5-year Survival of 266 Patients with Epithelial Ovarian Cancer

문을주 ( Eul Ju Moon ),( Byoung Sun Youn ),( Sang Young Ryu ),( Jong Hoon Kim ),( Byoung Gie Kim ),( Sang Yoon Park ),( Eui Don Lee ),( Kyung Hee Lee ),( Soo Yong Choi ) 대한산부인과학회 1999 대한산부인과학회 학술대회 Vol.84 No.-

상피성 난소암 217 례의 임상병리학적 특징과 생존율 분석

문을주(Eul Ju Moon),전우진(Woo Jin Jeon),이재규(Jae Kyu Lee),윤병선(Byoung Sun Youn),유상영(Sang Young Ryu),김종훈(Jong Hoon Kim),김병기(Byoung Gie Kim),박상윤(Sang Yoon Park),이의돈(Eui Don Lee),김경희(Kyung Hee Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : 난소암은 우리 나라에서 점차 증가하고 있는 악성 부인종양으로 진단시 대부분 진행성으로 발견되어 예후가 매우 불량하다고 알려져 있으나 우리 나라에서의 상피성 난소암 환자의 예후 및 예후인자에 관하여 알려진 바가 많지 않다. 이에 본 연구에서는 상피성 난소암 환자의 임상병리학적 특징, 5년 생존율과 생존율에 영향을 미치는 예후인자 등을 평가하고자 하였다. 연구 방법 : 1990년 1월부터 1996년 12월까지 원자력병원 산부인과에서 치료를 받았던 상피성 난소암 환자 266명 중 경계성 종양과 일차 중복 종양을 제외한 217명을 대상으로 임상병리학적 특성 및 생존율을 분석하였으며 생존율에 영향을 미치는 예후인자 평가를 위해 단변량 및 다변량 분석을 시행하였다. 결과 : 평균 연령은 49세(연령 분포 13-85세)였으며 임상 증상으로는 복강내 종괴 촉지가 가장 많았다. FIGO 분류에 따른 병기별 분포는 제 1기가 34.0%, 제 2기가 6.4%, 제 3기가 43.6%, 제 4기가 10.1%로 대부분 진행성으로 발견되었으며, 병리학적 분포는 장액성 낭선암이 39.2%로 가장 많았고 점액성 낭선암, 자궁내막양 선암, Brenner 종양 및 투명세포암 순이었다. 상피성 난소암의 5년 생존율은 42.3%였으며 FIGO 수술적 병기에 따른 생존율은 1기가 78.2%, 2기가 53.5%, 3기가 21.1%, 4기가 8.3%였다. 상피성 난소암 환자에서 단변량 분석을 시행해 본 결과 연령, FIGO 수술적 병기, 수술 후 잔류 종괴 크기가 생존율에 영향을 미쳤으나 다변량 분석상 FIGO 수술적 병기(p=0.0002)와 수술 후 잔류 종괴 크기(p=0.0116)가 유의한 예후인자로 확인되었다.결론 : 본 연구에서 상피성 난소암 환자의 평균 연령은 49세로 기존의 보고보다 진단 연령이 10여년 낮게 나타났으며 대부분 FIGO 병기 3, 4기에 발견되었고 상대적으로 1기의 환자가 많은 분포를 보였다. 상피성 난소암의 5년 생존율은 42.3%이었으며 FIGO 병기와 수술 후 잔류 종괴가 생존율에 영향을 미치는 예후인자로서 유의하였다. Objective : Ovarian cancer usually presents with already advanced disease at the time of diagnosis and is known to have a poor prognosis. But the prognosis and prognostic factors of patients with epithelial ovarian cancer are still inconclusive. This study is performed to evaluate the clinicopathologic characteristics, overall 5-year survival rate and prognostic factors affecting survival in patients with epithelial ovarian cancer. Methods : We retrospectively investigated the outcome of 266 patients with epithelial ovarian cancer, who had been treated at the Korea Cancer Center Hospital from Jan. 1990 to Dec. 1996. Among 266 cases of the epithelial ovarian cancer, 49 cases were excluded due to borderline tumor or double primary cancer. Univariate and multivariate analysis for survival were conducted to test the prognostic significance of several clinicopathologic factors among subjects. Results : The median age of the patients with epithelial ovarian cancer was 49 years (range 13-85) and the most common subjective symptom was abdominal mass sensation (31.3%). The FIGO stage distribution was 34.0% for stage I, 6.4% for stage II, 43.6% for stage III, and 10.1% for stage IV. Serous carcinoma was the most common histologic type (39.2%), followed by mucinous (29.5%), endometrioid (12.9%), Brenner tumor and clear cell carcinoma (1.8%, respectively). The overall 5-year survival rate was 42.3%. The 5-year survival rates of stage I were 78.2%, stage II 53.5%, stage III 21.1% and stage IV 8.3%. In multivariate analysis, stage and residual disease were found to be significant independent prognostic factors (p=0.0002, p=0.0116 respectively), but age (< 50 vs. 50) was not significant (p=0.1099). Conclusion : In this study, the median age of the patients with epithelial ovarian cancer was 49 years, which is 10 years younger than that of other reports. Most patients were with advanced stage but the proportion of patients with stage I was relatively higher. The overall 5-year survival rate of patients with epithelial ovarian cancer was 42.3% and the survival depends on two most important prognostic factors, stage and residual tumor after primary surgery.

평활근 분화를 보이는 자궁내막 기질육종 1 예

이시은(Si Eun Lee),문을주(Eul Ju Moon),박연진(Yeon Jin Park),노주원(Ju Won Roh),김희성(Hee Sung Kim),심정석(Jung Suk Sim),박종두(Jong Du Park),박상윤(Sang Yoon Park) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

Mixed endometrial stromal and smooth-muscle tumor is one of the uncommon forms of uterine sarcoma. Only a few cases of endometrial stromal tumors showing smooth muscle differentiation have been reported in the literature. We experienced a case of low grade endometrial stromal sarcoma with smooth muscle differentiation in a 44-year-old woman, so we report this case with brief review of literatures.

자궁내막암 100 례의 임상병리학적 특성 및 예후에 관한 연구

전우진(Woo Jin Jeon),문을주(Eul Ju Moon),유상영(Sang Young Ryu),김종훈(Jong Hoon Kim),김병기(Byoung Gie Kim),박상윤(Sang Yoon Park),이재규(Jae Kyu Lee),이의돈(Eui Don Lee),이종성(Jong Sung Lee),이경희(Kyung Hee Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

목적 : 본 연구는 자궁내막암의 임상병리학적 특징 및 예후를 알아보기 위하여 본원에서 자궁내막암으로 진단 받은 100명의 환자를 대상으로 시행하였다. 연구 방법 : 1988년 1월부터 1997년 12월까지 원자력 병원에서 자궁내막암으로 치료 받은 100명의 환자를 대상으로 하였으며, 환자의 임상병리학적 특징과 예후인자, 질병 및 생존여부확인을 위하여 환자의 의무기록, 수술기록, 병리검사 결과지 등을 검토하였다.환자의 생존율은 의무기록 상 최종추적 관찰일과 서신, 전화 등에 의한 생존유무 확인을 근거로 산출하고, 대상환자의 임상병리학적 특징과 각 예후인자에 따른 5년 무병생존율을 조사하였으며 예후인자간의 생존율을 비교하였다. 결과 : 환자의 평균 연령은 52세였으며, 가장 흔한 증상은 비정상적 질 출혈(89%)이었다. 1예의 유두상 장액성 선암을 제외한 모든 환자가 자궁내막양선암이었다. 조직학적 분화도(grade)는 grade 1, 2, 3, 미상이 각각 38%, 39%, 7%, 16%였으며, FIGO 수술적 병기는 1, 2, 3, 4, 미상이 각각 73%, 3%, 18%, 1%, 5%였다. 대부분의(85%) 환자에서 수술적 처치 단독 혹은 수술적 처치 후 방사선치료를 시행하였다. 전체 환자의 5년 무병생존율은 86.9%였으며, FIGO 수술적 병기 제1, 2기의 5년 무병생존율은 90.3%였고, 제 3, 4기는 73.6%였다. 발생시 연령, 분만력, 조직학적 분화도, 수술 전 시행한 자궁경부 세포진 검사결과 등은 예후인자로서의 중요성을 가지지 못했다. 자궁근층 침범정도 (p=0.039), FIGO 수술적 병기 (p=0.0249), 림프절 전이유무 (p=0.0054) 등이 단변량 분석상 통계적으로 유의한 결과를 보였다.결론 : 대상 환자의 수가 충분하지는 않았지만 자궁근층 침범정도, FIGO 수술적 병기, 림프절 전이유무 등이 자궁내막암의 예후인자로서의 중요성을 가지는 것으로 조사되었다. Objective : This study was performed to evaluate the clinicopathologic characteristics and prognosis of uterine endometrial cancer.Methods : From Jan. 1988 to Dec. 1997, medical records including operation record and pathologic reports of 100 patients with histologically proven endometrial cancer at Korea Cancer Center Hospital were reviewed. The survival of patients was determined by description of last follow up date in medical records. If more than 3months passed from last follow up date, we used mail and phone call to identify the status of patients. Results : The mean age of these patients was 52years, the most common presenting symptom was abnormal vaginal bleeding(89%). All except one case of papillary serous adenocarcinoma were endometrioid adenocarcinoma(99%). The grades were classified into G1(38%), G2(39%), G3(7%) and unknown(16%). The FIGO surgical stages were classified as ; stage I(73%), stage II(3%), stage III(18%) and stage IV(1%) and unknown stage(5%). Most of the patients(85%) were treated by surgery only or surgery followed by adjuvant radiotherapy. The overall 5-year disease free survival rate(5YDFSR) was 86.9%: FIGO surgical stage I and II, 90.3%; stage III and IV, 73.6%. A age, parity, grade and preoperative Pap test were not significant prognostic factors. The depth of uterine invasion(p=0.039), FIGO surgical stage(p=0.0249) and lymph node metastasis(p=0.0054) were significant prognostic factors by univariate analysis. Conclusion : Although the number of patients was not enough, the depth of myometrial invasion, FIGO surgical stage and lymph node metastasis seemed to be significant prognostic factors of uterine endometrial cancer.

난관에 발생한 악성 혼합 뮐러씨 종양 1 예

전우진(Woo Jin Jeon),문을주(Eul Ju Moon),고재수(Jae Soo Koh),유상영(Sang Young Ryu),김종훈(Jong Hoon Kim),김병기(Byoung Gie Kim),박상윤(Sang Yoon Park),이의돈,이경희(Kyeong Hee Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

Malignant tumor originating in the fallopian tube is the least common gynecologic cancer, accounting for less than 2% overall. Among this, malignant mixed m llerian tumor of the fallopian tube is extremely rare. Malignant mixed m llerian tumor is an uncommon tumor arising in the endometrium, followed in decreasing order by the vagina, cervix, and ovary. Malignant mixed m llerian tumor of the fallopian tube accounts for less than 4% of all malignant mixed m llerian tumors. The diagnosis is usually obtained at surgery, 75% of the patients had tumor extension beyond the fallopian tube at the time of surgery. The first treatment is abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by postoperative adjunctive radiation and/or chemotherapy. Nulliparity or primiparity has been described as risk factors, accounting for 60% of the patients. The most important prognostic factors are spread of the tumor and the amount of residual tumor at operation. Prognosis is poor, 1-year survival rate is 63% and 2-year survival rate is 47%. Recently we have experienced a case of malignant mixed m llerian tumor of the fallopian tube, so we report this case with a brief review of literature.