ேཱྀ䛾᥎⛣䛸ᑗ᮶ேཱྀRESPECT͹HOR
FACTͲG/HADS/PGC/IADL/PNQͶͯ͏ͱฑ੔ਕɼᖔ໨ਜ਼޻ɼઔ‫୕ݬ‬໷ɼ৏ଞ༨ߵཀྵRESPECTStudyGroup㧗㱋໬⋡䠄䠒䠑ṓ௨ୖ䛾๭ྜ䠅z ᫛࿴䠐䠑ᖺ䠈䠓䠊䠍䠂z ᖹᡂ䠓ᖺ䠈䠍䠐䠊䠑䠂 䠄㧗㱋໬♫఍䠅z ᖹᡂ䠍䠕ᖺ䠈䠎䠍䠊䠑䠂䠄㉸㧗㱋໬♫఍䠅2022/10/15୊14յ CSPͲHOR೧ճ㧗㱋⪅ங䛜䜣䛾༨䜑䜛๭ྜ䠈ங䛜䜣Ⓩ㘓㞟ィ䜘䜚⥲ົ┬䝩䞊䝮䝨䞊䝆䜘䜚䠄http://www.stat.go.jp/data/nihon/02.htm䠅

㧗㱋⪅ங䛜䜣䛾⏕≀Ꮫⓗ≉ᛶ䛸䜰䜴䝖䜹䝮¾ Lessaggressive

18.6

18.7

19.2

20.3

20.8

21.6

䞉 ቑṪ⬟䠖ప䞉 䝩䝹䝰䞁ཷᐜయ䛾Ⓨ⌧䠖㧗

Cancer2003;97(6).

䞉 p53Ⓨ⌧ṇᖖ䠖ከ䞉 EGFR,HER2㐣๫Ⓨ⌧䠖పJNatlCancerInst.2000;92(7).

¾ Highmortality䞉 ங䛜䜣䛻䜘䜛⑌⑓≉␗Ṛஸ⋡䛿75ṓ௨ୖ䛷᭱㧗䞉 underͲtreatment䞉 㧗㱋⪅䛷䛿㐍⾜ᮇ䛷䛾Ⓨぢ䛜ከ䛔᪥ᮏங⒴Ꮫ఍ ᖺḟங䛜䜣Ⓩ㘓㞟ィ䜘䜚ᅗ䜢సᡂ䠄http://www.jbcs.gr.jp/member_o/member_o.html䠅

NEnglJMed1986;315(9).

㧗㱋⪅䛻ᑐ䛩䜛⾡ᚋ໬Ꮫ⒪ἲ䛾ᜠᜨ, EBCTCG෌ⓎNͲSASBC07ʁRESPECTࢾ‫ݩ‬υδ΢ϱṚஸ

70ṓ௨ୖ䛻ᑐ䛩䜛ከ๣⸆≀⒪ἲ䛾ᜠᜨ䛿Ͳ ෌Ⓨ䝸䝇䜽ῶ䠈12㼼11%Ͳ Ṛஸ䝸䝇䜽ῶ䠈13㼼12%
(70ṓ௨ୖ䛾๭ྜ䛿䠈඲ゎᯒ౛䛾4%)

NͲSASBC07ʁQOL/PRO඲Ճ͹६ඍ

NͲSASBC07ʁQOL/PRO඲Ճ͹қٝʀ໪దz ઎ߨ‫ڂݜ‬͹Ϫϑϣʖʤ2009/4౲࣎ʥ
Ͳ઎ߨ‫ڂݜ‬ʤ߶ྺ೗͗Ξ‫ं׳‬ɼԿָྏ๑༙ໃ͹QOL඲Ճʁໃ͢ʥ
•IBCSGͲtrialϮ (pN+,CMFvs.HT,߶ྺंγϔմੵ 2000೧)•CALGB 49907(߶ྺ೗͗ΞɼAC/CMFvs.Capecitabine, QoL2011೧)z ઒໵ԿͶซ͚

ʰCGA͹݃Վ͗‫ं׳‬͹༩‫ޛ‬ͶӪ‫ͤڻ‬ΖՆ೵੓΍͍Εɾ࣑ྏ๏๑મ୔͹ࢨඬͳ͵ΖՆ೵੓͍͗Ζɽʱ(1) ྡজබ‫ غ‬IʛIIIA͹‫ݬ‬൅੓೗͗ΞͶ͕͏ͱɾφϧηςθϜϔୱಢྏ๑‫ͳ܊‬φͲ ߶ྺं૱߻ద‫ؽ‬೵඲Ճ(CGA)͹॑གྷ੓ʤ౨‫ښ‬୉ָͲ CGA͹ϪϑϣʖɼϪϑϣʖ࿨ชʰHʶCT‫܊‬ͺɾH‫܊‬Ͷർ΄QOL͹Ӫ‫͗ڻ‬ଡ୉Ͳ͍Ζͳ༲ҝͶਬࡱ͠ΗΖ͗ɾྈ‫܊‬Ͷ͕͜Ζਐର໚ɾ੠ਈৼཀྵ໚ɾऀճ໚ɾ‫ؽ‬೵໚Ͳ͹୻‫غ‬దʀௗ‫غ‬దࠫҡͳਬҢΝՌָదͶ‫ͤৄݗ‬Ζ͞ͳɽɽɽʱ߶‫౐ڰ‬઎ਫ਼ʥ(TairaNetal.BreastCancer2010)z ࿟͏Ͷͯ͏ͱָ΁Ͳ ਦॽ‫ؙ‬Ͷ௪͑ɼϚʖϲΧϭʖϩʲ࿟͏ʳϧηςθϜϔ+Կָྏ๑ญ༽ྏ๑‫ͳ܊‬͹HRQOLɾ߶ྺं૱߻ద‫ؽ‬೵Ͷ‫ͤ·ٶ‬Ӫ‫ڻ‬͹૮ҩΝ໎Δ͖ͶͤΖɽ(2) ߶ྺ೗‫ं׳ؠ‬͹HRQOL,߶ྺं૱߻ద‫ؽ‬೵͹೼ѴΝߨ͏ɾࠕ‫ޛ‬͹߶ྺ೗‫ؠ‬‫ं׳‬͹࣑ྏࢨਓΏࢩԋର੏͹੖ඍͶༀཱིͯ৚ๅΝಚΖɽHER2ཇ੓͹߶ྺं‫ݬ‬൅੓೗‫ؠ‬ͶଲͤΖढ़‫ྏঁึޛ‬๑Ͷ͕͜ΖφϧηςθϜϔୱࡐͳԿָྏ๑ญ༽͹ϧϱξϞԿർֳࢾ‫ݩ‬NͲSASBC07: QOLϏ΢ϫρφࢾ‫ݩ‬NͲSASBC07ʁQOL/PRO඲Ճ‫ܯ‬ժౌ࿧࣎ʤಋқखಚʛౌ࿧ධFAXૻ৶઴ʥ˕

ऊౕ

FACTͲGϕϫφαʖϩ
࣑ྏ֋࢟2ϴ݆‫ޛ‬ϕϫφαʖϩ࣑ྏ֋࢟1೧‫ޛ‬ϕϫφαʖϩ
࣑ྏ֋࢟3೧‫ޛ‬˕˕˕z 2008೧೗͗Ξघढ़ྭɼ70ࡂҐ৏25໌Νଲেͳͪ͢QOLϏ΢ϫρφࢾ‫ݩ‬z ௒ࠬߴ໪ʁ௒ࠬ࣎ؔɼυʖνܿ଎ɼช࣊γ΢θɼෝ୴‫״‬ɼ௒ࠬ͹қٝ౵ฑ‫ۋ‬೧ྺ75.2ࡂɼ௒ࠬ࣎ؔฑ‫ۋ‬34෾ʤ12Ͳ60෾ʥ

HADS˕

˕

˕

˕

EQͲ5D

˕

˕

˕

˕

PNQ˕

˕˕˕࿟‫׈ࣞݜ‬ಊ೵ྙࢨඬ

˕

˕

˕

FACTͲG

3.75/2714%

23

MMSE*˕˕

˕

HADS

0/140Ͳ˕˕

˕

EQͲ5D0/50Ͳ

PGCϠϧʖϩηίʖϩ

PNQ

0.25/212.5%

2ऀճ‫׈‬ಊ੓͹௒ࠬ˕˕˕⪁◊ᘧάື⬟ຊᣦᶆ

0/130Ͳ♫఍άືᛶ

0/20Ͳ

PGC䝰䝷䞊䝹䝇䜿䞊䝹

0/170Ͳෝ୴͵͚௒ࠬՆ೵͵͹͖ʃ ͹қ‫ݡ‬ྛᑻᗘ䛾䝕䞊䝍Ḟㄪᰝ⚊Ḟ ᩘᖹᆒ/㡯┠ᩘḞ⋡ (%)᭱ከḞᩘೖຌ೗‫ָؠ‬ճָढ़ॄճ2009,ฑ,ᖔ໨ ଠ

FACTͲGܿ଎͹Ϗνʖϱช࣊γ΢θෝ୴‫״‬ෝ୴ͺ͵͏գ‫̕ڊ‬ೖؔΝଲেͶɼࣙ෾͹յ౶ͳ͢ͱ࠹΍నͪ͢൬ߺΝ֦ߴ໪Ͷͯ͘Ҳͯમ;ɼ˕ͲҕΞͲ͚ͫ͠͏ɽෝ୴ͺ͍Ζ͗౶͓ΔΗΖಝͶ໲ୌ͵͏ঘ͠͏͗౶͓ΔΗΖঘ͙ͤ͠ͱ౶͓ΔΗ͵͏ෝ୴͗୉͚͘౶͓ΔΗ͵͏

13%

㻺㼛㻚㌟య

♫఍⢭⚄άືḞ୙㐺᱁㻟 㻟 㻟 㻜 㻟 㻞 㻞㻜㻜㻝 㻝 㻠 㻠㻞 㻝 㻝 㻝 㻜 㻝 㻜㻡㻝㻟㻜 㻜 㻜 㻝㻠 㻠 㻠 㻠 㻠 㻠 㻠㻜㻜㻞㻜 㻜 㻜 㻝㻟 㻟 㻞 㻠 㻟 㻟 㻞㻜㻜㻞㻡㻜㻠㻞㻡㻜㻝 㻞 㻟 㻠 㻡 㻢 㻣㻝㻞㻟㻠㻡㻢 㻣 㻤 㻥 㻝㻞㻟 㻠 㻡 㻢 㻝 㻞 㻟 㻠 㻡 㻢 㻣㻜 㻜 㻜 㻜 㻜 㻜 㻜㻟㻟㻟㻞㻜㻜 㻜 㻟 㻜 㻝㻜㻜 㻜 㻝 㻜㻟㻝 㻞 㻝㻝㻞㻞㻜㻘㻞㻜 㻟 㻜 㻜 㻟㻜㻠㻜 㻜 㻜 㻞 㻜 㻜 㻜㻠㻠㻠㻠㻟㻠 㻠 㻠 㻜 㻜㻡㻜 㻜 㻜 㻜 㻜 㻝 㻜㻟㻠㻜㻜㻜㻜 㻟 㻜 㻜 㻜㻝
㻞87%100%㻜㻢㻟㻞㻣㻝㻤㻝 㻜 㻜 㻝 㻜 㻝 㻜㻟㻟㻟㻞㻝㻠㻟㻠㻟㻟㻠㻟 㻟 㻟 㻜 㻜㻠㻜 㻝 㻜 㻝㻟 㻞 㻟 㻟 㻟 㻟 㻞㻜㻜㻥㻜 㻜 㻝 㻜 㻜 㻝 㻜㻠㻜㻠㻠 㻠 㻠 㻜 㻜㻟㻜 㻜 㻞 㻟㻞 㻞 㻟 㻟 㻠 㻟 㻟㻜㻜㻝㻜㻜 㻜 㻜 㻜 㻜 㻜 㻜 㻞㻚㻠 㻟 㻝㻚㻞㻜㻜㻚㻠 㻠 㻠 㻠 㻜 㻜㻠㻜 㻜 㻜 㻞㻠 㻠 㻟 㻠 㻞 㻞 㻠㻜㻟㻝㻝㻞 㻜 㻝 㻞 㻜 㻜 㻜㻞㻟㻟㻠㻠㻠 㻠 㻠㻜㻜㻜 㻜 㻜 㻝㻟 㻟 㻟 㻠 㻠 㻠 㻠㻝㻜㻝㻞㻞 㻝 㻜 㻜 㻞 㻝 㻝㻝㻟㻟㻜㻠㻟 㻟 㻟 㻜 㻞㻞㻝 㻝 㻞 㻟㻟 㻞 㻞 㻟 㻞 㻝 㻟㻜㻜㻟㻠㻞㻝㻟㻝 㻠 㻠 㻜 㻞㻞㻜 㻝 㻜 㻝㻠 㻠 㻠 㻠 㻟 㻠 㻠㻣㻜㻝㻟㻝㻠㻜 㻜 㻜 㻝 㻜 㻜 㻜㻟㻠㻠㻟㻠㻠 㻠 㻠 㻜 㻝㻝㻜 㻝 㻜 㻞㻟 㻟 㻟 㻟 㻠 㻟 㻟㻜㻜㻝㻡㻜 㻜 㻜 㻜 㻜 㻜 㻜㻠㻠㻞㻞㻠㻠 㻠 㻠 㻜 㻜㻠㻜 㻜 㻜 㻝㻠 㻠 㻠 㻠 㻠 㻠 㻠㻜㻜㻝㻢㻝 㻜 㻝 㻟 㻜 㻝 㻜㻞㻟㻟㻝㻟㻞 㻟 㻟 㻜 㻞㻞㻜 㻝 㻜 㻝㻟 㻟 㻟 㻟 㻠 㻠 㻠㻜㻜㻝㻣㻟 㻜 㻞 㻝 㻜 㻟 㻝

㻟㻠㻠

㻠

㻠

㻟 㻠 㻠 㻜 㻝 㻝㻚㻟 㻜 㻝㻞 㻟 㻟 㻟 㻠 㻟 㻟㻝㻝㻜௒ࠬධ͹‫ى‬೘ͶɾͫΗ͖͹ঁ͜Νචགྷͳ͢Ή͖ͪ͢ʃ͏͏͓ͺ͏͞͹Γ͑͵௒ࠬ͗સࠅదͶߨΚ
ΗΖ͞ͳΝʹ͑‫ͣ״‬Ή͖ͤʃ୉઀͵௒ࠬͲ͍Εɾߨ͑͹͗Γ͏ಝͶ‫͏͵ͣ״‬ߨ͑΄͘Ͳ͵͏

13%

19%
87%

81%

JClinOncol.2021;39GlobalQoL:FACTͲGtotal

JClinOncol.2021;39ਐରɼऀճɼৼཀྵɼ‫ؽ‬೵χϟ΢ϱ߶ྺं͹क؏ద߀ෳ‫״‬ʁPGCMS

JClinOncol.2021;39෈҈ʀཊ͑ͯʁHADS

JClinOncol.2021;39࿓ࡠ੓‫׈‬ಊ೵ྙʁTMIGͲICJClinOncol.2021;39JClinOncol.2021;39Կָྏ๑༢൅੓຦঩ਈ‫্֒ܨ‬ʁPNQ

RESPECT͹HORʁགྷ༁z 70Ͳ80ࡂɼHER2ཇ੓೗͗Ξ‫ं׳‬ͶଲͤΖTrastuzumab+Կָྏ๑ͺ
Trastuzumabୱಢྏ๑Ͷർ΄Ͳ ࣑ྏ‫̏ޛ‬೧໪ΉͲɼસൢద͵QOL͹ѳԿׄ߻͗߶͚ɼಝͶͨ͹Ӫ‫ڻ‬ͺɼਐରʀ‫ؽ‬೵χϟ΢ϱͶ୉͘͏Ͳ ಋ༹Ͷɼ෈҈ʀཊ͑ͯɼक؏ద߀ෳ‫״‬ɼIADLɼԿָྏ๑༢൅੓຦঩ਈ‫্֒ܨ‬Ͷ୻‫غ‬ద͵ѳӪ‫ڻ‬Ν‫ͤ·ٶ‬Ͳ ࣑ྏ‫ޛ‬3೧఼࣎Ͳͺɼྈ‫ؔ܊‬Ͷࠫ͗೟ΌΔΗ͵͏ɽJClinOncol.2021;39߶ྺं͹͗Ξ࣑ྏͳQOL:CALGB49907Ӎ65ɾStageϨͲϪA,AC,CMFvs.Capecitabine(N=600)߶ྺ͗Ξ‫ं׳‬͹࣑ྏમ޹͹ಝ௅̐̒̒ྭ͹͗Ξ‫ं׳‬Νଲেͳ࣯ͪ͢ద‫͖ڂݜ‬Δz Կָྏ๑͹ण༲Ͷ‫ͱؖ͢‬ɾ߶ྺंͳऑ೧ंͶ૮ҩͺ͵͏z ͖͢͢ɾSurvivalbenefitͳQOLͳ͹ώϧϱηͶ͕͏ͱͲ ऑ೧ंͺQOLͳӀ͘‫͓׷‬ͶɾΓΕSurvivalbenefitΝ॑ࢻඬ६࣑ྏͶΓΖਫ਼ଚ‫ؔغ‬Ԉௗ͹οϡϱηΝಚΖେঊͺɾ୻‫ؔغ‬͹QOLఁԾͲ͍ΖMussHBetal.NEJM2009

Korn AMetal.JCO2011Ͳ ߶ྺंͺSurvivalbenefitͳӀ͘‫͓׷‬ͶɾQOLң࣍Ν॑ࢻYellen SBetal.JNatl CancerInst,1994⾡ᚋ໬Ꮫ⒪ἲ䛾ᜠᜨ䛸୙฼┈㧗㱋⪅䛻ᑐ䛩䜛⾡ᚋ໬Ꮫ⒪ἲ䛾ᜠᜨz ⾡ᚋ໬Ꮫ⒪ἲ䛾ᜠᜨ䛜♧䛥䜜䛴䛴䛒䜛䝞䝷䞁䝇䛿䠈ຍ㱋䛻䜘䜚ᙳ㡪䜢ཷ䛡䜛ᝈ⪅䛾㑅ዲz 䛧䛛䛧䠈௒䜎䛷䛾ヨ㦂䛻ཧຍ䛧䛯㧗㱋⪅䛿䠈㧗ᗘ䛾㑅ᢥ䜢ཷ䛡䛯ᝈ⪅䛷䛒䜚䠈୍⯡䛾㧗㱋⪅෌Ⓨ䞉Ṛஸ䝸䝇䜽䛾పୗᝈ⪅䛾㑅ዲ๪స⏝䞉䠭䠫䠨་⒪⪅䜔ᐙ᪘䛾㑅ዲ෌Ⓨ䞉Ṛஸ䝸䝇䜽䛾పୗ๪స⏝䞉䠭䠫䠨ẕ㞟ᅋ䜢௦⾲䛩䜛䜒䛾䛷䛿䛺䛛䛳䛯䠊ຍ㱋їヨ㦂⤖ᯝ䜢୍⯡໬䛩䜛䛣䛸䛿䛷䛝䛺䛔•••••NCCN䜺䜲䝗䝷䜲䞁䠈㧗㱋⪅䛾䛜䜣἞⒪䜘䜚ᘬ⏝㧗㱋ங䛜䜣ᝈ⪅䛾἞⒪㑅ᢥ⏕࿨ணᚋ䛾▷⦰⮚ჾᶵ⬟పୗ⮬❧ᛶ㑅ዲ䛾ኚ໬♫఍ⓗ䝃䝫䞊䝖㧗㱋⪅⥲ྜⓗᶵ⬟ホ౯ComprehensiveGeriatricAssessment(CGA)z 㧗㱋ங䛜䜣䛾἞⒪㑅ᢥ䛻䛚䛡䜛䜶䝡䝕䞁䝇䛾ḞⴠͲ 㧗㱋⪅䛿䚸ẚ㍑⮫ᗋヨ㦂䛷䛧䜀䛧䜀㝖እͲ ἞⒪䛾ᜠᜨ䛸䝸䝇䜽䜢䛭䛾䜎䜎㐺ᛂ䛧䛶Ⰻ䛔䛛䠛Ͳ ⌧᫬Ⅼ䛷䛾἞⒪ཎ๎䛿䚸㠀㧗㱋⪅ྠᵝ䛾἞⒪䜢⾜䛖䛣䛸z 㧗㱋⪅䛾἞⒪㑅ዲͲ ⏕Ꮡᮇ㛫䜘䜚䚸⮬❧䛧䛯⏕ά䞉QoL䜢㔜ど䛩䜛ഴྥͲ ᐙ᪘䛾ពྥ䛜ᙳ㡪z ೺ᗣ≧ែ䛾୙ᆒ୍ᛶͲ ᇶ♏⑌ᝈ䞉ేᏑ⑕䚸Ͳ ⏕࿨ணᚋ䛾┦㐪Ͳ ἞⒪䛻క䛖᭷ᐖ஦㇟z ೧ɾӵࠅ ࣮බ඲ՃͶཻΉΔͥɾ߶ྺं͹য়ସΝଡ෾໼͖Δ඲Ճ
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