細胞悪性度からみた早期胃癌再発死

Recurrence of Early Gastric Carcinoma: A cytophotometric DNA analysis

要旨　早期胃癌の再発に関して，発育パターンと癌細胞核DNA量分布パターンによる検討を行い，癌の悪性度についての解析を試みた．術後早期に肝再発を来し，予後不良なPen A型は分散幅の広いⅢ，Ⅳ型のDNA量分布パターンを示すのに対し，経過が長く予後良好なSuper型は分散幅の狭いⅠ，Ⅱ型を示した．そしてPen A型の初期のものがSmall mucosal型に含まれており，その中の一部に再発したものがあることをDNA量分布パターン分析によって明らかにできた．このように，DNA量分布パターンは癌の悪性度をよく反映していた．

　A cytophotometric DNA analysis was performed in 108 cases of early gastric carcinoma according to the growth patterns. DNA distribution pattern was classified into types Ⅰ, Ⅱ, Ⅲ and Ⅳ, according to the degree of dispersion on the DNA histogram. The majority of Super (superficially spreading) type, which showed quite excellent prognosis of the patient, were type Ⅱ (high peak at 2 to 4 c ranges with a narrow scatter). On the contrary, Pen A (expansively penetrating growth) type, which had a poor prognosis of the patient due to early recurrence in the liver, showed types Ⅲ or Ⅳ (low or no peak with a wide scatter and an increase of cells over 6c) in the majority of cases. Most of the Pen B (infiltratively penetrating growth) type and the Small mucosal type (not classifiable into the Super or the Pen types), both of which had an excellent prognosis of the patient, were type Ⅱ. All five cases of normal gastric mucosa were type Ⅰ. Thus, there was a distinct difference in the DNA distribution pattern between Super and Pen A types. This would suggest that cancer cells of the Super type may have a low grade malignancy whereas those in Pen A type a high grade malignancy. Among 12 cases of the Small mucosal type with type Ⅳ, two recurrent cases were died after five years postoperatively. This suggests the existence of a highly malignant prototype of the Pen A type.

　Thus, an analysis of the DNA distribution pattern may be useful for detection of early gastric carcinomas of high grade malignancy in the early stages of development.