Department of Gastroenterology and Hepatology, Kinki University, Ohno-Higashi, Osakasayama, Japan.
Oncology. 2011;81 Suppl 1:50-5. doi: 10.1159/000333259. Epub 2011 Dec 22.
It is widely accepted that hepatocellular carcinoma (HCC) has an annual recurrence rate of approximately 15-20% even after potentially curative treatment, with the 5-year recurrence rate reaching 80-90%. This recurrence rate is also known to be similar after various curative treatments including resection, percutaneous ethanol injection therapy, and radiofrequency ablation. Generally, in treating patients with HCC associated with hepatitis C or liver cirrhosis, aggressive efforts to prevent secondary carcinogenesis are necessary rather than simply observing the clinical course after treatment. Presently, a combination of peg-interferon and ribavirin is known to be highly effective in patients with difficult-to-treat hepatitis C with a high viral load and genotype I virus. Therefore, indications of these treatments must be considered to prevent secondary carcinogenesis in patients with hepatitis C. Recently, long-term follow-up of low-dose, long-term maintenance therapy using pegylated interferon-α2a for cirrhotic patients clearly showed a preventive effect on HCC occurrence and recurrence. Preventing secondary carcinogenesis by suppressing inflammation employing the same treatment as that against primary carcinogenesis is also important. The molecular targeted agent sorafenib markedly suppresses the serine/threonine kinases of Raf in the MAP kinase cascade and inhibits the tyrosine kinases of angiogenesis factor receptors such as vascular endothelial growth factor and platelet-derived growth factor receptors. It thus simultaneously prevents the proliferation of tumors and inhibits angiogenesis. A clinical trial to examine the recurrence-preventing effect of sorafenib by administration of it after curative treatment such as resection or ablation is in progress (STORM trial: http://clinicaltrials.gov.com, NCT00692770). Treatments to prevent recurrence (including intrahepatic metastasis and multicentric carcinogenesis) as well as early detection and early curative treatment are extremely important to improve the prognosis of patients with HCC. Thus, further research on this issue should be carried out, especially in relation to molecular targeted therapy.
人们普遍认为，即使经过潜在的治愈性治疗后，肝癌（HCC）仍有 15-20%的年复发率，5 年复发率高达 80-90%。在包括切除、经皮乙醇注射治疗和射频消融在内的各种治愈性治疗后，复发率也相似。一般来说，在治疗与丙型肝炎或肝硬化相关的 HCC 患者时，积极预防二次癌变比单纯观察治疗后的临床过程更为重要。目前，聚乙二醇干扰素和利巴韦林联合治疗高病毒载量和基因 I 型病毒的难治性丙型肝炎患者效果显著。因此，必须考虑这些治疗的适应证，以预防丙型肝炎患者的二次癌变。最近，对使用聚乙二醇干扰素-α2a 进行低剂量、长期维持治疗的肝硬化患者进行的长期随访清楚地显示，该治疗对 HCC 发生和复发有预防作用。通过采用与原发性癌变治疗相同的方法抑制炎症来预防二次癌变也很重要。分子靶向药物索拉非尼显著抑制丝氨酸/苏氨酸激酶的 MAP 激酶级联中的 Raf，并抑制血管内皮生长因子和血小板衍生生长因子受体等血管生成因子受体的酪氨酸激酶。因此，它同时阻止肿瘤的增殖并抑制血管生成。一项关于索拉非尼在切除或消融等治愈性治疗后给药对预防复发（包括肝内转移和多中心癌变）的疗效的临床试验正在进行中（STORM 试验：http://clinicaltrials.gov，NCT00692770）。预防复发的治疗（包括肝内转移和多中心癌变）以及早期检测和早期治疗对改善 HCC 患者的预后非常重要。因此，应该对此问题进行进一步研究，尤其是在分子靶向治疗方面。
