초기 간세포암종의 치료 전략: 간절제가 첫 번째 선택이 될 수 있는가?

Abstract

Early stage HCC has generally been defined as the “Milan criteria”: a solitary tumor ≤ 5 cm in size, or ≤ 3 tumors each ≤ 3 cm in size and no evidence of gross vascular invasion. HCC is now increasingly detected at earlier stages. In addition, both liver transplantation and percutaneous ablative therapies have emerged as effective alternatives to hepatic resection. As a result, the ideal treatment strategy for patients with early stage HCC, particularly in the setting of well-preserved hepatic function, has become increasingly controversial. In the recent studies, the survival rates for transplantation in early stage HCC patients are excellent. However, when intention-to-treat analysis is used, dropouts from the waiting list due to death or disease progression clearly diminish long-term survival results and therefore patients are unlikely to benefit from liver transplantation. In addition, salvage transplantation after HCC resection may be performed without excessive morbidity and may result in equivalent survival rates compared with primary liver transplantation. In some studies, salvage transplantation may be feasible in up to 75-80% of patients with recurrence following hepatic resection. Similarly, locoregional therapies serve to sustain patients with HCC on the waiting list until a transplantation become available. While RFA and TACE are commonly used to prevent dropout, pretransplant therapy has not been associated with improved overall survival or disease-free survival due to persistenceof viable tumor. It is important to note that, while resection is a more invasive procedure, the benefit that it holds over nonresectional therapies is the complete removal of the tumor allowing for subsequent detailed pathologic examination of both the tumor and surrounding liver parenchyma. In conclusion, in patients with well-preserved hepatic function, liver resection remains the most appropriate and effective treatment.