Matsusaka T, Wakasugi K, Takenaka M, Kume K, Fujinaga Y, Iwashita A
Dept. of Surgery, Matsuyama Red Cross Hospital.
Gan No Rinsho. 1989 Jul;35(8):917-22.
Discussed are the attributable factors affecting the type of carcinomatous recurrence seen in 126 patients who had been operated on for their gastric carcinomas from 1979 to 1982 and who later showed a macroscopically positive serosal invasion (S0) and a histologically ss alpha approximately se invasion and required a curative resection. Forty-six percent of the patients with an ss beta approximately se invasion had a peritoneal recurrence, 21% a liver recurrence, and 33% a recurrence of some other type, whereas those with ss alpha had no such recurrence. Peritoneal recurrence tended to increase with the increase in the length of the serosal invasion and its rates were: one third in serosal invasions of less than 3 cm, one third in invasions of 3 approximately 6 cm and another third in invasions of over 6 cm. The smaller ratio of submucosal length to subserosal length, especially when less than 1.0, meant a greater frequency of peritoneal recurrence. The histologic characteristics of carcinomas that developed a peritoneal recurrence were poorly differentiated, contained INF alpha and had weaker cellular cohesion, whereas those that developed a liver metastasis were well differentiated carcinomas, contained INF beta and had a tighter cellular cohesion.
讨论了影响1979年至1982年接受胃癌手术的126例患者癌复发类型的相关因素。这些患者术后出现肉眼可见的浆膜侵犯阳性（S0），组织学显示ssα近似se侵犯，且需要进行根治性切除。ssβ近似se侵犯的患者中，46%出现腹膜复发，21%出现肝复发，33%出现其他类型复发，而ssα患者未出现此类复发。腹膜复发倾向于随着浆膜侵犯长度的增加而增加，其发生率分别为：浆膜侵犯小于3cm的患者中占三分之一，3至6cm侵犯的患者中占三分之一，超过6cm侵犯的患者中占三分之一。黏膜下层长度与浆膜下层长度的比例越小，尤其是小于1.0时，腹膜复发的频率越高。发生腹膜复发的癌的组织学特征为低分化、含有INFα且细胞黏附性较弱，而发生肝转移的癌为高分化癌、含有INFβ且细胞黏附性较强。
