食道癌EMR症例における他臓器重複癌

Cancers in Organs other than the Esophagus when EMR had been Performed for Esophageal Cancer

　食道粘膜切除220例(m癌196，sm癌24)を対象に他臓器重複癌の検討を行った．他臓器癌合併は81例(37％)，男性75例，女性6例であった．初回治療病巣が単発例は61例(75％)，多発例は20例(25％)であった．他臓器重複癌症例の食道癌深達度は，m1～2 61例(75％)、m3～sm1 18例(22％)，sm2以深2例(3％)であった．他臓器癌合併には，①他臓器癌先行25例，②同時性他臓器癌合併34例，③異時性他臓器癌合併37例があり，合併時期を問わず，食道癌を含め2臓器癌は61例(75％)，3臓器癌は18例(22％)，4臓器癌は2例(3％)であった．他臓器重複癌としては，胃癌35，頭頸部癌31(下咽頭癌13，中咽頭癌6，喉頭癌5，口腔底癌3，舌癌3，口蓋癌1)，大腸癌11，肺癌9，肝臓癌6，前立腺癌4，膵臓癌3，子宮癌2，乳癌，胆囊癌，腎臓癌，膀胱癌，尿管癌各1例であった．異時性他臓器癌を発見時期で分けると，粘膜切除後3年以内が20例(47％)，3～5年が13例(30％)，5年以降が10例(23％)であった．他臓器重複癌例の死亡例は22例(27％)，他病死11例，癌死11例であり，治療拒否の1例が食道癌にて死亡，5例は同時性他臓器癌で死亡，5例は異時性他臓器癌にて死亡した．

　In 81 cases (75 in males, 6 in females) out of a total of 220 cases treated by EMR for superficial esophageal cancer (m ;196, sm ;24) cancers also occurred in organs other than the esophagus. Among these 81 cases, the number of the esophageal cancer lesions treated by EMR for first time included 61 cases (75 ％) of single cancers and 20 cases (25 ％) in which there were two lesions. The cancers in other organs occurred in 25 cases before the first EMR, in 34 cases at the same time, and in 37 cases after it. The number of organs involved inculuding the esophagus were 2 organs in 61 cases (75 ％), 3 organs in 18 cases (22 ％), and 4 organs in 2 cases (3 ％). The other organs involved were the stomach (35 cases), the head and neck area (31 cases), colon (11 cases), the lung (9 cases), the liver (6 cases), the prostata (4 cases), the pancreas (3 cases), the uterus (2 cases), and others (the breast, gallbladder, kidney and urether). In the cases of metachronous cancers in the other organ after the first EMR, 20 cases occurred in less than 3 years after the EMR, 13 cases occurred between 3 to 5 years after it, and 10 cases occurred after 5 years. Death occurred in 22 cases (27 ％ of the total 81 cases). (In 11 of these cases, death was due to cancer and in 11 cases, death was due to other diseases). Only one patient died from esophageal cancer, but he had refused treatment for it. 5 patients died of synchronous cancer and 5 patients died of metachronous cancer occurring in organs other than the esophagus.