RT-PCR法による大腸癌腹腔洗浄液中CEAm-RNA陽性症例の臨床病理学的検討 Clinocopathological Examination of Positive CEA-mRNA of Colorectal Cancer with Peritoneal Wash Using the RT-PCR Method





初発大腸癌開腹手術症例42例を対象,良性疾患5例を対照とし術中腹腔洗浄液の細胞診及びRT-PCR法を用いたCEAm-RNAの定性を施行し,その臨床病理学的意義を検討した.CEAm-RNA陽性率は19.0%,細胞診陽性率は7.1%であった.良性疾患ではCEAm-RNA,細胞診共に陰性であった.肉眼的腹膜播種性転移陽性症例3例全例はCEAm-RNA,細胞診ともに陽性であった.CEAm-RNA陽性,細胞診陰性症例5例中1例に術後腹膜再発を認めた.RT-PCR法を用いたCEAm-RNAの定性は細胞診に比,癌細胞の存在診断をより鋭敏に可能とする可能性があり,有用な予後判定因子になり得ると考えられた.また臨床病理学的検討により,遊離癌細胞を生じやすい,あるいは合併しやすい因子として深達度SS以上で浸潤様式が散在性の症例,組織型が高分化腺癌よりも中分化腺癌,粘液癌の症例,リンパ節転移,リンパ管浸襲を有する症例,肝転移を有する症例,Stage II以上の症例が考えられた.

Forty-two patients who underwent laparotomy for primary colorectal cancers, and 5 patients with be-nign diseases, were examined. Intraperitoneal wash, obtained during operation, underwent cytodiagnosis, and qualitative analysis of CEAm-RNA was performed using RT-PCR method. CEAm-RNA was positive in 19.0%, and cytodiagnosis was positive in 7.1%. In the cases of benign diseases, both CEA-mRNA and cytodi-agnosis were negative. All of the patients who showed peritoneal-disseminated metastases macroscopically, were also positive for CEAm-RNA and negative in cytodiagnosis. In one patient who was positive for CEAm-RNA and negative in cytodiagnosis, postoperative recurrence in the peritoneum was found. Consequently, determination of CEAm-RNA seemed to be more sensitive than cytodiagnosis in detecting cancer cells, and therefore, the former may be a useful method for establishing a prognosis. By clinicopathological examination, it is easy to recognize detecting cancer cells in cases of SS or above in the depth showing scattered infiltration pattern, of moderately differentiated adenocarcinoma rather than highly differentiated one, of mucous cancer, of lymph node metastasis or invasion, of liver metastasis, and of Stage II and above.


  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 55(1), 1-8, 2002-01

    The Japan Society of Coloproctology

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