臨床外科63巻13号

2008年12月発行

特集 外科におけるadjuvant/neoadjuvant chemotherapy update

原発性肝癌に対するadjuvant/neoadjuvant chemotherapy

著者： 武田裕¹ 永野浩昭¹ 小林省吾¹ 丸橋繁¹ 種村匡弘¹ 北川透¹ 堂野恵三¹ 梅下浩司² 門田守人¹ 森正樹¹ 土岐祐一郎¹

所属機関： ¹大阪大学大学院医学系研究科外科学講座・消化器外科学 ²大阪大学大学院医学系研究科看護実践開発科学講座周手術期管理学

ページ範囲：P.1715 - P.1723

文献概要

要旨：原発性肝癌の治療法のなかで最も局所制御に優れているのは外科的切除であるが，肉眼的治癒切除が行われても残肝再発をきたすことも多い．肝細胞癌の術後再発形式には，肝内転移再発と多中心性発癌があるが，術後早期の再発は肝内転移再発が多くを占めると考えられ，治療成績向上のためにはこれらの制御が重要である．そこで，肝内転移再発の抑制を目的として，術前肝動脈化学塞栓療法や術後補助化学療法が行われている．

　残念ながら術前TAEに関するRCTでは肝切除後の再発抑制および予後改善効果はないと結論付けられており，また術後補助化学療法に関してもその有効性は示されていない．しかしながら，肝内微小転移を持つあるいは術中散布を引き起こすと考えられる症例を対象として術前肝動脈化学塞栓療法が施行されれば，あるいは残肝再発の高危険群である門脈内腫瘍栓症例や，全肝に多発する肝内転移を対象として術後補助化学療法が施行されれば，再発予防効果が証明される可能性があると考えられる．今後，対象症例を選択した多施設におけるランダム化比較試験が行われ，術前または術後補助療法により肝細胞癌の治療成績が向上することを期待したい．

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