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Stomach and Intestine(Tokyo) Volume 29, Issue 11 （October 1994）

胃と腸 29巻11号（1994年10月発行）

Japanese English

今月の主題大腸sm癌の細分類とその意義

主題研究

大腸sm癌における先進部組織異型度とリンパ節・遠隔転移 The Significance of Histopathologic Findings in the Submucosal Invasive Front of Early Colorectal Carcinoma in Terms of Regional Lymph Node Metastasis and Tumor Recurrence 望月英隆 ¹ , 長谷和生 ¹ , 柳生利彦 ¹ Hidetaka Mochizuki ¹ , Kazuo Hase ¹ , Toshihiko Yagyu ¹ ¹防衛医科大学校第1外科 ¹Depurtment of Surgeryl, School of Medicine, National Defense Medical College キーワード：大腸sm癌 , 腫瘍先進部 , 組織異型度 , リンパ節転移 , 遠隔転移再発 Keyword: 大腸sm癌 , 腫瘍先進部 , 組織異型度 , リンパ節転移 , 遠隔転移再発 pp.1143-1150

発行日 1994年10月25日 Published Date 1994/10/25

DOI https://doi.org/10.11477/mf.1403105940

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要旨　R₁以上の郭清を伴う腸切除を行った大腸sm癌131例を対象に，腫瘍先進部の組織学的所見に着目してretrospectiveに検討を行い，リンパ節（LN）転移や再発の危険因子を明らかにした．LN転移に関しては，深達度sm_2,3，sm組織型；中・低分化，INFβ，簇出(＋)，脈管侵襲(＋)の5因子中3因子以下ではLN転移は皆無なのに対し，4因子以上のLN転移率は42.6％に達した．再発に関しては，LN転移(＋)，深達度sm_2.3，INFβ，静脈侵襲(＋)の4因子のうち1因子以下では再発は皆無であったのに対し，2因子以上の再発率は15.4％であった．腫瘍先進部の組織学的所見の検索は大腸sm癌のLN転移や再発を予知するうえで重要であり，治療法選択の際に不可欠と考えられた．

　The histopathologic findings in the submucosal invasive front of 131 early colorectal cancer patients, who underwent curative bowel resection with lymph node dissection, were investigated retrospectively in terms of their significance as predictors of regional lymph node metastasis and tumor recurrence.

　Twenty patients (15.3%) had regional lymph node involvement at thetime of the primary operation, 10 patients (7.6%) developed tumor ecurrence, mainly hepatic metastasis, after curative resection. Five histopathologic findings showed significantly higher rates of lymph node metastasis respectively, compared to those without these findings. They were: 1) middle or deep submucosal tumor invasion (sm_2･3), 2) moderate or poor tumor differentiation in the submucosal invasive front, 3) poorly demarcated cancer growth at invasive front (INFβ), 4) tumor budding ahead of invasive front, and 5) vessel permeation. These 5 factors were thus considered as risk factors possibly leading to regional lymph node metstasis. Whereas patients with ≦3 risk factors had no nodal spread, the rate of lymph node involvement with≧4 was 42.6%. As for tumor recurrence after curative resection, four pathologic findings: a) nodal involvement, b) sm_2･3, c) -INFβ, and d) venous permeation were considered as risk factors. While patients with ≦1risk factors had no tumor recurrence, those with ≧2 showed a recurrence rate of 15.4%.

　It is concluded that histopathologic findings in the submucosal invasive front in early colorectal carcinoma are very useful for the prediction of the high risk group for lymph node metastasis and tumor recurrence.