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( Jong Man Kim ),( Deok Gie Kim ),( Jihyun Kim ),( Keunsung Lee ),( Kwang-woong Lee ),( Je Ho Ryu ),( Bong-wan Kim ),( Dong Lak Choi ),( Young Kyoung You ),( Dong-sik Kim ),( Yang Won Nah ),( Koo Jeon 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.3
Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications. (Clin Mol Hepatol 2021;27:451-462)
최근 15년간 한국에서의 자궁 내막암의 생존율 및 치료 방법의 변화
민경진 ( Kyung Jin Min ),송승훈 ( Seung Hun Song ),이재관 ( Jae Kwan Lee ),이낙우 ( Nak Woo Lee ),강재성 ( Jae Sung Kang ),이규완 ( Gyu Wan Lee ),류기성 ( Ki Sung Ryu ),김병기 ( Byung Gie Kim ),박종택 ( Chong Taik Park ),유희석 ( 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.10
목적: 이 연구는 최근 15년간 한국에서 자궁 내막암 환자의 치료 방법의 변화 및 생존율을 알기 위해 시행하였다. 연구 방법: 1990년 1월부터 2005년 3월까지 국내 9개 기관에서 자궁 내막암으로 진단받은 환자의 의무기록을 검토하여 740명을 대상으로 일부 기본 기록이 누락된 환자는 제외하였다. 생존율은 대한 통계청의 사망 자료를 바탕으로 구하였다. 결과: 환자 나이의 평균값은 51.5세였으며 임신력과 분만력의 평균값은 3.3과 2.1이었다. 진단 당시 자궁 내막암의 병기와 분화도는 FIGO 병기 1기와 분화도 1이 가장 많았으며 조직학적 분류는 자궁내막양 선암이 87.2%로 가장 많았다. 치료 방법으로는 병기 1기에서는 수술만 시행한 경우가 59.8%로 가장 많았으며 병기 2기에서는 수술-보조 방사선 요법 (55.1%), 병기 3기에서는 수술-보조 방사선 요법과 수술-보조 항암화학 방사선 요법이 많이 사용되었고 4기에서는 수술-보조 항암화학 요법이 55.6%로 가장 많이 시행되었다. 분화도에 따라서는 분화도 1에서는 수술이 (69.0%), 2와 3에서는 수술-보조 방사선 요법이 많이 시행되었다 (43.4%, 53.2%). 1998년 이전에는 수술이 가장 많이 사용되는 치료 방법이었으나 이후 점차 감소하여 2004-2005년에는 수술-보조 방사선 요법과 수술-보조 항암화학 요법이 가장 많이 사용되고 있으며 수술-보조 항암화학-방사선 요법도 두 배 이상 증가하였다. 전체 환자의 5년 생존율은 81.3%였으며 병기 1기 환자의 생존율은 89.0%, 각 분화도에 따라 각각 96.0%, 92.0%와 80.0%로 나왔다. 1998년 이전에는 생존율이 77.0%였으나 이후는 생존율이 증가하여 83-88%로 나타났으며 2000-2001년에는 88.0%로 가장 높게 나타났다. 결론: 자궁 내막암의 생존율은 최근 15년간의 비교에서 향상되고 있으며 치료방법도 변화하고 있다. 자궁 내막암의 생존율 향상을 위해서는 유전인자, 환경 요인 등을 포함한 자궁 내막암의 발병 기전 규명 및 위험 인자들에 대한 역학 연구가 병행되어야 할 것이다. Objective: This study was performed to evaluate the overall survival and the change in treatment modalities in patients with uterine endometrial cancer in Korea. Methods: From January 1990 to March 2005, medical records of 740 patients with endometrial cancer in nine hospitals were reviewed. The overall survival was determined supported by the death statistics of Korea National Statistical Office. Results: The mean age of patients was 51.5 years (range: 21-82 years). The mean gravidity and parity were 3.3 and 2.1 (range: 0-18, 0-9), respectively. The most common stage, grade and histological type at diagnosis were FIGO stage I, grade 1 and endometrioid adenocarcinoma (76.5%, 56.4% and 87.2%), respectively. The main treatment modalities was surgery on stage I (59.8%), surgery-adjuvant radiotherapy on stage II (55.1%), surgery-adjuvant radiotherapy or surgery-adjuvant chemoradiation on stage Ⅲ (38.3%) and surgery-adjuvant chemotherapy on stage IV (55.6%). The preferred treatment modality was surgery only on grade 1 (69.0%) and surgery-adjuvant radiotherapy on grade 2-3 (43.4% and 53.2%). Surgery had been the most common method of therapy before 1998 but its prevalence gradually decreased. As a result, surgery-adjuvant radiotherapy and surgery-adjuvant chemotherapy were most widely performed in 2004-2005 and surgery-adjuvant chemoradiation also increased more than a twofold. The overall 5 years survival rate (5YSR) for all 740 patients was 81.3%. The overall 5YSR of stage I was 89.0%. The overall 5YSR of grade 1, grade 2, grade 3 were 96.0%, 92.0%, 80.0%. Before 1998, the survival rate was 77.0%. Since then it increased to 83-88% and in 2000-2001 it increased to 88.0%, and it was the highest survival rate. Conclusion: The survival rate of endometrial cancer has been improving for the past 15 years and the method of treatment is also being changed currently. In order to improve the survival rate of endometrial cancer, a close investigation including genetic and environmental factors of the pathophysiology of endometrial cancer along with the epidemiology of risk factors, should be carried out.