불완전한 병기결정 수술 후 발견된 난소암의 치료 = Pattern of care: epithelial ovarian cancer in case of incomplete previous surgery

다국어 초록 (Multilingual Abstract)

Objective: A significant number of patients with ovarian cancer are referred to tertiary center after inadequate staging operation. The purpose of this study was to evaluate the impact of pattern of care, including restaging operation or chemotherapy in these patients. Methods: We conducted a retrospective analysis of patients with epithelial ovarian cancer (n=29) or borderline tumor (n=15) who were inadequately staged elsewhere at the time of initial surgery between April 1996 and March 2006. Results: In the patients with ovarian cancer, restaging operation was performed in 65.5% (19/29), and primary chemotherapy in 24.1% (7/29). Older age and higher parity was noted in the restaged group, however, it was statistically insignificant. In the restaged group, 26.3% (5/19) were upstaged due to residual tumors. Presence of residual tumor was not associated with histologic type and grade of tumor. Six patients (31.6%) without residual tumor escaped adjuvant chemotherapy. During median 50 months follow up, 13.8% (4/29) of patients with ovarian cancer recurred. There was no difference in recurrence rate according to whether a restaging operation was performed. However, residual tumor status was significantly associated with recurrence rate (60% vs 0%). Restaging operation was undergone in 46.7% (7/15) of patients with borderline tumors and there were no recurrence or residual tumor in patients with borderline tumors. Conclusion: It is suggested that restaging operation could reveal residual tumors which are important prognostic factor in predicting recurrence. Nonetheless, Restaging operation seems to have no impact on the prognosis of ovarian cancer.

국문 초록 (Abstract)

목적: 일부의 난소암 환자는 부적절한 병기결정 수술 후 추가치료를 위하여 3차 병원으로 의뢰된다. 본 연구는
이들 환자에 있어 병기결정을 위한 재수술 또는 항암화학요법 등의 치료 방법의 선택이 환자의 예후에 미치는
영향을 분석하고자 하였다.
연구 방법: 1996년 4월부터 2006년 3월까지 외부병원에서 수술 후 상피성 난소암 환자(n=29) 또는 경계성 종양
환자(n=15)로 판명되어 전원 된 환자의 의무기록을 후향적으로 조사하였다.
결과: 상피성 난소암 환자 중 병기결정을 위한 재수술은 65.5%(19/29)에서 시행되었고 항암화학요법은 24.1%
(7/29)에서 시행되었으며 3명의 환자에는 추가치료가 시행되지 않았다. 분화도와 조직형에 따른 재수술 시행율
은 차이가 없었다. 재수술을 시행한 환자군의 연령이 높고 임신력이 높은 경향이 있었으나 통계적 유의성은 없
었다. 재수술 시행한 환자 중 26.3%(5/19)에서 잔존병소가 발견되었고 분화도와 조직형은 잔존병소의 유무와 관
련성이 없었다. 재수술을 시행한 환자 중 68.4%의 환자에서만 항암화학요법이 시행되었다. 50개월의 추적 관찰
중 13.8%(4/29)의 환자에서 재발하였다. 재수술 시행여부에 따른 재발률의 차이는 없었으나 재수술 시행 후 잔
존 병소가 있는 환자에서 유의하게 재발률이 높았다(60% vs 0%). 경계성 종양 환자에서 재수술은 46.7%(7/15)에
서 시행 되었고 모든 환자에서 잔존병소가 관찰되지 않았으며 재발한 환자는 없었다.
결론: 본 연구는 재수술을 시행하면 많은 잔존병소를 발견하게 되고 이는 재발여부를 예측하는데 중요한 지표
가 되며 불필요한 항암화학요법을 피하게 하지만 재수술 자체가 임상적으로 초기인 난소암 환자에서 크게 예후
에 영향을 미치지는 않음을 제시한다.

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