Significant of newral cell adhesion molecule (NCAM) in rectal cancer. - Special reference to the indication of nerve preserving operation -

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First year, we macroscopically studied the histologic characteristics of the autonomic nerve using human body of autopsy. Next year, clinical research was performed.Method : Preoperative biopsies of rectal cancer were performed. Then we studied the expression of NCAM and DCC gene by immunohistchemical method using frozen sections. Postoperatively, the relationship between PNI and NCAM or DCC was studied in the resected specimen. However, we added previous paraffin embedded specimen to study the correlation between other pathologic factors including PNI and NCAM,because of the small number of frozen section. The prognosis was analized for only patients with long-term follow up. Results : (1) The expression of NCAM in paraffin embedded specimen was demonstrated in 47 cases (15.5%). (2) In the prognositic determinants, there was statistical correlations between NCAM and PNI,venous invasion, lymphatic permeation, liver metastasis, depth of tumor invasion, histologic type, lymph node metastasis or inflammatory cell infiltration. Multivariate analysis showed the most significant correlation between NCAM and PNI.(3) In patients with Dukes C disease who underwent curative surgery, there was trend towards a higher rate of recurrence and a significantly higher rate of overall survival in those with positive expression of NCAM compared with those negative expression of NCAM.(4) The expression of NCAM or DCC in the preoperative biopsies was compatible with the expression of resected specimen. Moreover, the combination of NCAM and DCC had a significant correlation with presence of PNI in the resected specimen. Conclusions : It was suggested that the expression of NCAM or DCC in the preoperative biopsies can become a good marker to indicate PNI,and a good index to decide whether nerve preserving operation is applied or not. It is interesting that DCC may become a good index as well as NCAM.