Imaoka S, Sasaki Y
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Nihon Geka Gakkai Zasshi. 1998 Apr;99(4):229-33.
Pre- and/or postoperative adjuvant therapy for hepatocellular carcinoma (HCC) is discussed. There is a high recurrence rate of HCC of up to 50% or more within three years after hepatectomy. More than 80% of those recurrences are in the form of intrahepatic metastases. Therefore it is extremely important to administer successful adjuvant therapy to prevent intrahepatic recurrence. There are two types of intrahepatic recurrence: simple dissemination from the primary focus of HCC; and newly developed HCC in the remnant liver. TAE is one option for preoperative adjuvant therapy to prevent intrahepatic recurrence. Postoperative adjuvant chemotherapy via the hepatic artery has occasionally been administered, but it is not yet established as an effective adjuvant therapy. However, a report by Muto et al showed that retinoid administration can prevent intrahepatic recurrence of newly developed HCC after hepatectomy. On the other hand, adjuvant therapy must not be tooaggressive, because: 1) HCC develops mainly in cirrhotic liver (with poor liver function); and 2) locoregional therapy for intrahepatic recurrence results in good survival rats even after detection of an established recurrence.
本文讨论了肝细胞癌（HCC）的术前和/或术后辅助治疗。肝癌肝切除术后三年内的复发率高达50%或更高。其中超过80%的复发表现为肝内转移。因此，进行成功的辅助治疗以预防肝内复发极为重要。肝内复发有两种类型：肝癌原发灶的单纯播散；以及残肝内新发生的肝癌。经动脉栓塞化疗（TAE）是预防肝内复发的术前辅助治疗选择之一。偶尔也会通过肝动脉进行术后辅助化疗，但尚未确立其作为有效辅助治疗的地位。然而，Muto等人的一份报告显示，服用维甲酸可以预防肝切除术后残肝内新发生肝癌的肝内复发。另一方面，辅助治疗不能过于激进，原因如下：1）肝癌主要发生在肝硬化肝脏（肝功能较差）；2）即使在检测到已确诊的复发后，针对肝内复发的局部区域治疗仍能带来较好的生存率。
