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엄순호 ( Soon Ho Um ),류호상 ( Ho Sang Ryu ),박미라 ( Mi Ra Park ),이재원 ( Jea Won Lee ),진윤태 ( Yoon Tae Jeen ),전훈재 ( Hoon Jae Chun ),송치욱 ( Chi Wook song ),이상우 ( Sang Woo Lee ),김창덕 ( Chang Duck Kim ),현진해 ( Jin Ha 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6
Background/Aims: Well designed staging system of hepatocellular carcinoma(HCC) is needed for comparative therapeutic studies regarding HCC to be of value. The aim of study is to reevaluate prognostic factors affecting natural history of HCC and to devise a staging system according to prognostic index estimated mathematically Methods: One hundred eighty patients with HCC were analyzed retrospectively. All patients received only conservative treatments. Univariate and multivariate analysis were performed using clinical, biochemical and imaging data obtained at diagnosis. Results: The overall acturial survival rate at 1, 3, 6, 12, 24 months were 74%, 33%, 11%, 7%, 5%, respectively. For significant prognostic variables in the univariate analysis, multivariate survival analysis disclosed that tumor size(p=0.0039), ascites(p=0.0190), total serum bilirubin(p=0.001) were independent prognostic factors. Considering the contribution of each of these factors to prediction of survial, a pronostic index(PI) was defined as a following regression equation. PI=EXP(tumor size×0.1904+ascites×0.4114+Bilirubin×0.0504). According to PI, a new staging system was devised allowing division of patients into three groups with significantly different survival rates(p<0.01). Conclusions: The new staging system for HCC according to PI would be useful for the staratification of HCC patients in the comparative evaluation of various therapeutic modalities.(Korean J Gastroenterol 1997;29:786-796)
이상우,김윤환,이재원,김경수,박미라,박동규,이성준,이구,김광희,김창덕,최재현,류호상,전훈재,송치욱,서성옥,엄숭호,현진해,진윤태 대한간학회 1998 Clinical and Molecular Hepatology(대한간학회지) Vol.4 No.4
Background/ Aims : Cases of small hepatocellular carcinoma (HCC) have been increasing with the progress of diagnostic methods . In t his study the screening methods for early diagnos is of HCC were re-evaluated, and comparative ther apeutic analyses were perfomed. Methods : A total of 110 pat ients with small HCC ($lt; 5 cm and $lt; 4 nodules ) were retrospectively analyzed. The patients were divided into four treatment groups ; unt reated group (No T x, n=12), transarterial-oily-chemoembolization group (TOCE, n=43), combined treatment group of percutaneous ethanol injection and TOCE (CEI, n=22), OP group ( OP, n=33). Results : Small HCC occupied 22.6% of t ot al HCC cases . Only one thir d of small HCC cases were detected during the regular screening. In this group, Alpha- fet oprotein as say pr ovided a diagnostic clue in 50% of cases, ultras onography in 71%, and the combination of both in 88%. Five year s ur vival rat e and 5- year non- recurrence rate in small HCC was 29% and 37% respectively. Comparative ther apeutic analys es showed t hat CEI and OP gave a bet t er s ur vival t han T OCE in Child gr ade A. CEI prolonged survival in Child grade B wher eas TOCE did not . Only TOCE was tried and did not improve the survival in Child grade C. Conclus i on : 1) A more strict screening is needed in high risk group of HCC. 2) As a first line of treatment in small HCC, OP or CEI can be selected in Child grade A, and CEI in Child grade B. In Child grade C, a less invasive treatment (PEIT , microwave coagulat ion therapy) should be investigated. (Korean J Hepatol 1998;4:365 380)
간세포암 선별검사로서 정기적인 초음파 및 α-fetoprotein 검사의 유용성
이정환,이상우,이재원,박미라,이홍식,김창덕,진윤태,최재현,엄순호,류호상,전훈재,송치욱,현진해,허병원,강창돈 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1
Background/Aims : Periodic follow-up with abdominal ultrasonography and/or α-fetoprotein (AFP) assay has been used for the early detection of hepatocellular carcinoma (HCC). However, its effectiveness is still controversial. The aim of this study was to re-evaluate the effectiveness of these follow-up methods. Methods: Five hundreds and thirty patients with HCC were divided into two groups: follow- up group with regular screening (n=81) and non follow-up group without screening (n=449). According to the interval of checkup, the follow-up group was divided into three subgroups: FU-1 group ($lt;3 months), FU-2 group (4-6 months), FU-3 group (7-12 months). Results : The rate of early detection (58% vs 27% in the detection of the single nodular type), median survival (48 months vs 6 months) and therapeutic trial (91% vs 60%) were higher in the follow-up group than in the non follow-up group. The diameter of the largest tumor in each group was 3.4±2.3 cm and 9.0±5.0 cm, respectively. As screening methods, abdominaltrasonography combined with AFP assay was superior to AFP assay alone or abdominal ultrasonography alone. There were no significant differences in type and size of the tumor and the survival rate among three follow-up subgroups. Conclusions: Periodic follow-up with abdominal ultrasonography and/or AFP assay enabled the early detection of HCC and improved its prognosis and survival.
이상우,김윤환,이재원,박미라,이성준,이구,김창덕,최재현,엄순호,류호상,전훈재,송치욱,현진해,진윤태,김광희,서성옥 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6
Background/Aims: Recent progress in both diagnostic and therapeutic technique of hepatocellular carcinoma (HCC) appears to improve the prognosis. The purpose of this study was to evaluate the prognosis of HCC in relation to treament methods. Methods: A new staging scheme (PI stage) based on the prognostic index was used. A total of 487 patients with HCC were divided into 4 treatmen groups; no treatment (No Tx), transarterial oily chemoembolization (TOCE), combination of percuta neous ethanol injection and TOCE (CEI), partial hepatectomy (OP). Results: In PI stage I, the groups of CEI and OP showed similar survival rates, and both prolonged survival compared with the group of TOCE. In PI stage II, CEI gave a better survival than TOCE, whereas OP could not improve survival rate, compared with TOCE. In PI stage III, only TOCE was done in some patients and i prolonged survival, particularly when serum bilirubin was 1.5 mg/dL or less. Conclusions: In the P stage I, operation is recommended firstly, but if operation is impossible, CEI could be selected. CE may be chosen as the first treatment choice in PI stage II. In PI stage III, TOCE may be considered for patients whose serum bilirubin is 1.5 mg/dL or less.