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항문관의 표피양암종: 치료결과 및 예후인자

Epidermoid Carcinoma of the Anal Canal: Treatment Outcome and Prognostic Factor

대한대장항문학회지 2002년 18권 1호 p.42 ~ 52
강성범 ( Kang Sung-Bum ) - 서울대학교 의과대학 외과학교실

육의곤 ( Youk Oui-Gon ) - 서울대학교 의과대학 외과학교실
허승철 ( Heo Seung-Chul ) - 서울대학교 의과대학 외과학교실
정승용 ( Jeong Seung-Yong ) - 국립암센터 대장암센터
최효성 ( Choi Hyo-Seong ) - 국립암센터 대장암센터
박규주 ( Park Kyu-Joo ) - 서울대학교 의과대학 외과학교실
최국진 ( Choi Kook-Jin ) - 서울대학교 의과대학 외과학교실
박재갑 ( Park Jae-Gahb ) - 국립암센터 대장암센터

Abstract


Purpose: During recent two decades, therapeutic strategy for epidermoid carcinoma of anal canal has been changed on basis of the knowledge of the natural course and biologic features. The current study evaluated the treatment outcome and prognostic factors in epidermoid carcinoma of the anal canal.

Methods: Fifty-seven cases with epidermoid carcinoma of anal canal were treated curatively in Seoul National University College of Medicine from 1976 to 1997. The sex ratio was 1.5 to 1 with male predominance, with a median age of 57.0 years. The histology consisted of 59.6% (34 cases) in squamous cell carcinoma and 40.4% (23 cases) in cloacogenic carcinoma. According to UICC/AJCC staging system, there were 24.6% in stage Ⅰ, 28.1% in stage Ⅱ, 31.6% in stage Ⅲa and 15.8% in stage Ⅲb. Operation-based treatment was performed in 96.6% of 29 cases during period Ⅰ (1976∼1988) and in 60.7% of 28 cases during period Ⅱ (1989∼1997). Forty-five cases were treated on the basis of operation: 13 cases, operation only; 20, operation plus radiation; 12, operation plus chemoradiotherapy. And 12 cases were managed by combined radiation and chemotherapy.

Results: On median follow-up of 52.0 months (range, 1∼160 months), there were 19.3% in local recurrence and 8.8% in systemic recurrence. Recurrence rates were not significantly related to therapeutic strategy (P=0.37). The overall 5-year survival rate was 74.9%. The 5-year survival rates according to therapeutic strategy were 73.3% in the operation-based treatment and 80.0% in the combined radiation and chemotherapy. Survival rates were not significantly related to therapeutic strategy (P=0.48). Three cases, whose sizes were 1 ㎝, 2 ㎝ and 2.5 ㎝ without lymph node metastasis, were excised locally and are still alive without recurrence. In the multivariate analysis, the metastatic status of lymph nodes had the only independent significant influence on survival.

Conclusions: Combined radiation and chemotherapy in epidermoid carcinoma of anal canal is the preferred treatment for sphincter-preservation, and local excision in early lesion have good outcome without morbidity associated with chemotherapy or radiation therapy. In this study, lymph node status was the only prognostic variable.

키워드

표피양암종;항문관;치료결과;예후인자
Epidermoid carcinoma;Anal canal;Treatment outcome;Prognostic factor
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