早期胃癌に対するESD治療の予後―術後3年以上の成績

Long Term Survival of Gastric Cancer Treated with ESD

要旨　2000年1月から2002年10月までにESDを施行した胃癌のうち，ガイドライン適応胃癌群（以下適応群），適応拡大群を対象とした．適応群は68例であり，男性56例，女性12例．年齢中央値：69歳．平均観察期間：3.6年であった．適応拡大群は43例であり，男性30例，女性13例，年齢中央値：72歳，平均観察期間：3.8年と患者背景に差はなかった．ESDに伴う主な偶発症は出血と穿孔だが，輸血を要した大量出血は両群ともになく，適応群に1例の穿孔を認めたが両群間の偶発症発症率に有意差を認めなかった．適応群の一括完全切除率は95.6％（65/68），適応拡大群では90.7％（39/43）であり，両群間に有意差を認めなかった．適応群，適応拡大群ともに原病死はなく，両群ともに他病死を5例認めた．他病死を含む3年生存率は適応群で95.2％（平均観察期間3.63年），適応拡大群で89.8％（平均観察期間3.67年）であった．両者間には有意差を認めず，他病死を除く3年生存率はともに100％であった．

　The ESD method has made it possible to resect large gastric cancers in onepiece. The Japanese gastric cancer association decided the indication for EMR to be differentiated adenocarcinoma whose invasion depth is as for as the mucosal layer and which doesn't have ulcers. However, although recently the indication has been expanding, long-term survival rate after ESD hasn't been clarified.

　Patients and methods : 68 patients had guideline-indicated cancer and 43 patients had extended-indication cancer. There was no significant difference between the background of the two groups. The mean observation period was 3.6 years and 3.8 years, respectively.

　Result : Complication, complete en-bloc resection rate, local recurrent rate, overall survival rate and cause-specific survival rate were investigated. There wasn't any significant difference between these two groups. Three-year survival rate was 95.2％ in the indication group and 89.8％ in the extended indication group. And cause-specific survival rate was 100％ in both groups.

　Conclusion : The indication of ESD for early gastric cancer should be able to be extended.