방광암에서 근치적 방광적출술 후 예후인자에 따른 생존율분석
Retrospective Survival Analysis according to Prognostic Factors after Radical Cystectomy in Bladder Cancer
소속 상세정보
이현보/Hyun Bo Lee
이지열/김세웅/조용현/윤문수/Ji Youl Lee/Sae Woong Kim/Youg Hyun Cho/Moon Soo Yoon
KMID : 0358319990400030316
Abstract
서론
방광암으로 진단된 환자의 25%는 침윤성 방광암으로 진단되고, 침윤성 방광암으로 진단
된 환자의 50%는 원격전이가 있으며 원격전이가 있는 환자의 대부분은 2년 이내에 사망하
는 것으로 되어 있다. 침윤성 방광암에서 근치적 방광적출술 및 골반강 임파절절제술은 단
일 치료로는 가장 좋은 치료법으로 알려져 있으며, 그외에도 방사선치료나 항암화학요법 등
와 다양한 방법을 통하여 치료하여 침윤성 방광암환자의 술후 생존율을 높이려고 노력하고
있으나 아직까지 수술방법보다 더 효과적인 치료법은 없는 실정이다.
이에 저자들은 근치적 방광적출술 및 골반강 임파절를시행한 침윤성 방광암 환자에서 생
존율에 중요한 영향을 미치는 예후인자를 알기 위하여 연령, 성별, 종양의 병기 및 분화도,
병리조직 소견상 종양세포의 임파선 및 혈관 침윤여부, 수술시 임파절 침범여부, 전이여부를
후향적으로 분석하여 생존율과의 관계를 알아보고 이들중에서 예후인자를 분석하여 예후인
자 따른 생존율을 비교하고자 하였다.
Purpose: Radical cystectomy with pelvic lymphadenectomy is effective therapeutic
modality in the management of invasive bladder cancer. We reviewed our experience in
order to determine the prognostic factors on survival after radical cystectomy with
pelvic lymphadenectomy.
Materials and Methods: An analysis was performed of 113 patients with bladder
cancer who underwent radical cystectomy with pelvic lymphadenectomy from 1988 to
1997. Ages ranged from 46 to 78-year-old, average age was 61.4±9.8 years old. The
survival rate according to each factor was calculated by Kaplan-Meier method. Statistics
was determined by the log-rank test.
Results: 3-year survival rate was 80% in the male patients and 66% in the female
patients. Comparing between organ confined(≤pT3a) and non-organ confined disease(≥
pT3b), 3-year survival rate was 86% for organ confined disease and 34% for non-organ
confined disease. 3-year survival rate of the patients with grade Ⅰ cancer was 96%,
grade Ⅱ cancer 86% and grade Ⅲ cancer 66%. According to microscopic vascular
invasion of the bladder tumor, 3-year survival rate in vascular invasion was 66% and
80% in non-vascular invasion. According to microscopic lymphatic invasion of the
bladder tumor, 3-year survival rate was 62% in lymphatic invasion and 88% in
non-lymphatic invasion. According to the states of lymph node invasion, 3-year survival
rate in the NO was 84%, in N1 74% and in N2≤ 0%. According to the metastasis
3-year survival rate in the absence of metastasis was 90% in nodal invasion 32% and
in visceral organ metastasis 26%.
There were statistical significant differences in sex, pathologic stage grade lymph
node invasion and distant metastasis(p<0.05).
Conclusions: From this study, we think the prognostic factors affecting survival after
radical cystectomy with pelvic lymphadenectomy may be sex, pathologic stage, grade,
lymph node invasion and distant metastasis. Therefore careful and more frequent
followup is needed in patients with poor prognostic factor.
키워드
Bladder cancer; Radical cystectomy; Survival;
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