대장암의 간전이에 대한 치료: 99예의 후향적 비교분석
Treatment of Hepatic Metastasis of Colorectal Cancer: A Retrospective Analysis of the Outcome in 99 Patients
대한암학회지 1998년 30권 6호 p.1175 ~ 1183
소속 상세정보
김진천/Jin Cheon Kim
김창남/유창식/이한일/김상위/이제환/김우건/강경훈/이문규/Chang Nam Kim/Chang Sik Yu/Han Il Lee/Sang We Kim/Je Hwan Lee/Woo Kun Kim/Gyeong Hoon Kang/Moon Kyu Lee
KMID : 0360319980300061175
Abstract
서론
대장암의 근치수술후 외래진료상 혈청 CEA수가 증가하면 CT 및 MRI에서 간전이를 빈
번하게 발견하게 된다. 이와같이 대장암에서 가장 흔한 전이는 간으로 알려져 있고, 대장암
수술후 재발되는 환자의 2/3에서 간전이가 있다고 보고된다. 이는 대장의 특이한 해부학적
구조 및 종양세포의 특이적 간내 합착 등이 관련된 것으로 연구되고 있다.
대장암의 간전이에 대한 치료는 절제술, 냉동수술을 포함하는 수술적치료와 정맥 혹은 간
동맥을 통한 항암약물요법, 간동맥색전요법, 피하에탄올주사 등의 비수술적치료가 있는데 주
로 절제술과 항암약물요법이 이용되고 있다.
대장암의 간전이환자에서 자연경과나 치료결과에 영향을 미치는 예후인자들에 대한 많은
연구가 있었는데 일반적으로 알려진 예후인자는 성별, 나이, 원발암의 위치, 치료형태, 절제
술의 종류, 절제연의 거리, 술전 혈청 CEA수치, 원발암의 병기, 전이암의 크기 및 숫자, 전
이암의 분포, 원발암치료후 무병기간 등이지만 이에 대한 결과는 다양하게 보고된다. 본 연
구는 대장암 간전이시 알려진 예후인자 중 의미있는 예후인자를 결정하고 간절제군에서 예
후인자에 따른 생존율을 비교하여 수술 및 추적조사시 유의하여야 할 사항을 파악하고자 하
였다.
Purpose : Among various modalities of treatment in hepatic metastasis of colorectal
cancer, hepatic resection has been proven to be the most effective treatment. This
analysis was intended to determine important prognostic parameters and to understand
clinically significant factors during hepatic resection and follow-up period in patients
with hepatic metastasis from colorectal cancer.
Materials and Methods : Among 1,022 colorectal cancer patients treated at Asan
Medical Center from July 1989 to December 1995, 99 patients were found to have liver
metastasis at the time of first diagnosis or during follow-up period. These 99 patients
were the subject of analysis in this retrospective clinical study. Surgical resection with
curative intent was done in 35 patients and chemotherapy in 46 patients. Eighteen
patients were with no treatment or missed during follow-up. Survival rate was analysed
according to clinicopathological parameters: sex, age, location of primary tumor,
preoperative serum CEA level, TNM staging of primary tumor, number of hepatic
metastasis, distribution, synchronous or metachronous lesions, disease free interval, mode
of treatment, type of resection, tumor free resection margin.
Results : Overall survival of the patients with hepatic metastasis was significantly
related with numbers of metastasis (<4 vs. >4), distribution (unilobar vs. bilobar),
synchronous or metachronous lesions, disease free interval (<12 vs. >12 months), mode
of treatmeat (hepatic resection vs. chemotherapy vs. no treatment, p<0.01. A multivariate
analysis showed a significant association of survival with mode of treatment (p<0.01).
Survival of patients with hepatic resection was significantly related with resection
margin (positive vs. <1 ㎝ vs. > 1 ㎝), TNM staging of primary tumor (Ⅱ vs. Ⅲ),
number of hepatic metastasis (p<0.01), disease free interval (p<0.05). A multivariate
analysis showed a significant correlation with survival for tumor free resection margin
(p<0.01).
Conclusion : An aggressive approach of hepatic resection in the colorectal liver
metastasis will improve survival, if the lesion _permits. In patients with hepatic
resection, tumor free resection margin was the most important prognostic parameter by
the uni- and multi-variate analysis. Therefore, every effort should be made to ensure
that the clear margin be kept at least more than 1 ㎝ during hepatic resection.
키워드
Colorectal cancer; Hepatic metastasis;
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