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

第一年，我们以尸体解剖标本为材料，对植物神经的组织学特征进行了宏观研究。方法：术前行直肠癌组织活检。采用免疫组织化学方法检测NCAM和DCC基因的表达。术后观察PNI与NCAM、DCC的关系。但由于冰冻切片数量较少，我们增加了以前的石蜡包埋标本，以研究其他病理因素包括PNI和NCAM之间的相关性。仅对长期随访的患者进行预后分析。结果：（1）石蜡包埋标本中NCAM阳性表达47例（15.5%）。(2)NCAM与PNI、静脉浸润、淋巴管浸润、肝转移、肿瘤浸润深度、组织学类型、淋巴结转移、炎性细胞浸润之间存在统计学相关性。多因素分析显示NCAM与PNI的相关性最显著。(3)在Dukes C期患者中，NCAM阳性表达者的复发率和总生存率均明显高于NCAM阴性表达者。(4)NCAM或DCC在术前活检组织中的表达与手术切除标本中的表达一致。此外，NCAM和DCC的组合与切除标本中PNI的存在具有显著相关性。结论：提示术前活检组织中NCAM或DCC的表达可作为判断PNI的良好指标，并可作为判断是否行神经保留手术的良好指标。有趣的是，DCC可能成为一个很好的指标，以及NCAM。

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.