한국인 안와 악성종양 환자에서 안와내용적출술 후 임상 결과
Clinical Outcomes of Orbital Exenteration in Korean Patients with Orbital Malignancies
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목적: 안와 악성종양을 진단 받고 안와내용적출술을 시행 받은 한국인 환자들의 임상 특징과 결과를 보고하고자 한다. 대상과 방법: 2009년 2월부터 2020년 3월까지 본원에서 안와내용적출술을 시행받은 14명 환자들의 임상 결과(종양의 원발 병변, 종양의 병리조직학적 진단, 국소 재발 또는 전신 전이의 비율, 종양 절제면의 잔존 종양 유무에 따른 전신 전이 발생률과 생존율, 전체 생존율과 무병 생존율, 수술 후 항암 또는 방사선 보조요법 유무)를 후향적으로 조사하였다. 결과: 총 14명의 환자 중 남자는 7명, 여자는 7명이었으며 수술을 시행 받을 당시의 평균 연령은 68세(37-80세)였고 평균 추적 관찰 기간은 44.6개월(10-133개월)이었다. 눈꺼풀이 원발 병변인 것이 7예(50.0%)로 가장 많았고, 병리조직 진단으로는 악성 흑색종이 5건(35.7%)으로 가장 많았다. 수술 후 종양의 국소적 재발은 없었으며 원격 전이는 총 7예에서 발생하였는데 악성 흑색종 5예 중 4예에서 발생하여 가장 많았다. 6예(42.9%)에서 수술 후 절제면에서 잔존 종양이 관찰되었으며 이들의 전신 전이 발생률은 42.9%, 전체 생존율은 60%였다. 1년 전체 생존율은 100%, 2년 전체 생존율은 81.8%, 5년 전체 생존율은 56.1%였으며, 1년 무병 생존율은 100%, 2년 무병 생존율은 72.7%, 5년 무병 생존율은 49.9%였다. 수술 후 9예에서 방사선 또는 항암 보조요법을 시행하였으며 이 중 6예에서는 전신 항암요법과 방사선 보조요법을 병행하였다. 결론: 안와 악성종양을 진단받고 안와내용적출술을 시행 받은 환자들은 추가적인 보조요법을 시행 받았으며 종양의 성질과 특징에 따라 다양한 임상경과와 생존율을 보였다.
Abstract
Purpose: We report the clinical outcomes of Korean patients who were diagnosed with orbital malignancies and underwent orbital exenteration. Methods: We retrospectively reviewed the tumor origins, histopathological diagnoses, local/regional recurrences, distant metastases, surgical margin clearances, overall and event-free survivals, and adjuvant chemotherapy or radiation therapy statuses of 14 patients who underwent orbital exenteration in our center from February 2009 to March 2020. Results: We enrolled seven men and seven women of mean age at the time of exenteration of 68 years (range, 37 to 80 years). The mean follow-up period was 44.6 months (range, 10 to 133 months). Most tumors had arisen in the eyelid (seven cases, 50.0%). The most common pathological diagnosis was malignant melanoma (five cases, 35.7%). We observed no local or regional recurrence after exenteration, but distant metastases developed in seven cases, of which four were malignant melanomas (80% of all melanomas). Positive surgical margins were observed in six cases (42.9%). The distant metastasis rate was 42.9%; the overall survival rate was 60%. The 1-year overall survival rate was 100%, the 2-year survival rate was 81.8%, and the 5-year survival rate was 56.1%. The 1-year event-free survival (EFS) rate was 100%, the 2-year EFS rate was 72.7%, and the 5-year EFS rate was 49.9%. Nine patients received adjuvant radiation or chemotherapy and six patients received combined chemoradiation. Conclusions: Patients underwent orbital exenteration to treat orbital malignancies and received postoperative chemotherapy and/or radiation exhibited differences in clinical outcomes and survival rates depending on the tumor type.
참고문헌 (39)
- Shields JA, "Orbital exenteration with eyelid sparing : indications, technique, and results", Ophthalmic Surg, 22, pp.292~297 (1991)
- Frezzotti R, "Repair after orbital exenteration. Personal technique", Acta Neurochir (Wien), 60, pp.119~124 (1982)
- Shore JW, "Dermis-fat graft for orbital reconstruction after subtotal exenteration", Am J Ophthalmol, 102, pp.228~236 (1986)
- Lee SY, "A 6-year series of orbital exenteration", J Korean Ophthalmol Soc, 41, pp.1102~1111 (2000)
- Bartley GB, "Orbital exenteration at the Mayo Clinic. 1967-1986", Ophthalmology, 96, pp.468~473 (1989)
- Zhang Z, "Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice", Br J Ophthalmol, 102, pp.654~658 (2018)
- Levin PS, "A 20-year series of orbital exenteration", Am J Ophthalmol, 112, pp.496~501 (1991)
- Mohr C, "Orbital exenteration : surgical and reconstructive strategies", Graefes Arch Clin Exp Ophthalmol, 235, pp.288~295 (1997)
- Rahman I, "Orbital exenteration : a 13year Manchester experience", Br J Ophthalmol, 89, pp.1335~1340 (2005)
- Nagendran ST, "Orbital exenteration : the 10-year Massachusetts eye and ear infirmary experience", Orbit, 35, pp.199~206 (2016)
- Naquin HA, "Exenteration of the orbit", AMA Arch Ophthalmol, 51, pp.850~862 (1954)
- Rathbun JE, "Evaluation of 48 cases of orbital exenteration", Am J Ophthalmol, 72, pp.191~199 (1971)
- Schwartz JN, "Ocular and orbital phycomycosis", Surv Ophthalmol, 22, pp.3~28 (1977)
- Wong JC, "Life expectancy following orbital exenteration", Br J Ophthalmol, 99, pp.1~4 (2015)
- abolfazl kasaee, "Orbital Exenteration: A 23-year Report", Korean Journal of Ophthalmology, 33(4), pp.366~370 (2019), 대한안과학회[DOI]
- Ben Simon GJ, "Orbital exenteration : one size does not fit all", Am J Ophthalmol, 139, pp.11~17 (2005)
- Aryasit O, "Factors related to survival outcomes following orbital exenteration : a retrospective, comparative, case series", BMC Ophthalmol, 18, pp.186~ (2018)
- Maheshwari R, "Review of orbital exenteration from an eye care centre in western India", Orbit, 29, pp.35~38 (2010)
- Pushker N, "Pattern of orbital exenteration in a tertiary eye care centre in India", Clin Exp Ophthalmol, 32, pp.51~54 (2004)
- Sihota R, "Malignant eyelid tumors in an Indian population", Arch Ophthalmol, 114, pp.108~109 (1996)
- Paridaens AD, "Orbital exenteration in 95 cases of primary conjunctival malignant melanoma", Br J Ophthalmol, 78, pp.520~528 (1994)
- Shields CL, "Conjunctival melanoma : risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients", Arch Ophthalmol, 118, pp.1497~1507 (2000)
- Shields JA, "Clinical features predictive of orbital exenteration for conjunctival melanoma", Ophthalmic Plast Reconstr Surg, 16, pp.173~178 (2000)
- Rose AM, "Primary orbital melanoma : presentation, treatment, and long-term outcomes for 13patients", Front Oncol, 7, pp.316~ (2017)
- Rose AM, "Presentation, treatment, and prognosis of secondary melanoma within the orbit", Front Oncol, 7, pp.125~ (2017)
- Rini FJ, "The treatment of advanced choroidal melanoma with massive orbital extension", Am J Ophthalmol, 104, pp.634~640 (1987)
- Pach JM, "Prognostic factors in choroidal and ciliary body melanomas with extrascleral extension", Am J Ophthalmol, 101, pp.325~331 (1986)
- Kersten RC, "The role of orbital exenteration in choroidal melanoma with extrascleral extension", Ophthalmology, 92, pp.436~443 (1985)
- Shan Y, "Epidemiology and survival outcomes for eyelid primary malignant melanoma : an analysis of 1397 cases in the SEER database", J Ophthalmol, 2020, pp.4858636~ (2020)
- Malhotra R, "Mapped serial excision for periocular lentigo maligna and lentigo maligna melanoma", Ophthalmology, 110, pp.2011~2018 (2003)
- Cook BE Jr, "Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota", Ophthalmology, 106, pp.746~750 (1999)
- Breslow A, "Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma", Ann Surg, 172, pp.902~908 (1970)
- Esmaeli B, "Prognostic factors for survival in malignant melanoma of the eyelid skin", Ophthalmic Plast Reconstr Surg, 16, pp.250~257 (2000)
- Rahman I, "Mortality following exenteration for malignant tumours of the orbit", Br J Ophthalmol, 89, pp.1445~1448 (2005)
- Mouriaux F, "Survival after malignant tumors of the orbit and periorbit treated by exenteration", Acta Ophthalmol Scand, 77, pp.326~330 (1999)
- Nemet AY, "Orbital exenteration : a 15-year study of 38 cases", Ophthalmic Plast Reconstr Surg, 23, pp.468~472 (2007)
- Skinner HD, "Outcomes of malignant tumors of the lacrimal apparatus : the University of Texas MD Anderson Cancer Center experience", Cancer, 117, pp.2801~2810 (2011)
- Croce A, "Orbital exenteration in elderly patients : personal experience", Acta Otorhinolaryngol Ital, 28, pp.193~199 (2008)
- Tyers AG, "Orbital exenteration for invasive skin tumours", Eye(Lond), 20, pp.1165~1170 (2006)