대장암의 AJCC 병기분류법의 재평가
Reappraisal of AJCC Staging System in Colorectal Cancer
유창식, 김희철, 유장학, 김정랑, 조영규, 남궁환, 김진천,
소속 상세정보
유창식 ( Yu Chang-Sik )
울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol )
울산대학교 의과대학 외과학교실
유장학 ( Yoo Jang-Hak )
울산대학교 의과대학 외과학교실
김정랑 ( Kim Jung-Rang )
울산대학교 의과대학 외과학교실
조영규 ( Cho Young-Kyu )
울산대학교 의과대학 외과학교실
남궁환 ( Namgung Hwan )
울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 외과학교실
KMID : 0356720020180040262
Abstract
Purpose: The TNM classification for carcinoma of the colon and the rectum provides more detail than other staging systems. This study was performed to evaluate the effectiveness of AJCC staging system (5th ed., 1997) for the colorectal cancer in predicting prognosis.
Methods: We analyzed a data base of 1,233 colorectal cancer patients (M：F=673：560) who underwent surgery in Asan Medical Center during July 1989∼December 1996. Survival analysis was performed between the stages and the subgroups in same stage by using Kaplan-Meier method and log rank test. Borderline subgroup comparison between the stages was performed, also. Significance was assigned to a P value of ＜0.05.
Results: Mean age of the patients was 57 (19∼90) years old. Median follow-up period was 42 (6∼129) months. The number of patients in each stage were 0: 15, Ⅰ: 152, Ⅱ: 390, Ⅲ: 465, Ⅳ: 199. The 5 year overall & disease free survival rates of each stage were 100%, 100% (in stage 0), 96.4%, 93.6% (in stage Ⅰ), 82.7%, 82.2% (in stage Ⅱ), 59.9%, 55.3% (in stage Ⅲ), and 7.3%, 24.9% (in stage Ⅳ), respectively (P=0.000). Subgroup analysis in stage Ⅰ (T1N0 vs. T2N0) and Ⅱ (T3N0 vs. T4N0) revealed no differences. However, in stage Ⅲ, N1 (n=246) group showed better survival than N2 (n=219) group (70.3%, 65.5% vs. 49.2%, 44.6%: P=0.000). Borderline survival analysis between stage Ⅰ and Ⅱ (T2N0 vs. T3N0) was significantly different (96.6%, 95.7% vs 82.7%, 82.3%: P=0.006). However, between stage Ⅱ and Ⅲ (T4N0 vs. T1N1), appropriate analysis was impossible due to small number of cases.
Conclusions: AJCC staging system for colorectal cancer was reliable and effective in predicting prognosis. However, substages are needed in stage Ⅲ.
키워드
대장암;병기분류;생존율
Colorectal carcinoma;Staging;Survival
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