Korean Journal of Radiology

  • 제7권3호
  • /
  • Pages.187-192
  • /
  • 2006
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

Long-term Results of Percutaneous Ethanol Injection for the Treatment of Hepatocellular Carcinoma in Korea

  • Sung, Yon-Mi (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Dong-Il (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyo-K. (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Won-Jae (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Seung-Hoon (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Min-Ju (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Paik, Seung-Woon (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Byung-Chul (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Kwang-Cheol (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Joon-Hyoek (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Moon-Seok (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2006.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate the long-term follow-up results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in Korea. Materials and Methods: Sixty-eight nodular HCCs initially detected in 64 patients, were subjected to US-guided PEI as a first-line treatment. Long-term survival rates, local tumor progression rates, and complications were evaluated, as were the influences of tumor size and Child-Pugh class on these variables. Results: No major complications occurred. The overall survival rates of the 64 patients at three and five years were 71% and 39%, and their cancer-free survival rates were 22% and 15%, respectively. The overall survival rate of patients with a small HCC (${\leq}$ 2cm) was significantly higher (p=0.014) than that of patients with a medium-sized HCC (${\leq}$ 2cm). The overall survival rate of patients with Child Pugh class A was significantly higher (p=0.049) than that of patients with Child-Pugh class B. Of 59 cases with no residual tumor, local tumor progression was observed in ablation zones in 18, and this was not found to be significantly influenced by tumor size or Child-Pugh class. Conclusion: The results of our investigation of the long-term survival rates of PEI in HCC patients in Korea (a hepatitis B virus-endemic area) were consistent with those reported previously in hepatitis C endemic areas. Patients with a smaller tumor or a better liver function exhibited superior survival rates.

키워드

참고문헌

  1. Bartolozzi C, Lencioni R. Ethanol injection for the treatment of hepatic tumours. Eur Radiol 1996;6:682-6966
  2. Livraghi T, Festi D, Monti F, Salmi A, Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 1986;161:309-312 https://doi.org/10.1148/radiology.161.2.3020612
  3. Shiina S, Yasuda H, Muto H, Tagawa K, Unuma T, Ibukuro K, et al. Percutaneous ethanol injection in the treatment of liver neoplasms. AJR Am J Roentgenol 1987;149:949-952 https://doi.org/10.2214/ajr.149.5.949
  4. Sheu JC, Sung JL, Huang GT, Chen DS, Yang PM, Lai MY, et al. Intratumor injection of absolute ethanol under ultrasound guidance for the treatment of small hepatocellular carcinoma. Hepatogastroenterology 1987;34:255-261
  5. Livraghi T, Salmi A, Bolondi L, Marin G, Arienti V, Monti F, et al. Small hepatocellular carcinoma: percutaneous alcohol injection—results in 23 patients. Radiology 1988;168:313-317 https://doi.org/10.1148/radiology.168.2.2839865
  6. Shiina S, Tagawa K, Unuma T, Fujino H, Uta Y, Niwa Y, et al. Percutaneous ethanol injection therapy of hepatocellular carcinoma: analysis of 77 patients. AJR Am J Roentgenol 1990;155:1221-1226 https://doi.org/10.2214/ajr.155.6.2173384
  7. Ebara M, Ohto M, Sugiura N, Kita K, Yoshikawa M, Okuda K, et al. Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients. J Gastroenterol Hepatol 1990;5:616-626 https://doi.org/10.1111/j.1440-1746.1990.tb01115.x
  8. Giorgio A, Tarantino L, Francica G, Scala V, Mariniello N, Aloisio T. Percutaneous ethanol injection under sonographic guidance of hepatocellular carcinoma in compensated and decompensated cirrhotic patients. J Ultrasound Med 1992;11:587-595
  9. Livraghi T, Bolondi L, Lazzaroni S, Marin G, Morabito A, Rapaccini GL, et al. Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients. Cancer 1992;69:925-929 https://doi.org/10.1002/1097-0142(19920215)69:4<925::AID-CNCR2820690415>3.0.CO;2-G
  10. Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: longterm results of percutaneous ethanol injection. Radiology 1995;197:101-108 https://doi.org/10.1148/radiology.197.1.7568806
  11. Lencioni R, Pinto F, Armillotta N, Bassi AM, Moretti M, Di Giulio M, et al. Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience. Eur Radiol 1997;7:514-519 https://doi.org/10.1007/s003300050194
  12. Shiina S, Tagawa K, Niwa Y, Unuma T, Komatsu Y, Yoshiura K, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 1993;160:1023-1028 https://doi.org/10.2214/ajr.160.5.7682378
  13. Castells A, Bruix J, Bru C, Fuster J, Vilana R, Navasa M, et al. Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 1993;18:1121-1126
  14. Kotoh K, Sakai H, Sakamoto S, Nakayama S, Satoh M, Morotomi I, et al. The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomy. Am J Gastroenterol 1994;89:194-198
  15. Kang HW, Kim YJ, Kim KM, Kang JM, Kim SH, Kim JH, et al. Efficacy of percutaneous ethanol injection therapy in Korean with hepatocellular carcinoma. Korean J Gastroenterol 2003;42:502-509
  16. Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or = 4 cm. Gastroenterology 2004;127:1714-1723 https://doi.org/10.1053/j.gastro.2004.09.003
  17. Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC. Randomized controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut 2005;54:1151-1156 https://doi.org/10.1136/gut.2004.045203
  18. Lencioni R, Bartolozzi C, Caramella D, Paolicchi A, Carrai M, Maltinti G, et al. Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 1995;76:1737-1746 https://doi.org/10.1002/1097-0142(19951115)76:10<1737::AID-CNCR2820761010>3.0.CO;2-P
  19. Seki T, Nonaka T, Kubota Y, Mizuno T, Sameshima Y. Ultrasonically guided percutaneous ethanol injection therapy for hepatocellular carcinoma. Am J Gastroenterol 1989;84:1400- 1407
  20. Tanaka K, Okazaki H, Nakamura S, Endo O, Inoue S, Takamura Y, et al. Hepatocellular carcinoma: treatment with a combination therapy of transcatheter arterial embolization and percutaneous ethanol injection. Radiology 1991;179:713-717 https://doi.org/10.1148/radiology.179.3.1851313
  21. Shiina S, Tagawa K, Unuma T, Takanashi R, Yoshiura K, Komatsu Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer 1991;68:1524-1530 https://doi.org/10.1002/1097-0142(19911001)68:7<1524::AID-CNCR2820680711>3.0.CO;2-O
  22. Benvegnu L, Alberti A. Patterns of hepatocellular carcinoma development in hepatitis B virus and hepatitis C virus related cirrhosis. Antiviral Res 2001;52:199-207 https://doi.org/10.1016/S0166-3542(01)00185-1
  23. Chen TH, Tseng LM, Chau GY, Lui WY, Tsay SH, King KL, et al. Clinicopathologic and prognostic differences between patients with hepatitis B- and C-related resectable hepatocellular carcinoma. J Formos Med Assoc 2001;100:443-448
  24. Yamamoto J, Okada S, Shimada K, Okusaka T, Yamasaki S, Ueno H, et al. Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 2001;34:707-713 https://doi.org/10.1053/jhep.2001.27950
  25. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434-1440 https://doi.org/10.1002/hep.510300629
  26. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790-800 https://doi.org/10.1097/00000658-199906000-00005
  27. Wayne JD, Lauwers GY, Ikai I, Dohery DA, Belghiti J, Yamaoka Y, et al. Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg 2002;235:722-731 https://doi.org/10.1097/00000658-200205000-00015
  28. Khan KN, Nakata K, Kusumoto Y, Shima M, Ishii N, Koji T, et al. Evaluation of nontumorous tissue damage by transcatheter arterial embolization for hepatocellular carcinoma. Cancer Res 1991;51:5667-5671
  29. Nishizaki T, Takenaka K, Yoshida K, Ikeda T, Sugimachi K. Influence of lipiodolization on a cirrhotic liver. J Surg Oncol 1995;58:263-268 https://doi.org/10.1002/jso.2930580413
  30. Uchida H, Ohishi H, Matsuo N, Nishimine K, Ohue S, Nishimura Y, et al. Transcatheter hepatic segmental arterial embolization using lipiodol mixed with an anticancer drug and Gelfoam particles for hepatocellular carcinoma. Cardiovasc Intervent Radiol 1990;13:140-145 https://doi.org/10.1007/BF02575465
  31. Matsuo N, Uchida H, Nishimine K, Soda S, Oshima M, Nakano H, et al. Segmental transcatheter hepatic artery chemoembolization with iodized oil for hepatocellular carcinoma: antitumor effect and influence on normal tissue. J Vasc Interv Radiol 1993;4:543-549 https://doi.org/10.1016/S1051-0443(93)71918-1
  32. Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993;188:79-83 https://doi.org/10.1148/radiology.188.1.8390073
  33. Khan KN, Yatsuhashi H, Yamasaki K, Yamasaki M, Inoue O, Koga M, et al. Prospective analysis of risk factors for early intrahepatic recurrence of hepatocellular carcinoma following ethanol injection. J Hepatol 2000;32:269-278 https://doi.org/10.1016/S0168-8278(00)80072-0
  34. Koda M, Murawaki Y, Mitsuda A, Ohyama K, Horie Y, Suou T, et al. Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma. Cancer 2000;88:529-537 https://doi.org/10.1002/(SICI)1097-0142(20000201)88:3<529::AID-CNCR6>3.0.CO;2-M
  35. Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991;214:114-117 https://doi.org/10.1097/00000658-199108000-00004
  36. Nagasue N, Yukaya H, Ogawa Y, Sasaki Y, Chang YC, Niimi K. Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery 1986;99:694-701
  37. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210:655-661 https://doi.org/10.1148/radiology.210.3.r99fe40655
  38. Lim HK. Radiofrequency thermal ablation of hepatocellular carcinomas. Korean J Radiol 2000;1:175-184 https://doi.org/10.3348/kjr.2000.1.4.175
  39. McGhana JP, Dodd GD 3rd. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001;176:3-16 https://doi.org/10.2214/ajr.176.1.1760003
  40. Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003;228:235-240 https://doi.org/10.1148/radiol.2281020718