다발성 간세포암 환자에서 다발 부위 간절제 또는 고주파 치료를 병합한 간절제술 후 장기 성적

Abstract

Purpose: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. Methods: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). Results: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p＜0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) ＞10% were adverse prognostic factors for overall survival. Conclusion: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.