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大学・研究所にある論文を検索できる 「胃・食道神経内分泌癌における治療標的分子発現の検討」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

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胃・食道神経内分泌癌における治療標的分子発現の検討

山下, 智 東京大学 DOI:10.15083/0002007083

2023.03.24

概要

[課程-2]
審査の結果の要旨
氏名 山下 智
本研究は、予後不良で治療標的が未確立な胃・食道の神経内分泌癌(neuroendocrine
carcinoma, NEC)に対して、免疫治療関連の標的分子発現の探索を目的とし、胃 25 例、
食道 15 例の NEC の PD-L1(Combined positive score, CPS と Tumor Proportion Score,
TPS で定量的に評価)
、HLA class I、MMR 蛋白、HER2(胃のみ)の発現を免疫組織化
学的に評価し、腫瘍組織浸潤リンパ球(Tumor-Infiltrating Lymphocytes, TILs)の多寡を検
討した。
結果は以下の通りである。
1)胃は 18 例(72%)で PD-L1 CPS≧1(陽性)を示し、TPS≧1%(陽性)は 10 例(40%)で
あった。なお、CPS≧1 陽性であるにも関わらず TPS<1%陰性症例は 8 例存在し、これら
症例は免疫細胞により強く PD-L1 の発現を認めた。CPS<1 症例では有意にリンパ節転移
が多く peritumoral TIL 低値を全例に認めた。生存分析では、CPS≧1 で生存期間が長い
傾向を認めた。HER2 は全例陰性、HLA-Class I 発現保持は 21 例(84%)、MMR 蛋白欠損
は 4 例(16%)であった。
2)食道の PD-L1 は CPS≧1 が 9 例(60%)、CPS≧10 が 5 例(33%)、TPS≧1%は 5 例
(33%)に認められた。生存分析では、CPS≧1 で生存期間が有意に長かった。HLAClass I 発現保持が 10 例(67%)、HLA-Class I 陰性化はリンパ節転移と TNM Stage、腫瘍
浸潤リンパ球低値と有意に相関した。MMR 蛋白欠損は認めなかった。
上記結果より、胃 NEC における HER2 の発現は乏しく、NEC の治療標的分子として
の意義は乏しいと考えられた。一方で PD-L1 や HLA-ClassⅠの発現は胃 NEC や食道
NEC で高頻度に認められ、免疫チェックポイント阻害薬やがんワクチン等のがん免疫治
療が、有望な治療選択肢と考えられた。
以上、本論文は、予後不良なサブタイプである胃・食道 NEC において、腫瘍免疫治療
関連の標的分子の発現等を詳細に評価した研究であり、NEC の免疫治療戦略のための基
礎データを供する貢献をなし得たと考えられる。
よって本論文は博士( 医学 )の学位請求論文として合格と認められる。

この論文で使われている画像

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105

略語集

略語:AC+,腺癌成分のみで HER2 陽性; AdenoCa,腺癌成分の有無; Adj, adjuvant

chemotherapy 術補補助化学療法;

Alive,alive with no evidence of disease 無病生存;

AWD,Alive with disease 有病生存; CCRT, concurrent chemoradiotherapy 同時性化学放射

線療法;

CPS, combined positive score ;

chemotherapy 化学療法;

CR, complete response 完 全 奏 功 ;

DOC,dead of other causes 他病死;

病死; Large,大細胞型;

LN,リンパ節;

CT,

DOD,dead of disease 原

Ly,リンパ管侵襲; MANEC,混合腺

神経内分泌癌; MiNEN,mixed neuroendocrine-non-neuroendocrine neoplasm 混合神経内

Mut,変異型パターン;

分泌-非神経内分泌腫瘍;

NAC, neoadjuvant chemotherapy 術

前化学療法; NEC, neuroend ...

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