Clinical Analysis of 312 Patients with Hepatobiliary Cancer in Oriental Hospital

서 론

2008 10 2003

2005

4 8

1)

. , 2001 2005

5 10

18.9% 7.8%, 15.5%

22.3%

.

,

2-6)

.

1)

.

, ,

7-11)

.

, ,

12-13)

. Clinical Analysis of 312 Patients with Hepatobiliary Cancer in Oriental Hospital

Tae-Young Jeong, Bong-Ky Park, Jung-Hyo Cho, Chang-Gue Son Liver-Immune Center, Daejeon Oriental Hospital of Daejeon Univ

Objective: This study sought a clinical analysis of hepatobiliary cancer patients treated by oriental medical therapy.

Methods: 312 hepatobiliary cancer patients treated in East-west Cancer Center of Dunsan Oriental Hospital from October 2004 to September 2008 were reviewed. These patients’ general characteristics and clinical change after treatment were investigated.

Results: 83.3% of patients’ tumors were stage IV. The median survival period of stage IV patients was 107.0±82.2 (IVa), 207.0±26.8 (IVb) days (hepatocellular carcinoma), 132.0±15.8 days (cholangiocarcinoma), and 203.0±24.6 days (gallbladder carcinoma).

Conclusions: This study presents the general characteristics of hepatobiliary cancer patients treated by Oriental medical therapies, and thus would be valuable for further studies of Oriental medicine-based cancer treatments.

Key Words : Oriental medicine, hepatocellular carcinoma, cholangiocarcinoma, gallbladder cancer, survival 정태영, 박봉기, 조정효, 손창규

대전대학교 한의과대학 간장내과학교실 Case Report

Received：27 May 2009 Revised：15 July 2009 Accepted：20 July 2009

Correspondence to：손창규

(301-724) 대전시 중구 대흥동 대전대 22-5 대전대학교 한방병원 면역내과센터

Tel：+82-42-229-6723, Fax：+82-42-254-3403, Emai：[email protected]

,

14-16)

.

17)

.

18,19)

.

2004 10 2008 9

4 312

.

연구방법

1. 연구 대상 및 기간

2004 10 1 2008 9 30 4

. , ,

312 .

2. 분석 항목 및 평가 방법

Table 1 .

.

General characteristics of patients Gender Male / Female

Age Age at first visit

Treatment history Operation / Chemotherapy / Radiation therapy / Etc.

Purpose of first visit Management after completion of conventional treatment / Combination therapy with east and west medicine / Only oriental medical therapy/ Hospice care / Others

Stage According to UICC stage classification

Viral hepatits

antigen career Yes or No(HBV or HCV) Liver cirrhosis Yes or No

Sasang constitution Classify one of three(Soumin, Taumin, Soyangin) by QSCC II(Questionnare for Sasang Constitution Classification II)

Child Pugh score Classify Class A or B or C

Treatment in Oriental hospital Treatment period Duration of taking medicine

Medication Use or Not use CGX

/ HAD † / Herb medication

Clinical change after treatment Clinical score ECOG / Child Pugh score

Survival Analysis Median survival

*Chungan plus †Hang-Am-Dan

Table 1.

1)

, , , , , ,

, , ECOG

(Eastern Cooperative Oncology Group perfomance status), Child Pugh score

2)

22)

,

,

3)

ECOG, Child Pugh score ,

,

.

. ECOG Child

Pugh score 1

. 30

. ,

.

2

2

.

3. 통계분석

Kaplan-Meier ,

Log-Rank test .

paired t-test .

5% .

결 과

1. 환자의 특징

312

Table 2 .

198 , 80 , 34

.

TACE ,

, .

34.3%,

30.8% .

83.3% IV

. 89.4%

B ,

. 37.6%

, .

33

57.6% , (30.3%),

(12.1%) . Child pugh score A

59.7% , B(30.8%),

C(9.4%) .

2. 환자들이 받은 치료에 관한 특징

, ,

Table 3 .

32 ,

30 , 35 , 53.5 .

85.4%,

70.0%, 64.7%

.

56.1%, 58.7% (Table 3).

3. 환자들의 치료 경과

1) ECOG Child Pugh score 1

.

ECOG Child Pugh score .

ECOG

. 25.0%,

26.5%, 11.1%

.

Total HCC

Cholangio

GB

Number

312 198 (63.5) 80 (25.6) 34 (10.9)

Gender Male 234 (75.0) 166 (83.8) 51 (63.8) 17 (50.0)

Female 78 (25.0) 32 (16.2) 29 (36.3) 17 (50.0)

Age Average (year) 56.3±10.2 54.5±9.7 60.4±10.2 60.6±10.8

Treatment history (Overlapping

statistics)

Number 238 156 (78.0) 56 (70.0) 26 (76.5)

Operation 77 (32.4) 39 (19.7) 22 (27.5) 16 (47.1)

TACE

126 (52.9) 121 (61.1) 5 (6.3) 0 (0.00)

RFA

16 (6.7) 15 (7.6) 1 (1.3) 0 (0.0)

CTx

75 (31.5) 33 (16.7) 31 (38.8) 11 (32.4)

RTx

52 (21.8) 31 (15.7) 13 (16.3) 8 (23.5)

Etc. 24 (10.1) 2 (1.0) 17 (21.3) 5 (14.7)

Purpose of the first visit

Number 312 198 80 34

Management after completion of

conventional treatment 21 (6.7) 18 (9.1) 1 (1.3) 2 (5.9)

Combination therapy with east and west

medicine 107 (34.3) 71 (35.9) 26 (33.0) 10 (29.4)

Only oriental medical

therapy 96 (30.8) 51 (25.8) 33 (41.3) 12 (35.3)

Hospice care 33 (10.6) 24 (12.2) 6 (7.6) 3 (8.8)

Others 54 (17.3) 34 (17.2) 14 (16.3) 7 (20.6)

Stage

Number 191 115 50 26

Ⅰ 4 (2.1) 3 (2.6) 1 (2.0) 0 (0.0)

Ⅱ 11 (5.8) 7 (6.1) 1 (2.0) 3 (11.5)

Ⅲ 16 (8.4) 10 (8.7) 5 (10.) 1 (3.9)

Ⅳ 159 (83.3) Ⅳa 16 (13.91)

43 (87.8) 22 (84.6)

Ⅳb 78 (67.83) Viral hepatitis

antigen career

Number 240 169 55 16

B 162 (67.5) 151 (89.4) 10 (18.2) 1 (6.3)

C 9 (3.8) 8 (4.7) 0 (0.0) 1 (6.3)

None 70 (29.2) 10 (5.9) 45 (81.8) 15 (93.8)

Liver cirrhosis (LC)

Nember 257 165 65 27

LC 65 (25.3) 62 (37.6) 3 (4.6) 0 (0.0)

None 192 (74.7) 103 (62.4) 62 (95.4) 27 (100.0)

Sasang Constitution

Number 33 27 6 0

Taeumin 10 (30.3) 8 (29.6) 2 (33.3)

Soyangin 4 (12.1) 4 (14.8) 0 (0.0)

Soumin 19 (57.6) 15 (55.6) 4 (66.7)

Child Pugh Score

Number 159 100 42 17

A 95 (59.7) 55 (55.0) 26 (61.90) 14 (82.4)

B 49 (30.8) 33 (33.0) 13 (31.0) 3 (17.7)

C 15 (9.4) 12 (12.0) 3 (7.1) 0 (0.0)

*

Hepatocellular carcinoma

Cholangiocarcinoma

Gallbladder cancer §Number of patients

Transarterial chemoembolization

Radio-frequency ablation

**

Chemotherapy

Radiation therapy

Table 2.

ECOG (p<0.05), (p>0.05) (Fig. 1).

Child Pugh score , ,

A,B,C ,

Total HCC

Cholangio

GB

Administration period Median(day) 32.0 30.0 35.0 53.5

CGX

Use 247 (79.2) 169 (85.4) 56 (70.0) 22 (64.7)

Not use 65 (20.8) 29 (14.7) 24 (30.0) 12 (35.3)

HAD

Use 175 (56.1) 108 (54.6) 46 (57.5) 21 (61.8)

Not use 137 (43.9) 90 (45.5) 34 (42.5) 13 (38.2)

Herb medication Use 183 (58.7) 118 (59.6) 41 (51.3) 24 (70.6)

Not use 129 (41.3) 80 (40.4) 39 (48.8) 10 (29.4)

*

Hepatocellular carcinoma

Cholangiocarcinoma

Gallbladder cancer

Chungan plus

Hang-Am-Dan Table 3.

75.0

25.0 26.5

73.5

88.9

11.1

%

0 0 0

Cholangio GB

HCC

Improved Unchange Aggravated

A A A A

57.9

42.1

26.7 66.7

80.0

20.0

%

0

6.7

0

Cholangio GB

HCC

Improved Unchange Aggravated

B

B B

B

Fig. 1.

.

1 . 42.1%,

26.7%, 20.0%

.

(p<0.05), (p>0.05)

(Fig. 1).

2)

381.0±

78.6, 148.0±20.0, 241.0±45.3

. 1,2,3

. IVa

107.0±82.2 , IVb

207.0±26.8 . 4

132.0±15.8, 203.0±24.6 (Table 4, Fig. 2).

고 찰

,

.

,

80% IV .

III IV

3,26-28)

. Child Pugh

score , 2007 score

26)

.

Stage No. Median Survival (day) 95% C.I.

(Min~Max) P value

Hepatocellular carcinoma

Total 81 381.0 ± 78.6 226.9~535.1 NS

(0.06)

I 3 NR

II 5 759.0 ± 218.0 331.7~1186.3

III 8 412.0 ± 122.3 172.2~651.8

IVa 9 107.0 ± 82.2 0~268.2

IVb 33 207.0 ± 26.8 112.6~301.4

Cholangiocarcinoma

Total 39 148.0 ± 20.0 108.8~187.2 NS(0.8)

I 1 NR

II 1 NR

III 1 239.0

IV 17 132.0 ± 15.8 101.1~162.9

Gallbladder cancer

Total 17 241.0 ± 45.3 152.3~329.7 NS(0.6)

I 0

II 2 205.0

III 0

IV 11 203.0 ± 24.6 110.2~295.8

*

Confidence interval

Not reached

Not significance

Table 4.

.

B

26)

.

37.6%

3)

. ,

.

.

.

60%

.

Duration(day) Duration(day)

C um ula tiv e su rv iv al

1.0

0.8

0.6

0.4

0.2

0.0

0.00 200.0 400.0 600.0 800.0 1000.0 1200.0

C um ula tiv e su rv iv al

1.0

0.8

0.6

0.4

0.2

0.0

0 200 400 600 800 1000 1200

A A

A A B B B B

Duration(day)

C um ula tiv e su rv iv al

1.0

0.8

0.6

0.4

0.2

0.0

0 200 400 600 800 1000 1200 1400

C C C C

Fig. 2.

22)

23)

, .

.

, , (QOL)

.

.

, ECOG

, Child Pugh score

. Child Pugh score ,

3,26,28)

.

ECOG Child Pugh score

.

Stage IV , Child Pugh score . Child Pugh score

, ECOG

Child pugh score 50%

3,9,26,29-31)

.

Stage IV

, Stage IVa

IVb

Stage IVa

. Stage IV

2007

Stage IVa 4.3

, IVb 3.7

. 2006

Stage IVa 4

, IVb 3

3)

. IVa

3.6 , IVb 6.9 , IVa

IVb

. 2000

Stage IVb

4.3

.

Stage

IV 3~6

32-36)

. 6.8

. Stage

. 2007

4.2

3~4

.

Stage

IV 4.4

.

1.5~2 .

,

2

.

,

.

.

,

Stage IV

.

IV

.

,

.

,

.

,

. ,

.

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