자궁내막암의 임상 및 병리학적 분석

Abstract

[한글]

최근 경제성장에 따른 식이의 변화로 점차 증가되는 경향인 자궁내막암의 처치에 있어서 중요한 위험 및 예후인자에 대한 분석 자료가 없는 한국 실정에서 저자는 1966년 1월부터 1986년 6월까지만 20년 6개월간 연세의료원 산부인과에 입원 치료받은 총 50예의 자

궁내막암 환자의 임상기록부와 수술적출물의 병리조직학적 예후인자들을 분석하여 다음과 같은 결과를 얻었다.

1. 연도별 발생빈도는 각각 5년간을 주기로 볼 때 증가하는 경향을 보이고 있었다.

2. 연령별 분포는 20대가 2%, 30대가 12%, 40대가 18%, 50대가 42%, 60대가 22%, 70대가 4%이었다.

3. 초경연령은 기록이 있었던 38예에서 그 범위가 13-20세이었고, 그 평균은 15.6세이었고, 약 4분의 3이 51-17세 사이에 속해 있었다.

4. 폐경여부는 25명(50%)이 폐경후였고 13명(26%)은 폐경전이었으며 12명(24%)은 폐경기에 있었다.

5. 폐경시 연령은 기록이 있었던 22예에서 그 범위는 42-53세이었고 그 평균은 47.9세이었다.

6. 기왕분만력은 3회 이상의 기왕분만력을 가진 환자가 34명(68%)이었고 1회의 기왕분만력을 가진 환자는 5명(10%)이었으며 기왕분만력이 없는 환자는 11명(22%)이었다.

7. 체중은 과소체중이 9.7%, 정상체중이 41.9%, 과체중이 29%, 비만체중이 19.4%이 었다.

8. 조직학적 유형은 선암이 34예(68%), 유두성선암 6예(12%), 선극세포암 4예(8%), 선편평세포암 3예(6%), 투명세포암 3예(6%)이었다.

9. 입원진단시 암파급정도는 암 제 1기가 29예(58%), 제 2기가 7예(14%), 제 3기가 9예(18%), 제 4기가 5예 (10%)이었다.

10. 암 제 1b기의 grade가 la기의 grade보다 높은 경향을 보였으며 grade가 높을수록 자궁근층의 암세포 침윤이 깊은 경향을 보였다.

11. 자궁강의 크기가 8cm 이상일 때 8cm 미만인 경우보다 자궁근층의 침윤정도가 깊었다.

12. 치료방법은 외과적 처치만 받은 경우가 24%, 외과적 처치와 방사선 치료를 병합한 경우가 38%, 방사선 치료만 받은 경우가 26%이었다.

13. 1986년 6월 30일 현재 생존한 사람은 15명 이었으며 암 제 1a기가 6명, 1b기가 8명, 제 2기가 1명이었고 이들의 생존기간은 6개월에서 108개월이었다.

Clinical and Histopathologic Analysis of Endometrial carcinoma

Jung Hyun Cho, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by professor Tchan Kyu Park, M.D.)

Between January, 1966 and June, 1986, total of 50 patients with endometrial

carcinoma admitted to the Department of Obstetrics and Gynecology, Yonsei

University College of Medicine were retrospectively analysed.

The purpose of this study is to evaluate the patients clinical characteristics

and the histopathology as to whether or not there were certain correlation.

The results were as follows:

1. There was an increasing tendency of endometrial carcinoma during 5 year time

interval between January, 1966 to June, 1986.

2. Age distribution of the patients with endometrial cancer showed; the twenties

2%, thirties 12%, fourties 18%, fifties 42%, sixties 22%, and seventies 4%.

3. The mean age of menarche of the patients was 15.6 years-old, and it was not

significantly different from that of average Korean woman.

4. The state of menopause of the patients showed; premenopausal state 26%,

menopansal state 24%, and postmenopausal state 50%. The sum of the menopausal and

postmenopausal state was 74%.

5. The mean age of menopause of the patients was 47.9 years-old, and it was not

significantly different from that of average Korean woman.

6. The parity of the patients showed: nulliparity 22%, primiparity 10%, and

multiparity 68%.

7. Distribution of body weight showed; underbody weight 9.7%, normal body weight

41.9%, overweight 29.0%, and obesity 19.4%.

8. According to WHO histopathologicaL classification, The percentage of the

adenocarcinoma was 68%, papillary adenocarinoma 12%, adenoacanthoma %,

adenosquamous cell carinaoma 6%, and clear cell carcinoma 6%.

9. According to FIGO classification, The stages of the patients were classified

as: stage Ⅰ 58%, stage Ⅱ 14%, stage Ⅲ18%, and stage Ⅳ10%.

10. All of the tumor grades of the stage Ⅰb cancers were generally higher than

those of the Stage Ⅰa cancers, and the higher the tumor grades, the deeper were

cancer invasion into myometrium.

11. Correlation between depth of uterine cavity and myometrial invasion was that

depth greater than 8cm were associated with deeper myometrial invasion than that

less than 8cm, and it was statistically significant.

12. The modality of treatment of the disease showed; surgery alone 24%, surgery

and radiation therapy 38%, and only radiation therapy 26%. There was one case with

surgery followed by combination chemotherapy.

13. The present state of the patients showed; six in stage Ⅰa, eight in stage

Ⅰb and one in stage Ⅱ were alive, but the others were unknown.

[영문]

Between January, 1966 and June, 1986, total of 50 patients with endometrial carcinoma admitted to the Department of Obstetrics and Gynecology, Yonsei

University College of Medicine were retrospectively analysed.

The purpose of this study is to evaluate the patients clinical characteristics and the histopathology as to whether or not there were certain correlation.

The results were as follows:

1. There was an increasing tendency of endometrial carcinoma during 5 year time interval between January, 1966 to June, 1986.

2. Age distribution of the patients with endometrial cancer showed; the twenties 2%, thirties 12%, fourties 18%, fifties 42%, sixties 22%, and seventies 4%.

3. The mean age of menarche of the patients was 15.6 years-old, and it was not significantly different from that of average Korean woman.

4. The state of menopause of the patients showed; premenopausal state 26%, menopansal state 24%, and postmenopausal state 50%. The sum of the menopausal and postmenopausal state was 74%.

5. The mean age of menopause of the patients was 47.9 years-old, and it was not significantly different from that of average Korean woman.

6. The parity of the patients showed: nulliparity 22%, primiparity 10%, and multiparity 68%.

7. Distribution of body weight showed; underbody weight 9.7%, normal body weight 41.9%, overweight 29.0%, and obesity 19.4%.

8. According to WHO histopathologicaL classification, The percentage of the adenocarcinoma was 68%, papillary adenocarinoma 12%, adenoacanthoma %, adenosquamous cell carinaoma 6%, and clear cell carcinoma 6%.

9. According to FIGO classification, The stages of the patients were classified as: stage Ⅰ 58%, stage Ⅱ 14%, stage Ⅲ18%, and stage Ⅳ10%.

10. All of the tumor grades of the stage Ⅰb cancers were generally higher than those of the Stage Ⅰa cancers, and the higher the tumor grades, the deeper were cancer invasion into myometrium.

11. Correlation between depth of uterine cavity and myometrial invasion was that depth greater than 8cm were associated with deeper myometrial invasion than that less than 8cm, and it was statistically significant.

12. The modality of treatment of the disease showed; surgery alone 24%, surgery and radiation therapy 38%, and only radiation therapy 26%. There was one case with surgery followed by combination chemotherapy.

13. The present state of the patients showed; six in stage Ⅰa, eight in stageⅠb and one in stage Ⅱ were alive, but the others were unknown.