비대상성 간경변을 동반한 진행성 간세포암종에서 간동맥내 저용량 5-fluorouracil 및 cisplatin 주입요법의 효과 = Effect of Low Dose 5-Fluorouracil and Cisplatin Intra-arterial Infusion Chemotherapy in Advanced Hepatocellular Carcinoma with Decompensated Cirrhosis

다국어 초록 (Multilingual Abstract)

Background/Aims: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of repeated arterial infusions of low dose cisplatin and 5-fluorouracil (FU) in patients with advanced HCC with decompensated cirrhosis. Methods: Between January 1995 and December 2003, a total of 79 decompensated cirrhotic patients having HCC and PVT were enrolled and divided into 2 groups. Group 1 (n=40) received intra-arterial infusion chemotherapy with cisplatin (10 mg for 5 days) and 5-FU (250 mg for 5 days) via an implanted chemoport every 4 weeks’ and group 2 (n=39) was managed with only conservative treatment. Results: The two groups were well matched with respect to the features relating to the prognosis, including age, gender and the Child- Pugh class. Although diffuse tumor involvement, main portal vein tumor thrombosis and bi-lobar involvement were more frequent in group 1, the median survival period of group 1 was significantly longer than group 2 (5 months vs. 3 months, respectively, P=0.016). Also, the 1-year survival rate of group 1 (7.5%) was higher than that of group 2 (5.1%) (P=0.016). When we analyzed the patients with the Child class B, the survival benefits of intra-arterial chemotherapy were more significant (P=0.008). Conclusions: Intra-arterial chemotherapy consisting of low dose 5-FU and cisplatin achieved favorable results for advanced HCC patients who had decompensated cirrhosis, and it showed better survival in selected patients. This therapy may be useful as a palliative treatment for HCC patients with decompensated cirrhosis. (Korean J Hepatol 2006;12: 65-73)

국문 초록 (Abstract)

목적: 간문맥 종양혈전을 동반한 진행성 간세포암종은 예후가 매우 불량하며, 일부에서는 간기능 부전의 위험이 적은 간동맥내 항암제주입요법이 시행되고 있으나, 비대상성 간경변이 동반된 경우의 치료에 대한 효과 및 안전성은 밝혀진 바 없다. 본 연구에서는 비대상성 간경변을 동반한 진행성 간세포암종 환자에서 간동맥내 저용량 5- fluorouracil (5-FU) 및 cisplatin 주입요법의 효과와 안전성을 알아보고자 하였다. 대상과 방법: 1995년 1월부터 2003년 12월까지 비대상성 간경변을 동반하고 간문맥 종양혈전이 있는 간세포암종 환자 총 79명(간동맥내 항암제주입군: 40명, 보존적 치료군: 39명)을 대상으로 후향적 분석을 시행하였다. 간동맥내 항암제 주입은 4주마다 5일간 5-FU 250 mg 및 cisplatin 10 mg을 chemoport를 통해 주입하였다. 치료군과 대조군 간의 생존율 비교는 Kaplan-Meier 방법을 이용하였다. 결과: 간동맥내 항암제주입군과 보존적 치료군 사이에 성별(남:여=38:2 vs 34:5), 나이(52.7±11.2 vs 56.3±10.6), Child-Pugh 분류는 차이가 없었다{A: 12명(30%), B: 28명(70%) vs A: 14명(36%), B: 25명(64%)}. 보존적 치료군에 비해 간동맥내 항암제 주입군에서 중앙 생존 기간이 연장되었으며(5개월 vs 3개월), Kaplan-Meier 분석 상 생존 기간이 증가되는 경향을 보였다(P=0.016). 특히 Child B군만을 대상으로 했을 때 생존율의 차이가 두드러졌다(P=0.008). 결론: 간문맥 종양혈전을 동반한 진행성 간세포암종 환자에서 비대상성 간경변증인 경우에도 5-FU 및 cisplatin을 이용한 저용량 간동맥내 항암제주입요법은 비교적 안전하며 신중히 선택된 환자에서 생존율 향상을 기대할 수 있다.

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