Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 청소년 골육종 재발 후 치료성적 : 한국의 단일기관 성적

Outcome after relapse in childhood and adolescent osteosarcoma : single institution experience in Korea

  • Lee, Yun-Jeong (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Lee, Hyun-Jae (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Kim, Dong-Ho (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Lim, Jung-Sub (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Lee, Jun-Ha (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Park, Kyung-Duk (Department of Pediatrics, Korean Cancer Center Hospital) ;
  • Jeon, Dae-Geun (Department of Orthopedics, Korean Cancer Center Hospital) ;
  • Lee, Soo-Yong (Department of Orthopedics, Korean Cancer Center Hospital)
  • 투고 : 2007.08.19
  • 심사 : 2007.09.15
  • 발행 : 2008.01.15
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초록

목 적 : 골육종은 소아 청소년기에 뼈에 발생하는 가장 흔한 악성종양으로 종양 제거술 및 집중적 항암 화학요법을 시행한 경우에도 약 30-40%에서 재발하는 매우 침습적인 질환이다. 하지만 아직까지 재발한 골육종의 예후 및 예후인자에 대한 연구가 부족한 상태이다. 저자들은 치료 후 재발한 골육종 환아의 치료성적 및 재발 후 생존율에 영향을 주는 요인들을 분석하고자 하였다. 방 법 : 1985년 2월부터 2004년 2월까지 원자력병원에서 골육종으로 치료한 461명의 환아 중 재발한 180명의 의무기록을 후향적으로 조사하였으며 재발 후 생존율과 재발 후 예후인자로 재발병소의 위치, 재발 후 치료 방법, 원발병소의 수술전 화학요법에 대한 병리학적 반응도, 첫 진단 시 전이여부 및 재발기간을 분석하였다. 결 과 : 전체 재발율은 39%였고 재발한 골육종 환아의 5년 및 10년 재발 후 생존율은 각각 13%와 4%였다. 평균 재발기간은 15개월이었다. 재발 후 5년 생존율에 영향을 주는 인자는 재발 부위(폐, 39%; 원발병소, 0%; 폐와 뼈의 재발, 25%; 기타 부위의 재발, 12%), 병소 부위 절제 여부(절제한 경우 38%; 절제하지 않은 경우 11%), 재발기간(1년 이내에 재발한 경우 13%, 1년 이후에 재발한 경우 44%)이었다. 결 론 : 재발된 골육종 환자의 생존율은 높지 않다. 하지만 본 연구에서는 재발된 병변을 적극적으로 치료할 때 생존율이 향상됨을 보여주고 있으며 특히 재발기간이 길고 폐에 재발된 경우에는 수술 및 항암 화학요법과 그 외의 적극적인 치료가 필요하다 하겠다.

Purpose : Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. Although survival rate of osteosarcoma patients has markedly improved, about 20-30% of patients still have a relapse. This study was aimed to find factors that influence postrelapse survival of osteosarcoma in childhood and adolescents. Methods : Between 1985 and 2004, of 461 patients who were diagnosed and treated as osteosarcoma in Korean Cancer Center Hospital, 180 patients with recurrent osteosarcoma were retrospectively reviewed. We examined survival rates and analyzed prognostic factors, such as relapse site, post-relapse treatment methods, pathologic response to neoadjuvnat chemotherapy, metastasis at first diagnosis, and relapse free interval. Results : The overall recurrence rate of patients with osteosarcoma was 39%. The 5-year and 10-year postrelapse survival rates in the recurrent osteosarcoma were 13% and 4%, respectively. The 5-year post-relapse survival rate was influenced by site of relapse (lung, 39%; local, 0%; lung & bone, 25%; others, 12%; P<0.05), relapse-free interval (<12 months, 13%; ${\geq}12$ months, 44%, P<0.05), and post-relapse treatment methods (with surgery, 38%; without surgery, 11%; P<0.05). Conclusion : The survival rate of recurrent case is very low after 10 years, so new second-line chemotherapy and active treatment is needed to increase survival. Aggressive surgery with the removal of recurrence sites combined with multi-agent chemotherapy could either cure patients with recurrent osteosarcoma or significantly prolong their survival.

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