간세포암종의 수술 직후 치명적 재발의 위험인자 분석
Risk Factors for Immediate Postoperative Fatal Recurrence of Hepatocellular Carcinoma

한국간담췌외과학회지 2005년 9권 1호 p.36 ~ p.43

김봉완(Kim Bong-Wan) - 아주대학교 의과대학 외과학교실
김인규(Kim In-Gyu) - 한림대학교 의과대학 외과학교실
김영배(Kim Young-Bae) - 아주대학교 의과대학 병리학교실
왕희정(Wang Hee-Jung) - 아주대학교 의과대학 외과학교실
김명욱(Kim Myung-Wook) - 아주대학교 의과대학 외과학교실

Abstract

Purpose: Tumor recurrence after partial hepatectomy for hepatocellular carcinoma is a major cause of death from this disease. Among those recurrences, when it occurs immediate during the postoperative period, it may due to the overt expression of pre-existing micrometastases or circulating disseminated cancer cells. Therefore; we evaluate herein the risk factors for the immediate postoperative period fatal recurrence to help establish effective preventive countermeasures against these fatal recurrences.

Methods: From 1994 to 2004, the 269 patients in this study all had greater than 6 months of follow-up after curative resection for HCC at our medical center. Those patients who had a fatal recurrence that included diffuse intra-hepatic recurrence or multiple systemic recurrence within 6 months after hepatectomy, and all of the patients who didn’t have a fatal recurrence within 6 month after resection of HCC were compared. The clinicopathological factors associated with immediate postoperative recurrence were then analyzed.

Results: The overall postoperative mortality was 1%. There were 30 patients in the immediate postoperative group (the subjective group) among the total 269 patients. Among the subjective group patients, 20 patients had diffuse intra-hepatic recurrence and remained 10 patients had multiple systemic recurrence. The mean disease free survival period of the subjective group was 3.9±1.7 months and the mean survival period after recurrence was 6.7±6.1 months. On multivariate analysis, a serum alpha-fetoprotein level greater than 1,000 ng/ml (p=0.019; odds ratio: 2.98), a tumor size greater than 6.5 cm (p=0.03; odd ratio: 2.98), and the presence of microvascular invasion (p=0.01; odd ratio: 4.89) were associated with the risk factors for immediate postoperative fatal recurrence.

Conclusion: These findings can be important indicators to establish countermeasures against immediate postoperative period fatal recurrence, and the high risk patients would also be good candidates for clinical trials with adjuvant anti-cancer treatments such as early postoperative TACE, immunotherapy, anti-angiogenic treatment and so on.

키워드

Carcinoma, Hepatocellular, Hepatectomy, Recurrence, Risk Factors, 간세포암종, 간절제술, 재발, 위험 인자
원문 및 링크아웃 정보
등재저널 정보
학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
Pre-operative serum AFP leve, tumor size, and micro vascular invasion were three distinct risk factors for immediate post-operative fatal recurrence of HCC after curative resection.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
KCD코드
ICD 03
건강보험코드