Clinicopathological Factors Associated with Remnant or Regrowth of Benign Breast Tumor after Previous Vacuum-Assisted Core Biopsy

PURPOSE: We sometimes encounter remnant or regrowth of benign breast tumors diagnosed as Breast Imaging-Reporting and Data System (BI-RADS) C4 in follow-up breast ultrasound after previous vacuum-assisted core biopsy (VACB). We aimed to evaluate the factors that influence remnant or regrowth tumors at post-VACB site or adjacent tissue. METHODS: From January 2010 to December 2015, we analyzed 647 cases on follow-up. Patients were divided into two groups; group A was defined as patients without recurrent masses on breast ultrasonography during the follow-up period, and group B was defined as those with recurrent masses diagnosed as more than BI-RADS C4 on ultrasonography. RESULTS: Fibrocystic changes, proliferative disease without atypia, intraductal papilloma, apocrine cell change, atypical ductal hyperplasia, sclerosing adenosis, and radial scars were observed in 89.5% (n=579), 15.9% (n=103), 15.3% (n=99), 5.3% (n=34), 5.7% (n=37), 7.6% (n=49), and 6.3% (n=41) of patients, respectively. During the follow-up period, 85 patients were diagnosed as group B. Group B was significantly associated with proliferative diseases without atypia, sclerosing adenosis, and microcalcifications compared to group A (p=0.008, p=0.007, and p=0.001, respectively). After adjustment for confounding variables, group B was more significantly associated with proliferative breast diseases than group A (hazard ratio [HR], 0.558; 95% confidence interval [CI], 0.343–0.907; p=0.018). Furthermore, group B was more significantly associated with intraductal papilloma (HR, 0.571; 95% CI, 0.342–0.953; p=0.032). CONCLUSION: Previously diagnosed proliferative diseases without atypia or microcalcification at first VACB were significantly associated with recurrent breast tumor. Intraductal papilloma was also significantly associated with tumor regrowth.

Clinical significance of serum CA15-3 as a prognostic parameter during follow-up periods in patients with breast cancer

PURPOSE: To assess the relationship between the kinetics of the serum CA15-3 level and the five-year disease-free survival rate of breast cancer patients. METHODS: The subjects of this study, 297 women who were diagnosed with breast cancer, were the subset of patients operated on at Kosin University Gospel Hospital from January 2008 to December 2010. We evaluated the change of serum CA15-3 levels during outpatient follow-up period. The changing patterns of serum CA15-3 level were divided into 5 categories; surge without decline, surge with incidental decline, decline without surge, decline with incidental surge, and no change. Clinicopathologic factors were evaluated for each group. RESULTS: The number of patients in surge without decline, surge with incidental decline, decline without surge, decline with incidental surge, and no changes groups were 30 (10.1%), 85 (28.6%), 80 (26.9%), 73 (24.6%), and 29 (9.7%), respectively. The clinicopathologic characteristics were not significantly different among these groups. The log rank test found that 5-year disease-free survival rate according to the kinetics of serum CA15-3 levels were significant (P = 0.004) particularly for the surge without decline group. CONCLUSION: According to the findings of this study, the surge without incidental decline pattern of serum CA15-3 levels during the follow-up period is associated with poor prognosis. Significant association was found among changing patterns of serum CA15-3 levels and breast cancer recurrence rate.

Erratum: Diagnostic Value of Elastography Using Acoustic Radiation Force Impulse Imaging and Strain Ratio for Breast Tumors / 한국유방암학회지

This article was initially published on the Journal of Breast Cancer with a misspelled name of the first author. His name should be corrected as "Yoonseok Kim".

Erratum: Clinicopathologic Characteristics of Breast Cancer Stem Cells Identified on the Basis of Aldehyde Dehydrogenase 1 Expression / 한국유방암학회지

This article was initially published on the Journal of Breast Cancer with a misspelled name of the first author. His name should be corrected as "Yoonseok Kim".

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients / 고신대학교의과대학학술지

OBJECTIVES: Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM). METHODS: In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected. RESULTS: Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P < 0.01). However, there was no significant correlation between overall survival period and operative methods (P = 0.67). In addition, recurrence pattern (P = 0.21), recurrent rate (P = 0.36) and site (P = 0.45, P = 0.09) were not associated with operative method. CONCLUSIONS: In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.

Peritoneal and gastric metastasis from invasive lobular breast carcinoma: a case report / 고신대학교의과대학학술지

Peritoneal and gastrointestinal metastasis from breast cancer is very rare. We report here a rare case of metastatic peritoneal and gastric cancer from breast lobular carcinoma after modified radical mastectomy. A 65-year old woman presented with anorexia, nausea, vomiting and dyspepsia for several weeks at 44 months after surgery. Radiologic study showed peritoneal metastasis, and surgical histopathology reported peritoneal and omental metastatic carcinoma. Esophagogastroduodenoscopic (EGD) biopsy also confirmed metastatic carcinoma originated from breast primary.

Clinicopathologic Characteristics of Breast Cancer Stem Cells Identified on the Basis of Aldehyde Dehydrogenase 1 Expression / 한국유방암학회지

PURPOSE: Breast cancer displays varying molecular and clinical features. The ability to form breast tumors has been shown by several studies with aldehyde dehydrogenase 1 (ALDH1) positive cells. The aim of this study is to investigate the association between ALDH1 expression and clinicopathologic characteristics of invasive ductal carcinoma. METHODS: We investigated breast cancer tissues for the prevalence of ALDH1+ tumor cells and their prognostic value. The present study included paraffin-embedded tissues of 70 patients with or without recurrences. We applied immunohistochemical staining for the detection of ALDH1+ cells. Analysis of the association of clinical outcomes and molecular subtype with marker status was conducted. RESULTS: ALDH1+ and ALDH1- tumors were more frequent in triple-negative breast cancers and in luminal A breast cancers, respectively (p<0.01). ALDH1 expression was found to exert significant impact on disease free survival (DFS) (ALDH1+ vs. ALDH1-, 53.1+/-6.7 months vs. 79.2+/-4.7 months; p=0.03) and overall survival (OS) (ALDH1+ vs. ALDH1-, 68.5+/-4.7 months vs. 95.3+/-1.1 months; p<0.01). In triple-negative breast cancer (TNBC) patients, DFS and OS showed no statistical differences according to ALDH1 expression (ALDH1+ vs. ALDH1-, 45.3+/-9.4 months vs. 81.3+/-7.4 months, p=0.52; 69.0+/-7.5 months vs. 91.3+/-6.3 months, p=0.67). However, non-TNBC patients showed significant OS difference between ALDH1+ and ALDH1- tumors (ALDH1+ vs. ALDH1-, 77.6+/-3.6 months vs. 98.0+/-1.0 months; p=0.04) with no statistical difference of DFS (ALDH1+ vs. ALDH1-, 60.5+/-8.0 months vs. 81.8+/-4.6 months; p=0.27). CONCLUSION: Our findings suggest that the expression of ALDH1 in breast cancer may be associated with TNBC and poor clinical outcomes. On the basis of our findings, we propose that ALDH1 expression in breast cancer could be correlated with poor prognosis, and may contribute to a more aggressive cancer phenotype.

Diagnostic Value of Elastography Using Acoustic Radiation Force Impulse Imaging and Strain Ratio for Breast Tumors / 한국유방암학회지

PURPOSE: The aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone. METHODS: ARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch(TM) tissue imaging (VTI) and Virtual Touch(TM) tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations. RESULTS: Among the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7+/-1.0 vs. 1.6+/-0.8, p<0.01), SWV (4.23+/-1.09 m/sec vs. 2.22+/-0.88 m/sec, p<0.01), and SR (5.69+/-1.63 vs. 2.69+/-1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each). CONCLUSION: ARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.

Outcome of triple-negative breast cancer in patients with or without markers regulating cell cycle and cell death / 대한외과학회지

PURPOSE: The genes p53 and B-cell lymphoma (bcl)-2 play an important role in regulating the mechanisms of apoptosis. In this paper, we retrospectively applied these factors to our series of triple negative breast cancer (TNBC) patients, in conjunction with an evaluation of the prognostic significance of these factors' influence on TNBC survival rate. Particular focus was placed on the role of bcl-2, p53, Ki-67. METHODS: The study subjects, 94 women with TNBC, were a subset of patients operated at Kosin University Gospel Hospital from January 2000 to December 2005. Chi-squared tests were used for statistical analysis. RESULTS: Positive staining for cytokeratin (CK)5/6 in 23 cases (24.5%), epidermal growth factor receptor in 15 cases (16.0%), bcl-2 in 26 cases (27.7%), p53 in 55 cases (58.5%) and Ki-67 in 74 cases (78.7%) was determined. Lymph node status, tumor size and expression of CK5/6 or Ki-67 were independent prognostic factors for patients with TNBC. CONCLUSION: Markers regulating cell cycle and cell death such as p53 and bcl-2 cannot be used to classify TNBCs into two subtypes with differing disease-free survival. But because our study is small in size, more abundant patient data will be needed to evaluate the factors' predictive role in regulating cell cycle and cell death.

Circulating Tumor Cells and Extracellular Nucleic Acids in Breast Cancer / 고신대학교의과대학학술지

Circulating tumor cells (CTCs) are defined as tumor cells circulating in the peripheral blood of patients, shed from either the primary tumor or from its metastases. The detection of circulating tumor cells (CTCs) in the peripheral blood of breast cancer patients may account for the different steps in the biologic progression of the disease. The detection of microscopic disease in patients with breast cancer is imperative to prognosis and can predict the efficacy of targeted treatments. In general, there are two main methods for their detection. These are based on cytometric and nucleic acid manipulation. Both methods generally require an enrichment step to increase sensitivity of the assay. This step is based on either detection of specific surface markers using immuno-selection and/or on morphological features, such as cell size or density. We review the methods of detecting CTCs, their prognostic implications, and opportunities to exploit the properties of CTCs to develop personalized therapy.

Impact of Serum HER2 Levels on Survival and Its Correlation with Clinicopathological Parameters in Women with Breast Cancer / 한국유방암학회지

PURPOSE: The aims of our study were to assess the correlation between serum HER2 and clinicopathologic factors, the effect of serum HER2 on survival rate, and the effect of changes in serum HER2 levels between pre- and post-adjuvant chemotherapy on survival rate. METHODS: The study subjects, 200 women with breast cancer, were a subset of patients operated on between January 2005 and December 2006. We evaluated changes in serum HER2 levels between pre- and post-adjuvant chemotherapy. RESULTS: Being estrogen receptor (ER) negative was also correlated with high serum HER2 (p=0.017). The number of patients with changes in serum HER2 (>20% increased level during the follow-up period) was correlated with advanced T-stage (p=0.010), advanced American Joint Committee on Cancer (AJCC) stage (p=0.015) and poor histologic grade (p=0.001). Univariate analysis for prognostic factors associated with disease-free survival (DFS) revealed that the difference in DFS between those with serum HER2 level or =15 ng/mL was statistically significant (p=0.0129) and the changes in serum HER2 levels were also statistically significant (p=0.001). Prognostic factors associated with overall survival revealed that the changes in serum HER2 levels between pre- and post-adjuvant chemotherapy were statistically significant (p=0.0012). CONCLUSION: Serum HER2 level is associated with a more advanced degree of axillary lymph node involvement and associated with ER negativity. And Changes in serum HER2 levels are associated with more advanced AJCC staging and histologic tumor grade. There are significant associations between serum HER2 level, changes in serum HER2 levels and 5-year DFS.

Outcome of Ductal Carcinoma in Situ in Patients with or Without p53 Mutations / 고신대학교의과대학학술지

OBJECTIVES: p53 is a tumor suppressor gene and plays an important role in the etiology of breast cancer. The aim of this study is to clarify clinical significance of p53 in Ductal Carcinoma in situ (DCIS), and discuss about survival effect. METHODS: The study subjects, 69 women with breast cancer, were a subset of patients operated from Jan 2005 to Dec 2006. We used a cutoff of 10% to distinguish between positive and negative p53 staining. The University of Southern California (USC)/Van Nuys Prognostic Index (VNPI) were compared with 2 categories of p53. RESULTS: The positivity of p53 was found in 20 patients (29.0%) in DCIS. And negativity of p53 was found in 49 patients (71.0%). And 15 patients (21.7%) had a low USC/VNPI score, 42 patients (60.9%) intermediate and 12 patients (17.4%) a high score. The positivity of p53 was correlated with high USC/VNPI (P = 0.001). The univariate analysis for prognostic factors associated with Disease Free Survival (DFS) revealed that patients with p53 positivity show shorter Disease Free Survival (DFS) than patients with p53 negativity (P = 0.013) and USC/VNPI was also statistically significant (P = 0.030). CONCLUSIONS: According to our study, p53 was associated with high USC/VNPI. These findings suggest that p53 can be used to classify DCIS into at least two subtypes with differing prognoses.

Clinical significance of morphologic characteristics in triple negative breast cancer / 대한외과학회지

PURPOSE: No clinically useful target molecule has been identified for triple-negative (TN) breast cancer, i.e., estrogen receptor-negative, progesterone receptor-negative, human epidermal growth factor receptor-2-negative phenotype, and its prognosis is poor. The aim of this study is to clarify the clinical and pathologic characteristics of triple negative breast cancer (TNBC). METHODS: The study subjects, 87 women with TNBC, were a subset of patients operated at Kosin University Gospel Hospital from January 2000 to December 2005. We examined pathologic characteristics such as tumor necrosis, infiltrating border, lymphocytic infiltration, prominent nucleoli in TNBC. And we studied the correlation between TNBC and several factors related to pathologic morphology. Chi-squared tests were used for statistical analysis. Kaplan-Meier estimates are presented for the survival function, and differences in survival were analyzed using the log rank test. RESULTS: Tumor necrosis was found in 51 patients (58.3%) in TNBC. And infiltrating border was found in 71 patients (81.0%). Also continuous lymphocytic distribution and prominent nucleoli was found in 31 patients (35.7%), 52 patients (59.7%), respectively. No association was detected between pathologic characteristics and other biological markers. Patients with tumor necrosis positive for TNBC didn't show shorter disease-free survival (P = 0.4490) or overall survival (P = 0.979) than patients without tumor necrosis. CONCLUSION: These findings suggest that pathologic characteristics cannot be used to classify triple-negative breast cancer into only two subtypes with differing prognoses. But because our study is small size study, more abundant patients' dates will be needed to evaluate the morphologic characteristics' predictive role.

Response to Paclitaxel in Node-positive Triple Negative Breast Cancer

PURPOSE: Triple negative breast cancer (TNBC) has had poor prognosis compared with the luminal subtype. And there has been no benefit from doxorubicin. However, the addition of paclitaxel is known to improve both disease-free survival (DFS) and overall survival (OS). The aim of our study was to assess the effect of the addition of paclitaxel after adjuvant chemotherapy with doxorubicin plus cyclophosphamide in TNBC. METHODS: We randomly selected 87 women from 104 women with TNBC who had been randomly assigned to receive doxorubicin (60 mg per square meter of body-surface area) plus cyclophosphamide (600 mg per square meter) for four cycles, followed by four cycles of paclitaxel (175 mg per square meter) or two more cycles of doxorubicin plus cyclophosphamide. Due to predictions of clinical outcomes in women who receive adjuvant paclitaxel based chemotherapy, immunohistochemical analyses of these tissue specimens for CK5/6 were used. RESULTS: Among patients with TNBC, 24 patients (27.6%) were classified as CK5/6-positive triple negative type. Twelve patients were classified as paclitaxel chemotherapy group and 75 patients were classified as no paclitaxel group. No interaction was observed between DFS or OS and paclitaxel regimens. CK5/6 was, however, not associated with a significant benefit from paclitaxel in our study. CONCLUSION: In our study, the addition of paclitaxel after adjuvant treatment with doxorubicin (<60 mg per square meter) is not associated with DFS or OS in TNBC.

Neoadjuvant Chemotherapy with Docetaxel and Adriamycin in Breast Cancer; Clincopathologic Factors Influencing to Response Rate / 한국유방암학회지

PURPOSE: The objective of this study was to test the efficacy and toxicity of adriamycin plus docetaxel as the primary chemotherapy for women with advanced breast carcinoma, and including those patients with inflammatory breast cancer. Our study also evaluated the clinicopathologic factors influencing the response rate to neoadjuvant chemotherapy. METHODS: Twenty-eight patients who underwent neoadjuvant chemotherapy between 2002 and 2004 were included for this study. The patients were treated with adriamycin (50 mg/m2; intravenous bolus) followed by docetaxel (75 mg/m2; 1-hr intravenous infusion) on the first day of each cycle for an average four cycles. We analysed the response rate to adjuvant chemotherapy by reviewing the post operative pathologic report. Additionally we compared the clincopathologic factors related to the response rate. Statistical analyses were performed with 2-tests and using SPSS 11.0. RESULTS: The mean age at diagnosis was 48.9 yr old (range 29-63 yr). The tumoral response to neoadjuvant chemotherapy was, 3 patients (10.7%) showed a complete response (CR), 21 patients (75%) showed a partial response (PR). and which about lymph node were that 15 patients (75%) have shown responder, 5 patients (25%) have shown non-responder. The overall response rate to neoadjuvant chemotherapy was 85.7%. The preoperative serum-CEA level was influenced the response rate to neoadjuvant chemotherapy (p=0.025). Grade 3 or 4 neutropenia was recorded in 81.9% of the patients (N=59/72). Grade 3 or 4 anemia was recorded in 2.8% of the patients. CONCLUSION: Neoadjuvant chemotherapy with adriamycin plus docetaxel was effective treatment for patients with locally advanced breast cancer. The preoperative serum CEA level colud be the important factor for the neoadjuvant chemotherapy response rate.

The Clinical and, Pathologic Risk Factors for Local Recurrence of Phyllodes Tumor / 한국유방암학회지

PURPOSE: Phyllodes tumors of the breast are biphasic neoplasms. They are composed of epithelium and a spindle cell stroma. However, there is some controversy over its clinical behavior, pathologic characteristics, and local recurrence rates. Therefore we analyzed the clinicopathological characteristics of phyllodes tumor and the risk factor that influence a local recurrence after surgery were analyzed. METHODS: We retrospectively analyzed the medical records of 73 patients with a phyllodes tumor and who had undergone surgery at the Department of Surgery, Kosin University, from 1994 to 2005. The median follow up period was 73 months (range: 5-250 months). The microscopic slides were re-examined and the pathologic criteria we analyzed were cellular atypia, stromal cellularity, pleomorphism, necrosis, differentiation, the tumor margin, and the number of mitosis. The malignancy was reclassifed using the histological criteria reported by Pietruszka et at. (benign was 0-4 mitoses/10 highpower folds, borderline 5-9 mitoses, and malignant was more than 10 mitoses), The clinical features we evaluated included age, the preoperative diagnosis, the tumor size, surgical methods, and local recurrence. RESULTS: The mean age was 38.2 yr (range: 15-60 yr) and the mean tumor size was 4.3 cm (range: 1.6-18 cm), The most commonly performed surgical procedures were local or wide excision (60 cases, 82.2%), mastectomy in 10 cases (13.7%) and MRM in 3 cases (4.1%). Out of the 73 cases we reviewed, 49 (67.1%) were confirmed as being a benign, 3 (4.1%) were borderline, and 21 (28.7%) were malignant phyllodes tumor. Cellular atypia was minimal in 55 cases (75.3%) and it was prominent in 18 cases (24.6%). The stromal cellularity was minimal in 49 cases (67.1%) and it was prominent in 24 cases (32.8%). The tumor margin was infiltrating in 27 cases (36.9%) and pushing in 46 cases (63.0%). A local recurrence developed in 12 cases (16.4%). There were no dependable histopathological features to predict a local recurrence except for stromal cellularity, and an infiltrating margin. CONCLUSION: From the above results, the strong prognostic factors that can be used to predict a local recurrence appear to be stromal cellularity, and an infiltrating tumor margin.

Correlation of the Lewis Blood Group and the CEA Serum Level in Stomach Cancer Patients

PURPOSE: The purpose of our study was to compare the serum levels of CEA, CA19-9 and H.pylori antibody in patients with the Lewis (a+) blood group with that of the patients with the Lewis (a-) blood group. We also compared the outcome of the stomach cancer patients with the Lewis (b+) blood group with that of the stomach cancer patients with the Lewis (b-) blood group. METHODS: All of the 94 patients who underwent gastrectomy for stomach cancer at our hospital were retrospectively reviewed. The outcomes of the CEA, CA19-9 and H.pylori. antibody serum levels, the TNM stage, the ABO blood group and the Rh blood group were compared between the patients with the Lewis blood groups (a+) and (a-) and the patients with the Lewis blood groups (b+) and (b-), respectively. RESULTS: The mean serum level of CEA between the patients with the Lewis blood group (a+) and (a-) showed a statistical correlation (mean value: 5.51 ng/ml vs 3.25 ng/ml, respectively, P=0.016). But the mean serum level of CA19-9 and H.pylori. antibodies between the patients with the Lewis blood group (a+) and (a-) did not show a significant difference. The mean serum levels of CEA, CA19-9 and H.pylori antibodies between the patients with the Lewis blood group (b+) and (b-) did not show a significant difference. CONCLUSION: It was revealed that an elevated CEA level was related with the Lewis blood group (a), but this was not related with the Lewis blood group (b) in stomach cancer patients.

Initial nutritional status of stomach cancer patients

The purpose of this study is to investigate initial nutritional status of stomach cancer patients. The study subjects were 88 patients with stomach cancer admitted at Kosin University Gospel Hospital in Busan. We assessed the initial nutritional status by anthropometric, biochemical and dietary intake data along with subjective global assessment(SGA). The results are as follows. 1. The mean age, weight, height, triceps skinfold thickness, mid arm circumference, and mid arm muscle circumference of the subjects were 55.9+/-11.0years, 60.0+/-9.8kg, 162.4+/-8.5cm, 10.9+/-5.7mm, 26.8+/-3.8cm, and 23.4+/-3.5cm respectively. The mean body mass index was within the normal range, with 22.7+/-2.8kg/m2, while 15.4% of the patients was underweight. The result shows that body fat mass and body protein mass of the patients with stomach cancer were decreased. 2. The mean biochemical data of the subjects were 4.0+/-0.5g/dl for albumin, 174.7+/-41.9mg/dl for cholesterol, 107.6+/-57.2mg/dl for triglyceride, 92.1microgram/dl for Zn, 297.0+/-103.1mg/dl for transferrin, 1980.0+/-0.8mm3 for total lymphocyte count. 3. Daily energy intake was 1997.8+/-579.3kcal. And the ratio of carbohydrate, protein, and lipid to energy intake was 72:14:14. 4. The patients were divided into three groups according to SGA performed by an observer. Group A(well nourished) was 55.7% with 49 patients, Group B(moderately malnourished) was 22.7 % with 20 patients, and Group C(severely malnourished) was 21.6 % with 19 patients. The three groups showed a significant difference in body weight(p<0.01), 1 month weight loss %(p<0.001), 6 months weight loss %(p<0.001), body mass index(p<0.01), and mid arm circumference(p<0.05), albumin(p<0.01), energy intake(p<0.05) as well as carbohydrate intake(p<0.05). From these results, it may be concluded that SGA can be used as a nutrition screening tool, and comprehensive nutrition assessment is desirable for those malnourished.

Abnormalities of Liver Function during Total Parenteral Nutrition (TPN): Alteration of Serum Liver Enzyme during Short-term TPN

PURPOSE: TPN has been widely used to treat nutritional depletion since the late 1960s. However, many metabolic complications may occur as a result of parenteral feeding. Among these, hepatic complications has received increasing attention. A retrospective review of liver function abnormalities in adult patients who underwent TPN was done to determine the frequency and magnitude of the abnormalities in a liver function test. METHODS: From January 2001 to Jun 2001, 160 adult patient receiving TPN were reviewed. Of these, 111 had a malignant disease and 49 had a benign disease. The duration of TPN therapy ranged from 5 days to 52 days, with a mean duration of 14 days. Abnormalities of liver function test were defined as a value greater than the upper normal limit. Forty cases of gastric cancer were analyzed to determine the risk factors that contribute to abnormal liver function in individual patients receiving TPN. RESULTS: Abnormalities of the liver function test appeared after 6~7 days of therapy. Increases in the ALP levels were noted in 34 out of 93 patients (37.6%), in the AST levels in 42 out of 116 patients (36.2%), in the ALT levels in 54 out of 125 patients (43.2%), in the LDH levels in 20 out of 72 patients (27.8%), in the gamma-GTP levels in 44 out of 81 patients (54.3%), and in the bilirubin levels in 30 out of 126 patients (23.8%). The serum ALP level rose to 1.6 times upper the limit of normal; AST, 1.7 times; ALT, 2.0 times; LDH, 1.2 times; gamma-GTP, 2.4 times; bilirubin, 2.4 times. gamma-GTP value was most sensitive. In 40 gastric cancers, factors as age, the amount of TPN solution, the duration of TPN, intraoperative chemotherapy, transfusion, and postoperative infection were investigated. However, no association with TPN-associated liver function abnormalities was found. CONCLUSION: The incidences of an abnormal liver function during TPN were 23.8~54.3%. However, the liver function abnormalities that developed during short term-TPN were reversible and not serious.

Prevalence of Liver Metastasis of Colorectal Cancer According to Clinical and Histopathologic Characteristics

PURPOSE: In Korea, the incidence of colorectal cancer is increasing quickly. The liver metastasis is the most common cause of death. But current diagnosis methods such as CT, MRI, USG have significant false negative rate (up to 15%) especially in micrometastasis. We designed this study to identify the predictive value of liver metastasis of known clinical and histopathologic factors. METHODS: Retrospectively, we reviewed 248 patients who underwent resection of colorectal cancer between 1997 and 1999. Clinical and histopathologic factors of colorectal cancer with synchronous liver metastasis was compared with those without liver metastasis. RESULTS: Twenty-nine patients had synchronous liver metastasis. In clinical factors, there was significant difference in liver metastatic rate according to tumors location, and serum carcinoembryonic antigen (CEA). The metastatic rate of right colon was 9.5%, left colon was 27.9%, rectum was 8.0% (P=0.001). The metastatic rate in cases with CEA or =5.0 ng/ml was 18.4% (P=0.001). In histopathologic factors, there was significant difference in liver metastatic rate according to depth of tumor invasion (T-stage), extent of lymph node metastasis (N-stage), venous invasion (9.5 vs 19.3 %, P=0.043), perineural invasion (8.5 vs 19.7 %, P=0.013). The metastatic rate of T1 was 0%, T2 was 3.43%, T3 was 12.3%, T4 was 26.9% (P=0.009). The metastatic rate of N0 was 4.9%, N1 was 15.6%, N2 was 30.3% (P=0.002). But there was no significant difference according to tumor size, histologic differentiation grade, lymphatic invasion. In multi- variant analysis with significant factors, independent factor associated with liver metastasis was N-stage. CONCLUSIONS: In colorectal cancer, tumor location, CEA, T-stage, N-stage, venous invasion, and perineural invasion of tumor cell had significant relationship with liver metastasis. The most important factor associated with liver metastasis was N-stage. This factors shoud be considered carefully in the planning treatment and follow up in colorectal cancer.