호르몬 치료를 받은 한국 폐경 여성에서 발생한 유방암의 임상적 특성
Clinical Characteristics of Breast Cancer Detected during Hormone Therapy in Korean Women
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연구목적: 국내 한 병원에서 호르몬 치료를 받은 여성들에게서 발생한 유방암의 위험인자의 비교 및 유방암의 조직학적, 임상적인 특징과 예후 등에 대한 연구를 시행하였다. 연구재료 및 방법: 부산대학교병원에서 폐경으로 인해 호르몬 치료를 받은 여성 중 악성 유방암이 발생한 환자40명을 대상으로 후향적으로 의무기록지를 통해 조사하였다. 조사 항목으로는 환자군의 병력 및 기초 조사, 받았던 호르몬 치료의 종류와 기간, 호르몬 치료 시작 후 발병까지의 기간, 방사선학적인 특징, 환자의 병기, 조직학적인 진단, 종양의 크기, 조직의 등급, 임파선의 전이 상태, 그리고 에스트로겐 수용체와 프로게스테론 수용체의 유무, 5년 생존율의 여부 등에 대해 조사하였다. 결과: 유방암이 발생한 환자들의 위험요인 조사 항목으로 가족력을 가지고 있던 사람은 1명, 흡연력이 있는 사람은 없었고, 평균 BMI는 23.2 kg/m2로 나타났다. 유방암이 발생한 환자들의 이전 호르몬 치료 종류는 에스트로겐 단일 요일요법을 받은 여성이 12명으로 30%, 에스트로겐 프로게스테론 혼합 요법을 받은 여성이 13명으로 32.5%, 티볼론 요법을 받은 여성이 10명으로 25%였고 기타 환자들에게는 복합적으로 사용되었다. 호르몬의 치료기간은 평균 31 ± 27.9 (0.4-115)개월이었고 호르몬 치료 시작 후 유방암의 발생시간 분포는 1년 이내가 4건 (10%), 1-2년 사이가 5건 (12.5%), 2-3년 사이가 10건 (25%), 3-4년 사이가 4건 (10%), 4-5년 사이가 1건(2.5%), 5년 이상 16건 (40%)으로 나타났다. 유방암의 평균 직경은 1.7 cm으로 작은 양상을 보이고, 조직학적으로 관암종 형태의 유형이 92.5%로 다수였으며, 병기는 0기와 I기가 66%로 나타났고, 등급으로는 1등급이 38%로 가장 높은 빈도를 보였으며, 호르몬 수용체가 양성인 유방암이 85%로 조사되었고, 임파절 전이는 70%에서음성, 5년 생존률은 92%로 나타났다. 결론: 호르몬 치료를 받은 폐경기 여성에게서 발생한 유방암은 호르몬 수용체가 양성인 경우가 많으며 크기나병기가 낮고 저등급의 분화도를 보여 재발이 흔하지 않고 5년 생존률에서 좋은 예후를 보이는 양상을 보였다.
Abstract
Objectives: This study was performed to assess the risk factors, histologic and clinical features of breast cancer in postmenopausal women receiving hormone therapy (HT). Methods: We evaluated 40 breast cancer patients who received HT due to postmenopausal symptoms by reviewing their medical charts at Pusan National University Hospital. Research variables, including patients’ history, type and duration of received HT,moment of cancer debut after starting HT, radiological characteristics of breast cancer stage, histologic type, tumor size, grade,lymph node metastasis, estrogen and progesterone receptor status and 5-year survival were investigated. Results: In the risk factors of breast cancer patients, only one patient had familial history of breast cancer. No patient had smoking history. The average body mass index (BMI) was 23.2 kg/m2. Twelve patients (30%) had estrogen only therapy, 13 patients (32.5%)had combined estrogen and progesterone therapy, 10 patients (25%) had tibolone therapy and the others consecutively received combination therapy of the above regimens. The mean duration of treatment was 31 ± 27.9 months (range 0.4-115 months). In the distribution of the cancer debut after starting HT, in 4 cases (10%) was within 1 year, 5 cases (12.5%) within 1-2 years, 10cases (25%) within 2-3 years, 4 cases (10%) within 3-4 years, 1 case (2.5%) within 4-5 years, and 16 cases (40%) within more than 5 years. The average diameter of tumor size was 1.7 cm. In 92.5% of cases, the tumor was of ductal type. Tumor stage 0 and 1appeared in 66% and grade I was present in 38% of investigated cases. Hormone receptor-positive breast cancers were 85% and 70% of patients had negative lymph node metastases. The 5-year survival rate was 92%. Conclusion: The breast cancers which emerged during HT in postmenopausal women had hormone receptor-positive tendency. The size and stage of these breast cancers were shown as small and low, and represented low-grade differentiation. Recurrences of disease were uncommon and we found favorable 5-year survival rates and good prognosis.
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