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간세포암종 환자에서 간동맥화학색전술 재치료 전략의 입증 및 두 번째 치료 후 생존분석 원문보기

  • 저자

    유양재

  • 학위수여기관

    고려대학교 대학원

  • 학위구분

    국내석사

  • 학과

    의학과 내과학전공

  • 지도교수

    변관수

  • 발행년도

    2014

  • 총페이지

    40 p.

  • 키워드

    Hepatocellular carcinoma Transarterial chemoembolization Survival Validation;

  • 언어

    kor

  • 원문 URL

    http://www.riss.kr/link?id=T13542000&outLink=K  

  • 초록

    Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the fourth most common cancer in Korea, with a poor prognosis. Transarterial chemoembolization (TACE) is the recommended modality for hepatocellular carcinoma (HCC) patients with BCLC (Barcellona Clinic Liver Cancer) B stage. Although overall survival (OS) is prolonged in majority of patients treated with sequential TACE sessions, some may die early due to deterioration of liver function and procedure related adverse events. Assessment for retreatment with TACE (ART score) was developed to distinguish a group of patients who may have a dismal prognosis after second TACE session. We aimed to validate ART score and evaluated survival factors after second session of TACE in our HCC patients. Methods: Between January 2004 and December 2009, 182 patients who were first diagnosed as HCC with BCLC stage A (n=86) or B (n=96) and treated with more than 2 session of TACE within ≤90 days in Korea University Guro Hospital (training cohort) were enrolled. Ninety-four patients in Soonchunhyang University Bucheon Hospital (validation cohort), who qualified for the same eligiblilty criteria were also included. We collected demographic and clinical data at baseline and 1 day before second session of TACE. Tumor response was assessed according to modified RECIST criteria. OS was defined as time from second TACE to last day of follow up or death. We performed survival analysis using Kaplan - Meier method and Cox regression. Results: The mean age of patients in the training cohort was 58.8±10 years and male consisted 84.1% (n=153). There was no survival difference between ART score ≥2.5 group (n=37, 20.3%) and ART score 0-1.5 group (n=145, 79.7%) in our population (37.0 months vs. 29.0 months, p=0.236). Therefore, we analyzed survival factors from second session of TACE. The ART score factors of AST increase > 25%, tumor response and Child-Pugh score increase did not show a significance in univariate analysis. According to univariate analysis, age, tumor size, tumor number, BCLC stage, AFP prior to first and second TACE session, AFP response, Child-Pugh stage prior to second TACE, and serum creatinine increase > 25%, platelet count decrease > 25% were entered into a stepwise Cox regression model. Age, tumor number, BCLC stage, Child-Pugh stage and AFP prior to second TACE session were independent factors for survival (all p


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