원발성 간내 담관세포암의 임상적 고찰

Abstract

Background/Aims: Intrahepatic cholangiocellular carcinoma is devided into the peripheral and hilar type according to the location. The clinical features of hilar type is similar to that of extrahe- patic bile duct cancer and the peripheral type similar to the hepatocellular carcinoma. We conducted this study to identify the differences of clinical characteristics and survival rates between the hilar and peripheral type. Methods: We analyzed 42 cases with intrahepatic cholangiocellular carcinoma who were histologically confirmed from January 1981 to December 1990 at Severance Hospital, Yonsei University. Results: The mean age was 57.2 years, the male to female ratio 2.2 to 1. The most common symptom was abdominal pain(83.3%), jaundice was more frequently encountered in hilar type(33.3%) than peripheral type(6.7%) and abdominal mass more common in peripheral type(48.4%) than hilar type(11.1%). Associated diseases were infestation of Clonorchis sinensis(19.0%), liver cirrhosis(19.0%) and intrahepatic bile duct stones(7.1%). The elevation of serum CEA(more than 5 ng/ml) was noted in 52.0%. On abdominal ultrasonography, the hypere- choic pattern in hilar type and the hypoechoic pattern in peripheral type were commonly noted. The hepatic arterial angiography showed mostly hypovascular pattem(72.7%). Local invasion was more frequent in hilar type than peripheral type, however distant metastasis was more common in peripheral type. The overall median survival of 36 cases was 5.5 months, and hilar type 5.3 months and peripheral type 5.9 months. According to the treatment modalities, the survival rates in cases underwent curative resection(median survival; 12.5 months) and in cases with combination of chemotherapy, radiotherapy and hyperthermia(median survival; 9.6 months) were significantly higher than that of no treatment group(median survival; 2.0 months)(pC0.05). Conclusions: To improve the survival in cases with intrahepatic cholangiocellular carcinoma, the efforts to diagnose in early stage should be recommanded, especially in the high risk group such as the patients with Clonorchiasis and intrahepatic bile duct stones. Additionally we should remind the differences including the pattern of metastasis between hilar and peripheral types in the management of these patients.