Ultimate Total Stomach Preservation for Early Gastric Cancer. -Does Cancer Cell Spread Present in the Mesogastrium

早期胃癌的终极全胃保留。

• 批准号: 18591483
• 负责人: NAGAO Gen
• 金额: $ 0.95万
• 依托单位: Kyorin University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18591483/
• 关键词: gastric cancer; immunohistochemistry; Micrometastasis; whole section analysis; mesogastrium; cancer cell spread in mesogastrium : CSM; 微少転移

BACKGROUND Ultimate approach for total stomach preservation has became possible by our recent developed technique "laparoscopic lymph node dissection (LLD)" under sentinel node navigation, within has been performed for patients with early gastric cancer who have a potential of regional lymph node metastasis following endoscopic submucosal dissection (ESD). On the other hand, not only peri-nodal cancer deposits but also extra-nodal metastases were reportedly significant critical issue in any gastrointestinal malignancies. However, these particular issues especially in gastric cancer have not yet been well described. This study was designed to clarify the prognostic impact of these factors.METHODS In this study, these extra-nodular lesions were named as cancer cell spread in the mesorectum (SM) and were sub-grouped by categorizing appearance on microscopic findings as follows; lymphatic involvement type (ly). Vessel involvement type (v), scattered type (sct), and extra-capsular invasion … More type (ext). The present study was composed of two analysis (STUDY1 and 2).STUDY1 : Whole serial section of the mesogastrium ; This technique has not yet been described in the former literatures for detecting CNS. The mesogastrium was rolled-up. Then serial sections were performed. Prospectively, the mesogastriums in 34 patients with gastric cancer were examined by the technique with immunochemical stains such as anti-human cytokeratin antibody and a monoclonal antibody for D2-40, which was a specific marker of lymphatic vessels.STUDY2 : Retrospective analysis of risk factor ; Retrospectively, former one hundred forty-four gastric cancer including early and advanced stage were evaluated. Since the previous specimen handling had been performed with lymph node extraction technique, this retrospective investigation could obtain solely in peri-nodal investigation.RESULTS STUDY1: The CSM was detected in three (8.8%) of 34 patients. The CNS-positive patients were accompanied significantly by undifferentiated type, positive for lymph node metastasis, and lymphatic involvement. In three of these patients, one had the "sct" type; two had all types of CSM recognized in wide area of the mesogastrium. Two of these 3 patients had locally advanced type representing serosal or subserosal invasion. The CSM was found in 3 of 12 patients with advanced cancer, nor in 22 patients with early gastric cancer.STUDY2: The CSM was detected in 23 (16%) of 144 specimens. The "ext" was detected in 15 specimens, "ly" in 14, "v" in 3, and "sct" in 2 patients and some of these findings were overlapped. The incidence of CSM was significantly prominent in the adverse events of advanced gastric cancer such as tumor size, the depth of invasion, advanced staging, positive for lymphatic vessel invasion, and distant metastasis. The CSM was found in 1.4% of early gastric cancer specimens with submucosal (sm) and 29% of advanced cancer specimens. In the cumulative 5-years follow-up after potential curative resection, the CSM-positive patients had significantly higher incidence of tumor recurrence than that of CSM-negative patients, so did overall survival (91% vs. 60%, p=0.01). Multivariate analysis revealed that CSM was an independent risk factor of adverse event(hazard ratio 3.1, p=0.04). Less

背景通过我们最近开发的前哨淋巴结导航下的“腹腔镜淋巴结清扫术（LLD）”技术，全胃保存的最终方法已经成为可能，该技术已用于内镜粘膜下清扫术（ESD）后有可能发生区域淋巴结转移的早期胃癌患者。另一方面，据报道，在任何胃肠道恶性肿瘤中，不仅结周癌沉积物而且结外转移也是重要的关键问题。然而，这些特殊的问题，特别是在胃癌还没有得到很好的描述。这项研究的目的是澄清预后的影响，这些factors.METHODS在这项研究中，这些结节外病变被命名为癌细胞扩散在直肠系膜（SM），并通过分类外观显微镜检查结果分组如下：淋巴受累类型（LY）。血管受累型（V型）、散在型（SCT）和包膜外侵犯 ...更多信息 type（ext）.本研究包括两项分析（第一项和第二项）。第一项：胃系膜全连续切片;这项技术在以前的文献中尚未被描述用于检测CNS。胃系膜卷起。然后进行连续切片。本文应用免疫组化技术，对34例胃癌患者的胃系膜进行了检测，包括抗人细胞角蛋白抗体和淋巴管特异性标记物D2-40单克隆抗体。由于以前的标本处理已经进行了淋巴结提取技术，这一回顾性调查可以获得仅在周围nodal investigation.Results1.1：CSM检测到3（8.8%）的34例。CNS阳性患者伴有明显的未分化型、淋巴结转移阳性和淋巴结受累。其中3例中1例为“sct”型，2例在胃系膜广泛区域内有各种类型的CSM。这3例患者中有2例为局部晚期型，代表浆膜或浆膜下浸润。12例进展期胃癌中3例检出CSM，22例早期胃癌中未检出CSM。15例标本中检测到“ext”，14例标本中检测到“ly”，3例标本中检测到“v”，2例标本中检测到“sct”，这些结果中的一些重叠。CSM的发生率在肿瘤大小、浸润深度、晚期分期、淋巴管浸润阳性和远处转移等进展期胃癌不良事件中显著突出。CSM在早期胃癌粘膜下组织中的检出率为1.4%，在进展期胃癌组织中的检出率为29%。在潜在根治性切除术后的累积5年随访中，CSM阳性患者的肿瘤复发率显著高于CSM阴性患者，总生存率也是如此（91% vs. 60%，p=0.01）。多因素分析显示CSM是不良事件的独立危险因素（风险比3.1，p=0.04）。少