한국인에서 간암발생의 위험요인 분석

Abstract

Background : Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world. Although screening test for HCC has been performed, the high risk factors were not well evaluated in Korea. This study was undertaken to evaluate the risk factors of HCC development in Korea. Methods : We studied a total of 2,020 patients who visited Yonsei University Medical Center for regular check-up including ultrasonography (US) and alpha-fetoprotein (AFP) from January 1990 to December 1998. All the detailed data of clinical parameters were obtained by our self-exploited data base system prospectively and analyzed by SAS program. Results : Among 2,020 subjects, 1295 were male and 725 were female (mean age, M: 47 years, F: 50 years). 117 (5.8%) out of 2,020 subjects developed HCC during follow-up period (33months). Annual detection rate of HCC was 1.64%. The independent risk factors by univariate analysis were liver cirrhosis, chronic hepatitis, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, old age (over 40 years old), heavy alcoholics, severe liver parencymal echogenic pattern in US, initial level of serum AFP (>20 ng/mL) or alanine aminotransferase (ALT) (>40 IU/L). Multivariate analysis with a proportional hazards model showed liver cirrhosis (p=0.000), chronic hepatitis (p=0.014), HCV infection (p=0.007), HBV infection (p=0.049), and old age over 40 years old (p=0.000) to be significant risk factors for HCC. We also found that the more risk factors, the higher HCC development. The development of HCC might not be related to history of smoking, family history of HCC, previous therapy such as interferon (IFN), diet, drugs, and transfusion. Conclusion : Screening test for early detection of HCC should be reconsidered according to the relative risk rate of these risk factors.