경화간세포암종의 외과 치료
Surgical Treatment of Sclerosing Hepatocellular Carcinoma
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목적: 경화간세포암종은 성인에서 발생하는 간세포암종의 드문 형태로서 종양세포의 관모양 증식과 주위의 치밀한 섬유화가 특징이다. 저자들은 경화간세포암종의 외과적 접근법과 치료성적에 대해 조사하였다. 대상과 방법: 저자들은 1989년부터 2005년까지 서울아산병원에서 수술받은 6명의 경화간세포암종 환자를 대상으로 후향적으로 조사하였다. 결과: 연구기간 동안 1,390명의 간세포암종 환자중 6명이 경화간세포암종으로 진단되었다(0.43%). 평균 나이는 58세였고, 남자 4명, 여자 2명이었다. 주증상은 복통과 체중감소였다. 모든 환자에서 혈청 칼슘 수치와 인 수치는 정상이었다. 6명의 환자 모두가 B형간염 표면항원이 양성이었고, C형간염 항체는 음성이었다. 종양은 모든 환자에서 단일 병변이었다. 직경은 평균 8 cm (4.5-15 cm)이었다. 모든 환자에서 수술 치료를 하였는데 우엽확대절제술 1예, 중앙2구역절제술 1예, 우전구역절제술 1예, 체외절제 및 자가 이식 1예 그리고 우후구역절제술 2예를 시행하였다. 이 환자들의 정중생존기간은 24개월이었고, 정중무병생존기간은 9.5개월이었다. 결론: 이 연구에서 경화간세포암종의 발생빈도는 0.4%로 매우 낮았고, 경화간세포암종은 수술 전 진단 시 다른 암으로 오인될 수도 있지만, 적극적인 간절제술이 시행된 경우 그 예후는 일반 간세포암종과 비교하여 심각하게 나쁘지는 않은 것으로 보여지기 때문에 적극적인 수술 치료가 환자 예후 향상에 도움이 될 것으로 생각한다.
Abstract
Background/Aims: Sclerosing hepatocellular carcinoma (HCC) is an unusual subtype of HCC that is characterized by an embedded dense fibrous stroma in the tubular neoplastic structures. We aimed to assess the surgical approaches and outcomes of sclerosing HCC. Methods: We retrospectively analyzed the clinicopathologic features of 6 patients with sclerosing HCC who underwent surgical treatment at Asan Medical Center between July 1989 and December 2005. Results: Six HCC patients with sclerosing HCC were diagnosed out of the total 1390 HCC patients (0.43%) during the study period. The mean age was 58 years and 4 patients were male. Weight loss and abdominal pain were the most common symptoms. The serum calcium and phosphorus levels were normal in all the patients. All of them were hepatitis B surface antigen-positive, but none was positive for hepatitis C. All the lesions were solitary. The tumor size ranged from 45 to 150 mm in diameter (median size: 81 mm). We performed right trisegmentectomy (n=1), central bisegmentectomy (n=1), right anterior segmentectomy (n=1), ex-vivo resection and autotransplantation (n=1) and right posterior segmentectomy (n=2). The median overall survival and disease free-survival periods were 24 months and 9.5 months, respectively. Conclusions: The incidence of sclerosing HCC was very low. Sclerosing HCC was often not correctly diagnosed before an operation, but performing resection prolonged the patients’ survival and their prognosis was not worse than that for ordinary HCC. Our experience implicates that aggressive surgical treatment for sclerosing HCC is beneficial for patient survival.
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