Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Changes of the Clinicopathological Characteristics and Survival Rates of Gastric Cancer with Gastrectomy - 1990s vs early 2000s

위절제 위암 환자의 임상병리학적 특성과 생존율의 변화: 1990년대와 2000년대 초기의 비교

  • Sim, Young-Kwan (Department of Surgery, Chonbuk National University Medical School) ;
  • Kim, Chan-Young (Department of Surgery, Chonbuk National University Medical School) ;
  • Jeong, Yeon-Jun (Department of Surgery, Chonbuk National University Medical School) ;
  • Kim, Jong-Hun (Department of Surgery, Chonbuk National University Medical School) ;
  • Hwang, Yong (Department of Surgery, Chonbuk National University Medical School) ;
  • Yang, Doo-Hyun (Research Institute of Clinical Medicine, Chonbuk National University Medical School)
  • 심영관 (전북대학교 의학전문대학원 외과학교실) ;
  • 김찬영 (전북대학교 의학전문대학원 외과학교실) ;
  • 정연준 (전북대학교 의학전문대학원 외과학교실) ;
  • 김종훈 (전북대학교 의학전문대학원 외과학교실) ;
  • 황용 (전북대학교 의학전문대학원 외과학교실) ;
  • 양두현 (전북대학교병원 임상연구소)
  • Received : 2009.09.16
  • Accepted : 2009.10.28
  • Published : 2009.12.30
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Abstract

Purpose: The incidence of upper gastric cancer and especially the diffuse type have increased in western countries. The aim this study was to investigate the chronologic changes of the clinicopathological features and survival rates of Korean upper gastric cancer patients. Materials and Methods: 1,638 gastric cancer patients who underwent gastrectomy were included in this study and they were divided into two groups; the 1990's (1991~1999, n=987) and the early 2000's (2000~2003, n=651). We evaluated the differences of the clinicopathologic features and the factors that affected the survival rates by univariative and multivariative analysis. Results: The older age (>60) patients increased from 42.7% to 50.7% respectively. Being overweight (body mass index$\geq$23) also increased from 31.5% to 43.2%. For the pathology, the incidence of stage Ia gastric cancer increased (29.8% to 44.5%) and the incidence of stage IV gastric cancer decreased (23.5% to 11.8%). Yet there was no difference according to the WHO classification, Lauren's classification and the location of tumor between the groups. The 5 year survival rates increased 67.7% to 83.7%, according to the group. Multivariative analysis showed that the odd ratios of the early 2000s was 0.715 (95% CI; 0.555~0.921) as compared to that of the 1990s. Conclusion: There were no changes of the clinicopathologic features, like the pattern in western countries, although the incidence early gastric cancer, old age patients and overweight patients increased. The survival rate of early 2000s was better that that of the 1990s.

목적: 서구에서의 위암은 상부암과 미만형이 증가하고 있는 것으로 알려져 있다. 우리나라도 서구화되어 감에 따라 위암의 임상병리학적 특성과 생존율의 변화가 있는지를 알아보고자 하였다. 대상 및 방법: 위암의 위절제수술 환자 1,638명을 1990년대(1991~1999년)의 987명과 2000년대 초기(2000~2003년)의 651명으로 구분하였다. 두 시기별 임상병리학적 특성의 변화와 생존율의 영향을 미치는 인자에 대해 단변량과 다변량 분석을 하였다. 결과: 60대 이상의 고령환자가 1990년대 42.7%에서 2000년대 초기에는 50.7%로 증가하였다. 과체중(체질량지수$\geq$23)은 31.5%에서 43.2%로 증가하였다. Ia기 29.8%에서 44.5%로 증가하고 IV기는 23.5%에서 11.8%로 감소하였다. WHO 조직학적 분류, Lauren 분류와 병변의 위치는 변화 없었다. 전체 환자의 5년 생존율은 74.4%이고 5년 생존율은 67.7%에서 83.7%로 증가하였다. Cox proportional hazard 모델에서는 TNM, 근치도 여부와 시기의 구분이 생존율의 독립적인 예후 인자이었다. 2000년대 초기에 수술 받은 환자는 1990년대의 수술 환자에 비해 비교위험도 0.715 (95% 신뢰구간; 0.555~0.921)로 생존율이 좋았다. 결론: 본 연구의 결과 서구에서 나타나는 임상병리학적변화는 관찰되지 않았다. 그렇지만 조기위암과 고연령 환자가 증가하였으며 과체중 환자 증가의 특징이 관찰되었다. 또한 위암 수술 환자의 생존율도 1990년대에 비해 증가하였다.

Keywords

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