6. 병리조직소견을 등급별로 분류한 결과 저도 평활근육종 15예, 고도 평활근육종 18예였으며 조직학적 분화등급과 종양의 발생부위, 크기, 주위조직 침윤정도의 관계는 통계적 유의하지 않았다.
7. 수술적 처치 결과 근치적 절재율은 64%였고 고식적 절제율은 24%로 전체 절제율은 88%었다.
8. 근지적 절제술 후 전이가 가장 호발한 부위는 간이었다.
9. 수술후 방사선 치료나 항압화학요법은 생존기간의 연장에 영향을 미치지 못했다.
10. 전체 환자의 3년, 5년 생존율은 각각 41.6%, 17.2%였다.
11. 생존율에 영향을 미치는 예후인자를 다변량분석 (Multivariated analysis)한 결과 병리조직학적 분화등급및 주위조직 침윤여부가 중요하였다.
이상의 결과를 종합하면 위장관 평활근육종은 예후인자에 준해서 치료계획이 새워져야 하고, 불량한 예후 인자의 경우 수술후 방사선 치료나 항압화학요법등의 병합요법의 필요성이 제기되나 향후 이에 대한 전향적 연구가 필요할 것으로 생각된다.
[영문]
Thirty-three patients with primary gastrointestinal leiomyo-sarcoma treated at Yonsei Medical Center from Jan.1980 to Dec.1989 were studied retrospectively to identify clinical presentation, hiatopathologic feature, treatment modality, and possible prognostic factors. The following results were obtained.
1. The median age of the patients was 54.7 years. The male and female ratio was 1.5 to 1.
2. The primary site was stomach 9, small bowel 19, and large bowel in 5.
3. The poet common symptom and sign were abdominal mass (55%), abdominal pain (36%), and bleeding (24%).
4. It was possible to obtain a preoperative diagnosis using barium study combined with endoscopic biopsy and abdominal CT scan in 10 cased (30%) of gastrointestinal leiomyosarcomas.
5. The average sine of tumors was 11.3 cm(2.5-27.0 cm).
6. The low grade tumors were 15 cases, and high grade tumors were 18 cases. The histopathologic grading was not significantly correlated with site and size of tumor, and invasion of adjacent organs.
7. The overall resectability was 88% ; 64% of the tumor were rejected curatively and 24% were palliatively.
8. The most common trite of metastasis after curative resection was liver.
9. The postoperative radiation therapy and/or chemotherapy did not influence to survival .
10. The actuarial 3-and 5-year survival rate of gastrointestinal leiomyosarcoma were 41.6%, 17.2%.
11. The multivariate analysis for prognostic factors showed a prognosis based on histopathologic grade and invasion of adjacent orleans.
It is concluded that the gastrointestinal leiomyosarcoma should be managed according to prognostic factors, and further trial of combined modality treatment for patients with adverse prognostic factors is warrented.