臨床外科70巻3号

2015年03月発行

特集 生検材料を手術に活かす 臓器別 癌診療における生検の役割

大腸癌—外科治療における生検材料の活用

著者： 橋口陽二郎¹ 松田圭二¹ 上野秀樹² 神藤英二² 野澤慶次郎¹ 藤井正一¹ 土屋剛史¹ 端山軍¹ 中村圭介¹ 島田竜¹ 赤羽根拓弥¹ 福島慶久¹ 塚本充雄¹ 長谷和生²

所属機関： ¹帝京大学外科 ²防衛医科大学校外科

ページ範囲：P.297 - P.303

【ポイント】
◆生検標本におけるdesmoplastic reactionの存在が非有茎性病変のSM浸潤度予測に有用である．
◆潰瘍性大腸炎のスクリーニングに狙撃生検（target biopsy）が推奨されるようになってきた．
◆原発巣を切除せずに化学療法を先行させる場合には，原発巣の生検材料を用いてRAS遺伝子変異の有無を確認する．

参考文献

1）Ueno H, Shinto E, Shimazaki H, et al：Histologic categorization of desmoplastic reaction：its relevance to the colorectal cancer microenvironment and prognosis. Ann Surg Oncol, 2014［Epub ahead of print］

2）Hirose M, Fukui H, Igarashi Y, et al：Detection of desmoplastic reaction in biopsy specimens is useful for predicting the depth of invasion of early colorectal cancer：a Japanese collaborative study. J Gastroenterol 45：1212-1218, 2010

3）Kimura R, Fujimori T, Ichikawa K, et al：Desmoplastic reaction in biopsy specimens of early colorectal cancer：a Japanese prospective multicenter study. Pathol Int 62：525-531, 2012

4）Okamoto Y, Fujimori T, Ohkura Y, et al：Histological assessment of intra-and inter-institutional reliabilities in detection of desmoplastic reaction in biopsy specimens of early colorectal carcinomas. Pathol Int 63：539-545, 2013

5）Watanabe T, Ajioka Y, Matsumoto T, et al：Target biopsy or step biopsy? Optimal surveillance for ulcerative colitis：a Japanese nationwide randomized controlled trial. J Gastroenterol 46（Suppl 1）：11-16, 2011

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8）神藤英二，上野秀樹，長谷和生，他：直腸癌側方進展の予測手段としての腫瘍肛門側先進部におけるpunch biopsyの有用性について．日本大腸肛門病会誌53：248-251, 2000

9）Ueno H, Mochizuki H, Shinto E, et al：Histologic indices in biopsy specimens for estimating the probability of extended local spread in patients with rectal carcinoma. Cancer 94：2882-2891, 2002

10）橋口陽二郎，上野英樹，梶原由規，他：術前punch biopsyによる生物学的悪性度からみた，下部直腸癌手術における側方郭清と術前短期chemoradiationの検討．癌の臨55：127-132, 2009

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12）Sato T, Ozawa H, Hatate K, et al：A Phase II trial of neoadjuvant preoperative chemoradiotherapy with S-1 plus irinotecan and radiation in patients with locally advanced rectal cancer：clinical feasibility and response rate. Int J Radiat Oncol Biol Phys 79：677-683, 2011

13）Birgisson H, Pahlman L, Gunnarsson U, et al：Adverse effects of preoperative radiation therapy for rectal cancer：long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 23：8697-8705, 2005

14）Shinto E, Hashiguchi Y, Ueno H, et al：Pretreatment CD133 and cyclooxygenase-2 expression as the predictive markers of the pathological effect of chemoradiotherapy in rectal cancer patients. Dis Colon Rectum 54：1098-1106, 2011

15）Folprecht G, Gruenberger T, Bechstein W, et al：Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept（CELIM study）. Ann Oncol 25：1018-1025, 2014

16）Krol LC, 't Hart NA, Methorst N, et al：Concordance in KRAS and BRAF mutations in endoscopic biopsy samples and resection specimens of colorectal adenocarcinoma. Eur J Cancer 48：1108-1115, 2012

17）Baas JM, Krens LL, Guchelaar HJ, et al：Concordance of predictive markers for EGFR inhibitors in primary tumors and metastases in colorectal cancer：a review. Oncologist 16：1239-1249, 2011

18）横田知哉，谷田部恭：セツキシマブの効果予測因子としてのKRAS遺伝子測定における検体の取り扱い．医のあゆみ228：1237-1241, 2009