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예후인자에 따른 자궁경부 잔류암 및 재발암의 분석

Other Titles
 Analysis of persistent and recurrent carcinoma of the cervix according to prognostic factors 
Authors
 최동일 
Issue Date
1986
Description
의학과/석사
Abstract
[한글]

본 연구는 1976년 9월부터 1984년 6월까지 연세대학교 의과대학 산부인과학 교실에 입원 치료를 받은 침윤성 자궁경부암 환자 중 일관성있는 암 파급정도의 결정에 따른 처치 및 추적관찰이 가능하였던 644예의 침윤성 자궁경부암 환자를 대상으로 이 중 잔류 및 재발된 94예에서 예후인자에 따른 자궁경부 잔류암 및 재발암의 분석을 통하여 다음의 결과를 얻었다.

1. 연구대상 환자의 연령은 40대, 암 파급정도는 제2기, 세포형태는 편평상피암 중 large cell non-keratinizing type이 가장 높은 빈도를 보였다.

2. 암 파급정도에 따른 5년 무병생존율은 제1기 87.8%, 제2기 78.9%, 제3기 52.6%로 암 파급정도가 클수록 무병생존율이 감소하였다.

3. 예후인자에 따른 잔류 및 재발 빈도는 세포형태별로는 편평상피암 중 small cell type이 33.4%로 그 빈도가 가장 높았고, 병소의 크기별로는 병소의 크기가 클수록 그 빈도가 높았다.

4. 일차치료 후 재발까지의 기간은 6개월 이내 44.7%, 1년 이 71.3%, 2년 이내 90.4%로, 90% 이상이 일차치료 후 2년 이내에 재발하였다.

5. 재발부위 분포는 중앙골반재발 43.6%, 골반측벽재발 35.1% 원격재발 21.3%였다.

6. 진행된 암일수록, 병소의 크기가 큰 암일수록 재발까지의 기간이 짧았다.

7. 일차치료 방법간의 재발부위 분포의 차이는 통계학적으로 유의하지 않았다.

8. 잔류암 및 재발암의 누적생존율은 치료실패 후 6개월에 73.7% 1년에 29.8% 2년에 8.2%로, 90% 이상이 치료실패 후 2년이내에 사망하였고, 잔류암과 재발암사이의 누적생존율의 차이는 통계학적으로 유의하지 않았다.

9. 재발부위 에 따른 누적생존율은 중앙골반재발이 원격재발에 비하여 누적생존율이 높았다.

10. 재발 후 치료여부에 따른 누적생존율은 치료군의 경우 치료실패 후 6개월에 94.4% 1년에 50.0% 2년에 16.7%이고, 비치료군의 경우 6개월에 64.1% 1년에 20.5% 2년에 4.4%로 치료군이 비치료군에 비하여 누적생존율이 높았다.

11. 재발 진단시 정맥성신우조영술상 요관폐쇄를 보이지 않은 군이 요관폐쇄를 보인 군에 비하여 양호한 누적생존율을 보였으나 그 차이는 통계학적으로 유의하지 않았다.

[영문]

Of the patients with invasive cervical carcinoma admitted to the department of obstetrics and Gynecology, Yonsei University, College of Medicine from September, 1976 to June, 1984, 644 patients who received consistent staging, treatment, and follow up were studied. Of these, 94 patients developed tumor persistence and recurrence.

Analysis of persistent and recurrent carcinoma of the cervix according to prognostic factors was made, of which results were as follows :

1. Patient characteristics were as follows : the highest incidence occurred in patients acted 40-49, in patients with stage Ⅱ, and with epidermoid carcinoma large cell non-kera-tinizing type.

2. Five-year disease-free survival rates according to stage were as follows: stage Ⅰ, 87.8%: stage Ⅱ 78.9%; and stage Ⅲ 52.6%. Thus the more advanced carcinoma showed the poorer disease-free survival.

3. The highest incidence of persistence and recurrence occurred in patients with small cell carcinoma, and with the larger lesion size.

4. Time interval between primary treatment and recurrence was as follows: within 6 months after therapy, 44.7%: within 1 year, 71.3%: and within 2 years, 90.4%. Thus more than 90% of recurrence occurred within the first 2 years after primary treatment.

5. Site of recurrence was as follows: central pelvic recurrence, 43.6%: pelvic sidewall recurrence, 35.1%: and distant recurrence, 21.3%.

6. The more advanced carcinoma and the carcinoma with the larder lesson size showed the shooter tome to recurrence.

7. Site of recurrence by modalities of primary treatment showed no statistically significant differences.

8. Cumulative survival rates for persistent and recurrent carcinoma were as follows: 6-month survival, 73.7%; 1-year survival, 29.8%; 2-year survival, 8.2%. Thus more than 90% of the patients with persistent and recurrent cervical carcinoma died within the first 2 years after the detection of recurrence. Difference in cumulative survival rate between persistent carcinoma and recurrent carcinoma was not statistically significant.

9. Central pelvic recurrence showed higher cumulative survival than pelvic sidewall recurrence or distant recurrence.

10. Cumulative_ survival rates for the patients treated after recurrence were as follows; 6-month survival, 94.4%: 1-year survival, 50.0%: 2-year survival, 16.7%1 whereas for the patients untreated: 6-month survival, 64.1%; 1-year survival, 20.5%: 2-year survival, 4.4%. Thus the patients treated after recurrence showed higher cumulative survival rate than the patients untreated.

11. The patients without ureteral obstruction on IVP at the diagnosis of recurrence showed higher cumulative survival rate than the patients with ureteral obstruction, but the difference was net statistically significant.
Full Text
https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000044760
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1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/126722
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