자궁경부 선암에서 인유두종바이러스의 감염 양상과 p53 단백의 발현에 관한 연구

김대연(Dae Yeon Kim),이호표(Hyo Pyo Lee) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12

N/A Although squamous cell carcinomas compose the majority of invasive cervical cancers, adenocarcinomas account for 10-20% of cervical cancers. Human papillomavirus (HPV) types 16 and 18 are strongly involved in the development of cervical neoplastic lesions squamous cell type. However, little is known about the association of HPV with adenocarcinoma because of its rarity, The p53 gene acts as a tumor suppressor and has been implicated in controlling cell cycle progression at the Gl-S transition, and absence or mutant of p53 gene is related to tumor progression. The present study was undertaken to identify clinical profiles, to characterize HPV infection status and p53 overexpression in the cervical adenocarcinoma and to investigate the prognostic significance of these findings. Thirty-six paraffin-embedded tumor tissues were obtained and patients clinical records were reviewed from tumor registry. Tissues were analyzed for the detection of HPV 16/1S by multiplex PCR and for the expression of p53 protein by immunohistochemical staining. Eighty-four percent of the cases were positive for HPV 16 and/or 18. HPV 16 positive rate was 36.1%, HPV 18 was 72.2%. The rate of double infection with HPV 16 and 18 was 25.0%. The p53 overexpression was detected in 11.1%. The overall 5 year-survival rate (YSR) was 72.2%. There were no significant difference in survival rate between HPV 18-positive and HPV 18-negative groups. The 5 YSR of the p53-positive group was 25.0% and that of p53-negative group was 78.1% (p=0.174). Inverse relationship between p53 overexpression and HPV DNA positivity was not found. In cervical adenocarcinoma, HPV type 18 was detected as the predo#minant type and may play a role in the carcinogenic process.

재발성 자궁경부암의 예후인자로서 SCC 항원의 유용성

강순범(Soon Beom Kang),이철민(Chul Min Lee),오수영(Su Young Oh),노주원(Ju Weon Roh),김용범(Yong Beom Kim),김재원(Jae Weon Kim),박노현(Noh Hyun Park),송용상(Yong Sang Song),이호표(Hyo Pyo Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

연구목적: 재발성 자궁경부암 환자의 생존율에 영향을 미치는 예후 예측인자를 알아보기 위하여 본 연구를 시행하였다. 연구대상 및 방법: 1988년 1월부터 1998년 12월까지 서울대학교병원 산부인과에서 재발성 자궁경부암으로 진단된 68명의 환자를 대상으로 하였다. 6개월 이상의 무병기간 후 새로이 암이 발견된 경우를 재발암으로 정의하여 임상적 특징을 분석하였으며, 생존율에 영향을 미치는 인자를 알아보기 위하여 Cox 비례위험함수를 이용한 다변량분석을 시도하였다. 병리조직학적 분포는 편평상피암이 70.6%, 선암이 11.8%, 선상피암이 11.8%, 그리고 소세포암이 1.5%를 차지하였고, 병기별 분포는 FIGO 병기 제 1기가 25.0%, 제 2기가 66.2%, 그리고 제 3기가 4.4%를 차지하였다. 재발부위별로는 중심골반재발이 44.1%, 골반측벽재발이 11.8%, 그리고 원격재발이 44.1%를 차지하였으며, 가장 흔한 원격전이 장기는 골반외 림프절(29.4%)이었다. 재발의 29.4%가 일차치료 후 12개월 이내에 발생하였고, 50.0%가 2년, 그리고 64.7%가 3년내에 재발하였다. 결과: 처음 진단 당시 SCC 항원의 양성율(>2.0ng/ml)은 45.2%이었고, 재발당시 측정한 SCC 항원의 양성율은 60.0%이었다. 대상환자의 총누적생존율은 29.1%이었다. 중앙골반재발의 경우가 골반측벽재발 및 원격재발에 비하여 완전관해율이 높았고(P = 0.002), 재발 진단당시 SCC 항원의 농도가 정상이었던 경우 완전관해율이 높았다(P = 0.032). 재발후 1년의 총누적생존율은 66.8%, 2년 생존율은 36.7%, 그리고 5년 생존율은 18.7%이었다. 중심골반재발의 경우 골반측벽재발 및 원격재발에 비하여 누적생존율이 높았으며(P = 0.029), 재발당시 측정한 SCC 항원의 농도가 정상이었던 경우 누적생존율이 높았다(P < 0.001). Cox 비례위험함수 모형을 이용한 다변량분석 결과 재발당시 측정한 SCC 항원 농도는 재발성 자궁경부암 환자의 누적생존율을 예측하는 독립적인 예후인자이었다(OR = 2.56, 95% CI [1.22-5.39], P = 0.01). 결론: 본 연구에서 자궁경부암의 재발 당시 측정한 혈중 SCC 항원 농도가 재발성 자궁경부암 환자에 있어서 독립적인 예후 예측인자임을 다변량분석을 통하여 확인할 수 있었다. 따라서 자궁경부암 환자의 추적검사에 있어서 혈중 SCC 항원을 정기적으로 검사하여 보다 일찍 재발을 발견하고 적절한 치료를 시행하는 것이 재발성 자궁경부암 환자의 생존율을 높이는데 기여하리라고 사료된다. Objective: This study was performed to identify the prognostic factor for survival of patients with recurrent cervical cancer. Methods: Sixty-eight patients were diagnosed as recurrent cervical cancer at the Seoul National University Hospital from January, 1988 to December, 1998. Recurrence was defined as new evidence of tumor after 6 months of disease free survival. Retrospective analysis was done in terms of clinical features and the Cox proportional hazard model was used to identify independent variables associated with an improved survival rate. Histopathologic types were distributed as follows; squamous cell carcinoma in 70.6%, adenocarcinoma in 11.8%, adenosquamous cell carcinoma in 11.8%, and small cell carcinoma in 1.5%. Distribution of FIGO stage was as follows; stage I in 25.0%, stage II in 66.2%, and stage III in 4.4%. Sites of recurrence were as follows; central pelvic recurrence in 44.1%, pelvic side wall recurrence in 11.8%, and distant metastasis in 44.1% and the most common site of distant recurrence was extrapelvic lymph nodes (29.4%). 29.4% of recurrences were observed within the first 12 months after initial therapy, 50.0% within 2 years and 64.7% within 3 years. Results: Positive rate of SCC-Ag at initial diagnosis was 45.2% with cutoff value of 2.0 ng/ml. Positive rate of SCC-Ag at the diagnosis of recurrence was 60.0%. Overall response rate to the treatment was 29.1%. Complete response rate was higher in central pelvic recurrrence than pelvic side wall recurrence and distant metastasis (P = 0.002) and also higher in normal SCC-Ag level (≤ 2.0 ng/ml) at the diagnosis of recurrence than elevated level (P = 0.032). Cumulative survival rates of 1 year after recurrence was 66.8%, 2 year 36.7%, and 5 year 18.7%. Central recurrence showed higher cumulative survival rate than pelvic side wall or distant recurrence (P = 0.029). The patients with elevated SCC-Ag level at the time of diagnosis of recurrence showed lower cumulative survival rate than those with normal SCC-Ag level (P < 0.001). Cox proportional hazard model showed that SCC-Ag elevation at the time of diagnosis of recurrence retained significant values in predicting survival(OR = 2.56; 95% CI = [1.22-5.39]; P = 0.01). Conclusion: SCC-Ag elevation at the diagnosis of the recurrence is a strong independent prognostic indicator for survival of patients with recurrent cervical cancer.

자궁근종 불임여성에서 자궁근종절제술 후 임신율에 관한 연구

김석현(Seok Hyun Kim),최영민(Young Min Choi),문신용(Shin Yong Moon),이진용(Jin Yong Lee),박노현(Noh Hyun Park),지병철(Byung Chul Jee),강순범(Soon Beom Kang),김재원(Jae Weon Kim),송용상(Yong Sang Song),이호표(Hyo Pyo Lee),김은경(Eun K 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.1

목적: 자궁근종 이외에 다른 불임증의 원인인자가 없었던 불임환자에서 자궁근종절제술 시술 후의 임신율 및 임신율에 영향을 미칠 수 있는 인자 등을 분석 규명하고자 하였다. 방법: 1992년 1월부터 1998년 12월까지 서울대학교병원 산부인과에서 자궁근종절제술을 시행받은 불임환자 76명을 대상으로 후향적으로 의무기록을 검토하였다. 수술 후 임신 성공 여부 및 출산 결과를 추적 관찰하였으며, 임신군과 비임신군에 있어서 산과력, 연령, 불임 기간, 자궁근종의 특성, 수술 중 자궁내강 개통 여부, GnRH agonist 사용 유무 등에 있어서 유의한 차이가 존재하는지 분석하였다. 결과: 자궁근종절제술 시술 후 임신율은 46.1%(35/76) 이었다. 임신 성립까지의 기간은 평균 11.5±10.9개월(1-49개월)로서 12개월 이내에 임신된 경우가 68.6%(24/35) 이었다. 자연유산된 7명과 임신 말기에 자궁내 태아사망된 2명을 제외한 26명에서 생존아를 분만하여 생존아 분만율은 74.3%(26/35) 이었다. 분만시 25명(96.2%)에서 제왕절개술이 시행되었다. 환자의 산과력, 불임 기간, 자궁근종의 수, 종류 및 위치, 수술시 자궁내강 개통 여부 등에 있어서 임신군과 비임신군 사이에 유의한 차이가 없었다. 그러나 임신군에서 가장 큰 자궁근종의 직경이 비임신군에 비하여 유의하게 큰 것으로 나타났다. 결론: 본 연구에서 불임증의 원인인자로서 자궁근종만 존재하는 불임환자에서 자궁근종절제술 시술 후 비교적 양호한 임신율을 얻을 수 있었다. 따라서 자궁근종절제술은 불임검사상 다른 뚜렷한 이상이 발견되지 않으면서 자궁근종, 특히 직경이 큰 자궁근종이 존재하는 불임환자의 경우 우선적으로 시술할 수 있는 불임증 치료 방법이라고 사료된다. Objective: To investigate the fertility outcomes after abdominal or laparoscopic myomectomy in infertile patients with no other infertility factors except uterine myoma. Methods: From January, 1992 to December, 1998, abdominal or laparoscopic myomectomy was performed in 76 patients with desire for children and no other recognizable infertility factors. The medical records were reviewed retrospectively. The mean duration of postoperative follow-up was 23.4±21.2 months(1∼82 months). Results: After myomectomy, 35 patients(46.1%) became pregnant during the follow-up period, especially with 24(68.6%) within 12 months. Excluding 7 cases of spontaneous abortion and 2 cases of intrauterine fetal death, 26 patients(74.3%) had a viable birth. Parity, duration of infertility, number, type and location of myoma, and the proportion of opening the intrauterine cavity during operation were not significantly different between the pregnant and nonpregnant groups. However, the size of uterine myoma was significantly larger in the pregnant group(p<0.05). Conclusion: We obtained a reasonable pregnancy rate in infertile patients with uterine myoma as a sole infertility factor. The size of myoma may influence the postmyomectomy pregnancy rate, and this may indicate a more beneficial effect of myomectomy in infertile patients with a relatively larger myoma.

화학-방사선 동시요법으로 완전관해된 국소진행성 외음암

한수연(Soo Yeon Han),박노현(Noh Hyun Park),우홍균(Hong Gyun Wu),노주원(Ju Weon Roh),정현정(Hyeon Jeong Jeong),김재원(Jae Weon Kim),송용상(Yong Sang Song),강순범(Soon Beom Kang),이호표(Hyo Pyo Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Cancer of the vulva accounts for approximately 0.5% of all gynecologic malignancies. At diagnosis, one-third of these cases is detected in an advanced stage (FIGO stages III, IV), and local extension of primary vulvar cancer may involve adjacent midline structures such as the clitoris, urethra, vagina, and anus. Initial surgical therapy of such locally advanced primary cancers may compromise the functional integrity of midline structures, necessitating ultraradical surgery including pelvic exenteration. In view of the relatively elderly age of the patients and the morbidity of this ultraradical dissection, concomitant chemoradiation therapy - that the efficacy had been proven in head and neck cancer, anal cancer has approached for patients with locally advanced vulvar cancer. We experienced a case of stage III vulvar cancer patient, who underwent concomitant chemoradiation therapy with 5-fluorouracil(FU) and cisplatin and who showed complete response. So, we report this case with brief review of the literatures.