자궁내막암 98예의 생존율 분석
Clinocopathologic analysis of survival of 98 patientswith uterine endometrial cancer
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=목적: 자궁내막암 환자 98예의 임상병리학적 예후인자들과 생존율과의 관계를 분석하고자 하였다.연구 방법: 1995년 1월부터 2000년 12월까지 고신대학교 복음병원 산부인과에서 자궁내막암으로 치료를 받은 98명의 환자의 의무 기록을 분석하였고 통계청 자료를 통해 환자의 생존 여부를 조사하였다. 각 예후인자와 생존율과의 관계에 대하여 단변량 분석을 시행하였고 이들 인자사이에는 다변량 분석을 시행하였다.결과: 총 98예 자궁내막암 환자의 평균 연령은 53세이었고, 비정형 질출혈 (65.3%)이 가장 흔한 증상이었으며 자궁내막양 선암(85.1%)이 가장 많은 조직학적 소견이었다. 총 98예 환자의 전체 5년 생존율은 66.8%이었고, 50세 이하 환자의 5년 생존율은 82.5%, 50세 이상 환자의 5년 생존율은 57.6%였다 (p=0.04). 술전 CA-125치가 35 u/mL 이상일 경우 5년 생존율이 40%, 이하일 경우가 80%였고 (p=0.001), 수술적 병기 I, II, III, IV의 5년 생존율은 86.8%, 76.9%, 39.4%, 14.4%였고 (p=0.001), 분화도 따른 전체 5년 생존율은 분화도 1이 75%, 분화도 2가 70%, 분화도 3이 45%였고 (p=0.002), 자궁근층(-), 1/2 이하, 1/2 이상 침범한 경우 전체 5년 생존율은 84.3%, 80.3%, 57.2%였고 (p=0.004), 복강 세포진 검사의 양성, 음성의 전체 5년 생존율은 23.8%, 73.4%를 보였고 (p=0.001), 림프절 전이의 양성, 음성의 전체 5년 생존율은 15%, 80%를 보였다 (p=0.001).결론: 50세 이상의 나이, 술전 CA-125치, FIGO 수술적 병기, 조직 분화도, 자궁근층 침범정도, 림프절 전이 유무, 복강 세포진검사는 단변량 분석상 유의한 자궁내막암의 예후인자였다. 다변량 분석상에는 자궁근층의 침범정도와 분화도가 통계학적으로 유의한 인자로부터 나타났다.
Abstract
Objective: This study was performed to evaluate the clinicopathologic prognostic factors and overall survival in patients with uterine endometrial cancer. Methods: From Jan, 1995 to Dec. 2000, medical records of 98 patients with endometrial cancer treated in Kosin University Gospel Hospital were reviewed and the overall survival of patients was determined by support of the death statistics of Korea National Statistical Office. Survival rate was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison, Cox proportional hazards model was used for multivariate analysis. Results: The median age of all patients was 53 years. The most common presenting symptom was abnormal vaginal bleeding (65.3%). The most common histological type was endometrioid adenocarcinoma. (85.1%) The overall 5 years survival rate (5YSR) for all 98 patients was 66.8%. The overall 5YSR for premenopause and postmenopause were 80% and 50%, respectively (p=0.08). The overall 5YSR for preop CA-125 level above 35 U/mL, below 35 U/mL were 40%, 80% (p=0.001). The overall 5YSR of stage I, stage II, stage III, stage IV were 86.8%, 76.9%, 39.4%, 14.4% (p=0.001). The overall 5YSR of grade 1, grade 2, grade 3 were 75%, 70%, 45% (p=0.002). The overall 5YSR of myometrium invasion of none, <1/2, ≥1/2, were 84.3%, 80.3%, 57.2% (p=0.004). The overall 5YSR of peritoneal cytology of negative, posivite were 73.4%, 23.8% (p=0.001). The overall 5YSR of lymphnode metastasis negative, positive were 80.1%, 15% (p=0.001). Conclusion: The age (>50), preop CA-125 level, FIGO surgical stage, grade, myometrial invasion, lymph node metastasis and peritoneal cytology were significant prognostic factors of uterine endometrial cancer affecting 5YSR by univariate analysis. The myometrium invasion and grade were significant prognostic factors affecting 5YSR by multivariate analysis.
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