| 特集名 | 肝癌診療のアルゴリズム2010 | |
|---|---|---|
| 題名 | 肝癌発生の危険因子と高危険群の設定 (1) B型慢性肝炎・肝硬変に発生する肝癌 | |
| 発刊年月 | 2010年 04月 | |
| 著者 | 池田 健次 | 虎の門病院肝臓センター |
| 【 要旨 】 | 抗ウイルス薬を投与しないB型慢性肝炎症例からの発癌率は5年2.9％，10年7.2％，15年9.9％で，B型肝硬変からの発癌率は5年19.7％，10年29.8％，15 年36.3％であった．これらは同病期のC型慢性肝疾患からの発癌率の約半分の率であった．発癌率を高める要因は，進行肝病変，多飲酒歴，高齢，男性，低い血小板数，e抗原陽性，ICGR15高値などが挙げられるほか，B型肝硬変では，血中DNA量の経時的経過が発癌リスクと強い関係にあった．非進行B型肝疾患からの肝癌発癌は，すべての症例を肝癌高危険群として十分に囲い込むことは困難であり，危険性が相対的に低いこれらの症例をいかにサーベイランスしていくかはまだ解決されていない． | |
| Theme | Algorithm for Diagnosis and Treatment of Liver Cancer | |
|---|---|---|
| Title | Carcinogenesis Rates and Risk Factors for Hepatocellular Carcinogenesis in Patients with Hepatitis B Virus-related Chronic Hepatitis and Cirrhosis | |
| Author | Kenji Ikeda | Department of Hepatology, Toranomon Hospital |
| [ Summary ] | Cumulative carcinogenesis rates for hepatitis B virus (HBV)-related chronic hepatitis and cirrhosis were 2.9% and 19.7% at the end of the fifth year, 7.2% and 29.8% at the tenth year, and 9.9% and 36.3% at the fifteenth year, respectively. Independent risk factors for hepatocellular carcinogenesis in patients with chronic hepatitis included fibrotic stage of hepatitis (F1 vs. F2/3, H. R. 4.14, P=0.0042), heavy alcohol intake (former alcohol intake>=500 kg, H. R. 2.97, P=0.027), and positive HBe antigen levels (P=0.078). In patients with cirrhosis, carcinogenesis was significantly affected by advanced age (P＝0.0001), male gender (P=0.029), low platelet counts (P=0.0079), and positive HBe antigen levels (P=0.019). In a nested case-controlled study of 98 patients with untreated HBV-related cirrhosis, hepatocellular carcinogenesis was exclusive found in patients with a high HBV DNA level of 3.7 log copy/ml or higher. In the advanced stages of chronic hepatitis or cirrhosis, HBV DNA concentrations were more associated with future carcinogenesis rates compared to values of aminotranseferase. Since carcinogenesis rates are low in patients with HBs antigen-positive chronicinactivehepatitis, the significance of general surveillance of liver cancer for all "HBV positive" patients still remains unknown. |
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