소세포폐암의 예후인자 : 이중병기체계의 타당성 분석
Prognostic Factor Analysis of Small Cell Lung Cancer: Appropriateness of Two Staging System
대한암학회지 1997년 29권 6호 p.1000 ~ 1010
소속 상세정보
장재진
김태유/이춘택/남승모/김재학/송은정/김성환/김봉석/류백렬
KMID : 0360319970290061000
Abstract
서론
소세포폐암은 치료하지 않은 경우 생존기간이 2∼3개월에 불과한 반면, 복합화학요법으로
치료를 하였을 때 80% 이상의 반응률을 보이며 반응군의 중앙생존기간이 limited
disease(LD)는 15개월, extensive disease(ED)는 9개월 이상으로 연장되는 것으로 알려져 있
다. 소세포폐암에 대한 생존예후인자로는 1989년 'International Association for the Study
of Lung Cancer(IASLC)'에서 제시된 바와 같이 이중병기체계 (LD vs. ED)가 가장 강력한
예후인자로 알려져 있으나, 반대측 종격동림프절, 반대측 쇄골하림프절, 동측 흉수의 경우와
같이 병기결정에 여전히 논란이 있으며, 동일한 병기의 경우에도 생존기간의 차이가 관찰되
고 있다. 또한 외국의 여러 연구자에 의해 이중병기체계 이외의 다양한 생존예후인자가 발
표되고 있어서 명확한 이중병기체계를 기본으로 한 생존예후인자의 정립의 필요성이 대두되
고 있으나, 국내의 경우 이에 대한 연구결과가 미미한 실정이다. 이에 저자 등은 원자력병원
에 내원한 소세포폐암 환자를 대상으로 하여 이중병기체계의 정립과 이를 근거로 한 생존예
후군을 분석하고자 하였다.
#초록#
Purpose : The two staging system, which divides the tumors into limited disease(LD)
and extensive disease(ED) has been widely accepted as a major prognostic determinant
in small cell lung cancer(SCLC). However this system has provoked several
controversial issues in defining stage categories, for instance, ipsilateral pleural effusion
as LD or ED. Furthermore, identification of favorable subgroups in the same stage has
been recognized as an important factor to determine appropriate treatment strategies. In
this study, we performed a retrospective analysis in an attempt to resolve the
controversial issues about staging and identify the patient group with favorable
prognosis based on this two staging system.
Materials and Methods : The clinical data of 233 patients with SCLC treated from
1990 to 1996 at Korea Cancer Center Hospital were retrospectively analyzed for this
study. All patients were treated with chemotherapy containing cisplatin and/or
radiotherapy. The independent prognostic factors for survival were identified by
multivariate analysis using Cox's proportional hazards model.
Results : Performance status(relative risk of death [RR]:2.89), number of
metastasis(RR:2.2), response to treatment(RR:2.2) as well as stage(RR:1.77) were
identified as independent prognostic factors for survival in patient with SCLC. The
median survival of patients with ipsilateral pleural effusion(13 months) which was
categorized as ED was similar to that of patients with contralateral mediastinal or
supraclavicular lymph nodes(13.8 months) or other LD patients(13.7 months). This result
suggests that ipsilateral pleural effusion should be categorized as LD. In LD, response
to treatment was the only independent prognostic factor(RR:2.34) and thoracic
radiotherapy moderately improved survival as compared with combination chemotherapy
alone(17.7 months vs. 10.4 months, p=0.06). In ED, the patient group with a good
performance status(ECOG 0-1), normal range of serum alkaline prophatase, and
metastasis less than 2 sites showed significantly prolonged survival, comparing with
other ED patients(11.2 months vs. 7.2 months, p=0.0001).
Conclusion : As a result of survival analysis, we confirmed independent prognostic
factors such as stage and performance status in SCLC. We could recommend that LD
category include patients with ipsilateral pleural effusion as well as those with
contralateral lymphadenopathy. In ED, the survival in patients with favorable prognostic
factors was comparable to LD, suggesting this patient group may be a candidate for
aggressive therapy.
키워드
Prognostic factors; Small cell lung cancer;
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