Prognostic Value of Bone Marrow Micrometastasis Detected by Nested RT-PCR for Cytokeratin 19 and Mammaglobin in Breast Cancer

PURPOSE: Breast cancers frequently undergo distant metastasis during the early phase, on which the survival of patients is greatly dependent. It has been suggested that the occurrence of micrometastasis relates with other prognostic features of breast cancer, such as lymph node metastasis and the presence of vascular invasion. The aim of this study was to examine the presence of keratin-19 and mammaglobin mRNA in bone marrow aspirates obtained from breast cancer patients, and their possible correlation with tumor staging and disease free survival. METHODS: Bone marrow samples were obtained from 254 breast cancer patients at the time of surgery. We separated the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction for the detection of keratin-19 and mammaglobin mRNA using two different pairs of primers. We also studied the possible correlations between the tumor size, nodal involvement, stage, and distant metastasis. RESULTS: Seventy-five of the 254 samples were studied for cytokeratin 19 and the others for cytokeratin and mammaglobin. The median follow-up time was 21.1 months. Sixty-five (26%) of the 254 samples were cytokeratin 19 positive and 25 (14.3%) of the 175 were mammaglobin positive. Eight cases (12.3%) in the cytokeratin positive group showed a recurrent disease in distant organs. Whereas, six (3.2%) out of 185 cytokeratin negative patients had distant recurrences. Mammaglobin positivity was not correlated with distant metastasis. The stage, nodal status, and estrogen receptor were independent of bone marrow micrometastasis. CONCLUSION: Bone marrow micrometastasis, detected by nested RT-PCR for cytokeratin 19, could be a useful predictive marker for the distant metastasis of breast cancer.

Clinical Analysis of Three Different Surgical Techniques in Unilateral Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: The conventional surgical treatment for thyroid disease requires long skin incision with skin flap that can result in prominent scar, parethesia, hypesthesia in the neck. With recent developement in surgical techniques for thyroid tumors, several apporaches have been applied to neck surgery. We performed thyroid operations with 3 different methods and evaluated the role of respective operation method. METHODS: Three different surgical methods; conventional, minimally invasive open, and endoscopic thyroidectomy with axillary approach, were performed on 60 patients who were admitted to Ajou medical center from June to December 2003. All patients were diagnosed as having a benighn mass in unilateral lobe of thyroid gland preoperatively by ultrasonography and fine needle aspiration cytology. We compared the clinical results of respective 3 operation methods each other. RESULTS: Hospital stay and the operation time for minimal invasive open thyroidectomy was significantly shorter than those for endoscopic thyroidectomy (P<0.000). Amounts of post operative analgesics were the lowest in minimal invasive open thyroidectomy than other groups (P<0.019). The patients who was treated by using endoscopic procrdure were more satisfied with the cosmetic result. There was no significant complication in three groups. CONCLUSION: Minimally invasive open thyroidectomy and endoscopic thyroidectomy can be performed safely with cosmetic benefit, and then recommanded as a alternative operative method in selected patients.

Evaluation for prognostic factors following surgical management of gastric cancer patients with hepatic cirrhosis / 한국간담췌외과학회지

BACKGROUNDS: Prognosis following surgery of gastric cancer has markedly improved as a result of early diagnosis, advances in operative techniques and perioperative managements. However, gastrointestinal surgery in patients with hepatic cirrhosis has continued to be associated with a high operative morbidity and mortality. The purpose of this retrospective study is to evaluate the prognostic factors on postoperative morbidity and survival in gastric cancer patients with hepatic cirrhosis. METHODS: We analysed 24 gastric cancer patients with hepatic cirrhosis between November 1994 and October 1999 (19 patients with Child A, 5 patients with Child B) to evaluate postoperative complications and survivals. RESULTS: There were no significant differences in age, sex, stage, operative types, and range of dissection between Child A and B. Postoperative complications occurred more commonly in the patients with more severe hepatic cirrhosis (Child A 5/19, Child B 4/5, p<0.05). There was no significant difference in 5-year survival rates between patients with Child A and B hepatic cirrhosis. Only the stage of cancer was proved to be the most significant prognostic factor. CONCLUSION: Patients with gastric cancer accompanied by hepatic cirrhosis can be successfully managed surgically on the basis of an appropriate preoperative assessment of hepatic conditions, proper selection of surgical procedures, and careful perioperative management.