大腸低分化腺癌の治療成績 Surgical Results for Poorly Differentiated Adenocarcinomas of the Colorectum

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大腸低分化腺癌63例と高分化腺癌608例・中分化腺癌609例の臨床病理学的因子および治療成績について比較検討した.男女比,年齢に差は認められなかった.低分化腺癌は高・中分化腺癌に比して腫瘍径が大きく,右側結腸に多く発生し,3・4型の肉眼型の頻度が高く,深達度が深かった.臨床病理学的因子についてss(al)以深の症例で比較検討した結果,肝転移率に差は認められなかったが,腹膜播種率は高/中/低分化腺癌の順に0/11/20%,リンパ節転移率は45/50/71%,リンパ管侵襲率は31/40/69%,静脈侵襲率は17/26/46%,といずれも高分化腺癌に比して低分化腺癌で高値であった.治癒切除率は順に87/80/66%で,最も低分化腺癌が低値であった.全症例の5年生存率は高/中/低分化腺癌の順に70/56/41%と有意に低分化腺癌が低かったが,治癒切除症例においては差を認めなかった.低分化腺癌を間質結合織量から髄様/中間/硬性型に亜分類すると,5年生存率は順に86/35/27%と髄様型が予後良好であり,髄様型低分化腺癌は特殊型として扱うべきと考えられた.

Sixty-three poorly differentiated carcinomas (Por), 608 well differentiated carcinomas (Well), and 609 moderately differentiated carcinomas (Mod) were identified among 1, 280 surgically resected colorectal carcinomas. The clinicopathologic characteristics and prognosis of Por were compared with those of Well and Mod. Por was more frequently found in the right side of the colon, and it included more frequent cases of ss (al) layer or deeper penetration, compared with Well and Mod. Peritoneal dissemination and lymph node metastasis were significantly more common in Por than in Well, in advanced colorectal cancer. The 5-year survival rates in patients with Well, Mod, and Por were 70%, 56%and 41%, respectively. That of Por was significantly lower compared with Well and Mod. After curative operation, there was no significant difference in three groups. According to fibrous stroma, Por cases were classified into three groups : medullary, intermediate, or scirrhous type. The medullary type of Por was associated with significantly longer survival compared with the intermediate and scirrhous types of Por. In conclusion, advanced disease was more common in patients with Por, but the prognosis after curative resection did not differ among Well, Mod, and Por. These findings suggest that the medullary type of Por should be regarded as a distinct type of Por, leading to a good prognosis.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 55(1), 52-58, 2002-01

    The Japan Society of Coloproctology

参考文献:  21件中 1-21件 を表示

被引用文献:  2件中 1-2件 を表示

各種コード

  • NII論文ID(NAID)
    10008386112
  • NII書誌ID(NCID)
    AN00195100
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00471801
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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