간세포암종 파열 환자의 임상양상 및 예후인자에 관한 연구
Analysis of the clinical characteristics and prognostic factors of ruptured hepatocellular carcinoma
3
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 간세포암종의 파열은 드물지만 생명을 위협하는 중요한 합병증이다. 우리나라는 간세포암종의 유병률 및 사망률이 높은 지역이나, 간세포암종의 파열에 관한 연구는 많지 않다. 이에 간세포암종 파열 환자의 임상 특징 및 예후인자를 파악하고자 하였다. 대상과 방법: 2002년 1월부터 2007년 12월까지 전남대학교 병원에서 간세포암종으로 진단된 886명 중 간세포암종 파열 환자 62명을 대상으로 의무기록을 후향적으로 조사하여 임상양상, 종양의 특징 및 치료 등을 파악하고, 30일 내 조기 사망에 미치는 예후인자를 조사하였다. 결과: 간세포암종 파열의 빈도는 7.0%, 30일 사망률은 43.5%, 파열 후 평균 생존기간은 8.0±1.7개월이었다. 일차 지혈치료로 90.3%에서 TAE를 시행하였고, 성공률은 89.3%였다. 경과 중 파열군과 대량출혈군은 간기능 저하가 많았고, 병기가 더 진행되어 있어, 30일 조기 사망이 많았다. 간세포암종 파열 후 30일 이내의 조기 사망에 영향을 미치는 인자로는 간성 혼수(OR=44.7; 95% CI, 1.9～1051.1; P=0.018), 혈청 총 빌리루빈치 >3 mg/dL(OR=36.7; 95% CI, 1.3～1068.5; P=0.036), 괴상형 또는 미만형의 종양 형태(OR=53.5; 95% CI, 3.0～964.2; P=0.007)였다. 결론: 간세포암종 파열 환자에서 일차 지혈치료로 TAE는 효과적인 치료법이었다. 간세포암종 파열 후 30일 이내 조기 사망률은 43.5%로 높았으며, 내원 시 간성 혼수, 총 빌리루빈치, 괴상형 또는 미만형의 종양 형태는 조기 사망의 독립적인 예후인자였다.
Abstract
Background/Aims: Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but life-threatening complication. Although the prevalence rate and mortality of HCC has been reportedly high in Korea, studies on ruptured HCC are limited. The aim of this study was to determine the clinical characteristics and prognostic factors of ruptured HCC. Methods: Among 886 cases with HCC that had been diagnosed at Chonnam National University Hospital from January 2002 to December 2007, 62 cases (7.0%) with ruptured HCC were studied retrospectively regarding their clinical characteristics and prognostic factors. Results: Transarterial embolization was performed in 56 cases (90.3%) to control bleeding, with a hemostasis success rate of 89.3%. The survival time after the rupture of HCC was 8.0±1.7 months (mean±SD), although it was longer in HCC cases that were first diagnosed in a ruptured state or ruptured with a small amount of bleeding than in those that ruptured during follow-up after diagnosis or with a large amount of bleeding, respectively. The 30-day mortality rate in patients with a ruptured HCC was 43.5%, and the early deaths were independently associated with the presence of hepatic encephalopathy (odds ratio, OR=44.7; 95% confidence interval, CI=1.9-1051.1; P=0.018), serum bilirubin >3.0 mg/dL (OR=36.7; 95% CI=1.3-1068.5; P=0.036), and the massive or diffuse type of tumor morphology (OR=53.5; 95% CI=3.0-964.2; P=0.007). Conclusions: The prognosis in patients with ruptured HCCs was poor with a 30-day mortality of 43.5%. The early deaths after the rupture of HCC were associated with elevated serum bilirubin levels, hepatic encephalopathy, and the massive or diffuse type of tumor morphology.
참고문헌 (28)
- Parkin DM, "Estimating the world cancer burden: globocan 2000", Int J Cancer, 94, pp.153~156 (2001)
- Bosch FX, "Epidemiology of hepatocellular carcinoma", Clin Liver Dis, 9, pp.191~211 (2005)
- "Annual report on the cause of death statistics. Korea National Statistical Office", ~ (2007)
- Liu CL, "Management of spontaneous rupture of hepatocellular carcinoma: single-center experience", J Clin Oncol, 19, pp.3725~3732 (2001)
- Castells L, "Hemoperitoneum as a first manifestation of hepatocellular carcinoma in western patients with liver cirrhosis: effectiveness of emergency treatment with transcatheter arterial embolization", Dig Dis Sci, 46, pp.555~562 (2001)
- Chen CY, "Spontaneous rupture of hepatocellular carcinoma. A review of 141 Taiwanese cases and comparison with nonrupture cases", J Clin Gastroenterol, 21, pp.238~242 (1995)
- Clarkston W, "Acute hemoperitoneum from rupture of a hepatocellular carcinoma", J Clin Gastroenterol, 10, pp.221~225 (1988)
- 민현주, "자연적 파열을 동반한 간세포암의 임상적 고찰", 대한소화기학회지, 44(3), pp.160~167 (2004), 대한소화기학회
- Levine CD, "Low attenuation of acute traumatic hemoperitoneum on CT scans", AJR Am J Roentgenol, 166, pp.1089~1093 (1996)
- Eggel H, "Ueber das primare Carcinoma der Leber", Beitr z Pathol Anat u z allgem Pathol, 30, pp.506~604 (1901)
- Greene FL, "AJCC cancer staging manual. 6th ed", pp.131~138 (2002), Springer
- Okuda K, "Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients", Cancer, 56, pp.918~928 (1985)
- Zhu LX, "Spontaneous rupture of hepatocellular carcinoma", Br J Surg, 83, pp.602~607 (1996)
- Akriviadis EA, "Hemoperitoneum in patients with ascites", Am J Gastroenterol, 92, pp.567~575 (1997)
- Miyamoto M, "Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases", Am J Gastroenterol, 86, pp.67~71 (1991)
- Tanaka A, "Treatment of ruptured hepatocellular carcinoma", Int J Clin Oncol, 6, pp.291~295 (2001)
- Wang B, "Management of spontaneous rupture of hepatocellular carcinoma", ANZ J Surg, 78, pp.501~503 (2008)
- Chiappa A, "Emergency liver resection for ruptured hepatocellular carcinoma complicating cirrhosis", Hepatogastroenterology, 46, pp.1145~1150 (1999)
- Shimada R, "Staged hepatectomy after emergency transcatheter arterial embolization for ruptured hepatocellular carcinoma", Surgery, 124, pp.526~535 (1998)
- Buczkowski AK, "Multidisciplinary management of ruptured hepatocellular carcinoma", J Gastrointest Surg, 10, pp.379~386 (2006)
- Hirai K, "Transcatheter arterial embolization for spontaneous rupture of hepatocellular carcinoma", Am J Gastroenterol, 81, pp.275~279 (1986)
- Ngan H, "The role of hepatic arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma", Clin Radiol, 53, pp.338~341 (1998)
- Yeh CN, "Spontaneous tumor rupture and prognosis in patients with hepatocellular carcinoma", Br J Surg, 89, pp.1125~1129 (2002)
- Mizuno S, "Are the results of surgical treatment of hepatocellular carcinoma poor if the tumor has spontaneously ruptured?", Scand J Gastroenterol, 39, pp.567~570 (2004)
- Chen WK, "Outcomes of emergency treatment in ruptured hepatocellular carcinoma in the ED", Am J Emerg Med, 23, pp.730~736 (2005)
- Tan FL, "Factors affecting early mortality in spontaneous rupture of hepatocellular carcinoma", ANZ J Surg, 76, pp.448~452 (2006)
- Franco D, "Resection of hepatocellular carcinomas. Results in 72 European patients with cirrhosis", Gastroenterology, 98, pp.733~738 (1990)
- Sakar B, "Prognostic features and survival of inoperable hepatocellular carcinoma in Turkish patients with cirrhosis", Am J Clin Oncol, 27, pp.489~493 (2004)