수술 전 알파태아단백치가 높은 간세포암 환자에서 간절제술 후 알파태아단백만을 이용한 추적관찰이 가능한가?
Could patients who underwent hepatic resection due to hepatocellular carcinoma with high alpha-fetoprotein be monitored for recurrence by alpha-fetoprotein level?
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목적: 근치적 간절제술 후 추적감시의 간격 및 검사 방법은 임상의의 경험에 의존한다. 반복적인 영상검사는 의료비용의 증가와 환자의 불편으로 연결된다. 본 연구에서는 불필요한 영상검사를 줄일 목적으로 수술 전 고AFP를 보인 간세포암 환자의 수술 후 AFP의 변화 양상과 재발과의 관계를 통해, AFP만으로 수술 후 추적감시가 가능한지를 알아보고자 하였다. 대상 및 방법: 수술 전 AFP >400 ng/ml의 간세포암으로 근치적 간절제술을 받은 66명의 수술 후 AFP값의 변화와 재발과의 관계를 조사하였다. 추적감시 중 AFP가 2회 연속 증가하며, 20 ng/ml 이상 증가하는 경우, AFP만으로 재발을 의심할 수 있다고 정의하였다. 결과: 수술 후 AFP값이 20 ng/ml 이하로 감소한 34명(51.5%) 중 16명에서 재발하였다. 20 ng/ml 이하로 감소하지 않은 32명(48.5%)은 모두 재발하였고, 이 중 31명은 1년 내에 재발하였다. 재발이 없었던 18명의 AFP 농도는 수술 후 20 ng/ml 이하로 유지되었다. 재발 환자 48명 중 44명(91.7%)에서 재발 시 AFP의 농도가 20 ng/ml 이상으로 상승하였나, 정의상 43명에서 AFP만으로 재발을 의심할 수 있었다. AFP만으로 재발을 의심하기 어려운 5명 중 4명은 재발 시 AFP가 증가하지 않았고, 수술 후 1년 이후에 재발하였다. 결론: 수술 전 AFP>400 ng/ml인 환자들의 대부분이 재발 당시 AFP가 정상 이상으로 증가하며 수술 후 1년 이내에 재발하므로, 수술 후 1년까지는 AFP만을 이용한 추적감시가 가능할 것으로 생각된다.
Abstract
Background/Aims: The follow-up strategy after hepatectomy for hepatocellular carcinoma (HCC) usually depends on the experience of physician, resulting in frequent imaging studies, which leads to increased cost. Hence, we investigated the role of monitoring alpha-fetoprotein (AFP) levels after hepatectomy in patients with preoperative high AFP. Methods: From January 2000 to December 2004, 66 patients who underwent curative hepatectomy due to HCC with preoperative AFP level >400 ng/mL were reviewed. Changes in AFP level after the operation were investigated. The recurrence was suspected in case of two consecutive increase of AFP over cut-off value. Cut-off value was determined by ROC curve. All patients were divided into 2 groups: patients who met the definition (Group S) and those who didn’t (Group D). Results: AFP level of 20 ng/ml was proposed as the cut-off value for diagnosis of recurrence by ROC curve. Thirty two patients who didn’t have the AFP level decreased below 20 ng/ml after the resection had HCC recurred, whereas 16 out of 34 patients who had AFP decreased had tumor recurrence. The AFP level of patients without recurrence was kept below 20 ng/ml during the follow-up. The AFP level of 44 out of 48 recurred patients increased over 20 ng/ml upon recurrence. By definition, group D were 5 patients. In 4 patients of group D, the AFP level didn’t increase above 20 ng/ml upon recurrence. These patients had HCC and they recurred 1 year after the surgery. Conclusions: In patients with preoperative AFP level >400 ng/ml, the AFP level tended to increase above 20 ng/ml at recurrence mostly within 1 year. Hence, we proposed that these patients could be monitored by only AFP until 1 year after surgery.
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