Yonsei University Medical Center Research Articles

Comparison of Physician-Controlled Maneuver and Assistant-Controlled Maneuver during Endoscopic Retrograde Cholangiopancreatography.

Cannulation of the major papilla is the most challenging part of endoscopic retrograde cholangiopancreatography (ERCP) for which physician-controlled wire-guided cannulation (PCWGC) and assistant-controlled wire-guided cannulation (ACWGC) are used as the cannulation techniques. PCWGC can reportedly save up to about 30% of the labor cost by reducing the number of assistants. This study aims to compare the safety and efficacy of PCWGC and ACWGC. Of the 2151 patients aged >20 years (4193 cases) who underwent ERCP at Yonsei University Medical Center between January 2015 and December 2016, 989 were included in this study. Among efficacy outcomes, cannulation success rate, rate of precut sphincterotomy (PCWGC vs. ACWGC: 21.3% vs. 25.9%), bile duct cannulation time (PCWGC vs. ACWGC: median 3.0 minutes vs. 3.6 minutes), and total procedure time (PCWGC vs. ACWGC: median 13.6 minutes vs. 13.1 minutes) were not significantly different. Among safety outcomes, lower rates of post-ERCP pancreatitis were observed with PCWGC than with ACWGC (PCWGC vs. ACWGC: 5.8% vs. 8.8%, p=0.128). Among other post-ERCP adverse events (bleeding, perforation, and cholangitis), the difference was not significant between the groups. Radiation exposure (total dose area product, PCWGC vs. ACWGC: median 1979.9 µGym² vs. 2062.0 µGym², p=0.194) and ERCP cost excluding labor cost (PCWGC vs. ACWGC: $1576 vs. $1547, p=0.606) were not significantly different. Requiring less assistants, PCWGC showed comparable efficacy and safety to ACWGC. PCWGC can be considered as an alternative option, especially in facilities lacking manpower and resources.

Microsatellite instability is associated with early recurrence in resected pT1 and pT2 ampulla of Vater cancer

Introduction: Ampulla of Vater cancer(AoVca) is one of the periampullary cancers with a better prognosis, but recurrence still occurs early in some patients. The aim of this study was to evaluate risk factors of early recurrence after curative resection of AoVca. Method: Between January 2005 and December 2012, 123 patients received radical resection for AoVca at Yonsei University Medical Center. 74 patients with T1 or 2 stage AoVca were reviewed and analyzed to assess risk factor of early recurrence. Result: Among the 74 patients, nineteen patients (25.7%) experienced recurrent disease. Thirteen patients (17.5%) suffered recurrent disease within 12 months (early recurrence). The median follow-up for non-recurrence was 81.3 months, 17.6 months for early recurrence, and 34.4 months for late recurrence. After Multiivariate analysis, lymph node involvement(odds ratio 4.34, P=0.02), microsatellite instability (odds ratio; 8.01, P<0.01) were significant predictors for early recurrence. Conclusion: Lymph node involvement and microsatellite instability were found to be predictors for early recurrence.

Long-term outcomes of ethanol injection therapy for locally recurrent papillary thyroid cancer.

The standard treatment regimen for locally recurrent lesions is total thyroidectomy, or complete removal of the recurrent thyroid lesion within the thyroid bed. However, reoperation increases the risk of complications and patients have to undergo general anesthesia. Percutaneous ethanol injection therapy represents a far less invasive procedure without general anesthesia and with lower risk of complications. Thirty-four patients who received PEIT at Yonsei University Medical Center between October 2002 and August 2009 for recurrent cervical nodal metastases of differentiated papillary thyroid cancer were included in this retrospective study. During a minimum follow-up of 60months, treatment outcomes were determined by measuring the lesion size prior to the first injection and 3months after the last injection. A total of 46 recurrent lesions were detected in 34 patients. Five patients underwent surgery and PEIT was administered to the remaining 19 and 22 lesions in the central compartment and lateral neck lymph nodes, respectively. Size increases were observed in seven (17.1%) lesions, whereas no changes in size and decreases were detected in 10 (24.4%) and 24 (58.5%) lesions. Patients with increased lymph nodes were significantly older (65.3±14.4 vs. 48.2±16.3years; p=0.02) and had smaller sizes (9.3±1.0 vs. 12.3±6.4mm; p=0.012). Although reoperation remains the first-line treatment for recurrent thyroid cancer, PEIT may be considered as a treatment option in selected patients with lesions larger than 1cm who are ineligible for surgery or have refused reoperation.

Human Coronavirus in the 2014 Winter Season as a Cause of Lower Respiratory Tract Infection

PurposeDuring the late autumn to winter season (October to December) in the Republic of Korea, respiratory syncytial virus (RSV) is the most common pathogen causing lower respiratory tract infections (LRTIs). Interestingly, in 2014, human coronavirus (HCoV) caused not only upper respiratory infections but also LRTIs more commonly than in other years. Therefore, we sought to determine the epidemiology, clinical characteristics, outcomes, and severity of illnesses associated with HCoV infections at a single center in Korea.Materials and MethodsWe retrospectively identified patients with positive HCoV respiratory specimens between October 2014 and December 2014 who were admitted to Severance Children’s Hospital at Yonsei University Medical Center for LRTI. Charts of the patients with HCoV infection were reviewed and compared with RSV infection.ResultsDuring the study period, HCoV was the third most common respiratory virus and accounted for 13.7% of infections. Coinfection was detected in 43.8% of children with HCoV. Interestingly, one patient had both HCoV-OC43 and HCoV-NL63. Mild pneumonia was most common (60.4%) with HCoV, and when combined with RSV, resulted in bronchiolitis. Two patients required care in the intensive care unit. However, compared with that of RSV infection, the disease course HCoV was short.ConclusionInfections caused by HCoVs are common, and can cause LRTIs. During an epidemic season, clinicians should be given special consideration thereto. When combined with other medical conditions, such as neurologic or cardiologic diseases, intensive care unit (ICU) care may be necessary.

Lack of Polypoidal Lesions in Patients With Myopic Choroidal Neovascularization as Evaluated by Indocyanine Green Angiography

To investigate the prevalence of polypoidal choroidal vasculopathy (PCV) in patients with myopic choroidal neovascularization (CNV) using indocyanine green angiography (ICGA). Retrospective cross-sectional study. A total of 297 eyes (255 patients) who presented with treatment-naive myopic CNV between January 2005 and December 2011 at Yonsei University Medical Center in Seoul, South Korea, were reviewed. Fluorescein angiography (FA) images obtained from the patients were analyzed to detect CNV presence and classify disease type. ICGA images were reviewed to detect polypoidal lesions. The main outcome measure was the prevalence of polypoidal lesions in patients with myopic CNV. All 297 eyes with myopic CNV were type 2 CNV, and mean age at diagnosis was 47.32 ± 14.69 years. The mean refractive error was -11.95 ± 5.88 diopters, and the mean axial length was 29.39 ± 2.02 mm in the affected eyes. Among the myopic CNV eyes, 141 eyes (118 patients) were older than 50 years of age (mean 60.48 ± 7.34 years). No eyes with myopic CNV showed polypoidal lesions on ICGA at initial presentation. After treatments for myopic CNV, 243 eyes (206 patients) completed at least 12 months of follow-up, and 86 eyes (35.4%) showed at least one recurrence of CNV during follow-up. The follow-up imaging studies, FA, and ICGA, showed no polypoidal lesions associated with recurred myopic CNV. ICGA analysis demonstrated no polypoidal component in myopic eyes with CNV.

Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy

A potential independent association was recently demonstrated between high red blood cell distribution width (RDW) and the risk of all-cause mortality in patients with cardiovascular disease, although the mechanism remains unclear. However, there have been no reports on the relationship between RDW and mortality in acute kidney injury (AKI) patients treated with continuous renal replacement therapy (CRRT). In this study, we assessed whether RDW was associated with mortality in AKI patients on CRRT treatment in the intensive care unit (ICU). We enrolled 470 patients with AKI who were treated with CRRT at the Yonsei University Medical Center ICU from August 2007 to September 2009 in this study. We performed a retrospective analysis of demographic, biochemical parameters and patient outcomes. Following CRRT treatment, 28-day all-cause mortality was evaluated. At the initiation of CRRT treatment, RDW level was significantly correlated with white blood cell count, hemoglobin (Hb) and total cholesterol. Patients with high RDW levels exhibited significantly higher 28-day mortality rates than patients with low RDW levels (P < 0.01). Baseline RDW level, Sequential Organ Failure Assessment (SOFA) score, low mean arterial pressure (MAP) and low cholesterol levels were independent risk factors for mortality. In multivariate Cox proportional hazard analyses, RDW at CRRT initiation was an independent predictor for 28-day all-cause mortality after adjusting for age, gender, MAP, Hb, albumin, total cholesterol, C-reactive protein and SOFA score. Our study demonstrates that RDW could be an additive predictor for all-cause mortality in AKI patients on CRRT treatment in the ICU.

Glucocorticoid-induced diabetes mellitus in patients with systemic lupus erythematosus treated with high-dose glucocorticoid therapy

The aim of this study was to investigate the prevalence and associated factors of glucocorticoid-induced diabetes mellitus (GDM) in patients with systemic lupus erythematosus (SLE) receiving high-dose glucocorticoid therapy. Patients with SLE who had received high-dose glucocorticoid therapy (prednisolone ≥1 mg/kg/day) at Yonsei University Medical Center, Seoul, Korea, were recruited between January 1999 and June 2009. In total 127 patients with SLE were evaluated. Sixteen (12.6%) of them developed GDM after high-dose glucocorticoid therapy (95% confidence interval, 6.8-18.4%). Univariate analysis showed that old age, family history of diabetes mellitus (DM), hypertension, higher body mass index, higher mean dose of prednisolone before high-dose glucocorticoid therapy, and concurrent use of mycophenolate mofetil (MMF) were factors that would increase the likelihood of GDM. Multivariate analysis determined that age, family history of DM, mean dose of prednisolone before high-dose glucocorticoid therapy and concurrent use of MMF were independent associated factors for GDM. In summary, GDM was developed among 12.6% of patients with SLE after high-dose glucocorticoid therapy. Old age, family history of DM, higher mean dose of prednisolone before high-dose glucocorticoid therapy and concurrent use of MMF were determined to be factors responsible for increasing the risk of developing GDM.

Predictive factors related to progression toward rheumatoid arthritis in Korean patients with undifferentiated arthritis

Some patients with undifferentiated arthritis (UA) experience spontaneous remission; however, one-third of patients progress to rheumatoid arthritis (RA) in the final process of the disease. This study evaluated clinical variables in order to find a prediction model that could predict the development of RA in patients with UA. The medical records of 164 patients, who were initially diagnosed with undifferentiated arthritis in Yonsei University Medical Center from January 2004 to December 2007, were retrospectively reviewed. They were followed up for at least 6months. The clinical variables related to the development of RA were identified by univariate analyses. Using logistic regression analysis, the prediction model was made and the diagnostic performance of the model was evaluated. Thirty-two patients of the 164 total patients progressed to RA during the follow-up period. The prediction model was composed of clinical factors including the duration of morning stiffness, the number of tender joints, the number of swollen joints, C-reactive protein level, rheumatoid factor, anti-cyclic citrullinated peptide antibody, and erosive change on baseline X-ray. The prediction score ranged from 0 to 10. All of the patients with a higher prediction score greater than five experienced RA progression. The area under the curve value for the prediction rule was 0.976. The prediction model could predict progression to RA in patients with UA. It especially helps the clinician to decide on a management plan for patients with a high prediction score.

Retroperitoneal Fibrosis in 27 Korean Patients: Single Center Experience

Retroperitoneal fibrosis (RPF) is a rare disease with unclear etiology, which is characterized by chronic non-specific inflammation of the retroperitoneum. This study was performed to investigate the clinical characteristics, laboratory findings, radiologic findings, treatment and outcome in Korean patients with RPF. We retrospectively reviewed medical records of 27 RPF patients who were admitted to Yonsei University Medical Center between 1998 and 2009. Twenty-two patients (81%) were male. The mean age at diagnosis was 56 yr. Nine patients had identifiable risk factors of RPF and three patients had combined autoimmune diseases. Acute phase reactants were elevated in most patients. Rheumatoid factor was positive in 3 of 16 patients (19%) and antinuclear antibody in 4 of 17 (24%). Five of 6 patients who were taken positron-emission tomography showed positive uptake. Glucocorticoids were used in 16 patients (59%) and four of them received combination therapy with azathioprine. After immunosuppressive treatment, the levels of acute phase reactants dropped, and the size of mass also decreased in most patients. In conclusion, the clinical characteristics of RPF in Korean patients are similar with other series except for higher proportion of male. Some patients with RPF have autoimmune features. The effect of immunosuppressive treatment on RPF is good.

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*Retina Department, Nune Eye Hospital Seoul, Korea; and †Yonsei University Medical Center Seoul, Korea.

Clinical validation and risk factors for delayed gastric emptying based on the International Study Group of Pancreatic Surgery (ISGPS) Classification

Delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy (PD). Because an objective, universally accepted definition of DGE does not yet exist, it is impossible to compare complication rates and outcomes of new operative approaches, operative techniques, and clinical trials. The International Study Group of Pancreatic Surgery (ISGPS) has proposed a universal classification for DGE based on clinical outcomes, but this classification has not been tested rigorously and applied to clinical data. Therefore, the aim of this study was to analyze our experience and to identify predictive factors for DGE by applying the ISGPS classification at a high-volume hospital. From October 2002 to December 2007, 129 consecutive patients underwent PD at the Department of Surgery, Yonsei University Medical Center. The severity of DGE was determined according to the ISGPS classification, and risk factors were evaluated retrospectively. The overall incidence of DGE was 33.3%, with 16 (12.4%) patients having grade A, 14 (10.9%) grade B, and 13 (10.1%) grade C. Clinical outcomes worsened progressively as clinical relevant DGE increased. In multivariate analysis, clinically relevant pancreatic fistula (grade B/C) and patients with benign pathology were identified as independent factors for DGE. Pancreatic leakage is a serious complication after PD and is also associated with DGE. The ISGPS classification is a clear and useful tool to assess clinical outcomes.

Obstructive Colitis Proximal to Obstructive Colorectal Carcinoma

The term "obstructive colitis" refers to ulceroinflammatory lesions occurring in the colon proximal to a completely or partially obstructing lesion. It has been referred to by various terms in the literature. This entity differs from the carcinoma of the colon that complicates true ulcerative colitis where there is involvement distal to the neoplasm as well as proximal to it. Although it has appeared in the literature over several decades, it remains an uncommon and troublesome disease. In Yonsei University Medical Center, for 11 years from January 1996 to December 2006 we encountered seven patients with obstructing colorectal carcinoma complicated by obstructive colitis. Here we report our cases to share our experience and to review the literature to facilitate the recognition and proper management of this rare disease entity.

Clinicopathological Features of Retrorectal Tumors in an Adult - A Case Report and Review of the Literatures -

Retrorectal tumors are particularly rare among the adult population, occurring in 1 of 40,000 hospital admissions. Clinical diagnosis is difficult and is often delayed because of vague symptoms. This study aimed to investigate the clinicopathological features of retrorectal tumors. Between January 1999 and March 2005, 10 patients were diagnosed with retrorectal tumors at the Department of Surgery, Yonsei University Medical Center, and their medical records were reviewed. We analyzed chief complaints, imaging studies, surgical approaches and pathologic examinations. Out of 10 patients, 8 were female and 2 were male. The mean age was 42.8 years. Four patients had no symptoms. Perianal and abdominal pain were the most common presentations. CT and MRI were the most frequently performed imaging studies. Surgery was performed in 9 patients. Postoperative pathologic diagnosis was possible in 9 patients. An epidermal cyst was the most common tumor (4 patients); others included a mature teratoma, an adenocarcinoma from a tail gut cyst, a duplication cyst, a neurogenic tumor, and a smooth muscle cell tumor. Imaging techniques like CT scans, MRI and TRUS are helpful to determine the size and the extent of a tumor and its relationship to the surrounding anatomical structures for the operative approach. A surgical resection is the standard of treatment and demonstrates good results and a good prognosis

Long-term oncologic results of patients with distal rectal cancer treated by local excision with or without adjuvant treatment

The aim of this study is to review long-term oncologic results of local excision (LE) and to investigate the validity and feasibility of LE as a treatment option for distal rectal cancer. Seventy-six patients who underwent LE for distal rectal adenocarcinoma with curative intent from 1991 to 2000 at Severance Hospital Yonsei University Medical Center, Seoul, Korea were enrolled in this study. Preoperative transrectal ultrasonography revealed 3 cases of uT0, 55 cases of uT1 and 18 cases of uT2. Postoperative pathologic examination revealed 10 cases of pT0 (where no residual cancer cells remained), 11 cases of pTis, 37 cases of pT1, 16 cases of pT2, and 2 cases of pT3. Eleven out of 37 patients with pT1 tumors received adjuvant radiation therapy. Among 16 patients with pT2 tumor, 7 undertook salvage operation and 8 received adjuvant therapy. The median follow-up period was 84.9 months. Local recurrence was observed in six patients. The 5-year local recurrence-free survival rate (LFS) was 89.4% in the pT1 group and 75.0% in the pT2 group (p = 0.012). Among the patients with pT1 cancer, those who received adjuvant radiation therapy demonstrated a 5-year LFS of 100%, compared to those who did not, 76.0% (p = 0.038). Our results imply a potential role of LE and adjuvant radiation as an option for the treatment of distal rectal cancer, and that even for pT1 carcinoma, LE alone might not be a valid modality.

Treatment outcomes of 70 cases of early esophageal carcinoma: 12 years of experience

Early esophageal cancer (EEC) has an excellent prognosis compared to advanced esophageal cancer. Nowadays, endoscopic mucosal resection (EMR) may offer another alternative to cure early cancers of the gastrointestinal tract. We aimed to evaluate the clinical outcomes of EEC in Korea after curative treatments; EMR or surgery. We retrospectively reviewed the medical records of patients diagnosed as EEC from January 1994 to August 2005 at Yonsei University Medical Center, Seoul, Korea. Among 888 patients diagnosed with esophageal cancer, 70 (7.9%) were included as EEC. Among them, 10 patients (14.3%) were treated by EMR, and 50 (71.4%) by operation. The treatment outcomes of EEC in relation to various clinicopathologic factors along with survival rates were analyzed. There were 18 cases (30%) of mucosal lesions and 42 cases (70%) of submucosal lesions. Overall 5-year survival rate was 84.3%. When comparing treatment outcomes between EMR-treated and operated groups, there were no significant differences in complete remission (80%vs. 84%), recurrence (20%vs. 16%) and 5-year survival rate (100%vs. 78.3%). EEC is a potentially curable entity with a good clinical prognosis. EMR can be considered as another treatment arm for EEC, along with surgical resection.

Bilateral thoracoscopic splanchnicectomy with sympathectomy for managing abdominal pain in cancer patients

Background Simple interruption of splanchnic nerve can lead to incomplete transection of nerve fibers responsible for cancer-derived abdominal visceral because lots of neural communications exist. Methods From December 1999 to June 2005, a total of 21 cancer patients underwent bilateral thoracoscopoic segmental resection of splanchnic nerve with sympathectomy for intractable abdominal pain based on the anatomic observation of 26 embalmed Korean cadaveric specimens in Yonsei University Medical Center, Seoul, Korea. All patients were preoperatively asked to rate the extent of their current pain by using the numeric rating scale (NRS), where 0 indicated no pain and 10 indicated intractable pain. The effectiveness of this thoracoscopoic procedure was assessed based on the NRS reevaluated after surgery. Results NRS score was significantly reduced after thoracoscopic surgery (1.71 ± 1.10 versus 8.52 ± 1.08, paired t test, P < .0001). Sixteen patients (76.2%) could tolerate pain without or with reduced dose of analgesics. No mortality and morbidity were found in this study. Conclusion This bilateral thoracoscopic splanchnicectomy with sympathectomy is safe, easy, and effective method in managing cancer-derived visceral abdominal pain.

A Glu487Lys polymorphism in the gene for mitochondrial aldehyde dehydrogenase 2 is associated with myocardial infarction in elderly Korean men

Background A homozygous mutant ( ALDH2 ⁎ 2/ ⁎ 2) of the gene for mitochondrial aldehyde dehydrogenase 2 ( ALDH2) at codon 487 was reported to be associated with myocardial infarction (MI) among Japanese men. However, such an association has never been studied in a Korean population. Method The subjects consisted of 122 men (60–81 y) with MI recruited randomly from Yonsei University Medical Center, Korea. A total of 439 men (60–84 y) without MI were selected as controls from the Ansan Geriatric Study. ALDH2 genotypes were determined using the TaqMan fluorogenic 5′ nuclease polymerase chain reaction assay. Results Genotypes carrying the mutant ALDH2 allele ( ALDH2 ⁎ 1/ ⁎ 2 plus ALDH2 ⁎ 2/ ⁎ 2) were significantly more frequent in patients with MI than in the controls (42.6% vs. 30.5%, P = 0.0163). Multiple logistic regression analysis revealed that ALDH2 ⁎ 1/ ⁎ 2 plus ALDH2 ⁎ 2/ ⁎ 2, together with abnormal high density lipoprotein cholesterol and elevated body mass index, was an independent risk factor for MI in elderly Korean men (odds ratio = 1.976, 95% CI: 1.202–3.248). Conclusions ALDH2 polymorphisms may play an important role in the pathogenesis of MI in elderly Korean men.

Factors influencing recurrence after curative resection for ampulla of vater carcinoma

Carcinoma of the ampulla of Vater has a relatively higher resection rate, lower recurrence rate, and more favorable prognosis than other malignant tumors of the periampullary region. Because of the relative low incidence of carcinoma of the ampulla of Vater, there have been few reports on the patterns and risk factors of recurrence after curative resection. The aim of this study was to evaluate the patterns and risk factors of recurrence after curative resection of ampulla of Vater carcinoma. Between January 1992 and December 2002, 102 patients received radical resection for ampulla of Vater carcinoma at Yonsei University Medical Center. Fifteen patients were excluded because of incomplete clinicopathologic data. Finally, 87 patients were reviewed and analyzed to assess predictors of tumor recurrence. Among the 87 patients, 37 patients (42.5%) experienced recurrent disease. The mean length of time to recurrence was 29.3 +/- 35.3 months, and the most common sites of recurrence were the intra-abdominal organs: liver and loco-regional lymph nodes. The patients were divided into two groups: early recurrence (<or=18 months) and late recurrence (>18 months). In the early recurrence group, ulcer formation tumors and poorly differentiated tumors were more common in comparison with the late recurrence group. Lymph node metastasis was identified as an independent factor of tumor recurrence after curative resection for ampulla of Vater carcinoma. Lymph node metastasis is the most important risk factor for recurrence after a curative resection. Also, the fact that a higher probability of recurrence is anticipated in cases of ulcer formation and poorly differentiated tumors, there exists a need for a close-up follow-up program.

Actual Recurrence Patterns and Risk Factors Influencing Recurrence After Curative Resection with Stage II Gallbladder Carcinoma

Despite the advances in imaging techniques, most patients can only be diagnosed at advanced stage: The prognosis is very poor. Recent studies showed that aggressive radical resection for advanced gallbladder carcinoma can give an acceptable prognosis. However, recurrence frequently remains the main problem after curative resection of advanced gallbladder carcinoma. The aim of this study was to identify the patterns and risk factors of recurrence after curative resection for stage II gallbladder carcinoma. Between January 1991 and December 2003, 100 patients received radical curative resection for gallbladder carcinoma at Yonsei University Medical Center. Of these, 77 were defined with stage II gallbladder carcinoma according to the Union Internationale Contre Le Cancer classification (sixth edition). Of the 77 patients, 67 were reviewed for the predictors of tumor recurrence. Among the 67 patients, 38 (56.7%) suffered a recurrence. The mean length to the recurrence was 21.1±26.7 months, with the most common site being the intraabdominal organs: liver and aortocaval lymph nodes. Infiltrating and poorly differentiated types were identified as independent prognostic factors of recurrence after curative resection for stage II gallbladder carcinoma and it suggests that large multicenter randomized control trials are necessary to clarify the role of adjuvant chemotherapy in these patients.

CD34 Expression and Clinical Outcome of Childhood Acute Leukemia.

Purpose: CD34 is a surface glycophosphoprotein which is expressed on early hematopoietic stem cells. It has been thought that leukemic blast with CD34 expression was associated with poor prognosis. In this study, correlation between CD 34 expression and clinical outcome of childhood acute leukemia was explored.Method: Seventy-six patients who were diagnosed as acute leukemia in Department of Pediatrics, Yonsei University Medical Center, Seoul, Korea were enrolled in this study. All patients were analyzed retrospectively. Myeloid markers expression in acute lymphocytic leukemia (ALL) as well as CD34 presentation in ALL and acute myeloid leukemia (AML) were analyzed. Three-year event-free-survival (EFS) was calculated according to whether those antigens were expressed or not.Result: Fifty-eight and eighteen patients were ALL and AML, respectively. Median follow up period for all patients was 2.2 years (0.1–4.6 years). Boys and girls were 33 and 25 in ALL patients, respectively. In childhood AML, 11 and 7 patients were male and female, respectively. EFS for all patients with acute leukemia was 74.1± 5.4%. Three-year EFS of AML with or without CD34 expression was 83.3±15.2 % and 46.7±15.4 %, respectively. But, the difference was not different statistically (P=0.164, Fig. 1). In ALL, Three-year EFS was 80.7±8.9 % and 78.8±7.2 % for group of CD34 negative and positive, respectively (p=0.998, Fig. 2).Conclusion: According to data, CD34 expression of AML in children might contribute to the survival rate, however EFS was not different statistically. We think that because of small number of cohort, the statistical results were not significantly different. In ALL, there were no statistically significant differences in EFS between CD34 expression or not. [Display omitted] [Display omitted]