肉眼的門脈侵襲陽性肝癌切除後のSystemic IFN＋Low dose FP の有用性 : 理論的根拠と臨床的効果

Background and Aims : Despite a recent progress of treatment for hepatocellular carcinoma （HCC）, the prognosis of advanced HCC with macroscopic vascular invasion remains unsatisfactory. We investigated anti-tumor effect of IFNα using experimental model and show the outcome of our systemic adjuvant therapy consisting of IFNα,５FU and cisplatin（IFP）after hepatectomy on advanced HCC with macroscopic portal invasion. Methods［: Basic study］Anti-tumor effects such as inhibition of invasion, proliferation of pegylated IFN α２b（PegIFNα）was evaluated using MH１３４mouse HCC cells, in vitro and vivo. ［Clinical study］: Thirty patients who had HCC with Vp２or more of macroscopic portal invasion（Vp２; portal vein tumor thrombus in its２nd order branch）were included. Those patients were retrospectively divided into two groups : the systemic IFNα,５FU and cisplatin group （n＝１４, IFP group）; and the no adjuvant therapy group（n＝１６, control）. Clinicopathological variables were compared between the two groups, including patient survival and disease-free survival. Results［: Basic］In vitro, the proliferation was significantly suppressed by Peg-IFNα, and invasion potential was also inhibited. In vivo, tumor growth was significantly suppressed compared to control （０．５vs.５．０cm, p＜０．０５）, and liver metastases was decreased（number :１９vs.６, p＜０．０５）. ［Clinical］The overall and disease-free survival rate in IFP group was significantly higher than in control group（１y :１００％ vs３８％,３y :６５％ vs２５％, P＜０．０１,１y :３６％ vs２５％,３y :３６％ vs１９％, P＜０．０１）. Regarding the recurrent patterns,５of９patients in IFP group had controllable tumors in the remnant liver, although１２of１３patients in control group had distant metastasis or multiple recurrences in the residual liver. Conclusion : Our new adjuvant regimen of systemic IFP may be a promising strategy after radical resection for HCC with macroscopic portal invasion.

四国医学雑誌 : http://www.med.tokushima-u.ac.jp/article/0012780.html