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4 cm 이하의 단일결절 간세포암종에서 고주파열치료와 경동맥화학색전술의 효과 비교

Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm

이민석|정재연|김재근|왕희정|조성원|안소연|원제환|문은준|황주안|양민재
대한간학회 (The korean Association for the Study of the Liver)|2009.12|Clinical and Molecular Hepatology|제15권 제4호|pp. 474-485

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참고문헌

키워드

TherapeuticCarcinoma고주파열치료간세포암종경동맥화학색전술Hepatocellular; Radiofrequency ablation; Chemoembolization

초록

목적: 간세포암종에서 경동맥화학색전술과 고주파열치료의 효과를 비교한 연구는 드물다. 저자들은 단일결절 간세포암종을 진단받고, 고주파열치료 혹은 경동맥화학색전술 시행 후 완전반응을 보인 환자들에서 치료법에 따른 재발 및 생존율의 차이를 비교하고, 이에 관여하는 예후인자들을 분석하고자 하였다. 대상과 방법: 2002년 1월부터 2009년 2월까지 간외 전이와 혈관 침범이 없는, 4 cm 이하의 단일결절 간세포암종을 진단받고 일차 치료로서 고주파열치료 혹은 경동맥화학색전술을 시행받았던 환자군 중에서, 시술 후 전산화단층촬영상 완전괴사나 완전 리피오돌 흡착 반응을 보이고 1년 이상 추적관찰이 확인된 43명의 고주파열치료 환자와 50명의 경동맥화학색전술 환자를 선별하였다. 결과: 1년, 2년, 3년 누적재발률은 고주파열치료군에서 각각 33.9%, 44.3%, 55.4%였고, 경동맥화학색전술군에서 각각 42%, 68.3%, 71.7%로 고주파열치료군에서 낮았으나, 통계적인 유의성은 없었다(P=0.130, log-rank test). 1년, 2년, 3년 누적생존율은 고주파열치료군에서 각각 97.7%, 77.4%, 63.1%, 경동맥화학색전술군에서 각각 95.9%, 76.1%, 60.2%로 두 군이 유사하였다(P=0.495). 다변량 분석 결과 남성, B형간염, 높은 알부민 수치를 보이는 환자들에서 통계적으로 유의하게 생존율이 높았다. 결론: 4 cm 이하의 단일결절 간세포암종 환자에서 경동맥화학색전술 또는 고주파열치료를 시행한 후, 완전반응을 보인 환자들을 대상으로 3년간 추적관찰한 결과, 두 치료군 간에 재발률 및 생존율의 차이가 없었다. 향후, 장기 예후의 차이를 알아보기 위한 연구가 필요하다.

Abstract

Background/Aims: Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. Methods: Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. Results: The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. Conclusions: TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.

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