胃と腸56巻8号

2021年07月発行

今月の主題 早期大腸癌内視鏡治療の新展開 トピックス

分子病理学的バイオマーカーによる大腸T1癌のリンパ節転移予測診断

著者： 菅井有¹

所属機関： ¹岩手医科大学医学部病理診断学講座

ページ範囲：P.1093 - P.1100

はじめに
　大腸癌では粘膜内に限局している限り粘膜固有層内に浸潤しても転移することはなく，粘膜下層以深に浸潤して初めてリンパ節や遠隔臓器に転移する能力を獲得する^1）．転移率は深達度におおよそ相関するので，粘膜下層浸潤癌は早期癌というよりは粘膜固有層癌と進行癌の中間型に位置する癌と考えるほうが合理的である．実際，粘膜下層浸潤癌のリンパ節転移率は約10%程度とされているが^2），そうであれば約90%の粘膜下層浸潤癌は転移しないことになる．したがって，理論的にはこれらの癌はリンパ節郭清の必要性はなく，局所切除のみで治療が完結できることになり^2），多くの粘膜下層浸潤癌の不必要な手術を回避することが可能になる．
　このような事情から，粘膜下層浸潤癌のリンパ節転移予測因子についてはこれまで多くの報告があるが^1）〜5），これらの検討は大きく組織学的因子と生物学的因子に分類することが可能である．本稿では後者に重点を置いて，生物学的因子における粘膜下層浸潤癌のリンパ節転移予測因子について概説を行う．しかし，コンセンサスの得られた生物学的因子はほとんどないのが現状であるので，進行大腸癌において報告されている生物学的予後因子についての概説を加えることにする．

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