비인강암의 예후인자가 생존율에 미치는 영향

Nasopharyngeal Carcinoma : Correlations with Prognostic Factors and Survival

1979년부터 1985년까지 서울대학교병원 치료방사선과에서 비인강암으로 확진되어 방사선치료를 시행한 총 환자는 110명이었다. 이중 진단시 원격전이된 5명과, 근치 방사선량을 받지 못한 16명을 제외한 89명의 치료성적을 분석하였다. 생존 환자의 최소 추적기간은 36개월이었다. 전체 환자의 $43\%$가 T4병변, $72\%$가 제 4병기이었으며, 편평상피암이 $40\%$, 미분화암이 $47\%$이었고 임파상피암은 $5\%$이었다. T1, T2의 초기병변과 경부 임피절 전이는 6,500cGy의 선량으로 대부분이 근치되었다. 추적기간 중 재발된 환자는 42명, $(47\%)$으로, 이중 16명 $(38\%)$은 국소재발, 24명 $(57\%)$은 원격전이를 일으켰다. 국소재발된 예중 9명에게 재치료를 시행하여 이중 2명에서 장기 생존이 관찰되고 있다. 전체 환자의 5년 생존율 $42\%$, 무병생존율은 $38\%$이었다. T-병기와 조직학적 아형은 생존율에 무관하나, N-병기는 생존율에 유의한 상관관계가 있음이 증명되었다.

One hundred and ten patients with carcinoma of the nasopharynx were treated by radiation therapy in Department of Therapeutic Radiology, Seoul National University Hospital between 1979 and 1985. Among these, one hundred and five patients were treated with curative intent and 5 patients with palliative aim. Excluding 16 patients who did not receive a full course of radiation therapy, the remaining 89 patients were reviewed for this analysis. Minimum follow-up period of survivors was 36 months. Forty-three percent of the patients had T4 primary lesions and $72\%$ had stage IV disease. The histology was squamous cell carcinoma in $46\%$ of the patients. undifferentiated carcinoma in $49\%$, and lymphoepithelioma in $5\%$. Total radiation dose to the primary site averaged 6,500cCY for T1, T2 lesions and 7500cCY for T3, T4 lesions. Neck node were given boost treatment to a maximum 7,500cCY depending on the extent of disease. Early primary lesion (T1, T2) and neck nodes were successfully controlled in most cases when dose of greater than 6,500cCY was delievered. Forty two patients $(47\%)$ had recurred, 16 of whom $(38\%)$ed at the primary site and $24(57\%)$ developed distant metastases. Of these. 9 patients received re-irradiation with or without chemotherapy and local control was obtained in 2 patients$(22\%)$. Actuarial overall survival and disease-free survival rate was $42\%\;and\;38\%$ at 5 years. T-stage and histologic subtype were not correlated with survival. However, N-stage was related to survival significantly (p=0.043).