하대정맥 침습 또는 심방 종양혈전증을 보이는 진행 간세포암종의 임상 특징과 치료에 따른 예후
Clinical Features and Treatment Outcome of Advanced Hepatocellular Carcinoma with Inferior Vena Caval Invasion or Atrial Tumor Thrombus
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배경 및 목적: 아직까지 하대정맥 침습 또는 우심방 종양혈전증을 보이는 진행 간암의 치료 및 예후는 사례 보고만 있을 뿐 잘 알려져 있지 않다. 본 연구에서는 하대정맥 침습 또는 우심방 종양혈전증을 보이는 진행 간암 환자들을 대상으로 임상 특징과 예후, 치료의 유무에 따르는 생존율을 비교, 분석하고자 하였다. 대상 및 방법: 1987년 11월부터 2004년 6월까지 연세대학교 세브란스병원에서 하대정맥 침습 또는 우심방 종양혈전증을 보이는 간암으로 진단받은 총 41명의 환자를 대상으로 후향 분석하였다. 이들은 보존 치료만 받은 대조군(17명)과 적극적 치료를 받은 치료군(24명)으로 나누어 전체 환자의 생존율, 임상 특징과 함께 각 군의 생존율을 비교하였고 예후를 살펴보았다. 결과: 총 41명 환자의 평균 연령은 50세였고 남녀 비는 33:8이었다. 간암의 원인으로는 B형간염 35명(85.4%), C형간염 3명(7.3%), 원인 미상 2명(4.9%), 알코올 1명(2.4%)이었다. 전체 간용적의 50%를 넘는 종양과 문맥혈전을 동반한 환자는 각각 14명(34.1%)과 22명(53.7%)이었다. Child- Pugh 분류 A는 24명(58.5%), B는 15명(36.6%)이었고, 폐전이는 10명(24.4%)에서 관찰되었다. 치료군에서 항암치료 방법은 5-FU와 cisplatin을 사용한 전신 항암제 투여 11명, 간동맥 내 항암제 주입요법 10명, 동시 항암-방사선치료 2명이었고 수술이 1명이었다. 총 41명 환자의 중앙생존기간은 3개월로 매우 나쁜 예후를 보였다. 대조군과 치료군의 6개월 생존율은 각각 23.5% (4/17명), 29.2% (7/24명)였으며 12개월 생존율은 각각 0% (0/17명), 25.0% (6/24명)로 치료군에서 6, 12개월 생존율이 모두 높았다. 결론: 하대정맥 침습 또는 우심방 종양혈전증을 보이는 진행 간암의 예후는 불량하지만 치료에 반응을 보일 경우 생존기간의 향상을 기대해 볼 수 있어 환자에 따른 적절한 치료가 도움을 줄 수 있겠고 향후 다기관 전향연구가 필요하다 하겠다.
Abstract
Background/Aims: Hepatocellular carcinoma (HCC) with an extension to the inferior vena cava (IVC) or right atrium is uncommon, and its prognosis remains unclear due to the few case reports. In order to elucidate the natural history and treatment outcome, this study investigated advanced HCC patients with an IVC invasion or atrial tumor thrombus. Methods: Between November 1987 and June 2004, a total of 41 patients were diagnosed as having HCC with IVC or right atrial involvement using the new imaging techniques including a two-dimensional echocardiography. Those patients were stratified into the untreated ‘control group’ (n=17) and ‘treated group’ (n=24). The clinical features, treatment outcome and prognosis including patient survival were analyzed. Results: The mean age of the total patients was 55 years (male:female, 33:8). The most common cause of HCC was a hepatitis B virus infection (85.4%), followed by a hepatitis C virus infection (7.4%). According to the Child-Pugh classification, 24 patients were Child-Pugh class A (58.5%), 15 were Child-Pugh class B (36.6%), and 2 were Child-Pugh class C (4.9%). Lung metastases were identified in 10 patients (24.5%). The treatment modalities of the treated group included 11 systemic chemotherapy regimens (5-FU and cisplatin), 10 transarterial chemotherapy regimens, 2 chemoradiation procedures and 1 hepatic resection. The overall survival was 3.0 months (range, 1-29 months). The 6 month survival rate was 23.5% (4/17) in the control group and 29.2% (7/24) in the treated group. The 12 months survival rate was 0% (0/17) and 25.0% (6/24), respectively. Independent prognostic factor affecting the survival was whether or not any treatment had been carried out. Conclusions: Although the prognosis of advanced HCC with IVC invasion or a right atrial tumor thrombi is poor, treatment might improve the survival rate. (Korean J Hepatol 2007;13: 387-395)
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