胃粘膜内癌のリンパ節転移と予後 RISK FACTORS OF LYMPH NODE METASTASES AND RECURRENCE FROM INTRAMUCOSAL GASTRIC CANCER
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初発単発胃粘膜内癌464例を対象に,リンパ節転移と再発の危険性につき検討した.リンパ節転移は6例(1.3%, n1 2例, n2 4例)にみられ,腫瘍最大径は1～10cm(平均5.6cm),肉眼型はIIc 3例, IIc+III 1例, 3型1例, 5型1例と全て潰瘍合併の陥凹型で,組織型はpor 3例, sig 2例, tub2 1例でtub2にも一部に低分化腺癌の像があり,全てに低分化腺癌の部分が見られた.リンパ節転移陽性例は陰性例に比して有意に腫瘍最大径が大きく潰瘍合併頻度が高く, 6例中3例が再発死している.生存例399例と比較すると癌死例4例は腫瘍最大径が全て4cm以上であり,潰瘍合併とリンパ節転移陽性の割合が有意に高かった.潰瘍を伴う陥凹型の低分化腺癌では粘膜内癌でもリンパ節転移の可能性がありD2のリンパ節郭清が不可欠で,転移があれば術後補助化学療法が必要である.
Four hundred and sixty-four patients with solitary intramucosal gastric cancer were subjected to a study of risk factors of lymph node metastases and the recurrence. Lymph node metastases were recognized in 6 cases (1.3%, n1 2, n2 4). The largest diameters of these tumors ranged from 1 cm to 10 cm (mean 5.6 cm). They showed macroscopically depressed types including 3 IIc types, IIc+III type, 3 type and 5 type. Histology revealed all the tumors contained foci of poorly differentiated adenocarcinoma including 3 por, 2 sig and tub 2. Intramucosal gastric cancers with lymph node metastases were characterized by larger diameter, more often associated ulceration and more often overstimated serosal invasion than those without lymph node metastases. Three of 6 patiens with lymph node metastases died of cancer recurrence at 25, 61 and 71 months after surgery. The 4 recurrent cases died of cancer and had larger diameter (more than 4 cm) and were more often associated with ulceration and lymph node metastases than nonrecurrent 399 cases. We conclude that the depressed poorly differentiated gastric cancer with ulceration, even if it is an intramucosal cancer, can metastasize to lymph nodes; such a cancer should be treated by gastrectomy with lymph node dissection; and postoperative adjuvant chemotherapy should be mandatory, if lymph node metastases exist.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 57(9), 2119-2123, 1996
Japan Surgical Association