구강 편평세포암 수술 후 5년 생존율에 관한 연구

Abstract

[한글]

전체 악성 종양의 2~5%를 차지하고 있는 구강암은 대부분 암종이고 약 80~90%를 구강 편평세포암이 차지하고 있다.

구강암은 대부분 초기에 발견하지 못하고 암종이 많이 커진 후 내원하게 되는데 이 경우 5년 생존율은 50% 미만이 되고, 수술후 생존한다고 해도 재건술의 어려움으로 심각한 기능적(functional), 심미적(esthetic) 문제가 야기되어 삶의 질(quality of life)이 떨어지게 된다. 이런 이유로 구강암의 조기 발견과 조기 치료 및 환자의 보다 나은 삶의 질을 위해서는 기초적인 역학 자료가 필요하다.

이에 저자는 연세대학교 치과대학병원 구강악안면외과에서 1994년 1월부터 2003년 12월에 치료한 구강암 환자 중 기록이 양호하고 생존 추적이 가능했던 구강 편평세포암 환자 142명의 치료 결과에 대한 역학적 조사를 하여 적절한 치료 계획의 근거로 삼고자, 본 연구를 시행하여 다음과 같은 결과를 얻었다.

1. 전체 구강암 환자 220명 중 구강 편평 세포암 환자는 142명(64.7%)를 차지했으며, 구강 편평세포암 환자의 평균 나이는 59.0세 (±13.2)였고 남녀 비율은 3.2대 1, 호발 연령은 60대, 50대, 70대, 40대 순이었다.

2. 전체 구강 편평세포암 환자의 5년 생존율은 66.90%였다.

3. 성별에 따른 5년 생존율은 여성의 생존율이 81.86%, 남성의 생존율이 61.51%로 여성의 생존율이 높았으며, 흡연에 따른 5년 생존율은 비흡연 환자가 77.41%로 흡연력이 있는 환자의 생존율(58.26%)보다 높았다.

4. 병기별 생존율은 StageI 85.82%, StageII 82.33%, StageIII 78.75%, StageIV 49.98%순이었다.

5. 원발 부위별로는 혀(Oral tongue)에서 가장 호발하였으며(31.7%) 하악 치은(22.5%), 상악 치은(15.5%), 후구삼각(9.2%), 협점막과 구강저(5.6%) 순이었으며, 원발부위별 5년 생존율은 혀(75.30%), 상악 치은(62.41%), 하악 치은(60.61%)순이었다.

6. 치료 방법에 따른 5년 생존율은 복합 치료를 받은 환자들의 생존율(53.85%)이 수술 단독 치료(73.82%)를 받은 환자보다 낮았다.

7. 세포 분화도별 분류는 고분화형(well-differntiated)이 제일 많았고(57.7%), 세포 분화도에 따른 5년 생존율은 고분화형(well-differntiated)이 70.62%로 가장 높았으며 중분화형(moderate-differentiated)이 60.96%, 저분화형(poorly-differentiated)이 53.15%이었다.

8. 경부 청소술에 따른 5년 생존율은, 경부 청소술을 시행하지 않은 환자의 생존율이 77.09%로 가장 높았으며 SOND(69.27%), SND(63.64%), MRND(52.27%), RND(41.67%)순이었고, 경부 전이 여부에 따른 5년 생존율은 경부 전이를 한 환자군의 생존율(46.78%)이 경부 전이를 하지 않은 환자군의 생존율(76.82%)보다 낮았다.

9. 성별, 병기별, 치료 방법별, 경부 전이 여부에 따른 5년 생존율은 통계적으로 유의했다. (p < 0.05)

10. 연조직 재건술은 일차 봉합술이 31.5%로 가장 많았으며 전완 유리 피판술(30.8%), 피부 이식술(17.1%), 대흉근 피판(11.0%)순이었다

추후에 이비인후과 영역에서 주로 수술하는 하인두 (hypopharynx) 나 후두(larynx), 혀 기저부(base of tongue) 환자를 포함한 전체 구강암의 역학적 조사 및 분석이 필요할 것으로 사료된다.

[영문]Oral cancers, which constitute roughly 2~5% of all malignant tumors, are mostly carcinomas, and 80~90% of them are squamous cell carcinoma.

In most cases, oral cancers are not detected in the early stage, and patients come to the hospital when it becomes fairly large. Theses patients show less than 50% of 5-year survival rate, and although they survive, there are serious functional and esthetic problems due to difficulty in reconstruction causing decrease of the quality of life. Therefore, it is important to collect basic epidemiologic data in order to detect and treat oral cancers at an early stage and improve the quality of life.

Thus, this study was done in order to establish evidence for adequate treatment planning from epidemiologic investigation of results of 142 oral squamous cell carcinoma patients treated in the Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University from January, 1994 to December, 2003, who had adequate medical records and whose survival was able to be traced. The results were as follows :

1. Out of 220 oral cancer patients, 142(67.4%) patients had oral squamous cell carcinoma, and the average age of oral suqamous cell cancer patients was 59.0 (±13.2). The ratio of the male to female patients was 3.2:1. Highest occurrence rate was shown in ages of sixties, followed by fifties, seventies, and forties.

2. 5-year survival rate of oral squamous cell carcinoma patients was 66.90%.

3. 5 year survival rate according to the sex grouping was 81.65% for female which was higher that for male, which showed 61.51%. 5 year survival rate for non-smoking patients was 77.41% which was higher than for smoking patients, which was 58.26%.

4. Survival rate according to the stage grouping was 85.82% in Stage I, 82.33% in Stage II, 78.75% in Stage III, and 49.98% in Stage IV.

5. In terms of the originating site of the oral squamous cell carcinoma, the oral tongue showed highest rates (31.7%), followed by the mandibular gingiva (22.5), the maxillary gingiva(15.5), the retromolar pad (9.2), and the buccal mucosa and the floor of mouth(5.6). 5-year survival rate according to the originating site was 75.30% for tongue, 62.41% for maxillary gingiva, and 60.61% for mandibular gingiva.

6. 5-year survival rate according to treatment procedure was 73.82% in patients treated only by surgery and 53.82% in patients who received composite treatment.

7. In terms of cell differentiation, well-differentiated type was the majority, which showed 57.7%, and 5-year survival rate was 70.62% in well-differentiated type, 60.96% in moderate-differentiated type, and 53.15% for poorly-differentiated type.

8. 5-year survival rate according to neck dissection showed a higher survival rate for those treated without neck dissection (77.09%), followed by 69.27% in SOND, 63.64% in SND 52.27% in MRND, and 41.67% in RND. In terms of cervical metastasis state, patients who had undergone cervical metastasis showed lower survival rate (46.78%) than patients who had not undergone cervical metastasis (76.82%)

9. 5-year survival rate according to sex, stage, treatment procedure, and whether the patients had undergone cervical metastasis or not were statistically significant (p<0.05).

10. Soft tissue reconstruction was mostly performed by primary closure (31.5%), followed by free forearm flap (30.8%), skin graft (17.1%), and pectoralis major myocutaneous flap (11.0%).

To investigate prospective study for oral squamous cell carcinoma, further epidemiologic investigation and analysis on oral cancer patients whose primary sites are were treated in the hypopharynx, larynx, or base of tongue, is better to be taken into consideration.