Evaluation of the New UICC Staging System for Gastric Carcinoma / 대한암학회지

PURPOSE: There are several kinds of classificatian dealing with the staging of the gastric adenocarcinoma. However, such different staging systems pose difficulty in the inter- institutional or intemational comparison of the disease status and the treatment results. The purpose of this study is to evaluate each staging system and to assess the usefulness of the new UICC-TNM staging system (1997) for gastric adenocarcinoma. MATERIAL AND METHODS: We retrospectively analysed 473 cases of gastric adenocarcinoma who were operated at the Department of General Surgery, Hanyang University Hospital during the period from 1992 to 1996. Using these cases, we analyzed their cumulative 5-year survival rate according to three kinds of staging systems; old UICC-TNM staging system (1987), new UICC-TNM staging system (1997), and the Japanese staging system for gastric carcinoma (1993). RESULTS: The follow up rate was 94.3% and the median follow up period was 30.3 months. All of these three systems showed a statistically significant survival difference according to their different classifications. When the distribution of stage between old and new UICC-TNM staging system was compared, 95 cases (20.1%) were subjected to stage shifting, which involves 12.1% of up-staging and 8.4% of down-staging. Stage shifting was most prominent in stage IIIb (68.8%). The cumulative 5-year survival rate according to the new UICC-TNM staging system was 99.1% in stage Ia, 81.4% in stage Ib, 75.2% in stage II, 45.9% in stage IIIa, 21.0% in stage IIIb, and 19.4% in stage IV. CONCLUSION: We conclude that the new UICC-TNM staging system is simple, practically convenient, and highly reproducible, and it showed a statistically significant survival difference according to their staging classification.

A Study on the p53 Mutations in Korean Breast Cancer Tissues / 대한암학회지

PURPOSE: The role of mutation of p53 gene on the carcinigenesis was studied since 1991. There were some relationships of p53 mutation and clinicopathologic factors. This sutudy was designed for the clinicopathologic and genetic factor relation in Korean breast cancer. MATERIALS AND METHOD: A retrospective study on the clinicopathologic findings such as age, menopausal status, TNM stage, histologic grade, estrogen receptor, DNA ploidy and S-phase fraction was camed out on 47 breast cancer tissues which had been resected at the Department of Surgery, Hanyang University Hospital. Forty-seven tissues were grouped into 3 groups. Group 1 was ductal carcinoma in situ, Group 2 was invasive ductal carcinoma without axillary lymph node metastasis and Group 3 was invasive ductal carcinoma with axillary lymph node metastasis. The numbers of tissues in each groups were 14, 15 and 18, respectively. Mutation screening on the p53 tumor suppressor gene was also performed with PCR-SSCP-direct sequencing method from the genomic DNA extracted from formalin fixed and paraffin-embedded pathologic tissue blocks. The results were as followings; RESULT: p53 mutations were detected in 12 cases(25.5%) of 47. In Group 1, 4 cases(28.6%) had mutations, and in Group 2, 5 cases(33.3%), and in Group3, 3 cases(16.7%). There was no significant differences in mutation rate between three groups. In 12 mutations detected, 6 cases were transition, 5 of which were missense mutation in coding sequences, and one of which was splicing mutation at acceptor site. One case was transversion and five cases were deletions or insertions of various lengths resulting in frameshift mutations. There was no statistically significant difference between groups and clinicopathologic factors except the strong relationship between the negative estrogen receptor and p53 mutation(p< 0.001). CONCLUSIONS: From the above findings, p53 gene could be considered to be inactivated at the all stage of multistep carcinogenesis processes. The nature of mutations and genetic background of Korean breast cancers may be somewhat different from those of Caucasians. And the p53 mutation status may be used as one of the useful prognostic factors in addition to the estrogen receptor status.