Human Papillomavirus 와 c-myc 유전자의 발현이 자궁경부암의 예후에 미치는 영향 = Prognostic Significance of Human Papillomavirus and c-myc Gene Expression in Uterine Cervical Cancer

다국어 초록 (Multilingual Abstract)

Cancer of the uterine cervix is the most prevalent gynecologic cancer in Korea. Though the etiolgy of this cancer has not been elucidated, it has been suggested that certain types of human papillomavirus (HPV) are closely associated with uterine cervical cancer. Recently certain oncogenes also have been implicated in the progression of the diesease. c-myc proto-oncogene is associated with cellular proliferation and its inappropriate expression may be involved in carcinogenesis and in tumor progression. c-myc gene overexpression has been observed in some cervical cancer and relates with a risk of relapse. In order to investigate the prognostic significance of the presence of high-risk HPVs(type 16 and 18) and the expression of c-myc gene product, 54 patients with cervical cancer and 33 controls with normal cervix in Korean women from the Seoul National University Hospital and the Soonchunhyang University Hospital during the period of January, 1985 to December, 1985 were studied. The prevalence of HPV 16 and 18 in cervical cancer patients was 79.6% while that in control group was 18.2% (P<0.001). HPV 16 DNA was detected in 74.1% of patients with cervical cancer, 12.1% of control group (P<0.01). And HPV 18 DNA was detected in 13.0% of patients with cervical cancer, 9.1% of control group (P>0.1). The HPV infection was not significantly associated with age, tumor size, lymphnod metastases, and clinical stage. The c-myc gene product was detected in 33.3% of the patients with cervical cancen while it was detected in 3.0% of control group (P<0.001). The expression of c-myc gene product was not significantly associated with age, tumor size, and nodal status. But the increase in the expreesion of c-myc gene product correlated with the stage of the disease and the depth of cervical invasion. The 5-year disease-free survival was 39.0% for the cancer patients with positive HPV infection and 50.0% for the cancer patients with negative HPV infection(p>0.1). The 5-year relapse-free survival rate was 23.1% for the cancer patients with c-myc gene expression and 50.0% for the cancer patients without c-myc gene expression (p<0.005). In a multivariate analysis, only nodal status correlated with a risk of relapse. The major prognostic factor was lymph node metastasis (p<0.0001). The result of this study indicates that HPV and c-myc oncogene might take a role in carcinogenesis of the cervical cancer, and that HPV and c-myc oncogene are not independent prognostic factors in cervical cancer.