근치적 자궁적출술을 시행한 침윤성 자궁경부암 환자에 대한 임상적 분석
Clinical Analysis of The Invasive Cervical Cancer Patients Treated by Radical Hysterectomy
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=목적: 근치적 자궁적출술을 시행한 자궁경부암 환자들의 임상 기록을 통하여 여러가지 임상병리학적 양상 및 예후인자와 5년 생존율과의 상관관계를 알아보고자 하였다.연구 방법: 1986년 1월부터 2001년 3월까지 경희의료원 산부인과에서 침윤성 자궁경부암으로 진단받고 근치적 자궁적출술을 시행받은 285명을 대상으로 연령별 분포, 조직학적 분포, 임상병기에 따른 림프절의 전이빈도, 재발율 등을 조사하였고, 각 예후인자에 따라 단변수분석을 통해 5년 생존율과의 상관관계를 구하였다.결과 및 결론: 연령은 28세부터 78세까지였으며 평균 나이는 50.6세였다. 임상병기는 Ia기가 11.9%, Ib기가 51.2%, IIa기가 27.4%, IIb기가 9.5%였다. 조직학적 분포는 편평상피세포암이 90.5%, 선암이 7.0%, 선편평상피세포암이 2.5%였다. 림프절전이는 Ia기에서 5.9%, Ib기 16.4%, IIa기 24.4%, IIb기 25.9%로 나타났으며 폐쇄림프절의 침윤빈도 (28.0%)가 가장 높았다. 요로감염이 가장 흔한 (15.1%) 수술 후 합병증이었다. 26예 (9.1%)에서 재발하였는데 Ia기에서는 0%, Ib기 8.2%, IIa기 11.5%, IIb기 18.5% 였으며, 5년 생존율은 Ia기에서 100%, Ib기 89.4%, IIa기 80.0%, IIb기 72.2%였다. 림프절의 전이유무, 병소의 크기, 절단면의 잔류암 침윤여부에 따라 5년 생존율에 통계학적으로 유의한 차이를 보였다.
Abstract
Objective: This study was undertaken to analyze the demographic profile and clinicopathologic characteristics of the patients with invasive cervical cancer who had undergone radical hysterectomy. Methods: Records of 285 patients with invasive cervical cancer who had undergone radical hysterectomy and pelvic lymph node dissection at Kyung Hee University Hospital from January 1986 to March 2001 were reviewed retrospectively. In this study, we analyzed the clinicopathologic characteristics such as age, FIGO stage, histologic type, nodal metastasis, treatment modalities, complications, recurrence rates, and the overall 5-year survival rates et al. by using univariate anaysis and Kaplan-Meier method. Results & Conclusion: Ages ranged from 28 to 78. The mean age was 50.6. The number of patients of 285 being in FIGO stage Ia was 34 (11.9%), Ib 146 (51.2%), IIa 78 (27.4%), IIb 27 (9.5%). In the distribution of histological type, the number of squamous cell carcinoma was 258 (90.5%), adenocarcinoma 20 (7.0%), adenosquamous carcinoma 7 (2.5%). LN involvement was present in 5.9% with stage Ia, 16.4% with Ib, 24.4% with IIa, 25.9% with IIb. Obturator LN was the most frequently involved among pelvic lymph node. Urinary tract infection was the most common complication after surgery, occupying 15.1%. 26 cases (9.1%) developed recurrence. The recurrence rate was 0% in stage Ia, 8.2% in stage Ib, 11.5% in stage IIa, 18.5% in stage IIb. The overall 5-year survival rate was 100% in stage Ia, 89.4% in stage Ib, 80.0% in stage IIa and 72.2% in stage IIb. FIGO stage, tumor mass size, resection margin, lymph node involvement had a statistical prognostic significance (P<0.01).
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