유방암 환자에서 Adriamycin/docetaxel (AD) 과 Adriamycin/cyclophosphamide (AC-T) 선행항암화학요법의 비교
Comparison of two neoadjuvant chemotherapy in locally advanced breast cancer patients; Adriamycin and Docetaxel (AD) versus Adriamycin, Cyclophosphamide followed by Paclitaxel (AC-T)
- 주제(키워드) 유방암 , 선행항암화학요법 , 종양 반응 , 병리학적 완전관해율 , Gankyrin
- 발행기관 아주대학교
- 지도교수 강석윤
- 발행년도 2013
- 학위수여년월 2013. 2
- 학위명 석사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000013391
- 본문언어 한국어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
연구배경 : 선행항암화학요법은 국소 진행 유방암 환자의 표준 치료로 알려져 있다. 보조항암화학요법에서 사용되는 anthracycline 과 taxane 이 주로 사용되고 있으나 아직 어떠한 방법의 항암화학요법이 우월한지 확립되어 있지는 않다. 대상 및 방법 : 본 연구에서는 2005년 1월부터 2011년 9월까지 선행항암화학요법으로 adriamycin 과 docetaxel (AD) 을 투약 받은 군과 adriamycin, cyclophosphamide 투여 후 paclitaxel (AC-T) 으로 치료 받은 두 군을 후향적으로 비교분석하였다. AD 군은 3주 간격으로 6차례 투약받았고 (50mg/m2 and 75mg/m2), AC-T 군은 3주 간격으로 AC (60mg/m2 and 600mg/m2) 를 4차례 투여 후 T (175mg/m2) 를 4차례 투약하였다. 선행항암화학요법 종료 후 5주 이내에 모든 환자들은 근치적 수술을 받았다. 두 군에서 병리학적 완전관해율, 임상적 반응, 유방 보존술 시행률 및 약물부작용을 비교하였으며 FOX M1, gankyrin 에 대한 면역조직화학검사를 시행하였다. 결과 : 37명은 AD 로 38명은 AC-T 로 치료받았다. 양군간 기본 특성의 차이는 관찰되지 않았으나 AD군에서 T4를 포함한 병기가 높은 환자들이 더 많이 포함되어 있었다. 선행항암화학요법의 전체반응률은 AD 군 89%, AC-T 군 87% 로 차이가 없었고 병리학적 관해율도 11%, 8% 로 유사한 결과를 보였다. 유방 보존율 및 유방 보존술식으로의 변경율도 AD군 각각 62%, 24%, AC-T 군에서는 76%, 29% 로 통계적 차이가 없었다. 부작용면에서 비혈액학적 부작용은 차이가 없었으나 AD 군에서 대부분의 환자들에서 3등급 이상의 호중구 감소증 및 호중구 감소증을 동반한 발열이 있었고 이는 AC-T 군과 통계적 차이를 보였다.(각각 p<0.001, p<0.001). Gankyrin 의 발현과 환자들의 기본특성 및 임상반응과 비교시 양군간 차이가 없었으나 진단시 HER-2 양성인 군에서 gankyrin 이 더 많이 발현됨이 확인되었다.(p=0.028) 결론 : 선행항암화학요법으로 AD 또는 AC-T 투여 후 근치적 수술이 가능했던 두 군에서 병리학적 관해율, 임상적 반응율, 유방보존율은 차이가 없었으나 혈액학적 부작용 측면에서 AD군에서 의미있게 많았고 심각한 부작용으로 입원치료가 필요한 경우가 많아 AC-T 요법이 견딜만한 치료법으로 생각된다.
more목차
국문요약 ··············································································· i
차례 ···················································································· iii
그림차례 ··············································································· iv
표차례 ·················································································· v
I. 서론··················································································· 1
II. 대상 및 방법········································································ 3
A. 대상 ·············································································· 3
B. 치료 ·············································································· 3
C. 평가 ·············································································· 4
D. 면역화학조직염색 ······························································· 5
E. 통계 분석 ········································································ 5
III. 결과 ················································································ 6
IV. 고찰 ················································································ 13
V. 결론 ················································································· 16
참고문헌 ················································································ 17
ABSTRACT ··········································································· 20
목차
Fig. 1. Gankyrin expression on normal breast tissue and breast cancer
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목차
Table 1. Baseline characteristics in the AD and AC-T group ························································································· 6
Table 2. Chemotherapy response ···································· 8
Table 3. Toxicity ···································································· 9
Table 4. Association between clinicopathologic variables and gankyrin
expression ············································································· 11
