大腸低分化腺癌の臨床病理学的検討 : 充実型,非充実型低分化腺癌の分類法の予後因子としての重要性  [in Japanese] Clinicopathologic Characteristics of Poorly Differentiated Adenocarcinoma of the Colorectum : Prognostic Significance of Solid and Non-solid Types of Poorly Differentiated Adenocarcinoma  [in Japanese]

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Abstract

大腸低分化腺癌は頻度が低いため,臨床病理学的に十分な検討がなされていない.そこで,低分化腺癌の臨床病理学的特徴を抽出するために,1986年から1999年までに当院で経験した低分化腺癌82例について,同時期の分化型腺癌1,003例と臨床病理学的に比較し,さらに,低分化腺癌を充実型と非充実型に亜分類し検討を加えた.低分化腺癌は高・中分化腺癌に比べ腫瘍径が大きく,リンパ節・肝・腹膜転移陽性例が多く(p<0.01~0.0001),予後不良で(logrank test,p<0.0001),5年生存率は低分化腺癌47%,中分化腺癌66%,高分化腺癌75%であった.また非充実型低分化腺癌は充実型に比べ有意にリンパ節・肝転移が多く(p<0.05),予後不良で(p<0.01),5年生存率は非充実型37%,充実型68%であった.Coxの回帰分析では,独立した予後不良因子の1つとして非充実型が抽出され,低分化腺癌の亜分類は予後を推定する上で有用な指標と考えられた.

AIMS The aim of this work was to clarify clinicopathologic features of poorly differentiated adenocarcinomas of the colorectum, which were especially subclassified into solid and nonsolid types, in comparison with well to moderately differentiated adenocarcinomas.<BR>METHODS A total of 1085 patients with colorectal carcinoma (82 poorly differentiated, 631 well differentiated, and 372 moderatery differentiated adenocarcinomas) that received surgery at Kitasato University East Hospital, between 1986 and 1999, were investigated for clinicopathologic variables. Comparative study was performed between 34 solid type and 48 non-solid type poorly differentiated adenocarcinomas. Data were analyzed by univariate and multivariate statistics. RESULTS Larger tumor and metastases to lymph nodes, liver, or peritoneum were more frequently observed in poorly differentiated type than in other types of adenocarcinomas. Five-year survival was significantly worse in the former (47%) than in the latter (well differentiated type, 75 % ; moderately differentiated type, 66%). Non-solid type poorly differentiated adenocarcinomas frequently showed lymph node liver metastases compared with solid type. Five-year survival was significantly worse in the non-solid type (37 %) than in the solid type (68%). Cox 's logistic regression multivariate analysis showed that non-solid type and older patients (≥66 yrs) were statistically significant worse predictors.<BR>CONCLUSIONS Poorly differentiated adenocarcinomas were aggressive tumors associated with frequent metastases. subclassification of these tumors into non-solid and solid types is an independent prognostic predictor.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(1), 16-21, 2002-01

    The Japan Society of Coloproctology

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