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병기 IB 자궁경부암에서 혈관내피세포성장인자(VEGF)의 발현이 예후에 미치는 영향

Other Titles
 (The) expression of vascular endothelial growth factor(VEGF) is a highly significant prognostic factor in stage IB carci 
Authors
 이익재 
Department
 Dept. of Radiation Oncology (방사선종양학교실) 
Issue Date
2001
Description
의학과/석사
Abstract
[한글] 본 연구에서는 자궁경부암에서 VEGF의 발현과 기존의 예후인자들인 종양의 크기, 골반내림프절의 전이, 림프계침윤, 혈관계침윤, 자궁경부 심부침윤과의 상관관계를 분석하고, 생존율을 분석하여 VEGF의 예후 예측인자로서의 임상적 의의에 대해 알아보고자 하였다. 대상환자들은 1986년 1월부터 1998년 10월까지 연세대학교 원주의과대학 원주기독병원에서 자궁경부암으로 진단 받고 근치적 자궁절제술과 양측 골반 림프절 적출술을 받은 FIGO 병기 IB인 환자 118명으로, 88명은 수술 후 화학요법이나 방사선치료가 시행되었다. VEGF 발현은 수술을 시행한 파라핀 조직을 가지고 면역조직화학염색을 시행하였다. 분석은 염색의 강도에 따라 0, +, ++, +++로 판정하였으며 0에서 ++까지를 저발현(low expression), +++를 고발현(high expression)으로 분류하였다. 118명중 고발현을 보이는 환자는 35명(30%)이었으며 VEGF 발현과 예후인자들과의 상관관계에서 자궁경부 심부침윤(p=0.009)과 골반 내 림프절 전이(p=0.02)에서 의미 있는 관계가 있었다. 5년 생존율과 무병생존율은 VEGF 발현이 낮을 때 각각 94.6%, 92%였고, 고발현일때는 90.7%, 81.7%로 의미 있는 차이를 보였다 (p=0.01, 0.001). 재발양상에서 VEGF 발현이 높은 환자에서 골반 내 재발(p=0.003)과 원격전이(p=0.02)가 의미 있게 많았다. 다변량분석에서 생존율에 의미 있는 예후인자는 VEGF 발현(p=0.001)과 골반 내 림프절전이(P=0.01)였다. 무병생존율에 의미 있는 예후인자는 VEGF 발현 (p=0.01), 혈관계 침윤(P=0.02) 그리고 종양의 크기(P=0.03)였다. 결론적으로, 조기 자궁경부암에서 재발의 위험도가 높은 환자들을 찾아내고 기존의 치료들과 VEGF 항체등의 새로운 혈관억제요법을 병행하기에 적합한 대상 환자들을 찾아내는데 있어서 면역조직화학염색을 통한 VEGF 발현의 정도는 임상적으로 유용한 지표로 사용될 수 있을 것으로 생각된다.
[영문] Purpose: The aim of this study was to clarify the role of VEGF expression as an in dependent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Methods: A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, 88 patients were treated with postoperative radiotherapy and/or chemotherapy, VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low staining intensity and the patients with a score of +++ as high staining intensity. Results: Of the 118 patients, 35 patients (30%) showed high staining intensity (3) of VEGF. Strong correlations were found between the high staining intensity of VEGF and both deep stromal invasion (p=0.009) and the positive pelvic node (p=0.02) . The 5-year overall and disease-free survival rates for all 118 patients were 94.6% and 92%. The 5-year overall (p=0.01) and disease-free survival (p=0.001) rates were 97.1% and 98.6% for low intensity (0, +, and ++) of VEGF and 90.7% and 81.7% for high intensity of VEGF, respectively. Pelvic and distant failures for low versus high intensity of VEGF were 1.2% versus 17.1%. (p=0.003) and 0% versus 14.3%(p=0.002), respectively. In a Cox multivariate analysis of survival, the high staining intensity of VEGF (p=0.008) and the positive pelvic node (p=0.01) were significant prognostic factors for overall survival. The high staining intensity of VEGF (p=0.01), vascular invasion (p=0.02), and bulky mass (p=0.03) demonstrated as significant prognostic indicators for disease free survival. Conclusion: These results showed that the intensity of VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage 1B cervix cancer treated with radical surgery. We strongly suggest that the immunohistochemistry for VEGF expression be performed in a routine clinical setting in order to identify patients at high risk for poor prognosis in early stage cervical cancer.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 2. Thesis
Yonsei Authors
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/127672
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