卵巣悪性腫瘍の疫学・診断 ... - jsog.umin.ac.jp

1 70 70 0500100015002000250030003500400045005000 0100020003000400050006000700080009000100 002010 8,000 4,500 50 8 050010001500200025000-1920-2930-3940-495 0-5960-6970-7980-2010 2 Grade 1-3)

2 Serous, 1819, 35%Clear-cell, 1222, 24%Endometrioid, 868, 17%Mucinous, 559, 11%Others, 672, 13%2113, 50%331, 8%723, 17%494, 12%555, 13%SerousClear-cellEndometrioidMucinousO thers2012 2006 FIGO annual report IntJ GynaecolObstet. 2006 Nov;95 Suppl1:S161-92 ActaObstetricaEt GynaecologicaJaponica. 2004 66 (3) 2015 8 UseCoverageCostCT LN metastasis Distant lesion Recurrence screeningWideLowMRI Local invasiveness Tumor assessmentLocalLowPET/CT Screening of distant metastasis Diagnosis of malignant potentialWideHigh CA125 CA19-9 CA72-4 SCC CEA AFP

3 10cm 10cm CK7+ / CK20-/ CDX2-CK7-/ CK20+/ CDX2+ CK7+--/+++CK20-+++/-+ STIC de novo (HGSC) (LGSC)TP53, BRCA (HGSC)KRAS, BRAF (LGSC) PTEN / PI3 KCAHNF-1b PTEN / b-catenin KRAS* STIC: Serous tubal intraepithelial carcinoma MEDICAL VIEW25 MEDICAL VIEW 40 60 CA125 200 IU/ml 80% III 25-30% HGSC HGSC 50 60 STIC STIC HGSC STIC p53 HGSC) LGSC)

4 90 HGSC HGSC p53 p53 LGSC K-ras BRA HGSCLGSC hobnail A Hodgkin Hodgkin ( ) C B Hodgkin ( ) D : 5 ,2010 PDS vsNAC+IDSEORTC 55971 Primary endpoint: OSSecondary endpoints: PFS, QOL, complicationPDS vsNAC+IDSEORTC 55971 PDS vsNAC+IDSEORTC 55971 Occult Cecelia A.

5 GynecolOncol2009 Stage I: 61%, II: 24% Ser: 25%, Muc: 16%, End: 37%, Clear: 14% 9 pts. / 211 pts. upstaged 2015 CQ04 Staginglaparotomy Ia grade1 grade2 IC grade1 grade2 Ia 2015 ICG2G3 IAICNCCN (2015) ACOG (2007) NDNDESMO (2008) JSGO(2010) JSGO(2014) JCOG (2010) NCCN: Natural Comprehensive Cancer Network (NCCN)ESMO: European Society for Medical OncologyJSGO: Japan Society of Gynecologic OncologyJCOG.

6 Japan Clinical Oncology Group : IA/G1 BentivegnaE, FertilSteril20154312080%20%40%60%80%100% / Extra-ovarianOvarian or 1 2 3 RegimenAuthorYearResponse rate NConventionalPlatinum-basedGoff196617%1/ 6 Sugiyama200011%3/27Ho200427%4/15 Takano200617%5/30 Taxane-PlatinumHo200456%9/16 Takano200632%9/28 Utsunomiya200653%8/15 Irinotecan-cisplatinTakano200630%3/10 Total NCRPRNCPDR esponserate M. GynecolOncol113 (2009)Takano M. J ExpClinCancer Res. (2012)Response to chemotherapy PFS p= OS 15 Arm I n=625 AUC6 175mg/m2 21 Arm III n=623 AUC6 175mg/m2 BEV15mg/kg 3 21 Arm II n=625 AUC6 175mg/m2 16 BEV3 6 3 6 3 6 R n=1,873 III/IV (Burger RA, et al.)

7 N EnglJ Med. 2011; 365: 2473-83)GOG-0218 Burger RA, et al. N EnglJ Med 2011 Months since + BEV BEV maintenance (Arm III)CP (Arm I)+ BEV (Arm II) n 95%CI / III/1cm TCB15 vs. TCPTCB15 vs. TCP510496 IVTCB15 vs. TCPTCB15 vs. TCP317318 III/1cm TCB15 vs. TCPTCB15 vs. TCP423434 GOG0218 (Grade2 ICON7 (Grade2 ) OCEANS 1 GOG0213 %(Grade 1 AURELIA (4/179) 2 AVF2949g (5/44) 3 BEV Patients Platinum-sensitive high-grade serous ovarian cancer 2 previous platinum regimens Maintained PR or CR following last platinum regimenPlacebo(n = 129)Olaparib400 mg BID, orally(n = 136)Primary endpoint PFS by RECISTS econdary endpoints TTP by CA-125 (GCIG criteria) or RECIST, OS, safetyRandomized 1:182 sites in 16 countriesLedermann, et al.)

8 J ClinOncol. 2011;29 (suppl; abstr5003).Ledermann, et al. N EnglJ Med. 2012;366 in Recurrent Ovarian from randomization (months)LedermannJA et al. Lancet Oncol2014 Overall population (n=265)Olaparib(n=136)Placebo(n=129)Even ts: total pts (%)60:136 ( )94:129 ( )Median PFS, CI ( , ); P< of patients progression freeNumber at riskOlaparib 400 mg bidPlacebo1361065324701297224710 Olaparib 400 mg bid monotherapyPlaceboOlaparibis effective as maintenance post-platinum in both BRCA mand wtBRCApts 0102030400-910-1920-2930-3940-4950-5960- 6970-7980- ( ) SEER * 55%) 32%) 13%)

9 760 10 20 * Chan JK, J SurgOncol. 2008 AFP HCG LDH SCC 2015 grading growing teratomasyndrome 1982 Logothetis Growingteratomasyndrome mature teratoma1. 2.

10 3. Growing teratomasyndrome 80 40 60 SCC 10-15 LDH hCG 20~25% 30 18 AFP Schillar-Duval body eosinophilichyaline globule Yolk sac tumor)1.