| Project/Area Number |
16591301
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Digestive surgery
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| Research Institution | Niigata University |
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Principal Investigator |
WAKAI Toshifumi Niigata University, Medical and Dental Hospital, Fellow, 医歯学総合病院, 医員 (50372470)
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| Co-Investigator(Kenkyū-buntansha) |
SHIRAI Yoshio Niigata University, Institute of Medicine and Dentistry, Associate Professor, 医歯学系, 助教授 (50216173)
横山 直行 新潟大学, 医歯学総合病院, 医員
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| Project Period (FY) |
2004 – 2005
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| Project Status |
Completed (Fiscal Year 2005)
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| Budget Amount *help |
¥2,000,000 (Direct Cost: ¥2,000,000)
Fiscal Year 2005: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 2004: ¥1,000,000 (Direct Cost: ¥1,000,000)
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| Keywords | Ampullary carcinoma / Metastasis / Lymph node metastasis / Micrometastasis / Cytokeratin / Anticytokeratin / Immunohistochemistry / Prognosis / Metastases / Lymph node metastases / Micrometastases / 十二指腸乳頭部癌 / リンパ節転移 / 微小転移 / サイトケラチン / 抗サイトケラチン抗体 / 免疫組織化学 / 予後 |
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| Research Abstract |
This study aimed to clarify the clinical significance of lymph node micrometastasis in ampullary carcinoma. Pancreaticoduodenectomy with regional lymphadenectomy was performed for 50 consecutive patients with ampullary carcinoma. A total of 1283 regional lymph nodes (median, 25 per patient) were examined histologically for metastases. Overt metastasis was defined as metastasis detected during routine histologic examination with hematoxylin and eosin. Micrometastasis was defined as metastasis first detected by immunohistochemistry with an antibody against cytokeratins 7 and 8. The median follow-up period was 119 months after resection. Overt metastasis was positive in 90 lymph nodes from 27 patients. Micrometastasis was positive in 33 lymph nodes from 12 patients, all of whom also had overt nodal metastases. Patients with nodal micrometastasis had a larger number of lymph nodes with overt metastasis (median, 3.5) than those without (median, 0 ; p < 0.001). Overt metastasis to distant nodes (superior mesenteric nodes, para-aortic nodes) was more frequent (p = 0.001 and p = 0.038, respectively) in patients with nodal micrometastasis. Nodal micrometastasis was found to be a strong independent prognostic factor on univariate (p < 0.0001) and multivariate (relative risk, 5.085; p = 0.007) analyses. From among the 27 patients with overt nodal metastasis, the outcome after resection was significantly worse in the patients with nodal micrometastasis (median survival time of 11 months) than in those without (median survival time of 63 months; p = 0.0009). Immunohistochemically detected lymph node micrometastasis indicates intensive lymphatic spread, and thus adversely affects the survival of patients with ampullary carcinoma.
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