漿膜下層浸潤胆嚢癌におけるnm23遺伝子翻訳産物の免疫組織化学的発現率とリンパ節転移および予後との関連

Abstract

乳癌ほかいくつかの癌で癌組織内のnm23遺伝子翻訳産物/NDP kinaseの発現の多寡が転移および予後に深く関与していることが明らかにされ,予後因子としての有用性が期待されている.しかし漿膜下層浸潤胆嚢癌における検討は文献的にはまだ認められない.今回われわれは胆嚢癌手術材料について免疫組織化学的方法を用い,NDP kinase-Aと漿膜下層浸潤胆嚢癌との関連を検討した.漿膜下層浸潤胆嚢癌40例を対象とし癌細胞のNDP kinase-A発現50%未満(A群)と50%以上(B群)に分けて検討すると,2群以上の遠位リンパ節転移率はB群に有意に高く,予後も有意に不良であった.漿膜下層浸潤胆嚢癌においてはNDPkinase-A発現はリンパ節転移および予後とは有意な関連があり,転移予後の予測因子として有用性が示唆された.また11症例(27%)では粘膜内癌,筋層浸潤癌の部より漿膜下層浸潤癌の部においてNDP kinase-A染色程度は強く認められ,NDP kinase-Aは胆嚢癌の進展に関連することが示唆された.Levels of nm23 gene product/NDP kinase expression have been demonstrated to be inversely correlated with metastatic potential in some tumors, but not in others. It is not yet clear, whether the NDP kinase is associated with metastatic potential in gallbladder carcinomas that has invaded the subserosal layer (Gb-ssca). We therefore immunohistochemically examined the expression of NDP kinase-A in Gb-ssca in order to clarify associations between its expression and the clinical features of the disease. Of the 40 patients tested, 25 (63%; Group B) showed strong immunoreactinity for NDP kinase-A in most carcinoma cells within the subserosal tumor tissue, while 15 (37%; Group A) contained few or no NDP kinase-A-positive carcinoma cells. In addition, carcinoma cells in the mucosa showed lower NDP kinase-A immunoreactively than those in the subserosa in 11 cases (27%). In Gb-ssca, high levels of NDP kinase-A expression were associated with positive status of distant lymph node (p <0.05) and poorer prognosis (p <0.05). These findings are consistent with the view that higher levels of NDP kinase expression are associated with carcinoma progression in Gb-ssca and that it may be a prognosis-regulating factor in Gb-ssca. It is also suggested that expression of NDP kinase-A in Gb-ssca, may not only have implications for metastasis but that it may also play a part in local invasion