下咽頭頸部食道癌の臨床病理学的研究

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A study was conducted of various aspects of 160 cases of hypopharyngeal and cervicalesophageal squamous cell carcinomas treated at the Department of Head and Neck Surgery of the Cancer Institute Hospital during the 14-year period from 1969 through 1982,
The carcinomas consisted of 64 cases of pyriform sinus, 54 cases of postcricoid, 14 cases of the posterior wall and 28 cases of cervical esophagus. Surgical treatment was administered to 83 patients (51, 9%). Of these, 3 underwent surgical treatment alone, 53 were administered with radiological treatment prior to the surgery, and 27 underwent a salvage operation for the treatment of recurrence after radical radiotherapy.
The depth of invasion to the adventitia was determined for each resected specimen in accordance with the General Rules for Clinical & Pathological Studies on Esophageal Cancers “. No cancer cells were detected in some specimens due to preoperative therapy, and these cases were designated as ” Ca (-). The histological depth of invasion to the adventitia (a) was determined as “Ca (-)” in 5 cases, “a₀”in 34 cases, “a₁” in 4 cases, “a₂” in 15 cases and “a₃” in 25 cases.
The deeper the histological invasion to the adventitia was, the greater were the number of pathological metastases to the lymph nodes, the number of postoperative metastases to the lymph nodes and the number of distant metastases.
The prognosis in relation to the histological depth of invasion to the adventitia was good in the group consisting of “a₀” and “Ca (-), ” while it was poor in the other groups, and the difference in prognosis between the “a0” + “Ca (-)” group and the “a1” + “a₂”, “a₃” group was statistically significant (P<0.05).
With regard to invasion of other organs in “a₃”, laryngeal invasion was seen at a high incidence in the pyriform cancer cases, while thyroidal invasion was detected at a high incidence in the postcricoid cancer cases and cervical escphagus cancer cases.
The depth of invasion was diagnosed using CT. The diagnoses consisted of 22 cases of CTA0, 3 cases of CTA₁, 9 cases of CTA₂ and 25 cases of CTA₃.
Comparison of the histological depth of invasion to the adventitia and the CT-diagnosed depth of invasion (CTA) revealed that the accuracy of diagnosis by CT was about 67%. This difference was surmised to be due to reduction or disappearance of cancers achieved by preoperative therapy.
In the CT diagnosis of invasion of other organs in CTA₃ specimens of laryngeal invasion the specificity was about 90%, the sensitivity was about 70%, and the accuracy was about 90%. In CTA₃ specimens of thyroid invasion the specificity, sensitivity and accuracy of the CT diagnoses were about 85%, 71% and 86%, respectively. Thus, CT was found to be an excellent technique in the diagnosis of invasion of other organs.
The survival rate was high in patients whose CTA had been diagnosed as CTA_O or CTA₁, while it was low in patients whose CTA had been diagnosed as CTA₂ or CTA₃. However, the difference in the survival rate between these twopatient groups was not statistically significant.