CIN3 치료에서 자궁경부 원추절제술후 잔류 병변의 예측 인자로 절제면 양상 및 고위험 HPV 검사에 대한 연구

전섭,배동한,김윤숙,김종수,최승도 대한부인종양학회 2005 Journal of Gynecologic Oncology Vol.16 No.2

Objective : To identify resection margin status and HPV DNA test as predictive factors for residual lesion in the management of CIN3 with cervical conization. Methods : A retrospective study was conducted on 96 patients with CIN3 who had been performed cervical conization (LEEP or CKC) between January 1999 and December 2003 at Soonchunhyang university Chunan hospital. Secondary conization or hysterectomy were performed in case of positive margin on cone specimen or negative margin with other hysterectomy indication. Resection margin status and pre conization HPV DNA test were compared with residual lesion on subsequent cone or hysterectomy specimen. Results : Among 96 cases, 24 cases (15.6%) showed positive resection margin on cone specimen. Of 24 cases with positive resection margin, 2 cases were followed up without treatment, 2 cases were treated with secondary conization and 20 cases were treated with hysterectomy. Of 72 cases with negative resection margin, hysterectomy was performed due to other indication in 16 cases. Persistence of residual lesion in the secondary conization and hysterectomy specimens was significantly correlated with high risk HPV infection and positive resection margin status (p<0.05). Conclusion : Conization is good treatment modality of the management of CIN3. HPV DNA test and resection margin status are good predictor of residual lesion after cervical conization for the management of CIN 3. Therefore, when HPV positive and resection margin positive, secondary treatment is mandatory 목적 : CIN3의 치료로 자궁경부 원추절제술후 잔류 병변의 예측 인자로 절제면 양상과 HPV DNA 검사의 유용성을 확인하고자 하였다. 연구 방법 : 1999년 1월부터 2003년 12월까지 순천향대학 천안병원 산부인과학교실에서 원추절제술후 CIN3로 진단받은96예를 대상으로 하였다. 모든 예에서 HPV DNA 검사가 시행되었고 절제면에 종양이 침범된 경우 2차 원추절제술 혹은 자궁적출술을 시행하였고 절제면에 종양이 침범되지 않은 경우에도 다른 적응증으로 자궁적출술을 시행하여 잔류 병변여부와 절 제면 양상 그리고 HPV 감염 여부를 비교하였다. 결과 : 96예 중 24예(25%)에서 절제면에 종양이 침범되었고 이중 2예에서는 2차 원추절제술이 20예에서는 자궁 적출술이 2예에서 추적관찰이 시행되었고 절제면에 종양의 침범이 없었던 72예 중 16예에서 다른 적응증으로 자궁적출술이 시행되었다. 2차 원추절제술과 자궁적출술 시행후 잔류 병변은 HPV 양성이면서 절제면 종양이 침범된 경우에서 증가하는 유의한 상관 관계가 있었다(p<0.05). 결론 : 원추절제술은 CIN3의 치료로 유용한 방법이지만 HPV DNA 검사와 절제면 양상은 원추절제술후 잔류 병변을 예측하는데 좋은 지표가 될 수 있으며 HPV DNA 양성이면서 절제면에 종양의 침범이 있는 경우에는 2차 치료를 반드시 고려해보아야 할 것으로 사료된다.

국소적으로 진행된 자궁경부암에서 동시 항암화학방사선요법과 선행보조항암화학요법 후 근치적 수술의 치료효과 및 생존율 비교

전섭,문성택,김윤숙,송은석,선우재근,최승도,배동한,김은석,남계현 순천향대학교 순천향의학연구소 2009 Journal of Soonchunhyang Medical Science Vol.15 No.2

Background : To compare of toxicity and survival in two treatment groups ; neoadjuvant chemotherapy followed by radical surgery versus standard cisplatin based chemoradiation therapy in the treatment of locally advanced cervical cancers. Methods : From 2004 to 2007, Among 31 patients with locally advanced cervical carcinoma stages IB2-IIIB, 17 patients were treated with pelvic radiation plus 6 weekly course of cisplatin 40mg/m2 followed by brachytherapy (CCRT group) and 14 patients were treated with three 21 day course of neoadjuvant chemotherapy(paclitaxel 135 mg/m2 plus cisplatin 75 mg/m2) followed by radical hysterectomy (NACT group). Results : In the CCRT group, complete remission occurred in 14 out of 17 patients, 3 patients recurred. Overall and disease free survival rates were 81.2% and 62.5% respectively. In the NACT group, overall clinical response rate to chemotherapy is 78.5% (CR, 50.0% PR 28.5%), pathologic response rate is 14.2%, and toxicity of chemotherapy was well tolerable. 3 patients recurred and overall and disease free survival rates were 92.8% and 71.4% respectively. At median follow up of 24 (range12-39) and 18 (range4-53)months in the CCRT and NACT groups respectively, there were no differences in overall survival and disease free survival rates. Conclusions : The combination of paclitaxel and cisplatin seems to be tolerated and active in the locally advanced cervical cancer. The results of our comparison study suggest that neoadjuvant chemotherapy at least as effective in terms of overall and disease free survival as standard cisplatin based chemoradiation therapy. Large sample of randomized study is needed to confirm these findings.

부인종양학 : 임신 중 부인암의 처치

전섭 대한산부인과학회 2012 연수강좌 Vol.47 No.-

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers

전섭,이성종,임명철,송태종,배재만,김기동,이정윤,김상운,장석준,이종민 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.1

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

부인암에 자주 사용되는 항암제

전섭 대한산부인과학회 2018 연수강좌 Vol.59 No.-

Long-term effectiveness of HPV vaccines

전섭 대한산부인과학회 2013 연수강좌 Vol.49 No.-

자궁적출술의 적응과 술기

전섭 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

자궁적출술의 적응과 술기

전섭 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-

A Study on the expression of p16 gene, methylation of p16 gene promotor and HPV typing in uterine cervical neoplasia

전섭 ( Seob Jeon ),( Dong Han Bae ),( Chang Jin Kim ) 대한산부인과학회 2004 대한산부인과학회 학술대회 Vol.90 No.-

자궁경부 종양에서 Thymidine Phosphorylase 및 Ki - 67 발현에 대한면역조직화학적 연구

전섭(Sub Jun),한효상(Hyo Sang Han),김창진(Chang Jin Kim),배동한(Dong Han Bae),김민관(Min Kwan Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

목적 : 정상 자궁경부조직, 자궁경부 상피내암종 Ⅰ/Ⅱ, Ⅲ, 미세침윤암 그리고 침윤암 등 4군에서의 맥관 형성인자인 thymidine phosphorylase와 세포증식관련 항원인 Ki-67의 발현을 보고 그 두 인자의 상관관계를 알아 보고자 계획되었다. 연구 방법 : 정상 자궁경부 조직군 15예, 자궁경부 상피내암종 Ⅰ/Ⅱ군 13예, Ⅲ군 21예, 미세침윤암 군 15예, 그리고 침윤암 군 13예의 검체를 각각의 단일항원을 이용하는 면역조직화학적 방법으로 연구하였다. 결과 : Thymidine phosphorylase의 발현율은 정상 자궁경부 군에서 6.7%, 자궁경부상피내암종 Ⅰ/Ⅱ군에서 23.1%, 자궁경부상피내암종 Ⅲ군에서 38.0%, 미세침윤암 군에서 73.3%, 침윤암 군에서 84.6%이었고, Ki-67 표지 지수는 각각 정상 자궁경부 군에서 2.0±0.7, 자궁경부상피내암종 Ⅰ/Ⅱ군에서 26±5.4, 자궁경부 상피내암종 Ⅲ 군에서 41.2±10.1, 미세침윤암 군에서 53.1±10.0, 침윤암 군에서 74.7±9.3이었다. Ki-67 표지지수와 thymidine phosphorylase 발현율은 정상 자궁경부조직에서 전암단계, 그리고 침윤암으로 진행될수록 의미 있게 증가하는 결과를 보였다. 결론 : 자궁경부 종양의 암으로의 진행과 맥관형성 그리고 세포증식과 상관관계가 있다는 것을 의미하 며, 이로써 Ki-67과 thymidine phosphorylase의 발현이 자궁경부종양의 예후인자로 유용하리라는 결론을 얻었다. 앞으로 자궁경부암에서 Ki-67과 thymidine phosphorylase가 발현되는 환자의 임상적 예후를 직접 연관시키는 연구와 thymidine phosphorylase의 발현을 감소시키고 암억제 효과를 얻는 암치료에 대한 진전된 연구가 필요할 것으로 사료된다. Objective : We evaluated the relationship between the expression of Ki-67 and thymidine-phosphorylase (TP) according to the cancerous progression of uterine cervical cancer with immunohistochemical method. Methods : The material was obtained from hysterectomized uterus and punched cervical specimen for two years from 1998 to 1999 at the Soonchunhyang Chunan hospital. The material included 15 normal epithelium, 13 CINⅠ/Ⅱ, 21 CIN Ⅲ, 15 microinvasive carcinoma and 13 invasive carcinoma. Monoclonal antibodies of Ki-67 and TP were used for immunohistochemical determination of cellular proliferation and angiogenic activity. Results : 1. The positive rate of thymidine phosphorylase in each group of normal epithelium, CIN Ⅰ/Ⅱ, CIN Ⅲ, microinvasive carcinoma and invasive carcinoma were 6.7%, 23.1%, 38.0%, 73.3%, 84.6% respectively. 2. The labeling indexes of Ki-67 in each group of normal epithelium. CIN Ⅰ/Ⅱ, CIN Ⅲ, microinvasive carcinoma and invasive carcinoma were 2.0±0.7, 26±5.4, 41.2±10.1, 74.7±9.3 respectively. 3. There was statistically significant relationship between TP and Ki-67 expression. Conclusion : The above results indicates that the angiogenic activities and cellular proliferation indices increase according to the invasiveness of cervical cancer. We were able to reveal the expression of TP and Ki-67 and their relationship in cervical carcinoma.