大腸癌肺転移切除・非切除例の臨床病理学的検討:原発巣における簇出の肺転移切除予測因子としての重要性 Clinicopathological Evaluation of Patients with Pulmonary Metastasis from Colorectal Cancer Treated of not Treated by Lung Resection : Importance of Tumor "budding" in the Primary Lesion as a Factor Predicting Resection of Lung Metastatic Lesions

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Abstract

大腸癌では,同時性又は異時性に肺転移を認める例があり,この再発巣をコントロールすることで遠隔成績の向上が期待できる.そこで1986年から2000年までに北里大学東病院で経験した大腸癌肺転移58例について,肺転移切除,非切除例に分け臨床病理学的に比較した.非切除例は切除例に比し固有筋層を越える浸潤例が多く(p=0.0317),また,原発巣浸潤先進部の腫瘍の"簇出"が高度の症例が多かった(p=0.0006).ロジスティック回帰分析では肺切除,非切除を予測する因子として腫瘍の"簇出"の程度(p=0.0012);オッズ比0.0296)と壁深達度(p=0.0141;オッズ比9.3845)が抽出された.肺切除,非切除例の5年生存率は各々67.4%,27.9%,10年生存率は24.7%,0%で有意差を認めた(p<0.0001).以上より大腸癌肺転移巣切除の可否を予測する上で,原発巣浸潤先進部の簇出の評価は有用な指標と考えられる.

In some cases of colorectal cancer, synchronous or heterochronous lung metastasis occurs, and control of this recurrent lesion is important for improving prognosis. Therefore, weclassified 58 patients with lung metastasis from colorectal cancer, encountered at Kitasato University East Hospital between 1986 and 2000, into two groups, who underwent or did not undergo resection of the lung metastatic lesion (lung resection and non-resection groups, respectively), and weclinicopathologically compared them. The non-resection group more frequently showed that the primary carcinoma had invaded beyond the muscularis propria (p=0.0317), and marked tumor "budding" of the invasive front of the primary lesion (p=0.0006), compared with the lung resection group. Logistic regression analysis revealed the degree of tumor "budding" (p=0.0012 ; odds ratio, 0.0296) and the depth of tumor invasion (p=0.0141 ; odds 9.3845) as factors predicting lung resection or non-resection. Significant differences (p<0.0001) were observed (p<0.0001) between the lung resection and non-resection groups in the 5-year survival rate (67.4% and 27.9%, respectively) and the 10-year survival rate (24.7% and 0%, respectively). These results suggest that the eveluation of tumor "budding" of the invasive front of the primary lesion is a useful indicator in predicting the resection of lung metastases from colorectal cancer.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(6), 287-292, 2002-06-01

    The Japan Society of Coloproctology

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