Stomach and Intestine(Tokyo) Volume 43, Issue 12 (November 2008)
Japanese

Depth of Invasion and Time Course of Early Gastric Cancer Based on Cases Followed up Endoscopically : With Special Reference to Slow Factors Involved in the Speed of Growth and Progression from M Cancers to SM Cancers Takashi Nagahama 1 , Toshiyuki Matsui 1 , Shinichiro Maki 1 , Takahiro Beppu 1 , Kenshi Yao 1 , Masao Takeichi 1 , Masaki Miyaoka 1 , Yasuhiro Takaki 1 , Noritaka Takatsu 1 , Shizuka Matsuo 1 , Tsuyoshi Morokuma 1 , Youichiro Ono 1 , Kazeo Ninomiya 1 , Yuji Murakami 1 , Takashi Hisabe 1 , Fumihito Hirai 1 , Sumio Tsuda 1 , Hiroshi Tanabe 2 , Akinori Iwashita 2 , Hiroyuki Uno 3 1Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 3Department of Gastroenterology, Fukuoka City Medical Association Hospital, Fukuoka, Japan Keyword: 早期胃癌 , 内視鏡診断 , 深達度診断 , 発育進展 , 自然史 pp.1735-1751
Published Date 2008/11/25
DOI https://doi.org/10.11477/mf.1403101511
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 We investigated the speed at which depth of invasion of the gastric wall progressed in 105 early gastric cancer lesions whose course it was possible to follow up endoscopically for 6 months or more. (1) Frequency of progression and speed of progression of M cancers and SM cancers : The mean follow-up period of the M cancers was 46 months, and the frequency of progression was 30.0%(from M cancer to SM cancer : 16.7% ; from M cancer to advanced cancer : 13.3%), whereas the mean follow-up period of the SM cancers was 23 months, and at a frequency of progression from SM cancer to advanced cancer of 73.3%, the rate of progression of SM cancer was significantly higher(p = 0.001). There was a wider range of progression periods of M cancer than of SM cancer, and it was concluded that the diversity of growth and progression in early cancers is determined during the M cancer period. (2)Cumulative progression rate of early cancer : The estimated time required for a cumulative progression rate of 50% was 85 months for M→SM cancer and 31 months for SM→advanced cancer, and the speed of progression from SM cancer to advanced cancer was significantly faster than that of progression from M cancer to SM cancer(p < 0.0001). (3) Factors affecting progression from M cancer to SM cancer : Cumulative progression rates were compared according to the patients'clinicopathological factors, including age and macroscopic type, but no significant differences were found according to any of the factors. 11 cases in a rapid growth group(RG group)that had progressed in less than 4 years and 15 cases in a slow growth group(SG group)that had not progressed in 4 years or more were selected from among the M cases, the frequency of progression was compared according to clinicopathological factors and the results showed a significantly higher frequency in the SG group of patients with differentiated cancer according to histological type(p=0.08). Among those cases the frequency was higher in extremely very well differentiated adenocarcinoma that were mostly that type(p < 0.05). Based on the above results, it was estimated that the mean time required for progression from M cancer to SM cancer endoscopically is about 7 years, and that the mean time required for progression from SM cancer to advanced cancer is 2~3 years. It was impossible to identify predictive factors for the growth and progression of M cancers based on any of the clinical findings, but the results of the sub-analysis indicated that there may be very slow growth and progression by M cancers with a high degree of differentiation histopathologically.


Copyright © 2008, Igaku-Shoin Ltd. All rights reserved.

基本情報

05362180.43.12.jpg
胃と腸
43巻12号 (2008年11月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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