| 抄録 |
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Although several factors contribute to the poor prognosis associated with HCC, major vascular invasion is one of the most important. Vascular invasion of the portal vein or the hepatic veins is associated with an increased risk of intrahepatic and systemic metastases, as well as an overall decreased survival. Natural history data obtained from patients with HCC and major vascular invasion reveal a median survival time of only 9 to 10 weeks. Liver transplantation, which is an effective modality for patients with small HCC without vascular invasion, is contraindicated in patients with major vascular invasion because of the high rates of recurrence and the associated poor long-term survival. Hepatic resection, therefore, remains as the only therapeutic option that may offer a chance for disease-free survival in some patients. Surgical resection for patients with HCC invading the portal vein and/or the hepatic veins, however, remains controversial. In one multi-center, international study, surgical resection of HCC patients with major vascular invasion was associated with perioperative mortality rate of 5.9%. Median survival was 11 months and the 1-, 3-, and 5-year survival rates were 45%, 17%, and 10%. Sorafenib has been shown to improve overall survival among patients with advanced HCC (SHARP trial). Sorafenib inhibits angiogenesis by targeting the vascular endothelial growth factor receptor 2 (VEGFR2) and platelet derived growth factor receptor (PDGFR) pathway while also blocking cell proliferation by targeting the Ras/MAPK signaling (b-RAF) pathway. In the SHARP trial, sorafenib therapy resulted in an overall survival of 10.7 months compared with 7.9 months for patients who received placebo. While a similar relative survival benefit associated with sorafenib was found in the subsequent Asia-Pacific trial (hazard ratio, 0.68), survival among patients was still less than 1 year. Whether patients with advanced HCC are best served by aggressive surgical strategies or systemic treatment with sorafenib remains ill defined and will be discussed in the presentation. |
