<原著>漿膜浸潤陰性胃癌における癌再発死亡の検討

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Out of 503 patients with gastric cancer without serosal invasion (s_0 gastric cancer) who had undergone resection, 448 patients had undergone histological curative resection. The 42 patients who died of recurrence were clinically and pathologically investigated according to the degree of depth of invasion. The proportion of curative resection was 99.4% in m, 98.4% in sm, 94.9% in pm and 71.4% in ssα, β. The proportion of recurrence was 1.2% in m, 2.4% in sm, 20.7% in pm and 29.8% in ssα, β. Although the proportion of curative resection in pm was high similar to early gastric cancer, it had a high proportion of recurrence similar to ss and the survival rate showed a median of m, sm and ssα, β. The cases of death due to recurrence in early gastric cancer were 2 cases in m and 3 cases in sm. The macroscopic type was depressed type (IIc, IIc+III) in 3 cases and mixed type (IIa+IIc) in 2 cases. The histological type was well (tub 1) and moderately (tub2) differentiated adenocarcinoma in 5 cases, but none were undifferetiated type. Twenty three cases in pm and 14 cases in ssα, β among the patients who died due to recurrence were clinically and pathologically investigated according to the proportion of recurrence. The M area (9.7%) in pm showed a significantly low rate compared with the A and C areas (p<0.05) and showed a low rate compared with the M area (33.3%) in ssα, β. In macroscopic type, the proportion of recurrence in pm and ssα, β were 26.6%, 35.3% in Borrmann type and 16.7%, 25.0% in unclassified type cases. According to histological type, undifferentiated type showed a significantly different low proportion of recurrence from moderately differentiated type in pm (p<0.05), the undifferentiated showed a higher rate in ssα, β than in pm. The rate of positive cases of lymph node metastasis (p<0.01) and lymphatic vessel invasion (ly) (p<0.05) in pm was significantly higher than that of negative cases. In the pattern of recurrence, liver metastasis (23.3%) in pm and peritonitis carcinomatosa (73.3%) in ssα, β were higher than in other wall depths. The average survival time was 2,917 days in m, 1,182.7 days in sm, 846 days in pm and 815.7 days in ssα, β (p<0.05,there being a significant difference between m and ssα, β). The frequency of recurrence of lymph nodes in prognosis of s_0 gastric cancer was low in cases of standard lymph node dissection, in which the lymph nodes upto group 2 or group 3 had been resected. On the other hand, the frequency of a hematogenous pattern of recurrence in m, sm and pm, and peritonitis carcinomatosa in ss gastric cancer was high. These findings suggest the importance of adjuvant therapy at operation and after operation in these cases.
近畿大学の論文
1992-09-25

<原著>漿膜浸潤陰性胃癌における癌再発死亡の検討

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