臨床泌尿器科73巻11号

2019年10月発行

特集 希少癌に備える―いざという時のための基礎知識

原発不明癌の診断と治療

著者： 高橋俊二¹

所属機関： ¹がん研有明病院総合腫瘍科

ページ範囲：P.850 - P.856

文献概要

▶ポイント

・原発不明癌は悪性腫瘍全体の1〜5％を占めるとされるが，原発を明らかにできる可能性はあり，体系的な検査と免疫染色を含む病理診断が必要である．

・予後良好群を同定して最適の治療を選択することが重要である．

・予後不良群でもプラチナ製剤＋タキサンにより1年以上の生存期間が得られる可能性はあるが，予後不良な患者も非常に多い．

参考文献

1） Pavlidis N, Briasoulis E, Hainsworth J, et al : Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 39 : 1990-2005, 2003

2） Dowell JE : Cancer from an unknown primary site. Am J Med Sci 326 : 35-46, 2003

3） CRUK : UK Cancer Statistics　www.carncerresearchuk.org/health-professional/cancer-statistics, 2014

4） Naresh KN : Do metastatic tumours from an unknown primary reflect angiogenic incompetence of the tumour at the primary site? --a hypothesis. Med Hypotheses 59 : 357-360, 2002

5） Pentheroudakis G, Briasoulis E and Pavlidis N : Cancer of unknown primary site : missing primary or missing biology? Oncologist 12 : 418-425, 2007

6） http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#occult

7） 日本臨床腫瘍学会 : 原発不明がん診療ガイドライン.　http://www.jsmo.or.jp/about/kanko.html#guideline

8） Oien KA : Pathologic evaluation of unknown primary cancer. Semin Oncol 36 : 8-37, 2009

9） Selves J, Long-Mira E, Mathieu MC, et al : Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. Cancers （Basel） 10 : pii, 2018

10） Rosenfeld N, Aharonov R, Meiri E, et al : MicroRNAs accurately identify cancer tissue origin. Nat Biotechnol 26 : 462-469, 2008

11） Monzon FA, Lyons-Weiler M, Buturovic LJ, et al : Multicenter validation of a 1,550-gene expression profile for identification of tumor tissue of origin. J Clin Oncol 27 : 2503-2508, 2009

12） Hayashi H, Kurata T, Takiguchi Y, et al : Randomized Phase II Trial Comparing Site-Specific Treatment Based on Gene Expression Profiling With Carboplatin and Paclitaxel for Patients With Cancer of Unknown Primary Site. J Clin Oncol 37 : 570-579, 2019

13） Johansen J, Buus S, Loft A, et al : Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 30 : 471-478, 2008

14） Fizazi K, Greco FA, Pavlidis N, et al : Cancers of unknown primary site : ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26 （Suppl 5） : v133-138, 2011

15） Seve P, Billotey C, Broussolle C, et al : The role of 2-deoxy-2- ［F-18］ fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer 109 : 292-299, 2007

16） ESMO : ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site （CUP）. Ann Oncol 12 : 1057-1058, 2001

17） Segal R, Lukka H, Klotz LH, et al : Surveillance programs for early stage non-seminomatous testicular cancer : a practice guideline. Can J Urol 8 : 1184-1192, 2001

18） Carter HB, Pearson JD, Metter EJ, et al : Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 267 : 2215-2220, 1992

19） Panza N, Lombardi G, De Rosa M, et al : High serum thyroglobulin levels. Diagnostic indicators in patients with metastases from unknown primary sites. Cancer 60 : 2233-2236, 1987

20） Harris L, Fritsche H, Mennel R, et al : American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 25 : 5287-5312, 2007

21） Jacobs IJ, Skates SJ, MacDonald N, et al : Screening for ovarian cancer : a pilot randomised controlled trial. Lancet 353 : 1207-1210, 1999

22） Locker GY, Hamilton S, Harris J, et al : ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 24 : 5313-5327, 2006

23） Hainsworth JD and Fizazi K : Treatment for patients with unknown primary cancer and favorable prognostic factors. Semin Oncol 36 : 44-51, 2009

24） Culine S : Prognostic factors in unknown primary cancer. Semin Oncol 36 : 60-64, 2009

25） Lee J, Hahn S, Kim DW, et al : Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary : a systematic review and meta-analysis. Br J Cancer 108 : 39-48, 2013

26） Zaren HA and Copeland EM 3rd : Inguinal node metastases. Cancer 41 : 919-923, 1978

27） Guarischi A, Keane TJ and Elhakim T : Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases. Cancer 59 : 572-577, 1987