Susumu N, Aoki D, Suzuki N, Nozawa S
Dept. of Obstetrics and Gynecology, School of Medicine, Keio University.
Gan To Kagaku Ryoho. 2001 Jul;28(7):934-45.
Recently, the number of cases of endometrial cancer has increased in Japan. Most of the increase are accounted for by premenopausal cases, which are frequently positive for ER or PR. Hormonal treatment using progestins such as MPA has been widely applied to endometrial cancer patients under 40 years old under the conditions of grade 1 well-differentiated endometrioid adenocarcinoma without myometrial invasion. In our hospital, we applied high-dose (600 mg/day) MPA for over 8 weeks in 14 cases of endometrial cancer, of which adenocarcinoma disappeared in 12 cases (86%), followed by cyclic administrations of low-dose MPA, with 7 subsequent recurrences. We think that a protocol for improving ovarian function, such as active induction of ovulation, should be established to induce intrinsic progesterone sufficient for the prevention of the recurrence of endometrial cancers. In the 2 cases, in which adenocarcinoma remained even after long administrations of MPA, myometrial invasion was noted in the surgically resected specimens. For advanced or recurrent endometrial cancers, MPA has been reported to be effective in an average of 26% in several reports, and effective in 42% cases when applied with combination chemotherapy, such as CAP, by virtue of the "chemical modulator" effect, which can delay the acquired resistance against ADM or CDDP. Furthermore, MPA has resulted in a significant improvement of 5-year disease-free survival rate when used as adjuvant therapy after complete operations and whole pelvic irradiation, compared with administrations of 5-FU in a randomized controlled study in Japan. Thus, in the future, we consider that hormonal therapy will play a more important role in endometrial cancer treatment.
近年来，日本子宫内膜癌的病例数有所增加。增加的病例大多为绝经前病例，这些病例的雌激素受体（ER）或孕激素受体（PR）通常呈阳性。对于年龄在40岁以下、病理分级为1级、高分化子宫内膜样腺癌且无肌层浸润的子宫内膜癌患者，已广泛应用甲羟孕酮（MPA）等孕激素进行激素治疗。在我院，我们对14例子宫内膜癌患者应用了高剂量（600mg/天）的MPA，疗程超过8周，其中12例（86%）腺癌消失，随后进行低剂量MPA的周期治疗，有7例复发。我们认为，应该制定一个改善卵巢功能的方案，比如积极诱导排卵，以诱导内源性孕激素的产生，从而预防子宫内膜癌的复发。在2例长期使用MPA后腺癌仍未消退的病例中，手术切除标本显示有肌层浸润。对于晚期或复发性子宫内膜癌，几份报告显示MPA的平均有效率为26%，与CAP等联合化疗方案联合应用时，有效率为42%，这得益于其“化学调节剂”作用，可延缓对阿霉素（ADM）或顺铂（CDDP）的获得性耐药。此外，在日本的一项随机对照研究中，与使用5-氟尿嘧啶（5-FU）相比，MPA在完整手术和全盆腔放疗后用作辅助治疗时，能显著提高5年无病生存率。因此，我们认为在未来，激素治疗在子宫内膜癌治疗中将发挥更重要的作用。
