Shuji Azuma

Development of Liver Metastasis in Colorectal Carcinoma

The development of hepatic metastases in 344 patients with colorectal carcinoma was examined for correlation with the presence of both venous invasion by the primary tumor and basement membranes in the tumor tissue. The former was detected by Victoria blue and hematoxylin eosin staining and the latter by antilaminin antibody. A significant difference in the incidence of venous invasion was noted between patients with and those without liver metastasis at surgery. Basement membrane deposition was found in half of all cases of well differentiated adenocarcinoma, which was significantly high compared with other tumor types. This was more distinct in metastatic foci in the liver and lymph nodes than in the primary lesion, but less marked in intravascular tumor tissue. Basement membrane deposition was seen more frequently in Dukes’A tumors than in B tumors, although this was not statistically significant. No relationship was found between basement membrane laminin positivity and five‐year survival, nor was there any correlation between the incidence of liver metastasis and tumor histologic type. Venous invasion was considered to be intimately related to the development of liver metastasis. Deposition of laminin‐positive basement membrane was dependent on the grade of tumor differentiation, whereas it had no direct relation to the development of liver metastasis.

Immunological Response to Surgical Stress in Cancer Patients.

手術侵襲による担癌生体の免疫能低下に対する非特異的免疫療法の有用性について検討した.担癌ラットの末梢血単核球 (PBMC) のPHA幼若化能やNK活性は手術侵襲の程度の増大に伴って低下し, 肺転移も促進されたが, 手術侵襲の加わる前にOK-432を投与しておくと, それらを防止できた.また, 胃癌患者のPBMCのPHA幼若化能やNK活性は, 手術の翌日より免疫療法を開始しても, 術後1～2週目には術前に比べて有意に低下したが, 術前から治療を施行した場合には低下がみられなかった.さらに, 胃切除可能胃癌患者 (ただしstage Iのうちm, n0を除く) 275例を対象とした非特異的免疫療法に関する検討において, stage II症例で術前後免疫療法施行群の生存率が術後免疫療法施行群と比較して有意に優れていた.以上から, 手術侵襲により免疫担当細胞の抗腫瘍活性は低下するものの, 術前から免疫療法を開始することでそれを防止でき, 予後にも好影響を及ぼすことが示唆された.

CLINICOPATHOLOGICAL STUDIES ON THE EARLY GASTRIC CANCERS : ESPECIALLY ON THE DEGREE OF THEIR SUBMUCOSAL INVASION

早期胃癌 (192例) のうち粘膜下浸潤 (sm) 胃癌 (68例) の粘膜下層 (sm層) への浸潤程度を新たにsm1, sm2, sm3の3段階に分類し, 早期胃癌の臨床病理学的検討を行い, 以下の結果を得た.(1) sm層への浸潤程度が強くなるほどリンパ節転移率, 脈管侵襲陽性率が高率となった.(2) sm2～3と判定された症例は組織型ではpor, tub2に, 肉眼病型では混合型 (IIc+IIa), 占居部位ではA領域のものに頻度が高い傾向がみられた.(3) sm胃癌再発死亡5例中4例は脈管侵襲陽性のsm2～3例であり, 再発様式は肝転移2例, 腹膜再発, リンパ節再発, 不明が各1例ずつみられた.早期胃癌の術式や術後補助療法の決定に当っては, sm層への浸潤程度をも考慮する必要性があると推察された.