この論文は進行下部直腸癌に対し、当科単一施設での臨床成績を比較検討した報告です。過去10年間に経験したstage II/III下部直腸癌123例を抜粋し、主として再発様式と生存成績について5年間追跡した解析結果です(追跡率94.3%)。以下、詳細を御高覧頂ければ幸いです。 

We investigated the correlation between the mode of tumor recurrence and prognosis in 123 patients with clinical stage II/III rectal cancer. In the past 10 years, patients had received systemic chemotherapy following radical (R0, with no macroscopic residual tumor lesions) resection using total or tumor-specific mesorectal excision. Patients with rectosigmoid cancers and T4 + chemoradiation therapy were excluded. We calculated 5-year relapse-free survival rate (5Y-RFS), 5-year overall survival rate (5Y-OS), and correlations between early post-operative complications, recurrence mode and prognosis, as well as 5Y-OS for patients with relapsed cancer. Overall 5Y-RFS and 5Y-OS were 71.4% and 83.5%, respectively, and overall recurrence rate was 28/123 patients (22.8%). Among relapses, remote metastases were observed in 17/123 patients (13.8%): the lung in 8 patients (6.5%), the liver in 5 patients (4.1%), and elsewhere in 4 patients (3.3%). Eleven patients (8.9%) had pelvic local recurrence as the first relapse, located anterior to the sacrum in seven patients (5.7%), at the anastomosis site in two patients (1.6%), and in the inner pelvis in two patients (1.6%). Among relapsed patients, 5Y-OS was 69.3% in those with distant metastases and 27.3% in those with local relapse (p = 0.02; no significant differences in patient demographics). The results indicate that advanced rectal cancer and control of pelvic local recurrence are manageable by R0 resection and postoperative chemotherapy. However, for patients whose initial relapse is pelvic local recurrence, the relapsed tumor initiated a new metastatic cascade to organs such as the lung and liver, and significantly affected prognosis.

Previous studies demonstrated that freely floating cancer cells (FFCCs) in the lymph node sinuses were of prognostic significance for colorectal and gastric cancers. We investigated the clinical significance of detecting FFCCs using Fast Red staining for cytokeratin in both stage I/II non-small cell lung cancer (NSCLC) patients and hilar lymph node positive NSCLC patients who underwent curative resection. Between 2002 and 2011, a total of 164 patients ( including 22 hilar lymph node positive patients) were investegated. Resected lymph nodes were stained for cytokeratin using an anti-cytokeratin antibody. In order to achieve a clear distinction from coal dust, an anti-cytokeratin antibody was labeled with a secondary antibody conjugated with alkaline phosphatase, which was detected by a reaction with Fast Red/naphthol that produced a red color. Patients were considered to be positive for FFCCs (FFCCs+) if one or more than one freely floating cytokeratin-positive cells were detected in the lymph node sinuses which could not be detected by hematoxylin and eosin stainig. Among all 164 patients, a significant difference was observed in five-year relapse-free survival rates (5Y-RFS), with 76.9% and 33.3% being achieved by FFCCs- and FFCCs+ patients, respectively (P<0.001). Similarly, the 5-year overall survival rate (5Y-OS) was significantly lower in FFCCs+ patients, with 86.6% being achieved by FFCCs- and 65.8% by FFCCs+ patients, respectively (P=0.014). Among 22 hilar lymph node positive patients, a significant difference was also observed in 5Y-RFS, with 53.8% and 0.0% being achieved by FFCCs- and FFCCs+ patients, respectively (P=0.006). The 5Y-OS tended to be lower in FFCCs+ patients, with 69.2% and 53.3% being achieved by FFCCs- and FFCCs+ patients, respectively (P=0.463). The presence of FFCCs in stage I/II NSCLC patients was associated with a poor prognosis. In addition, FFCCs in hilar lymph node positive patients also have potential as a useful marker foreseeing the recurrence.