Child-Pugh分類Aかつ遠隔転移のない進行肝細胞癌に対して，治療法選択および後治療の有無が予後に影響するか検討した．一次治療としてHAICを施行した83例（HAIC開始群），Sorafenibを施行した53例（Sorafenib開始群），無治療で経過を観察した12例，合計148例を対象とした．HAIC開始群とSorafenib開始群の比較では，奏効率に有意差を認めたが（26.5％ vs. 7.5％，P=0.007），腫瘍制御率と生存率には有意差を認めなかった．また，両群とも無治療群と比較して有意に生存期間の延長を認めた．さらに，後治療の有無により両治療群を副グループ化し追加検討した．結果，Sorafenibで治療を開始し後治療が施行された症例は最も生存率が高く，多変量解析でも独立した予後因子であった（［HR］；0.144，P<0.001）．また，Sorafenibから後治療（HAIC）へ移行するためには，Sorafenibの初期体重換算投与量：［13>―≥7（mg/kg/day）］が寄与因子であった．進行肝細胞癌は，体重を指標にSorafenibを先行投与しHAICへ移行することで予後の改善が得られる可能性がある．
Since 2012, the VirtuTRAXTM instrument navigator (GE Healthcare, USA) is being used as a navigation system for guiding radiofrequency ablation (RFA) needles in Japan. Fifteen patients were treated using RFA needles guided by VirtuTRAXTM. The short clip method was performed in the following way: after measuring the distance between the body surface and the target position of the needle tip, and considering 3 cm for attachment, a bracket was fixed to the RFA needle at the calculated position. The positional gap caused by the deflection of the RITA needle was small. These gaps were sometimes large for patients undergoing cool-tip RFA because of weak stiffness. However, the positional gap became small and useful for 7 patients on whom the short clip method was used during RFA.
The real-time polymerase chain reaction (PCR) techniques are widely used to diagnose sustained virological response (SVR). And we occasionally come across transient sero-positive HCV-RNA cases during antiviral therapy and after diagnosis of SVR in chronic hepatitis C. Eight SVR cases showed transient sero-positivity of HCV-RNA during and within 6 months after IFN treatment (Study 1). And 19 SVR cases showed it in long-term follow up after the diagnosis of SVR (Study 2). Seven out of 8 Study 1 patients were cases with other than sero group 1 with high viral load. Four patients showed sero-positivity during IFN treatment, and rest of patients showed it within 6 months after the IFN treatment, when we diagnose SVR. The viral load of one of them was even quantifiable, and another one of them showed re-positivity after SVR diagnosis. In Study 2, 12 out of 19 patients were cases with other than sero group 1 with high viral load. Three patients showed transient positivity of HCV-RNA with quantifiable viral load. And 3 patients showed repeated transient positivities in a long-term follow up. Transient sero-positive HCV-RNA was occasional incidence in SVR patients after IFN treatment for CH-C especially in cases with other than serogroup 1 with high viral load. Although its clinical importance is unclear, HCV is supposed to present in most of those patients. We would be better to beware of the presence of such cases in the follow up of SVR patients.
We examined thyroid function in 358 patients with chronic hepatitis C undergoing interferon (IFN) therapy. Prevalence of antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibodies before therapy was 10.8% and 9.4%, respectively. Of the 358 patients, 15 (4.2%) developed a thyroid disorder 1-19 months after IFN therapy had commenced. Of these 15 patients, 13 exhibited hypothyroidism and were TgAb- or TPOAb-positive. The remaining 2 patients exhibited signs of hyperthyroidism and neither antibody was detected. High titers of TgAb and TPOAb were seen in patients with thyroid dysfunction compared with subclinical patients. All patients completed IFN therapy. Our findings show that high TgAb and TPOAb titers were predictive factors of thyroid dysfunction during IFN therapy.