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항문암: 종류, 치료 및 예후에 대한 고찰

Malignant Tumors of the Anus: Spectrum of Disease, Treatment and Outcomes

대한대장항문학회지 2002년 18권 5호 p.337 ~ 342
허규하 ( Huh Kyu-Ha ) - 연세대학교 의과대학 외과학교실

이강영 ( Rhee Kang-Young ) - 연세대학교 의과대학 외과학교실
하현수 ( Ha Hyun-Soo ) - 연세대학교 의과대학 외과학교실
박재균 ( Park Jea-Kun ) - 연세대학교 의과대학 외과학교실
김남규 ( Kim Nam-Kyu ) - 연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook ) - 연세대학교 의과대학 외과학교실
민진식 ( Min Jin-Sik ) - 연세대학교 의과대학 외과학교실

Abstract


Purpose: This retrospective study was performed to evaluate clinicopathologic findings, outcomes according to the treatment modality, and prognostic factors in anal cancer.

Methods: Among the 64 patients who were diagnosed as anal cancer at our department from September 1986 to December 1999, 55 patients were analysed retrospectively. Nine patients who refused the treatment or whose medical record could not be retrieved were excluded. Concurrent chemoradiotherapy was performed for twenty-seven patients with squamous cell carcinoma. The chemotherapy with 5-Fμ and cisplatin and the radiotherapy were started at the same time. 750 ㎎/㎡/day of 5-Fμ was infused intravenously for 5 days and 100 ㎎/㎡ of cisplatin was started on the second day of therapy. The second cycle chemotherapy was given for 5 days before the radiotherapy was completed. A dose of 5,400c㏉ was given to the primary lesion and whole pelvis including inguinal area. Eight patients with squamous cell carcinoma were treated by surgery including abdominoperineal resection, local excision, or wide excision. Abdominoperineal resection was the primary treatment modality for melanoma of anus.

Results: Among 55 patients with anal cancer, the dominant histologic type was squamous carcinoma (n=35), followed by cloacogenic carcinoma (n=6) and melanoma (n=6). The clinical stages by AJCC were classified as stage Ⅰ: 4 cases, stage Ⅱ: 15 cases, stage Ⅲ: 29 cases, stage Ⅳ: 7 cases. The overall 5-year survival rate of anal cancer was 60%. The 5-year survival rate in squamous carcinoma was 79.9% for the concurrent chemoradiotherapy group (n=27) and 54.7% for the surgical resection group (n=8), which was statistically insignificant. Variables affecting the survival rate with statistical significance were age, the initial tumor size, and the state of lymph node and distant metastasis.

Conclusions: The concurrent chemoradiotherapy for patients with squamous cell carcinoma of the anus offered the same outcomes equivalent to surgical modality and preserved anal sphincter function. Melanoma of the anus exhibited poor prognosis and more systemic recurrence regardless of treatment modality. On univariate analysis for risk factors, age, tumor size, and lymph node and distant metastasis had statistical significance.

키워드

항문암;화학방선요법
Anal cancer;Chemoradiaotherapy
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