口腔扁平上皮癌において浸潤様式が治療成績に関連することは,これまでにも多数報告されているが,すべての症例で浸潤様式と治療成績が相関するとは限らず検討課題の一つとなっている.そこで,口腔扁平上皮癌23例を対象に,その連続標本の三次元画像をコンピュータグラフィクスにより再構築し,腫瘍の浸潤様式を検討するとともに,治療成績との関係ならびに従来より用いられている二次元解析法の山本・小浜分類(以下Y・K分類)との関係について比較検討した.三次元的解析による浸潤様式を形態的特徴から,連続型と非連続型の二つに大別し,さらに連続型は圧迫型と索状型の二つに分類した.腫瘍制御,非制御別では,非連続型は連続型に比較し有意に不良で,また,それらとY・K分類との関係では,比較的予後が良好とされるY・K分類2型でも非連続型の場合には制御不良であったのに対し,予後が不良とされる4C,4D型では連続型の場合には制御良好であった.三次元解析法では腫瘍の浸潤様式を立体的に再現できること,連続型と非連続型の2つに大別されるため判定が容易であること,さらに治療成績と有意に関連することなどから臨床において有用な方法と思われた.It has been described in many previous reports that mode of invasion is associated with prognosis in oral squamous cell carcinoma (OSCC). However, there is not necessarily correlation between mode of invasion and prognosis clinically. Although we have evaluated the grade for mode of invasion in OSCC by two-dimensional view from H-E section, in this study, we tried three-dimensional analysis for mode of invasion in OSCC. We performed three-dimensional reconstruction of mode of invasion in OSCC by computer graphics, and compared with that of two-dimensional evaluation and examined the relationship between three-dimensional analysis and prognosis. Mode of invasion in OSCC was classified into two types by three-dimensional analysis as follows; 1) continuous type, and 2) discontinuous type. Furthermore, continuous type was subclassified into a) solid type, and b) cord type. The cases of continuous type were recognized in all grade type of mode of invasion according to Yamamoto and Kohama classification, but the cases of discontinuous type were recognized in only 2, 4C, and 4D grade types. In continuous type, thirteen out of fifteen cases (86.7%) were controlled, where in discontinuous type only 4 out of 8 cases (50.0%) were controlled. The control rate of local recurrence in the patients with discontinuous type was significantly lower than that with the continuous type (p=0.0429). We suggest that three-dimensional analysis is useful clinically, because we could judge mode of invasion easily and reconstruct whole structure of OSCC more exactly, and furthermore, this analysis is associated with prognosis of OSCC
