Radiation Oncology Journal

  • 제21권4호
  • /
  • Pages.283-290
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  • 2003
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
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자궁경부암 방사선치료 후 혈중 Squamous Cell Carcinoma 항원치의 장기추적 결과

Long Term Follow Up Results of Serum Squamous Cell Carcinoma Antigen Level in Uterine Cervix Cancer Treated by Radiotherapy

  • 윤형근 (단국대학교 의과대학 방사선종양학교실)
  • Yun, Hyong-Geun (Department of Radiation Oncology, Dankook University College of Medicine)
  • 발행 : 2003.12.01
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초록

목적: 자궁경부암의 방사선치료 후의 재발이나 병소의 지속을 발견하기 위한 종양표지자로서의 Squamous cell carcinoma (SCC) 항원의 의의를 장기간의 경과관찰을 통해서 확인하고자 하였다. 대상 및 방법: 1995년 10월부터 2001년 5월까지 단국대학병원 방사선종양학과에서 원발성 자궁경부암으로 근치적 방사선치료를 시행 받은 환자 중 치료 전후에 혈중 SCC 항원치를 주기적으로 측정한 48예를 대상으로 하였다. 결과: 방사선치료 전에 측정한 SCC 항원치는 전체의 79.2$\%$에서 정상치 보다 높았다. 치료 후에 SCC 항원치는 유의하게 감소하였으며 치료 후 3개월 경에는 23.0$\%$에서 정상치 보다 높았다. 병소의 완전 관해가 이루어지고 치료실패가 일어나지 않은 경우는 6개월 이후의 장기적인 관찰 중 SCC 항원치는 결국 정상범위가 되었다. 치료 후의 장기적인 경과 관찰 중에 SCC 항원치가 재상승하여 지속적으로 높은 값을 나타낸 경우는 치료실패를 아주 잘 예측하였으며 SCC 항원치의 재상승과 임상적 치료실패 확인 사이의 시간간격(lead time)의 평균은 4개월이었다 재발과 관련된 SCC 항원치의 지속적 상승의 민감도는 85.7$\%$, 특이도는 100.0$\%$이었다. 첫 번째 치료실패가 폐 전이로 나타났던 4예 중 3예에서는 SCC 항원치의 재상승이 일어나기 전에 흉부단순 촬영 소견에서 폐 전이가 나타났으나 그 외의 모든 임상적 재발 시에는 SCC 항원치의 재상승이 동반되거나 선행되었다. 결론: 본 연구에서 치료 전 SCC 항원치가 높았던 경우에 치료 후 SCC 항원치의 지속적 상승은 치료 실패를 정확하게 예견하게 해 주는 좋은 예후인자였으며 SCC 항원치 상승과 치료실패 사이의 시간간격은 평균 4개월이었다. 그러나 치료 전 SCC 항원치가 높은 경우의 치료실패 양상 중, 폐 전이 초기와 같이 종양부피가 작은 경우는 처음에는 일시적으로 SCC항원치가 정상범위로 관찰될 수 있으므로 경과 관찰 시 반드시 흉부단순 촬영을 병행하여 폐 전이 여부를 함께 관찰하여야 할 것으로 생각된다.

Purpose: To evaluate the long term significance of the squamous cell carcinoma (SCC) antigen (Ag) as a tumor marker in uterine cervix carcinoma. Materials and Methods: The SCC antigen levels of pre-radiotherapy and serial post-radiotherapy serum were analyzed in 48 patients who received radiotherapy with histologically proven primary SCC of the uterine cervix. Results: Pre-radiotherapy SCC Ag level was high ($\geq$2 ng/ml) at 79.2$\%$. After the treatment, the SCC Ag level was significantly decreased. The SCC Ag level measured at about 3 months after radiotherapy was high at 23.0$\%$. In further follow up measurements, a rise of the SCC Ag to a high level was well associated with clinical relapse. The specificity of the elevated SCC Ag level in association with recurrent or persistent disease was 100$\%$, and the sensitivity was 85.7$\%$. In 3 of 4 lung metastasis cases, lung lesions were detected in chest PA before elevation of the SCC Ag level. The median lead time of the high SCC Ag level to clinical recurrence was 4 months. Conclusion: SCC Ag was a good tumor marker for monitoring treatment effect in patients with increased pre-treatment levels except in case of early lung metastasis. Elevation of the SCC Ag level after radiotherapy accurately predicted the treatment failure with lead time of 4 months. But, in early lung metastasis cases, the SCC level may be normal temporarily. Thus, chest PA should be checked to evaluate the presence of lung metastasis.

키워드

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