会長挨拶 24 12 12 4 15 9 HPV 6 2018 1 8 1,124 CQ 7 HPV 3 CRT CQ 24 舘田勝 1
プログラム テーマ 中咽頭 (13 : 30-16 : 45) 1 13 : 30-14 : 35 : CQ1 : HPV 1. 2. 3. CQ2 : 4. 2 14 : 35-15 : 40 : CQ3 : 5. 6. CQ4 : 7. 8. 3 15 : 40-16 : 45 : CQ5 : 9. CQ6 : 10. 11. CQ7 : CRT 12. 140 2
17 : 00-18 : 00 : : 楯谷一郎 : 3
: 2 1 1 980-0805 1-5 TEL : 022-227 - 1591 450 m 6 2-6 - 4 TEL : 022-224 - 1456 4
1. 当科における中咽頭癌症例の臨床的検討 2009 2016 55 48 7 49 84 67 33 13 6 3 5 TNM T1 T2 T3 T4a T4b 9 21 9 14 2 N0 N1 N2a N2b N2c N3 18 6 5 13 10 3 M0 I II III IVa IVb 2 9 9 31 4 13 33 6 3 HPV p16 47 24 DNA 35 11 55 27 18 18 10 8 2-84 28 47 5 69% 5 75% HPV 21 51% 5 94% 56% 5 5 I 100% II 100% III 89% IVa 69% IVb 37% 5
2. 札幌医科大学における中咽頭癌の治療成績の検討 : : 2009 1 2016 12 8 77 59 18 65.9 67.0 18-89 50 5 75 16 2017 12 38.2 37.0 4-102 OS CSS 1999-2008 CSS p16 SCC 49 TN T12 vs T34 N vs + p16 OS CSS p16 : 15 56 2 4 Stage I 5 II 10 III 4 IVA 45 IVB 12 IVC 1 T1 10 T2 30 T3 11 T4a 16 T4b 10 N0 21 N1 5 N2a 4 N2b 33 N2c 11 N3 3 M0 76 M1 1 p16 49 31 18 21 56 BSC 0 0 3 5 OS 65.9 56.3% 3 5 CSS 70.3% 61.8% 1999-2008 5 CSS 59.0% OS CSS TN T12 vs T34 N vs + p16 p16 80.6% 83.3% : p16 TN p16 6
3. 北海道大学病院における中咽頭扁平上皮癌症例の検討 2009 1 2016 12 8 213 189 24 39-88 64 65 109 72 33% 17 15 7% 0 1 0.5% I 20 10% II 28 13% III 19 9% IVA 121 60% IVB 17 7% IVC 7 213 193 58 16 119 40 IV - CRT 82 BRT 7 RADPLAT 30 193 5 : 77.4% 0 - I : 80.4% II : 83.8% III : 100% IV : 72.6% 1989-1996 5 : 52% I 57% II 56% III 52% IV : 49% n=65 ; 4 1998-2007 5 : 65% I 72% II 79% III 73% IV : 54% n=156 ; 15 HPV PCR HPV 158 91 58% HPV 2009-2012 61 31 51% HPV 2013-2016 97 60 62% HPV HPV 8 5 HPV 92.8% 65.4% HPV 7
4. 当科における中咽頭扁平上皮癌症例の治療成績 2009 1 2016 12 43 38 5 37 94 65.2 67.0 1 95 44.7 45.0 50 3 50 75 31 75 9 10 28 4 1 I :3 II :4 III :5 IVA : 26 IVB :4 IVC :1 T T1 : 6 T2 : 21 T3 : 7 T4a : 7 T4b : 2 N N0 : 8 N1 : 5 N2a : 1 N2b : 15 N2c : 11 N3 : 3 M1 1 11 30 TPF 15 BRT 7 RT 3 3 CDDP CRT 2 BSC 2 p16 26 13 3 3 5 68.3% 3 5 82.7% I 3 5 100% II 3 5 75.0% III 3 5 60% IVA 3 5 71.4% IVB 3 5 50.0% IVC 3 5 0% I 3 5 100% II 3 5 75.0% III 3 5 100% IVA 3 5 83.2% IVB 3 5 75.0% IVC 3 5 0% 8
5. 当科における中咽頭癌症例の検討 2009 1 2016 12 37 5 42 65.0 41 91 43 1 105 38 90.4% 2 1 17 40.5% 14 33.3% 7 16.7% 4 9.5% T T1 : T2 : T3 : T4a : T4b= 4 9.5% : 26 61.9% : 9 21.4% : 3 7.1% : 0 N N0 : N1 : N2a : N2b : N2c : N3 17 40.5% : 6 14.3% : 1 2.4% : 12 28.6% : 4 9.5% : 2 4.8% Stage Stage I : II : III : IVA : IVB=1 2.4% : 12 28.6% : 9 21.4% : 18 42.9% : 2 4.8% 34 81.0% 3 7.1% 5 14.0% Best Supportive Care Stage II : 2 Stage IVa : 2 Stage IVb : 1 3 /5 Stage II : 77.1 / 77.1% Stage III : 88.9/ 71.1% Stage IVA : 66.7/66.7% Stage I Stage IVB 1 77 9
6. 福島県立医科大学における中咽頭癌症例の臨床的検討 HPV 2018 1 6 HPV 2009 1 2016 12 8 65 56 9 48-89 66.5 66 50 1 75 16 1-107 34.3 31 15 34 8 8 5 Stage I 9 Stage II 9 Stage III 8 Stage IVA 27 Stage IVB 4 Stage IVC 8 TNM T : T1 11 T2 28 T3 7 T4a 13 T4b 6 N : N0 23 N1 6 N2a 3 N2b 12 N2c 17 N3 4 M : M0 57 M1 8 14 CRT 48 BSC 3 Kaplan - Meier 3 75.1% 5 63.2% 3 76.8% 5 76.8% Stage 5 StageI 71.1% Stage II 100% Stage III 100% Stage IVA 69.1% Stage IVB 25.0% 3 Stage IVC 20.0% 5 Stage I 100% Stage II 100% Stage III 100% Stage IVA 76.0% Stage IVB 25.0% 3 Stage IVC 20.0% Stage IVB 5-58 5 p16 10
7. 秋田大学における中咽頭癌症例の検討 2009 1 2016 12 8 106 89 17 23 87 : 64.6 : 66 50 : 10 75 : 16 0 140 : 36.2 : 27 : 25 : 61 :8 : 12 0 :3 I :1 II :7 III : 13 IVA : 65 IVB : 13 IVC :4 T Tis : 3 T1 : 4 T2 : 38 T3 : 29 T4a : 21 T4b : 11 N N0 : 15 N1 : 11 N2a : 1 N2b : 39 N2c : 32 N3 : 8 M1 4 0 I II III IV 2013 40 Gy 2014 : 21 : 22 : 58 BSC : 1 : 10 : 10 : 86 Kaplan - Meier 3 3 0 : 100% 100% I : 100% 100% II : 100% 100% III : 75% 75% IVA : 58.8% 62.2% IVB : 45.8% 45.8% IVC : 0% 0% 5 5 0 : 100% 100% I : 100% 100% II : 75% 100% III : 62.5% 75% IVA : 44.4% 51.3% IVB : 15.3% 15.3% IVC : 0% 0% 11
8. 当院における中咽頭癌症例についての検討 2009 1 2016 12 45 41 4 49-86 67 67 33.2 31.7 0-81 14 25 3 1 I :3 II :6 III :4 IVA : 25 IVB :2 IVC :1 T T1 : 8 T2 : 23 T3 : 1 T4a : 12 T4b : 0 N N0 : 11 N1 : 5 N2a : 5 N2b : 14 N2c :7 N3 : 2 M1 1 23 20 BSC 1 3 5 62.2% I : 100% 100% II : 80% 80% III : 100% 100% IVA : 60% 60% 3 5 75.9% I : 100% 100% II : 100% 100% III : 100% 100% IVA : 68% 68% 0 p16 13 5 8 7 2 3 2 25 12
9. 当科における中咽頭癌症例の検討 2009 1 2016 12 170 153 133 86.9% 20 13.1% 40 87 64.6 65 0-105 30 38.7 69 45.5% 53 34.4% 19 12.3% 13 8.4% 0 5 3.3% I 10 6.5% II 19 12.4% III 31 20.3% IVa 75 49.0% IVb 10 6.5% IVc 3 2.0% T Tis 5 3.3% T1 21 13.7% T2 66 43.1% T3 24 15.7% T4a 32 20.9% T4b 5 3.3% N N0 46 30.1% N1 28 18.3% N2a 2 1.3% N2b 35 22.9% N2c 35 22.9% N3 7 4.6% 5 60 39.2% ELPS 8 86 56.2% 14 BSC 7 4.6% 14 3 5 63.6% 56.8% 3 5 67.3% 61.7% 3 5 61.7% 59.4% 3 5 61.9% 54.4% Stage 3 5 Stage 0 66.7% 66.7% Stage I 87.5% 87.5% Stage II 93.3% 72.0% Stage III 76.5% 68.9% Stage IVa 54.7% 49.8% Stage IVb 22.2% 22.2% Stage IVc 0.0% 0.0% p16 87 56.5% 43 49.4% 23 19 1 p16 3 5 83.1% 83.1% p16 3 5 71.3% 71.3% 13
10. 当科における中咽頭癌症例の臨床的検討 2009 1 2016 12 8 67 63 4 42 81 65 40.7 1 113 62 92.5% 1 15 38 5 9 p16 5 p16 10 52 p16 51 76% 8 5 4 5 5 63.4% 0 100% I 100% II 83.3% III 71.1% IV 59.1% 5 43.6% 73.9% 80.0% 46.9% p16 5 p16 100% p16 38.8% 5 58.2% 100% p16 QOL 14
11. 当科における中咽頭癌症例の検討 2009 1 2016 12 123 107 16 41 86 64.7 64 50 10 75 23 0-104 27.1 22.2 : 29 : 77 :7 : 10 Stage I : 13 Stage II : 16 Stage III : 16 Stage IVA : 52 Stage IVB : 18 Stage IVC : 8 TNM Tis : 0 T1 : 19 T2 : 48 T3 : 23 T4a : 18 T4b : 15 N0 : 37 N1 : 12 N2a : 2 N2b : 44 N2c : 23 N3 : 5 M0 : 114 M1 : 9 Kaplan - Meier 3 5 Stage I : 90.0% 60.0% Stage II : 67.7% 67.7% Stage III : 77.9% 77.9% Stage IVA : 70.4% 63.8% Stage IVB : 46.7% 46.7% Stage IVC : 12.5% 12.5% 3 5 Stage I : 90.0% 60.0% Stage II : 74.1% 74.1% Stage III : 85.7% 85.7% Stage IVA : 70.4% 63.8% Stage IVB : 46.7% 46.7% Stage IVC : 12.5% 12.5% : 49 : 70 BSC : 4 : 16 : 107 p16 : 27 : 37 : 59 15
12. 中咽頭癌 140 例の臨床統計 2009 1 2016 12 8 140 135 2 1 2 2 NOS 1 135 112 : 23 35 84 64.9 65.0 50 12 75 26 1.4 111.2 39.7 36.2 33 85 6 11 0 0 I 13 II 12 III 15 IVA 78 IVB 13 IVC 4 57.8% IVA TNM Tis 0 T1 29 T2 44 T3 23 T4a 32 T4b 7 N0 34 N1 11 N2a 5 N2b 53 N2c 24 N3 8 M0 131 M1 4 p16 28 17 90 45 62.2% 28 16 82 BSC 10 69 84.1% CDDP 36 TPF 21 Cetuximab 4 CDDP 2 3 5 65.4% 57.8% 3 5 70.7% 66.4% 3 5 I : 70.0% 58.3% II : 90.9% 90.9% III : 66.7% 59.3% IVA : 64.7% 57.3% IVB : 52.7% 42.2% IVC : 25.0% 25.0% 3 5 I : 90.0% 90.0% II : 100% 100% III : 73.3% 73.3% IVA : 68.5% 62.9% IVB : 52.7% 42.2% IVC : 25.0% 25.0% 16
12 55 77 213 43 42 65 106 45 153 67 123 135 48 59 189 38 37 56 89 41 133 63 107 112 7 18 24 5 5 9 17 4 20 4 16 23 49-84 18-89 39-88 37-94 41-91 48-89 23-87 49-86 40-87 42-81 41-86 35-84 67.8 65.9 64 65.2 65.3 66.5 64.6 67 64.6 65 64.7 64.9 67 67 65 67 65 66 66 67 65 65 64 65 50 1 5 19 3 3 1 10 1 10 4 10 12 75 13 18 39 9 7 16 16 12 24 14 23 26 2 84 4-102 0-110 1-95 1-105 1-107 0-140 0-81 0-105 1-113 0-104 1-111 32.5 38.2 43.9 44.7 44 34.3 36.2 33.2 30 40.7 27.1 39.7 28 37 38.9 45 43 31 27 31.7 38.7 26 22.2 36.2 13 15 72 10 14 15 25 14 53 15 29 33 33 56 109 28 17 34 61 25 69 38 77 85 6 2 15 4 7 8 12 3 19 5 7 6 3 4 17 1 4 8 8 1 13 9 10 11 0 0 0 1 0 0 0 3 0 5 1 0 0 I 2 5 20 3 1 9 1 3 10 1 13 13 II 9 10 28 4 12 9 7 6 19 8 16 12 III 9 4 19 5 9 8 13 4 31 11 16 15 IVA 31 45 121 26 18 27 65 25 75 32 52 78 IVB 4 12 17 4 2 4 13 2 10 12 18 13 IVC 0 1 7 1 0 8 5 1 3 2 8 4 Tis 0 0 1 0 0 0 3 0 5 1 0 0 T1 9 10 38 6 4 11 4 8 21 6 19 29 T T2 21 20 80 21 26 28 38 23 66 24 48 44 T3 9 11 38 7 9 7 29 1 24 15 23 23 T4a 14 16 40 7 3 13 21 12 32 18 18 32 T4b 2 10 16 2 0 6 11 0 5 3 15 7 N0 18 21 64 8 17 23 15 11 46 17 37 34 N1 6 5 17 5 6 6 11 5 28 10 12 11 N N2a 5 4 12 1 1 3 1 5 2 3 2 5 N2b 13 33 72 15 12 12 39 14 35 15 44 53 N2c 10 11 41 11 4 17 32 7 35 11 23 24 N3 3 3 7 3 2 4 8 2 7 11 5 8 M M1 0 1 7 1 0 8 4 1 3 2 9 4 0 100 100 66.7 100 I 100 100 79.3 100 88.9 100 100 87.5 100 90 70 II 87.5 80 80.5 75 57.1 100 100 80 93.3 71.4 67.7 90.9 3 OS III 88.9 100 100 60 88.9 100 75 100 76.5 42.4 77.9 66.7 IVA 55.7 67.5 80.4 71.4 58.3 76 58.8 60 54.7 55.2 70.4 64.7 IVB 37.5 40 55.7 50 100 25 45.8 X 22.2 66.7 46.7 52.7 IVC 0 0 0 20 0 X 0 0 12.5 25 65 65.9 79.5 68.3 69.7 75.1 59.7 62.2 63.6 55.5 65.1 65.4 0 100 100 66.7 100 I 100 80 79.3 100 71.1 100 100 87.5 100 60 58.3 II 87.5 80 80.5 75 57.1 100 75 80 72 71.4 67.7 90.9 5 OS III 88.9 75 100 60 59.3 100 62.5 100 68.9 42.4 77.9 59.3 IVA 55.7 58.8 72.9 71.4 38.9 69.1 44.4 60 54.7 55.2 63.8 57.3 IVB 37.5 20 55.7 50 100 X 15.3 X 22.2 66.7 46.7 42.2 IVC 0 0 0 20 0 X 0 0 12.5 25 61.2 56.3 75.1 68.3 58.1 63.2 46 62.2 56.3 45.1 60.1 57.8 0 100 100 66.7 100 I 100 100 90 100 100 100 100 87.5 100 90 90 II 100 77.8 83.6 75 77.1 100 100 100 93.3 83.3 74.1 100 3 DSS III 88.9 100 100 100 88.9 100 75 100 76.5 71.1 85.7 73.3 IVA 55.7 69.9 82.8 83.2 66.7 76 62.2 68 60 57.5 70.4 68.5 IVB 37.5 50 59.7 75 100 25 45.8 X 33.3 66.7 46.7 52.7 IVC 0 0 0 20 0 X 0 0 12.5 25 66.3 70.3 82.9 85.7 74.8 76.8 62.6 76.6 67.3 63.4 67 70.7 0 100 100 66.7 100 I 100 80 90 100 100 100 100 87.5 100 60 90 II 100 77.8 83.6 75 77.1 100 100 100 72 83.3 74.1 100 5 DSS III 88.9 75 100 100 71.1 100 75 100 76.5 71.1 85.7 73.3 IVA 55.7 64.1 78.1 83.2 66.7 76 51.3 68 54.6 57.5 70.4 62.9 IVB 37.5 50 59.7 75 100 X 15.3 X 33.3 66.7 46.7 42.2 IVC 0 0 0 20 0 X 0 0 12.5 25 66.3 61.8 80.1 85.7 69.8 76.8 54.1 76.6 61.7 63.4 64.2 66.4 10 21 56 11 3 14 43 23 61 4 49 28 36 56 145 30 34 48 58 20 86 63 64 82 p16 BSC 8 0 12 2 5 3 1 1 7 0 4 10 18 0 31 3 0 9 0 0 14 8 16 2 37 77 182 40 42 54 106 45 139 59 107 133 24 31 88 26 0 6 10 13 43 5 27 28 23 18 64 13 0 5 10 7 43 10 37 17 8 28 61 4 42 54 86 25 66 52 59 90 17