난소종양으로 수술한 환자의 임상 조직학적 양상 및 수 술 전 CA 125의 의미
The Clinico-Pathologic Features and Significance of Preoperative CA 125 in Patients Who Had an Operation for Ovarian Tumors
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연구목적: 난소종양은 조직학적으로 복잡하고, 수술 전에 양성과 악성의 구별이 어렵다. 이 때문에 난소종양은 조기진단이 힘들어 예후가 나쁜 것으로 알려져 있다. 본 연구에서는 난소종양의 임상 조직학적 양상을 관찰함으로써 수술 전 진단에 도움이 되고자 하였다. 이를 통해 난소종양의 조기진단과 치료방향 결정 및 예후 개선에 도움이 되고자한다. 연구재료 및 방법: 가천대 길병원 산부인과에서 2007년 4월부터 2009년 12월까지 난소종양으로 수술 받은 765명의 환자를 대상으로 하였다. 연구 대상의 연령, 분만력, 폐경 여부, 수술 전 CA 125, 조직검사 소견, 초음파 소견, 치료 방법에 대해 후향적 연구를 진행하였다. 결과: 1. 양성 난소종양 중 자궁내막낭이 211예 (30.1%)로 가장 많았고, 수술 전 CA 125 또한 가장 높았다 (76.07 U/mL). 2. 경계성 난소종양에서는 점액성이 많았고 (16예, 62.5%), 수술 전 CA 125는 장액성 (144.38 U/mL)이 점액성(82.59 U/mL)에 비해 높았다. 3. 악성 난소종양에서는 장액낭선암종이 14예 (29.8%)로 가장 많았고, 수술 전 CA 125는 미분화암종에서 가장 높았다 (500.0 U/mL). 4. 악성 난소종양에서 병기에 따라 수술 전 CA 125가 증가하는 경향을보였다. 5. 연령, 수술 전 CA 125, 폐경 여부, 초음파 소견은 난소 종양의 양성 악성을 구별할 수 있는 인자이며, 각각7.47 (4.34-12.86), 13.65 (7.66-24.32), 5.76 (3.37-9.85), 63.80 (30.76-132.30)의 상대 위험도를 보였다. 결론: 난소 종양의 수술 전 진단에 환자의 연령, 폐경여부, 수술 전 CA 125, 초음파 소견을 복합적으로 이용한다면 조기진단을 통한 조기치료와 예후 개선에 도움이 될 것으로 사료된다.
Abstract
Objectives: The aim of this study is to confirm the clinical and histopathologic findings of ovarian tumors and determine the malignancy before operation. It will attribute to early diagnosis, determining direction of treatment and improving prognosis of malignant ovarian tumor. Methods: Seven hundred sixty-five patients who had an operation for ovarian tumors in the department of Obstetrics and Gynecology of Gachon University Gil Medical Center from April 2007 to December 2009 were enrolled as subjects. A retrospective analysis of age, parity, menopausal status, preoperative CA 125, histology, ultrasound, and treatment method was done. Results: 1. Among benign ovarian tumors, endometrial cyst (211 cases, 30.1%) was most common and had the highest preoperative CA 125 (76.07 U/mL). 2. Among borderline ovarian tumors, mucinous type (16 cases, 62.5%) was most common,but preoperative CA 125 was higher in serous type (144.38 U/mL) than mucinous type (82.59 U/mL). 3. Among malignant ovarian tumors, serous adenocarcinoma (14 cases, 29.8%) was most common, and undifferentiated carcinoma had the highest preoperative CA 125 (500.0 U/mL). 4. The preoperative CA 125 showed a tendency to increase in relation to stage in malignant ovarian tumors. 5. Age, preoperative CA 125, menopausal status and ultrasound finding were identified as discriminating factors for malignancy and relative risk of them were 7.19, 7.90, 5.56 and 61.43, respectively. Conclusion: Using the combination of age, menopausal status, preoperative CA 125 and ultrasound to diagnose ovarian tumors before the operation will be a help to early diagnosis and determining the treatment and improve prognosis.
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