자궁경부암 병기 IIB 환자에서 치료법에 따른 예후 비교: 근치자궁절제술, 신보강화학요법 후 근치자궁절제술 및 동시화학방사선요법의 예후를 비교한 후향적 연구
Prognosis of stage IIB cervical cancer among treatment regimens: Radical hysterectomy vs. neoadjuvant chemotherapy followed by radical hysterectomy vs. concurrent chemoradiotherapy
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목적자궁경부암 병기 IIB인 환자들에서 근치자궁절제술, 신보강화학요법 후 근치자궁절제술 및 동시화학 방사선요법을 시행받은 군 간의 예후를 비교하였다. 연구방법2000년 1월부터 2006년 12월까지 인제대학교 부산백병원 산부인과에서 자궁경부암 IIB로 진단된 104명의 환자에서 근치자궁절제술, 신보강화학요법 후 근치자궁절제술 및 동시항암화학 방사선요법을 시행받은 군 간의 5년 무병생존율 및 전체생존율과 재발률을 비교하여각각 치료에 대한 예후를 분석하였다. 결과근치자궁절제술을 시행받은 20명, 신보강화학요법을 시행한 후 근치자궁절제술을 시행받은 43명, 동시항암화학 방사선요법을 시행받은 23명을 포함하여 총 86명을 대상으로 분석하였다. 연령이 낮을수록(P＜0.001) 신보강화학요법이 시행되었고, 종양크기가 클수록 신보강화학요법이나 동시화학방사선 요법보다는 근치자궁절제술이 시행되었다(P＜0.001). 세 군 중 신보강화학요법을 받은 군에서 원격재발이 의미 있게 낮았다(P = 0.014). 근치자궁절제술만 시행한 군과 신보강화학요법 후 근치자궁절제술을 한군을 비교하였을 때, 근치자궁절제술을 한군의 조직학적 소견에서 중등도 위험인자인 4 cm 이상인 종양크기와 림프혈관강 침윤이 통계적으로 의미 있게 증가하였다(P = 0.0459, 0.0158). 결론세군 간 5년 무병생존율 및 전체생존율에 차이는 없었으나 신보강화학요법은 원격전이를 낮추고, 종양의 크기와 림프혈관강 침윤을 감소시켜 불필요한 추가치료를 피할 수 있도록 하였다.
Abstract
Objective We aimed to compare the prognosis of patients with stage IIB cervical cancer treated with radical hysterectomy alone, with neoadjuvant chemotherapy followed by radical hysterectomy, and with concurrent chemoradiation therapy (CCRT). Methods From January 2000 to December 2006, 104 patients with cervical cancer IIB were diagnosed and managed with radical hysterectomy alone, neoadjuvant chemotherapy followed by radical hysterectomy, and CCRT. The outcomes of patients in terms of the 5-year disease-free survival, overall survival, and recurrence rates were compared. Results Of 86 eligible patients, 20 were treated with radical hysterectomy alone, 43 with neoadjuvant chemotherapy, and 23 with CCRT. Neoadjuvant chemotherapy with radical hysterectomy was performed in young (P<0.001) and radical hysterectomy alone was performed in the patients with a large tumor size (P<0.001). Among the 3 groups, distant metastasis was the lowest in the neoadjuvant chemotherapy group (P=0.014). Between the neoadjuvant chemotherapy group and radical hysterectomy alone group, radical hysterectomy alone group showed a larger tumor size (>4 cm) (P=0.0459) and more extensive lympho-vascular involvement (P=0.0158) in pathologic finding. Conclusion No significant differences in the 5-year disease-free and overall survival rates were observed among the 3 groups. However, the neoadjuvant chemotherapy group showed lower distant metastasis, smaller tumor size, and less extensive lympho-vascular involvement than the other 2 groups. Accordingly, unnecessary adjuvant therapy could be avoided. These results imply that neoadjuvant chemotherapy could improve the prognosis of patients with cervical cancer IIB.
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