ONONONON

Focus Report

ONONONON Vol. 2੃≸䈱ᴦ≮ᣇ㊎᳿ቯ䈮㊀ⷐ䈭∛ℂቇ⊛Evidence䇭੹ᣣ䈱੃≸ᴦ≮䈲䇮⑼ቇ⊛ᩮ᜚䉕ᛠី䈚䈢਄䈪䇮୘䇱䈱ᖚ⠪䈘䉖䈱ᴦ≮ᣇ㊎䉕᳿䉄䈩䈇䈒䈖䈫(EBM䋺Evidence Based Medicine)䈏㊀ⷐⷞ䈘䉏䈩䈇䉁䈜䇯䇭੃≸䈱ᴦ≮䈮៤䉒䉎਎⇇ਛ䈱ක≮ᓥ੐⠪䈮䇮ᦨ䉅ᵈ⋡䈘䉏䈩䈇䉎St. Gallen࿖㓙ળ⼏䈪䈲䇮2005ᐕ1᦬䈱䉮䊮䉶䊮䉰䉴䊚䊷䊁䉞䊮䉫䈮䈍䈇䈩䇮ⴚᓟᖚ⠪䈱ౣ⊒䊥䉴䉪䉕ಽ㘃䈚䈢䊥䉴䉪䉦䊁䉯䊥䊷䉕್ᢿ䈜䉎੍ᓟ࿃ሶ䈮䇮HER2ㆊ೾⊒⃻/ㆮવሶჇ᏷䈱᦭ή䈫⣂▤ᶐẢ䈱᦭ή䈏ㅊട䈘䉏䉁䈚䈢䇯䈠䈱ઁ䇮Evidence䈫䈭䉎੍ᓟ࿃ሶ䈲䇮∛ℂᬌᩏ⊛䈭㗄⋡䈏ᱴ䈬䈪䈅䉍䇮ⴚᓟᖚ⠪䈱ᴦ≮ᣇ㊎䈱᳿ቯ䈮∛ℂᬌᩏ䈏䈫䈩䉅ᄢಾ䈭ᓎഀ䉕ᜂ䈦䈩䈇䉁䈜䇯䇭䈖䈖䈪䈲᧲ർᄢቇ∛㒮∛ℂㇱ䈱᫪⼱ ථ਽వ↢䈮䇮St. Gallen 䉮䊮䉶䊮䉰䉴䊚䊷䊁䉞䊮䉫2005䈱ᖱႎ䉕䈸䉁䈋䉁䈚䈩䇮੃≸䈱ᴦ≮ᣇ㊎᳿ቯ䈮㊀ⷐ䈫䈭䉎∛ℂᬌᩏ⊛㗄⋡䈮䈧䈇䈩䈗ၫ╩䉕㗂䈐䉁䈚䈢䇯

CONTENTS੃≸ߦኻߔࠆ∛ℂቇ⊛ᖡᕈᐲ್ቯ㧧 ఺∉⚵❱ൻቇᨴ⦡ࠍ฽߼ߡ᧲ർᄢቇ∛㒮‫∛ޓ‬ℂㇱ‫ޓޓ‬᫪⼱ථ਽੃≸ߦኻߔࠆ∛ℂቇ⊛ᖡᕈᐲ್ቯ㧧఺∉⚵❱ൻቇᨴ⦡ࠍ฽߼ߡ᧲ർᄢᄢቇ∛㒮‫ޓ‬ቇ∛㒮‫∛ޓ‬ℂㇱ᫪⼱ථ਽ߪߓ߼ߦ‫ᧄޓ‬㇌ߩ੃≸ᖚ⠪ᢙߪჇടߩ৻ㅜࠍߚߤߞߡ߅ࠅ‫ޔ‬ᅚᕈߦ⿠ߎࠆ≸ߩ⤳ེ೎⟕ᖚ₸ߩ╙৻૏ࠍභ߼ߡ޿ࠆ‫ޕ‬ᬌ⸻ߦࠃࠆᣧᦼ⊒⷗ߦ઻ߞߡ‫ޔ‬ㅴⴕᐲߩૐ޿ᣧᦼߩ≸߇⊒⷗ߐࠇࠆ㗫ᐲ߇Ⴧߒߡ޿ࠆ‫ޔߚ߹ޕ‬㊎↢ᬌߩዉ౉‫੃ޔ‬ᚱ᷷ሽ≮ᴺߩቯ⌕‫↢▵ࡄࡦ࡝࡞ࡀ࠴ࡦ࠮ޔ‬ᬌ‫ⴚߪ޿ࠆ޽ޔ‬ᓟ⵬ഥ≮ᴺߩ⊒ዷߥߤߦ઻ߞߡ‫∛ޔ‬ℂᬌᩏߦ᳞߼ࠄࠇࠆ੐㗄߽߹ߔ߹ߔᄙ᭽ൻ࡮ⶄ㔀ൻߒߡ޿ࠆߩ߇ታᖱߢ޽ࠆ‫ޕ‬‫੹ޓ‬࿁ߪ‫ޔ‬ᚻⴚᮡᧄߦ߅޿ߡ‫≸ޔ‬㧔․ߦᶐẢᕈ੃≸㧕ߩ∛ℂ⸻ᢿࠍⴕ߁㓙ߦႎ๔߇᳞߼ࠄࠇߡ޿ࠆ࿃ሶࠍ⺑᣿ߒ‫❱⚵∉఺ߦ․ޔ‬ൻቇ⊛ᬌᩏ߇ᔅ㗇ߢ޽ࠆ߽ߩߦߟ޿ߡ‫↪᦭ߩߘޔ‬ᕈߦߟ޿ߡㅀߴࠆ‫ࡋߪߢ⁁⃻ޔߚ߹ޕ‬ࡑ࠻ࠠࠪ࡝ࡦ࡮ࠛࠝࠫࡦᨴ⦡ߦࠃࠅ್ቯࠍⴕߞߡ޿ࠆ߇‫੹ޔ‬ᓟ‫❱⚵∉఺ޔ‬ൻቇߩᔕ↪߇ᦼᓙߐࠇࠆ㗄⋡ߦ㑐ߒߡ߽᭎⺑ࠍⴕ߁‫ޕ‬੃≸ߩᖡᕈᐲ⹏ଔ㧦St. Gallen Consensus Meeting 2005ࠍ߰߹߃ߡ‫∛ޓ‬ℂቇ⊛ߦ≸ߩ⸻ᢿ߇ߥߐࠇߚ႐ว‫ޔ‬ේ⊒ 2) ࠣ࡟࡯࠼ಽ㘃߇ߥߐࠇߡ޿ࠆ႐วߦߪ‫ޔ‬ߘߩォ⒖୘ᢙߩ߶∛Ꮍߦኻߒߡߪ⚵❱ဳ್ቯߣ‫ޔ‬ߘߩ߶߆᭽‫࠼࡯࡟ࠣޓ ޘ‬㧔⇣ဳᐲ㧕ߦߟ޿ߡߪ‫ޔ‬ᩭ⇣ဳᐲ ߁߇࡝ࡦࡄ▤ଚⷅࠃࠅ᦭↪ߥ੍ᓟ࿃ሶߢ޽ߥᖡᕈᐲ⹏ଔ߇ታᣉߐࠇ‫ޔ‬୘‫ ߌ߅ߦ଀∝ߩޘ‬㧔⚦⢩⇣ဳᐲ㧕߹ߚߪ⚵❱ቇ⊛⇣ဳᐲߩ޿ߕ ࠆߎߣߪ⸒߁߹ߢ߽ߥ޿‫ޕ‬ߒ߆ߒ‫▵ࡄࡦ࡝ޔ‬ࠆ≸ߩ․ᕈ߇⹏ଔߐࠇࠆ‫ޕ‬ᰴ޿ߢ‫ޔ‬ᐢ߇ࠅ⸻ ࠇ߆ࠍ↪޿‫ޔ‬1 ᐲ㧔シᐲ㧕㧔࿑ 2㧕
ߣ 2-3 ᐲ㧔ਛ╬ ォ⒖㒶ᕈ଀ߦ߅ߌࠆ࡝ࡦࡄ▤ଚⷅ㓁ᕈ௝ߩᢿ㧔࡝ࡦࡄ▵ォ⒖ߩ᦭ή߿‫ޔ‬᷷ሽᚻⴚ଀ߦ߅ ᐲ߆ࠄ㜞ᐲ㧕ⴚᓟߩ੍ᓟ࿃ሶࠍផቯߔࠆ਄ߢᬌ⚝㧔࿑ 3‫ޔ‬4㧕ߦಽߌࠆ‫ޕ‬․ቯߩၮḰߦ ᛠីߪ‫ޔ‬ߌࠆಾ㒰ᢿ┵ߩ⹏ଔ㧕߇ⴕࠊࠇ‫ޔ‬ᚻⴚߩᅷᒰ 㒢ቯߒߡㅀߴࠄࠇߡߪ޿ߥ޿߇‫ޔ‬߹ࠊ߇࿖ߦ߅ ߒߡ߅ߊଔ୯߇ᱷߐࠇࠆࠃ߁ߦᕁࠊࠇࠆ‫ޕ‬ᕈߦ㑐ߔࠆᬌ⸽ࠍⴕ߁‫ޕ‬ߘߒߡ‫ߦ⊛⚳ᦨޔ‬ਔ ޿ߡߪ੃≸ขᛒ޿ⷙ⚂╙ 15 ߢ߽⚫੺ߐࠇ ߚ‫੃ޔ‬ᚱ᷷ሽᚻⴚߦ߅޿ߡߪ‫▤ࡄࡦ࡝ޔ‬ଚⷅ⠪ࠍ૬ߖߚ∛ℂႎ๔ᦠ߇૞ᚑߐࠇࠆߩ߇ㅢ ߡ޿ࠆ N࡮SAS࡮BC ߦࠃࠆᩭࠣ࡟࡯࠼ಽ ௝ߩሽ࿷ߪዪᚲౣ⊒࿃ሶߩ৻ߟߣߒߡᵈ⋡଀ߢ޽ࠆ‫ޕ‬ਛ╬ᐲએ਄ߩ㓁ᕈ଀ߢߪⴚᓟ
㘃 3㧕߿‫ޔ‬Nottingham ߩ⚵❱ቇ⊛⇣ဳᐲಽ㘃 4) ߔߴ߈ߢ޽ࠅ‫ޔ‬߇⦟ߊ↪޿ࠄࠇߡ߅ࠅ‫ޔ‬ߘࠇࠄߩ৻ᣇ߹ߚߪ ᡼኿✢㕖ᾖ኿ߩㆡᔕߣߪߥࠅߦߊ޿ߣ⠨߃a. ⚵❱ဳಽ㘃ߩᗧ⟵6㧕‫ޔߪߡ޿ߟߦဳ❱⚵ޓ‬㕖ᶐẢ≸㧔㕖ᶐẢᕈ੃ ਔᣇࠍ⸥タߔࠆߎߣ߇ᦸ߹ߒ޿‫ޕ‬N࡮SAS࡮ ࠄࠇߡ޿ࠆ‫▤ࡄࡦ࡝ ޕ‬ଚⷅߩ఺∉⚵❱ቇ⊛⹏ଔߦߟ޿ߡߪᓟㅀߔࠆ‫ޕ‬߹ߚ‫ޔ‬㕒⣂ଚⷅߦBCߢߪ‫ޔ‬‫ޟ‬ᩭࠣ࡟࡯࠼‫ޠ‬ߣߪᩭ⇣ဳ
㧔nuclear▤≸߹ߚߪዊ⪲≸㧕‫ޔ‬ㅢᏱဳߩᶐẢᕈ੃▤≸‫ޔ‬㆙㓒ォ⒖ߩᜰᮡߣߥࠅ߁ࠆߎߣ߇
․ᱶဳ੃≸‫ߦ∛࠻࠶ࠚࠫࡄޔ‬ᄢ೎ߐࠇࠆ‫ޕ‬ࠊ atypia㧕ࠬࠦࠕ߅ࠃ߮ᩭಽⵚ௝ࠬࠦࠕࠍߘࠇ 㑐ߒߡߪ‫ޔ‬ᮡḰߣߥࠆᬌ⚝ᣇᴺ߿ࠇࠊࠇߩᣉ⸳ߦ߅ߌࠆ⚵❱ဳߩಽᏓࠍ⴫ 1 ߙࠇ 3 Ბ㓏ߦ႐วಽߌߒ‫✚ࠍࠄࠇߎޔ‬วߒߚ චಽߦ੍ᗐߐࠇࠆ߇‫ޔ‬⃻‫ޠ࠼࡯࡟ࠣޟ‬ߣ๭⒓ߒߡ߅ࠅ‫⹏ ޔ‬ଔᣇᴺߩ⏕┙߇ߥߐࠇߡ޿ߥ޿ߚ߼ߦ‫ޔ‬ߦ␜ߒߚ‫ޕ‬
ߎߩ߁ߜ․ᱶဳߪ‫ޔ‬Ყセ⊛⒘ߥ⣲ ߽ߩࠍᦨ⚳⊛ߦ
5㧕≌ߢߪ޽ࠆ߇‫ޔ‬ߘࠇߙࠇߩ․ᓽ⊛∛ℂ⚵❱௝ ↪⺆ߩᷙੂࠍ㒐ߋᎿᄦ߇ߥߐࠇߡ޿ࠆ‫ᤨ ․ ޕ‬ὐߢߪᬌ⚝ߩᔅⷐᕈߦߟ޿ߡ߶ߣࠎߤ⺰⥄૕߇੍ᓟ࿃ሶ߿ᐢ߇ࠅᣇߩ㕙ߢ․⇣⊛ߥ ᱶဳ੃≸ߦ߅޿ߡ⇣ဳᐲಽ㘃ࠍⴕ߁ߴ߈߆ ߓࠄࠇߡ޿ߥ޿‫ޕ‬⃻ᤨὐߢߪචಽߥࠦࡦ࠮ࡦࠨࠬ 4) ࡝ࡦࡄ▵ォ⒖߽ߩߢ޽ࠆ㧔࿑ 1㧕‫ޕ‬৻ᣇ‫ో≸੃ޔ‬૕ߩ 70㧑⒟ ߦߟ޿ߡߪ‫ޔ‬ߥ߅‫❱⚵∉఺ޔ‬ቇ⊛ߦ ‫▵ࡄࡦ࡝ޓ‬ォ⒖ߩ᦭ήߪ‫ޔ‬ᐲࠍභ߼ࠆᶐẢᕈ੃▤≸ߪ‫ޔ‬ᧄ㇌ߢߪ੃㗡⣼ ߇ᓧࠄࠇߡ޿ߥ޿‫ޕ‬੃≸ߩ੍ᓟߦ⋥⚿▤≸‫ޔ‬లታ⣼▤≸‫ ߩ≸⎬ޔ‬3 ߟߦ੝ಽ㘃ߐࠇ Ki-67 ߩᨴ⦡ࠍⴕߞߡ⇣ဳᐲࠍᬌ⚝ߔࠆᣇ ߔࠆᦨ߽㊀ⷐߥ࿃ሶߩ৻ߟߣ⠨߃ࠄࠇߡ޿ߡ߅ࠅ‫ޔ‬࡝ࡦࡄ▵ォ⒖⁁ᴫࠃࠅߪᒙ޿ߥ߇ࠄ ᴺߪฃߌ౉ࠇࠄࠇߡ޿ߥ޿‫ޕ‬ࠆ‫ޕ‬ᓥ᧪ߪォ⒖ߩ᦭ήߦࠃࠅಽ㘃ߐࠇߡ޿ߚ߽‫ޔ‬੍ᓟࠍⷙቯߔࠆ࿃ሶߩ৻ߟߢ޽ࠆߎߣ߽ 3) ⣂▤ଚⷅ߇‫ޔ‬
2005 ᐕ ߢߪォ⒖୘ᢙ
㧔1-3 ୘߹ߚߪ 4 ୘1)⸽᣿ߐࠇߡ޿ࠆ‫ޕ‬
߽㊀ⷐⷞߐࠇߚ‫ޕ‬߹ߚ‫ޔ‬ᓸዊォ⒖
㧔2mm‫ޓ‬⣂▤ᶐẢߦ㑐ߒߡߪ‫ޔ‬⣲≌ㄝ✼ㇱಽߦ߅ߌ એ਄㧕߿ቅ┙⚦⢩ᕈߩォ⒖ߪ੍ᓟ
ࠆଚⷅ௝ߩߎߣࠍᜰߒߡ߅ࠅ‫ޔ‬․ߦ࡝ࡦࡄ▤ ᓘᧂḩߩォ⒖Ꮍ㧕
b. St. Gallen 2005 ߦࠃࠆ࡝ࠬࠢಽ㘃⃻ᤨ࡝ࡦࡄ▤ଚⷅ ߦᓇ㗀ࠍਈ߃ࠆߣ⸒޿㔍޿ߎߣ߆ࠄ 7㧕‫ޔ‬‫ޔߦࠄߐޓ‬ⴚᓟߩᴦ≮ᣇ㊎ࠍ᳿ቯߔࠆߚ߼ߦ ଚⷅߩߎߣࠍ㊀ⷐⷞߒߡ޿ࠆ‫ޕ‬ὐߢߪߘࠇࠄߩሽ࿷ߦࠃߞߡ࡝ࠬࠢࠞ࠹ࠧ
ࠍ⣲≌ߩౝㇱߢ⷗಴ߔߎߣߪᭂ߼ߡ㔍ߒߊ‫ޔ‬ߪ‫ޔ‬᭽‫⥃ߥޘ‬ᐥ∛ℂቇ⊛࿃ሶ߇㑐ࠊߞߡ޿ࠆ
⣲≌ߩవㅴㇱߢ޽ࠆㄝ ࡝࡯ࠍᄌᦝߔࠆߎߣߪߥ޿‫ޕ‬߇‫ޔ‬࿖㓙⊛ߥࠦࡦ࠮ࡦࠨࠬߩ႐ߣߒߡ㓒ᐕߦ ઁ⤳ེߩ≸ߣห᭽ߦ‫ޔ‬✼ㇱಽߢߩ್ᢿ߇᳞߼ࠄࠇࠆ‫ޕ‬࡝ࡦࡄ▵ㇳᷡታᣉߐࠇߡ޿ࠆ St. Gallen ળ⼏߇ 2005 ᐕ 1᦬ߦࠬࠗࠬߩࠩࡦࠢ࠻ࠟ࡟ࡦߢ㐿௅ߐࠇ‫ޔ‬ࠕ࠶ࡊ࠺࡯࠻߇ⴕࠊࠇ‫ߩߘޔ‬ౝኈߪᄙዋߩୃ
⴫ 1 ේ⊒ᕈ੃≸ߩ⚵❱ဳ2㧕ᱜࠍ⚻ߡ‫ޔ‬Annals of Oncology ߦឝタߐࠇߚ‫ޕ‬㧔᧲ർᄢቇ∛㒮∛ℂㇱ‫ޔ‬2002 ᐕ 6 ᦬㨪 2005 ᐕ 9 ᦬‫ޔ‬1,368 ∝଀㧕‫ ⴫ߪ࡯࡝ࠧ࠹ࠞࠢࠬ࡝ޓ‬2 ߩᅤߊ 3 Ბ㓏ߦಽ㘃ߐࠇߚ‫ޕ‬ߎߩਛߦ⸥タߐࠇߡ޿ࠆ࿃ሶߩ
㕖ᶐẢᕈ੃▤≸
㧔DCIS㧕
225 (16.4%)㕖ᶐẢ≸ 233 (17.0%)߁ߜᐕ㦂ࠍ㒰ߌ߫⣲≌ᓘ‫ဳ⇣ޔ‬ᐲ㧔ࠣ࡟࡯
DCIS+LCIS2 (0.1%)࠼㧕‫ޔ‬⣂▤ଚⷅ‫ޔ‬HER2/neu‫▵ࡄࡦ࡝ޔ‬ォ⒖⁁ᴫ㕖ᶐẢᕈዊ⪲≸ (LCIS) 6 (0.4%)
ߪ޿ߕࠇ߽∛ℂቇ⊛ߦ⹏ଔߐࠇࠆߴ߈߽ߩ
੃㗡⣼▤≸250 (18.3%)
ᶐẢᕈ੃▤≸࡮ㅢᏱဳ߫߆ࠅߢ޽ࠆ‫ޕ‬
2005 ᐕ ߢߪ‫ߩ≮⸻ޔ‬ታᖱߦలታ⣼▤≸
178 (13.0%)
951 (69.7%)
วࠊߖߡ࡝್ࠬࠢቯၮḰ߇ᄌᦝߐࠇࠆߣߣ
⎬‫≸ޓޓޓ‬523 (38.3%)
߽ߦ‫ޔ‬ᣂߚߦ HER2/neu ߣ࡝ࡦࡄ▤ଚⷅߩ㗄ᶐẢᕈዊ⪲≸
83 ( 6.1% )․ᱶဳ੃≸⋡߇ㅊടߐࠇߚ‫ޕ‬ߐࠄߦ‫ࡦࡕ࡞ࡎޔ‬ฃኈ૕ߩ☼ᶧ≸41 ( 3.0% )180 (13.2%)
⁁ᴫ߽ട߃ߡᦨ⚳⊛ߥⴚᓟ⵬ഥ≮ᴺߩㆡᔕᶐẢᕈᓸዊ੃㗡≸ 18 ( 1.3% )߇ቯ߼ࠄࠇߡ޿ࠆ‫ޕ‬▤⁁≸
15 (1.1% )ࠕࡐࠢ࡝ࡦ≸
6 (0.4%)1) ∛ℂ⚵❱ቇ⊛⣲≌ᓘ㜑᭽≸
5 (0.4%)⣲≌ᓘߪ‫∛ޔ‬ℂ⚵❱ቇ⊛ߥᶐẢᓘ㧔pT㧕ࠍᜰߘߩઁ :ߒߡ޿ࠆ‫ޕ‬
2cm એ਄߆ߤ߁߆߇㊀ⷐߢ‫ߩઁޔ‬⚜㍝⚦⢩≸ 3‫ޔ‬㛽࡮エ㛽ൻ↢ࠍ઻߁≸ 2‫ޔ‬੍ᓟ࿃ሶߦᲧߴߡ߽ࠃࠅ㊀ⷐߢ޽ࠆ‫ޕ‬
1cm ߦ
ၮ⾰↥↢≸2‫ޔ‬ᚳᐔ਄⊹≸1‫ޔ‬ಽᴲ≸1‫ޔ‬ḩߚߥ޿⣲≌ߢߪ‫ޔ‬ઁߩ࿃ሶߦ߆߆ࠊࠄߕ੍
ࠞ࡞࠴ࡁࠗ࠼1‫ޔ‬Tubulolobular ca.2ᓟ⦟ᅢߢ޽ࠆߣߩ⷗⸃߽ㅀߴࠄࠇߡߪ޿ࠆ
Paget∛
6 ( 0.4% )߇‫ޔ‬ቢోߥวᗧ㗄⋡ߣߥࠅᓧߡߪ޿ߥ޿‫ޕ‬ᖡᕈ⪲⁁⣲≌ 1 ( 0.1% )⡺⣲(㛽࡮ⴊ▤) 2 ( 0.1% )1࿑1ᶐẢᕈᓸዊ੃㗡≸․ᱶဳߩ৻ဳߢ‫ᧄޔ‬㇌ߩ੃≸ขᛒ޿ⷙ⚂ߢ߽ᰴ࿁ᡷ⸓ᤨߦขࠅ਄ߍࠄࠇࠆߎߣ߇᳿ቯߒߡ޿ࠆ‫੍ޕ‬ᓟਇ⦟ߣߩႎ๔߇޽ࠆ‫ޕ‬

࿑ 2 ᩭࠣ࡟࡯࠼㧝‫ޔ‬⚵❱ቇ⊛⇣ဳᐲ I ߩᶐẢᕈ੃≸㧔੃㗡⣼▤≸㧕

࿑3 ᩭࠣ࡟࡯࠼㧝 ᩭಽⵚ௝߇ዋᢙ ‫ޔ‬⚵❱ቇ⊛⇣ဳᐲ ++ ߩᶐẢᕈ੃≸㧔⎬≸㧕⴫2‫≸੃ޓ‬ᚻⴚ∝଀ߩ࡝ࠬࠢಽ㘃
㧔St.Gallen ࠦࡦ࠮ࡦࠨࠬࠞࡦࡈࠔ࡟ࡦࠬ‫ޓ‬2005㧕

࿑4 ᩭࠣ࡟࡯࠼㧟‫❱⚵ޔ‬ቇ⊛⇣ဳᐲ+++ߩᶐẢᕈ੃≸㧔లታ⣼▤≸㧕㧖࡝ࡦࡄ▵ォ⒖
㧔−㧕߅ࠃ߮ એਅߩోߡࠍḩߚߔ࡮∛ℂቇ⊛⣲≌ᓘ㧔pT㧕
҇2cm
࡮Grade1࡮⣲≌๟ㄝߩ⣂▤ଚⷅ㧔−㧕‫ޓ‬
࡮HER2㧔−㧕࡮҈35 ᱦ
ਛ㑆࡝ࠬࠢ 㧖࡝ࡦࡄ▵ォ⒖㧔−㧕߅ࠃ߮એਅߩ߁ߜ৻ߟએ਄ࠍḩߚߔ࡮pT㧪2cm
࡮Grade2-3࡮⣲≌๟ㄝߩ⣂▤ଚⷅ
㧔+㧕‫ޓ‬
࡮HER2
㧔+㧕࡮㧨35 ᱦ
㧖࡝ࡦࡄ▵ォ⒖㓁ᕈ㧔1-3 ୘㧕߆ߟ HER2㧔−㧕㧖࡝ࡦࡄ▵ォ⒖㓁ᕈ㧔1-3 ୘㧕߆ߟ HER2
㧔+㧕㜞࡝ࠬࠢ㧖࡝ࡦࡄ▵ォ⒖㓁ᕈ
㧔4 ୘એ਄㧕ૐ࡝ࠬࠢ

ᢥ₂2ࠍᡷ⸶࡝ࠬࠢಽ㘃ߩߚ߼ߦ↪޿ࠄࠇࠆ఺∉⚵❱ቇ⊛ᨴ⦡‫ࠢࠬ࡝ޓ‬ಽ㘃ߩਛߢ‫ޔ‬ㅢᏱߩ HE ᨴ⦡╬ߢߪ⹏ଔߢ߈ߥ޿㗄⋡ߣߒߡ‫ޔ‬HER2/neu ㆮવሶ߹ߚߪ⤑Ⱞ⊕ߩㆊ೾⊒⃻ߣ‫ޔ‬ࡎ࡞ࡕࡦฃኈ૕㧔ࠛࠬ࠻ࡠࠥࡦฃኈ૕ ER‫ޔ‬ࡊࡠࠥࠬ࠹ࡠࡦฃኈ૕ PR㧕ߩᬌ⚝߇޽ࠆ‫ޕ‬೨⠪ߪ఺∉⚵❱ቇ⊛
ᚻᴺ޽ࠆ޿ߪ FISH ᴺࠍⴕ߁ߎߣ߇ផᅑߐࠇߡ޿ࠆ‫ޕ‬ࡎ࡞ࡕࡦฃኈ૕ߦ㑐ߒߡߪ‫ޔ‬એ೨ታᣉߐࠇߡ޿ߚ Enzyme Immunoassay ᴺ߇ᑄᱛߣߥߞߚߎߣ߽޽ࠅ‫ޔ‬⃻࿷ߢߪ఺∉⚵❱ൻቇߩߺߦ⚿ᨐ್ቯ߇ᆔߨࠄࠇߡ޿ࠆ‫ޕ‬HER2఺∉ᨴ⦡‫ޔ‬HER2-FISH ᴺ‫ޔ‬ER, PR ߪߘࠇߙࠇ⁛⥄ߩ଻㒾⸻≮ὐᢙ߽ઃߐࠇߡ߅ࠅ‫ޔ‬੃≸ߩ⸻≮ߦߪᰳ߆ߖߥ޿㗄⋡ߣߥߞߡ޿ࠆ‫ޕ‬‫ޔߚ߹ޓ‬ᦨㄭߢߪ࡝ࡦࡄ▤ౝ⊹ߦኻߔࠆ․⇣⊛ࡑ࡯ࠞ࡯
㧔D2-40‫ޔ‬podoplanin ߥߤ㧕߇㐿⊒ߐࠇ‫ޔ‬ᣣᏱ⸻≮ߦ߽ᔕ↪น⢻ߣߥߞߚߎߣ߆ࠄ‫ޔ‬ߘߩ᦭↪ᕈߦߟ޿ߡ߽⚫੺ߔࠆ‫ޕ‬a. ࡎ࡞ࡕࡦฃኈ૕ߩᬌ⚝‫ޓ‬ER, PR ߦ㑐ߒߡߪ‫ߩߤࠎߣ߶ޔ‬႐วਔ⠪ࠍหᤨߦᨴ⦡‫್ޔ‬ቯߔࠆ‫ޕ‬ߎࠇ߹ߢߪߤߜࠄ߆ߣ޿߃߫‫ޔ‬ER ߩ㓁࡮㒶ᕈࠍਛᔃߦᴦ≮ㆡᔕ߿੍ᓟផቯ߇⼏⺰ߐࠇࠆ௑ะߦ޽ߞߚ߇‫ޔ‬PR ߪࠛࠬ࠻ࡠࠥࡦߩ૞↪ߦࠃߞߡ↢ᚑߐࠇࠆ↥‛ߢ޽ࠆߎߣ߆ࠄ PR ࠍ㊀ⷐⷞߔࠆ௑ะߦ޽ࠆ‫ޕ‬
St. Gallen 2005 ߩ⸥タߦࠃࠇ߫‫ࡎޔ‬࡞ࡕࡦ≮ᴺߩ෻ᔕᕈߪ‫(ޔ‬i) ࡎ࡞ࡕࡦ෻ᔕᕈ‫ޔ‬(ii) ࡎ࡞ࡕࡦ෻ᔕᕈਇ⏕ታ‫(ޔ‬iii) ࡎ࡞ࡕࡦ㕖෻ᔕᕈ‫ ߩޔ‬3 ߟߦಽߌࠄࠇࠆ‫ޕ‬ߎࠇࠄࠍ᣿⏕ߦቯ⟵ߒߡߪ޿ߥ޿߇‫⸥ޔ‬タ߆ࠄߪ‫ޔ‬એਅߩࠃ߁ߦ⺒ߺขࠆߎߣ߇಴᧪ࠆ‫ޕ‬(i) ࡎ࡞ࡕࡦ෻ᔕᕈ㧦ER,PR ߣ߽ߦ㓁ᕈ‫ࠆ޽ޔ‬޿ߪ ER 㒶ᕈ PR 㓁ᕈ(ii) ࡎ࡞ࡕࡦ෻ᔕᕈਇ⏕ታ㧦ER 㓁ᕈ PR 㒶ᕈ‫ޔ‬޽ࠆ޿ߪࡎ࡞ࡕࡦฃኈ૕ߩᨴ⦡ᕈ߇ૐ޿㧔ㅢᏱߪ㓁ᕈ₸߇≸⚦⢩ߩ 10% ᧂḩ㧕႐ว‫࡞ࡎޔ‬ࡕࡦᴦ≮ᛶ᛫ᕈ߇⇼ࠊࠇࠆ∝଀㧔HER2/neuㆊ೾⊒⃻଀‫▵ࡄࡦ࡝ޔ‬ォ⒖୘ᢙ߇ᄙ޿଀‫ޔ‬⣲≌ ౝ ߩ urokinase-type plasminogen activator/
plasminogen activator inhibitor 1 (uPA/PAI-1)
࡟ࡌ࡞߇㜞޿଀‫ޔ‬Ⴧᱺࡑ࡯ࠞ࡯߇㜞୯ߩ଀㧕(iii) ࡎ࡞ࡕࡦ㕖෻ᔕᕈ㧦ER,PR ߣ߽ߦ㒶ᕈࡎ࡞ࡕࡦฃኈ૕ߩ್ቯᣇᴺߦ⛘ኻ⊛ߥ߽ߩߪߥ޿߇‫ޔ‬ᮡḰൻߩߚ߼ߦߪ৻ቯߩᣇᴺߢ࿕ቯ࡮ᨴ⦡ࠍⴕ޿‫ޔ‬৻ቯߩᣇᴺߢ್ቯࠍⴕ߁ߎߣ߇ᦸ߹ࠇࠆ‫ޕ‬ᨴ⦡ᴺߦ㑐ߒߡߪ‫ޔ‬⃻࿷‫ޔ‬૕ᄖ⸻ᢿක⮎ຠߣߒߡᏒ⽼ߐࠇߡ޿ࠆ᛫૕ߪ ER,PRߣ߽ 4 ⒳㘃ߢ‫ޔ‬ߘࠇߙࠇផᅑᨴ⦡ᴺ߇ቯ߼ࠄࠇߡ޿ࠆ‫ޕ‬ߎߩ߁ߜ࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠ߪ‫ޔ‬ࡅࠬ࠻ࡈࠔࠗࡦ‫ࡦࠗ࠹ࠬ࡞ࡊࡦࠪޓ‬ࠪ࡝࡯࠭ߣߒߡᛚ⹺ࠍฃߌ‫࡞࠽࡯ࡠࠢࡁࡕޔ‬᛫૕ ER(1D5) ߅ࠃ߮ PgR㧔A9621A㧕ࠍ⚵ߺวࠊߖߚࠠ࠶࠻
㧔ER/PgR㧔MONO㧕࡙࠾ࡃ࡯ࠨ
࡞ࠠ࠶࠻㧕ߣߒߡឭଏߒߡ޿ࠆ‫ޕ‬ࠦࡦ࠻ࡠ࡯
࡞ߪ㓁ᕈ∝଀ࠬ࡜ࠗ࠼‫ޔ‬޽ࠆ޿ߪౝ࿃ᕈࠦࡦ
࠻ࡠ࡯࡞ߣߒߡᱜᏱ੃▤ࠍ↪޿ࠆߎߣ߽น
⢻ߢ޽ࠆ
㧔࿑ 5㧕
‫ޕ‬

࿑5ᱜᏱߩᧃ᪳੃▤ߦ߅ߌࠆER⊒⃻੃▤਄⊹ߪ㓁ᕈ⚦⢩ߣ㒶ᕈ⚦⢩߇ᷙ࿷ߒߡ⷗
ࠄࠇࠆ‫ޕ‬ER᛫૕(1D5)㧦࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠2‫ޓ‬ฦ∝଀ߦ߅ߌࠆ㓁ᕈ‫ޔ‬㒶ᕈߩ್ቯၮḰߩ৻ߟߣߒߡ‫⚦≸ޔ‬⢩ߩ 10㧑એ਄㧔޽ࠆ޿ߪ 5㧑એ਄㧕ߩᩭߦ㓁ᕈᚲ⷗߇ᓧࠄࠇࠆ႐วߣ޿ߞ
ߚ್ቯၮḰ߇޽ࠆ‫ޕ‬ૉߒ‫ޔ‬ᶐẢ≸ߩౝㇱߦᷙ࿷ߔࠆ㕖ᶐẢ≸ߩᚑಽࠍ್ቯߦ฽߼ࠆ߆ߤ߁߆ߦߟ޿ߡߪ‫ޔ‬ࠦࡦ࠮ࡦࠨࠬ߇ᓧࠄࠇߡ޿ߥ޿‫ޕ‬ᨴ⦡ߩ⒟ᐲ߇ᒝ޿∝଀ߪౝಽᴲ≮ᴺߦኻߔࠆ෻ᔕᕈ߇⦟ᅢߣߩ࠺࡯࠲߽޽ࠆߎߣ߆ࠄ‫ޔ‬ᨴ⦡ᒝᐲ߽วࠊߖߡࠬࠦࠕൻߔࠆ႐ว߇޽ࠅ‫ޔ‬߽ߞߣ᳢߽↪ߐࠇߡ޿ࠆߣᕁࠊࠇࠆ⹏ଔᴺߩ߭ߣߟ߇ Allred ᴺߢ޽ࠆ㧔⴫ 3㧕‫ޕ‬8)
ߎߩᣇᴺߪ㓁ᕈ⚦⢩ߩᲧ₸ (proportion score;PS)0-5 ߣᨴ⦡ᒝᐲ (intensity score; IS)0-3 ࠍว⸘ߒ‫ޔ‬8 ὐḩὐߢ⹏ଔߔࠆ߽ߩߢ޽ࠆ‫ޕ‬ว⸘ࠬࠦࠕ (TS)3 ὐએ਄ࠍ㓁ᕈߣ⹏ଔߔࠆ㧔ߚߣ߃߫㓁ᕈ⚦⢩₸ 1-9% ߢ‫ߩߘޔ‬ᨴ⦡ᒝᐲ߇シᐲߢ޽ࠇ߫‫ޔ‬PS2+IS1=TS3 ߣߥࠅ㓁ᕈߢ޽ࠆ㧕‫ޕ‬‫ޔߚ߹ޓ‬ᣣᧄ੃≸ቇળߩ⎇ⓥ⃰㧔᪢᧛⃰㧕ߢߪ‫ ⴫ޔ‬4 ߩࠃ߁ߦ㓁ᕈ⚦⢩₸ߩߺߦࠃࠆ㓁ᕈ࡮㒶ᕈߩ್ቯၮḰࠍឭ໒ߒߡ޿ࠆ‫ޕ‬9㧕ࠃࠅታ↪⊛ߢౣ⃻ᕈ߇㜞޿್ቯᴺࠍᮨ⚝ߒߚ⚿ᨐ‫ޔ‬
ᨴ⦡ᒝᐲࠍ⚵ߺㄟ߹ߥߊߡ߽චಽߣ
್ᢿߒߚ⚿ᨐߢ޽ࠆ‫ޕ‬㓁ᕈ₸ 10㧑એ਄ࠍ⛘ኻ⊛ߥ㓁ᕈߩ್ቯၮḰߣߒߡ޿ࠆ߇‫ޔ‬ߘࠇએਅߩ∝଀߽‫ޔ‬⥃ᐥ⊛⁁ᴫߥߤߦࠃߞߡᴦ≮ߩㆡᔕࠍ⠨ᘦߔߴ߈႐ว߇޽ࠆߚ߼‫್ޔ‬ቯߦႺ⇇ၞࠍ⸳ߌߚ‫ޕ‬‫ޓ‬ታ㓙ߩ∝଀ߦ߅޿ߡߪ‫ࠎ߹߮ޔ‬ᕈ (100%)ᒝ㓁ᕈߩ∝଀
㧔࿑ 6㧕ߪ߻ߒࠈዋߥߊ‫⚦ޔ‬⢩ߏߣߦᨴ⦡ᒝᐲ߇⇣ߥࠆ∝଀㧔࿑ 7㧕߇ᄙߊ‫ޔ‬㓁ᕈ࡮㒶ᕈߩ㗔ၞ߇ಽ߆ࠇߡ޿ࠆ∝଀㧔࿑ 8㧕߽޽ࠆ‫ޕ‬್ቯ⠪߇⹏ଔᴺߦᘠࠇߡ߅ߊߎߣ߽㊀ⷐߣᕁࠊࠇࠆ‫ޕ‬b. HER2/neuHER2/neu
HER2/neu ߩㆊ೾⊒⃻ߪ఺∉⚵❱ൻቇߦࠃࠆ⚦⢩⤑Ⱞ⊕ߩᬌ಴‫ ߪ޿ࠆ޽ޔ‬FISH ᴺࠍታ
ᣉߒߡㆮવሶߩㆊ೾⊒⃻ࠍ⏕⹺ߔࠆᣇᴺ߇޽ࠆ‫ޕ‬⃻࿷ߢߪ‫❱⚵∉఺ޔ‬ൻቇߩ⚿ᨐࠍᨴ⦡ᒝᐲ߆ࠄ 0‫ޔ‬1+‫ޔ‬2+‫ޔ‬
3 ߩ 4 Ბ㓏ߦಽߌ‫ޔ‬0 ߆ 1+ࠍ㒶ᕈ‫ޔ‬3+ ࠍ㓁ᕈߣ್ᢿߒ‫ޔ‬2+ ߩ∝଀ߪ
FISH ᴺࠍ૬↪ߒߡᦨ⚳್ᢿߔࠆᣇᴺ‫ࠆ޽ޔ‬޿ߪోߡߩᬌ૕ߦߟ޿ߡ FISH ᴺࠍታᣉߔࠆᚻ㗅ߩ 2 ⒳㘃ߩ߿ࠅᣇ߇ផᅑߐࠇߡ޿ࠆ‫ޕ‬఺∉⚵❱ൻቇᴺߩ࿕ቯߪ 10㧑✭ⴣࡎ࡞ࡑ࡝ࡦ‫ޔ‬48 ᤨ㑆એౝߩ࿕ቯᤨ㑆߇ផᅑߐࠇߡ޿ࠆ‫ޕ‬್ቯߦ㓙ߒߡߪ‫ࡦࡕ࡞ࡎޔ‬ฃኈ૕ߣߪ߿߿⇣ߥࠅ‫ޔ‬ᶐẢ≸ᚑಽߩߺߢ್ቯ߇ߥߐࠇ
ࠆ‫ޕ‬10㧑એ਄ߩ≸⚦⢩߇㓁ᕈߢ޽ࠆߎߣࠍ߽ߞߡ‫್ޔ‬ᢿߩၮḰߣߔࠆ㧔࠻࡜ࠬ࠷࠭ࡑࡉ
∛ℂㇱળߦࠃࠆ㧕㧔࿑ 9㧕‫ޕ‬‫❱⚵∉఺ޓ‬ൻቇࠍታᣉߔࠆ਄ߢᵈ⋡ߔߴ߈ߎߣߩ৻ߟߦ‫ޔ‬FISH ᴺߩ⚿ᨐߣߩᢛวᕈ߇޽ࠆ‫ޕ‬ߤߩ್ቯᣇᴺߢ‫ޔ‬ᅤ૗ߦ್ᢿࠍਅߔߩ߆ߪ‫ޔ‬ᦨ⚳⊛ߦߪ್ቯ⚿ᨐߣ࠻࡜ࠬ࠷࠭ࡑࡉߩᴦ≮ലᨐߣߩ⋧㑐ᕈࠍ⷗ࠆᔅⷐ߇޽ࠆ߇‫ޔ‬2+ ∝଀ߦኻߒߡ FISH ᴺࠍታᣉߔࠆߎߣ߇ផᅑߐࠇߡ޿ࠆએ਄ߪ‫ޔ‬ᒰ㕙 FISH ᴺࠍၮḰߦ఺∉⚵❱ൻቇߩᅷᒰᕈࠍᬌ⸽ߒߡࠁ߆ߑࠆࠍᓧߥ޿‫ޕ‬‫ޓ‬ᢥ₂⊛ߦߪ‫߽ᦨޔ‬᳢↪ߐࠇߡ޿ࠆ᛫ HER2
Ⱞ⊕᛫૕ߢ޽ࠆ HercepTest ߣ FISH ᴺߩ⋧㑐ᕈߪ 0‫ޔ‬1+‫ޔ‬
2+‫ޔ‬3+ ߢߘࠇߙࠇ 3.6㧑‫ޔ‬
5.3㧑‫ޔ‬16.9㧑‫ޔ‬78.2㧑
㧔Press ࠄ 10㧕㧕‫ ߪ޿ࠆ޽ޔ‬3.5㧑‫ޔ‬ߢ‫ޔ‬㒶ᕈ㧔ࠬ
6.4㧑‫ޔ‬25.7㧑‫ޔ‬81.5㧑(Prati ࠄ 11)㧕ࠦࠕ 0‫ޔ‬1+㧕
଀ߦ߽ 5% ೨ᓟߩ FISH 㓁ᕈ଀߇

⴫3‫ࡦࡕ࡞ࡎޓ‬ฃኈ૕ᬌ⚝ߩߚ߼ߩ್ቯᴺ㧔Allredᴺ㧕㓁ᕈ⚦⢩₸ࠬࠦࠕ(PS)PS0 ᨴ⦡ᕈߥߒPS1‫ޓ‬㨪 1/100
PS2‫ޓ‬㨪 1/10
PS3‫ޓ‬㨪 1/3‫ޓ‬
PS4‫ޓ‬㨪 2/3
PS5‫ޓ‬㨪 1㓁ᕈᒝᐲࠬࠦࠕ (IS)IS0‫ޓ‬㒶ᕈ
IS1‫ޓ‬ᒙ޿
IS2‫ޓ‬ਛ╬
IS3‫ޓ‬ᒝ޿ว⸘ࠬࠦࠕ (TS)PS+IS ߩว⸘0‫ޔ‬2-8ὐ
TS3 એ਄ߩ∝଀㧦㓁ᕈሽ࿷ߔࠆߎߣ‫ޔ‬3+ ∝଀ߩ FISH 㓁ᕈ₸߽ 80%ߦߣߤ߹ࠆߎߣ߇ᜰ៰ߐࠇߡ޿ࠆ‫ޕ‬‫ޓ‬ᣂߒ޿૕ᄖ⸻ᢿ⮎ߣߒߡ⊒ᄁߣߥߞߚ࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠ߩࡅࠬ࠻ࡈࠔࠗࡦ HER2 ࠠ࠶࠻ (MONO) ࠍ↪޿ߚห᭽ߩᬌ⸛⚿ᨐࠍ⴫ 5 ߦ␜ߒߚ‫ޕ‬ߔߥࠊߜ‫ޔ‬0/1+ ߩ
FISH ᴺ㓁ᕈ₸ߪ 4.2%‫ޔ‬0% ߢ‫߿߿ޔ‬ዋߥ߼ߣߥߞߡ߅ࠅ‫ޔ‬
৻ᣇ2+/3+ ߢߪ83.3%‫ޔ‬
95.0% ߢ‫ޔ‬ᬌ⸛∝଀ᢙߪ߹ߛਇචಽߥ߇ࠄ‫ޔ‬ᗵᐲ࡮․⇣12㧕ᐲߣ߽ߦᲧセ⊛⦟ᅢߥ⚿ᨐߣߥߞߚ‫ޕ‬c. D2-40㧔࡝ࡦࡄ▤ౝ⊹ࡑ࡯ࠞ࡯㧕㧔࡝ࡦࡄ▤ౝ⊹ࡑ࡯ࠞ࡯㧕‫ᦨޓ‬ᓟߦ‫ޔ‬࡝ࡦࡄ▤ౝ⊹ࡑ࡯ࠞ࡯ߩ᦭↪ᕈߦߟ޿ߡㅀߴࠆ‫ޕ‬ᦨೋߦ߽ㅀߴߚߣ߅ࠅ‫⃻ޔ‬࿷ߩ St. Gallen ࡝ࠬࠢಽ㘃ߦ߅޿ߡ߽‫ޔ‬ᶐẢ≸ߦ߅ߌࠆ࡝ࡦࡄ▤ଚⷅߩ᦭ήߩᬌ⚝߇㊀ⷐⷞߐࠇߡ޿ࠆ‫ޕ‬ᓥߞߡ‫ޔ‬HE ᨴ⦡ࠃࠅቴⷰ⊛ߥ್ቯ߇ਅߖࠆ఺∉⚵❱ൻቇߩ೑↪ߪଔ୯߇㜞޿߽ߩߣផ᷹ߐࠇࠆ‫ޕ‬‫ޓ‬ᱜᏱߩ⁁ᘒߢߪ‫ޔ‬࡝ࡦࡄ▤ߩౝ⣧ߪ⯯⣕ߒߡ߅ࠅ‫ޔ‬HE ᨴ⦡ᮡᧄ਄ߢߩ⹺⼂߇ኈᤃߢߪߥ޿‫ޕ‬ߒ߆ߒ‫❱⚵∉఺ޔ‬ൻቇߩታᣉߦࠃߞߡ࡝ࡦࡄ▤߇ኈᤃߦหቯߢ߈ࠆ㧔࿑ 10㧕‫ޕ‬߹ߚ‫ޔ‬࡝ࡦࡄ▤ߪⴊ▤ߦઃ㓐ߒߡሽ࿷ߔࠆߎߣ߇ᄙ޿ߚ߼‫ޔ‬๟࿐⚵❱ߣߩ㑐ଥࠍࠃߊⷰኤߔࠆߎߣ߽㊀ⷐߢ޽ࠆ‫ޕ‬‫▤ࡄࡦ࡝ޓ‬ଚⷅ߇⿠ߎࠆߣ‫ޔ‬HE ᨴ⦡਄ߪ⚵❱㑆㓗ߩਛߦ≸⚦⢩߇ᶋㆆߒߡ߅ࠅ‫ޔ‬㑆㓗ߩㄝ✼ߦߪ৻ጀߩౝ⊹⚦⢩ߩⵍⷒࠍ⹺߼ࠆ㧔࿑11㧕‫ޕ‬఺∉⚵❱ቇ⊛ߦߪߘߩౝ⊹⚦⢩߇㓁ᕈߦߥࠆߚ߼‫ޔ‬㓁ᕈ⚦⢩߇᭴ᚑߔࠆⓨ㓗ߩਛߦ≸⚦⢩߇ᶋㆆߒߡߺࠄࠇࠆ㧔࿑ 12㧕‫ޕ‬ⴊ▤ౝ⊹ߪ㒶ᕈߢ޽ࠆ‫ޕ‬ߎߩࠃ߁ߦ D2-40 ߪᣣᏱ⸻ᢿߦ߽ᄢᄌᓎ┙ߟߣᕁࠊࠇࠆ߇‫ޔ‬⃻ᤨὐߢ࡞࡯࠴ࡦߦዉ౉ߔࠆߎߣߪᔅߕߒ߽ኈᤃߢߪߥ
13㧕ߊ‫ޔ‬᦭↪ᕈߦ㑐ߔࠆߐࠄߥࠆᬌ⸛ࠍⷐߔࠆ‫ޕ‬߹ߚ‫ޔ‬ߣ߈ߦ╭਄⊹⚦⢩߇㓁ᕈߦߥࠆߎߣ߇޽ࠅ‫ޔ‬࡝ࡦࡄ▤ౝ⣲≌Ⴇᩖߣ㕖ᶐẢ≸ᚑಽߣߩ㐓೎ߦᵈᗧߔࠆ‫ޕ‬ᶐẢᕈᓸዊ੃㗡≸㧔࿑1㧕ߪ࡝ࡦࡄ▵ォ⒖₸߇㜞޿⣲≌ߢ޽ࠆ߇‫❱⚵ޔ‬㑆㓗ߩౝኈߪⓨ⯯ߢ‫ޔ‬ⴊ▤෶ߪ࡝ࡦࡄ▤ౝ⊹ߩⵍⷒࠍ઻ߞߡ޿ߥ޿‫ޕ‬

ᢥ₂8ࠍᡷ⸶

⴫5‫ࡦࠗࠔࡈ࠻ࠬࡅޓ‬HER2ࠠ࠶࠻(MONO)ߩ
್ቯ⚿ᨐߣ FISHᴺߩኻᲧ⴫4‫ࡦࡕ࡞ࡎޓ‬ฃኈ૕ᬌ⚝ߩߚ߼ߩ್ቯᴺ ‫ޓ‬㧔ᣣᧄ੃≸ቇળ⎇ⓥ⃰ߦࠃࠆឭ໒㧕123್ቯࠬࠦࠕScore 0
Score 1
Score 2
Score 3್ቯ඙ಽ㒶ᕈႺ⇇ၞ㓁ᕈ㓁ᕈ⚦⢩ᢙ㒶ᕈ㓁ᕈ⚦⢩භ᦭₸㓁ᕈ⚦⢩භ᦭₸㓁ᕈ⚦⢩භ᦭₸1% ᧂḩ
1% એ਄‫ޓ‬10% ᧂḩ
10% એ਄

HER2 ࠬࠦࠕ

01+FISH 㓁ᕈ (%)

3 (4.2)0FISH 㒶ᕈ (%) 68
㧔95.8㧕 㧔8 100㧕


ว⸘

71

82+3+

ว⸘

5 (83.3)

19 (95.0) 27 (25.7)

1 (16.7)

1 (5.0)78 (74.3)

620105

Score 0Score 1‫ޔ‬
2
Score 3

࿑6PR㓁ᕈ଀

࿑7ER㓁ᕈ଀࿑8PR㓁ᕈ଀

Allred score ߪ PS5+IS3=TS8 ߢ‫⚦≸ޔ‬⢩ߩᩭߦ߮߹ࠎᕈᒝ㓁ᕈࠍ␜ߔ‫ޕ‬
PgR ᛫૕ (A9621A)㧦࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠㓁ᕈ⚦⢩ >10% ߪ᣿ࠄ߆ߢ‫ޔ‬㓁ᕈ∝଀ߢ޽ࠆ‫ޕ‬ᨴ⦡ᒝᐲߪ⚦⢩ߦࠃࠅ᭽‫ޕޘ‬ታ㓙ߦߪߎߩࠃ߁ߥ∝଀ߩ㗫ᐲ߇㜞޿‫ޕ‬ER ᛫૕ (1D5)㧦࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠㓁ᕈㇱಽ㧔Ꮐ㧕ߣ㒶ᕈㇱಽ߇޽ࠆ⒟ᐲߩ㗔ၞᕈࠍ᦭ߒߡ޿ࠆ‫ޕ‬ᨴ⦡ࡓ࡜ߢߥ޿ߎߣߦᵈᗧࠍᛄ߁ᔅⷐ߇޽ࠆ‫ޕ‬PgR ᛫૕ (A9621A)㧦࠾࠴࡟ࠗࡃࠗࠝࠨࠗࠛࡦࠬ␠࿑9ࡅࠬ࠻ࡈࠔࠗࡦHER2ࠠ࠶࠻ (MONO)ࠍ↪޿ߚHER2ᬌᩏᒝ㓁ᕈ
㧔3+㧕଀‫ޕ‬

࿑10D2-40ߦኻߔࠆ఺∉⚵❱ൻቇ࡝ࡦࡄ▤ౝ⊹߇㓁ᕈߢ‫ߩ▤ࡄࡦ࡝ޔ‬หቯߦᓎ┙ߟ‫ࠢࡁࡕ␠ࠬࡦࠛࠗࠨࠝࠗࡃࠗ࡟࠴࠾ ޕ‬ࡠ࡯࠽࡞᛫૕‫࡯࠽ࠗ࠹ࠬ࠻ࠬࡅޔ‬36Aߦࠃࠆ⥄േᨴ⦡)

࿑11࡝ࡦࡄ▤ଚⷅ㓁ᕈ௝
㧔HEᨴ⦡㧕

߹ߣ߼‫ߦ≸੃ޓ‬ኻߔࠆⴚᓟ⵬ഥ≮ᴺߪᄙጘߦࠊ
ߚߞߡ߅ࠅ‫ޔ‬୘‫ߦߣߏ଀∝ߩޘ‬ታᖱߦวࠊߖ
ߚᴦ≮ᴺࠍㆬᛯߔࠆߎߣ߇น⢻ߦߥߞߚ‫ޕ‬ߘߩㆡᔕࠍ᳿ቯߔࠆߚ߼ߦߪ∛ℂ⚵❱⸻ᢿ߇㊀ⷐߢ‫ ߦ․ޔ‬St. Gallen 2005 ߦḰ᜚ߒߚ࡝ࠬࠢಽ㘃ࠍⴕ߁ߎߣ߇ᦸ߹ࠇࠆ‫ޕ‬್ቯ㗄⋡ߩ߁ߜ‫ࡦࡕ࡞ࡎޔ‬ฃኈ૕ (ER,PR) ߩ᦭ήߦ㑐ߔࠆᬌ⚝ߪ఺∉⚵❱ቇ⊛ߦᣉⴕߐࠇ‫ޔ‬HER2 ㆊ೾⊒⃻ߩᬌ⚝߽఺∉⚵❱ൻቇ߹ߚߪ FISH ᴺߦࠃࠅ್ቯߐࠇࠆ‫ޕ‬ᱜ⏕ߥᬌᩏߩߚ߼ߦߪ‫ޔ‬ᨴ⦡߅ࠃ್߮ቯᣇᴺߩᮡḰൻ߇ᔅ㗇ߢ޽ࠆ‫ޕ‬߹ߚ‫ޔ‬࡝ࡦࡄ▤ଚⷅߩᬌ⚝ࠍ఺∉⚵❱ቇ⊛ߦታᣉߔࠆߎߣ߽น⢻ߢ޽ࠅ‫੹ޔ‬ᓟ‫ޔ‬ᣣᏱ⸻ᢿ߳ߩᔕ↪߇ᦼᓙߐࠇࠆ‫ޕ‬⻢ㄉ఺∉⚵❱ൻቇᨴ⦡‫ޔ‬FISH ᴺߩታᣉߦߟ޿ߡߪ᧲ർᄢቇ∛㒮ߩ౷჻⵨⟤‫ޔ‬㜞ᯅᒎ↢‫ⴕޔ‬Ꮉ⵨ሶߩฦᛛᏧߦᄢᄌߏዧജࠍ޿ߚߛ߈߹ߒߚ‫ޕ‬ߎߩ႐ࠍ୫ࠅߡෘߊᓮ␞↳ߒ਄ߍ߹ߔ‫ޕ‬

࿑12࿑ߩ∝଀ߦ߅ߌࠆ᛫D2-40఺∉⚵❱ቇ⊛ᨴ⦡ౝ⊹⚦⢩㧔㓁ᕈ⚦⢩㧕߇≸⢩Ꮍࠍขࠅ࿐ࠎߢ޿ࠆ‫ޕ‬

ᢥ₂1㧕᭱‫ޓ‬ᘮሶ‫ޔ‬ဈర๋உ‫ޔ‬㔰ን჻㓶㧦ᶐẢᕈ੃▤≸㧔੃㗡⣼▤≸‫ޔ‬లታ⣼▤≸‫≸⎬ޔ‬㧕ߩ⚵❱ဳ೎↢‛ቇ⊛ᕈ⁁‫ޕ‬੃≸ߩ⥃ᐥ 21㧦
165-169‫ޔ‬
2006.
2㧕Goldhirsch A, Glick JH, Gelber RD, CoatesAS, Thurlimann B, Senn HJ; Panel members.
Meeting highlights: international expert
consensus on the primary therapy of earlybreast cancer 2005. Ann Oncol 16: 1569-1583,
2005.
3㧕Tsuda H, Akiyama F, Kurosumi M, Sakamoto
G, Watanabe T: Establishment of histologicalcriteria for high-risk node-negative breast
carcinoma in an randomized clinical trial ofadjuvant therapy. Jpn J Clin Oncol 28:486-491, 1998.
4㧕Elston CW and Ellis IO: pathologicalprognostic factors in breast cancer. I. The valueof histological grade in breast cancer:
Experience from a larger study with long-term
follow-up. Histopathol 19: 403-410, 1991.
5㧕ᣣᧄ੃≸ቇળ / ✬㧦⥃ᐥ࡮∛ℂ‫≸੃ޓ‬ขᛒ޿ⷙ⚂ ╙ 15 ‫ޔ‬㊄ේ಴ ‫ޔ‬᧲੩‫ޔ‬2004.
6㧕⍹↰ቁት‫ޔ‬ᄢౝᙗ᣿㧦੃≸ᚻⴚ≮ᴺ㧔᷷ሽ
≮ᴺ㧕ߩቢᚑᐲ‫ޕ‬⥃ᐥᄖ⑼ 57㧦283-288‫ޔ‬2002.
7㧕Moriya T, Usami S, Tada H, Kasajima A,Ishida K, Kariya Y, Ohuchi N, Sasano H:
Pathological evaluation of sentinel lymph
nodes for breast cancer. Asian J Surg 27:
256-261, 2004.
8㧕Allred DC, Harvey JM, Berardo M, Clark
GM㧦 Prognostic and predictive factors inbreast cancer by immunohistochemical
analysis. Mod Pathol 11: 155-168, 1998.

9㧕Umemura S, Kurosumi M, Moriya T, OyamaT, Arihiro K, Yamashita H, Umekita Y,Komoike Y, Shimizu C, Fukushima H,Kajiwara H, Akiyama F: Immunohistochemicalevaluation for hormone receptors in breast
cancer: a practically useful evaluation systemand handling protocol. Breast Cancer 13:232-235, 2006.
10㧕
Press MF, Sauter G, Bernstein L, Villalobos IE,Mirlacher M, Zhou JY, Wardeh R, Li YT,Guzman R, Ma Y, Sullivan-Halley J, Santiago
A, Park JM, Riva A, Slamon DJ: Diagnostic
evaluation of HER-2 as a molecular target: anassessment of accuracy and reproducibility oflaboratory testing in large, prospective,
randomized clinical trials. Clin Cancer Res 15:6598-6607, 2005.
11㧕Prati R, Apple SK, Gornbein JA, Chang HR:
Histopathologic characteristics predicting
HER2/neu amplification in breast cancer.
Breast J 11: 433-439, 2005.
12㧕᫪⼱ථ਽‫ޔ‬౷჻⵨⟤‫ޔ‬㜞ᯅᒎ↢‫ޔ‬⍹↰ቁት‫ޔ‬ᐔᎹ‫ޓ‬ਭ‫ޔ‬ጤ㑆ᙗⴕ‫ޔ‬ᧁ᧛㆏ᄦ‫ޔ‬ᄢౝᙗ᣿‫ޔ‬╣㊁౏િ㧦HER2 ㆊ೾⊒⃻ߦኻߔࠆ఺∉⚵❱ቇ⊛ᬌᩏᴺ‫ޕ‬᛫૕ߩ⒳㘃ߦࠃࠆ․ᕈ
ߩᬌ⸛‫ޕ‬╙ 14 ࿁ᣣᧄ੃≸ቇળ✚ળ‫ޔ‬2006ᐕ‫ޔ‬㊄ᴛ‫ޕ‬13㧕દ⮮ᱜ⵨‫ޔ‬᫪⼱ථ਽‫═ޔ‬ፉᢕሶ‫ޔ‬ቝ૒⟤િ‫ޔ‬⍹↰ቁት‫╣ޔ‬㊁౏િ‫ޔ‬ᄢౝᙗ᣿㧦੃≸⚵❱ߦ߅ߌࠆ࡝ࡦࡄ▤ౝ⊹ࡑ࡯ࠞ࡯ࠍ↪
޿ߚ఺∉⚵❱ൻቇߩ᦭↪ᕈ‫ޕ‬╙ 13 ࿁ᣣᧄ੃≸ቇળ✚ળ‫ޔ‬2005 ᐕ‫ޔ‬ୖᢝ‫ޕ‬4

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