자궁경부암

이효표,Lee, Hyo-Pyo 한국건강관리협회 1994 건강소식 Vol.18 No.10

최신임상강좌 : 한국 부인암의 현황: 1991~2004년까지의 동향

이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.12

Korean Society of Obstetrics and Gynecology estimates the number of new gynecologic cancer cases and deaths expected in Korea in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the Gynecologic Cancer Registry Program every one or two years. Recently, gynecologic cancer registry gathering clinical data in 2005~2006 is in progress. In this article, we provide an overview of cancer statistics, including recent trends in gynecologic cancer incidence, mortality, and survival rates from 1991 through 2004.

자궁경부 상피내종양 및 자궁경부암 조직에서 bcl-2 및 c-myc 암유전자 발현과 세포증식 및 apoptosis와의 상관관계에 관한 연구

김병기(Byoung Gie Kim),이효표(Hyo Pyo Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

bcl-2 prevents cell death from a wide variety of stimuli and provides survival of cells with accumulated genetic alterations and c-myc can promote both cell proliferation and cell death through the transcriptional regulation of target genes. Although several studies have been reported on the expression of bcl-2 or c-myc separately, little has been known about the role of coexpression of bcl-2 and c-myc to cell proliferation and apoptosis, as well as the frequency of these coexpression in cervical cancer specimens. In this study, we have examined the expression of bcl-2 and c-myc in cervical cancer specimens and cervical intraepithelial neoplasia(CIN) to determine the role of coexpression of bcl-2 and c-myc during progression into cervical cancer. Proteins and transcripts of bcl-2 and c-myc were evaluated by immunohistochemistry in 60 clinical specimens(20 cervical cancer, 30 CIN, and 10 normal cervix). In addtion, we evaluated kinetic indices of cell proliferation and apoptosis simultaneously. The cell proliferation index was determined by detection of the Ki- 67 in immunohistochemistry. Apoptotic index was determined by the detection of apoptotic cells with TUNEL staining. Medical records including pathologic reports were reviewed. Overexpression of bcl-2 and c-myc was identified in 7(35%) and 10(50%) of 20 cervical cancer specimens respectively, but none in normal cervix and CIN samples. In addition, coexpression of bcl-2 and c-myc was found in 5(25%) of 20 cervical cancer specimens. The cell proliferation index increased with progression from normal to CIN and invasive cancer(normal cervix, 10.2; CIN 1, 24.1; CIN 2/3 59.7; cervical cancer, 71.2; p <0.01). The apoptotic index also increased with grade of lesions(normal cervix, 0; CIN 1, 0.33; CIN 2/3, 1.85; cervical cancer, 3.89; p <0.01) and showed a significant correlation with proliferation index(r=0.7451, p=0.0002). However, there was no significant difference in apoptotic index between bcl-2 positive and bcl-2 negative group in cervical cancer(p=0.4765). In addition, there was also no significant difference in cell proliferation between c-myc positive and c-myc negative group(p=0.6891). Furthermore, there was no significant difference in cell proliferation and apoptosis between bcl-2 and c-myc positive group and others in cervical cancer(p=0.6311 and p=0.7600 respectively). The well-known clinicopathologic parameters, including tumor diameter, FIGO clinical stage, lymph node metastasis, did not correlate with simultanuos positive immunoreactivity for bcl-2 and c-myc proteins in cervical cancer. In conclusion, the cell proliferation and apoptosis increase with increasing lesion grade of cervical neoplasia and apoptosis correlates with cell proliferation. In addition, overexpression of bcl-2 and/or c-myc may be genetic alteration found only in cervical cancer and may not play a role in the development and progression of CIN. However, neither bcl-2 nor c-myc immunoreactivity correlated with the proliferation index or apoptotic index. These results suggest that other factors may also play a role in controlling the cell proliferation and apoptosis of cervical cancer.

재발성 자궁경부암의 임상 양상 및 예후에 관한 연구

이승호 ( Seung Ho Lee ),이유경 ( Yoo Kyung Lee ),김희승 ( Hee Seung Kim ),김재원 ( Jae Won Kim ),박노현 ( Noh Hyun Park ),송용상 ( Yong Sang Song ),강순범 ( Soon Beom Kang ),이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.2

Objective: The purpose of this study was to analyze the clinical course and prognosis in patients with recurrent cervical cancer. Methods: Between January 1999 and December 2003, sixty-three patients were diagnosed as recurrent cervical cancer. The data for clinical characteristics and survival were analyzed retrospectively. Survival after recurrence (SAR) according to prognostic factors was evaluated using Kaplan-Meier analysis with log-rank test. Independent prognostic factors were identified by use of Cox regression model. Results: The most common stage and age group of the patients were FIGO stage Ib (38.1%) and age between 40 and 49 (39.7%) respectively. Distant metastases were present in 29 patients (46.0%) and the most common site was para-aortic lymph node. Median disease-free survival before the recurrence of cervical cancer was 19 months (95% CI=9.5 - 28.5). Median SAR was 24 months (95% CI = 17.4 - 30.6) and 5-year survival rate after recurrence was 20.0%. In univariate analysis of the prognostic factors, age, FIGO stage, primary treatment with surgery and number of recurred site were statistically significant. But, multivariate analysis showed that only FIGO stage and the number of recurrent site had prognostic significance. Conclusion: FIGO stage and number of recurrent site may be independent prognostic factors for the survival in patients with recurrent cervical cancer.

Radiotherapy of Recurrent Uterine Cervical Cancer

하성환,박찬일,채규영,강순범,이효표,신면우,Ha Sung Whan,Park Charn Il,Chai Kyu Young,Kang Soon Beom,Lee Hyo Pyo,Shin Myon Woo The Korean Society for Radiation Oncology 1987 Radiation Oncology Journal Vol.5 No.2

수술후 골반강내에 국소재발된 자궁경부암의 진단하에 1979년부터 1984년까지 6년 간 서울대학교병원 치료방사선과에서 방사선치료를 시행한 47명의 환자에 대하여 후향적 분석을 시행하여 다음과 같은 결과를 얻었다. 1. 방사선치료 후 완전관해를 보인 환자는 35명으로 완전관해율은 $74.5\%$이었다. 2. 완전관해를 보인 35명중 7명에서 국소재발 또는 원격전이를 보여 전체적으로 19명 $(40.4\%)$의 환자에서 치료실패를 나타내었다. 3. 4년 무병생존을 및 전체생존율은 각각 50.1 및 $55.2\%$이었다. 4. 병소의 범위를 자궁경부암에 적응되는 FIGO병기 결정기준에 의하여 분류한 결과 각 병기에 따른 4년 생존율은 IIa기에서 $80.4\%$, IIb기에서 $73.0\%$, IIIb기에서 $25.0\%$, IVa기에서 $0\%$이었다. 따라서 수술 후 골강내에 국소재발된 자궁경부암의 경우 적절한 방사선치료를 시행함으로써 좋은 결과를 얻을 수 있음을 알 수 있었다. Forty seven patients with locally recurrent uterine cerival cancer after surgery were treated with radiation during the 6 year period from 1979 through 1984 at the Department of Therapeutic Radiology of Seoul National University Hospital. In 30 out of the 47 patients, recurrence was diagnosed within 2 years after surgery. Site of recurrence was vagina in 19 patients, vagina and parametrium in 21 patients and parametrium only in 7 patients. Complete tumor control was achieved in 35 patients $(74.5\%)$; the complete response rates were $94.7\%(18/19)$ in vaginal recurrences, $57.1\%(12/21)$ in combined vaginal and parametrial recurrences and $71.4\%(5/7)$ in parametrial recurrences. Overall and disease free survival rates at 4 years were 55.2 and 50.1 percent, respectively, for entire group. Overall 4 year survival rates were $77.0\%$ for vaginal recurrences, $44.1\%$ for vaginal and parametrial recurrences and $42.9\%$ for parametrial recrrences. When the disease extent was classified in the same way as the staging system of FIGO, the 4 year survival was 80.4, 73.0, 25.0 and 0 percent for stage IIa, IIb, IIIb and IVa, respectively.

난소 섬유종과 포막종의 호르몬 분비능에 관한 연구

이숭덕,서진석,한영미,김정란,서정욱,함의근,이효표,Lee, Soong-Deok,Suh, Jin-Suk,Han, Young-Mee,Kim, Jung-Ran,Seo, Jeong-Wook,Ham, Eui-Keun,Lee, Hyo-Pyo 한국현미경학회 1989 Applied microscopy Vol.19 No.1

Six cases of ovarian fibrous stromal neoplasm were studied clinically, light microscopically and ultrastructurally for the clinico-pathological evidences of hormone production. Of the six cases, two cases were fibroma, three cases were fibrothecoma, and one case was thecoma. Two cases of fibroma and one fibrothecoma were associated with clinical history of menstrual abnormality, however fat staining of the tumor was negative or weakly positive. Two cases of fibrothecoma and one thecoma were negative for the clinical history of hormone imbalance. Fat stain of those cases revealed positive in varying intensity. Ultrastructural examination of fibroma-thecoma group revealed dark and pale cells by their nuclear characteristics. The dark cells had indented nucleus and abundant cytoplasmic organelles of rough ER, Golgi apparatus and mitochondria. Intracytoplasmic cisternal spaces were seen in the dark cell cytoplasm and some lipid droplets were seen around the cisternae. Pale cells had pale swollen nucleus and fine chromatins. Their cytoplasm showed scanty amount of organelles. Fibroma-thecoma spectrum showed varying degree of population of dark cells, light cells and intervening collagenous stroma. Lipid droplet was structurally associated with intracytoplasmic cisterna and they were frequently seen in thecoma and two of the fibrothecoma. But clinical history of hormone imbalance was poorly related to the light microscopic morphology and ultrastructural organization.

자궁경부 선암에서 고위험 인유두종바이러스 감염 양성도와 p53 단백 과발현의 관계

강석범 ( Sok Bom Kang ),이동옥 ( Dong Ock Lee ),손영수 ( Young Soo Son ),김재원 ( Jae Weon Kim ),박노현 ( Nog Hyun Park ),송용상 ( Yong Sang Song ),강순범 ( Soon Beom Kang ),이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.10

Objective : The aim of the present study was to analyze the relation between p53 mutation and cervical adenocarcinoma without HPV infection. Methods : From 1998 to 2002, 54 patients were diagnosed with cervical adenocarcinoma and underwent radical hystere

한국인 여성에서 자궁경부암의 위험요인에 관한 환자-대조군 연구

구혜원,유근영,김동현,송용상,박노현,강순범,이효표,안윤옥,이채언,Koo, Hye-Won,Yoo, Keun-Young,Kim, Dong-Hyun,Song, Yong-Sang,Park, No-Hyun,Kang, Soon-Beom,Lee, Hyo-Pyo,Ahn, Yoon-Ok,Lee, Chae-Un 대한예방의학회 1996 예방의학회지 Vol.29 No.2

A hospital-based case-control study was carried out to investigate the risk factors of uterine cervical cancer in Korea. Information on a wide-range of life-styles, which might be related with uterine cervix cancer, has been routinely collected through a dual application of the self-administered questionnaire and the direct interview by a well-trained nurse at the Department of Gynecology, Seoul National University Hosiptal since 1992. The number of cervical cancer cases, histologically confirmed at the hospital, were 284. Included were 939 women as controls, who were free of past history of any malignancies. Adjusted odds ratio and 95% confidence limits were based on the unconditional logistic regression model. The multivariate logistic model was constructed under the consideration of biologic characteristics on the natural history of the malignancy. In the multivariate results, the uterine cervical cancer risk was higher in women of shorter height$(P_{trend}<0.05)$, less educated spouse$(P_{trend}<0.001)$(0.001), multiple marriages(adjusted OR=2,70, 95% C.I. $1.64\sim4.47$), ever had a family history (adjusted OR=2.14., 95% C.I. $1.18\sim3.89$), multiparity$(P_{trend}<0.001)$, and early age at first $(P_{trend}<0.001)$. These results strongly suggest that the uterine cervix cancer might be related to the reproductive factors, and probably with sexual behaviour of both women and men in Korea.

자궁경부상피내종양 치료 후 재발 예측인자로서 인유두종 바이러스 검사

김지연 ( Ji Yeon Kim ),김수녕 ( Soo Nyung Kim ),이선주 ( Sun Ju Lee ),권한성 ( Han Sung Kwon ),전경훈 ( Kyung Hun Zun ),이지영 ( Ji Young Lee ),손인숙 ( In Sook Sohn ),이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.10

Objective: The aim of this study was to evaluate high-risk (HR) HPV DNA test to predict recurrence/residual disease in patients treated for CIN (cervical intraepithelial neoplasia). Methods: Four hundred and fifty-two patients treated with LLETZ (large loop excision of the transformation zone) were followed by HR HPV DNA test, cytology and colposcopy. The sensitivity, specificity and diagnostic odds ratios in predicting recurrence/residual disease were compared to those of cytology and HPV DNA test. Results: Fourteen patients (3.1 %) developed recurrent/residual disease, during follow up. Of these women, 7 were diagnosed at the time of recurrence with a CIN 1 lesion, 5 with a CIN 2 lesion, and 2 with a CIN 3 lesion. The sensitivity and specificity of the HPV DNA test were 92.9% (CI 68.5%, 98.7%) and 75.3% (71.1%, 79.1%). The sensitivity and specificity of the cytology were 71.4% (45.4%, 88.3%) and 92.5% (89.6%, 94.6%), respectively. The likelihood ratio of a positive and negative HPV DNA test were 3.77 (3.03, 4.69) and 0.09 (0.01, 0.63). And the likelihood ratio of a positive and negative cytology were 9.48 (5.95, 15.11) and 0.31 (0.13, 0.71). The accuracy of cytology and HPV DNA test were 94.7% and 78.3%. The sensitivity and specificity of the combination test (PAP and/or HPV DNA test) were 92.9% (68.5%, 98.7%) and 73.1% (68.7%, 77.0%). The likelihood ratio of a positive and negative combination test were 3.45 (2.79, 4.26) and 0.10 (0.01, 0.65). Conclusion: Cytology remains the base in the follow up after of CIN. HPV DNA test increase the sensitivity of cytology. Negative HPV test can rule out recurrent/residual disease.

한국여성에서 L-myc 유전자 다형성과 자궁경부암의 감수성 및 침습도 사이의 연관성

주웅 ( Woong Ju ),신은경 ( Eun Kyoung Shin ),이소현 ( So Hyun Lee ),김재원 ( Jae Weon Kim ),박노현 ( Noh Hyun Park ),송용상 ( Yong Sang Song ),김승철 ( Seung Cheol Kim ),강순범 ( Soon Beom Kang ),이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.2