The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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The Korean National Liver Cancer Surveillance Program: Experience of a Single Healthcare Center in 2011

2011년도 단일 병원에서 경험한 간암 국가암검진사업

  • Shim, Jae-Jun (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Park, Hyun Jin (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Kim, Jung-Wook (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Hwang, Eun Jung (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Lee, Chang Kyun (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Jang, Jae Young (Department of Internal Medicine, Kyung Hee University School of Medicine) ;
  • Park, Seong Jin (Department of Radiology, Kyung Hee University School of Medicine) ;
  • Choi, Hyun Rim (Department of Occupational and Environmental Medicine, Kyung Hee University School of Medicine) ;
  • Kim, Byung-Ho (Department of Internal Medicine, Kyung Hee University School of Medicine)
  • 심재준 (경희대학교 의학전문대학원 내과학교실) ;
  • 박현진 (경희대학교 의학전문대학원 내과학교실) ;
  • 김정욱 (경희대학교 의학전문대학원 내과학교실) ;
  • 황은정 (경희대학교 의학전문대학원 내과학교실) ;
  • 이창균 (경희대학교 의학전문대학원 내과학교실) ;
  • 장재영 (경희대학교 의학전문대학원 내과학교실) ;
  • 박성진 (경희대학교 의학전문대학원 영상의학과교실) ;
  • 최현림 (경희대학교 의학전문대학원 직업환경의학과교실) ;
  • 김병호 (경희대학교 의학전문대학원 내과학교실)
  • Received : 2012.11.08
  • Accepted : 2012.12.20
  • Published : 2013.05.01
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Abstract

Background/Aims: The aim of this study was to investigate outcomes and current status of the National Liver Cancer Screening Program in a single healthcare center. Methods: Subjects received abdominal ultrasonography (US) and/or serum alpha-fetoprotein (AFP) testing from January 2011 to December 2012. The clinical characteristics of the subjects, detection rate of liver cancer, and direct medical costs were investigated. Results: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. Conclusions: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer.

목적: 간암 조기 검진을 위한 국가암검진사업의 유용성과 문제점을 조사하기 위해 단일 병원에서 일 년간 경험한 간암검진사업 결과를 분석하였다. 방법: 2011년 1월 1일부터 12월 31일까지 경희대학교병원에서 간암검진을 위해 복부 초음파 검사 또는 혈청 알파태아단백 검사(이하 AFP)를 받은 수검자를 대상으로 하였다. 이들의 기본적인 특성, 간암 발견율, 그리고 간암을 발견하기 위해 지출된 의료 비용을 위암과 비교 조사하였다. 결과: 일 년간 621명을 검진하여 총 5명(0.8%)의 간세포암(이하 간암)을 발견하였다. 이 중 4명은 복부 초음파 검사로 발견되었고 모두 근치적 치료(수술 2명, 고주파응고술 2명)를 받았다. 나머지 한 명은 AFP 상승으로 발견되었고 침윤성 간세포암으로 진단 후 2개월만에 사망하였다. 과거 병력을 조사할 수 있었던 492명 가운데 45%가 B형간염이었고 5%가 C형간염, 1%가 B형 C형 동시감염, 3%가 알코올성 간경변증을 포함한 기타 간경변증이었다. 나머지 46%의 수검자들은 간암 고위험인자를 하나도 가지고 있지 않았다. 간암 1명을 발견하기 위해 사용된 의료 비용은 총 842만원이었고 이는 위암의 4,506만원에 비해 낮은 수준이었다. 비대상자들을 제외하였을 때 간암 검진 비용은 556만원까지 낮출 수 있었다. 결론: 간암검진사업의 효율성과 형평성을 높이기 위해 적절한 고위험군 선별을 위한 대책 마련이 시급하다. 국가암검진사업이 적절하게 수행된다면 약 1%의 수검자에서 간암을 발견할 수 있다. 완치가 가능한 초기 간암은 대부분 복부 초음파 검사로 발견되며 AFP는 초기 간암 발견에는 유용성이 떨어지는 편이다.

Keywords

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