| Budget Amount *help |
¥2,200,000 (Direct Cost: ¥2,200,000)
Fiscal Year 2000: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 1999: ¥1,200,000 (Direct Cost: ¥1,200,000)
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| Research Abstract |
Along with the increase in discovery of early and superficial esophageal cancer, the endoscopic mucosal resection (EMR) has become a treatment widely performed for esophageal mucosal cancer in Japan. While the cancer limited in epithelium (m1) and in the proper mucosal layer (m2) are all indicated to EMR because they have no lymph node metastasis, the cancer invading to muscularis mucosae (m3) and shallow layer of submucosa (sm1) have also only 10 to 15% of lymph node metastasis.
We analyzed the patients of m3 and sm1 to investigate which lesions of these can also be treated by EMR without problems considering the operative invasiveness and post operative quality of life. Total of 160 cases of m3, sm1 esophageal cancer from various hospitals of Japan were subjected to the study to investigate the features without lymph node metastasis after analyzing the endoscopic figures, resected specimens and pathology.
Lymph node metastasis was occasionally observed in the mixed type of protrusion a
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nd depressed, poorly differentiated type, the lesion of INF γ ly (+). Then, such lesions larger than 4cm of diameter or of O-I, O-III, O-IIa+IIc appearance should be operated by surgery. The other types of such lesions should be performed EMR to investigate its pathology to be operated in case of moderately differentiated, INFβ, ly (+) type and moderately differentiated, INF γ type and poorly differentiated type, but only to be followed up in case of the other types. 54.5% of m3・sm1 cancer patients can avoid the operation in this way.
The observation of factor-8 in the superficial esophageal cancer indicated the neovascularity of cancer surrounding tissue beginning from m3, and the significant relationship between factor-8 staining and lymph node metastasis was observed.
The obseration of MIB-1 of Ki-67 for the proliferation of superficial esophageal cancer revealed the sudden increase of Labeling Index (LI) from m3 to show the high proliferation in this layer. LI of MIB-1 indicated the significant relationship with lymphatic invasion and lymph node metastasis.
Further studies are to be accumulated in order to develop the minimally invasive treatment of esophageal cancer. Less
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