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이마리아 ( Maria Lee ),남가현 ( Ka Hyun Nam ),권자영 ( Ja Young Kwon ),박용원 ( Yong Won Park ),김영한 ( Young Han Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.12
목적: 본 연구는 항간질약을 복용하는 간질 여성에서 lamotrigine 복용 여부에 따른 임신 예후를 조사하고자 하였다. 연구 방법: 1996년 2월부터 2007년 12월까지 본 병원에서 산전진찰을 시행 받고 분만한 총 138명의 간질 여성에 대해 후향적 연구를 시행하였다. 9명의 환자는 항간질약을 복용하지 않아 연구에서 제외되었다. Lamotrigine을 복용한 군과 Lamotrigine을 제외한 항간질약을 복용한 군으로 분류하여 선천성 기형, 자연 유산, 저체중출생아, 임신 종결, 자궁내태아사망, 조기 분만 그리고 불량한 산모 예후를 비교 분석하였다. 통계 분석은 유의확률이 0.05 미만일 때 유의한 것으로 보았다. 결과: 항간질약을 복용한 129명의 산모 중 8건 (6.2%)의 선천성 기형이 발생하였다. Carbamazepine 단일제제 사용 군에서 4건, valproate 단일제제 사용 군에서 1건, valproate와 carbamazepine 복합제제 사용 군에서 3건의 선천성 기형이 발생하였다. Lamotrigine을 복용하지 않은 군에서만 8건 (8.7%)의 선천성 기형이 발생하였고, 이는 통계학적으로 lamotrigine 복용 군과 유의하게 차이가 있었다 (P=0.047). 특히 복합제제와 단일제제 사용 군으로 나누어 비교하였을 때, 복합제제 사용 군 중, lamotrigine을 포함하지 않는 복합제제 사용 군에서 선천성 기형 발생이 유의하게 높게 나타났다 (P=0.049). 자연유산, 저체중출생아, 임신 종결, 자궁내태아사망, 조기 분만 그리고 불량한 산모의 예후는 두 군간에 차이가 없었다. 결론: 간질이 있는 여성에서 임신 중 Lamotrigine 복용은 복합제제 사용 군에서 다른 약제를 포함한 복합제제를 복용한 경우보다 선천성기형 발생을 감소시키는 데 더 효과적일 것으로 사료된다. Objective: The purpose of this study was to investigate pregnancy outcomes in women with epilepsy using lamotrigine (LTG). Methods: We retrospectively reviewed the medical records of all patients who had been diagnosed as epilepsy and gave live singleton births in Yonsei University Health System, Seoul, Korea, between February 1996 and December 2007. Nine patients who were not taking antiepileptic drugs (AEDs) were excluded from this study. We subdivided the enrolled patients into 2 groups; patients exposed to LTG and others exposed to other AEDs. Congenital malformation, spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were documented to evaluate the pregnancy outcomes. The statistical significance was defined as P<0.05. Results: 129 cases were found in all medical records. The overall risk of congenital malformations in the AED group was 6.2% (n=8), which included 4 cases to carbamazepine (CBZ) monotherapy, 1 to valproate (VPA) monotherapy, and 3 to VPA+CBZ polytherapy. Congenital malformations were significantly increased in the non-LTG groups than in the LTG group (8.7% vs. 0%, P=0.047), especially in non-LTG polytherapy group (20.0% vs. 0%, P=0.049). The rates of spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were no significant differences between the two groups. Conclusion: This study demonstrates that administration of LTG in pregnant women with epilepsy could be more effective in decreasing teratogenicity than administration of other AEDs in polytherapy.
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김미선,권병수,장하균,이승미,장석준,최진영,박상윤,이마리아,유희석,김용범 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.3
Objective: To compare the survival outcomes of adjuvant radiotherapy and chemotherapy in women with uterine-confined endometrial cancer with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CCC). Methods: Medical records of 80 women who underwent surgical staging for endometrial cancer were retrospectively reviewed. Stage I UPSC and CCC were pathologically confirmed after surgery. Survival outcomes were compared between the adjuvant radiotherapy and chemotherapy groups. Results: Fifty-four (67.5%) and 26 (32.5%) women had UPSC and CCC, respectively. Adjuvant therapy was administered to 59/80 (73.8%) women (25 radiotherapy and 34 chemotherapy). High preoperative serum cancer antigen-125 level (25.1±20.2 vs. 11.5±6.5 IU/mL, p<0.001), open surgery (71.2% vs. 28.6%, p=0.001), myometrial invasion (MI) ≥1/2 (33.9% vs. 0, p=0.002), and lymphovascular space invasion (LVSI; 28.8% vs. 4.8%, p=0.023) were frequent in women who received adjuvant therapy compared to those who did not. However, the histologic type, MI ≥1/2, and LVSI did not differ between women who received adjuvant radiotherapy and those who received chemotherapy. The 5-year progression-free survival (78.9% vs. 80.1%, p>0.999) and overall survival (77.5% vs. 87.8%, p=0.373) rates were similar between the groups. Neither radiotherapy (hazard ratio [HR]=1.810; 95% confidence interval [CI]=0.297–11.027; p=0.520) nor chemotherapy (HR=1.638; 95% CI=0.288–9.321; p=0.578) after surgery was independently associated with disease recurrence. Conclusion: Our findings showed similar survival outcomes for adjuvant radiotherapy and chemotherapy in stage I UPSC and CCC of the endometrium. Further large study with analysis stratified by MI or LVSI is required.
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