간세포암종 환자에서 폐전이 시 폐절제술의 임상적 결과
Clinical Outcome of Pulmonary Resections in Patients with Pulmonary Metastasis of Hepatocellular Carcinoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 간세포암종 환자에서 폐는 간외전이가 가장 흔하게 일어나는 장기이며 아직까지 간외전이에 대한 치료 방법이 확립되어 있지 않다. 저자들은 간세포암종 환자에서 폐전이가 발생하였을 때 적극적으로 부분폐절제술로 폐전이를 제거한 환자에서 장기적 임상 효과를 알아보고자 하였다. 대상과 방법: 2000년 7월부터 2004년 7월까지 간세포암종으로 치료받던 중 폐전이가 발생하여 부분 폐절제술을 시행받은 6명의 환자를 대상으로 간내 간세포암종을 절제한 이후 적어도 간내 재발 없이 추적관찰 중 단일 폐결절이 발견되어 수술한 군과 간내 간세포암종이 치료 후 완전반응(complete response)을 보이거나 가까운 시기에 잘 조절될 것으로 판단되었던 환자에서 폐전이가 발견되어 폐절제술을 시행한 군으로 나누어 후향적으로 의무기록 등을 통해 관련 간질환, 폐절제술 후 재발 기간 및 재발 장기, 생존기간 등을 조사하였다. 결과: 간세포암종에서 폐전이가 발생하여 부분폐절제술을 시행받은 환자 6명 중 간세포암종을 절제한 이후 간내 재발 없이 추적관찰 중 단일 폐결절 전이가 발견되어 폐절제술을 시행한 환자는 3명이었다. 1명은 폐절제술 후 흉벽에 재발이 발생했고 나머지는 재발이 없었다. 간세포암종 진단 후 생존기간은 79, 122, 54개월이었고 폐절제술 후 생존기간은 49, 39, 20개월로 현재 모두 생존해 추적관찰 중이다. 간내 간세포암종이 치료 후 완전반응을 보이거나 영상학적으로 부분반응을 보여 가까운 시기에 잘 조절될 것으로 판단되었던 환자에서 폐전이가 발견되어 폐절제술을 시행한 환자는 3명이었다. 모두 간에 재발이 발생했고 2명은 폐에도 동시에 재발했다. 간세포암종 진단 후 생존기간은 153, 83, 12개월이었고 폐절제술 후 생존기간은 51, 4, 2개월이었다. 1명은 폐절제술 후 4개월만에 사망했다. 결론: 원발성 간세포암종을 조절한 후 국소적 폐전이 시 폐절제술을 포함한 적극적인 폐전이에 대한 치료가 일부 환자에서는 생존기간을 연장시킬 수 있는 하나의 치료 방법으로 고려할 수 있다고 생각된다.
Abstract
Background/Aims: Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma (HCC), the role of surgery for pulmonary metastasis remains unclear. The aim of this study was to evaluate the efficacy of pulmonary resection in patients with pulmonary metastasis from HCC. Methods: Between July 2000 and July 2004, a total of 6 patients with pulmonary metastasis from HCC underwent curative pulmonary resections. The patients were divided into two groups (Surgery group and Non-surgery group) according to the primary treatment modality of HCC. Medical records, imaging studies, and pathologic reports of the surgical specimens were reviewed. Results: Three patients in the surgery group underwent pulmonary resections for a solitary metastasis after hepatectomy for HCC, and they are all still alive. One of the 3 patients developed a tumor recurrence in the chest wall after pulmonary resection. The survival time after diagnosis of HCC were 79, 122, and 54 months, respectively. The survival time after pulmonary metastatectomy were 49, 39, and 20 months in the three patients. Another 3 patients in the non-surgery group, received a pulmonary metastatectomy; they had either a complete response HCC or partial radiologic response. These 3 patients developed recurrent disease in the liver. One of 3 patients died. The survival time after diagnosis of HCC were 153, 83, 12 months. The survival time after pulmonary metastatectomy were 51, 4, 2 months. Conclusions: The surgical resections of a solitary pulmonary metastasis from HCC in highly selected patients might be an effective treatment modalities for prolonged survival.
참고문헌 (26)
- "Annual report on the cause of death statistics of 2003" (2004)
- "Effectiveness of periodic checkup with abdominal ultrasonography and α- fetoprotein assay for the early detection of hepatocellular carcinoma", 36, pp.81~92 (2000)
- "Analysis of survival rates by surgical resection or transarterial chemo- embolization as the initial treatment for the patients with hepatocellular carcinoma", 35, pp.600~609 (2000)
- "Outcome of hepatic resection for hepatocellular carcinoma patients", 6, pp.480~486 (2003)
- "Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma results in a series of 100 Italian patients", 82(6), pp.1028~1036 (1998)
- "Hepatic resection for hepatocellular carcinoma--Japanese experience", 45, pp.1267~1274 (1998)
- "Risk factors of morbidity and mortality following surgical resection for hepatocellular carcinoma", 1, pp.51~61 (2004)
- "Extrahepatic metastasis of hepatocellular carcinoma", 216, pp.698~703 (2000)
- "Practice guideline for diagnosis and treatment of hepatocellular carcinoma", 10, pp.88~98 (2004)
- "간암규약 개정: 배경과 내용" (2004), 대한간암연구회 편찬
- "Hepatic resection for hepatocellular carcinoma - Retrospective study of 49 cases -", 48, pp.374~383 (1995)
- "A clinical study of 15 long term survivors after liver resectinos for hepatocellular carcinomas", 54, pp.383~395 (1998)
- "A clinical study on the prognosis of hepatocellular carcinomain relation to therapeutic modalities", 32, pp.757~772 (1998)
- "Prognostic factors after hepatic resection of hepatocellular carcinoma", 39, pp.33~39 (2002), univariate and multivariate analysis
- "Analysis of factors affecting intrahepatic recurrence after curative resection of hepatocellular carcinoma", 27, pp.72~82 (1995)
- "Long-term survival rates and prognostic factors for a hepatocellular carcinoma after a curative hepatic resection", 5, pp.715~727 (1999)
- "Prognosis of hepatocellular carcinoma patients with extrahepatic metastases", 44, pp.251~257 (1997)
- "Efficacy of pulmonary metastatectomy for recurrent soft tissue sarcoma", pp.1~4
- "Reoperative pulmonary metastasectomy for sarcomatous pediatric histologies", 66, pp.908~913 (1998)
- "Small solitary pulmonary metastasis detected before primary sigmoid colon cancer report of a case", 33, pp.709~711 (2003)
- "Complete response to treatment with low-dose FP therapy in a patient with stage IVB primary hepatocellular carcinoma with multiple lung and bone metastases", 31, pp.107~111 (2004)
- "Low-dose cisplatin plus oral tegafur and uracil for the treatment of lung metastases of hepatocellular carcinoma", 50, pp.1583~1586 (2003)
- "Complete disappearance with oral UFT administration of recurrent hepatocellular carcinoma of the remnant liver and multiple lung metastasis after hepatic resection Gan To Kagaku Ryoho 2003", 30(ike t), pp.1327~1332 (2003)
- "Prognostic efficacy of treatment for extrahepatic metastasis after surgical treatment of hepatocellular carcinoma", 50, pp.41~48 (2003)
- "Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma", 85, pp.1198~1200 (1998)
- "Long-term survival after pulmonary metastatectomy of hepatocellular carcinoma treatment outcome or natural history", 51, pp.1428~1433 (2004)