n_1,n_2進行胃癌例に対する拡大リンパ節郭清の意義 CLINICOPATHOLOGICAL STUDY ON THE SIGNIFICANCE OF EXTENDED LYMPH NODES DISSECTION FOR ADVANCED GASTRIC CANCER WITH n_1 OR n_2 LYMPH NODES INVOLVEMENT

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H<sub>0</sub>, P<sub>0</sub>でD<sub>2</sub>以上が行われた根治度AまたはBの進行胃癌症例中, n<sub>1</sub>, n<sub>2</sub>例を対象に,拡大リンパ節郭清が予後に反映されるか否かを検討した.<br> D<sub>2</sub>群とD<sub>3</sub>以上の拡大郭清(EX)群でn因子別の5生率は, n<sub>1</sub>D<sub>2</sub>群: 63%, n<sub>1</sub>EX群: 73%, n<sub>2</sub>D<sub>2</sub>群: 33%, n<sub>2</sub>EX群: 52%で, n<sub>2</sub>例でEX群が有意に良好であった. n<sub>2</sub>例では占居部位がA, C, 肉眼型が浸潤型(EX群: 48%, D<sub>2</sub>群: 28%), 組織型が未分化型(EX群: 37%, D<sub>2</sub>群: 16%)でD<sub>2</sub>群に比しEX群が有意に5生率が良好であったが, 4型胃癌は両群とも予後不良であった.以上より, D<sub>2</sub>で良好な治療成績が期待できるのはAまたはC領域,限局型,深達度mp~ssの限られたn<sub>1</sub>症例であり, n<sub>2</sub>例,特にAまたはC領域,浸潤型,未分化型癌では, D<sub>2</sub>群に比しEX群が有意に良好な予後が得られることが判明した.一方, 4型胃癌は拡大郭清の効果は少なく,今後免疫化学療法を駆使した集学的治療の必要性があると思われた.

Advanced gastric cancers with n<sub>1</sub> or n<sub>2</sub>were reviewed to investigate wheter or not exteded lymph nodes dissection improved the prognosis and to determine an indication for extended lymph nodes dissection.<br> They were divided into two groups: D<sub>2</sub> group and extended lymph nodes dissection (EX) group. The cumulative 5-year-survival rates of n<sub>1</sub> cases were 63% in D<sub>2</sub> group and 73% in EX group and those of n<sub>2</sub> cases were 33% in D<sub>2</sub> group and 52% in EX group (p<0.01). Survival rate of EX group was significantly higher than that of D<sub>2</sub> group in the n<sub>2</sub> cases with tumor locating in the upper or lower third lesion (p<0.05). Five-year-survival rate of EX group (48%) was better than that of D<sub>2</sub> group (28%) of in n<sub>2</sub> cases with infiltrative type in gross appearance (p<0.01), however, there was poor prognosis in type 4 cancers. Regarding the histological type, survival rate of EX group (37%) was significantly higher than that of D<sub>2</sub> group (16%) in n<sub>2</sub> cases with undifferentiated type (p<0.01).<br> We conclude that patients from D<sub>2</sub> group whom a better survival can be expected have the following factors: upper or lower third lesions, localized type in gross appearance and mp_??_ss in depth in n<sub>1</sub> cases. The survival rate was significantly better with extended lymph nodes dissection in n<sub>2</sub> cases, especially for upper or lower third lesions, infiltrative type and for undifferentiated type than with D<sub>2</sub> dissection. Type 4 gastric cancer had a poor prognosis and little benefit for extended lymph nodes dissection. In the further management of these patients, not only curative resection of the tumor but also application of multimodal treatments including immunochemotherapy would be necessary.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(9), 2112-2118, 1996-09-25

    Japan Surgical Association

参考文献:  9件中 1-9件 を表示

被引用文献:  1件中 1-1件 を表示

  • SS胃癌における拡大リンパ節郭清の意義

    大城 望史 , 八幡 浩 , 三浦 義夫 , 丹治 英裕 , 篠崎 勝則 , 内田 一徳 , 杉野 圭三 , 丸林 誠二 , 浅原 利正 , 土肥 雪彦

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 61(6), 1390-1394, 2000-06-25

    医中誌Web 参考文献12件 被引用文献1件

各種コード

  • NII論文ID(NAID)
    10008523853
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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