Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Outcome of Pulmonary Metastasectomy in Patients with Pulmonary Metastasis

전이성 폐암에 대한 폐절제술의 성적

  • Lee, Young-Ok (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Lee, Eung-Bae (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine) ;
  • Ryu, Kyoung-Min (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine)
  • 이영옥 (경북대학교 의과대학 부속병원 흉부외과학교실) ;
  • 이응배 (경북대학교 의과대학 부속병원 흉부외과학교실) ;
  • 류경민 (경북대학교 의과대학 부속병원 흉부외과학교실)
  • Published : 2007.10.05
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Abstract

Background: Surgical resection is accepted widely as the standard therapy for complete resectable pulmonary metastases. The number of cases of pulmonary metastasectomy and its survival rate is increasing due to the development of the therapeutic modalities. We attempted to analyze the survival rate and prognosis factors of pulmonary metastasectomy during the last 10 years. Material and Method: We retrospectively analyzed the data of 89 patients who underwent 96 procedures of pulmonary metastasectomy between January 1996 and December 2005. The factors that may influence the long term prognosis such as completeness of resection, the type of primary cancer, the disease-free interval, the number and size of metastasis and the laterality were investigated. Result: There was no operative mortality. The mean disease free interval (DFI) was $29.6{\pm}27.9$ months and there were 3 cases of synchronous metastasis (3.4%). The overall 3, 5 and 10 year survival rate was 52.5%, 32.1% and 20.7%, respectively. The median survival time was 38 months. The 5-year survival rate according to the IRLM appraisal was 63.5%, 33.3%, 22.1% and 0% for stage I, II, III and IV, respectively Univariate analysis showed a better prognosis for patients with a disease free interval of 36 months or more, unilateral metastasis and 4 or less metastases. Conclusion: The survival rate for completely resectable pulmonary metastasectomy was favorable. The disease free interval, laterality and the number of metastasis were the prognosis factors.

배경: 완전절제가 가능한 고형암의 폐전이에 대한 절제술은 이미 표준화된 치료방법이며, 1997년 International Resistry of Lung Metastases (IRLM)에서 대규모의 연구를 통해 전이성 폐암에 대한 병기설정 및 예후인자에 관하여 제시한 바 있다. 국내에서도 전이성 폐암에 대한 수술이 꾸준히 증가하고 있으며, 치료방법의 개선에 따른 생존율 역시 좋아지는 추세이다. 이에 경북대학교병원 흉부외과에서는 지난 10년간 전이성 폐암으로 수술을 받은 환자들의 치료결과에 대해서 조사하였다. 대상 및 방법: 1996년 1월부터 2005년 12월까지 전이성 폐암 환자 89명에 대해서 96예의 폐절제술을 시행하였다. 이들의 의무기록을 토대로 생존율 및 예후에 영향을 미치는 임상적, 병리학적 요인에 대하여 분석하였다. 결과: 환자의 평균나이는 $45.9{\pm}17.4$세($10{\sim}75$세)였으며, 남성이 51명, 여성이 38명이었다. 이 중 암종의 폐전이가 55예, 육종인 경우가 30예, 기타 4예였다. 암종 중에서는 대장암이 35예(64%), 육종 중에서는 골육종이 22예(73%)로 가장 많았다. 원발암 치료 후부터 폐절제술까지의 종양자유기간은 평균 $29.6{\pm}27.9$개월($0{\sim}180$개월)이었으며, 원발암과 동시에 발견된 경우는 3예(3.4%)였다. 전체 환자들의 3, 5, 10년 생존율은 각각 52.5%, 32.1%, 20.7%였고 중앙 생존기간은 38개월이었다. 재수술은 15예(16.8%)에서 시행하였다. IRLM 제시에 따른 병기별 5년 생존율은 1기 63.5%, 2기 33.3%, 3기 22.1%, 4기 0%였다. 36개월 미만의 종양자유기간, 양측 폐전이, 5개 이상의 전이병소를 가진 경우 예후가 좋지 않았다(p<0.05). 결론: 완전절제가 가능한 전이성 폐암에 대한 폐절제술은 만족할만한 생존율을 보였으며, 특히 양측의 다발성 전이가 있는 경우 예후가 불량함을 보였다. 하지만 각 종양별로의 치료성적 및 예후에 관한 보다 많은 경험과 추적관찰이 필요하겠다.

Keywords

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