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StageIIおよびIIIの閉塞性結腸直腸癌におけるImmunoscoreの予後予測因子としての意義

近藤, 僚 東京大学 DOI:10.15083/0002006980

2023.03.24

概要

[課程-2]
審査の結果の要旨
氏名 近藤 僚
本研究は、大腸癌予後予測因子とされる Immunoscore を用いて閉塞性大腸癌の予後を
評価した。閉塞性大腸癌と非閉塞性大腸癌、閉塞性大腸癌における Bridge to surgery(BTS)
と手術単独症例(ストマ増設など行わず一期的に手術をおこなった症例)の比較を、
Immunoscore を交えておこなった。BTS 症例におけるステント留置部位の病理学的変化を、
Immunoscore を交えて比較し下記の結果を得ている。
1、大腸癌全体の Immunoscore を評価したところ、Immunoscore Low / High の割合は
66.3% / 33.7%であった。次に閉塞性大腸癌と非閉塞性大腸癌の比較をおこなった。閉塞性
大腸癌の Immunoscore Low / High は 78.3% / 21.7%であった。非閉塞性大腸癌の
Immunoscore Low / High は 54.3% vs 45.7%であり、閉塞性大腸癌で有意に Immunoscore
Low の症例を多く認めた(p = 0.0251)

2、Stage II / III 大腸癌において、DFS は Immunoscore High で有意に長かった(P =
0.0090)

3、続いて BTS 群と手術単独群の Immunoscore の比較を行なったが、両者の
Immunoscore に差はなかった(p = 1.000)

4、BTS 群と手術単独群の DFS、OS、再発部位を解析した。両者の OS(P = 0.901)

DFS(p = 0.741)に差はなく、再発部位にも偏りはなく肝転移の割合が一番多かった。
5、閉塞性大腸癌において、神経侵襲は DFS に関連がある因子であったが、Immunoscore
は関連がある因子ではなかった。
6、続いて BTS 症例におけるステント留置部位の病理学的解析をおこなった。大腸ステン
ト留置から手術までの期間は最短で 10 日、最長で 81 日であった(中央値 28 日)
。28 日
を基準として Immunoscore と再発との関係を調べたが、両者とも統計学的な差はみられ
なかった(Immunoscore p = 0.146、再発 p = 0.261)。
7、大腸ステント留置による機械的腸管圧排により生じる腫瘍周囲膿瘍と非腫瘍部粘膜潰
瘍の有無や程度は、Immunoscore、再発の有無との関連を示唆しなかった。
以上、本論文は閉塞性大腸癌と非閉塞性大腸癌、BTS 症例と手術単独症例の
Immunoscore を比較した新しい試みである。また、閉塞性大腸癌の予後は非閉塞性大腸
癌と同等である事を示し、BTS 症例の予後を免疫学的側面からと病理学的変化を含めて評
価し、BTS の安全性と有用性に関する知見を得られた。

よって本論文は博士( 医 学 )の学位請求論文として合格と認められる。

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