The Korean Journal of Medicine

  • 제85권3호
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  • Pages.285-293
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  • 2013
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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조기위암에서 내시경점막하박리술 후 국소 재발의 위험인자

Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection

  • 김정호 (가천대학교 길병원 내과) ;
  • 이정현 (가천대학교 길병원 내과) ;
  • 정준원 (가천대학교 길병원 내과) ;
  • 안정석 (가천대학교 길병원 병리과) ;
  • 원인식 (가천대학교 길병원 내과) ;
  • 이지원 (가천대학교 길병원 내과) ;
  • 하민수 (가천대학교 길병원 내과) ;
  • 김주승 (가천대학교 길병원 내과) ;
  • 안홍대 (가천대학교 길병원 내과) ;
  • 박재찬 (가천대학교 길병원 내과) ;
  • 김윤재 (가천대학교 길병원 내과) ;
  • 권광안 (가천대학교 길병원 내과) ;
  • 박동균 (가천대학교 길병원 내과)
  • Kim, Jung Ho (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Lee, Jung Hyun (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Chung, Jun-Won (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • An, Jungsuk (Department of Pathology, Gachon University Gil Medical Center) ;
  • Won, In Sik (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Lee, Ji Won (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Ha, Minsu (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Ju Seung (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Ahn, Hong Dae (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Park, Jae Chan (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Yoon Jae (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kwon, Kwang An (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Park, Dong Kyun (Department of Internal Medicine, Gachon University Gil Medical Center)
  • 투고 : 2012.10.08
  • 심사 : 2013.01.25
  • 발행 : 2013.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 내시경 점막하 박리술(endoscopic submucosal dissection, ESD)은 림프절 전이가 없는 조기위암에서 널리 시행되고 있는 치료 방법이다. 하지만 국소 재발과 관련된 위험인자에 관한 연구는 부족하다. 본 연구에서는 조기위암에서 ESD 후 국소 재발의 위험인자를 알아보고자 하였다. 방법: 2008년 2월부터 2011년 7월까지 가천대 길병원에서 조기위암으로 진단받고 ESD를 시행받은 214명의 환자, 222예의 병변을 대상으로 의무기록을 후향적으로 검토하였다. ESD 후 추가적인 치료를 시행한 경우와 동일 부위 조기위암 재발로 ESD를 2차로 시행한 경우 그리고 12개월 이내의 추적관찰이 시행된 경우를 제외하여 총 150예가 연구에 포함되었다. 결과: 평균연령은 $63.9{\pm}9.8$이었으며 74.3%가 남자였다. 일괄 절제율은 139/150 (92.7%)이고 완전 절제율은 131/150 (87.3%)이었다. ESD 시행 부위에서 국소 재발은 5예(3.3%)에서 발생하였으며 평균 추적관찰기간은 24개월이었다. 다변량 분석에서 수평 절제면 양성[HR: 13.12 (1.19-145.10); p = 0.036], 분할 절제[HR: 25.31 (1.24-517.57); p = 0.036], 그리고 맥관 침습[HR: 485.06 (2.30-102449.79); p = 0.024]이 국소 재발의 독립적인 위험인자로 확인되었다. 결론: 조기위암의 ESD 후 국소 재발의 독립적인 위험인자는 수평 절제면 양성, 분할 절제, 그리고 맥관 침습으로 확인되었다. 그러므로 이러한 위험인자를 갖고 있는 환자들에서는 국소 재발을 조기에 확인할 수 있는 주의 깊은 추적관찰이 필요하다.

Background/Aims: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. Methods: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. Results: The mean age of the patients was $63.9{\pm}9.8$ years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. Conclusions: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence.

키워드

참고문헌

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피인용 문헌

  1. Risk Factors for Metachronous Recurrence after Endoscopic Submucosal Dissection of Early Gastric Cancer vol.32, pp.3, 2013, https://doi.org/10.3346/jkms.2017.32.3.421
  2. Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea vol.53, pp.2, 2020, https://doi.org/10.5946/ce.2019.123