早期胃癌に対する内視鏡的切除後の長期予後―ガイドライン病変と適応拡大病変との比較

Long-term Outcome of ESD for Early Gastric Cancer

要旨　1999年1月から2005年12月までに国立がんセンター中央病院にて早期胃癌に対する内視鏡的切除が施行された全症例を対象に長期予後について検討した．全生存曲線はガイドライン治癒切除群と比較して，非治癒切除非外科切除群で予後が悪く（年齢・性・癌の既往歴の調整ハザード比；2.54，95％信頼区間；1.62～3.98），多発群ではハザード比が0.44（95％信頼区間；0.21～0.91）と有意に予後が良いという結果であった．適応拡大治癒切除群とガイドライン治癒切除群とで5年生存率に有意な差を認めなかった．本検討は，がん対策情報センターにて全例の生死・死因の捕捉が行われており，プログラムされた前向き研究ではないが現場における実データとして信頼性の高い結果と考えられた．

　With the development of new endoscopic resection techniques such as endoscopic submucosal dissection (ESD), removal of large early gastric cancer (EGC) lesions has become possible. To clarify the long-term outcome of this treatment, 2,335 lesions in a consecutive 1,955 EGC patients were enrolled. They had been treated with endoscopic resection from January, 1999 to December, 2005, at the National Cancer Center Hospital. Clinical outcome of all patients was able to be followed.

　In the histological assessment, the curative resection rate was 78％ and the non-curative resection rate was 22％. In the curative resection group among patients who had single lesions, the curative resection rate according to the guide line was 49％ and the curative resection rate according to the expanded criteria was 51％. The rate of patients who underwent additional surgery among the non-curative group was 53％. Among the overall 5-year-survival-rate group the curative resection group according to the guideline, the curative resection group according to expanded criteria, and the non-curative resection group with additional surgery, there were not significant differences. Concerning the hazard ratio, the same results were recognized.

　In our study, endoscopic resection especially ESD, using expanded criteria, showed an excellent long-term outcome.