다발성 폐전이를 동반한 진행성 간세포암종 환자에서 전신항암화학요법의 치료성적
Clinical outcomes of systemic chemotherapy in hepatocellular carcinoma patients with multiple lung metastases
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Background/Aims: Advanced hepatocellular carcinoma (HCC) with multiple lung metastases has a poor prognosis with no effective treatment having been established. This study evaluated the outcomes of systemic chemotherapy for advanced HCC with multiple lung metastases. Methods: Between January 2000 and December 2006, 68 patients were diagnosed with HCC presenting with multiple lung metastases. Sixteen patients in the terminal stage, such as Child-Pugh grade ‘C’ or an Eastern Cooperative Oncology Group performance status exceeding grade 2, were excluded from the analysis. The following treatment modalities were applied: 26 patients received primary tumor treatment (transarterial chemoembolization or intra-arterial chemotherapy) with systemic chemotherapy, 10 patients received primary treatment only, 8 patients received systemic chemotherapy only, and 8 patients received highly supportive care. The treatment responses and median survival times for the modalities were analyzed and compared. Results: The median age of the 52 analyzed patients (45 males) was 52.4 years. The most common etiology of HCC was chronic hepatitis B virus infection (n=44, 84.6%) followed by hepatitis C virus infection (n=2, 3.8%), with the etiology being unknown in 6 cases (11.5%). The treatment modality had no significant effect on the treatment response rate (P=0.432) or median survival time (133, 66, 74, and 96 days for primary tumor treatment with systemic chemotherapy, primary tumor treatment only, systemic chemotherapy only, and highly supportive care, respectively; P=0.067). Conclusions: We found that systemic chemotherapy was not effective in treating HCC presenting with multiple lung metastases. Improving the effectiveness of systemic treatment and selecting patients who would benefit from such treatment remains a major challenge.
Abstract
Background/Aims: Advanced hepatocellular carcinoma (HCC) with multiple lung metastases has a poor prognosis with no effective treatment having been established. This study evaluated the outcomes of systemic chemotherapy for advanced HCC with multiple lung metastases. Methods: Between January 2000 and December 2006, 68 patients were diagnosed with HCC presenting with multiple lung metastases. Sixteen patients in the terminal stage, such as Child-Pugh grade ‘C’ or an Eastern Cooperative Oncology Group performance status exceeding grade 2, were excluded from the analysis. The following treatment modalities were applied: 26 patients received primary tumor treatment (transarterial chemoembolization or intra-arterial chemotherapy) with systemic chemotherapy, 10 patients received primary treatment only, 8 patients received systemic chemotherapy only, and 8 patients received highly supportive care. The treatment responses and median survival times for the modalities were analyzed and compared. Results: The median age of the 52 analyzed patients (45 males) was 52.4 years. The most common etiology of HCC was chronic hepatitis B virus infection (n=44, 84.6%) followed by hepatitis C virus infection (n=2, 3.8%), with the etiology being unknown in 6 cases (11.5%). The treatment modality had no significant effect on the treatment response rate (P=0.432) or median survival time (133, 66, 74, and 96 days for primary tumor treatment with systemic chemotherapy, primary tumor treatment only, systemic chemotherapy only, and highly supportive care, respectively; P=0.067). Conclusions: We found that systemic chemotherapy was not effective in treating HCC presenting with multiple lung metastases. Improving the effectiveness of systemic treatment and selecting patients who would benefit from such treatment remains a major challenge.
참고문헌 (31)
- Korea National Statistical Office, "Annual report on the cause of death statistics of 2003" (2004), Korea National Statistical Office
- Natsuizaka M, "Clinical features of hepatocellular carcinoma with extrahepatic metastases", J Gastroenterol Hepatol, 20, pp.1781~1787 (2005)
- Katyal S, "Extrahepatic metastases of hepatocellular carcinoma", Radiology, 216, pp.698~703 (2000)
- Lam CM, "Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma", Br J Surg, 85, pp.1198~1200 (1998)
- Gwak GY, "Long-term survival after pulmonary metastatectomy of hepatocellular carcinoma; treatment outcome or natural history?", Hepatogastroenterology, 51, pp.1428~1433 (2004)
- Kim KK, "Clinical outcome of pulmonary resections in patients with pulmonary metastasis of hepatocellular carcinoma", Korean J Hepatol, 11, pp.350~358 (2005)
- Park JW, "Practice guideline for diagnosis and treatment of hepatocellular carcinoma", Korean J Hepatol, 10, pp.88~98 (2004)
- The Korean Liver Cancer Study Group, "The general rules for the study of primary liver cancer", pp.1~56 (2004), The Korean Liver Cancer Study Group
- WHO handbook for reporting results of cancer treatment, "WHO handbook for reporting results of cancer treatment" (1979), World Health Organization
- Nakashima T, "Pathology of hepatocellular carcinoma in Japan. 232 Consecutive cases autopsied in ten years", Cancer, 51, pp.863~877 (1983)
- Yuki K, "Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases", Cancer, 66, pp.2174~2179 (1990)
- Bruix J, "Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution", Hepatology, 27, pp.1578~1583 (1998)
- Pelletier G, "Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial", J Hepatol, 29, pp.129~134 (1998)
- Llovet JM, "Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial", Lancet, 359, pp.1734~1739 (2002)
- Nowak AK, "Systemic therapy for advanced hepatocellular carcinoma: a review", Eur J Cancer, 40, pp.1474~1484 (2004)
- Lai CL, "Doxorubicin versus no antitumor therapy in inoperable hepatocellular carcinoma. A prospective randomized trial", Cancer, 62, pp.479~483 (1988)
- Pohl J, "Systemic chemotherapy with epirubicin for treatment of advanced or multifocal hepatocellular carcinoma", Chemotherapy, 47, pp.359~365 (2001)
- Dunk AA, "Mitozantrone as single agent therapy in hepatocellular carcinoma", J Hepatol, 1, pp.395~404 (1985)
- Porta C, "5-Fluorouracil and d,l-leucovorin calcium are active to treat unresectable hepatocellular carcinoma patients: preliminary results of a phase II study", Oncology, 52, pp.487~491 (1995)
- Okada S, "A phase 2 study of cisplatin in patients with hepatocellular carcinoma", Oncology, 50, pp.22~26 (1993)
- Malaguarnera M, "Treatment of nonresectable hepatocellular carcinoma: review of the literature and meta-analysis", Adv Ther, 11, pp.303~319 (1994)
- Simonetti RG, "Treatment of hepatocellular carcinoma: a systematic review of randomized controlled trials", Ann Oncol, 8, pp.117~136 (1997)
- O’Reilly EM, "A phase II study of irinotecan in patients with advanced hepatocellular carcinoma", Cancer, 91, pp.101~105 (2001)
- Boige V, "Irinotecan as first-line chemotherapy in patients with advanced hepatocellular carcinoma: a multicenter phase II study with dose adjustment according to baseline serum bilirubin level", Eur J Cancer, 42, pp.456~459 (2006)
- Hebbar M, "Phase II trial of docetaxel therapy in patients with advanced hepatocellular carcinoma", Oncology, 70, pp.154~158 (2006)
- Fuchs CS, "A phase II trial of gemcitabine in patients with advanced hepatocellular carcinoma", Cancer, 94, pp.3186~3191 (2002)
- Alexandre J, "Combination of topotecan and oxaliplatin in inoperable hepatocellular cancer patients", Am J Clin Oncol, 25, pp.198~203 (2002)
- Stuart K, "A Phase II trial of nolatrexed dihydrochloride in patients with advanced hepatocellular carcinoma", Cancer, 86, pp.410~414 (1999)
- Maeda T, "Low-dose cisplatin plus oral tegafur and uracil for the treatment of lung metastases of hepatocellular carcinoma", Hepatogastroenterology, 50, pp.1583~1586 (2003)
- Nagata H, "Retrospective analysis of clinical results in eight patients with advanced hepatocellular carcinoma with lung metastases treated by TS-1", Gan To Kagaku Ryoho, 34, pp.233~235 (2007)
- "J Clin Oncol", 2007, LBA00001~