島根県江津市に暮らす中高年者の死生観と終末期療養ニーズに関する意識調査

日本では全国的に、高齢社会の進展、家族機能・地域共同体の衰退等に対応して、終末期療養に関する市民の関心が高まっている。本調査では、全国的にも少子高齢化が進む島根県の江津市に暮らす市民の死生観と終末期療養ニーズの実態について調査を行った。その結果、江津市の中高年者の理想とする死にとって重要なことは「周囲に迷惑をかけない」「苦痛が少ない」「闘病生活が短い」こと、女性は男性に比べて、終末期療養場所を「自宅以外」に求め、家族に依存しない医療に期待していることがわかった。周囲に迷惑をかけずに、最期まで生活の質を大事にしたいというニーズに対応した終末期ケアについて検討が必要である

Stromal Palladin Expression Is an Independent Prognostic Factor in Pancreatic Ductal Adenocarcinoma

It has been clear that cancer-associated fibroblasts (CAFs) in the tumor microenvironment play an important role in pancreatic ductal adenocarcinoma (PDAC) progression. However, how CAFs relate to the patients' prognosis and the effects of chemoradiation therapy (CRT) has not been fully investigated. Tissue microarrays (TMAs) representing 167 resected PDACs without preoperative treatment were used for immunohistochemical studies (IHC) of palladin, alpha-smooth muscle actin (SMA), and podoplanin. Correlations between the expression levels of these markers and clinicopathological findings were analyzed statistically. Whole sections of surgical specimens from PDACs with and without preoperative CRT, designated as the chemotherapy-first group (CF, n = 19) and the surgery-first group (SF, n = 21), respectively, were also analyzed by IHC. In TMAs, the disease-specific survival rate (DSS) at 5 years for all 167 cases was 23.1%. Seventy cases (41.9%) were positive for palladin and had significantly lower DSS (p = 0.0430). alpha-SMA and podoplanin were positive in 167 cases (100%) and 131 cases (78.4%), respectively, and they were not significantly associated with DSS. On multivariable analysis, palladin expression was an independent poor prognostic factor (p = 0.0243, risk ratio 1.60). In the whole section study, palladin positivity was significantly lower (p = 0.0037) in the CF group (5/19) with a significantly better DSS (p = 0.0144) than in the SF group (16/22), suggesting that stromal palladin expression is a surrogate indicator of the treatment effect after chemoradiation therapy

Prognostic factors for disease-specific survival and disease-free survival on univariate analysis.

<p>Prognostic factors for disease-specific survival and disease-free survival on univariate analysis.</p

Immunostaining results for cancer-associated fibroblast markers.

<p>Immunostaining results for cancer-associated fibroblast markers.</p

Stromal expression of cancer-associated fibroblast markers.

<p>Stromal expression of cancer-associated fibroblast markers.</p

Survival analysis of pancreatic ductal carcinoma patients according to palladin expression.

<p>(A) Disease-specific survival and (B) disease-free survival. For disease-free survival, two cases were excluded due to lack of information about recurrence dates. Univariate analyses show that palladin expression is significantly correlated with unfavorable prognosis, both disease-specific survival and disease-free survival.</p

Disease-specific survival analysis of PDAC patients who underwent surgery after CRT based on palladin expression level.

<p>In a subanalysis of the chemotherapy-first group, palladin-positive cases have significantly shorter disease-specific survival after surgery.</p

Immunohistochemical staining with palladin, podoplanin, and α-SMA antibodies.

<p>A-C were from the same core and stained with palladin (A, ×100), α-SMA (B, ×100), and podoplanin (C, ×100). These were regarded as positive. D: Few palladin-stained stromal cells are seen, but the proportion is <30% and categorized as negative (×200). E: Example of a podoplanin-negative case (×100). F: α-SMA-positive cells are seen diffusely, even in a case with relatively weak staining (×100). G-I: Pancreatic parenchyma outside the tumor is stained with each antibody, and podoplanin- or α-SMA-stained cells are seen abundantly, while this is not true for palladin (×100).</p