The exemption for the four-year requirement is announced by the Buddha. Please let us know where to insert it, and now we are at the National Cancer Center, which is responsible for that part. Today's topic is about how to track the recovery of patients who have undergone subtotal gastrectomy due to advanced gastric cancer. I would like to ask for your presentation on this issue. 

Thank you for the introduction. There are no special remarks. Let me briefly introduce a patient I have personally experienced. He is a male patient who underwent surgery for gastric cancer, and the stage was determined to be D3. I have regularly monitored him since then. After about two years and three months, a tumor marker slightly increased. However, with this level of increase, it cannot be determined as a recurrence, so I continued to observe. Three months later, I performed a CTA scan, and the CT results showed...

There is evidence of peritoneal metastasis, so from that time on, we started to focus on palliative care. However, after five months of chemotherapy, most patients passed away. Looking at the names, it seems that for about two months, we were uncertain whether the treatment actually helped the patients. This raises some concerns. The same goes for other cancers, but after gastric cancer surgery, the reason for follow-up observation is to detect any recurrence early, so that we can treat it aggressively and improve survival rates. 

After undergoing gastric cancer surgery, various symptoms such as vomiting often appear. This can be due to improper eating or poor nutrition, and since we performed a subtotal gastrectomy, the side effects can persist. Therefore, we also provide treatment to alleviate these patient symptoms.

Patients are very anxious about not coming to the hospital. They worry about whether there will be a recurrence. This political and emotional anxiety has a purpose of stabilizing those feelings, but no one really knows if it truly achieves that goal. It's been about ten years since this has been the case. At Inje University, a survey was conducted to see how past patients manage their follow-ups. Many people responded, and when you look at the results, it’s quite varied. For advanced cases, some doctors recommend follow-ups every three months, while others suggest every six months or even every twelve months. Additionally, the types of tests conducted vary widely. I find this important, as everything differs among individuals, and there is no standardized approach. So now, I am utilizing data from the center to see if…

이렇게 빨리 오브 하는 게 정말 생존율에 형성 도움을 주는지에 대해 좀 해봤습니다. 제 주변 사람들을 보니까, 내 주변에서 발견된 환자나 그 팔로 중간에 자기가 증상이 있는 사람이나 사실은 오버 서브에 버린 차이가 없더라고요. 단지 차이가 나는 것은 재발을 발견한 이후부터 사망할 때까지의 차이였습니다. 결국은 치료 후에 언젠가는 재발했겠지만, 차마 하는 것도 같았습니다. 이 얘기는 결국 팔로브라더가 일찍 발견된 뿐이지 결국 상한의 시기는 똑같습니다. 이런 리드 타임 바이러스 효과가 아닌가 싶습니다. 그런데 이런 결과들이 나름 스펙티브 스터디이기 때문에 이걸 명확하게 증명할 수는 없는 상태였고, 저희뿐만 아니라 이제 국내 또는 해외에서도 발표된 파울러 관련 논문들이 조금의 차이는 있지만 대부분 대동소이합니다.

I will present the conclusion. Most of it is about retro specifications and studies. Then, even if we consider survival, there is no way to know how to calculate the patient's quality of life or whether it helps improve nutritional status and emotional well-being. This is the fourth gastric cancer adequacy evaluation published in 2019. As you can see, there are about 14,000 gastric resections performed each year and nearly 9,000 endoscopic resections. Therefore, excluding patients who receive palliative care, around 23,000 patients annually need to undergo regular procedures and treatments. I’m not sure about the exact numbers, but our research team has calculated this. They looked into the costs of one CT scan and one endoscopy, and eventually, for about 5,000 patients who underwent surgery, we have follow-up examinations after each procedure.

If we do this, how much is it? Is it around 370 billion? Well, it costs about this much. In fact, the director mentioned foreign examples, but it's not a huge amount of money, yet it is still significant. We are aware that such costs exist. About three years ago, when I was creating guidelines for the Taean Weah Mark with several teachers, we initially had to define how far we would go with the scope. We decided not to include commands for follow-up because there was no basis; we couldn't determine where to recommend anything without evidence. Therefore, we excluded follow-up items from the guidelines. This is similar in other countries; for example, in Japan, they cannot definitively say what their standards are, but they do recommend based on their own consensus.

In NC CNN, it was actually written in this way: once every six months or once every eleven months, something like that. It clearly defines the control model, and the app is more straightforward. This time, I compared the guidelines from various countries, looking at how treatments differ and organizing it a bit. In Korea, it was not recommended because it couldn't be expelled, while in Japan, as I mentioned earlier, it was recommended based on the concept source. In China, LCC and M&S have their own variations. In other words, there is currently no answer regarding how to address stomach cancer. Ultimately, the app needs to be utilized, and if we examine how to approach this, it seems that there may be some past benefits.

There was a meta-analysis, and a large-scale clinical study was conducted in Europe called Colorectal. It was the largest study, and when compared, there seemed to be no significant differences. However, these researchers compared the results at six months and one year. After this paper was published in JAMA, there was some uncertainty about how to proceed with fourth-generation treatments for colorectal cancer. In subsequent review papers, it was mentioned that there was almost no difference. Fortunately, we were able to form a team with the gastroenterologists, and we were granted permission to proceed with the research. We named the project Stove Colorectal, and we are currently moving forward with it, as you can see.

Currently, there are patients who frequently come in for Stage II and III cancer treatment, and we are looking to increase the frequency of visits for these patients. We have conducted a comparison between survival rates and quality of life through a multi-center study involving Samsung Medical Center. As I mentioned earlier, both survival rates and quality of life are important, so we plan to analyze these details separately later on.

At present, 16 institutions across the country are participating in this study. In fact, we are conducting this study on almost all Stage II and III cancer patients nationwide. The target patients are those who have undergone surgery and have been diagnosed with pathologically confirmed Stage II or III cancer. We are particularly focusing on patients who are not experiencing significant complications.

We are conducting follow-ups at intervals of 3 months and 6 months. Our assumption is that there will be about a 6% difference in the outcomes, and the reason we estimated a 6% difference is based on the colon data.

Since the information was included there, I applied the same 1% criteria. Based on that, I tried to allocate it on both sides, and it turns out there are about 16 participants for the study. In fact, when we researchers were developing the protocol, we wondered what we could observe in just three or six months. Personally, I wanted to look at patients who had not undergone any treatment for six months, but realistically, it is difficult to obtain consent from patients for that. In Korea, patients are already being followed up at least every six months, and when we tell them to come back if they have any symptoms, there would be no patients willing to consent. Judging that we could not proceed with the study under those circumstances, I tried to compare six months and one year, but in the National Assembly, there are already discussions about guarantees and costs associated with this follow-up, which makes it even more complicated as we approach the one-year mark.

Regarding the compliance of selling through a channel, one wonders how much compliance there will actually be. Even if there is consent, patients will not wait for six months. Patients must come to the hospital unconditionally, so researchers believe that the best way to maintain compliance is through a three-month to six-month period. This is how we designed the study. 

In Korea, we will conduct tests such as the recurrence survival analysis and nutrition assessments. The primary endpoint is the three-year overall survival rate. The reason we chose three years is that, honestly, we want to see the five-year survival rate, but the research institution supported by the mechanism does not cover up to five years. Therefore, we had no choice but to design the study to observe three years. The secondary endpoint will be the secondary survival.

We designed it by looking at things like early cross-protocols and so on. Next, we look at the Mercure L and nutrition. We write about clinical trials and register everything. We conduct studies and design studies, and we have patents open to the public. So, as you saw earlier, we send out newsletters every three months, and this is based on the end of February. Researchers are working together continuously, and we create opportunities to advance the project about once or twice a year. As you can see, the progress is slightly slower than we had planned, but we hope to increase it in the future to meet our final goals. Currently, most of the work is being done in Korea.

Endoscopic treatment has been performed for early-stage gastric cancer, which is stage one. In this situation, 16 major hospitals across the country have gathered. Despite the fact that stage two patients are almost being registered, the reality is that I face difficulties. I hope for a good outcome, but to provide some stimulation, each institution is tasked with reporting how many cases of your illness have appeared. We have met several times at the conference and discussed ways to increase the number of cases reported.

In conclusion, I would like to emphasize that monitoring patients at stage two and three is absolutely necessary. We need to identify the chain of care and determine how we can effectively provide assistance. Additionally, we should consider how we can manage the societal costs of this issue efficiently. Ultimately, in order to establish evidence-based guidelines, we need to consider not only Korea's guidelines but also those from Japan and the global community.

Our ultimate goal can be said to be providing this. Thank you for listening. Yes, thank you. Regarding this generation, there have been questions registered, and Professor Kim has pointed out that there is a significant difference that everyone acknowledges. However, how we approach this is important. It seems that simply having land is not enough. Do you have any special methods? It’s interesting to think that perhaps more incentives could be a crucial factor. However, this incentive comes from national research funding, and as the person in charge, I can't just distribute it freely. As Joe Rogers mentioned, the research team is definitely focused on this. If you have anything to say, please do. As I mentioned earlier in the study design, we have already been working for three years on primary and secondary points.

The reason for this discussion is that research positions and support for research are being proposed. However, clinical research does not yield results overnight, as it often takes time. Although this project is said to last five years, the actual start date was around the end of December. Therefore, the timeline for this research is quite tight. Aligning the research with this timeframe is honestly very challenging. I hope that these issues can be improved or that additional support can be provided, as that would be greatly beneficial. I understand that there are limitations within the country, but I believe that researchers are working hard, and I hope that we can achieve meaningful outcomes.

We are currently planning to support research on the composition based on the database established in the latter half of the year, if you manage the database well. So, we will provide information step by step. Thank you.

[대한소화기학회-PACEN 공동 심포지엄] ③ PACEN 지원 소화기질환 분야 연구 및 예상성과 소개(2) (류근원 국립암센터)

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