臨床婦人科産科67巻5号

2013年05月発行

今月の臨床 子宮体がん診療アップデート

治療のトピックス

5．子宮体がんの妊孕性温存療法

著者： 三橋暁¹ 生水真紀夫¹

所属機関： ¹千葉大学大学院医学研究院生殖医学

ページ範囲：P.498 - P.504

文献概要

●プロゲスチン療法の奏効率は，子宮体がんで76％，子宮内膜異型増殖症で86％ほどで比較的高い．

●プロゲスチン療法で寛解した子宮体がんの30～50％，子宮内膜異型増殖症の23～26％が再発する．

●MPA+メトホルミン併用療法は，温存療法の問題点である高い再発率を改善する可能性がある．

参考文献

1） 日本産科婦人科学会婦人科腫瘍委員会報告 : 2011年度子宮体癌患者年報．日産婦誌64 : 2340─2388，2012

2） Gitsch G, Hanzal E, Jensen D, et al : Endometrial cancer in premenopausal women 45 years and younger. Obstet Gynecol 85 : 504─508, 1995

3） Walsh C, Holschneider C, Hoang Y, et al : Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol 106 : 693─699, 2005

4） 日本婦人科腫瘍学会（編） : 子宮体がん治療ガイドライン，2009年版．金原出版，2009

5） Gunderson CC, Fader AN, Carson KA, et al : Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma : a systematic review. Gynecol Oncol 125 : 477─482, 2012

6） Minig L, Franchi D, Boveri S, et al : Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women. Ann Oncol 22 : 643─649, 2011

7） Varma R, Soneja H, Bhatia K, et al : The effectiveness of a levonorgestrel-releasing intrauterine system（LNG-IUS）in the treatment of endometrial hyperplasia--a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol 139 : 169─175, 2008

8） Wildemeersch D, Janssens D, Pylyser K, et al : Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system : long-term follow-up. Maturitas 57 : 210─213, 2007

9） Park JY, Kim DY, Kim JH, et al : Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer（KGOG 2002）．Eur J Cancer, 2012（in press）

10） Kaku T, Yoshikawa H, Tsuda H, et al : Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women : central pathologic review and treatment outcome. Cancer Lett 167 : 39─48, 2001

11） Ota T, Yoshida M, Kimura M, et al : Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger. Int J Gynecol Cancer 15 : 657-662, 2005

12） Niwa K, Tagami K, Lian Z, et al : Outcome of fertility-preserving treatment in young women with endometrial carcinomas. BJOG 112 : 317─320, 2005

13） Yahata T, Fujita K, Aoki Y, et al : Long-term conservative therapy for endometrial adenocarcinoma in young women. Hum Reprod 21 : 1070─1075, 2006

14） Yu M, Yang J-x, Wu M, et al : Fertility-preserving treatment in young women with well-differentiated endometrial carcinoma and severe atypical hyperplasia of endometrium. Fertil Steril 92 : 2122─2124, 2009

15） Minaguchi T, Nakagawa S, Takazawa Y, et al : Combined phospho-Akt and PTEN expressions associated with post-treatment hysterectomy after conservative progestin therapy in complex atypical hyperplasia and stage Ia, G1 adenocarcinoma of the endometrium. Cancer Lett 248 : 112─122, 2007

16） Ushijima K, Yahata H, Yoshikawa H, et al : Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 25 : 2798─2803, 2007

17） Yamazawa K, Hirai M, Fujito A, et al : Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer. Hum Reprod 22 : 1953─1958, 2007

18） Fujiwara H, Jobo T, Takei Y, et al : Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma. Oncol Lett 3 : 1002─1006, 2012

19） Thigpen JT : Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma : a dose-response study by the Gynecologic Oncology Group. J Clin Oncol 17 : 1736─1744, 1999

20） 栗原操寿，他 : 子宮内膜癌に対するMedroxyprogesterone acetate（MPA）の治療効果に関する検討．産婦実際34 : 517─536，1985

21） Gallos ID, Yap J, Rajkhowa M, et al : Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia : a systematic review and metaanalysis. Am J Obstet Gynecol 207 : 266, e1─e12, 2012

22） 牛島公生 : 子宮体癌における高単位プロゲステロンによる妊孕性温存療法─治療効果および安全性，その後の妊娠について，長期観察結果．日産婦誌62 : 2107─2114，2010

23） Park JY, Seong SJ, Kim TJ, et al : Pregnancy outcomes after fertility-sparing management in young women with early endometrial cancer. Obstet Gynecol 121 : 136-142, 2013

24） Park JY, Lee SH, Seong SJ, et al : Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin. Gynecol Oncol, 2012（in press）

25） Evans JMM, Donnelly LA, Emslie-Smith AM, et al : Metformin and reduced risk of cancer in diabetic patients. BMJ 330 : 1304─1305, 2005

26） Jiralerspong S, Palla SL, Giordano SH, et al : Metformin and pathologic complete responses to neoadjuvant chemotherapy in diabetic patients with breast cancer. J Clin Oncol 27 : 3297─3302, 2009

27） Dowling RJ, Niraula S, Stambolic V, et al : Metformin in cancer : translational challenges. J Mol Endocrinol 48 : R31─43, 2012

28） Mitsuhashi A, et al : Metformin prevents recurrence following after progestin therapy for fertility-sparing treatment in young women with endometrial cancer or atypical endometrial hyperplasia. Int J Gynecol Cancer 21（Suppl 3） : s73, 2011