일반연제 발표 : 부인과종양학 ; 외음부암, 질암, 자궁경부암의 Mouse Model

강순범,김해석,송용상,이효표 대한산부인과학회 1991 대한산부인과학회 학술대회 Vol.68 No.-

자궁경부암에서 선행보조 항암화학요법의 효과

강순범,이효표,송용상,김재원,박노현,고창원 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

Neoadjuvant chemotherapy is used as a new therapeutic modality in the treatment of locally advanced cervical cancer, but limited information is available regarding the effectiveness and survival. The aim of this study is to identify the factors concerning chemoresponsiveness and survival, and to evaluate the efficacy of neoadjuvant combination chemotherapy(NAC) for the patients with locally advanced cervical cancer in terms of 2-year disease-free survival (DFS). Between June 1987 and May 1992, 77 patients with bulky or locally advanced cervical cancer(FIGO Stage IB-III) received two or three courses of NAC. Sixty patients were treated with FP chemotherapy regimen consisting of 5-FU 1000mg/m²(day 1~day 5), CDDP 60mg/m²(day 1) and remaining 17 patients received EP chemotherapy consisting of Epirubicin 110mg/m²(day 1), CDDP 60mg/m²(day 1). After chemotherapy, patients were treated with surgery or radiotherapy according to feasibility. The effectiveness of NAC was evaluated for response by using World Health Organization criteria. Factors related to chemores ponse and survival were analyzed. The overall clinical response rate was 61%, which included a complete response(CR) in 16 patients(20.8%) and a partial response(PR) in 27 patients (40.2%). Mass size but none of the other parameters studied(age, stage, histologic type, chemotherapy regimen) was related to chemoresponsiveness. This therapy rendered radical surgery feasible in 58 evaluable cases(75.3%). Pretereatment characteristics were analyzed for response to NAC. Significantly lower response rates(38.2%) and lower 2-year DFS rates(48.7%) were found in stage II or III patients with tumor size more than 4 cm in diameter. Patients achieving CR or PR had a significantly improved 2-year DFS rate compared with those who did not respond. Lymph-node metastases were found after chemotherapy in 34.5%(20/58) of the surgically treated patients and less than 3 lymph node were involved in 10 patients. Pathologic parametrial involvement was found to be the most significant prognostic factor for recurrence. A 2-year DFS of 72% and 48.7% for stage IB-IIA, I IB-III, respectively, was found. According to chemoresponsiveness, these rate was 78% for responders and 31.6% for nonresponders, respectively. Poor chemoresponsiveness and uncertain survival benifits in stage II, III with bulky mass necessitate more effective therapeutic modalities in this group of patients.

골반동정맥기형 1 례

강순범,이효표,송용상,박노현,박재형,노주원,김상준 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Arteriovenous malformation of the female pelvis is a rare condition, and its diagnosis, classification, and treatment are still sources of considerable confusion. Now, multidisciplinary and individualized approaches with the use of modern interventional radiologic technology are stressed and play an important role in the management of female pelvic arteriovenous malformation. We experienced a patient, 28-year0old woman with a uterine arteriovenous malformation presenting with irregular vaginal bleeding. At physical examination the slightly enlarged uterus was found, but no other abdominal or cardiopulmonary abnormalities were found. Diagnosis was established by angiography and contrast-enhanced CT/MRI scan. The patient underwent preoperative intra-arterial embolization to decrease operative morbidity and facilitate complete removal. Hysterectomy and resection of surrounding tissue was done successfully. Pathologic examination showed that the uterine myometrium was involved by the arteriovenous malformation and it was composed of fat and fibrous tissues with shick-walled and dilated blood vessels of various diameter. Now we report a case of arteriovenous malformation with a brief review.

진행성 난소암에서 분리중합효소연쇄반응 (differential PCR) 을 이용한 HER-2/neu 종양유전자 증폭양상의 임상적 유용성에 관한 연구

강순범,유상영 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

The HER-2/neu oncogene, located on chromosome 17q, encodes a transmembrane cell surface glycoprotein of 185kD that is similar to the epidermal growth factor receptor. HER-2/neu oncogene amplification was shown to occur in a number of adenocarcinomas and seems to be a valuable prognostic parameter. This present study was carried out to investigate the prevalence of HER-2/neu oncogene amplification by differential polymerase chain reaction and to examine whether HER-2/neu oncogene overamplification has any prognostic significance in advanced ovarian cancer patients. Amplification of HER-2/neu oncogene was assessed in 32 cases of FIGO stage Ⅲ and Ⅳ advanced ovarian cancers(24 epithelial ovarian cancers, 2 Brenner tumors, 2 malignant mixed mullerian tumors, 2 granulosa cell tumors, 1 struma ovarii, 1 Krukenberg tumor) using differential polymerase chain reaction. HER-2/neu oncogene was amplified in all of the ovarian cancers(100%, 32/32), but significant overamplification[gene copy number ≥ 1.5 a.u.(arbitrary unit)] was assessed in 50%(12/24) of epithelial ovarian cancers. There was no correlation between HER-2/neu oncogene overamplification and cell type or grade of tumor or initial CA-125 level. The clinical complete remission rate in high copy group(gene copy number ≥ 1.5 a.u.) was 25%(3/12) and that of low copy group(gene copy number < 1.5 a.u.) was 50%(6/12), and pathologic complete remission rate was 0%(0/12) in high copy group and 25%(3/12) in low copy group. Median survival in high copy group was 28 months and 35 months in low copy group, and there was no correlation between HER-2/neu oncogene overamplification and overall survival(p=0.12). This result suggests that HER-2/neu oncogene overamplification is not a significant prognostic factor of advanced ovarian cancer, but large scaled prospective randomized studies are required.

불임환자의 고 Prolactin 혈증에 관한 연구

강순범,강병문,김정구,이진용,장윤석,Kang, S.B.,Kang, B.M.,Kim, J.G.,Lee, J.Y.,Chang, Y.S. 대한생식의학회 1986 Clinical and Experimental Reproductive Medicine Vol.13 No.1

It is now apparent that many cases of amenorrhea. oligomenorrhea. corpus luteum deficiency, galactorrhea, and infertility are due to hyperprolactinemia. We investigated the relationships between serum prolactin values and factors such as menstrual pattern, frequency of galactorrhea etc, in 135 hyperproIactinemic patients at the Seoul National University Hospital during a period of 6 years, from January, 1979 to December, 1984. The results was as follows: 1. Menstrual pattern changed according to the serum prolactin level. The frequency of amenorrhea is 1.7 percent in patients with serum prolactin levels ranged from $25{\sim}40ng/ml$, whereas 72.4 percent in patients with serum prolactin levels above 100ng/ml. 2. The incidence of galactorrhea in hyperprolactinemic patients was 3.1 percent and the frequency of galactorrhea had direct relationship with the serum prolactin level and/or the frequency of abnormal menstrual pattern. 3. The incidence of pituitary tumor in hyperprolactinemic patients was 104 percent and sixty percent of patients with serum prolactin levels above 100ng/ml had a pituitary tumor . 4. There was an inverse correlation between serum prolactin and progesletone value. 5. The frequency of anovulatory menstrual cycle evidenced by basal body temperature is 23.9 percent in patients with serum prolactin levels ranged from $20{\sim}40ng/ml$, whereas 76.9 percent in patients with serum prolactin levels above 100ng/ml.

유전성 난소암: 3가계 증례 보고

강순범,김현열,문혜성,소용상,이효표,이진용,박재갑 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.4

임신성 융모종양 전이검사에서 최소검사기준의 효용성

강순범,이효표,송용상,박창수,박노현,김홍배,김현열 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.12

1980년부터 1992년까지 서울대학교 산부인과 종양크리닉에 등록된 총 238명의 임신성융모종양 환자의 임상기록을 검토하여 이들의 임상적 특성 및 최소검사기준의 효용성에 대하여 다음과 같은 결론을 얻었다. 1. 비전이성 환자는 110명(46.22%) 전이성 환자는 128(53.78%)이었고, 전이성 환자중 예후인자가 양호환 환자는 60명(46.88%), 불량한 환자는 68명(53.13%)이었으며 고위험부위 전이환자는 24명(18.75%)이었다. 2. 고위험부위 전이환자에 특징적 소견은 1) 흉부 혹은 질부위에 전이가 있는 경우 92%(22/24), 2) 고위험인자를 하나이상 소유한 경우 75%(18/24), 3) 고위험부위 전이소견이 있는 경우 97%(23/24)이었다. 3. 최소검사기준에 따라 방사선학적 정밀검사를 선택적으로 시행한 경우, 이러한 기준의 민감도는 100%(36/36), 특이도는 51.40%(110/214)이었다. 결론적으로 최소검사기준에 따라 검사를 시행했을 때 46.22%에서 고위험 부위전이를 찾아내는데 아무런 영향없이도 고가의 방사선 정밀검사를 줄일 수 있을 것으로 사료된다. Background : For adequate clinical classification and management of gestational trophoblastic tumor(GTT), metastatic survey is very important. But expensive cost for high resolution radiologic examinatin and relatively low incidence of high risk site metastatic made us to evaluate the efficacy of minimal work-up in detecting metastatic site. Materials and Methods : Between 1980 and 1992, 110 patients with nonmetastatic and 128 patients with metastatic Gestational Trophoblastic Tumors were enlisted at oncology department of Seoul National Unviersity Hospitial. These patient`s reconds were reviewed and factors which might predict the presence of high risk sites metastases(brain. liver, kidney, spleen,et al) were identifed. Results : Characteristics of high risk site metastatic patients were metastases in lungs or vagina(22/24, 92%) at least one or more other poor pognosis factor (i.e., b-HCG titer$gt;40,000mIU/ml, greater than 4 months since onset of symptoms, anteccedent term pregnancy) (18/24, 75%), obvious symptoms or signs related to high risk site metastases(23/24. 97%) On the basis of these data, we evaluated the efficacy of minimal staging work-up according to the following criteria. 1) all patients received history, physical examination, HCG level, and chest PA radiogaphy 2) only patients with lung or vaginal metastases or obvious symptoms received a brain and abdomen C-T scan. Using this criteria, minimal staging work-up ofr the patients with high risk site metastases were identified with sensitiveity of 100% and specificity of 51.40%. Conclusions : Minimal staging work-up can save the cost and time by reducing unneccessary CT scanning in approximately 46% of patients with GTT. Further study is neccessary to assess the actual role of minimal work-up in the management of GTT.

Management of Borderline Tumors of Ovary

강순범 대한부인종양 콜포스코피학회 1995 Journal of Gynecologic Oncology Vol.6 No.4

부인과 악성종양에서 종양표지물질 Sialyl-Tn (STN) 의 효용성에 관한 연구

강순범,이효표,송용상,박창수,박노현,김홍배 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.11

부인과 종양환자에서 종양표지물질인 Sialyl-Tn 항원의 혈청값을 측정하여 그효용성을 알아보고자 자궁경부상피내암 26명, 자궁경부암 90명, 난소암 41명, 자궁내막암 9명, 자궁근종 32명, 양성난소종양 환자 54명 등 총 252명을 대상으로 치료전후의 혈청내 STN 항원 값을 측정하여 다음과 같은 결론을 얻었다. 1. STN 항원의 정상기준치를 38 U/ml로 하였을때 양성율은 자궁경부상피내암 19%(5/26), 자궁경부암 1기 4.4%(2/45), 2기 14.3%(5/35), 3기 37.5%(3/8), 4기 100%(2/2)이었다. 자궁내막암 환자에서의 양성율은 22.2%(2/9)이었다. 악성난소종양 36.6%이었으며 악성 난소종양 병기별로는 1기 28.6%(4/14), 2기 0%(0/2), 3기 47.4%(9/19), 4기 50%(3/6)이었다. 자궁근종에서의 양성율은 0%(0/32), 양성난소종양에서는 1.9%(1/54)이었다. 2. 질환 및 병기별 STN 평균값은 자궁근종 16.34 U/ml, 자궁내막암 81.58 U/ml, 자궁경부암 1기 32.99 U/ml, 1기 21.17 U/ml, 2기 24.3 U/ml, 3기 33.3 U/ml, 4기 248.25 U/ml, 양성 난소종양 23.00 U/ml, 난소암 1기 31.50 U/ml, 2기 20.15 U/ml, 3기 107.31 U/ml, 4기 105.22 U/ml이었다. 3. 조직학적 분류에 따른 양성율은 자궁경부암에서 편평상피암 14%(12/83), 선암 및 소세포암 0%이었으며, 악성난소종양에서는 장액성 33.3%(8/24), 점액성 41.7%(5/12), 자궁내막양 33.3%(1/3), 기타 50%(1/2)이었다. 4. 자궁근종을 정상대조군으로 하였을때 자궁경부암에서의 STN 항원의 민감도는 13.3%, 특이도 100%, 양성예측도 100%, 음성예측도 29%, 정확도 36.1%이었으며 양성난소종양을 정상대조군으로도 36.1%이었으며 양성난소종양을 정상대조군으로 하였을때 악성난소암의 민감도는 39.0%, 특이도 98.1%, 양성예측도 94.1%, 음성예측도 67.9%, 정확도 72.6%이었다. 5. 71명의 부인암(자궁경부암 60명, 난소암 9명, 자궁내막암 2명)환자에서 수술후 검체를 채취하였으며 이들중 9명에서 양성을 보였다. 양성값을 보인 환자 9명중 5명에서는 정상치 이하로 감소하였으나 나머지 4명에서는 비슷한 값을 유지하거나 증가하였다. 이상의 결과로 STN종양표지물은 자궁경부암, 자궁내막암에서도 민감도가 낮아 임상적 사용에 한계가 있다. 그러나 난소암에서는 비교적 민감도가 높으며 특히 위양성율이 매우 낮기 때문에 CA-125의 위양성율을 보완할 수 있는 종양표지물질로 사용될 수 있을 것으로 생각되며 더 많은 수의 대상군 및 정상대조군에 대한 연구가 필요할 것으로 사료된다. To investigate the role of sialyl-Tn antigen in various gynecologic malignancies, we obtained serum samples from patients with benign and malignant tumors. Malignant tumors were 90 cervical cancers, 41 ovarian cancers and 9 endometrial cancers, and benign tumors were 32 uterine myomas, 54 benign ovarian tumors and 26 cervical carcinoma in situ. Circulating serum STN-antigen concentrations(U/ml) were determined by using a competitive radio-immunoassay kit(Otsuka Assay Laboratories, Tokushima, Japan). Using cutoff value of 38 U/ml, 13.3%(12/90) of cervical cancers, 22.2%(2/9) of endometrial cancers, 36.6%(15/41) of ovarian cancers had positive results. But in patients with myoma or benign ovarian tumors, abnormal STN elevation was not observed except one case of ovarian endometrioma. Mucinous ovarian cancer showed higher positive rate(41.7%, 5/12) than serous(33.3%, 8.24) or endometrioid type(33.3%, 1/3), but it was not statistically significant. Postoperative follow up samples were obtained from 71 cancer patients(9 ovarian cancer, 60 cervix cancer, 2 endometrial cancer). Among 9 patients with initially elevated STN level, only 5 patients showed significant decrease in serum STN antigen levels. Because of its low sensitivity and histologic specificity, STN antigen has limited clinical value in gynecologic malignancy. But it showed very low positive rate in benign ovarian tumors and myomas, and so the combination of STN antigen with other tumor markers may compensate the falso positive rate in diagnosing hynecologic malignancy. The use of the STN antigen as a tumor marker for various gynecologic cancers requires further study.

자궁선근증에 대한 임상 및 병리학적 고찰

강순범 대한산부인과학회 1984 대한산부인과학회 학술대회 Vol.53 No.-