臨床外科64巻1号

2009年01月発行

特集 外科診療上知っておきたい新たな予後予測因子・スコア 〔癌における新たな予後予測因子〕

膵癌切除例における予後規定因子

著者： 阿部展次¹ 杉山政則¹ 鈴木裕¹ 柳田修¹ 正木忠彦¹ 森俊幸¹ 跡見裕¹

所属機関： ¹杏林大学医学部外科

ページ範囲：P.31 - P.35

要旨：最近の膵癌切除例における予後因子に関する報告を血液マーカー，治療因子，臨床病理学的因子，分子マーカーに分けてレビューした．血液マーカーでは血小板数-リンパ球数の比率（platelet-lymphocyte ratio：P/L ratio）とCA19-9値が予後因子として重要であり，高P/L ratio，高CA19-9値はそれぞれ独立した予後不良因子と報告されている．治療因子では，術後補助療法の付加が予後を改善させ得る最も重要な因子である．R0切除の有無と予後との関連に関しては結論が出ていない．また，（1）術後に主要合併症があること，（2）非teaching hospitalでの手術，（3）3単位以上の輸血は独立した予後不良因子とする報告がある．臨床病理学的因子では，最近の多数例での検討から，年齢，腫瘍径，組織型，郭清リンパ節個数，腫瘍存在部位，リンパ節転移の有無，静脈侵襲の有無などが独立した予後因子として報告されている．また，検索リンパ節個数，lymph node ratio（転移個数/検索個数），腫瘍存在部位，傍大動脈リンパ節転移の有無，リンパ節微小転移の有無，門脈浸潤度，膵切離断端におけるK-ras変異の有無なども予後因子として有望であろう．分子マーカーではp16，MMP7，VEGFなどが予後因子として臨床に応用できることが示唆されている．

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