臨床外科62巻11号

2007年10月発行

特集 癌診療に役立つ最新データ2007-2008 Ⅶ．肝癌

肝癌の治療に関する最新のデータ

著者： 青木琢¹ 今村宏¹ 國土典宏¹ 幕内雅敏²

所属機関： ¹東京大学医学部肝胆膵外科 ²日本赤十字社医療センター

ページ範囲：P.227 - P.243

　要旨：肝細胞癌（HCC）に対しては，肝切除，肝移植，局所療法，肝動脈化学塞栓療法（TACE）などのさまざまな治療が行われてきた．治療法を比較するrandomized controlled trial（RCT）の報告はまだ少数であるが，従来の各療法の治療成績に基づき2005年には肝癌診療ガイドラインが作成され，治療方針の指針が示された．指針に沿い，肝機能良好かつ3個までの腫瘍数であれば，現在は外科切除が第一選択の治療となっている．しかしながら，術後補助療法はいまだ確立されておらず，切除後高頻度に認められる異時性多中心性再発の問題は未解決である．HCCに対する肝移植はミラノ基準（単発5cm以下，または3個以内・各3cm以下）を満たす症例で保険適応となり，今後も増加が予想される．現状では大部分が生体肝移植であるが，脳死移植症例の普及とともに，わが国におけるHCC治療のストラテジーも移植治療の占める位置が大きい欧米の治療方針に近づいていく可能性がある．局所療法ではラジオ波焼灼療法（RFA）が主流となり，最近では長期成績の報告がみられるようになっている．

　肝内胆管癌（ICC）の発生率は近年増加傾向にある．ICCに対する唯一の根治治療は外科切除であり，切除後の成績は徐々に向上しているが，累積5年生存率はまだ32％程度であり満足できるものとはいえない．ハイリスクグループの同定，早期発見へのストラテジーの確立が求められる．

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