臨床外科64巻7号

2009年07月発行

特集 肝胆膵癌に対する補助療法―治療成績の向上を目指して

肝細胞癌に対する補助療法の意義

著者： 竹村信行¹ 長谷川潔¹ 國土典宏¹

所属機関： ¹東京大学大学院医学系研究科肝胆膵外科

ページ範囲：P.887 - P.892

文献概要

要旨：肝細胞癌に対する肝切除はいまや安全かつ確立された治療であるが，5年で80％前後という高率な再発率のため長期予後は依然として不良である．肝細胞癌（hepatocellular carcinoma）には（1）主腫瘍からの肝内転移ならびに（2）背景肝を発生母地とした多中心性発癌という他臓器の腫瘍にない2つの再発機序が存在し，肝細胞癌切除後の予後を改善するためにはこの2種類の再発形態を制御することが重要である．現在までに様々な補助療法の研究がなされており，いくつか有効なレジメンは報告されているが，確立されたレジメンはなく，抗癌剤治療を付加することで長期予後を悪化させる可能性も報告されている．今後は，進行HCCなど切除後肝内転移再発の高危険群に対しては新たな薬剤などによる再発抑制目的の補助化学療法を，腫瘍条件が良好な症例には肝機能障害を避けつつ背景肝の多中心性発癌を抑制する目的で抗ウイルス療法を中心に行うなど，目的別の補助療法の検討が期待される．

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