胃腺腫の長期経過―増大例および癌化例の遡及的検討

Long Term Clinical Course of Gastric Adenoma : A Retrospective Analysis of Tumors with Enlargement and Those with Malignant Transformation

要旨　胃腺腫の長期経過を明らかにするために，30か月以上(平均69か月)経過観察された胃腺腫90症例107病変の内視鏡および生検組織像の経時的変化を遡及的に解析した．全107病変のうち，増大を28病変(26％)に，癌化を15病変(14％)に認めた．両群はオーバーラップしており，癌化例のうち13例(87％)は経過中に増大していた．増大群，癌化群ともに初回検査時に病変が大きいもの(16mm以上)と高度異型成分の存在が高頻度であった．Kaplan-Meier法で検討した結果，高度異型成分の存在，粗大結節状表面，16mm以上の大きな病変そして経過中の増大が有意な癌化危険因子であった．このような危険因子を有する腺腫に対しては，積極的に内視鏡的切除を行うべきと考えられる．

　To clarify the natural course of gastric adenoma, serial changes in endoscopic and histologic findings of 107 adenomas in 90 patients which were followed up for 30-189 months (mean, 69 months) were retrospectively investigated. At the final examinations, 28 adenomas (26％) had increased in size (enlargement group), while 15 adenomas (14％) transformed to carcinoma (malignant group). These two groups closely correlated : 13 of 15 adenomas in the malignant group (87％) had increased in size. In both groups, large-sized lesions (16mm or greater) and tumors with severe atypia were frequently observed at the initial examinations. The risk factors for malignant transformation in gastric adenoma determined by Kaplan-Meier analysis included the presence of severe atypia, uneven nodular surface, large-sized lesion (16mm or greater) and enlargement in size during the follow-up period. We thus consider that gastric adenomas accompanied by these risk factors should be treated by endoscopic resection.