Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Clinicopathologic analysis and prognosis of uterine cervical cancer

자궁경부암 환자의 임상병리학적 분석 및 예후에 관한 연구

Lim, Myong-Cheol;Lee, Seon-Kyung;Park, Seong-Jae;Kim, Seung-Bo
임명철;이선경;박성재;김승보

  • Published : 20050200
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Abstract

Objective: The object of this retrospective study was to evaluate the clinical characteristics and prognosis of invasive uterine cervical cancer. Methods: 445 evaluable patients with invasive cancer of the cervix were treated at Kyung Hee Medical Center from March 1984 to March 1998. In this retrospective study, we studied the clinico-pathologic characteristics (age, FIGO stage, histologic type, nodal metastasis, and treatment modalities et al) by the review of medical records. Results: 1. The age distribution among the 445 patients ranged from 27 to 90 years, mostly at 51-60 years, which occupied 26.5%. The mean age was 48.9 years. 2. The frequent number of pregnancies was 3-4 times, which occupied 33.3%. The mean number of pregnancies was 5.3 times. The frequent number of deliveries was 3-4 times, which occupied 41.7%. The mean number of deliveries was 3.2 times. 3. Subdivision of 445 cases of invasive cervical carcinoma were made according to the FIGO clinical staging: Stage Ia 77 cases (17.3%), Stage Ib 156 cases (35.0%), Stage IIa 95 cases (21.3%), and Stage IIb 52 cases (11.7%), Stage III 40 cases (9.0%), and Stage IV 25 cases (5.6%). 4. Histologically, squamous cell carcinoma comprised 91.2%, adenocarcinoma 6.6%, adenosquamous carcinoma 1.7%, and others 0.5%. 5. The types of treatment were as follows; operation 36.2%, operation with chemoradiation 13.8%, operation with radiotherapy 11.4%, operation with chemotherapy 11.0%, radiation 8.8%, chemoradiation 6.9%, and others 12.0%. 6. All the excised pelvic and para-aortic lymph nodes (LN) were histologically examined and the incidence of metastasis by clinical stage showed as follows. In Stage Ib 16.4%, 2.3%, in Stage IIa 24.5%, 3.2%, and in the stage IIb 26.7%, 6.7% respectively. The most frequently involved LN among regional pelvic LN is the obturator LN (32%) followed by the external iliac LN (29%). 7. Based on the 445 cases who were available to follow up 5 years or more after treatment, survival rates were studied and analyzed. 5 year survival rate by stage revealed 96% in stage Ia, 87.3% in stage Ib, 81.3% in stage IIa, 72% in stage IIb, 47% in stage III, and 26.4% in stage IV. Conclusion: FIGO stage, involvement of resection margin, and LN involvement had prognostic significance in multivariate analysis (p<0.01). However, tumor size, histologic type, depth of cervical wall invasion, and lymphovascular space invasion did not.

목적: 자궁경부암은 최근 조기 진단 및 치료로 생존율이 점차 증가하고 있으나 여전히 높은 발생 빈도를 보이는 여성암이라 할 수 있다. 이번 연구를 통해 임상적 특징과 인구통계학적 분석을 하고, 5년 생존률에 영향을 주는 임상적 예후인자를 확인하여 향후 자궁경부암 환자의 치료에 도움을 주고자 하였다. 연구 방법: 1984부터 1998년까지 경희대학교 산부인과에서 자궁경부암으로 진단받고 추적관찰이 가능하였던 445명을 대상으로 후향적으로 FIGO stage, 조직학적 유형, 림프절 전이, 치료방법 및 5년 생존율 등을 연구하였다. 결과: 환자의 평균나이는 48.9세였으며, 51-60세군이 26.5%로 가장 많은 분포를 차지했다. FIGO stage는 I기가 65명 (14.6%), Ⅰb기가 170명 (38.2%), Ⅱa기가 105명 (23.6%), Ⅱb기가 51명 (11.5%), Ⅲ기가 35명 (7.9%), Ⅳ기가 19명 (4.3%)이었다. 병리기록에 의하면 편평상피세포암이 91.2%, 선암이 6.6%, 편평상피선암이 1.8%, 기타가 0.45%였다. 내원 당시 호소하였던 주증상은 접촉성 출혈 (55.1%), 부정 성기출혈 (18.0%), 질 분비물 (6.3%), 하복부 불쾌감 (5.2%)의 순이었다. 치료방법은 수술 35.3%, 수술 및 항암화학-방사선요법 15.1%, 수술 및 방사선 요법 11.9%, 수술 및 항암화학요법 11.7%, 방사선치료 8.8%, 항암화학-방사선요법 6.9%, 기타 12.0%. 림프절 절제 전이의 빈도는 골반 림프절 및 방대동맥 림프절의 전이가 Ib기에서 각각 16.4%, 2.3%, Ⅱa기에서 24. 5%, 3.2%, IIb기에서 26.7%, 6.7%이었다. 가장 많이 전이된 림프절은 폐쇄 림프절 (32%)이었으며, 다음으로 외장골 림프절 (29%)이었다. 5년 생존율은 Ia기에서 96%, Ib기에서 87.3%, IIa기에서 81.3%, IIb기에서 72%, III기에서 47%, IV기에서 26.4%였다. 결론: FIGO stage, 절단면의 잔류암의 침범유무, 림프절 전이여부가 독립적 예후인자였고 (p<0.01), 종양의 크기, 조직학적 유형, 자궁경부 조직의 침범정도 및 림프혈관 침범유무는 생존율에 영향을 미치지 못했다.

Keywords

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