食道扁平上皮癌p-T1a-MM・pT1b-SM1の治療方針UPDATE

Updated Treatment Policy for Esophageal Squamous Cell Carcinoma with Pathological Depth of T1a-MM or T1b-SM1

要旨●食道扁平上皮癌に対する内視鏡切除の治療方針は時代とともに変化している．内視鏡切除を行い，病理結果がpT1a-MMまたはpT1b-SM1であった場合には脈管侵襲の有無で追加治療を判断する方針が一般的である．“pT1a-MMかつ脈管侵襲なし”は転移率が低く，経過観察を基本としている．一方，SM浸潤または脈管侵襲を認めた際は追加治療として手術または化学放射線治療を推奨する．適切に追加治療がなされれば，どちらも予後は良好で大きな差はなく，それぞれのよさがあり適切に判断するとよい．また，転移再発を認めた場合でも，適切に治療すれば効果が見込めることがあるため，早期診断のためのサーベイランスは重要である．

　The therapeutic strategy of endoscopic resection for esophageal squamous cell carcinomas has evolved over time. Following endoscopic resection, if the pathological diagnosis indicates pT1a-MM or pT1b-SM1, the presence or absence of lymphovascular invasion guides the decision regarding the requirement for additional treatment. Patients with “pT1a-MM without lymphovascular invasion” have a low risk of developing metastasis and are generally managed with surveillance alone. Contrarily, when submucosal invasion or lymphovascular invasion is present, additional treatments, including surgery or chemoradiotherapy, are recommended. With the addition of appropriate therapy, prognosis becomes favorable for both approaches, with no remarkable difference in overall outcomes ; however, each approach has its strengths and should be selected carefully. Furthermore, even in patients with recurrence or metastasis, effective treatment may still be possible if diagnosed early, highlighting the importance of continued surveillance.