위선암에서 외과적 치료 결과 - 단일병원의 14년간 경험 -

Results of Surgical Treatment for Primary Gastric Adenocarcinoma - Single Institute Experience for 14 Years -

  • 조준민 (고려대학교 의과대학 외과학교실) ;
  • 장유진 (고려대학교 의과대학 외과학교실) ;
  • 김종한 (고려대학교 의과대학 외과학교실) ;
  • 박성수 (고려대학교 의과대학 외과학교실) ;
  • 박성흠 (고려대학교 의과대학 외과학교실) ;
  • 목영재 (고려대학교 의과대학 외과학교실)
  • Cho, Jun-Min (Department of Surgery, Korea University College of Medicine) ;
  • Jang, You-Jin (Department of Surgery, Korea University College of Medicine) ;
  • Kim, Jong-Han (Department of Surgery, Korea University College of Medicine) ;
  • Park, Sung-Soo (Department of Surgery, Korea University College of Medicine) ;
  • Park, Seong-Heum (Department of Surgery, Korea University College of Medicine) ;
  • Mok, Young-Jae (Department of Surgery, Korea University College of Medicine)
  • 투고 : 2009.06.23
  • 심사 : 2009.10.26
  • 발행 : 2009.12.30

초록

목적: 고려대학교 구로병원에서 14년간 위암으로 수술받은 예를 대상으로 임상병리학적 특성, 치료 결과 및 예후 인자를 분석하여 보고자 하였다. 대상 및 방법: 1993년부터 2006년까지 본 교실에서 수술받은 2,327명의 위암 환자를 대상으로 후향적 연구를 하였다 결과: 절제율은 92.8%였고 근치적 절제율은 90.8%였다. 5년 생존율은 절제 예 70.0%, 근치적 절제 예 79.2%, 비근치적 절제 예 3.7% 그리고 비절제 1.5%였으며, 절제 예에서 병기별 5년 생존율은 IA기 98.9%, IB기 94.4%, II기 77.3%, IIIA기 69.3%, IIIB기 38.9% 그리고 IV기 13.6%였다. 예후 인자의 단변량 분석결과 나이, 종양의 크기 및 위치, 육안적 형태, 위벽 침윤, 림프절 전이, 원격 전이가 통계적으로 유의하였고 다변량 분석 결과 독립적 예후 인자는 림프절 전이, 위벽의 침윤도, 정맥 침윤, 연령의 순으로 나타났다. 결론: 위암에서의 예후는 병기에 의해서 가장 많이 영향을 받으므로 예후 향상을 위해서는 조기발견이 가장 중요하고, 적극적이며 체계적인 외과적 치료가 위암의 생존율향상에 기여할 것으로 생각한다.

Purpose: The aim of this study was to evaluate the clinicopathologic features, treatment outcomes, and prognostic factors of gastric cancer based on 14 years' experience in a single medical center, and to compare treatment outcomes with a previous study. Materials and Methods: We retrospectively studied 2,327 patients who were operated on for gastric cancer between 1993 and 2006 at Korea University Hospital. Results: The resection rate was 92.8% and curative resection was achieved for 1,960 (90.8%) patients. The 5-year survival rate was 70.0% for all patients undergoing resection and 79.2% for patients undergoing curative resection. The 5-year survival rate was 1.5% for unresected cases. Age, tumor size, location of the tumor, gross tumor type, depth of tumor invasion, lymph node involvement, distant metastasis, tumor stage, combined resection, complications, histology, and type of operation each had prognostic significance on univariate analysis. On multivariate analysis, lymph node involvement, depth of invasion, venous invasion, and age were independent prognostic factors. Conclusion: The 5-year survival rate for patients who underwent curative resection was 79.2%. Depth of invasion, lymph node involvement, venous invasion, and age were independent prognostic factors. The fact that tumor stage is the most important prognostic factor after curative resection, increases the importance of early detection.

키워드

참고문헌

  1. Ministry for Health, Welfare and Family Affairs. Annual report of cancer incidence (2005) and survival (1993∼2005) in Korea. 2008.
  2. Korea National Statistical Office. Death rates (2007) in Korea.2008.
  3. Chung CH, Mok YJ, Son GS, Kim SJ, Kim SM. Results of surgical treatment and analysis of prognostic factors in primary gastric adenocarcinoma. J Korean Cancer Assoc 1999;31:458-465.
  4. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years' experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36-41. https://doi.org/10.1016/j.ejso.2007.03.004
  5. Park JI, Jin SH, Bang HY, Paik NS, Moon NM, Lee JI. Survival rates after operation for gastric cancer: Fifteen-year experience at a Korea cancer center hospital. J Korean Gastric Cancer Assoc 2008;8:9-19. https://doi.org/10.5230/jkgca.2008.8.1.9
  6. The Information Committee of the Korean Gastric Cancer Association. 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2007;7:47-54. https://doi.org/10.5230/jkgca.2007.7.1.47
  7. Korean Gastric Cancer Association. Korean Classification of Gastric Carcinoma-1st English ed. Gastric Cancer 2002;2:33-42. https://doi.org/10.1007/s101200050018
  8. Sobin LH, Wittekind Ch, eds. International Union Against Cancer TNM Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss, 2002.
  9. Watanabe H, Jass JR, Sobin LH, eds. Histological Typing of Oesophageal and Gastric Tumors. 2nd ed. Heidelberg: Springer- Verlag, 1990.
  10. Garcia M, Jemal A, Ward EM, Center MM, Hao Y, Siegel RL, Thun MJ, eds. Global Cancer Facts & Figures 2007. Atlanta: American Cancer Society, 2007.
  11. Noh SH, Yoo CH, Kim YI, Kim CB, Min JS, Lee KS. Result after a gastrectomy of 2,603 patients with gastric Cancer: analysis of survival rate and prognostic factor. J Korean Surg Soc 1998;55:206-213.
  12. Powell J, McConkey CC. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 1990;62:440-443. https://doi.org/10.1038/bjc.1990.314
  13. Kim JP, Yoo HY, Kim SC, Yang HK. Clinical analysis of gastric cardia cancer. J Korean Cancer Assoc 1994;26:361-368.
  14. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J,Joypaul J, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomized controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995-999. https://doi.org/10.1016/S0140-6736(96)90144-0
  15. Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, et al. Randomized comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745-748. https://doi.org/10.1016/S0140-6736(95)90637-1
  16. Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujionaka T, Kinoshita T, Arai K, Yamamura Y, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy- Japan Clinical Oncology Group study 9501. J Clin Oncol 2004;22:2767- 2773. https://doi.org/10.1200/JCO.2004.03.950
  17. Tanaka A, Watanabe T, Okuno K, Yasutomi M. Perineural invasion as a predictor of recurrence of gastric cancer. Cancer 1994;73:550-555. https://doi.org/10.1002/1097-0142(19940201)73:3<550::AID-CNCR2820730309>3.0.CO;2-0
  18. Kim CH, Jang SW, Kang SH, Kim SW, Song SK. The significance of lymphatic, venous, and neural invasion as prognostic factors in patients with gastric cancer. J Korean Gastric Cancer Assoc 2005;5:113-119. https://doi.org/10.5230/jkgca.2005.5.2.113
  19. Song RJ, Kim SP, Min YD. Clinicopathologic characteristics and the prognosis of gastric cancer patients at both extremes of Age. J Korean Gastric Cancer Assoc 2007;7:67-73. https://doi.org/10.5230/jkgca.2007.7.2.67
  20. Chung HY, Yu W. Characteristics of gastric carcinomas in two extreme age groups. J Korean Gastric Cancer Assoc 2002; 2:200-204. https://doi.org/10.5230/jkgca.2002.2.4.200
  21. Otsuji E, Fujiyama J, Takagi T, Ito T, Kuriu, Y, Toma A. Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients. J Surg Oncol 2005;91: 232-236. https://doi.org/10.1002/jso.20330
  22. Katai H, Sasako M, Sano T, Maruyama K. The outcome of surgical treatment for gastric carcinoma in the elderly. Jpn J Clin Oncol 1998;28:112-115. https://doi.org/10.1093/jjco/28.2.112