진행성 간암환자에서 간이식 수술의 적응증 확대

이경근; 윤영철; 황정기; 박정현; 김지일; 유영경; 문인성; 김동구

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자료유형: 학술저널

저자정보: 이경근 (카톨릭대학교) 윤영철 (카톨릭대학교) 황정기 (카톨릭대학교) 박정현 (카톨릭대학교) 김지일 (카톨릭대학교) 유영경 (카톨릭대학교) 문인성 (카톨릭대학교) 김동구 (카톨릭대학교)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제13권 제3호

발행연도: 2009.9

수록면: 171 - 178 (8page)

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Purpose : The purpose of this study was to evaluate the possibility of expanding the indication for living donor live transplantation (LDLT) for treatment of hepatocellular carcinoma(HCC), beyond the Milan criteria without compromising patient survival.
Methods : This was a retrospective study of 5patients (36.4%) that had undergone LDLT, beyond the Milan criteria, among 143 patients with HCC. The study was conducted in aptients treated by the Department of Surgery, Catholic University of orea from Oct 2000 to May 2008. We evaluated the survival curve, prognostic factors for survival and compared survival between our new criteria and Milan criteria.
Results : The 5 year patient survival and disease free survival rate in patients treated with LDLT beyond the Milan criteria were 50.2% and 61.9%, respectively. The prognostic factors affecting disease free survival and patient survival included serum AFP level, tumor size, vascular invasion, and lumor cell differentation on univariate analysis. In multivariate analysis, AFP (200 ng/mL), tumor size (7cm) and vascular invasion had significant influence on survival and disease free survival. According to our new criteria (size<7 cm, AFP <200 ng/mL), 88.1% of our patients were included compare to the 63.6% that would have been if limited to the Milan criteria. With both factors met, the survival was comparable to the survival of Milan criteria (63.7% on our criteria and 78.2% on Milan criteria at 5 years)(P=0.103).
Conclusion : A tumor size <7cm and a AFP <200 ng/mL appear to be useful cut-off values, beyond that criteria required by Milan. An analysis according to our criteria showed an acceptable survival outcome. Further verification of these findings by a large volume or prospective study is required for widespread adoption of our new criteria.

#Advanced hepatocellular carcinoma #Expanded Criteria Living donor liver transplantation #진행성 간암 #확장된 적응증 생체간이식

참고문헌 (28)

참고문헌 신청

1. [학술지(정기간행물)] - Iwatsuki S / 1991 / Hepatic resection versus transplantation for hepatocellular carcinoma / Ann Surg 214 : 221 ~ 229

2. [학술지(정기간행물)] - Bismuth H / 1993 / Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients / Ann Surg 218 : 145 ~ 151

3. [학술지(정기간행물)] - Yokoyama I / 1991 / Clinicopathologic factors affection patient survival and tumor recurrence after orthotopc liver transplantation for hepatocellular carcinoma / Transplant Proc 23 : 2194 ~ 2196

4. [학술지(정기간행물)] - Mazzaferro V / 1996 / Liver transplantation for the treatment of small hepatocellular carcinomas inpatients with cirrhosis / N Engl J Med 334 : 693 ~ 699

5. [학술지(정기간행물)] - Yao FY / 2003 / A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy / Liver TranspI 9 : 684 ~ 692

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