予後の良い膵癌

Pancreatic Cancer with Good Prognosis

要旨　膵癌の術後5年以上生存例の予後良好な条件をみると，癌の大きさが2cm以上でありながら，膵被膜浸潤がなく，膨張性発育を示すものが多かった．われわれの発見した早期膵癌9例では，1例を除き，術後3～5年生存し，予後良好と推定しうる．粘液産生癌の膵内進展様式を胃癌の壁浸潤形態と比較して，粘液産生癌の主膵管内の発生，膵管内進展および膨張性発育が良好な予後を裏付けている．早期充実癌では，膵管内のcarcinoma in situが臨床的に認められず，発生の早期から周囲に浸潤するものであろう．主膵管近傍に発生した充実性癌で膵頭部では1.5cm内外，膵体部で1cm内外の大きさで発見されれば，予後良好と推定される．主膵管内および主膵管近傍に発生した膵癌による二次的膵炎をチェックし，ERCPで膵の異常をとらえることが，予後良好な膵癌を発見することになり，膵癌の早期診断に通ずるものである．予後良好な特殊型膵癌には囊胞腺癌と腺房細胞癌が認められる．

　Cases pancreatic cancer with good prognosis and surviving more than five years after surgery were studied. The authors discovered that many cases of them showed protruded growth and no capsular invasion in spite of the fact that they were more than 2 cm in size. Out of nine early pancreatic cancer cases found, eight survived three to four years after resection, by us showing good prognosis.

　The mode of cancer growth in the pancreas was compared to that of intramural spread of gastric cancer. Mucous producing cancer appeared and spread in the main pancreatic duct, and developed into form of protrusion. These are signs of good prognosis in pancreatic cancer.

　In the case of early solid cancer, carcinoma in situ was not recognized clinically in the pancreatic duct. It most probably invades the periphery of the duct in its early stage. For these solid cancer which occur in the neighbouring area of the main pancreatic duct, if they are within 1.5 cm of size the head of the pancreas or 1 cm of body of the pancreas, we can predict their prognosis to be good.

　Moreover, an attention should be paid to cases of recondary pancreatitis in the main pancreatic duct and neighbouring area due to cancer, and the further investigation should be done by as many ERCP as possible. This procedure may enable early diagnosis and detection which lead to good prognosis.

　Cystadenocarcinoma and acinar cell carcinoma were recognized in special-type pancreatic cancer with good prognosis.