The Korean Journal of Medicine

  • 제85권1호
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  • Pages.58-66
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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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국내 악성 척수 압박 환자의 임상적 고찰

Clinical Flow and Outcomes in Patients with Malignant Spinal Cord Compression in Korea

  • 김현정 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 한동훈 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 윤진아 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 김세형 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 문성권 (순천향대학교 의과대학 부천병원 방사선종양학과) ;
  • 김찬규 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 임수빈 (순천향대학교 의과대학 부천병원 신경외과) ;
  • 박성규 (순천향대학교 의과대학 부천병원 혈액종양내과) ;
  • 홍대식 (순천향대학교 의과대학 부천병원 혈액종양내과)
  • Kim, Hyun Jung (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Han, Donghoon (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Yun, Jina (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Se Hyung (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Moon, Sung Kwon (Department of Radiation Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Chan Kyu (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Im, Soo Bin (Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Seong Kyu (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Hong, Dae Sik (Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
  • 투고 : 2012.11.08
  • 심사 : 2012.12.10
  • 발행 : 2013.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 전이성 척수 압박 환자의 증상발현부터 치료까지의 경과를 조사하였고, 임상적 특징과 치료결과, 그리고 치료반응과 생존에 미치는 예후인자를 분석하였다. 방법: 2002년 1월부터 2011년 12월까지 본원에서 MRI에 의해 전이성 경막외 척수 압박으로 진단된 56명의 환자들의 의무기록을 후향적으로 조사하였다. 결과: 56명 환자의 중앙연령은 60세였고 가장 흔한 원발질환은 폐암이었다. 증상 발생 이후 내원하기까지의 중앙 간격은 7일(범위 1-60일)이었고, 내원 이후 임상 진단까지의 중앙 시간은 0일이었다(범위 0-16일). 임상 진단 후 MRI 시행까지의 중앙기간은 1일(범위 0-8일), 그리고 치료까지는 4일이었다(범위 0-34일). 26명의 환자(46.4%)가 처음 진단 시 보행 장애가 있었으며 수술이나 방사선 치료 이후에는 33명(61.1%)에서 보행 장애가 나타났다. 치료 전 보행 장애가 치료 이후 보행 가능으로 전환된 비율은 방사선 치료를 받은 환자에서는 17.6%였고, 수술을 받은 환자에서는 25%였다. 단일변수 분석 시 치료 전 좋은 전신수행능력 상태, 보행 가능여부 그리고 자율신경보전 여부가 치료 이후 보행 가능에 의미 있게 영향을 미치는 인자였고 다변량 분석에서 의미 있는 인자는 발견되지 않았다. 모든 환자에서 중앙생존기간은 67일이었고 다변량 분석 시 전립선암 환자에서 전신상태가 좋은 환자에서 생존기간이 향상되었다. 결론: 악성 척수 압박에서 보행기능과 생존율은 매우 불량하다. 이러한 불량한 치료반응을 극복하기 위해서는 다학제적 접근을 통해 신속하고 적절한 조치가 요구된다.

Background/Aims: We investigated the process from the development of symptoms to treatment and analyzed the clinical characteristics, treatment outcomes, and prognostic factors related to the treatment response and survival of patients with malignant spinal cord compression (SCC). Methods: This study retrospectively reviewed the medical records of 56 patients diagnosed with metastatic SCC using magnetic resonance imaging (MRI) from January 2002 to December 2011. Results: The median age of the patients was 59.5 years, and the most common origin of metastatic SCC was lung cancer. The median interval from symptom development to visiting the hospital was 7 days, and the median interval from admission to the date of clinical diagnosis was 0 days. The median interval from clinical diagnosis to the date of MRI or therapy was 1 or 4 days, respectively. Twenty-six patients (46.4%) had ambulation dysfunction at initial presentation, and 33 patients (61.1%) had ambulation dysfunction after radiotherapy or surgery. The rate of patients regaining walking ability was 17.6% with radiotherapy and 25% with surgery. In univariate analysis, good performance status, ambulatory function, and autonomic function before therapy were favorable predictors of ambulatory function after treatment in all patients. No significant factor was found in multivariate analysis. Median overall survival (OS) was 67 days, and the significant factors for survival by multivariate analysis were performance status and the presence of prostate cancer. Conclusions: The therapeutic response of ambulatory function and OS in malignant SCC is very poor. Multidisciplinary communication is required for the prompt and optimal management of patients with malignant SCC.

키워드

참고문헌

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