean Cancer Assoc. 1996;28(6):981-988.

Abstract PDF: Invasive papillary carcinoma of the breast is an uncommon cancer and its incidence in different series ranges between 0.3% and 3% of all breast cancers. It has been reported that in western countries papillary carcinoma generally presents in the seventh decade and is more frequently found in postmenopausal, non-white women. Generally the gross appearance of papillary carcinoma is well circumscribed or may appear to be encapsulated. The size of invasive papillary carcinoma is usually small but varies. Clinically, this tumor has lower freguency rate of axillary nodal involvement and better 5-year or 10-year survival rate than the other common types of breast cancer. To determine clinical and histopathologic characteristics of this tumor, the medical records of 14 women with invasive papillary carcinoma treated at KCCH between 1983 and 1995 were reviewed retrospectively. The results were as follows: ¨c The incidence of invasive papillary carcinama was 0.48% (14/2935) of all breast cancers. ¨e The mean age at the diagnosis was 45.8 years. ¨e The most common clinical manifestatian was a palpable mass. ¨e The mean size of tumor was 4.2 cm in diameter. ¨e The rate of ER positivity was 50%(4/8). ¨i The rate of axillary nodal involvement was 30.8%(4/13). ¨i There was one case of systemic recurrence at 16 months after modified radical mastectomy and the patient expired at 29 months after operation. There was one case of ipsilateral cervical lymph node metsstasis at 21 months after modified radical mastectomy and the patient is still alive. In conclusion, the incidence and prognosis of invasive papillary carcinoma in this study was similar to western series, but the peak age group with invasive papillary carcinoma was younger than in western countries. To determine the clinical, histopathologic chracteristics of Korean papillary carcinoma of the breast, multicenter data should be collected.

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Analysis of Recurrence and Survival Rate in Early Gastric Castric Cancer Patients: Seong Kwang Chang, Nam Sun Paik, Nan Mo Moon, Ho Yoon Bang, Jong Inn Lee, Dong Wook Choi; J Korean Cancer Assoc. 1996;28(6):1021-1032.

Abstract PDF: The prognosis of surgically treated early gastric cancer(EGC) is usually excellent and the recurrence rate is quite low. From January l985 to December l993, 708 cases of EGC among 4408 cases of gastric cancer underwent gastrectomy in Korea Cancer Center Hospital. Among them 619 cases could be followed-up, and disclosed 24 cases(3.9%) of recurred EGC. 5 and 10 year survival rate in EGC exclusive of other cause of death were 95.8% and 95.4%. Mean interval between surgery and recurrence was 31.7 month and mean survival time was 40.3 month. Retrospective analysis was performed to evaluate the clinicopathological factors which relate to recurrence and survival rate. In univariated and multivariated analysis of factors, statistically significant prognostic factors are regional lymph node metastasis and macroscopically elevated type(p<0.05). Mode of recurrence in EGC was commonly hematogenous metastasis(69.7%), and frequent metastatic sites were liver, bone and lung

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Prognostic Significances of p53 Protein and Other Prognostic Factors in Hepatocellular Carcinoma Patients: Gui Tark Hong, Dong Wook Choi, Jong Inn Lee, Nam Sun Paik, Nan Mo Moon, Seung Sook Lee; J Korean Cancer Assoc. 1995;27(6):916-924.

Abstract PDF: Hepatocellular carcinoma(HCC) is the one of most frequent cancers in Korea,and the mortality rate from HCC is highest in this country all over the world, probably due to high hepatitis B virus infection rate and extremely poor progonosis. Established prognostic factors in HCC are presence of venous invasion, multiplicity and curative resection, but we do not know all about prognosis in curatively resected cases. So, we studied p53 protein expression in Korean HCC patients, which is independent prognostic factor in breast cancer and lung cancer. We performed immunohistochemistry using Pab 180l, which is monoclonal antibody for p53 protein in 39 HCC patients, who underwent curative liver resection in Korea Cancer Center Hospital. Positive expression rate of p53 protein was 26 %. The p53 protein expression seemed to be higher in HCC patients with poor prognostic factors such as vein invasion, absence of encapsulation, and multiplicity, but they did not reach the stastistical significance. And slightly better survival rates were shown in p53 negative protein group, but no significant difference was detected(p=0.593). In conclusion, we could not detect the prognostic significance of p53 protein expression in curatively resected HCC patients, but we think that more extensive study will be needed in more patients using diverse antibodies to mutant p53 protein.

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Germline Mutation of BRCA1 Gene in Korean Breast and Overian Cancer Patients: Jae Hwan Oh, Dong Young Noh, Kuk Jin Choe, Soon Beom Kang, Lee Su Kim, Man Su Ro, Nam Sun Paik, Dae Hyun Yang, Se Min Oh, Soon Nam Lee, Jae Gahb Park; J Korean Cancer Assoc. 1995;27(6):1061-1070.

Abstract PDF: We analyzed germline mutations of the BRCAl gene in 29 Korean breast cancer patients, which included ¨c 10 breast cancer patients with family history of breast or ovarian cancer, ¨e 7 early onset breast cancer patients without family history of breast or ovarian cancer(1ess than 40 years old at diagnosis) and ¨e 12 breast cancer patients without family history of breast or ovarian cancer(more than 40 years old at diagnosis), and 1 hereditary ovarian cancer patient. One nonsense mutation at codon 1815 encoding a truncated protein was detected in a breast cancer patient with family history of ovarian cancer. One missense mutation at codon 1630 was detected in a group of breast cancer patients without family history(more than 40 years old at diagnosis), but still not determined whether it was polymorphism or not. Three polymorphisms were detected, which included 2 cases of silent mutation and a case of missense mutation. In early onset breast cancer group and a familial ovarian cancer patient, there was no detected mutation. We confirmed a germline BRCAl gene mutation in one Korean patient of hereditary breast-ovarian cancer family.

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Clinical Analysis of Ductal Carcinoma in Situ of the Breast: Jong Mu Lee, Nam Sun Paik, Yong Kyu Kim, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Kyung Ja Cho; J Korean Cancer Assoc. 1995;27(5):822-829.

Abstract PDF: Ductal carcinoma in situ has become clinically important with the advent of the rautine use of high quality mammography in western country. Literally, DCIS represent 15 to 20% of newly detected cases of breast cancer. At least half of these patients have treatment options other than conventional modified radical mastectomy, i.e. breast conserving surgery with radiotherapy. To determine clinical and histopathologic characteristics, the outcomes of 51 women with ductal carcinoma in situ treated at KCCH between l983 and 1993 are studied ret- rospectively. The results were as fo11ows; 1)The incidence of DCIS was 2.1%(51/2333) 2)The incidence of DCIS during 1980s was 2.0%, and 2.9% during 1990s. 3)The mean age of DCIS was 44.4 years old and peak age group was the 5th decade. 4)The most common clinical manifestation was a mass, followed by nipple discharge, Paget's disease, and pain in order. 5)The tumor size less than 2cm was the most common(26 out of 51 cases). 6)Cribriform type was the most common(15/51) and comedo-form represents 17.6%(9/51) of DCIS. 7)The ER positivity of DCIS was 70%(14/20). 8)Author experienced only one case of systemic recurrence at 24 months after modified radical mastectomy and at last she died 5 years after operation. Authors could not conclude the prognostic significance of DCIS according to the subtypes of DCIS or treatment modalities because of a little number of cases and a short term follow-up period. In conclusion, the incidence of DCIS in this study is not so high as in western countries, however for earlier detection of DCIS, it is better to make a screening mammography at least 2-years interval for women older than forty years old. Conservative procedures as an operative option may be considered in selected cases of DCIS.

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Prognostic Significance of p53 Protein Expression in Colorectal Cancer: Kang Choon Lee, Dong Wook Choi, Nan Mo Moon, Yong Kyu Kim, Nam Sun Paik, Jong Inn Lee, Dae Yong Hwang, Ja June Jang; J Korean Cancer Assoc. 1994;26(6):878-885.

Abstract PDF: Molecular carcinogenesis model in colorectal cancer was proposed by Vogelstein in 19B9, that is, the accumulation of a series of genetic alterations results in malignant transformation from normal epithelium. Among them, p 53 gene mutation is known to take place in late stage, and is detected in more than 70% of colorectal cancers. Also, it was suggested that genetic alteration of p53 gene was related to worse prognosis in colorectal cancer patients. On the other hand, it is controversial still now whether p53 oncoprotein expression have relation with poor prognosis in colorectal cancers or not. So, we studied the p53 protein expression in l39 case of colorectal cancer patients who underwent curative surgical resection in Korean Cancer Center Hospital from Jan. 1984 to Dec. 1988 with immunohistochemical technique using Pab 1801, which is monoclonal antibody to p53 protein. We also analyzed the relevance between p53 protein expression and the conventional prognostic parameters. The positive rate of p53 protein expression was 43.9%. We didn't find any relevance between positive p53 protein expression and the conventional prognostic parameters except significantly lower expression rate in mucinous carcinoma(p=0.02). And, we could not detect any prognostic significance of p53 protein expression in resectable colorectal cancer patients. In conclusion, nuclear p53 protein expression by immunohistochemistry is considered to have no prognostic impact in resectable colorectal cancer patients. and we suggest that further study shou1d be going on including multiple genetic alteraions, and cytoplasmic p53 protein expression to detect the factors influencing on prognosis.

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The Expression of c-erbB-2 Oncoprotein and Epidermal Growth Factor Receptor ( EGFR ) in Breast Cancer Patients in Korea: Won Park, Nam Sun Paik, Yong Kyu Kim, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Ja June Jang; J Korean Cancer Assoc. 1994;26(6):901-912.

Abstract PDF: Samples of breast carcinoma were collected from 1l7 patients who underwent mastectomy in Korea Cancer Center Hospital from Jan. 1982 to Dec. 1984. We studied expression of the c-erbB- 2 oncoprotein and EGFR with the immunohistochemical technique. We also analyzed to clarify the relationship between expression of the c-erbB-2 oncoprotein and/or EGFR and tumor size, node metastasis, stage, histo1ogic grade, TIL, and EIC, and to evaluate the prognostic significance of c-erbB-2 oncoprotein and EGFR in breast cancer. EGFR expression rate was 37.6%(44/ ll7) and EGFR status had positive correlation with histologic grade(p<0.05), But, we did not find any other relationship with other clinicopathological prognostic factors. c-erbB-2 expression rate was 64.1%(71/1 l7). There was no relevance between c-erdB-2 expression and other prognostic factors. Higher histologic grade was poorer survival rate. EGFR positive patients had poorer prognosis than negative patients in stage I and II breast cancer(p<0.05).

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The Prognosis and Expression of p53 , c-erbB-2 in Gastric Cancer Patients: Young Don Kim, Jong Inn Lee, Yong Kyu Kim, Nan Mo Moon, Nam Sun Paik, Dong Wook Choi, Dae Yong Hwang, Ja June Jang, Han Kwang Yang; J Korean Cancer Assoc. 1994;26(4):534-544.

Abstract PDF: Authors studied the ovcrexpression of p53 and c-erbB-2 in 278 gastric cancer patients who were operated in KCCH from 1985 Jan. to 1987 Jan., by immunohistochemical staining using ar- chival paraffin embedded tissue and the possibility of them as prognostic factors. Overall overexpression rate was 39.2% for p53 and 15.1% for c-erbB-2 respectively. There were no dif- ferences in overexpression rate according to sex, age, Borrmann type, depth of tumor, nodal metastasis, growth pattern, lymphatic or venous invasion, tumor size and distant organ metastasis in both p53 and c-erbB-2. The overexpression rate of c-erbB-2 of well or moderately differentiated type and that of Laurens intestinal type were higher than that of paorly differentiated type and diffuse type. Overall cumulative five year survival rates of positive group for p53 and c-erbB-2 were slightly lower than those of negative group, but the differences of them were not significant. However, cumulative five year survival rate of positive group for c-erbB-2 in intestinal type cancer was lower than that of negative group significantly (0. 035I). So, we suggest that c-erbB-2 overexpression could be a prognostic factor in gastric cancer, especially in intestinal type.

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Carcinoma of the breast in women 35 years of age or less: Tae Hyeon Lee, Nam Sun Paik, Yong Kyu Kim; J Korean Cancer Assoc. 1992;24(6):834-839.

Abstract PDF: No abstract available.

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Clinical analysis of 123 cases of total gastrectomy in the treatment of stomach cancer: Chang Young Kwon, Nam Sun Paik, Jong Inn Lee; J Korean Cancer Assoc. 1992;24(2):293-305.

Abstract PDF: No abstract available.

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Clinical study for prognostic factors in colorectal cancer: Chul Kyoo Lee, Nam Sun Paik, Dong Wook Choi; J Korean Cancer Assoc. 1991;23(3):619-629.

Abstract PDF: No abstract available.

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Clinical analysis of the surgical thyroid disease in male: Sung Man Kang, Nam Sun Paik, Yong Kyu Kim; J Korean Cancer Assoc. 1991;23(2):387-401.

Abstract PDF: No abstract available.

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A Clinical Study on 140 Cases of Early Gastric Cancer: Man Seok Heo, Nam Sun Paik, Nan Mo Moon; J Korean Cancer Assoc. 1990;22(2):334-341.

Abstract PDF: Carcinoma of the stomach is the most prevalent malignancy in Korea and usually has poor prognosis. But, the prognosis for the early gastric cancer has been reported very excellent. Authors analyzed 140 cases of EGC operated on from January 1980 to December 1988 at KCCH in the view of the incidence, ABO blood types, age distribution, depth of invasion, pathological classification, lymph node metastases and progno#sis. The results were as follows. 1) The incidence of EGC was 12.6% of all stomach cancer during the same period. The overall male to female sex ratio was 1.8:1 (male:female=90:50). 2) The most frequent age group was the 6the decade (34%), followed by the 5th decade (27.9%) and the 7th decade (20.7%) in order. 3) The major blood type of EGC patients was type A(42.1%). 4) The preoperative diagnostic accuracy was 40.3% by double contrast study and 62.0% by endoscopy with biopsy. 5) The most common site was antrum, followed by incisura angularis. 6) The most common type of EGC was type II, (57.9%), followed by type II,+III(17.9%). 7) In 43 cases the lesion was limited to mucosa only, and nintyseven cases invaded to submucosa, and the metastases to regional lymph nodes were zero in mucosa type and 16.4% (23 cases) in submucosa type. B) Histologic type revealed 20 cases of well differentiated type, 38 cases of moderated differentiated type, 62 cases of poorly differentiated type, 20 cases of signet ring cell type. 9) Radical operations were performed in all cases and adjuvant chemotherapy was done in the cases with lymph node metastases only. 10) Overall 5-year survival rate for the entire group was 96.0%.

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Estrogen and Progestrone Receptor Status and Histopathology of Korean Breast Cancers: Soo Tae Kim, Yong Kyu Kim, Nan Mo Moon, Nam Sun Paik, Jeong Hyun Yang, Suck Whan Koh, Sang Chul Park, Jung Bin Lee; J Korean Cancer Assoc. 1983;15(1):50-58.

Abstract PDF: It is generally accepted that the measurement of specific estrogen receptor (ER) and progesterone receptor(PgR) in the cytosol of human breast cancer tissue can be used as a clinical indicator of hormone dependency of tumor. This report provi- des estrogen receptor status,progesterone receptor status and the correlation hetween receptor status and histopathological features in 78 breast specimens. Included were 27 benign breast tissues and 51 carcinoma tissues, all from Korean women. The overall incidence of receptor-positive cancers was 59% in ER and 35% in PgR. The incidence of ER(+) cancers was increased in gostmenopause compared with premenopause, while that of PgR(p) cancers was decreased. PgR was found in 47% of ER(+) cancers but in only 19% of ER(-) cancers. 26, of cancers revealed not only ER (+) but PgR (+). Of benign breast tissues 2 cases (7%) contained both receptors. There was not a significant relationship between receptor status and the following morphological features of breast cancers: size of primary tumor, tumor duration, histopathological classification and histological grade. But our data showed clear tendency that an increasing degree of lymphocytic infiltrate in breast cancer was associated with decreasing incidence of positive receptors.

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