{"created":"2023-06-19T10:30:50.472129+00:00","id":2993,"links":{},"metadata":{"_buckets":{"deposit":"f4c46fb7-bfb7-473d-bc91-3397262f1282"},"_deposit":{"created_by":31,"id":"2993","owners":[31],"pid":{"revision_id":0,"type":"depid","value":"2993"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00002993","sets":["1709617079800:35:800"]},"author_link":["130783","130784","130785","130786","130787","130788","130789","130790","130791","130792","130793","130794","130795","130796","130797","130798"],"item_10001_alternative_title_1":{"attribute_name":"その他(別言語等)のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Therapeutic effect of lenvatinib and predictive factor of objective response in patients with unresectable large hepatocellular carcinoma","subitem_alternative_title_language":"en"}]},"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2021","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"111","bibliographicPageStart":"103","bibliographicVolumeNumber":"47","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_10001_description_33":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"原著論文","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_10001_description_34":{"attribute_name":"記事種別(英)","attribute_value_mlt":[{"subitem_description":"Regular Article","subitem_description_language":"en","subitem_description_type":"Other"}]},"item_10001_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"川崎医学会","subitem_publisher_language":"ja"}]},"item_10001_relation_14":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"https://doi.org/10.11482/KMJ-J202147103","subitem_relation_type_select":"DOI"}}]},"item_10001_relation_17":{"attribute_name":"関連サイト","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://igakkai.kms-igakkai.com/wp/wp-content/uploads/2021/KMJ-J202147103.pdf","subitem_relation_type_select":"URI"}}]},"item_10001_relation_35":{"attribute_name":"医中誌ID","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"2022194418","subitem_relation_type_select":"ICHUSHI"}}]},"item_10001_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00045593","subitem_source_identifier_type":"NCID"},{"subitem_source_identifier":"AN12940574","subitem_source_identifier_type":"NCID"}]},"item_10001_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0386-5924","subitem_source_identifier_type":"PISSN"},{"subitem_source_identifier":"2758-089X","subitem_source_identifier_type":"EISSN"}]},"item_10001_text_31":{"attribute_name":"著者所属(日)","attribute_value_mlt":[{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学・福山市民病院内科"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学・カンザス大学メディカルセンター内科"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学"},{"subitem_text_language":"ja","subitem_text_value":"福山市民病院内科"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学肝胆膵内科学"}]},"item_10001_text_32":{"attribute_name":"著者所属(英)","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School・Department of Internal Medicine, Fukuyama City Hospital"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School・Department of Internal Medicine University of Kansas Medical Center"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":" Department of Internal Medicine, Fukuyama City Hospital"},{"subitem_text_language":"en","subitem_text_value":"Department of Hepatology and Pancreatology, Kawasaki Medical School"}]},"item_10001_textarea_5":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"　Recently, some of hepatocellular carcinoma (HCC) in the intermediate stage of modified Barcelona Clinical Liver Cancer (BCLC) staging (maximum tumor diameter [cm] + number of tumors are beyond 7 [up-to-seven out]) have been shown to be refractory to transcatheter arterial chemoembolization therapy. Therefore, we retrospectively assessed the effect of lenvatinib and investigated predictive factor of its objective response in 45 patients with intermediate staged- (up-to-seven out) or advance staged-HCC, of which maximum tumor diameter was more than 6cm. The best response to lenvatinib assessed by modified response evaluation criteria in solid tumor (mRECIST) was partial response (PR) in 23 patients, stable disease (SD) in 13 patients, and progressive disease (PD) in 9 patients, respectively. The objective response rate and the disease control rate was 51.1% and 80.0%, respectively. Δ C reactive protein (ΔCRP) defined as a maximum increase in CRP value within 1 months after commencement of treatment was significantly greater in responders (PR) than in nonresponders (SD + PD) (P < 0.001), and was an independent predictive factor for objective response of lenvatinib (odds ratio: 1.39, 95%CI: 1.08-1.78, P = 0.01). The median overall survival and the progression free survival was 12.3 months and 4.9 months, respectively. The prognostic factors for lenvatinib-treated patients were pretreatment total bilirubin value (hazard ratio: 2.74, 95%CI: 1.35-5.55, P = 0.005), disease control rate of lenvatinib (hazard ratio: 0.33, 95%CI: 0.12- 0.94, P = 0.038), and posttreatment after cessation of lenvatinib administration (hazard ratio: 0.33, 95%CI: 0.13-0.70, P = 0.013). Adverse effects ≥ grade 3 in common terminology criteria for adverse events version 4 were AST elevation in 8 patients (17.8%) and ALT elevation in 8 patients (17.8%), respectively. Thus, lenvatinib provided favorable outcome in terms of treatment response and tolerability in patients with intermediate staged- (up-to-seven out) or advance staged-hepatocellular carcinoma (HCC), of which maximum diameter was more than 6cm. ΔCRP was useful in predicting the objective response of lenvatinib, and posttreatment after cessation of l　envatinib administration was important to prolong the overall survival."}]},"item_10001_textarea_6":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"　肝動脈化学塞栓療法（TACE）の適応とされてきた肝細胞癌の一部（最大腫瘍径（cm）と 腫瘍個数の和が７を超える［up-to-seven out］）は TACE 不応であることが明らかにされている． そこで最大腫瘍径 > ６cm の切除不能大型肝細胞癌に対するレンバチニブ（チロシンキナーゼ阻害 薬）の治療成績を検討し，治療奏効予測因子を解析した．対象は2018年４月から2020年10月までの間にレンバチニブを導入した122例の肝細胞癌症例のうち，治療効果判定が可能で最大腫瘍径 > ６cm であった45例である．mRECIST による最良治療効果は CR/PR/SD/PD が0/23/13/9例で， 奏効率は51.1％，腫瘍制御率は80％であった．奏効群（23例）は治療開始早期（１か月以内）の ΔCRP（治療開始後最大 CRP 値−治療前 CRP 値）が非奏効群（22例）にくらべて有意に大きく （ P < 0.001），独立した治療効果予測因子であった（オッズ比：1.39，95％ CI：1.08-1.78，P = 0.01）．一方，全生存期間中央値は12.3か月，無増悪生存期間中央値は4.9か月であり，生存期間予 測因子は総ビリルビン値（ハザード比：2.74，95％ CI：1.35-5.55，P = 0.005），腫瘍制御率（ハザー ド比：0.33，95％ CI：0.12-0.94，P = 0.038），後治療有り（ハザード比：0.33，95％ CI：0.13-0.70， P = 0.013）が有意な因子として抽出された．G3以上の有害事象では，ALT・AST上昇が８例（17.8%） と最も高頻度であった．以上より，腫瘍径 > ６cm の切除不能大型肝細胞癌に対するレンバチニブ の治療成績は良好で，レンバチニブ治療開始早期のΔCRP は治療奏効の予測因子であるとともに， レンバチニブ中断後も可能な限り後治療を行うことが生存期間を延ばすうえで重要であると考えられた．"}]},"item_10001_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"吉岡, 奈穂子","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"富山, 恭行","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"大海, 宏暢","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"佐々木, 恭","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"原, 裕一","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"仁科, 惣治","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"薮下, 和久","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"日野, 啓輔","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"YOSHIOKA, Naoko","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"TOMIYAMA, Yasuyuki","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Ooumi, Hironobu","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"SASAKI, Kyo","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HARA, Yuichi","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"NISHINA, Sohji","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"YABUSHITA, Kazuhisa","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HINO, Keisuke","creatorNameLang":"en"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2022-04-01"}],"displaytype":"detail","filename":"KMJ-J202147103.pdf","filesize":[{"value":"1.2 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"PDF","objectType":"fulltext","url":"https://kwmed.repo.nii.ac.jp/record/2993/files/KMJ-J202147103.pdf"},"version_id":"287031d1-42e0-4368-bf92-05f6a137cae6"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"肝細胞癌","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"レンバチニブ","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"BCLC staging","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Ｃ反応性タンパク質（CRP）","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"Hepatocellular carcinoma","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Lenvatinib, BCLC staging","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"C-reactive protein (CRP)","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal 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