2．BR膵癌の臨床病理学的特徴とその治療戦略
Borderline resectable（BR）膵癌の臨床病理学的特徴とその治療戦略について自験例の検討とともに概説した．当科の手術先行症例での検討では，BR膵癌はR膵癌に比べ，有意に，腫瘍径，リンパ節転移などの腫瘍進展度が高く，切除には過大な手術侵襲を要し，組織学的根治切除率が低く，全生存率も不良であった．特に，動脈接触BR（BR-A）膵癌は，過大な手術侵襲によるperformance statusの低下により術後補助化学療法施行率も低率で，術後補助化学療法の効果も限定的で予後不良であった．また，BR-A膵癌に対する術前化学療法は，手術先行治療に比べ，有意に，組織学的根治切除率を増加させ，...
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| Published in | 膵臓 Vol. 33; no. 1; pp. 18 - 26 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本膵臓学会
25.02.2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0913-0071 1881-2805 |
| DOI | 10.2958/suizo.33.18 |
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| Abstract | Borderline resectable（BR）膵癌の臨床病理学的特徴とその治療戦略について自験例の検討とともに概説した．当科の手術先行症例での検討では，BR膵癌はR膵癌に比べ，有意に，腫瘍径，リンパ節転移などの腫瘍進展度が高く，切除には過大な手術侵襲を要し，組織学的根治切除率が低く，全生存率も不良であった．特に，動脈接触BR（BR-A）膵癌は，過大な手術侵襲によるperformance statusの低下により術後補助化学療法施行率も低率で，術後補助化学療法の効果も限定的で予後不良であった．また，BR-A膵癌に対する術前化学療法は，手術先行治療に比べ，有意に，組織学的根治切除率を増加させ，全生存率を向上させた．BR膵癌の予後向上のためには，術前治療の導入が必須と考えられるが，術前治療として化学療法，化学放射線療法のどちらが選択されるべきかなど今後の臨床試験による解明が必要である． |
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| AbstractList | Borderline resectable（BR）膵癌の臨床病理学的特徴とその治療戦略について自験例の検討とともに概説した．当科の手術先行症例での検討では，BR膵癌はR膵癌に比べ，有意に，腫瘍径，リンパ節転移などの腫瘍進展度が高く，切除には過大な手術侵襲を要し，組織学的根治切除率が低く，全生存率も不良であった．特に，動脈接触BR（BR-A）膵癌は，過大な手術侵襲によるperformance statusの低下により術後補助化学療法施行率も低率で，術後補助化学療法の効果も限定的で予後不良であった．また，BR-A膵癌に対する術前化学療法は，手術先行治療に比べ，有意に，組織学的根治切除率を増加させ，全生存率を向上させた．BR膵癌の予後向上のためには，術前治療の導入が必須と考えられるが，術前治療として化学療法，化学放射線療法のどちらが選択されるべきかなど今後の臨床試験による解明が必要である． 要旨:Borderline resectable(BR)膵癌の臨床病理学的特徴とその治療戦略について自験例の検討とともに概説した. 当科の手術先行症例での検討では, BR膵癌はR膵癌に比べ, 有意に, 腫瘍径, リンパ節転移などの腫瘍進展度が高く, 切除には過大な手術侵襲を要し, 組織学的根治切除率が低く, 全生存率も不良であった. 特に, 動脈接触BR(BR-A)膵癌は, 過大な手術侵襲によるperformance statusの低下により術後補助化学療法施行率も低率で, 術後補助化学療法の効果も限定的で予後不良であった. また, BR-A膵癌に対する術前化学療法は, 手術先行治療に比べ, 有意に, 組織学的根治切除率を増加させ, 全生存率を向上させた. BR膵癌の予後向上のためには, 術前治療の導入が必須と考えられるが, 術前治療として化学療法, 化学放射線療法のどちらが選択されるべきかなど今後の臨床試験による解明が必要である. |
| Author | 末田, 泰二郎 中川, 直哉 近藤, 成 村上, 義昭 岡田, 健司郎 上村, 健一郎 |
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| References | 3) Murakami Y, Uemura K, Hashimoto Y, et al. Survival effects of adjuvant gemcitabine plus S-1 chemotherapy on pancreatic carcinoma stratified by preoperative resectablity status. J Surg Oncol 2016; 113: 405-12. 12) Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 2015; 261: 12-7. 5) Murakami Y, Satoi S, Sho M, et al. National Comprehensive Cancer Network Resectability Status for Pancreatic Carcinoma Predicts Overall Survival. World J Surg 2015; 39: 2306-14. 13) Murakami Y, Uemura K, Sudo T, et al. Prognostic impact of normalization of serum tumor markers following neoadjuvant chemotherapy in patients with borderline resectable pancreatic carcinoma with arterial contact. Cancer Chemother Pharmacol 2017; 79: 801-11. 4) Kato H, Usui M, Isaji S, et al. Clinical features and treatment outcome of borderline resectable pancreatic head/body cancer: a multi-institutional survey by the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2013; 20: 601-10. 1) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version 3. 2017 ed 2017. Available from http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf (Accessed December 4, 2017). 2) Murakami Y, Uemura K, Sudo T, et al. Survival impact of neoadjuvant gemcitabine plus S-1 chemotherapy for patients with borderline resectable pancreatic carcinoma with arterial contact. Cancer Chemother Pharmacol 2017; 79: 37-47. 8) Ishii H, Furuse J, Boku N, et al; JCOG Gastrointestinal Oncology Study Group. Phase II study of gemcitabine chemotherapy alone for locally advanced pancreatic carcinoma: JCOG0506. Jpn J Clin Oncol 2010; 40: 573-9. 6) Kondo N, Murakami Y, Uemura K, et al. A phase 1 study of gemcitabine/nab-paclitaxel/S-1 (GAS) combination neoadjuvant chemotherapy for patients with locally advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol 2017; 79: 775-81. 10) Takahashi H, Akita H, Tomokuni A, et al. Preoperative Gemcitabine-based Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer: Impact of Venous and Arterial Involvement Status on Surgical Outcome and Pattern of Recurrence. Ann Surg 2016; 264: 1091-7. 7) Sudo K, Yamaguchi T, Ishihara T, et al. Phase II study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2012; 80: 119-25. 9) Sho M, Akahori T, Tanaka T, et al. Importance of resectability status in neoadjuvant treatment for pancreatic cancer. J Hepatobiliary Pancreat Sci 2015; 22: 563-70. 11) Katz MH, Fleming JB, Bhosale P, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012; 118: 5749-56. |
| References_xml | – reference: 3) Murakami Y, Uemura K, Hashimoto Y, et al. Survival effects of adjuvant gemcitabine plus S-1 chemotherapy on pancreatic carcinoma stratified by preoperative resectablity status. J Surg Oncol 2016; 113: 405-12. – reference: 10) Takahashi H, Akita H, Tomokuni A, et al. Preoperative Gemcitabine-based Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer: Impact of Venous and Arterial Involvement Status on Surgical Outcome and Pattern of Recurrence. Ann Surg 2016; 264: 1091-7. – reference: 9) Sho M, Akahori T, Tanaka T, et al. Importance of resectability status in neoadjuvant treatment for pancreatic cancer. J Hepatobiliary Pancreat Sci 2015; 22: 563-70. – reference: 13) Murakami Y, Uemura K, Sudo T, et al. Prognostic impact of normalization of serum tumor markers following neoadjuvant chemotherapy in patients with borderline resectable pancreatic carcinoma with arterial contact. Cancer Chemother Pharmacol 2017; 79: 801-11. – reference: 2) Murakami Y, Uemura K, Sudo T, et al. Survival impact of neoadjuvant gemcitabine plus S-1 chemotherapy for patients with borderline resectable pancreatic carcinoma with arterial contact. Cancer Chemother Pharmacol 2017; 79: 37-47. – reference: 6) Kondo N, Murakami Y, Uemura K, et al. A phase 1 study of gemcitabine/nab-paclitaxel/S-1 (GAS) combination neoadjuvant chemotherapy for patients with locally advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol 2017; 79: 775-81. – reference: 4) Kato H, Usui M, Isaji S, et al. Clinical features and treatment outcome of borderline resectable pancreatic head/body cancer: a multi-institutional survey by the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2013; 20: 601-10. – reference: 7) Sudo K, Yamaguchi T, Ishihara T, et al. Phase II study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2012; 80: 119-25. – reference: 5) Murakami Y, Satoi S, Sho M, et al. National Comprehensive Cancer Network Resectability Status for Pancreatic Carcinoma Predicts Overall Survival. World J Surg 2015; 39: 2306-14. – reference: 12) Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 2015; 261: 12-7. – reference: 1) National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version 3. 2017 ed 2017. Available from http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf (Accessed December 4, 2017). – reference: 11) Katz MH, Fleming JB, Bhosale P, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012; 118: 5749-56. – reference: 8) Ishii H, Furuse J, Boku N, et al; JCOG Gastrointestinal Oncology Study Group. Phase II study of gemcitabine chemotherapy alone for locally advanced pancreatic carcinoma: JCOG0506. Jpn J Clin Oncol 2010; 40: 573-9. |
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| SubjectTerms | Borderline resectable膵癌 Resectable膵癌 術前療法 |
| Title | 2．BR膵癌の臨床病理学的特徴とその治療戦略 |
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