간세포암의 비수술적 치료후 생존율 평가에 의한 UICC 병기의 타당성에 관한 후향적 연구

Objectives: The management of hepatocellular carcinoma(HCC) has been frequently complicated due to the variable hepatic dysfunction from underlying chronic liver disease. The validity of UICC staging system based on the anatomical extent of malignant lesion has been questioned because of the poor correlation between stages and clinical outcomes. The purpose of this study is to elucidate the validity of UICC staging system as a prognostic factor and to compare with Child`s classification which represents the functional status of liver. Methods: A total of 831 patients with HCC who received no specific anti-cancer treatment, TACE and/or systemic chemotherapy, between January 1988 and December 1991, were analyzed retrospectively. Factors influencing the prognosis were analyzed by Cox proportional-hazard regression model. Results: Median survival of overall HCC patients was 4 months. There was no significant difference in overall median survival between UICC stage III and IVA; but significant differences between Child A and B, Child B and C were found. UICC staging system for HCC gave less significant clinical value in predicting the survival of HCC patients regardless of the treatment modalities given. In contrast, Child`s classification was better correlated with the survival of HCC patients who received systemic chemotherapy and no specific treatment. In Cox proportional-hazard regression model, Child`s classification was the most influential prognostic factor exceeding the role of UICC system.. Conclusion: UlCC staging system is not a good system for the staging of HCC. We beIieve that the poor correlation between stages and survival originated from the neglect of hepatic dysfunction which is the major prognostic factor in HCC. It is necessary to develop a new staging system which can represent the prognosis better.