三原 修一

Shuichi MIHARA

日本赤十字社熊本県支部健康管理センター

Kumamoto Red Cross Health Care Center

キーワード : Ultrasonography, Mass screening, Hepatocellular carcinoma, High-risk group, Early detection

From August 1983 through March 1989, 82377 people were evaluated using ultrasonic mass screening of abdominal organs for the first time. Among these subjects, forty-nine (0.06%) hepatocellular carcinoma (H. C. C.) cases were detected. Ten (20.4%) of these cases were surgically resected, thirty-one (63.3%) were treated by TAE therapy, and eight (16.3%) were administered other conservative therapy. The cumulative survival rate (by Kaplan-Meier's method) of operated cases in comparison with TAE therapy cases at one, two, three, and four years were 88.9% vs 90.3%, 59.3% vs 74.2%, 29.6% vs 50.9%, and 29.6% vs 0%, respectively. There was no significant difference in the cumulative survival rate between operated cases and TAE cases.
To be efficient in discovering H. C. C., it is helpful to select first high-risk H. C. C. groups, including 1) males over fifty years old, 2) subjects who have family histories or past histories of liver diseases, 3) liver dysfunction cases, and 4) HBs antigen carriers. Then these high-risk groups should be examined and given follow-up examinations by ultrasonography. However, it appears that H. C. C. cases detected in the high-risk group suffered hypofunction of the liver, and almost all of them had poor prognoses even though multi-disciplinary treatment was being used. Moreover, such H. C. C. cases that did not belong to the high-risk group were found in large number by ultrasonic mass screening. In other words, for the early detection of H. C. C. cases whose liver is functioning well, it may be indispensable to use ultrasonography as the first step in mass screening.
From now on, for earlier detection of H. C. C., this data suggests that it is very important to establish and promote ultrasonic mass screening systems. And to improve the prognoses of H. C. C., it is also essential to develop more successful treatments. In addition, to effectively diagnose malignant diseases and to evaluate their present status and prognoses economically through mass screening, it will be necessary to conduct ultrasonography for not only the liver but also for other abdominal organs such as the gallbladder, kidney, pancreas, and spleen.