雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

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

胃と腸 43巻12号（2008年11月発行）

Japanese English

今月の主題早期胃癌発育の新たな分析─内視鏡経過例の遡及的検討から

主題

早期胃癌の発育速度―内視鏡遡及例の全国集計 Natural History of Early Gastric Cancer ─Multicenter Follow-up Study 松井敏幸 ¹ , 長浜孝 ¹ , 長南明道 ² , 今村哲理 ³ , 小林広幸 ⁴ , 芳野純治 ⁵ , 飯田三雄 ⁶ , 神津照雄 ⁷ , 鶴田修 ⁸ , 馬場保昌 ⁹ , 野村昌史 ¹⁰ , 平田一郎 ¹¹ , 吉村平 ¹² , 川口実 ¹³ , 九嶋亮治 ¹⁴ Toshiyuki Matsui ¹ , Takashi Nagahama ¹ , Akimichi Chonan ² , Akimichi Imamura ³ , Hiroyuki Kobayashi ⁴ , Junji Yoshino ⁵ , Mitsuo Iida ⁶ , Teruo Kouzu ⁷ , Osamu Tsuruta ⁸ , Yasumasa Baba ⁹ , Masafumi Nomura ¹⁰ , Ichiro Hirata ¹¹ , Hitoshi Yoshimura ¹² , Minoru Kawaguchi ¹³ , Ryoji Kushima ¹⁴ ¹福岡大学筑紫病院消化器科 ²仙台厚生病院消化器内視鏡センター ³札幌厚生病院胃腸科 ⁴松山赤十字病院胃腸センター ⁵藤田保健衛生大学第二教育病院内科 ⁶九州大学大学院病態機能内科学 ⁷千葉大学医学部光学医療診療部 ⁸久留米大学医学部消化器病センター ⁹早期胃癌検診協会中央診療所 ¹⁰手稲渓仁会病院消化器病センター ¹¹藤田保健衛生大学消化管内科 ¹²三重県立志摩病院内科 ¹³国際医療福祉大学熱海病院 ¹⁴滋賀医科大学付属病院病理部 ¹Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan ²Digestive Endoscopy Center, Sendai Kousei Hospital, Sendai, Japan ³Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan ⁴Institute of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan ⁵Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan ⁶Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ⁷Department of Endoscopic Diagnostics and Therapeutics, Chiba University School of Medicine, Chiba, Japan ⁸Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan ⁹Foundation for Detection of Early Gastric Carcinoma, Tokyo ¹⁰Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan ¹¹Department of Gastroenterology, Fujita Health University, School of Medicine, Toyoake, Japan ¹²Department of Internal Medicine, Mie Prefectural Shima Hospital, Shima, Japan ¹³Department of Internal Medicine, International University of Health and Welfare, Atami Hospital, Atami, Japan ¹⁴Department of Pathology, Shiga University of Medical Science, Ohtsu, Japan キーワード：遡及例 , 早期胃癌 , 発育・進展 , 粘膜下層癌 , 内視鏡治療 Keyword: 遡及例 , 早期胃癌 , 発育・進展 , 粘膜下層癌 , 内視鏡治療 pp.1798-1809

発行日 2008年11月25日 Published Date 2008/11/25

DOI https://doi.org/10.11477/mf.1403101516

PDF(856KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference
サイト内被引用 Cited by

要旨　粘膜内（M）癌からSM塊状浸潤癌ないし進行癌に進展する過程を速度面から分析する目的で，多施設アンケート調査を行った．対象と方法：230例の早期胃癌の内視鏡追跡例（72％が遡及例）が解析された．初回観察時の推定深達度は，M癌211病変，SM癌19病変であった．初回M癌の肉眼型はIIcなどの陥凹型107病変，隆起型104病変であり，平均経過観察期間は33.6か月で，最終的には44病変が進展癌（SM塊状浸潤ないし進行癌）へと発育し，非進展癌は167病変であった．また，M癌の最終観察時の組織型は，分化型癌が176病変で未分化型癌が35病変であった．結果：（1）M癌から進展癌となる過程 ; 50％のM癌が進展癌へとなるのに91か月を要した．初回の深達度がMないしSMであった場合，50％が進行癌へと進展するまでの期間は111か月を要した．（2）発育に関与する因子 ; 性と腫瘍の存在部位は，発育速度に関与しなかった．組織型の検討では，未分化型癌は分化型癌よりhazard比2.48と有意（p＜0.01）に早く発育した．また，年齢が10歳高いと進展速度がhazard比1.34と有意（p＜0.05）に速かった．以上より，遡及例を中心としたM癌は，内視鏡治療の適応を越える深達度に達するのに約7年を要し，早期癌が進行癌になるには9年を要すると考えられ，分化度が低いことと年齢が高いことが発育速度に影響していた．また，SM浸潤癌の発育速度はM癌に比し速かった．

　Growth speed and development from early gastric cancer to advanced cancer has not been elucidated fully. In this study mainly mucosal cancer was collected and analyzed to discover the developmental speed of its growth into submucosal invasive cancer, which can not be treated by endoscopic resection. Multi-center analysis was conducted using questionnaire sheets regarding endoscopic follow-up records, biopsy records and the final histological record. Risk factors which accelerate growth speed were analyzed from these records using a hazard rate ratio model. Subjects and method ; 230 lesions of early gastric cancer which were followed up for 33.6 months were retrospectively analyzed regarding growth speed and development. 211 mucosal cancers and 19 submucosal cancers were included in the analysis. Eventually, 44 lesions developed into submucosally invasive cancer or advanced cancer, and mucosal cancer developed into 176 well differentiated cancers and 35 poorly differentiated cancers. Results ;（1）It was estimated that fifty percent of mucosal cancer developed into submucosally invasive cancer during the follow-up period of 91 months. Early gastric cancer developed into advanced cancer during a follow-up of 110 months.（2）Significant risk factors for early development were ; poorly differentiated cancer（hazard ratio 2.48）patient age. The risk increases with every 10 years of patient aging（hazard ratio 1.34）.（3）Submucosal invasive cancer developed into advanced cancer more rapidly than mucosal cancer（50％ of cancer developed into advanced cancer in 19 months）. From the results above it is concluded that early gastric cancer developed into the advanced stage for seven years and the risk factors are poor differentiation in histology and higher age of the patient. After the development into submucosal invasive cancer, growth speed is accelerated.