Sensitivities for anti-cancer drugs/hormones for endometrial cancer - from the viewpoint of tumor immunology

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K11156
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Obstetrics and gynecology
• Research Institution: Keio University
• Principal Investigator: SUSUMU NOBUYUKI 慶應義塾大学, 医学部(信濃町), 准教授 (90206459)
• Research Collaborator: YAMAGAMI Wataru ; HIRASAWA Akira ; SAKAI Kensuke ; MAKABE Takeshi ; HIRANO Takuro ; KATAOKA Fumio ; BANNO Kouji ; AOKI Daisuke
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 子宮体癌 / 腫瘍免疫 / 黄体ホルモン療法 / 化学療法 / MMR

Outline of Final Research Achievements

We performed fertility-preserving MPA therapy for young patients with endometrial cancer (EC) and atypical endometrial hyperplasia (AEH). Tumor disappeared in 98.5% in 131 AEH cases, 91.9% in 160 G1 EC cases, 100% in 6 G2 EC cases. Tumor relapsed in uterine cavity in 55%, 83%, 75%, respectively. Pregnancy was obtained in 87 cases. In total, 138 times pregnancies and 103 live-birth children were obtained, and the pregnancy rate was 45%. The pregnancy rates by age and pathological types were 35 to 75% under 40 years in both AEHC and EC patients, however, EC patients in age 40 or more showed 5% pregnancy rate. Repeated MPA therapy after recurrence showed high tumor disappearance rate and pregnancy rate as well as after initial MPA therapy. The clinicopathological factors such as polycystic ovary, irregular menstrual cycle, low expression of hMLH1 were associated with elevated recurrence rate. The data regarding regulatory T cells and sensitivity for progesterone are now in analysis.

Free Research Field

婦人科腫瘍学

Academic Significance and Societal Importance of the Research Achievements

若年子宮体癌例で妊娠を断念し標準治療の子宮全摘を行うかどうか悩む患者は多い。本研究では、国内の単独施設としては最多数の妊孕性温存療法成績（病変消失率、子宮内再発率、妊娠率、年齢別妊娠率、分娩後再発率、再発後再治療における病変消失率、妊娠率など）を明らかにしたことで、治療の客観性が治療選択の上で役立つと期待される。さらに、黄体ホルモンに対する感受性を規定する因子、再発に関与する因子、再発治療の病変消失に関わる因子なども示し、再発治療の安全性、有効性を示した。再発後の治療選択にも役立つ情報と判断される。