舌癌の術前化学療法効果に関する臨床病理学的検討 ―特に腫瘍縮小効果と組織学的効果との関連性について―
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The present study, using 79 patients, was conducted to elucidate the effect of preoperative chemotherapy with reference to the relationship between clinical and histological effects, as well as its effect in the determination of the safe surgical margins in the resection of squamous cell carcinoma of the tongue. The special relationship between clinical effect (tumor regression rate) and histological effect, including the residual aspects of tumor cell population in resected specimens to initial tumor size, as well as prognosis, was investigated. Fifty patients were treated with bleomycin alone and twenty-nine with a combination chemotherapy (bleomycin + methotrexate: 16 patients; bleomycin + cisplatin + OK-432: 13 patients). No significant difference was seen between the groups treated with bleomycin alone and the combination chemotherapy groups in histological or clinical effects. The histological effects, including the residual aspects of the tumor cell population, were associated with the grade of histological malignancy according to the mode of tumor cell invasion, the nuclear DNA pattern, the tumor differentiation and the degree of stromal lymphocyte infiltration, in addition to the tumor size. Relatively-small tumors less than 3 cm in size with low grades of histological malignancy revealed both sufficient histological effects and tumor regression rates for the chemotherapy. Tumor cells at the deepest sites of the tumors were markedly degenerated with no residuum of viable tumor cell populations. However, in many of the relatively-large tumors greater than 3 cm in size and in many of tumors with high grades of histological malignancy, there was no agreement in the relationship between tumor regression rate and the histological effects of chemotherapy. Especially, regardless of tumor size, viable tumor cells remained diffusely present at the deepest sites of tumor invasion in tumors with high grade malignancy. A relationship was found for patient survival between the grade of histological malignancy and both tumor size and tumor regression rate. These data indicate that special consideration should be given to the degree of histological malignancy, in addition to the tumor size and tumor regression rate, in determining safe surgical margins.
- 札幌医科大学の論文
- 1989-10-01
札幌医科大学 | 論文
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