臨床外科76巻2号

2021年02月発行

特集 外科医のための—悪性腫瘍補助療法のすべて 各論

大腸癌肝転移の術前術後補助療法

著者： 金光幸秀¹ 塚本俊輔¹ 森谷弘乃介¹ 高見澤康之¹

所属機関： ¹国立がん研究センター中央病院大腸外科

ページ範囲：P.194 - P.204

【ポイント】
◆大腸癌患者の約50%が経過中に肝転移を発症する．外科的切除が治癒と長期生存の可能性がある唯一の治療法であるが，5年生存率は約40%，10年生存率は約25%程度に留まっており，肝切除後の残肝再発と肺再発の制御が必要である．
◆現在のL-OHP含有補助化学療法レジメン（FOLFOX）の推奨は，肝切除周術期のFOLFOXは全生存期間（OS）には影響しないものの，無増悪生存期間（PFS）には効果がある可能性を示したEORTC 40983試験の結果の外挿に基づいている．
◆大腸癌肝転移切除後の補助化学療法として，mFOLFOX6を投与される患者と，手術のみの患者を比較したJCOG0603試験の結果，無病生存期間（DFS）はmFOLFOX6を投与した患者で改善したものの，OSの改善は認められず，FOLFOXによるGrade 3以上の好中球減少症が50%の患者に認められた．
◆癌の治療目標は，生存期間を延長させるかQOLを改善させるかである．大腸癌肝転移切除例に対する補助療法の至適投与法は確立しておらず，肝切除周術期の補助化学療法を正当化するエビデンスは依然としてないのが現状である．

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