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Eui Kyu Chie - One of the best experts on this subject based on the ideXlab platform.

  • the role of Adjuvant Chemoradiotherapy in nonhilar extrahepatic bile duct cancer a long term single institution analysis
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Won Ick Chang, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Byoung Hyuck Kim, Hyuncheol Kang, Kyunghun Lee, Hongbeom Kim, Wooil Kwon
    Abstract:

    Purpose Despite frequent use in the clinical setting, especially for patients with high-risk factors for relapse, the role of Adjuvant treatment has not been clarified in nonhilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of Adjuvant Chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery. Methods and Materials Patients with NH-EHBDC who underwent radical surgery from July 2007 to December 2018 were reviewed retrospectively. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were performed to further identify the role of Adjuvant CRT. Results Three hundred twenty-eight patients were accrued. At a median follow-up of 37.1 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.2%, and 67.5%, respectively. In multivariate analysis, Adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (P Conclusions In patients with NH-EHBDC, Adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly differentiated tumor, tumor size ≥ 5 cm, or R1 resection, Adjuvant CRT might contribute to improve treatment outcomes.

  • Role of Adjuvant Chemoradiotherapy for Duodenal Cancer: An Updated Analysis of Long-Term Follow-Up from Single Institution.
    World Journal of Surgery, 2018
    Co-Authors: Bum Sup Jang, Hae Jin Park, Jinyoung Jang, Do-youn Oh, Eui Kyu Chie
    Abstract:

    There are only limited data on the failure patterns after surgical resection for duodenal cancer, and the role of Adjuvant Chemoradiotherapy (CRT) also remains controversial. In this study, the treatment outcomes of surgery alone were compared to those of surgery plus Adjuvant CRT for duodenal cancer. Between January 1991 and February 2013, a total of 47 patients with duodenal cancer had pancreaticoduodenectomy, and their age ranged from 31 to 80 (median 62). Twenty-five patients (53%) underwent surgery alone, while 22 (47%) underwent surgery plus Adjuvant CRT. Postoperative radiotherapy with concomitant 5-fluorouracil was given to tumor bed and regional lymph nodes up to 40–55.4 Gy. Median duration of follow-up was 31 months (range 6–286) for all patients and 90 months (range 14–286) for survivors. CRT (+) group included more patients with advanced nodal stage and overall stage group (p = 0.003 and 0.002, respectively). The 5-year overall survival rates were not different between CRT (−) and CRT (+) groups (50.1 vs. 46.7%, p = 0.794). CRT (+) group achieved a superior 5-year loco-regional relapse-free survival rate compared with CRT (−) group, but the difference did not reach a statistical significance (80.1 vs. 68.4%, p = 0.267). On multivariate analysis, however, the addition of CRT was the only favorable prognosticator predicting loco-regional relapse-free survival (p = 0.046). Two patients experienced grade 3 neutropenia during CRT. Adjuvant CRT after pancreaticoduodenectomy was correlated with an improved loco-regional control in duodenal cancer. Considering the high loco-regional recurrence in surgery alone group, CRT may be considered as Adjuvant treatment.

  • Adjuvant Chemoradiotherapy is associated with improved survival for patients with resected gallbladder carcinoma a systematic review and meta analysis
    Annals of Surgical Oncology, 2018
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jeanny Kwon, Young Hoon Kim, Dong Wan Seo, Amol Narang, Joseph M Herman
    Abstract:

    The impact of Adjuvant radiotherapy (ART) on survival from gallbladder carcinoma (GBC) remains underexplored, with conflicting results reported. A systematic review and meta-analysis was performed to clarify the impact of ART in GBC. A systematic literature search of several databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, from inception to August 2016. Studies that reported survival outcomes for patients with or without ART after curative surgery were included. All the inclusion criteria was met by 14 retrospective studies including 9364 analyzable patients, but most of the studies had a moderate risk of bias. Generally, the ART group had more patients with unfavorable characteristics than the group that had surgery alone. Nevertheless, the pooled results showed that ART significantly reduced the risk of death (hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.44–0.67; p < 0.001) and recurrence (HR 0.61; 95% CI 0.38–0.98; p = 0.04) of GBC compared with surgery alone. Exploratory analyses demonstrated a survival benefit from ART for a subgroup of patients with lymph node-positive diseases (HR 0.61; p < 0.001) and R1 resections (HR 0.55; p < 0.001), but not for patients with lymph node-negative disease (HR 1.06; p = 0.78). No evidence of publication bias was found (p = 0.663). This study is the first meta-analysis to evaluate the role of ART and to provide supporting evidence that ART may offer survival benefits, especially for high-risk patients. However, further confirmation with a randomized prospective study is needed to clarify the subgroup of GBC patients who would benefit most from ART.

  • phosphorylated akt expression as a favorable prognostic factor for patients undergoing curative resection and Adjuvant Chemoradiotherapy for proximal extrahepatic bile duct cancer
    American Journal of Clinical Oncology, 2017
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    Objectives:To evaluate the prognostic significance of phosphorylated Akt (p-Akt), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expressions in patients undergoing Adjuvant Chemoradiotherapy (CRT) for proximal extrahepa

  • clinical implications of cytotoxic t lymphocyte antigen 4 expression on tumor cells and tumor infiltrating lymphocytes in extrahepatic bile duct cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy
    Targeted Oncology, 2017
    Co-Authors: Yu Jin Lim, Jaemoon Koh, Kyubo Kim, Eui Kyu Chie, Sehui Kim, Kyoung Bun Lee, Jinyoung Jang, Sun Whe Kim, Yungjue Bang
    Abstract:

    There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

Yungjue Bang - One of the best experts on this subject based on the ideXlab platform.

  • phosphorylated akt expression as a favorable prognostic factor for patients undergoing curative resection and Adjuvant Chemoradiotherapy for proximal extrahepatic bile duct cancer
    American Journal of Clinical Oncology, 2017
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    Objectives:To evaluate the prognostic significance of phosphorylated Akt (p-Akt), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expressions in patients undergoing Adjuvant Chemoradiotherapy (CRT) for proximal extrahepa

  • clinical implications of cytotoxic t lymphocyte antigen 4 expression on tumor cells and tumor infiltrating lymphocytes in extrahepatic bile duct cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy
    Targeted Oncology, 2017
    Co-Authors: Yu Jin Lim, Jaemoon Koh, Kyubo Kim, Eui Kyu Chie, Sehui Kim, Kyoung Bun Lee, Jinyoung Jang, Sun Whe Kim, Yungjue Bang
    Abstract:

    There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

  • the prognostic importance of the number of metastatic lymph nodes for patients undergoing curative resection followed by Adjuvant Chemoradiotherapy for extrahepatic bile duct cancer
    Journal of Gastrointestinal Surgery, 2015
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Taeyou Kim, Saewon Han, Jeanny Kwon, Yungjue Bang
    Abstract:

    Current nodal staging system for extrahepatic bile duct (EHBD) cancer is controversial. The number of metastatic lymph nodes (mLN) and lymph node ratio (LNR) has been studied for the assessment of the nodal status in many other gastrointestinal cancers, but there are few studies on assessing the prognostic impact of these parameters in EHBD cancer. We retrospectively reviewed 239 consecutive patients who underwent curative resection followed by Adjuvant Chemoradiotherapy for adenocarcinoma of EHBD from 1995 to 2009 in our institution. The prognostic value of the number of mLN and LNR was evaluated by adjusting for other known factors. Optimal cutoff points were determined using maximally selected chi-square test. Lymph node metastasis was found in 77 (32 %) patients. Univariate analysis for overall survival (OS) revealed both the number of mLN (0 vs. 1–3 vs. ≥4; p < 0.001) and LNR (<0.2 vs. ≥0.2; p < 0.001) as significant prognosticators. Multivariate analysis demonstrated that the number of mLN was an independent prognostic factor, whereas LNR was not. The estimated 5-year OS was 48.7 % for patients with negative nodes, 33.4 % for patients with 1–3 mLN, and 9.1 % for patients with 4 or more mLN (p < 0.001). The number of mLN is a powerful parameter to predict survival in the EHBD cancer, which is more reliable than LNR. As for many other gastrointestinal cancers, further classification of node positive patients based on the number of mLN seems to be useful and may provide precise information.

  • Chemoradiotherapy for extrahepatic bile duct cancer with gross residual disease after surgery
    Anticancer Research, 2014
    Co-Authors: Hae Jin Park, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Taeyou Kim, Saewon Han, Yungjue Bang
    Abstract:

    BACKGROUND The purpose of the present study was to analyze the outcome of Chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients with gross residual disease after surgical resection. PATIENTS AND METHODS We retrospectively analyzed 30 patients with EHBD adenocarcinoma who underwent Chemoradiotherapy after palliative resection (R2 resection). Postoperative radiotherapy was delivered to the tumor bed including residual tumor and regional lymph nodes (range=40-55.8 Gy). Most patients underwent Chemoradiotherapy concurrently with 5-fluorouracil (5-FU) or gemcitabine. RESULTS The 2-year locoregional progression-free, distant metastasis-free and overall survival rates were 33.3%, 42.4% and 44.5%, respectively. High radiation dose≥50 Gy had a marginally significant impact on superior locoregional progression-free survival compared to 40 Gy (p=0.081). One patient developed grade 3 late gastrointestinal toxicity. CONCLUSION Adjuvant Chemoradiotherapy for EHBD cancer patients with gross residual disease after surgery was well-tolerated. There could be a chance for durable locoregional control and even long-term survival in selected patients.

  • cd24 expression predicts distant metastasis in extrahepatic bile duct cancer
    World Journal of Gastroenterology, 2013
    Co-Authors: Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    CONCLUSION: CD24 expression was a significant predictor of distant metastasis for patients undergoing curative resection followed by Adjuvant Chemoradiotherapy especially for node-positive EHBD cancer.

Kyubo Kim - One of the best experts on this subject based on the ideXlab platform.

  • the role of Adjuvant Chemoradiotherapy in nonhilar extrahepatic bile duct cancer a long term single institution analysis
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Won Ick Chang, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Byoung Hyuck Kim, Hyuncheol Kang, Kyunghun Lee, Hongbeom Kim, Wooil Kwon
    Abstract:

    Purpose Despite frequent use in the clinical setting, especially for patients with high-risk factors for relapse, the role of Adjuvant treatment has not been clarified in nonhilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of Adjuvant Chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery. Methods and Materials Patients with NH-EHBDC who underwent radical surgery from July 2007 to December 2018 were reviewed retrospectively. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were performed to further identify the role of Adjuvant CRT. Results Three hundred twenty-eight patients were accrued. At a median follow-up of 37.1 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.2%, and 67.5%, respectively. In multivariate analysis, Adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (P Conclusions In patients with NH-EHBDC, Adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly differentiated tumor, tumor size ≥ 5 cm, or R1 resection, Adjuvant CRT might contribute to improve treatment outcomes.

  • Adjuvant Chemoradiotherapy is associated with improved survival for patients with resected gallbladder carcinoma a systematic review and meta analysis
    Annals of Surgical Oncology, 2018
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jeanny Kwon, Young Hoon Kim, Dong Wan Seo, Amol Narang, Joseph M Herman
    Abstract:

    The impact of Adjuvant radiotherapy (ART) on survival from gallbladder carcinoma (GBC) remains underexplored, with conflicting results reported. A systematic review and meta-analysis was performed to clarify the impact of ART in GBC. A systematic literature search of several databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, from inception to August 2016. Studies that reported survival outcomes for patients with or without ART after curative surgery were included. All the inclusion criteria was met by 14 retrospective studies including 9364 analyzable patients, but most of the studies had a moderate risk of bias. Generally, the ART group had more patients with unfavorable characteristics than the group that had surgery alone. Nevertheless, the pooled results showed that ART significantly reduced the risk of death (hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.44–0.67; p < 0.001) and recurrence (HR 0.61; 95% CI 0.38–0.98; p = 0.04) of GBC compared with surgery alone. Exploratory analyses demonstrated a survival benefit from ART for a subgroup of patients with lymph node-positive diseases (HR 0.61; p < 0.001) and R1 resections (HR 0.55; p < 0.001), but not for patients with lymph node-negative disease (HR 1.06; p = 0.78). No evidence of publication bias was found (p = 0.663). This study is the first meta-analysis to evaluate the role of ART and to provide supporting evidence that ART may offer survival benefits, especially for high-risk patients. However, further confirmation with a randomized prospective study is needed to clarify the subgroup of GBC patients who would benefit most from ART.

  • phosphorylated akt expression as a favorable prognostic factor for patients undergoing curative resection and Adjuvant Chemoradiotherapy for proximal extrahepatic bile duct cancer
    American Journal of Clinical Oncology, 2017
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    Objectives:To evaluate the prognostic significance of phosphorylated Akt (p-Akt), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expressions in patients undergoing Adjuvant Chemoradiotherapy (CRT) for proximal extrahepa

  • clinical implications of cytotoxic t lymphocyte antigen 4 expression on tumor cells and tumor infiltrating lymphocytes in extrahepatic bile duct cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy
    Targeted Oncology, 2017
    Co-Authors: Yu Jin Lim, Jaemoon Koh, Kyubo Kim, Eui Kyu Chie, Sehui Kim, Kyoung Bun Lee, Jinyoung Jang, Sun Whe Kim, Yungjue Bang
    Abstract:

    There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

  • the prognostic importance of the number of metastatic lymph nodes for patients undergoing curative resection followed by Adjuvant Chemoradiotherapy for extrahepatic bile duct cancer
    Journal of Gastrointestinal Surgery, 2015
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Taeyou Kim, Saewon Han, Jeanny Kwon, Yungjue Bang
    Abstract:

    Current nodal staging system for extrahepatic bile duct (EHBD) cancer is controversial. The number of metastatic lymph nodes (mLN) and lymph node ratio (LNR) has been studied for the assessment of the nodal status in many other gastrointestinal cancers, but there are few studies on assessing the prognostic impact of these parameters in EHBD cancer. We retrospectively reviewed 239 consecutive patients who underwent curative resection followed by Adjuvant Chemoradiotherapy for adenocarcinoma of EHBD from 1995 to 2009 in our institution. The prognostic value of the number of mLN and LNR was evaluated by adjusting for other known factors. Optimal cutoff points were determined using maximally selected chi-square test. Lymph node metastasis was found in 77 (32 %) patients. Univariate analysis for overall survival (OS) revealed both the number of mLN (0 vs. 1–3 vs. ≥4; p < 0.001) and LNR (<0.2 vs. ≥0.2; p < 0.001) as significant prognosticators. Multivariate analysis demonstrated that the number of mLN was an independent prognostic factor, whereas LNR was not. The estimated 5-year OS was 48.7 % for patients with negative nodes, 33.4 % for patients with 1–3 mLN, and 9.1 % for patients with 4 or more mLN (p < 0.001). The number of mLN is a powerful parameter to predict survival in the EHBD cancer, which is more reliable than LNR. As for many other gastrointestinal cancers, further classification of node positive patients based on the number of mLN seems to be useful and may provide precise information.

Jinyoung Jang - One of the best experts on this subject based on the ideXlab platform.

  • the role of Adjuvant Chemoradiotherapy in nonhilar extrahepatic bile duct cancer a long term single institution analysis
    International Journal of Radiation Oncology Biology Physics, 2021
    Co-Authors: Won Ick Chang, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Byoung Hyuck Kim, Hyuncheol Kang, Kyunghun Lee, Hongbeom Kim, Wooil Kwon
    Abstract:

    Purpose Despite frequent use in the clinical setting, especially for patients with high-risk factors for relapse, the role of Adjuvant treatment has not been clarified in nonhilar extrahepatic bile duct cancer (NH-EHBDC). The goal of this study is to identify the role of Adjuvant Chemoradiotherapy (CRT) in NH-EHBDC patients after radical surgery. Methods and Materials Patients with NH-EHBDC who underwent radical surgery from July 2007 to December 2018 were reviewed retrospectively. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Subgroup analyses were performed to further identify the role of Adjuvant CRT. Results Three hundred twenty-eight patients were accrued. At a median follow-up of 37.1 months (range, 1.0-144.2 months), the 3-year LRRFS, DMFS, DFS, and OS were 63.4%, 59.0%, 53.2%, and 67.5%, respectively. In multivariate analysis, Adjuvant CRT was an independent prognostic factor for LRRFS, DMFS, DFS, and OS (P Conclusions In patients with NH-EHBDC, Adjuvant CRT significantly improved LRRFS and DFS. For patients with risk factors such as nodal involvement, pT3 stage, poorly differentiated tumor, tumor size ≥ 5 cm, or R1 resection, Adjuvant CRT might contribute to improve treatment outcomes.

  • Role of Adjuvant Chemoradiotherapy for Duodenal Cancer: An Updated Analysis of Long-Term Follow-Up from Single Institution.
    World Journal of Surgery, 2018
    Co-Authors: Bum Sup Jang, Hae Jin Park, Jinyoung Jang, Do-youn Oh, Eui Kyu Chie
    Abstract:

    There are only limited data on the failure patterns after surgical resection for duodenal cancer, and the role of Adjuvant Chemoradiotherapy (CRT) also remains controversial. In this study, the treatment outcomes of surgery alone were compared to those of surgery plus Adjuvant CRT for duodenal cancer. Between January 1991 and February 2013, a total of 47 patients with duodenal cancer had pancreaticoduodenectomy, and their age ranged from 31 to 80 (median 62). Twenty-five patients (53%) underwent surgery alone, while 22 (47%) underwent surgery plus Adjuvant CRT. Postoperative radiotherapy with concomitant 5-fluorouracil was given to tumor bed and regional lymph nodes up to 40–55.4 Gy. Median duration of follow-up was 31 months (range 6–286) for all patients and 90 months (range 14–286) for survivors. CRT (+) group included more patients with advanced nodal stage and overall stage group (p = 0.003 and 0.002, respectively). The 5-year overall survival rates were not different between CRT (−) and CRT (+) groups (50.1 vs. 46.7%, p = 0.794). CRT (+) group achieved a superior 5-year loco-regional relapse-free survival rate compared with CRT (−) group, but the difference did not reach a statistical significance (80.1 vs. 68.4%, p = 0.267). On multivariate analysis, however, the addition of CRT was the only favorable prognosticator predicting loco-regional relapse-free survival (p = 0.046). Two patients experienced grade 3 neutropenia during CRT. Adjuvant CRT after pancreaticoduodenectomy was correlated with an improved loco-regional control in duodenal cancer. Considering the high loco-regional recurrence in surgery alone group, CRT may be considered as Adjuvant treatment.

  • phosphorylated akt expression as a favorable prognostic factor for patients undergoing curative resection and Adjuvant Chemoradiotherapy for proximal extrahepatic bile duct cancer
    American Journal of Clinical Oncology, 2017
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    Objectives:To evaluate the prognostic significance of phosphorylated Akt (p-Akt), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expressions in patients undergoing Adjuvant Chemoradiotherapy (CRT) for proximal extrahepa

  • clinical implications of cytotoxic t lymphocyte antigen 4 expression on tumor cells and tumor infiltrating lymphocytes in extrahepatic bile duct cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy
    Targeted Oncology, 2017
    Co-Authors: Yu Jin Lim, Jaemoon Koh, Kyubo Kim, Eui Kyu Chie, Sehui Kim, Kyoung Bun Lee, Jinyoung Jang, Sun Whe Kim, Yungjue Bang
    Abstract:

    There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

  • is c met oncoprotein expression an adverse prognosticator in extrahepatic bile duct cancer treated with curative resection followed by Adjuvant Chemoradiotherapy
    Clinical & Translational Oncology, 2016
    Co-Authors: Hae Jin Park, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Saewon Han, K Kim, Jihye Paik, Suzy Kim, Taeyou Kim
    Abstract:

    To analyze the expression of c-Met, and to investigate correlations between the expression of c-Met, clinicopathologic variables, and survival in patients undergoing curative surgery followed by Adjuvant Chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. Ninety EHBD cancer patients who underwent curative resection followed by Adjuvant Chemoradiotherapy were enrolled. Expression of c-Met was assessed with immunohistochemical staining on tissue microarray. The correlation between clinicopathologic variables and survival outcomes was evaluated using Kaplan–Meier method and Cox proportional hazard model. On univariate analysis, 66 patients (76.7 %) showed c-Met expression. c-Met expression had a significant impact on 5-year overall survival (OS) (43.0 % in c-Met(+) vs. 25.0 % in c-Met(−), p = 0.0324), but not on loco-regional relapse-free survival or distant metastasis-free survival (DMFS). However, on multivariate analysis incorporating tumor location and nodal involvement, survival difference was not maintained (p = 0.2940). Tumor location was the only independent prognostic factor predicting OS (p = 0.0089). Hilar location tumors, nodal involvement, and poorly differentiated tumors were all identified as independent prognostic factors predicting inferior DMFS (p = 0.0030, 0.0013, and 0.0037, respectively). This study showed that c-Met expression was not associated with survival outcomes in EHBD cancer patients undergoing curative resection followed by Adjuvant Chemoradiotherapy. Further studies are needed to fully elucidate the prognostic value of c-Met expression in these patients.

Sun Whe Kim - One of the best experts on this subject based on the ideXlab platform.

  • phosphorylated akt expression as a favorable prognostic factor for patients undergoing curative resection and Adjuvant Chemoradiotherapy for proximal extrahepatic bile duct cancer
    American Journal of Clinical Oncology, 2017
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Yungjue Bang, Taeyou Kim, Saewon Han, Hye Sook Min, Jajune Jang
    Abstract:

    Objectives:To evaluate the prognostic significance of phosphorylated Akt (p-Akt), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) expressions in patients undergoing Adjuvant Chemoradiotherapy (CRT) for proximal extrahepa

  • clinical implications of cytotoxic t lymphocyte antigen 4 expression on tumor cells and tumor infiltrating lymphocytes in extrahepatic bile duct cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy
    Targeted Oncology, 2017
    Co-Authors: Yu Jin Lim, Jaemoon Koh, Kyubo Kim, Eui Kyu Chie, Sehui Kim, Kyoung Bun Lee, Jinyoung Jang, Sun Whe Kim, Yungjue Bang
    Abstract:

    There currently is only limited knowledge on the role of tumor-specific immunity in cholangiocarcinoma. This study evaluated the clinical implications of cytotoxic T lymphocyte antigen-4 (CTLA-4) expression levels and CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) in extrahepatic bile duct (EHBD) cancer. Immunohistochemistry of CTLA-4, CD4, and CD8 was performed for 77 EHBD cancer patients undergoing surgery plus Adjuvant Chemoradiotherapy. CTLA-4 expression on tumor cells and TILs were assessed by using H-scores and the proportion of CTLA-4+ lymphocytes, respectively. With optimal cutoff values determined by a maximal chi-square method with overall survival (OS) data, patients with CTLA-4 H-score >70 and a proportion of CTLA-4+ TILs >0.15 showed higher mean density of CD8+ and CD4+ TILs, respectively (P = 0.025 for CD8+ and P = 0.055 for CD4+ TILs). The high CTLA-4 H-score level was associated with prolonged OS and disease-free interval (DFI) (P = 0.025 and 0.004, respectively). With differential levels of CTLA-4 H-score according to hilar and non-hilar locations (high rate 32 vs. 68%, respectively; P = 0.013), an exploratory subgroup analysis demonstrated that the associations between the CTLA-4 expression and OS and DFI were confined to hilar tumors (P = 0.003 and <0.001, respectively), but not to non-hilar ones (P = 0.613 and 0.888, respectively). This study demonstrates a potential prognostic relevance of CTLA-4 expression in EHBD cancer. We suggest a differential survival impact of the CTLA-4 expression level according to different tumor locations.

  • is c met oncoprotein expression an adverse prognosticator in extrahepatic bile duct cancer treated with curative resection followed by Adjuvant Chemoradiotherapy
    Clinical & Translational Oncology, 2016
    Co-Authors: Hae Jin Park, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Saewon Han, K Kim, Jihye Paik, Suzy Kim, Taeyou Kim
    Abstract:

    To analyze the expression of c-Met, and to investigate correlations between the expression of c-Met, clinicopathologic variables, and survival in patients undergoing curative surgery followed by Adjuvant Chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. Ninety EHBD cancer patients who underwent curative resection followed by Adjuvant Chemoradiotherapy were enrolled. Expression of c-Met was assessed with immunohistochemical staining on tissue microarray. The correlation between clinicopathologic variables and survival outcomes was evaluated using Kaplan–Meier method and Cox proportional hazard model. On univariate analysis, 66 patients (76.7 %) showed c-Met expression. c-Met expression had a significant impact on 5-year overall survival (OS) (43.0 % in c-Met(+) vs. 25.0 % in c-Met(−), p = 0.0324), but not on loco-regional relapse-free survival or distant metastasis-free survival (DMFS). However, on multivariate analysis incorporating tumor location and nodal involvement, survival difference was not maintained (p = 0.2940). Tumor location was the only independent prognostic factor predicting OS (p = 0.0089). Hilar location tumors, nodal involvement, and poorly differentiated tumors were all identified as independent prognostic factors predicting inferior DMFS (p = 0.0030, 0.0013, and 0.0037, respectively). This study showed that c-Met expression was not associated with survival outcomes in EHBD cancer patients undergoing curative resection followed by Adjuvant Chemoradiotherapy. Further studies are needed to fully elucidate the prognostic value of c-Met expression in these patients.

  • the prognostic importance of the number of metastatic lymph nodes for patients undergoing curative resection followed by Adjuvant Chemoradiotherapy for extrahepatic bile duct cancer
    Journal of Gastrointestinal Surgery, 2015
    Co-Authors: Byoung Hyuck Kim, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Taeyou Kim, Saewon Han, Jeanny Kwon, Yungjue Bang
    Abstract:

    Current nodal staging system for extrahepatic bile duct (EHBD) cancer is controversial. The number of metastatic lymph nodes (mLN) and lymph node ratio (LNR) has been studied for the assessment of the nodal status in many other gastrointestinal cancers, but there are few studies on assessing the prognostic impact of these parameters in EHBD cancer. We retrospectively reviewed 239 consecutive patients who underwent curative resection followed by Adjuvant Chemoradiotherapy for adenocarcinoma of EHBD from 1995 to 2009 in our institution. The prognostic value of the number of mLN and LNR was evaluated by adjusting for other known factors. Optimal cutoff points were determined using maximally selected chi-square test. Lymph node metastasis was found in 77 (32 %) patients. Univariate analysis for overall survival (OS) revealed both the number of mLN (0 vs. 1–3 vs. ≥4; p < 0.001) and LNR (<0.2 vs. ≥0.2; p < 0.001) as significant prognosticators. Multivariate analysis demonstrated that the number of mLN was an independent prognostic factor, whereas LNR was not. The estimated 5-year OS was 48.7 % for patients with negative nodes, 33.4 % for patients with 1–3 mLN, and 9.1 % for patients with 4 or more mLN (p < 0.001). The number of mLN is a powerful parameter to predict survival in the EHBD cancer, which is more reliable than LNR. As for many other gastrointestinal cancers, further classification of node positive patients based on the number of mLN seems to be useful and may provide precise information.

  • Chemoradiotherapy for extrahepatic bile duct cancer with gross residual disease after surgery
    Anticancer Research, 2014
    Co-Authors: Hae Jin Park, Kyubo Kim, Eui Kyu Chie, Jinyoung Jang, Sun Whe Kim, Taeyou Kim, Saewon Han, Yungjue Bang
    Abstract:

    BACKGROUND The purpose of the present study was to analyze the outcome of Chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients with gross residual disease after surgical resection. PATIENTS AND METHODS We retrospectively analyzed 30 patients with EHBD adenocarcinoma who underwent Chemoradiotherapy after palliative resection (R2 resection). Postoperative radiotherapy was delivered to the tumor bed including residual tumor and regional lymph nodes (range=40-55.8 Gy). Most patients underwent Chemoradiotherapy concurrently with 5-fluorouracil (5-FU) or gemcitabine. RESULTS The 2-year locoregional progression-free, distant metastasis-free and overall survival rates were 33.3%, 42.4% and 44.5%, respectively. High radiation dose≥50 Gy had a marginally significant impact on superior locoregional progression-free survival compared to 40 Gy (p=0.081). One patient developed grade 3 late gastrointestinal toxicity. CONCLUSION Adjuvant Chemoradiotherapy for EHBD cancer patients with gross residual disease after surgery was well-tolerated. There could be a chance for durable locoregional control and even long-term survival in selected patients.