臨床外科67巻11号

2012年10月発行

特集 外科医のための癌診療データ

臓器別最新データ 11．膵・消化管神経内分泌腫瘍（NET）

膵・消化管NETの非切除・再発例

著者： 大塚隆生¹ 上田純二¹ 高畑俊一¹ 水元一博¹ 田中雅夫¹

所属機関： ¹九州大学大学院医学研究院臨床・腫瘍外科

ページ範囲：P.307 - P.311

文献概要

覚えておきたいデータ

◆膵・消化管神経内分泌腫瘍（NET）では多発肝転移が切除不能の主要な因子となるが，集学的治療によって長期予後が得られる場合もある．

◆根治切除術後の再発部位は肝が最も多く，10年以上の長期経過観察が必要である．

◆2011年に切除不能NETの抗腫瘍薬としてソマトスタチンアナログ製剤（消化管）とエベロリムス（膵）がわが国ではじめて保険収載された．ほかにも臨床試験中の薬剤が多数あり，今後，わが国での切除不能NETの治療は大きく変わっていくことが予想される．

参考文献

1）Ito T, Sasano H, Tanaka M, et al：Epidemiological study of gastroenteropancreatic neuroendocrine tumors in Japan. J Gastroenterol 45：234-243, 2010

2）Zerbi A, Falconi M, Rindi G, et al：Clinicopathological features of pancreatic neuroendocrine tumors：Aprospective multicenter study in Italy of 297 sporadic cases. Am J Gastroenterol 105：1421-1429, 2010

3）Maithel SK, Fong Y：Hepatic ablation for neuroendocrine tumor metastases. J Surg Oncol 100：635-638, 2009

4）Kulle MH, Anthony LB, Bushnell DL, et al：NANETS treatment guidelines. Well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas 39：735-752, 2010

5）Steinmuller T, Kianmanesh R, Falconi M, et al：Consensus guidelines for the managements of patients with liver metastases from digestive（neuro）endocrine tumors：forgut, midgut, hindgut, and unknown primary. Neuroendocrinology 87：47-62, 2008.

6）Moertel CG, Hanley JA, Johnson LA：Streptozocin alone compared with streputozocin plus fluorouracil in the treatment of advanced islet-cell carcinoma. N Engl J Med 303：1189-1194, 1980

7）Ramanathan RK, Cnaan A, Hahn RG, et al：Phase Ⅱ trial of dacarbazine（DTIC）in advanced pancreatic islet cell carcinoma. Study of the Eastern Cooperative Oncology Group-E6282. Ann Oncol 12：1139-1143, 2001

8）Kulke MH, Stuart K, Enzinger PC, et al：Phase Ⅱ study of temozolomide and thalidomide in patients with metastatic neuroendocrine tumors. J Clin Oncol 24：401-406, 2006

9）Yao JC, Shah MH, Ito T, et al：Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 364：514-523, 2011

10）Raymond E, Dahan L, Raoul JL, et al：Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 364：501-513, 2011

11）National Comprehensive Cancer Netwok（NCCN）Clinical Practice Guidelines in Oncology. Neuroendocrine tumors, V. I. 2011（www.nccn.org）

12）奥坂拓志，森実千種，池田公史：膵神経内分泌腫瘍（pNET）に対する化学療法・分子標的治療．胆と膵32：227-233，2011

13）Kvols LK, Buck M, Moertel CG, et al：Treatment of metastatic islet cell carcinoma with a somatostatin analogue（SMS201-995）. Ann Intern Med 107：162-168, 1987

14）Rinke A, Muller HH, Schade-Brittinger C, et al：Placebo-controlled, double blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors：a report from the PROMID Study Group. J Clin Oncol 27：4656-4663, 2009

15）Kwekkeboom DJ, Teunissen JJ, Bakker WH, et al：Radiolabeled somatostatin analogu[177Lu-DOTA0, Tyr3]Octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol 23：2754-2762, 2005

16）Vogl TJ, Nagy NNN, Zangos S, et al：Liver metastasis of neuroendocrine carcinomas：Interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol 72：517-528, 2009

17）Mazzaglia PJ, Berber E, Milas M, et al：Laparoscopic radiofrequency ablation of neuroendocrine liver metastases：a 10-year experience evaluating predictors of survival. Surgery 142：10-19, 2007

18）Touzious JG, Kiely JM, Pitt SC, et al：Neuroendocrine hepatic metastases. Does aggressive management improve survival? Ann Surg 241：776-785, 2005

19）Filling A, Malamutmann LE, Schmid KW, et al：Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic diseases. Br J Surg 96：175-184, 2009

20）Le Treut VP, Gregorie E, Belghiti J, et al：Predictor of long-term survival after liver transplantation for metastatic endocrine tumors：An 85-cases French multicentric report. Am J Transplant 8：1205-1213, 2009

21）柴田　近，鹿郷昌之，木内　誠，他：周術期管理．今村正之（編）；膵・消化管神経内分泌腫瘍（NET）診断・治療実践マニュアル．総合医学社，2011，pp120-126

22）Tsutsumi K, Ohtsuka T, Mori Y, et al：Analysis of lymph node metastasis in pancreatic neuroendocrine tumors（PNETs）based on the tumor size and hormonal production. J Gastroenterol 2012（in press）

23）Schurr PG, Strate T, Rese K, et al：Aggressive surgery improves long-term survival in neuroendocrine pancreatic tumors. An institutional experience. Ann Surg 245：273-281, 2007

24）Bilimoria KY, Talamonti MS, Tomlinson JS, et al：Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors. Analysis of 3851 patients. Ann Surg 247：490-500, 2008

25）Saxena A, Chua TC, Sarkar A, et al：Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms（NENs）supports an aggressive surgical approach. Surgery 149：209-220, 2011