{"created":"2023-07-26T01:11:03.891686+00:00","id":2001050,"links":{},"metadata":{"_buckets":{"deposit":"cf12ba52-cc97-488d-a3f8-54298717ecd2"},"_deposit":{"created_by":4,"id":"2001050","owners":[4],"pid":{"revision_id":0,"type":"depid","value":"2001050"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:02001050","sets":["453:455","471:561:562"]},"author_link":[],"item_6_date_granted_51":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2023-03-23"}]},"item_6_degree_grantor_49":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_language":"ja","subitem_degreegrantor_name":"新潟大学"},{"subitem_degreegrantor_language":"en","subitem_degreegrantor_name":"Niigata University"}],"subitem_degreegrantor_identifier":[{"subitem_degreegrantor_identifier_name":"13101","subitem_degreegrantor_identifier_scheme":"kakenhi"}]}]},"item_6_degree_name_48":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士（医学）","subitem_degreename_language":"ja"}]},"item_6_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"大腸de novo癌(以下DN)を，“大きさ10mm以下の小pT1(SM)癌で，粘膜内部が全て癌からなる病変”と定義し，その臨床病理学的特徴と分子病理学的特徴を腺腫癌化例(Adenoma-carcinoma sequence: ACS，以下ACS)と比較・検討した．これまで，DNは平坦・陥凹型病変がその肉眼的特徴とされてきたが，本研究結果ではDNの52.4%はtype 0-I(隆起型)であった．しかし，その粘膜内増殖様式は57.1%がNPG type(辺縁過形成性粘膜と同等がそれより薄い: 肉眼型では0-IIa, IIc, IIa+IIcに相当)であり，その頻度はS-ACS(small ACS: 大きさ10mm以下の腺腫癌化例)，L-ACS(large ACS: 大きさ10mmを超える腺腫癌化例)に比べ有意に高かった(20.0%, 0%)(P<0.001)．このことから，DNはその発生初期段階では平坦・陥凹型として発生するものが多いと考えられたが，PG typeも42.9%存在したことから，発生初期段階でも隆起型の肉眼形態を示すものも存在し，DNの肉眼型は平坦・陥凹型に限定されるものではないと考えられた．DNは悪性度が高い癌とされてきたが，本研究結果では組織型，脈管侵襲，簇出などのリンパ節転移リスク因子の陽性率はACSとの間に有意差はなく，DNがACSに比べ明らかに悪性度の高い癌とは言えなかった．本研究では粘膜内部残存癌を対象としているため，de novo発生であったとしても粘膜内部が潰瘍化して脱落した病変は検討対象から除外されている．DNの悪性度を正確に評価するためには，こうした病変の検討が今後の課題として残されている．RAS変異は既報より検索範囲を拡げKRAS・NRASのcodon 12，13，59，61，117，146を検索した．結果は既報と同様であり，変異率は19%と低く，ACSとは有意差を認めた(P=0.007)が，DNのPG typeでも同様に低いRAS変異率であり(16.7%)，ポリープ状を呈するDNが存在することを裏付ける結果と考えられた．多くのヒト癌の発生に関与するTP53変異はDNで64.3%，S-ACSで60.0%，L-ACSで55.6%であり，既報と同様にDNとACSで有意差はなく，TP53変異はde novo発癌にも関与していると考えられた．BRAF変異，CIMP-High, MSI-Hの頻度は4.8%, 7.1%, 2.4%と低く(ACSとは有意差なし)，serrated neoplasia pathwayに関わる遺伝子変異はde novo発癌とは関連がないと考えられたが，DNの1例がBRAF変異陽性，CIMP-High, MSI-Hであり，少数例ながら，本研究でde novo癌として選択した病変の中に，初期病変として発生した鋸歯状病変の癌化例が含まれている可能性は残された．","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_6_description_53":{"attribute_name":"学位記番号","attribute_value_mlt":[{"subitem_description":"新大院博(医)第1103号","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_6_dissertation_number_52":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"甲第5112号"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"田口, 貴博","creatorNameLang":"ja"},{"creatorName":"Taguchi, Takahiro","creatorNameLang":"en"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2023-07-26"}],"displaytype":"detail","filename":"r4nmk1103.pdf","filesize":[{"value":"1.37MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"本文","objectType":"fulltext","url":"https://niigata-u.repo.nii.ac.jp/record/2001050/files/r4nmk1103.pdf"},"version_id":"6dbc8a2a-0781-47f1-aa53-d23c4bb5ac47"},{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2023-07-26"}],"displaytype":"detail","filename":"r4nmk1103_a.pdf","filesize":[{"value":"531KB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"要旨","objectType":"abstract","url":"https://niigata-u.repo.nii.ac.jp/record/2001050/files/r4nmk1103_a.pdf"},"version_id":"8602b5f6-5b29-4cf0-a4ed-8694d0d70cc1"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"大腸de novo癌","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"組織発生","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"遺伝子変異","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"臨床病理","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"分子病理","subitem_subject_language":"ja","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"doctoral thesis","resourceuri":"http://purl.org/coar/resource_type/c_db06"}]},"item_title":"大腸de novo癌の臨床病理学的・分子病理学的特徴","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"大腸de novo癌の臨床病理学的・分子病理学的特徴","subitem_title_language":"ja"},{"subitem_title":"Morphological and Molecular Pathological Characteristics of Colorectal de novo Carcinoma","subitem_title_language":"en"}]},"item_type_id":"6","owner":"4","path":["455","562"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2023-07-26"},"publish_date":"2023-07-26","publish_status":"0","recid":"2001050","relation_version_is_last":true,"title":["大腸de novo癌の臨床病理学的・分子病理学的特徴"],"weko_creator_id":"4","weko_shared_id":-1},"updated":"2023-07-26T01:11:13.279605+00:00"}