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A pilot clinical study to evaluate feasibility of using single patient classifier as a prognostic test in stage Ⅱ-Ⅲ gastric cancer patients

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Chinese Journal of Cancer Research 2024年第4期36卷 368-377页

作者： Ji Yeong An sung Eun Oh Soomin Ahn Hyoung-II Kim Yoo Min Kim Minah Cho Keun Won Ryu Hong Man Yoon Young Kyu Park In Gyu Kwon sung hoon noh Kyung Hee Lee In Cho Myoung Won Son Jong Won Kim Young-Woo Kim Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Department of Pathology and Translational Genomics Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Republic of Korea Department of Surgery Yonsei University College of MedicineSeoul 03722Republic of Korea Gastric Cancer Center Yonsei Cancer CenterYonsei University Health SystemSeoul 03722Republic of Korea Center for Gastric Cancer National Cancer CenterGoyang 10408Republic of Korea Department of Surgery Chonnam National University Hwasun HospitalChonnam National University College of MedicineGwangju 58128Republic of Korea Department of Surgery Gangnam Severance HospitalYonsei University College of MedicineSeoul 06273Republic of Korea Department of Hematology-Oncology Yeungnam University Medical CenterDaegu 42415Republic of Korea Department of Surgery Soonchunhyang University College of MedicineBucheon 14584Republic of Korea Department of Surgery Soonchunhyang University Cheonan HospitalSoonchunhyang University College of MedicineCheonan 31151Republic of Korea Department of Surgery Chung-Ang University HospitalChung-Ang University College of MedicineSeoul 06973Republic of Korea

Objective:Precision medicine approaches emphasize the importance of reliable prognostic tools for guiding individualized therapy *** this study,we evaluated the clinical feasibility of the single patient classifier(SPC)test,a new clinical-grade prognostic assay,in stageⅡ-Ⅲgastric cancer ***:A prospective multicenter study was conducted,involving 237 patients who underwent gastrectomy between September 2019 and August 2020 across nine *** SPC test was employed to stratify patients into risk groups,and its feasibility and performance were *** primary endpoint was the proportion of the cases in which the test results were timely delivered before selecting postoperative ***,3-year disease-free survivals of risk groups were ***:The SPC test met the primary endpoint *** 99.5%of SPC tests were timely delivered to hospitals before the postoperative treatment *** a clinical setting,the median time from the specimen transfer to laboratory to the result delivery to hospital was 4 ***,3-year disease-free survivals were significantly different between risk groups classified with SPC ***:This study highlights the SPC test's feasibility in offering crucial information timely delivered for making informed decisions regarding postoperative treatment *** also provides evidence to support the implementation of a future prospective clinical trial aimed at evaluating the clinical utility of the SPC test in guiding personalized treatment decisions for gastric cancer patients.

关键词： Prognostic test advanced gastric cancer adjuvant chemotherapy feasibility gastrectomy

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Analysis of demographic characteristics in 3242 young age gastric cancer patients in Korea

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World Journal of Gastroenterology 2010年第2期16卷 256-263页

作者： Hye Won Chung sung hoon noh Jong-Baeck Lim Department of Gastroenterology Yonsei University College of Medicine134 Shinchon-dongSeodaemun-gu120-752 SeoulSouth Korea Department of Surgery Yonsei University College of Medicine134 Shinchon-dongSeodaemun-gu120-752 SeoulSouth Korea Department of Laboratory Medicine Yonsei University College of Medicine134 Shinchon-dong Seodaemun-gu120-752 SeoulSouth Korea

AIM:To evaluate the epidemiologic features of young age gastric cancer(GC). METHODS:Retrospectively,a total of 3242 patients with GC between 18 and 45 years of age and 3000 sex-and age-matched controls were *** subjects were stratified into 3 groups based on age (A,18-30 years;B,31-40 years;C,41-45 years). Epidemiologic characteristics and risk factors were investigated with reference to their age and gender. RESULTS:Compared to controls,more frequent intake of high risk diet(P=0.00075),history of heavy smoking(P=0.00087),intake of heavy alcohol(P= 0.00091),lower social economic status(P=0.00083), body mass index>30(P=0.00097),urban residence(P=0.00065),and more frequent exposure to harmful occupational environments(P=0.00072)were observed in all age groups and both genders in young age *** relationships were weaker in females compared to males of the same age,and were stronger as the age of patients ***,in group C of young age GC patients,environmental factors played important roles in females and males with a similar body *** females,older age at first delivery(> 35 years),lack of lactation history,nulliparity,and poor nutritional status during pregnancy were significantly associated with an increased risk of GC(P=0.00034). In this study,252 patients(7.8%)had a family history of GC with high odds ratio(OR)(3.22-4.21).In particular, family history was more closely associated with GC in males(OR,4.21 in male vs 3.46 in female)and more advanced cases(P=0.00051). CONCLUSION:Hormonal associated factors were more commonly associated with females whereas environmental factors were more commonly associated with males in young age GC patients.

关键词： Young age gastric cancer Epidemiology Risk factor Age Gender

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Comments to young surgeons concerning laparoscopic spleenpreserving D2 lymph node dissection for advanced gastric cancer on the upper body

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Chinese Journal of Cancer Research 2014年第3期26卷 231-233页

作者： Yoon Young Choi Ji Yeong An Woo Jin Hyung sung hoon noh Department of Surgery Yonsei University Health System Yonsei University College of Medicine

Qualified radical gastrectomy with lymph node dissection is very important to the prognosis of patients with gastric cancer. Now D2 lymph node dissection is standard procedure for gastric cancer surgery, and spleen hilar lymph node dissection is mandatory for gastric cancer in upper body. Because the anatomy of vessels in this area is very complicated, D2 lymph node dissection is technical challenging not only for open gastrectomy but also for laparoscopic one. Adapting a new technique is important to all surgeons, but we surgeons should always consider a patient＇s safety as the most important factor during surgery and that efforts should be based on scientific rationale with oncologic principles. I hope that the recent report by Huang et al. about laparoscopic spleen preserving hilar lymph node dissection would be helpful to young surgeons who will perform laparoscpic total gastrectomy for gastric cancer.

关键词： Gastric cancer lymph node dissection laparoscopy spleen

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Single patient classifier as a prognostic biomarker in pT1N1 gastric cancer:Results from two large Korean cohorts

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Chinese Journal of Cancer Research 2021年第5期33卷 583-591页

作者： Yoon Young Choi Eunji Jang Hyunki Kim Kyoung-Mee Kim sung hoon noh Tae sung Sohn Yong-Min Huh Ji Yeong An Jae-Ho Cheong Department of Surgery CHA Ilsan Medical CenterCHA University School of MedicineGoyang-si 1205Korea Department of Surgery Yonsei University Health SystemSeoul 03722Korea Department of Radiology Yonsei University Health SystemSeoul 03722Korea Department of Pathology Yonsei University Health SystemSeoul 03722Korea Department of Pathology and Translational Genomics Samsung Medical Center Sungkyunkwan University School of MedicineSeoul 06351Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Korea YUHS-KRIBB Medical Convergence Research Institute Seoul 03722Korea Brain Korea 21 PLUS Project for Medical Science Yonsei University College of MedicineSeoul 03722Korea

Objective:Benefits of adjuvant treatment in pT1 N1 gastric cancer(GC)remain ***,an effective biomarker for early GC is the need of the *** prognostic and predictive roles of single patient classifier(SPC)were validated in stageⅡ/Ⅲ*** this study,we aimed to elucidate the role of SPC as a biomarker for pT1 N1 ***:The present retrospective biomarker study(NCT03485105)enrolled patients treated for pT1 N1 GC between 1996 and 2012 from two large hospitals(the Y cohort and S cohort).For SPC,mRNA expression of four classifier genes(GZMB,WARS,SFRP4 and CDX1)were evaluated by real-time reverse transcription-polymerase chain reaction *** SPC was revised targeting pT1 stages and the prognosis was stratified as high-and lowrisk group by the expression of SFRP4,a representative epithelial-mesenchymal transition ***:SPC was evaluated in 875 patients(n=391 and 484 in the Y and S cohorts,respectively).Among 864 patients whose SPC result was available,41(4.7%)patients experience GC *** to revised SPC,254(29.4%)patients were classified as high risk[123(31.5%)and 131(27.1%)in the Y and S cohorts,respectively].The high risk was related to frequent recurrence in both Y and S cohort(log-rank P=0.023,P<0.001,respectively),while there was no difference by GZMB and WARS *** analyses of the overall-cohort confirmed the high risk of revised SPC as a significant prognostic factor[hazard ratio(HR):4.402(2.293-8.449),P<0.001]of GC.A significant difference was not detected by SPC in the prognosis of patients in the presence and absence of adjuvant treatment(log-rank P=0.670).Conclusions:The present study revealed the revised SPC as a prognostic biomarker of pT1 N1 GC and suggested the use of the revised SPC for early-stage GC as like stageⅡ/Ⅲ.

关键词： Gastric cancer biomarker prognosis chemotherapy

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Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

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World Journal of Gastroenterology 2012年第1期18卷 49-54页

作者： Jong Won Kim Jae-Ho Cheong Woo Jin Hyung Seung-Ho Choi sung hoon noh Department of Surgery Gangnam Severance Hospital Yonsei University College of Medicine Department of Surgery Severance Hospital Yonsei University College of Medicine

AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medica records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.(± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was signif icantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and signif icantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were signif icantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was signif icantly correlated to T2DM status (P = 0.022).

关键词： Gastric cancer Diabetes mellitus Metabolic surgery Bariatric surgery

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Current practice of gastric cancer treatment

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Chinese Medical Journal 2014年第3期127卷 547-553页

作者： Yoon Young Choi Ji Yeong An Hyung-Il Kim Jae-Ho Cheong Woo Jin Hyung sung hoon noh Department of Surgery Yonsei University Health System Yonsei University College of Medicine Seoul Republic of Korea

Objective The aim of this review was to overview the current practice of gastric cancer treatment including surgery and other adjuvant *** sources The review was based on data obtained from the published articles and main guidelines in the East and *** selection Articles with high level of evidence or current best evidence in each issue were selected to be *** Although varied adjuvant modalities have been proved to be benefit for treating gastric cancer,surgery is still the most important treatment strategy against gastric *** adapting to new technology is important but it should be balanced with an effort to establish sound scientific rationale that adheres to oncologic *** Future treatment of gastric cancer will be focused on tailored,personalized *** achieving it,collaboration across disciplines is *** the philosophy of caring for the patients with gastric cancer should be rooted in the realization of true patient benefit regardless of who is providing the *** these philosophies,we can shift the scientific and technological advances toward triumph over gastric cancer.

关键词： gastric cancer treatment oncology

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Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

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World Journal of Gastroenterology 2005年第30期11卷 4623-4627页

作者： Jun Ho Lee Junuk Kim Jae Ho Cheong Woo Jin Hyung Seung Ho Choi sung hoon noh Research Institute and Hospital Department of Surgery

AIM： To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS： A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS： All but 12 patients were dassified as Child＇s class A. Only 35 patients （37.2%） were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy （77.7%） and 21 patients （22.3%） underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients （3.8%） who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients （39.4%） experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level （P = 0.011） and transfusion did （P = 0.008）. The most common postoperative complication was ascites （13.9%） followed by wound infection （10.6%）. CONCLUSION： We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

关键词： Gastric cancer Liver cirrhosis D2 lymph nodedissection Morbidity Mortality

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Influence of a microscopic positive proximal margin in the treatment of gastric adenocarcinoma of the cardia

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World Journal of Gastroenterology 2006年第24期12卷 3883-3886页

作者： Jian-Guo Shen Jae-Ho Cheong Woo-Jin Hyung Junuk Kim Seung-Ho Choi sung-hoon noh Department of Surgery Yonsei University College ot'Medicine Seoul- 120-752 Korea ' Department of Surgical Oncology Sir Run Run Shaw Hospital College of Medicine Zhejiang University Hangzhou 310016 China

AIM： To investigate the influence of a positive proximal margin in total gastrectorny patients with gastric adenocarcinorna of the cardia. METHODS： Medical records of 191 patients with total gastrectornies for adenocarcinorna of the cardia between 1995 and 2000 were reviewed. The clinicopathologic features associated with a positive margin were determined, and the predictors for survival were analyzed. RESULTS： The incidence of positive proximal margin was 8.4% （16/191）. The positive margins were associated with advanced diseases. The tumor size and the depth of tumor invasion were independent risk factors for a positive margin. The mean survival in the positive margin group was 33.9 mo as *** 62.4 mo in the negative group （P 〈 0.001）. However, the difference in survival lost significance in subgroup analysis according to stage. Multivariate analysis identified that a positive margin was not an independent prognostic factor for survival. CONCLUSION： A positive margin is more of an indication of advanced disease in patients with gastric adenocarcinoma of the cardia rather than an independent prognostic factor for survival.

关键词： Resection margin Gastric cancer Totalgastrectomy Outcome

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Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

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World Journal of Gastroenterology 2012年第27期18卷 3571-3577页

作者： Jaehoon Jahng Young hoon Youn Kwang Hyun Kim Junghwan Yu Yong Chan Lee Woo Jin Hyung sung hoon noh Hyunki Kim Hoguen Kim Hyojin Park Sang In Lee Department of Internal Medicine Gangnam Severance HospitalYonsei University College of MedicineSeoul 135-720South Korea Department of Internal Medicine Institute of GastroenterologyYonsei University College of MedicineSeoul 100-753South Korea Department of Surgery Yonsei University College of MedicineSeoul 100-753South Korea Department of Pathology Yonsei University College of MedicineSeoul 100-753South Korea

AIM： To investigate endoscopic and clinicopathologic characteristics of early gastric cancer （EGC） according to microsatellite instability phenotype. METHODS： Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability （MSI） mutation [high MSI （MSI-H）] and 146 consecutive EGC patients with one or no MSI mutation （non-MSI-H） were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC ***： In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern （OR 4.38, 95% Cl： 2.40-8.01, P 〈 0.001）, moderate- to-severe atrophy in the surrounding mucosa （OR 1.91, 95% CI： 1.05-3.47, P = 0.033）, antral location （OR 3.99, 95% CI： 2.12-7.52, P 〈 0.001） and synchronous le- sions, compared to non-MSI-H EGCs （OR 2.65, 95% CI： 1.16-6.07, P = 0.021）. Other significant clinicopatholog- ic characteristics of MSI-H EGC included predominance of female sex （OR 2.77, 95% CI： 1.53-4.99, P 〈 0.001）, older age （〉 70 years）（OR 3.30, 95% CI： 1.57-6.92, P = 0.002）, better histologic differentiation （OR 2.35, 95% Cl： 1.27-4.34, P = 0.007）, intestinal type by Lau- ren classification （OR 2.34, 95% CI： 1.15-4.76, P = 0.019）, absence of a signet ring cell component （OR 2.44, 95% CI： 1.02-5.86, P = 0.046）, presence of mu- cinous component （OR 5.06, 95% Cl： 1.27-20.17, P = 0.022）, moderate-to-severe lymphoid stromal reaction （OR 3.95, 95% CI： 1.59-9.80, P = 0.003）, and co-exist- ing underlying adenoma （OR 2.66, 95% CI： 1.43-4.95, P = 0.002）. CONCLUSION： MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics includ- ing frequent presentation in protruded type, co-exist- ing underlying adenoma, and synchronous lesions.

关键词： Microsatellite instability Early gastric can-cer Endoscopic characteristic Advanced gastric cancer

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Improvement of type 2 diabetes mellitus after gastric cancer surgery:Short-term outcome analysis after gastrectomy

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World Journal of Gastroenterology 2013年第48期19卷 9410-9417页

作者： Ji Yeong An Yoo Min Kim Min Ah Yun Byeong Hee Jeon sung hoon noh Department of Surgery Yonsei University College of Medicine Seodaemun-guSeoul 120-752 South Korea Department of Surgery Dong-A University College of Medicine Busan 602-715 South Korea Department of Clinical Care Graduate School of Nursing Yonsei University Seoul 120-752 South Korea

AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric ***:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively *** patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after ***:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo *** 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or *** multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes ***:Diabetes improved in more than 50%of patients during the first year after gastric cancer *** degree of diabetes control was related to diabetes duration.

关键词： Type 2 diabetes mellitus Gastrectomy Gastric cancer Short-term outcome Glucose control

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