Wilms 종양에서의 적극적 병합요법의 치료효과

Abstract

[한글]

Wilms 종양은 다른 어느 종양 보다도 전문적 연구팀이 조직되어 활발히 연구되어 온바 치료 성적에 있어서 눈부신 향상이 이루어 졌다. 우리나라에서는 이미 1975년 연세대학교 의과 대학 부속 연세 암센터가 설립되면부터 체계적으로 적극적 병합요법을 시행하여 왔

으며 그에 따른 완치율의 향상도 예상되었다.

이에 저자는 1970년 1월부터 1989년 12월까지 연세대학교 의과대하 부속 연세 암센터에서 Wilms 종양으로 진단 받고 치료가 끝났던 환아들중 추적이 가능했던 65명을 대상으로 후향성 추적조사를 시행하여 치료 성적을 평가하여 보았으며 이에 관여하는 예후인자들을

관찰하였다.

전체 환아의 2년 생존율은 80.0%였고 이들 중 45명이 적극적 병합요법을 충분히 받았으며 이들의 2년 무병생존율은 84.4%였다. 이중 favorable histology 인 경우 Ⅰ 병기에서는 94.4%, Ⅱ 병기에서는 90.0%, Ⅲ 병기에서는 87.57로 외국의 보고와 유사한 성적을 나타냈다. 그러나 위험도가 높은 군(Ⅳ 병기이거나 unfavorable histology인 경우)의 2년 무병생존율은55.6%로 외국의 보고(68.1%)보다 다소 낮은 치료성적을 보였다. 충분한 치료를 받지 못한 환아들중 favorable histology 이면서 Ⅰ병기, Ⅱ병기의 2년 무병생존율은 각각 75.0%, 60.O% 였으나, Ⅲ병기 이상이거나 unfavorable histology인 경우는 모두 2년 내에 재발되었다. 치료 성적에 영향을 미치는 예후인자로는 조직학적 유형(P < 0.005)과

국소임파절 전이 여부(P < 0.01)가 통계학적으로 의의있는 예후인자로 밝혀졌다.

이와같이 Wilms 종양 환아에 대한 치료 성적을 고찰해 본 결과 앞으로 우리나라에서도 외국에서 개발된 치료방법을 수용하는 단계를 넘어서서 여러 연구기관 사이에 긴밀한 협조 체제가 이루어져 좀더 많은 환아를 대상으로 공동연구를 시행하여 치료성적을 더욱 향상시켜야 하겠다.

The treatment results of Wilms tumor by multimodality approach

Un Jun Hyoung

Department of Dental Science, The Graduate School, Yonsei University

(Directed by professor Byung Soo Kim)

Wilms tumor, among numerous neoplastic diseases, has been subjected to the most

intense investigation by many research centers resulted in drastic improvement in

therapeutic outcome. Yonsei Cancer Center in Korea, since it's establishment in

1975, has been a source of state of art multimodal therapy in this tumor and

accordingly the cure rate was predicted to rise steadily.

Sixty - five cases of Wilms tumor, registered and followed - up at Yonsei Cancer

Center, between January 1970 and December 1989 were analysed retrospectively and

the overall two year survival rate was 80.0%. Forty-five patients received a

therapy with wellplanned multimodality concept. The two year relapse free survival

rate of this group was 84.4%. In detail, two year relapse free survival rate for

stage Ⅰ, Ⅱ, and Ⅲ of favorable histology was 94.4%, 90.0% and 87.5%

respectively. But in the high risk group (stage Ⅳ or unfavorable histology) the

two year relapse free survival rate was 55.6% and this outcome is seemingly poor as

compared to the report from other developed countries(68.1%).

In incompleted treatment group, the two year relapse free survival rate for stage

Ⅰ and Ⅱ of favorable histology was 75.0% and 60.0% respectively. But the two year

relapse free survival rate for stage Ⅲ, Ⅳ or unfavorable histology was 0%.

The most significant prognostic factor was the histologic subtype, i.e.favorable

vs. unfavorable histology (P < 0.005) and another prognostic factor was lymph mode

involvement (P < 0.01).

The author believes that many cancer centers are going to be founded in Korea.

Subsequently, more cases of Wilms' tumor are expected to be enrolled in systematic

treatment program. Therefore, a great endeavor to build up a cooperative system and

improves therapeutic outcome.

[영문]

Wilms tumor, among numerous neoplastic diseases, has been subjected to the most intense investigation by many research centers resulted in drastic improvement in therapeutic outcome. Yonsei Cancer Center in Korea, since it's establishment in

1975, has been a source of state of art multimodal therapy in this tumor and accordingly the cure rate was predicted to rise steadily.

Sixty - five cases of Wilms tumor, registered and followed - up at Yonsei Cancer Center, between January 1970 and December 1989 were analysed retrospectively and the overall two year survival rate was 80.0%. Forty-five patients received a therapy with wellplanned multimodality concept. The two year relapse free survival rate of this group was 84.4%. In detail, two year relapse free survival rate for stage Ⅰ, Ⅱ, and Ⅲ of favorable histology was 94.4%, 90.0% and 87.5% respectively. But in the high risk group (stage Ⅳ or unfavorable histology) the two year relapse free survival rate was 55.6% and this outcome is seemingly poor as compared to the report from other developed countries(68.1%).

In incompleted treatment group, the two year relapse free survival rate for stage Ⅰ and Ⅱ of favorable histology was 75.0% and 60.0% respectively. But the two year relapse free survival rate for stage Ⅲ, Ⅳ or unfavorable histology was 0%.

The most significant prognostic factor was the histologic subtype, i.e.favorable vs. unfavorable histology (P < 0.005) and another prognostic factor was lymph mode involvement (P < 0.01).

The author believes that many cancer centers are going to be founded in Korea.

Subsequently, more cases of Wilms' tumor are expected to be enrolled in systematic treatment program. Therefore, a great endeavor to build up a cooperative system and improves therapeutic outcome.