후복막육종
Retroperitoneal Sarcoma
대한암학회지 1998년 30권 2호 p.370 ~ 377
소속 상세정보
김지수/Ji Su Kim
한원식/노동영/윤여규/오승근/최국진/Won Shik Han/Dong Young Noh/Yeo Kyu Youn/Seung-Keun Oh/Kuk Jin Choe
KMID : 0360319980300020370
Abstract
서론
후복막 육종은 그 빈도가 드문 종양으로서 연부 조직 육종의 약 10∼15%,모든 악성 종양
의 0.1∼0.2%를 차지한다. 후복막 육종에 있어서 충분한 종양 절제연을 둔 완전 절제가 국
소 재발 감소 및 환자의 장기 생존에 가장 중요한 요소로 알려져 왔다. 그러나 진단의 지연
으로 대부분의 경우 큰 크기로 발견되고, 인접한 주요 장기들로 인하여 약 50%에서만 종양
의 완전 절제가 가능하다. 또한 보조 항암요법의 효과도 불투명하여, 몇몇 저자들은 그 효과
를 보고한 바 있으나, 방사선 치료가 생존율을 증가시킨다는 증거는 아직까지 없으며, 마찬
가지로 항암 화학 요법의 효용성 역시 입증된 바 없다. 결과적으로 후복막 육종은 그 예후
가 불량하여 15∼50%의 5년 생존율이 보고되고 있다. 저자들은 서울대학교병원에서 경험한
후복막 육종의 임상적, 조직학적 특성의 분석을 통하여 환자의 생존에 영향을 미치는 예후
인자를 알아보고 향후 후복막 육종의 치료 지침을 얻고자 본 연구를 시행하였다.
Purpose : To determine the clinical feature, surgical management of primary and
recurrent disease, predictive factors for outcome, and impact of multimodality therapy in
retroperitoneal sarcoma.
Materials and Methods : 60 patients were confirmed pathologically as soft-tissue
sarcoma of the retroperitoneum by operation or needle biopsy in Seoul National
University Hospital from 1983 to 1995.4 retrospective analysis was performed.
Results : The abdominal mass was common presenting symptom. Histologically
liposarcomas(25%) and leiomyosarcomas(23.3%) were most common, and MFH's(11.7%)
and malignant schwannomas(11.7%) followed. The overall 5 year survival rate was
54.6%. Complete resection was possible in 51.7% of patients and strongly predicts
outcome(<0.0001). These patients had a median survival of 130 months compared to 20
months for those undergoing partial resection and 9 months for those with unresectable
tumors. 11 (35%) of completely resected patients have had local recurrence. These
patients under went reoperation when feasible. Complete resection of recurrent disease
was performed in 10 patients(90%), with a 42 months median survival time after
reoperation. Resection of adjacent organ was performed in 19 Patients. 14 of these were
completely resected, and showed 100% of 5 year survival rate. Tumor grade was not a
significant predictor of outcome. Gender, histologic type, encapsulation, stage,
resectability, combined resection were significant prognostic factors by univariate
analysis. But resectability was only independent prognostic factor on multivariate
analysis. Radiation therapy and chemotherapy could not be shown to have significant
impact on survival.
Conclusion : Complete resection is the most important prognostic factor of
retroperitoneal sarcoma. Extensive and aggressive surgery must be considered including
resection of adjacent organs. Multiple resection seems to improve survival in recurrent
cases.
키워드
Retroperitoneal sarcoma;
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