消化器・総合外科では、基礎と臨床の橋渡しとなる研究で活躍の先生に講師をお願いしてセミナーを行っています。 今回は世界的に有名な肝臓外科医であるMyron E Schwartz先生をお招きし、肝移植後肝癌再発を予測するゲノム不安定性検出の 意義についてご講演いただきました。

演題：	Current HCC management: Incorporating molecular studies into clinical practice
演者：	Myron E Schwartz　先生(Professor of Surgery, Mount Sinai School of Medicine, New York, N.Y., USA)
座長：	前原喜彦　先生（九州大学大学院医学研究院　消化器・総合外科）
日時：	平成21年6月8日（月） 午後7時より
場所：	百年講堂　中ホール３

[発表要旨]
Background: Liver transplantation usually cures hepatocellular carcinoma when the Milan selection criteria are applied, whereas there is substantial risk of posttransplant recurrence with tumors beyond these criteria.This study uses molecular data to identify a subgroup of patients who, despite having hepatocellular carcinoma beyond Milan criteria, have favorable outcomes. Methods: Allelic imbalance of 18 microsatellites was analyzed in 70 consecutive patients (35 within Milan, 35 beyond Milan criteria) transplanted for hepatocellular carcinoma of whom 24 had recurrence and 46 survived at least 5 years recurrence-free. Fractional allelic imbalance (the fraction of significant microsatellites that demonstrated allelic imbalance) and relevant clinical / pathological variables were tested for correlation with time to recurrence. Results: Allelic imbalance in 9/18 microsatellites correlated with recurrence. Fractional allelic imbalance >0.27 and macrovascular invasion were independent predictors of recurrence in patients with tumors beyond Milan criteria; the probability of recurrence at 5 years was 85% with fractional allelic imbalance >=0.27 vs. 10% when <0.27 (p = 0.0002). An algorithm including Milan criteria and fractional allelic imbalance status is 89% accurate in predicting tumor recurrence after transplantation. Conclusion: Analysis of allelic imbalance of 9 microsatellites identifies a subgroup of patients who, despite having hepatocellular carcinoma beyond Milan criteria, have a low risk of posttransplant recurrence.

参考文献：Journal of Hepatology 49(2008)581-588 他