B. 最初の治療方法とその治療結果
Ⅳ. 結論
韓国における肝癌治療は持続的に発展しており
、
結果的に肝癌患者の全体的な生存期間が長くなっ ている。
まず、
韓国におけるB型肝炎ウイルス保有者の頻度はB型肝炎ウイルスのワクチン事業以後、
顕 著に減少している。
経口抗ウイルス剤の治療によりB型肝炎ウイルスの増殖を抑制して肝硬変症の進行と 償性肥大肝疾患、
肝癌を減少させ、
結果的に死亡率を減少させた。
また、
肝癌の高リスク群である慢 性肝疾患患者に対して肝癌監視体系を施行することで肝癌の早期発見が可能となり、
完全切除が多く の場合で可能となった。
実際にここ20年間の肝癌患者の5年生存率は2倍以上増加した。
ソウル大学病 院の肝癌コホート研究で6か月ごとに血清AFPおよび肝超音波あるいは肝臓ダイナミックCTを行う監視体 系の効果を分析し、
生存率において明らかなメリットがあった。
また、
様々な治療方法を用いた学際的な アプローチを通じた肝癌治療は肝癌患者の治療結果を向上させた。
結論的に
、
BCLC病期A、
Bなどの早期肝癌患者の生存期間を延長するためには、
早期診断が最も 重要であり、
また、
手術的な切除および局所療法による効果的な治療を行うことができる。
また、
現在研 究が進められている免疫治療を補助的に使用できるものと期待される。
BCLC病期Cのような進行した肝癌患者はソラフェニブや超選択的な経カテーテル的肝動脈化学塞栓術を用いて生存期間を延長できる
。
末期肝癌、
すなわちBCLC病期Dの患者は肝移植が長期生存の機会となる。
すなわち、
これらの治療 方法を適切に適用して肝癌患者の生活の質と期間を向上させることができ、
今後も肝臓分野の学者たち は肝癌克服という新紀元を画するために努力を続けていくことであろう。
參考文獻
1. Korea National Cancer Information Center (http://www.cancer.go.kr).
2. Han YS KB, Baek IY, Lee DK, Kim KJ, Dong SH. The change of the etiology, complications and cause of death of the liver cirrhosis in 1990s.
Korean J Hepatol 2000;6:328-339.
3. Kim CY KJ, Lee HS, Yoon YB, Song IS. Natural history and survival rate of chronic liver diseases in Korea- 20 years prospective analysis. Korean J Med 1994;46:168-180.
4. Chang MH, You SL, Chen CJ, Liu CJ, Lee CM, Lin SM, Chu HC, et al.
Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees:
a 20-year follow-up study. J Natl Cancer Inst 2009;101:1348-1355.
5. Kudo M. Imaging blood flow characteristics of hepatocellular carcinoma.
Oncology 2002;62 Suppl 1:48-56.
6. Andreana L, Isgro G, Pleguezuelo M, Germani G, Burroughs AK. Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis. World J Hepatol 2009;1:48-61.
7. Burrel M, Llovet JM, Ayuso C, Iglesias C, Sala M, Miquel R, Caralt T, et al. MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 2003;38:1034-1042.
8. Liu GJ, Xu HX, Lu MD, Xie XY, Xu ZF, Zheng YL, Liang JY. Correlation between enhancement pattern of hepatocellular carcinoma on real-time contrast-enhanced ultrasound and tumour cellular differentiation on
histopathology. Br J Radiol 2007;80:321-330.
9. Fracanzani AL, Burdick L, Borzio M, Roncalli M, Bonelli N, Borzio F, Maraschi A, et al. Contrast-enhanced Doppler ultrasonography in the diagnosis of hepatocellular carcinoma and premalignant lesions in patients with cirrhosis. Hepatology 2001;34:1109-1112.
10. Rydberg J, Buckwalter KA, Caldemeyer KS, Phillips MD, Conces DJ, Jr., Aisen AM, Persohn SA, et al. Multisection CT: scanning techniques and clinical applications. Radiographics 2000;20:1787-1806.
11. Forner A, Vilana R, Ayuso C, Bianchi L, Sole M, Ayuso JR, Boix L, et al.
Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008;47:97-104.
12. Baek CK, Choi JY, Kim KA, Park MS, Lim JS, Chung YE, Kim MJ, et al. Hepatocellular carcinoma in patients with chronic liver disease: a comparison of gadoxetic acid-enhanced MRI and multiphasic MDCT. Clin Radiol 2012;67:148-156.
13. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Ledinghen V, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005;41:48-54.
14. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ, Nash Clinical Research N. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2009;7:1104-1112.
15. Chen DS, Sung JL, Sheu JC, Lai MY, How SW, Hsu HC, Lee CS, et al.
Serum alpha-fetoprotein in the early stage of human hepatocellular carcinoma. Gastroenterology 1984;86:1404-1409.
16. Liebman HA, Furie BC, Tong MJ, Blanchard RA, Lo KJ, Lee SD, Coleman MS, et al. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med 1984;310:1427-1431.
17. Bae HM, Lee JH, Yoon JH, Kim YJ, Heo DS, Lee HS. Protein induced by vitamin K absence or antagonist-II production is a strong predictive
marker for extrahepatic metastases in early hepatocellular carcinoma: a prospective evaluation. BMC Cancer 2011;11:435.
18. Bruix J, Sherman M, American Association for the Study of Liver D.
Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020-1022.
19. Furuta T, Sonoda T, Matsumata T, Kanematsu T, Sugimachi K. Hepatic resection for a hepatocellular carcinoma larger than 10 cm. J Surg Oncol 1992;51:114-117.
20. Lee HS, Kim KM, Yoon JH, Lee TR, Suh KS, Lee KU, Chung JW, et al.
Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study. J Clin Oncol 2002;20:4459-4465.
21. Chung GE, Lee JH, Kim HY, Hwang SY, Kim JS, Chung JW, Yoon JH, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011;258:627-634.
22. Ishii H, Okada S, Nose H, Okusaka T, Yoshimori M, Takayama T, Kosuge T, et al. Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection. Cancer 1996;77:1792-1796.
23. Sung YM, Choi D, Lim HK, Lee WJ, Kim SH, Kim MJ, Paik SW, et al.
Long-term results of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in Korea. Korean J Radiol 2006;7:187-192.
24. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS.
Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210:655-661.
25. Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, Frings H, et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003;228:235-240.
26. Palmer DH. Sorafenib in advanced hepatocellular carcinoma. N Engl J
Med 2008;359:2498; author reply 2498-2499.
27. Cheng AL, Guan Z, Chen Z, Tsao CJ, Qin S, Kim JS, Yang TS, et al.
Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer 2012;48:1452-1465.
28. Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction.
A prospective controlled study. Cancer 1997;79:2087-2094.
29. Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RK, Dinniwell RE, et al. Sequential Phase I and II Trials of Stereotactic Body Radiotherapy for Locally Advanced Hepatocellular Carcinoma. J Clin Oncol 2013.
30. Ursino S, Greco C, Cartei F, Colosimo C, Stefanelli A, Cacopardo B, Berretta M, et al. Radiotherapy and hepatocellular carcinoma: update and review of the literature. Eur Rev Med Pharmacol Sci 2012;16:1599-1604.
31. Han KH, Seong J, Kim JK, Ahn SH, Lee do Y, Chon CY. Pilot clinical trial of localized concurrent chemoradiation therapy for locally advanced hepatocellular carcinoma with portal vein thrombosis. Cancer 2008;113:995-1003.
32. Hsu CY, Lee YH, Hsia CY, Huang YH, Su CW, Lin HC, Lee RC, et al.
Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system. Hepatology 2013;57:112-119.
33. Kew MC. Hepatitis B and C viruses and hepatocellular carcinoma. Clin Lab Med 1996;16:395-406.
34. Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, Huang GT, et al.
Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006;295:65-73.
35. Kim BK, Park JY, Kim do Y, Kim JK, Kim KS, Choi JS, Moon BS, et al.
Persistent hepatitis B viral replication affects recurrence of hepatocellular carcinoma after curative resection. Liver Int 2008;28:393-401.
36. Yu SJ, Lee JH, Jang ES, Cho EJ, Kwak MS, Yoon JH, Lee HS, et al.
Hepatocellular Carcinoma: High Hepatitis B Viral Load and Mortality in Patients Treated with Transarterial Chemoembolization. Radiology 2013.
37. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521-1531.
38. Papatheodoridis GV, Manolakopoulos S, Touloumi G, Vourli G, Raptopoulou-Gigi M, Vafiadis-Zoumbouli I, Vasiliadis T, et al. Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET. Greece cohort study. Gut 2011;60:1109-1116.
39. Chan AC, Chok KS, Yuen WK, Chan SC, Poon RT, Lo CM, Fan ST. Impact of antiviral therapy on the survival of patients after major hepatectomy for hepatitis B virus-related hepatocellular carcinoma. Arch Surg 2011;146:675-681.
40. Chen LT, Chen MF, Li LA, Lee PH, Jeng LB, Lin DY, Wu CC, et al.
Long-term results of a randomized, observation-controlled, phase III trial of adjuvant interferon Alfa-2b in hepatocellular carcinoma after curative resection. Ann Surg 2012;255:8-17.
41. Sun HC, Tang ZY, Wang L, Qin LX, Ma ZC, Ye QH, Zhang BH, et al.
Postoperative interferon alpha treatment postponed recurrence and improved overall survival in patients after curative resection of HBV-related hepatocellular carcinoma: a randomized clinical trial. J Cancer Res Clin Oncol 2006;132:458-465.
42. Kim BK, Oh HJ, Park JY, Kim do Y, Ahn SH, Han KH, Park Y, et al.
Early on-treatment change in liver stiffness predicts development of liver-related events in chronic hepatitis B patients receiving antiviral therapy. Liver Int 2013;33:180-189.
43. Lee JH, Lim YS, Song TJ, Yeon JE, Yoon JH. Randomized, Open-label, Multi-center and Phase 3 Clinical trial to compare the efficacy and safty of 'INNOCELL Immuncell-LC® group' and 'non-treatment group' in patient
undergone curative resection (PEIT, RFA or operation) for hepatocellular carcinoma in Korea: Interim analysis results. Korean J Hepatol 2010;16(3s):96
- 179
-癌について
杉村 隆
日本學士院幹事
關谷剛男
日本學士院會員