Cancer Research and Treatment

Original Articles

Effect of Adjuvant Chemotherapy on Stage II Colon Cancer: Analysis of Korean National Data: Min Ki Kim, Daeyoun David Won, Sun Min Park, Taejung Kim, Sung Ryong Kim, Seong Taek Oh, Seung Kook Sohn, Mi Yeon Kang, In Kyu Lee; Cancer Res Treat. 2018;50(4):1149-1163. Published online December 7, 2017; DOI: https://doi.org/10.4143/crt.2017.194

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Purpose
Debates exist regarding the effectiveness of adjuvant chemotherapy for stage II colon cancer. This study aimed to investigate the current status of adjuvant chemotherapy and its impact on survival for Korean stage II colon cancer patients by analyzing the National Quality Assessment data.
Materials and Methods
A total of 7,880 patientswho underwent curative resection for stage II colon adenocarcinoma between January 2011 andDecember 2014 in Koreawere selected randomly as evaluation subjects for the quality assessment. The factors that influenced overall survival were identified. The high-risk group was defined as having at least one of the following: perforation/ obstruction, lymph node harvest less than 12, lymphovascular/perineural invasion, positive resection margin, poor differentiation, or pathologic T4 stage.
Results
The median follow-up period was 38 months (range, 1 to 63 months). Chemotherapy was a favorable prognostic factor for either the high- (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.38 to 0.59; p < 0.001) or low-risk group (HR, 0.74; 95% CI, 0.61 to 0.89; p=0.002) in multivariate analysis. This was also the case in patients over 70 years of age. The hazard ratio was significantly increased as the number of involved risk factors was increased in patients who didn’t receive chemotherapy. Adding oxaliplatin showed no difference in survival (HR, 1.36; 95% CI, 0.91 to 2.03; p=0.132).
Conclusion
Adjuvant chemotherapy can be recommended for stage II colon cancer patients, but the addition of oxaliplatin to the regimen must be selective.

Citations

Citations to this article as recorded by

Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment
Hyo Seon Ryu, Hyun Jung Kim, Woong Bae Ji, Byung Chang Kim, Ji Hun Kim, Sung Kyung Moon, Sung Il Kang, Han Deok Kwak, Eun Sun Kim, Chang Hyun Kim, Tae Hyung Kim, Gyoung Tae Noh, Byung-Soo Park, Hyeung-Min Park, Jeong Mo Bae, Jung Hoon Bae, Ni Eun Seo, Cha
Annals of Coloproctology.2024; 40(2): 89. CrossRef
Postoperative chemotherapy use and survival in non-high-risk young and high-risk old-aged patients with stage II colon cancer
Tian Jin, Yingshuang Zhu, Wei Lu, Chenqin Le, Lijuan Wang, Qian Xiao, Kefeng Ding
Holistic Integrative Oncology.2023;[Epub] CrossRef
Risk factors for recurrence in elderly patients with stage II colorectal cancer: a multicenter retrospective study
Takuki Yagyu, Manabu Yamamoto, Akimitsu Tanio, Kazushi Hara, Ken Sugezawa, Chihiro Uejima, Kyoichi Kihara, Shigeru Tatebe, Yasuro Kurisu, Shunsuke Shibata, Toshio Yamamoto, Hiroshi Nishie, Setsujo Shiota, Hiroaki Saito, Takuji Naka, Kenji Sugamura, Kuniyu
BMC Cancer.2022;[Epub] CrossRef
The role of high-risk features in stage II colon cancer after surgical treatment
Patricio Bernardo Lynn, Garrett Yoon, Terry Li, Meng Cao, Michael Grieco, H. Leon Pachter, Russell C. Langan, Patrick Hilden, Joanna Sesti, Jason Maggi
Surgery Open Digestive Advance.2022; 7: 100054. CrossRef
Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database
Pietro Achilli, Jacopo Crippa, Fabian Grass, Kellie L. Mathis, Anne‐Lise D. D'Angelo, Mohamed A. Abd El Aziz, Courtney N. Day, William S. Harmsen, David W. Larson
International Journal of Cancer.2021; 148(1): 161. CrossRef
Associations of P Score With Real-World Survival Improvement Offered by Adjuvant Chemotherapy in Stage II Colon Cancer: A Large Population-Based Longitudinal Cohort Study
Qi Liu, Zezhi Shan, Dakui Luo, Sheng Zhang, Qingguo Li, Xinxiang Li
Frontiers in Oncology.2021;[Epub] CrossRef
Impact of Inadequate Number of Lymph Nodes Examined on Survival in Stage II Colon Cancer
Qi Wu, Zhiyuan Zhang, Yijiao Chen, Jiang Chang, Yudong Jiang, Dexiang Zhu, Ye Wei
Frontiers in Oncology.2021;[Epub] CrossRef
Effect of Adjuvant Chemotherapy on Elderly Stage II High-Risk Colorectal Cancer Patients
Yujin Lee, Inseok Park, Hyunjin Cho, Geumhee Gwak, Keunho Yang, Byung-Noe Bae
Annals of Coloproctology.2021; 37(5): 298. CrossRef
Elderly High-Risk Stage II Colorectal Cancer Patients: Candidates for Improving Outcome?
Min Ki Kim
Annals of Coloproctology.2021; 37(5): 267. CrossRef
Efficacy and tolerability of adjuvant therapy in ≥70-year-old patients with T3N0M0 colorectal cancer: An observational study
Abdullah Sakin, Nurgul Yasar, Suleyman Sahin, Serdar Arici, Saban Secmeler, Orcun Can, Caglayan Geredeli, Cumhur Demir, Sener Cihan
Journal of Oncology Pharmacy Practice.2020; 26(3): 619. CrossRef
Postoperative chemotherapy improves survival in patients with resected high‐risk Stage II colorectal cancer: results of a systematic review and meta‐analysis
C. Simillis, H. K. S. I. Singh, T. Afxentiou, S. Mills, O. J. Warren, J. J. Smith, P. Riddle, M. Adamina, D. Cunningham, P. P. Tekkis
Colorectal Disease.2020; 22(10): 1231. CrossRef
Patient Selection for Adjuvant Chemotherapy in High-Risk Stage II Colon Cancer
Chao Zhang, Songcheng Yin, Yuen Tan, Jinyu Huang, Pengliang Wang, Wenbin Hou, Zhe Zhang, Huimian Xu
American Journal of Clinical Oncology.2020; 43(4): 279. CrossRef
Mucinous Histology Might Be an Indicator for Enhanced Survival Benefit of Chemotherapy in Stage II Colon Cancer
Yong Huang, Kuanxue Ge, Guangshun Fu, Junfeng Chu, Wei Wei
Frontiers in Medicine.2020;[Epub] CrossRef
Re-Evaluation of the Survival Paradox Between Stage IIB/IIC and Stage IIIA Colon Cancer
Hongbo Li, Guangshun Fu, Wei Wei, Yong Huang, Zhenguang Wang, Tao Liang, Shuyun Tian, Honggang Chen, Wei Zhang
Frontiers in Oncology.2020;[Epub] CrossRef
Evaluating the Guiding Role of Elevated Pretreatment Serum Carcinoembryonic Antigen Levels for Adjuvant Chemotherapy in Stage IIA Colon Cancer: A Large Population-Based and Propensity Score-Matched Study
Qi Liu, Yongqiang Huang, Dakui Luo, Sheng Zhang, Sanjun Cai, Qingguo Li, Yanlei Ma, Xinxiang Li
Frontiers in Oncology.2019;[Epub] CrossRef
Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer
Kil-yong Lee, Ji Won Park, Ki-young Lee, Sangsik Cho, Yoon-Hye Kwon, Min Jung Kim, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park
Scientific Reports.2019;[Epub] CrossRef
The use of chemotherapy in older patients with stage II and III colon cancer: Variation by age and era of diagnosis
Susan L. Green, David E. Dawe, Zoann Nugent, Winson Y. Cheung, Piotr M. Czaykowski
Journal of Geriatric Oncology.2018;[Epub] CrossRef

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The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma: Sea-Won Lee, Jong Hoon Lee, In Kyu Lee, Seong Taek Oh, Dae Yong Kim, Tae Hyun Kim, Jae Hwan Oh, Ji Yeon Baek, Hee Jin Chang, Hee Chul Park, Hee Cheol Kim, Eui Kyu Chie, Taek-Keun Nam, Hong Seok Jang; Cancer Res Treat. 2018;50(3):1039-1050. Published online November 21, 2017; DOI: https://doi.org/10.4143/crt.2017.252

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Purpose
A pooled analysis of multi-institutional trials was performed to analyze the effect of surgical timing on tumor response by comparing short course concurrent chemoradiotherapy (CCRT) with long course CCRT followed by delayed surgery in locally advanced rectal cancer.
Materials and Methods
Three hundred patients with cT3-4N0-2 rectal adenocarcinoma were included. Long course patients from KROG 14-12 (n=150) were matched 1:1 to 150 short course patients from KROG 10-01 (NCT01129700) and KROG 11-02 (NCT01431599) according to stage, age, and other risk factors. The primary endpoint was to determine the interval between surgery and the last day of neoadjuvant CCRT which yields the best tumor response after the short course and long course CCRT. Downstaging was defined as ypT0-2N0M0 and pathologic complete response (ypCR) was defined as ypT0N0M0, respectively.
Results
Both the long and short course groups achieved lowest downstaging rates at < 6 weeks (long 20% vs. short 8%) and highest downstaging rates at 6-7 weeks (long 44% vs. short 40%). The ypCR rates were lowest at < 6 weeks (both long and short 0%) and highest at 6-7 weeks (long 21% vs. short 11%) in both the short and long course arms. The downstaging and ypCR rates of long course group gradually declined after the peak at 6-7 weeks and those of the short course group trend to constantly increase afterwards.
Conclusion
It is optimal to perform surgery at least 6 weeks after both the short course and long course CCRT to obtain maximal tumor regression in locally advanced rectal adenocarcinoma.

Citations

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Association between personality types and low anterior resection syndrome in rectal cancer patients following surgery
Ting‐Yu Chiang, Yu‐Jen Hsu, Yih‐Jong Chern, Chun‐Kai Liao, Wen‐Sy Tsai, Pao‐Shiu Hsieh, Hung‐Chih Hsu, Yu‐Fen Lin, Hsiu‐Lan Lee, Jeng‐Fu You
Cancer Medicine.2024;[Epub] CrossRef
Lateral Lymph Node Size and Tumor Distance From Anal Verge Accurately Predict Positive Lateral Pelvic Lymph Nodes in Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Diseases of the Colon & Rectum.2023; 66(6): 785. CrossRef
Robotic Lateral Pelvic Lymph Node Dissection Could Harvest More Lateral Pelvic Lymph Nodes over Laparoscopic Approach for Mid-to-Low Rectal Cancer: A Multi-Institutional Retrospective Cohort Study
Jung Hoon Bae, Jumyung Song, Ri Na Yoo, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
Biomedicines.2023; 11(6): 1556. CrossRef
Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses
Miao Yu, Deng-Chao Wang, Sheng Li, Li-Yan Huang, Jian Wei
International Journal of Colorectal Disease.2022; 37(4): 855. CrossRef
Predicting Factors of Complete Pathological Response in Locally Advanced Rectal Cancer
AmirHossein Latif, Mohammad Shirkhoda, Mohammad Reza Rouhollahi, Saeed Nemati, Seyed Hossein Yahyazadeh, Kazem Zendehdel, Ahmad Reza Soroush, Aidin Yaghoobi Notash
Middle East Journal of Digestive Diseases.2022; 14(4): 443. CrossRef
Practical recommendation for treatment of patients with colon cancer during covid-19 pandemic
M. Yu. Fedyanin
Meditsinskiy sovet = Medical Council.2020; (9): 213. CrossRef
Meta-analysis of the effect of extending the interval after long-course chemoradiotherapy before surgery in locally advanced rectal cancer
É J Ryan, D P O'Sullivan, M E Kelly, A Z Syed, P C Neary, P R O'Connell, D O Kavanagh, D C Winter, J M O'Riordan
British Journal of Surgery.2019; 106(10): 1298. CrossRef
Preoperative short-course radiotherapy (5 × 5 Gy) with delayed surgery versus preoperative long-course radiotherapy for locally resectable rectal cancer: a meta-analysis
Wang Qiaoli, Huang Yongping, Xiong Wei, Xu Guoqiang, Ju Yunhe, Liu Qiuyan, Li Cheng, Guo Mengling, Li Jiayi, Xiong Wei, Yang Yi
International Journal of Colorectal Disease.2019; 34(12): 2171. CrossRef
Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis
Yongjun Yu, Yuwei Li, Chen Xu, Zhao Zhang, Xipeng Zhang
Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef

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Clinical Significance of Discordance between Carcinoembryonic Antigen Levels and RECIST in Metastatic Colorectal Cancer: In-Ho Kim, Ji Eun Lee, Ji Hyun Yang, Joon Won Jeong, Sangmi Ro, Seong Taek Oh, Jun-Gi Kim, Moon Hyung Choi, Myung Ah Lee; Cancer Res Treat. 2018;50(1):283-292. Published online May 8, 2017; DOI: https://doi.org/10.4143/crt.2016.537

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Purpose
The purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients.
Materials and Methods
We retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response.
Results
In RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients.
Conclusion
Among patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.

Citations

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Presence of CD44v9-Expressing Cancer Stem Cells in Circulating Tumor Cells and Effects of Carcinoembryonic Antigen Levels on the Prognosis of Colorectal Cancer
Katsuji Sawai, Takanori Goi, Youhei Kimura, Kenji Koneri
Cancers.2024; 16(8): 1556. CrossRef
Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy
Nebojsa Manojlovic, Goran Savic, Bojan Nikolic, Nemanja Rancic
World Journal of Clinical Cases.2022; 10(3): 899. CrossRef
Current Applications and Discoveries Related to the Membrane Components of Circulating Tumor Cells and Extracellular Vesicles
Luis Enrique Cortés-Hernández, Zahra Eslami-S, Bruno Costa-Silva, Catherine Alix-Panabières
Cells.2021; 10(9): 2221. CrossRef
Tumor-Associated Macrophages Derived TGF-β‒Induced Epithelial to Mesenchymal Transition in Colorectal Cancer Cells through Smad2,3-4/Snail Signaling Pathway
Jianhui Cai, Limin Xia, Jinlei Li, Shichang Ni, Huayu Song, Xiangbin Wu
Cancer Research and Treatment.2019; 51(1): 252. CrossRef

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Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest: Taek Soo Kwon, Sung Bong Choi, Yoon Suk Lee, Jun-Gi Kim, Seong Taek Oh, In Kyu Lee; Cancer Res Treat. 2016;48(1):216-224. Published online April 15, 2015; DOI: https://doi.org/10.4143/crt.2014.312

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Purpose
Lymph node metastasis is an important factor for predicting the prognosis of colorectal cancer patients. However, approximately 60% of patients do not receive adequate lymph node evaluation (less than 12 lymph nodes). In this study, we identified a more effective tool for predicting the prognosis of patients who received inadequate lymph node evaluation.
Materials and Methods
The number of metastatic lymph nodes, total number of lymph nodes examined, number of negative metastatic lymph nodes (NL), lymph node ratio (LR), and the number of apical lymph nodes (APL) were examined, and the prognostic impact of these parameters was examined in patients with colorectal cancer who underwent surgery from January 2004 to December 2011. In total, 806 people were analyzed retrospectively.
Results
In comparison of different lymph node analysis methods for rectal cancer patients who did not receive adequate lymph node dissection, the LR showed a significant difference in overall survival (OS) and the APL predicted a significant difference in disease-free survival (DFS). In the case of colon cancer patients who did not receive adequate lymph node dissection, LR predicted a significant difference in DFS and OS, and the APL predicted a significant difference in DFS.
Conclusion
If patients did not receive adequate lymph node evaluation, the LR and NL were useful parameters to complement N stage for predicting OS in colon cancer, whereas LR was complementary for rectal cancer. The APL could be used for prediction of DFS in all patients.

Citations

Citations to this article as recorded by

Exploring the value of multiple preprocessors and classifiers in constructing models for predicting microsatellite instability status in colorectal cancer
Yi Ma, Zhihao Shi, Ying Wei, Feng Shi, Guochu Qin, Zhengyang Zhou
Scientific Reports.2024;[Epub] CrossRef
An Intelligent System of Predicting Lymph Node Metastasis in Colorectal Cancer Using 3D CT Scans
Min Xie, Yi Zhang, Xinyang Li, Jiayue Li, Xingyu Zou, Yiji Mao, Haixian Zhang, Subrata Kumar Sarker
International Journal of Intelligent Systems.2024;[Epub] CrossRef
Rectal Cancer: Are 12 Lymph Nodes the Limit?
Paweł Mroczkowski, Łukasz Dziki, Tereza Vosikova, Ronny Otto, Anna Merecz-Sadowska, Radosław Zajdel, Karolina Zajdel, Hans Lippert, Olof Jannasch
Cancers.2023; 15(13): 3447. CrossRef
Minimally invasive surgery versus laparotomy of nonmetastatic pT4a colorectal cancer: a propensity score analysis
Hui-Long Guo, Jing-Yao Chen, You-Zhen Tang, Qian-Lin Zeng, Qing-Long Jian, Ming-Zhe Li, Yu-Long He, Wen-Hui Wu
International Journal of Surgery.2023; 109(11): 3294. CrossRef
Construction of a Prognostic Nomogram for Colorectal Cancer Patients with Fewer than Twelve Lymph Nodes Examined: a Population-Based Study in the SEER Database and China
Hao Zhang, Hanqing Hu, Zilong Guan, Rui Chen, Chao Xu, Rui Huang, Guiyu Wang
Journal of Gastrointestinal Surgery.2022; 26(1): 214. CrossRef
A Preoperative Scoring System to Predict the Risk of Inadequate Lymph Node Count in Rectal Cancer
Hao Zhang, Chunlin Wang, Yunxiao Liu, Hanqing Hu, Guiyu Wang
Frontiers in Oncology.2022;[Epub] CrossRef
A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined
Hao Zhang, Yunxiao Liu, Chunlin Wang, Zilong Guan, Hang Yu, Chao Xu, Mingyu Zheng, Yuliuming Wang, Hanqing Hu, Rui Huang, Guiyu Wang
World Journal of Surgery.2021; 45(8): 2601. CrossRef
A clinical-radiomics nomogram for the preoperative prediction of lymph node metastasis in colorectal cancer
Menglei Li, Jing Zhang, Yibo Dan, Yefeng Yao, Weixing Dai, Guoxiang Cai, Guang Yang, Tong Tong
Journal of Translational Medicine.2020;[Epub] CrossRef
Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients
Giovanni Li Destri, Martina Barchitta, Antonio Pesce, Saverio Latteri, Dorotea Bosco, Antonio Di Cataldo, Antonella Agodi, Stefano Puleo
Journal of Investigative Surgery.2019; 32(1): 1. CrossRef
Application of highly efficient and lowly toxic bufadienolides screened from toad skin in lymphatic chemotherapy for colorectal cancer through a lymphatic metastatic model
Changzheng He, Zhenyu Zou, Shaoyou Xia, Xiaowei Xing, Shidong Hu, Zilong Hu, Yuxuan Li, Songyan Li, Hongliang Zhang, Yu Yang, Yichen Liu, Xiaolei Xu, Boyan Liu, Yufeng Wang, Yingxin Xu, Xiaohui Du
International Immunopharmacology.2019; 70: 241. CrossRef
Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer
J. Yu, X. Dai, H.‐H. Zou, J.‐C. Song, Y. Li, H.‐B. Shi, Q. Xu, H. Shen
Colorectal Disease.2018; 20(2): 116. CrossRef
Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy
Hongdian Zhang, Huagang Liang, Yongyin Gao, Xiaobin Shang, Lei Gong, Zhao Ma, Ke Sun, Peng Tang, Zhentao Yu
Scientific Reports.2016;[Epub] CrossRef

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Are There Any Clinicopathologic Differences Between Mucosal And Subumucosal Cancer Of Stomach ?: Byung Wha Chung, Cho Hyun Park, Seong Taek Oh, Jong Soe Lee, Woo Bae Park, Byoung Kee Kim, Sang Yong Choo, In Chul Kim; J Korean Cancer Assoc. 1994;26(3):385-392.

Abstract PDF: From 1980 through 1991, 17Z9 patients underwent operation for gastric cancer at Department of Surgery, Catholic University Medical College in Seoul, Korea. Three hundred and twelve patients (18.0%) were early gastric cancer (EGC): mucosal cancer were 107 cases (34.3%) and submucosa1 cancer were 205 cases (65.7%). The purpose of the present study was to compare the clinicopathologic features of EGC between mucosal cancer and submucosal cancer. Submucosal cancer developed in older age than mucosal cancer (average 55 vs 49 years old). No differences, however, were noted in clinical manifestations and duration of symptoms. Macroscopically, elevated lesions (type I or IIa predominant) were frequently encountered in submucosal cancer than mucosal cancer (24.6 vs 9.7%). Histologically, differentiated carcinoma or intestinal type by Lauren's classification was more common in submucosal cancer than mucosal cancer. The incidence of lymph node metastasis of EGC was 15.1% (47/312): 2.8% (3/ 107) in mucosal cancer and 21.5% (44/205) in submucosal cancer. Lymph node involvement of submucosal cancer was significantly higher in patients with elevated lesions (35.3%) than in depressed lesions (13.5%). No lymphatic or venous invasion was noted in mucosal cancer. In submucosal cancer, however, incidence of venous and lymphatic invasion was 7.2% and 20.3%, respectively. Kaplan-Meier estimates for 5-year survival were 98% for mucosal lesions and 79% for submucosal lesions (overall 5-year survival rate; 86.3%). The Syear survival rate in patients of submucosal cancer with lymph node metastasis was only 60% comyared with 88.5% in pa- tients of submucosal cancer without lymph node involvement. All recurrent cases were submucosal cancer patients. Six out of the 9 recurrent patients were macroscopically elevated type and had lymph nade metastasis. The authors conclude that there is definite difference in terms of clinicopathologic findings between mucosal and submucosal cancer of stomach even though EGC includes both lesions by definition. So, therapeutic approach of submucosal cancer should be different from mucosal cancer.

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Ductal Carcinoma In Situ of Breast: Seong Taek Oh, Sang Seol Jung, Ick Myung Kim, In Chul Kim; J Korean Cancer Assoc. 1994;26(4):576-582.

Abstract PDF: Ductal carcinoma in situ(DCIS)has traditionally been considered a very rare form of breast cancer. However, with mammography as a screening tool, the number of cases has increased markedly in western reports. To determine the clinical and histopathological characteristics, the outcomes of 15 women with ductal carcinoma in situ treated at Kangnam St. Mary's Hospital between 1983 and 1993 are studied retrospecitively. The results were as follow: 1) The prevalent rate of DCIS is 2.9%(15 out of 519 cases). 2) Age specific percentage of DCIS shows peak in their 40's. 3) The most initial manifestation is a palpable mass and nipple discharge(12 cases: 80.0%) but in 3 cases mammographic microcalcification is the only abnormal finding. 4) Average extent of the lesion is 29.8mm, ranged from 9mm to 90mm. 5) There is one multicentric and one multifocal disease out of 15 cases respectively. 6) 7 cases(46.7%) have microinvasion which is all comedo type DCIS. 7) The most common pathologic subtype is comedo type DCIS(80.0%, 12 out of 15 cases), fol- lowed by papillo-tubular type. 8) Hormone receptor status in evaluable 4 cases reveals ER(-), PgR(-). 9) Modified radical mastectomy was done in 13 cases(86.7%) and breast preserving surgery was done in 2 cases. 10) One local recurrence has occured(recurrence rate: 6.7%) in the ipsilateral breast at 28 months after modified radical mastectomy who eventually died because of systemic metastasis at the postoperative 3 years. In spite of short fo11ow-up periods, the author conclude that DCIS is regarded as an early stage of malignant disease and its outcome after surgery is good. In the future, as a result of widespread application of screening mammography, the incidence of DCIS could be increased and the tool for selecting aggressive form of DCIS should be developed.

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Occult Breast Carcinoma with Axillary Metastasis - 5 cases report -: Yun Bok Lee, Sang Seol Jung, Seong Taek Oh, In Chul Kim; J Korean Cancer Assoc. 1996;28(4):768-772.

Abstract PDF: Occult breast carcinoma may rarely first manifest itself by axillaty lymph node metastasis. A female patient who presents with adenocarcinoma in an axillary lymph node as the sole clinical site of disease can be a diagnostic and therapeutic dilemma because of unknown natural progress. This was first described in 1907 by William Stewart Halsted who studied three such Patients with adenocarcinoma in axillary lymph nodes. We reported 5 cases of occult breast carcinoma with axillary metastases with review of literature.

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