The Journal of the Korean bone and joint tumor society (대한골관절종양학회지)

The Korean Musculoskeletal Tumor Society (대한근골격종양학회)
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Treatment of Squamous Cell Carcinoma in Extremity & Trunk

사지와 체부에 발생한 편평상피 세포암의 치료

  • Shin, Duk-Seop (Department of Orthopedic Surgery, Yeungnam University Medical Center) ;
  • Kim, Beom-Jung (Department of Orthopedic Surgery, Yeungnam University Medical Center)
  • 신덕섭 (영남대학교의료원 정형외과) ;
  • 김범중 (영남대학교의료원 정형외과)
  • Received : 2012.04.01
  • Accepted : 2012.05.30
  • Published : 2012.06.30
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Abstract

Purpose: The purpose of this study is to compare general survival rate and survival rate according to expectable prognostic factors by analyzing the result of treating a patient of squamous cell carcinoma. Materials and Methods: From Mar. 1999 to Feb. 2011, 151 patients were pathologically confirmed as squamous cell carcinoma of limbs and body in our hospital, and among those patients, 51 patients underwent the surgical treatment. This study included 41 patients who underwent the surgical treatment and were followed-up for more than 12 months. The mean age of population was 64.4 years. 31 males and 10 females were included. Wide excision with following skin grafts or flaps for reconstruction (29 cases) was mostly performed, but amputation (12 cases) was also performed for cases with extremities where resection margin was difficult to obtain and cases with neural or vascular invasion. 8 patients underwent chemotherapy or radiotherapy after resection, and 33 underwent the operation only. Stages were classified by AJCC Classification, survival rate was calculated by Kaplan-Meier method and survival rate of groups was compared by Log-rank test. For the expectable prognostic factors related to survival rate, location of primary lesion, cause of disease, pathologic grade, staging, surgical method, additional anticancer therapy were examined and each survival rate was compared. Results: The average follow-up period was 65.2 (12-132) months. Thirty patients survived out of 41 patients till last follow up. The overall survival rate in 5 years was 77%. Three cases (7.3%) had local recurrence, and 7 cases (17.0%) had metastasis. The average period of recurrence from operation was 27 (18-43) months. Possible prognostic factors such as location of primary lesion, cause of disease, pathologic grade, staging, additional anticancer therapy showed no significant difference in survival rates. However, patients with amputation showed significantly lower survival rate than those with wide excision. Conclusion: In analysis the results of treating 41 cases of squamous cell carcinoma, the overall 5-year survival rate was 77%. And, among the several prognostic factors, only the surgical method was significant statistically.

목적: 편평상피 세포암 환자의 치료 결과를 분석하여, 전반적인 생존율과 예상 가능한 예후인자들에 따른 생존율을 비교하고 분석하는데 있다. 대상 및 방법: 1999년 3월부터 2011년 2월까지 본원에서 병리학적으로 진단된 사지와 체부에 발생한 편평상피 세포암은 151예였고 수술적 치료를 시행한 환자는 51예였다. 연구는 이 중 12개월 이상 외래추적이 가능하였던 41예를 대상으로 하였다. 평균 연령은 64.4세였고, 남자와 여자는 각각 31명, 10명이었다. 수술은 광범위 절제 및 재건술(29예)과 절제연을 얻기 힘든 사지 말단부나 신경, 혈관계를 침범한 경우에 절단술(12예)을 시행하였다. 수술적 치료만 시행한 환자는 33예이고, 절제 후 항암화학치료 또는 방사선 치료를 시행한 환자는 8예가 있었다. 병기는 AJCC 분류에 따라 나누었으며 생존율은 Kaplan-Meier 법으로 계산하였고 군간의 생존율 비교는 Log-rank test를 이용하였다. 생존율과 관련된 예후 인자들로 원발 병소의 위치, 병인, 조직학적 분류, 병기, 수술방법, 추가 항암요법 여부를 조사하여 각각 생존율을 비교하였다. 결과: 평균 외래 추적은 평균 65.2개월(12-132개월)이었고 최종 추시 상 생존은 30예(73.1%)이었고 Kaplan-Meier에 의한 5년 생존율은 77%이었다. 전체 환자에서 총 3예(7.3%)의 국소 재발과 7예(17.0%)의 전이가 있었다. 국소재발 3예에서 재발시기는 평균 27개월(18-43개월)이었다. 원발 병소의 위치, 병인, 조직학적 분류, AJCC 분류에 따른 병기, 추가 항암요법에서 생존율은 통계적으로 유의한 차이가 없었으나 절단술을 시행한 환자는 광범위 절제술을 시행한 환자보다 생존율이 낮았다. 결론: 41예의 편평상피 세포암의 치료결과를 분석한 결과 5년 생존율이 77%이었고 예후에 영향을 미칠 수 있는 여러 인자 중에 수술 방법만이 통계적으로 유의하였다.

Keywords

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