단일 결절 간세포암종에서 고주파 열치료 후 예후에 영향을 미치는 인자
The Factors Related to the Prognosis of Solitary Hepatocellular Carcinoma after Radiofrequency Ablation
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목적: 간세포암종 환자에서 고주파 열치료 후 국소 재발에 영향을 미치는 인자로 종양의 크기, 위치 등이 의미가 있다고 알려져 있다. 저자들은 위 두 인자를 포함한 여러 임상적 요소들이 고주파 열치료를 시행한 환자의 예후에 영향을 미치는지 여부를 알아보고자 하였다. 대상과 방법: 1999년 10월부터 2002년 12월까지 본원에서 간세포암종으로 진단되어 고주파 열치료를 시행받은 환자 중 단일 결절의 환자 107명을 대상으로 하였다. 역동성 복부전산화단층촬영으로 시술 후 3개월마다 추적 검사를 시행하였다. 종양의 크기, 위치, 나이, 성별, 원인 질환, 혈소판의 수, Child-Pugh 등급을 누적 생존율, 누적 무병 생존율에 대하여 Cox 회귀분석하였다. 결과: 추적 기간은 4-44개월(평균 20개월)이었다. 종양의 크기는 1.0-5.0 cm (평균 : 2.5 cm)이었으며, 위치는 피막하, 비피막하로 구분하였다. 누적 생존율은 12, 24, 36개월에 각각 90.5%, 67.4%, 46.4%이고, 누적 무병 생존율은 12, 24, 36 개월에 각각 71.4%, 46.7%, 20.9%이었다. 생존율 및 무병 생존율과 통계적으로 의미 있는 인자는 Child-Pugh 등급(P=0.001, P=0.026), 혈소판 수(P<0.001, P=0.002)였으며, 종양의 크기, 위치를 포함한 다른 인자는 생존율 및 무병 생존율과 통계적으로 의미가 없었다. 결론: 고주파 열치료 후 간세포암종의 국소 재발률에 영향을 미치는 것으로 알려진 종양의 크기, 위치는 생존율 및 무병 생존율에는 영향이 없었다. 고주파 열치료 시행 당시의 간기능 상태를 나타내는 Child-Pugh 등급, 혈소판의 수가 누적 생존율 및 누적 무병 생존율에 영향을 미치는 것으로 나타났다.
Abstract
Background/Aims: Several risk factors, such as size and location, are related to local recurrence after radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC). The objectives of this study were to clarify factors related to prognosis. Methods: From October 1999 to December 2002, we performed RFA for 107 consecutive patients with solitary HCC. We evaluated spiral computed tomography and serum alpha-fetoprotein level every 3 months after RFA. Seven possible factors for prognosis were analyzed using the Cox proportional hazards regression model: tumor size, tumor location, age, sex, etiology, platelet count, and Child-Pugh classification. Overall survival and disease free survival rate were estimated using the Kaplan- Meier method, and differences between two groups were compared using the log rank test. Results: The Kaplan-Meier estimates of overall survival after radiofrequency ablation were 90.5% at 12 months, 67.4% at 24 months and 46.4% at 36 months and disease free survival were 71.4%, 46.7% and 20.9%, respectively. Using the Cox proportional hazards regression model, it was shown that with regard to overall survival and disease free survival, Child-Pugh classification (P=0.001, P=0.026) and platelet count (P<0.001, P=0.002) were statistically significant factors. The other factors did not have a statistically significant relationship to overall survival and disease free survival. Conclusions: The size and location known as local recurrence factors were not statistically significant with regard to survival and disease free survival. The Child-Pugh classification and platelet count, that reflect the liver function at the time of RFA, were significant factors for prognosis.
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