A CLINICOPATHOLOGICAL STUDY ON VASCULAR INVASION IN PROGRESSIVE GASTIC CANCER

• Published in: Journal of The Showa Medical Association Vol. 47; no. 2; pp. 219 - 230
• Main Authors: KAWAMURA, Kazutoshi, CHO, Seikon, KAWAMURA, Masatoshi, KATAOKA, Tetsu
• Format: Journal Article
• Language: English; Japanese
• Published: The Showa University Society 1987; 昭和大学学士会
• ISSN: 0037-4342; 2185-0976
• DOI: 10.14930/jsma1939.47.219

Vascular invasion (v) in the primary foci of gastric cancer is concerned deeply with hematogenous metastasis and thus taken as one of the important factors that affect the prognosis after resection of gastric cancer. We elucidated the state of vascular invasion (presence or not of invasion, the grade of invasion, the diameterr of vein invaded) and recurrence in liver (hematogenous hepatic recurrence) in cases with curative resection of progressive gastric cancer. Furthermore, we made a clinicopathological study on how these parameters are concerned with the prognosis and related to 10 factors considered to affect the prognosis after resection of gastric cancer, they are age, sex, macroscopic findings of gastric cancer such as location of cancerous lesion, macroscopic type, and histologic findings such as depth of invasion, histologic type, lymph invasion (ly), lymph node metastasis, infiltrative growth (INF) and stroma of cancerous lesion. There were 740 cases with curative resection of single cancer among 1098 cases of primary gastric cancer which we had resected in the past 26 years (March, 1956-December, 1981) . Of them, 529 cases of progressive gastric cancer were used as the subjects of this study. Results obtained are as follows : Positive vascular invasion (v (+) ) was observed in 287 cases (54.3 %) . By the grade of vascular invasion, the cases with v (+) consisted of v1 169 cases (58.9 %), v2 91 cases (31.7 %) and v3 27 cases (9.4 %) . As for the diameter of the vein invaded, cases were divided into 3 groups in the order of those having a larger lumen : L, M and S. There were 144 cases (50.2 %) in group S, 96 cases (33.4 %) in group M and 47 cases (16.4 %) in group L. A correlation (p<0.05) was observed between the diameter of the vein invaded and the grade of invasion. The incidence of vi became lower and that of v2and v3became higher in the order of group S→group M→group L. Regarding the relationship between vascular invasion and risk factors, factors showing a significant difference as characteristics of v (+) cases numbered nine : sex (many in male), location of cancerous lesion (few in area M, many in area A), macroscopic type (many in type 2, few in type 5), depth of invasion (few in pm, many in s (+) ), histologic type (many in differentiated type), lymph invasion (many in ly (+) ), lymph node metastasis (many in n (+) ), INF (many in β, few in γ) and stroma of cancerous lesion (many in intermediate type, few in scirrhous type) . Factors showing a significantly high incidence in group L as to the diameter of vein invaded numbered seven : sex (male), macroscopic type (type 2), histologic type (differentiated type), lymph invasion (ly2, ly3), lymph node metastasis (n (+) ), INF (β (low in γ) and stroma of cancerous lesion (intermediate type (low in soirrhous type) ) . As for the prognosis, the cumulative survival rate for the v (-) cases and v (+) cases was 57.4 % and 33.4 % respectively as to the 5-year survival rate and 40.6 % and 23.7 % respectively as to the 10-year survival rate, the prognosis of the v (+) cases being poor with significant difference. The prognosis became poorer as the v-number increased with v1→v2→v3and the lumen of the vein invaded became larger as the lumen increased with group S→group M→group L. Recurrence in liver was observed in 55 cases (10.4 %) . Of them, 45 cases (81.8 %) were found to be v (+) . The rate of recurrence in liver was 4.2 % for the v (-) cases and 15.7 % for the v (+) cases, the difference being significant (p<0.005) . The risk of recurrence in liver was high in the order of v1→v2→v3 (v1⋅v3: p<0.05) and group S-group M-group L (S⋅M, S⋅L: p<0.005) .