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한국 전립샘암 데이터베이스를 활용한 근치적 전립샘절제술 후 생화학적 재발 예측

유성혜 ( Sung Hye Yu ),최문주 ( Mun Joo Choi ),이선정 ( Sun Jung Lee ),김청수 ( Choung Soo Kim ),서성일 ( Seong Il Seo ),변석수 ( Seok Soo Byun ),정창욱 ( Chang Wook Jeong ),박용현 ( Yong Hyun Park ),홍준혁 ( Jun Hyuk Hong ),최인 한국보건정보통계학회(구 한국보건통계학회) 2019 한국보건정보통계학회지 Vol.44 No.1
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  KCI
  
  KISS
Objectives: As the surgical techniques are developed such as adopting robotic surgery etc. It has been reduced postoperative side effects such as urinary incontinence and sexual dysfunction etc., but also remain constant risk of recurrence after the treatment. It is very important to figure out the predictive factors, whichincreasing the probability of long-term survival, by Analyzing the progression of the disease according to biochemical recurrence (BCR). This study aims to figure out the influential predictive factors on BCR by using Korean Prostate Cancer Registry (KPCR) database, which constructedwith providing data from Korean manifold, because of therecurrence-free survival rates are reported to vary according to geographical location and race. Methods: KPCR database consists 7,394 patients’ data which collected from six medical institutions, and final analysis was conducted with 5,119 patients’ data which collected from December 2003 to December 2014. Statistical analysis was conducted with the multivariable Cox proportional hazard regression models to figure out the correlation of clinical factors which affect BCR. The biochemical recurrence free survival rate (BCR-FS) was calculated using with Kaplan-Meier method. Results: The 5 year BCR occurred in 23.6% (1,209 patients). As a result of the recurrence rate, prostate specific antigen (PSA) value ≥20.1 ng/mL was 49.3%, the clinical T3 stage was 40.4%, Gleason score ≥8 was 54.4%, Gleason score 7 was 21.8%. The mean duration of BCR was 20.7 months and the strongest predictor of BCR was Gleason scoreand PSA value ≥20.1 ng/mL. Conclusions: It has been verified that, Gleason scores and PSA value are the most influential factors for biochemical recurrence after radical prostatectomy. These results will be helpful fordetermining the treatment direction in postoperative follow-up and able to contribute to improving survival outcome in the future.
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다기관 한국 전립샘 암 등록(KPCR) 데이터베이스를 이용한 근치적 전립샘 절제술의 수술 결과 비교

유성혜 ( Sung Hye Yu ),최문주 ( Mun Joo Choi ),김청수 ( Choung-soo Kim ),서성일 ( Seong Il Seo ),정창욱 ( Chang Wook Jeong ),변석수 ( Seok-soo Byun ),이지열 ( Ji Youl Lee ),홍준혁 ( Jun Hyuk Hong ),최인영 ( In Young Choi ) 한국보건정보통계학회(구 한국보건통계학회) 2018 보건정보통계학회지 Vol.43 No.3
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  KCI
  
  KISS
목적: 전립샘암은 한국 남성에서 발병률이 급격히 증가하는 추세이다. 국소 전립샘암의 표준 치료로 근치적 전립샘 절제술이 시행되고 있으며 수술 기법은 개복, 복강경 그리고 로봇 수술로 나뉜다. 여러가지 수술 기법은 삶의 질, 경제적 측면, 수술 및 예후의 결과에서 차이가 있다. 이에 저자는 다기관 한국 전립샘 암 등록(KPCR) 데이터베이스를 이용하여 국소 전립샘 암 수술을 시행한 환자들의 결과와 예후에 대한 결과를 비교하고자 한다. 방법: KPCR 데이터베이스에는 5개 의료기관에서 수집한 6,032명의 데이터가 수집되어 있고 데이터의 무결성 보장을 위해 데이터 표준화 및 품질 관리를 시행하였다. KPCR 데이터베이스로부터 분석에 필요한 데이터를 추출하였다. 추출된 데이터는 2006년 1월부터 2011 년 12월까지 수집된 3,262명으로 최종 분석을 시행하였다. 이 데이터를 이용하여 수술 기법에 따른 국소 전립샘 암 환자의 인구학적 특성, 수술 결과 및 예후에 대해 분석하였다. 통계 분석방법은 one-way ANOVA, chi-square test, post-hoc 분석을 실시하였다. 무재발 생존율 분석을 위해 Kaplan-Meier와 multivariable Cox proportional hazard regression model을 통해 분석을 실시하였다. 결과: 분석 결과, 초기 전립샘 특이 항원치의 평균 값은 10.30 ng/mL이었다. 총 환자의 56.7%는 임상 병기 T2를, 43.3%는 병기 T1을 가지고 있었고 환자의 64.4%는 글리슨 스코어가 7 이상이었다. 절제면 양성률의 결과는 개복수술이 33.6%, 복강경 수술이 27.0%, 로봇수술이 28.8%로 나타났다(p <0.001). 로봇수술은 수술 후 합병증 및 예상 출혈량 결과에서 우수한 결과를 나타냈다. 5년 생화학 무 재발 생존율은 전체 환자에서 77.0%의 결과를 보였고 세 수술 기법은 임상 결과에 있어서 차이가 없었다. 또한 Cox 회귀분석 결과 세 수술기법은 생존율에 영향을 미치지 않았다. 결론: 본 연구결과는 국소 전립샘 암 환자의 예후와 특성을 설명한다. KPCR 데이터베이스를 통한 본 결과는 환자와 의료진의 올바른 의사 결정에 도움을 줄 것이라는 것을 보여준다. Objectives: Prostate cancer, commonly is rapidly increasing the incidence of prostate cancer among Korean men. Primary treatment of localized prostate cancer involves radical prostatectomy, and surgery techniques are divided into the abdominal, laparoscopic, and robotic surgery. Different surgical techniques differ in quality of life, economic aspect, and outcome of surgery and prognosis. Therefore we compared the outcomes and prognosis of patients who underwent surgery for localized prostate cancer using the multicenter Korean Prostate Cancer Registry (KPCR) database. Methods: The KPCR database collected data of 6,032 patients from five medical institutions, and data standardization and quality management were performed to ensure data integrity. We extracted data necessary for analysis from the KPCR database. We analyzed data for 3,262 patients during the period from January 2006 to December 2011. The demographic characteristics, surgical outcomes, and prognosis of patients with localized prostate cancer were analyzed. All statistical analyses were performed using one-way ANOVA, chi-square test, and post-hoc analysis. We used the Kaplan-Meier method and multivariable Cox proportional hazard regression model for biochemical recurrence-free survival rate (BCR-FS) analysis. Results: The analysis results showed that the average initial prostate specific antigen value was 10.30 ng/mL. A total of 56.7% of the patients had clinical stage T2, 43.3% had stage T1, and 64.4% of the patients had a Gleason score of more than 7. The rate of positive surgical margin was radical retropubic prostatectomy, laparoscopic radical prostatectomy, robotic-assisted laparoscopic radical prostatectomy (RALP) as 33.6%, 27% and 28.8%, respectively (p<0.001). The RALP gave excellent results for postoperative complication, and estimated blood loss (EBL). The 5-year overall BCR-FS was 77.0%, and the three surgical techniques did not differ in clinical outcomes. Cox regression analysis showed that the surgical technique did not affect the biochemical recurrence rate. Conclusions: Our study describes the characteristics of patients with localized prostate cancer and their prognosis. These results indicate that patients and medical staff can rely on information from the KPCR database for decision-making.

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