胃sm癌の浸潤・転移・再発と生物学的特徴

Biological Characteristics of Submucosal Gastric Cancer in Invasion, Metastasis, and Recurrence

要旨　胃sm癌の浸潤・転移・再発について，従来の病理学的特徴に加えて腫瘍の生物学的特徴に着目し，検討した。まず増殖活性でみると，脈管侵襲もリンパ節転移もない群よりも，脈管侵襲陽性群やリンパ節転移陽性群でAgNOR数が有意に高くなっていた．発育進展形式で細分類すると，表層拡大型のSuper型に比べて深部浸潤傾向の強いPen-A型ではp53異常蛋白の陽性率が高く，腫瘍内血管密度も高かった．胃sm癌の浸潤・転移・再発のrisk factorとして，高い増殖活性，p53異常蛋白陽性，腫瘍内血管密度の高値が挙げられ，特にp53異常蛋白は予後因子の1つと考えられた，術前の生検などでhigh riskとされる症例には，手術で十分な範囲の切除・郭清が必要で術後の補助化学療法も検討すべきである．術後の経過観察も5年以上が望ましい．

　We analyzed biological characteristics of submucosal gastric cancer in relation to invasion, metastasis, and recurrence. The mean AgNOR count, a parameter of proliferative activity, was significantly higher in the group with vessel invasion or nodal metastasis than that in the group without those involvements. In terms of growth pattern, penetrating-growth type growing expansively (Pen-A) had significantly higher positive rate of p53 and higher vascularity than superficially spreading type (Super) had. High proliferative activity, overexpression of p53, and high intratumoral vascularity were risk factors of invasion, metastasis, and recurrence of submucosal gastric cancer. p53 is a predictor of the patients' prognosis. For patients with high risk factors, adequate lymph node dissection and adjuvant chemotherapy should be considered. It is better to follow-up the patients for more than five years.