The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Is the Prevalence of Cryptogenic Hepatocellular Carcinoma Increasing in Korea?

한국인에서 원인미상 간세포암은 증가하는가?

Oh, Kil-Chan;Park, Sang-Hoon;Park, Jin-Cheol;Jin, Do-Kyun;Park, Chul-Sung;Kim, Kyong-Oh;Jang, Hyun-Joo;Lee, Ja-Young;Park, Cheol-Hee;Han, Tai-Hoo;Yoo, Kyo-Sang;Kim, Jong-Hyeok;Kim, Dong-Jun;Lee, Myung-Seok;Park, Choong-Kee
오길찬;박상훈;박진철;진도균;박철성;김경오;장현주;이자영;박철희;한태호;유교상;김종혁;김동준;이명석;박충기

  • Published : 20050100
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Abstract

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) has been characterized by a wide spectrum of liver damages that span from steatosis to cryptogenic liver cirrhosis and even to hepatocellular carcinoma (HCC). The aims of this study were to determine whether the prevalence of HCC arising from cryptogenic cirrhosis has increased during the last ten years and to characterize the clinical features of cryptogenic HCC in Korea. Methods: A retrospective and hospital-based analysis of the clinical data was done in 1,145 HCC patients; group A (Jan. 1993-Dec. 1995), group B (Jan. 2000-Dec. 2002). The etiologies of HCC with liver cirrhosis in group A and group B were analyzed. The risk factors of NAFLD such as obesity, type 2 diabetes mellitus, hypertriglyceridemia and hypertension between cryptogenic HCC and HCC with well-defined etiologies were compared. Results: The major leading causes of HCC in each group were hepatitis B virus infection, followed by alcohol, hepatitis C virus and cryptogenic. There was a significant increase in the proportion of cryptogenic HCC in group B (A: 2.3%, B: 5.4%, p$\prec$0.05). In the case of HCV, it was 5.3% in group A and 9.9% in group B (p$\prec$0.05). Although the prevalence of cyptogenic HCC was significantly increased at an interval of seven years apart, there was no significant difference in the proportions of risk factors of NAFLD between cryptogenic HCC group and well-defined etiology group. Conclusions: The prevalence of cryptogenic HCC was significantly increased in Korea during the last decade. Although statistically insignifcant, there was a trend toward the higher proportion of risk factors with NAFLD in patients with cryptogenic HCC. This suggests that increased proportion of risk factors associated for NAFLD may have contributed to the development of cryptogenic HCC.

목적: 최근 10년 사이에 우리나라에서도 비만과 제2형 당뇨병의 유병률이 급격히 증가되어 NAFLD 환자도 증가되었으며, 장기간 추적하면 NAFLD에 의한 원인미상의 간경변, 간세포암종도 증가되었을 것으로 생각된다. 이번 연구는 우리나라에서 원인미상 간세포암종이 최근 10년 동안 증가하였는지 알아보고 NAFLD와 원인미상 간세포암종 발생과의 연관성을 알아보고자 하였다. 대상 및 방법: 1993년 1월부터 1995년 12월까지 간세포암종으로 진단받은 환자군을 A군, 2000년 1월부터 2002년 12월까지 간세포암으로 진단받은 환자군을 B군으로 분류하였으며, 모두 간경변에 합병된 간세포암 환자를 대상으로 하였다. 각 군의 간세포암종의 원인별 빈도를 비교 분석하였고, 원인미상 간세포암종군과 원인이 잘 알려진 간세포암종군으로 나누어, 각 군에서 NAFLD의 특징적인 위험요소라 생각되는 인자들의 유병률을 알아보았다. 결과: 간세포암종의 원인별 빈도는 B형 간염 바이러스 감염이 60.7%로 가장 높았으며, 원인미상인 예는 4.4%였다. A군과 B군 간의 간세포암종의 원인별 빈도를 비교하면 원인미상, C형 간염 바이러스가 원인인 경우를 제외하고 그 빈도에서 유의한 차이가 없었다. 원인미상 간세포암종의 빈도는 B군에서 A군보다 의미 있게 증가하였다. 비만, 제2형 당뇨병, 고중성지방산혈증, 고혈압 등의 임상특징을 비교한 결과 원인미상 간세포암종군에서 이러한 요소들의 유병률이 높은 경향이었으나, 유의한 차이는 없었다. 결론: 지난 10년 전과 비교해서 국내에서 원인미상 간세포암종의 유병률이 증가하였다. 원인미상 간세포암종 환자에서 NAFLD의 위험요소의 빈도는 원인이 잘 알려진 간세포암종 환자들과 비교해서 유의하게 높지는 않았지만, 증가 된 추세였다. 결론적으로 NAFLD가 잠복성 원인 간세포암종의 발생에 연관되었을 것으로 생각되며, 앞으로 국내에서보다 더 많은 환자를 대상으로 대규모 전향적 연구가 필요하다.

Keywords

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