臨床婦人科産科67巻8号

2013年08月発行

今月の臨床 婦人科がんの予防戦略と早期診断 子宮体がん

1．リスク因子を考慮した子宮体がん予防

著者： 水口剛雄¹ 吉川裕之¹

所属機関： ¹筑波大学医学医療系産科婦人科学

ページ範囲：P.798 - P.804

●国内での子宮体がん罹患率は年々増加傾向にあり，少子化・晩婚化と生活習慣の欧米化により，今後さらに増加を続けると思われる．

●子宮体がんの主なリスク因子は，少ない経妊・経産回数，肥満，糖尿病などであり，生活習慣の改善および経口避妊薬の服用が予防法として有効と考えられる．

●高用量MPA療法は子宮内膜異型増殖症に対する妊孕性温存療法として有用であるが，再発率も高く，厳重な管理とインフォームド・コンセントが重要である．

参考文献

1） 婦人科腫瘍委員会報告．日産婦誌64 : 2340─2388, 2012

2） Haenszel W, Kurihara M : Studies of Japanese migrants. I. Mortality from cancer and other disease among Japanese in the United States. J Nat Cancer Inst 40 : 43─68, 1968

3） Rose PG : Endometrial carcinoma. N Engl J Med 335 : 640─649, 1996

4） Cavalieri EL, Stack DE, Devanesan PD, et al : Molecular origin of cancer ; Catechol estrogen-3,4-quinones as endogenous tumor initiators. Proc Natl Acad Sci USA 94 : 10937─10942, 1997

5） Mutter GL, Lin MC, Fitzgerald JT, et al : Altered PTEN expression as a diagnostic marker for the earliest endometrial precancers. J Natl Cancer Inst 92 : 924─930, 2000

6） 森　満，工藤隆一，水内英充，他 : 過去10年間に入院した症例に基づいた子宮内膜がんの症例対照研究．癌の臨床39 : 1458─1464, 1993

7） Inoue M, Okayama A, Fujita M, et al : A case-control study on risk factor for uterine endometrial cancer in Japan. Jpn J Cancer Res 85 : 346─350, 1994

8） Albreksten G, Heuch I, Tretli S, et al : Is the risk of cancer of the corpus uteri reduced by a recent pregnancy? A prospective study of 765756 Norwegian women. Int J Cancer 61 : 485─490, 1995

9） Cibula D, Gompel A, Mueck AO, et al : Hormonal contraception and risk of cancer. Hum Reprod Update 16 : 631─650, 2010

10） Renehan AG, Tyson M, Egger M, et al : Body-mass index and incidence of cancer : a systematic review and meta-analysis of prospective observational studies. Lancet 371 : 569─578, 2008

11） Steffes MW, Gross MD, Schreiner PJ, et al : Serum adiponectin in young adults-interactions with central adiposity, circulating levels of glucose, and insulin resistance : the CARDIA study. Ann Epidemiol 14 : 492─498, 2004

12） Diamanti-Kandarakis E, Papavassiliou AG : Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 12 : 324─332, 2006

13） Friberg E, Orsini N, Mantzoros CS, et al : Diabetes mellitus and risk of endometrial cancer : a meta-analysis. Diabetologia 50 : 1365─1374, 2007

14） Nagamani M, Stuart CA : Specific binding and growth-promoting activity of insulin in endometrial cancer cells in culture. Am J Obstet Gynecol 179 : 6─12, 1998

15） Irwin JC, de las Fuentes L, Dsupin BA, et al : Insulin-like growth factor regulation of human endometrial stromal cell function : coordinate effects on insulin-like growth factor binding protein-1, cell proliferation and prolactin secretion. Regul Pept 48 : 165─177, 1993

16） Nestler JE, Powers LP, Matt DW, et al : A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 72 : 83─89, 1991

17） World Cancer Research Fund/American Institute for Cancer Research : Food, Nutrition, Physical Activity, and the Prevention of Cancer : a Global Perspective. AICR, Washington DC, 2007

18） Esposito K, Chiodini P, Colao A, et al : Metabolic syndrome and risk of cancer : a systematic review and meta-analysis. Diabetes Care 35 : 2402─2411, 2012

19） Beining RM, Dennis LK, Smith EM, et al : Meta-analysis of intrauterine device use and risk of endometrial cancer. Ann Epidemiol 18 : 492─499, 2008

20） Moyer DL, Mishell DR Jr : Reactions of human endometrium to the intrauterine foreign body. II. Long term effects on the endometrial histology and cytology. Am J Obstet Gynecol 111 : 66─80, 1971

21） Guillebaud J, Bonnar J, Morehead J, et al : Menstrual blood-loss with intrauterine devices. Lancet 1 : 387─390, 1976

22） de Castro A, Gonzalez-Gancedo P, Contreras F, et al : The effect of copper ions in vivo on specific hormonal endometrial receptors. Adv Contracept 2 : 399─404, 1986

23） Satyaswaroop PG, Zaino RJ, Mortel R : Estrogen-like effects of tamoxifen on human endometrial carcinoma transplanted into nude mice. Cancer Res 44 : 4006─4010, 1984

24） Gorodeski GI, Beery R, Lunenfeld B, et al : Tamoxifen increases plasma estrogen-binding equivalents and has an estradiol agonistic effect on histologically normal premenopausal and postmenopausal endometrium. Fertil Steril 57 : 320─327, 1992

25） Fisher B, Costantino JP, Redmond CK, et al : Endometrial cancer in tamoxifen-treated breast cancer patients : findings from the National Surgical Adjuvant Breast and Bowel Project（NSABP）B-14. J Natl Cancer Inst 86 : 527─537, 1994

26） Fornander T, Rutqvist LE, Cedermark B, et al : Adjuvant tamoxifen in early breast cancer : occurrence of new primary cancers. Lancet 1 : 117─120, 1989

27） Fisher B, Costantino JP, Wickerham DL, et al : Tamoxifen for prevention of breast cancer : report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90 : 1371─1388, 1998

28） Bernstein L, Deapen D, Cerhan JR, et al : Tamoxifen therapy for breast cancer and endometrial cancer risk. J Natl Cancer Inst 91 : 1654─1662, 1999

29） Bergman L, Beelen ML, Gallee MP, et al : Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres’ ALERT Group. Assessment of Liver and Endometrial cancer Risk following Tamoxifen. Lancet 356 : 881─887, 2000

30） Pukkala E, Kyyrönen P, Sankila R, et al : Tamoxifen and toremifene treatment of breast cancer and risk of subsequent endometrial cancer : a population-based case-control study. Int J Cancer 100 : 337─341, 2002

31） 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

32） Hirai Y, Banno K, Suzuki M, et al : Molecular epidemiological and mutation analysis of DNA mismatch repair（MMR） genes in endometrial cancer patients with HNPCC-associated familial predisposition to cancer. Cancer Sci 99 : 1715─1719, 2008