COX-2 억제제 투여 중 완전 관해된 간세포암종 1예
A Case of Complete Regression of Hepatocellular Carcinoma during Administration of COX-2 Inhibitor
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간세포암종은 예후가 불량한 대표적인 악성 종양으로 수술이 가능한 경우라도 5년 생존율이 25- 29% 정도이며,1 수술로 절제가 불가능한 진행 간암의 경우는 간동맥화학색전술, 방사선치료 등을 실시해 생존기간은 0.7-8.3개월 정도로 보고되고 있다.2 따라서 간세포암종에 대하여 보다 효과적인 치료법의 개발이 시급한 실정이다. 최근 여러 고형암에서 COX-2의 발현이 증가되며 COX-2 억제제가 암세포 성장과 혈관 형성을 억제하고 암세포의 세포자멸사(apoptosis)를 증가시킨다고 보고되고 있다.3 간세포암종에서도 주변의 간실질보다 더 높은 농도의 COX-2를 발현하고, COX-2 억제제 투여 시 암세포의 성장 억제 효과가 나타난다고 보고되고 있는데 이는 COX-2 억제제가 간세포암종을 비롯한 고형암의 효과적인 치료제로서의 가능성이 있음을 시사한다.1,4 그러나 아직 간세포암종 환자를 대상으로 시행한 임상연구는 거의 없는 실정으로 실제 임상에서의 효용성은 예측하기 어렵다. 저자들은 관절염 치료 목적으로 COX-2 억제제를 투여하던 중 진행 간세포암종이 완전히 관해된 흥미로운 사례를 경험하였기에 보고한다.
Abstract
Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit tumor invasion to the surrounding tissues. We report here a case of complete regression of advanced hepatocellular carcinoma (HCC) during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as an advanced HCC, which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase CT completely disappeared without specific treatment for the HCC, and the tumor size decreased on the follow-up CT scan.
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