자궁내막암 환자에서 림프-혈관 침윤의 임상적 고찰
The effect of lymph-vascular space invasion on clinicopathologic features in patients with endometrial cancer
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목적: 본 연구에서는 림프-혈관 침윤이 자궁내막암 환자들에서 임상-조직학적 특징 및 임상 결과에 관해 미치는 영향을 알아보고자 했다. 연구 방법: 2000년 1월부터 2003년 12월까지 4년 동안 제일병원에서 자궁내막암으로 진단된 후 수술로 치료한 141명의 환자들의 의무기록을 후향적으로 조사하였다. 모든 림프-혈관 침윤의 조직병리학적 소견들은 제일병원의 조직병리 전문의가 검토하였다. 림프-혈관 침윤이 임상-조직학적 특징과 임상결과에 미치는 영향을 림프-혈관 침범이 있는 환자군과 없는 환자군을 비교하여 분석하였다. 통계의 분석은 DBSTAT 4.0에 의해 실행되었다. 결과: 본 연구에서 림프-혈관 침윤이 있는 경우는 55명 (39%), 없는 경우는 86명 (61%)이었다. 림프-혈관 침윤이 있는 환자군 55명과 없는 환자군 86명을 비교하여 림프-혈관 침윤과 인구학적 요인들과의 상관 관계를 보면, 고령과는 통계적으로 유의한 차이가 있었다. 또 림프-혈관 침윤과 다른 예후 인자들간의 상관관계를 보면, 수술 전 자궁경부세포진검사, 분화도, 자궁내막암의 크기, 자궁근층의 침윤 정도, 골반림프절 침윤, 대동맥 주변 림프절 침윤, 병기의 진행 정도와 통계적으로 유의한 차이를 보였다. 결론: 자궁내막암 환자에서 림프-혈관 침윤이 있는 환자들의 경우 일반적으로 종양 크기가 2 cm 이상인 경우가 많고, 자궁근층의 침윤 및 림프절 전이와 진행된 병기와 관련 있는 경우가 더 많다. 그러므로 자궁내막암의 적절한 처치에 있어 반드시 림프-혈관 침윤 여부를 고려해야 한다.
Abstract
Objective: The aim of this study was to evaluate the effect of lymph-vascular space invasion (LVSI) on clinicopathologic features and outcomes in patients with endometrial cancer. Methods: All women who were surgically treated for endometrial cancer at the Cheil General Hospital & Women`s Healthcare Center between January 2000 and December 2003 were eligible. One hundred-forty one patients underwent retrospective review of medical record. Pathologic findings of LVSI were reviewed and divided in LVSI-positive group and LVSI-negative. Statistical analysis was performed by dBSTAT-4. Results: Fifty-five patients (39%) were LVSI-positive and eighty-six patients (61%) were LVSI-negative. LVSI-positive patients were statistically older than LVSI-negative. LVSI-positive patients had more abnormal cytology, poorer differentiation, larger tumor size (diameter>2 cm), more myometrial invasion. more pelvic nodal metastasis, more paraaortic nodal metastasis, and more advanced stage. There was no difference between the two groups in the percentage of patients with gravidity, parity, histologic types (endometrioid vs nonendometrioid). Conclusion: LVSI-positive patients with endometrial cancer are generally older, consistent with more abnormal cytology, poorer differentiation, larger tumor size, more myometrial invasion, more lymph-node metastasis, and more advanced-stage disease. So, LVSI should be a consideration in appropriate treatment in endometrial cancer.
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