목적 : 간 절제술은 절제 가능한 간세포암의 치료의 근간으로 자리잡고 있다. 그러나 절제 가능한 간세포암의 수술 전 경동맥화학색전술의 효과는 정립된 바 없다. 저자들은 수술 전 경동맥화학색전술이 무병생존율과 전체생존율에 미치는 효과를 살펴보고, 소집단으로 나누어 각 군에 미치는 효과를 규명해 보았다.방법 : 1995년 1월부터 2000년 12월까지 절제 가능한 간세포암으로 간절제술을 시행 받은 환자, 총 366명의 환자들 중 수술 전 경동맥화학색전술을 시행 받은 군 132명과 단독 수술을 시행한 군 234명을 대상으로 무병생존률과 전체 생존률을 후향적으로 분석하였다.결과 : 단독 간절제술군을 시행한 경우 수술 전 경동맥화학색전술군을 받은 경우보다 무병생존율과 전체생존률이 유의하게 높았다(각각 p<0.001, p<0.01). 소집단 분석에서는 UICC T1-2 stage에서 간절제술군이 술 전 경동맥화학색전술군보다 무병생존율이 높았다(p<0.01). UICC T1-2에서의 전체생존율은 간절제술군과 술 전 경동맥화학색전술군 간의 통계적 유의성을 관찰할 수 없었으나(p=NS), UICC T3 (p<0.01)에서는 간절제술군의 전체생존율이 수술 전 경동맥화학색전술군보다 높았다. 수술 전 경동맥화학색전술의 빈도가 증가함에 따라 무병생존율과 전체생존율은 감소하였다(p<0.001, p<0.05). 수술 전 경동맥화학색전술로서 95% 이상의 괴사율을 보이는 경우 단독 간절제술에 비해 전체 생존율의 차이가 없었으나, 95% 미만의 괴사를 보이는 경우는 단독 간절제술의 경우보다 무병생존율 및 전체생존률이 더 낮았다(p<0.001).결론 : 수술적 절제가 가능한 간세포암에서 수술 전 경동맥화학색전술은 수술을 바로 시행하는 경우에 비해 수술 후 종양의 재발율을 높이고 환자의 생존율을 낮추는 것으로 시사된다. 수술 전 경동맥화학색전술의 이런 악영향은 특히 종양의 병기가 진행될수록, 종양내 리피오돌의 섭취가 불완전할수록 두드러지게 나타난다.

Background : Although hepatic resection (HR) is the mainstay for the treatment of hepatocellular carcinoma (HCC), high recurrence rate (>60%) is major serious problem. Thus preoperative transarterial chemoembolization (TACE) has been proposed as a neoadjuvant treatment before HR. However, the effect of preoperative TACE in preventing recurrence for initially resectable HCC remains controversial. This study aims at assessing the role of preoperative TACE on the early and long-term outcome following resection of HCC. Methods : Retrospective randomized analysis was performed. A total of 366 patients who had HR for HCC between January 1995 and December 2000, were included, 132 patients underwent preoperative TACE (TACE plus HR) and 234 patients did not (HR). Statistically no baseline characteristic difference in two groups. Results : HR group was significantly higher than TACE plus HR group in disease-free survival rate and overall survival rate (p<0.001, p<0.01). In subgroup analysis, the disease-free survival rate of HR group was higher than TACE plus HR group in UICC T1-2 and UICC T3 (p<0.01 for both), whereas the difference in overall survival rate was significant only in UICC T3 (p<0.01). Those who achieved tumor necrosis of more than 95% by preoperative TACE showed comparable overall survival rate with HR group, while it was significantly lower in patients who demonstrated tumor necrosis of less than 95% (p<0.001). Conclusions : Preoperative TACE for initially resectable HCC may promote early and late tumor recurrence and reduces overall survival rate after surgery particularly in patients with advanced- stage tumors

Background : Although hepatic resection (HR) is the mainstay for the treatment of hepatocellular carcinoma (HCC), high recurrence rate (>60%) is major serious problem. Thus preoperative transarterial chemoembolization (TACE) has been proposed as a neoadjuvant treatment before HR. However, the effect of preoperative TACE in preventing recurrence for initially resectable HCC remains controversial. This study aims at assessing the role of preoperative TACE on the early and long-term outcome following resection of HCC. Methods : Retrospective randomized analysis was performed. A total of 366 patients who had HR for HCC between January 1995 and December 2000, were included, 132 patients underwent preoperative TACE (TACE plus HR) and 234 patients did not (HR). Statistically no baseline characteristic difference in two groups. Results : HR group was significantly higher than TACE plus HR group in disease-free survival rate and overall survival rate (p<0.001, p<0.01). In subgroup analysis, the disease-free survival rate of HR group was higher than TACE plus HR group in UICC T1-2 and UICC T3 (p<0.01 for both), whereas the difference in overall survival rate was significant only in UICC T3 (p<0.01). Those who achieved tumor necrosis of more than 95% by preoperative TACE showed comparable overall survival rate with HR group, while it was significantly lower in patients who demonstrated tumor necrosis of less than 95% (p<0.001). Conclusions : Preoperative TACE for initially resectable HCC may promote early and late tumor recurrence and reduces overall survival rate after surgery particularly in patients with advanced- stage tumors

Hepatocellular carcinoma, TACE (transarterial chemoembolization)