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Stomach and Intestine(Tokyo) Volume 44, Issue 1 （January 2009）

胃と腸 44巻1号（2009年1月発行）

Japanese English

今月の主題未分化型胃粘膜内癌のESD―適応拡大の可能性

主題

未分化型胃粘膜内癌に対するESD/EMRの成績と長期予後 Long-term Outcome of EMR/ESD for Undifferentiated Adenocarcinoma of the Stomach 横井千寿 ^1,2 , 新保卓郎 ³ , 草野央 ¹ , 小田一郎 ¹ , 鈴木晴久 ¹ , 平島徹朗 ¹ , 桐山真典 ¹ , 吉永繁高 ¹ , 中島健 ¹ , 松田尚久 ¹ , 斎藤豊 ¹ , 後藤田卓志 ¹ Chizu Yokoi ^1,2 , Takuro Shinbo ³ , Chika Kusano ¹ , Ichiro Oda ¹ , Haruhisa Suzuki ¹ , Tetsuro Hirashima ¹ , Shinsuke Kiriyama ¹ , Shigetaka Yoshinaga ¹ , Takeshi Nakajima ¹ , Takahisa Matsuda ¹ , Yutaka Saito ¹ , Takuji Gotoda ¹ ¹国立がんセンター中央病院内視鏡部 ²国立国際医療センター戸山病院消化器科 ³国立国際医療センター研究所医療情報解析研究部 ¹Endoscopy Division, National Cancer Center Hospital, Tokyo ²Department of Gastroenterology, Toyama Hospital, International Medical Center of Japan, Tokyo ³Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo キーワード：早期胃癌 , 内視鏡的切除 , 未分化型腺癌 , 長期予後 , ESD Keyword: 早期胃癌 , 内視鏡的切除 , 未分化型腺癌 , 長期予後 , ESD pp.71-80

発行日 2009年1月25日 Published Date 2009/1/25

DOI https://doi.org/10.11477/mf.1403101563

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要旨　国立がんセンター中央病院で1999年1月～2005年12月の期間に内視鏡的切除が施行された未分化型腺癌112病変107症例の治療成績と長期予後を検討した．切除方法は strip biopsy 4病変，ESD 108病変であった．穿孔率1.8％，一括断端陰性切除率85.7％であった．“脈管侵襲がなく，2cm以下で潰瘍成分を認めない粘膜内癌”の一括断端陰性切除例を治癒切除と定義すると，治癒切除例および非治癒切除・追加外科手術施行例に比べ，非治癒切除・追加外科手術未施行例の長期予後は有意に不良であった．全生存期間に影響を与える因子として脈管侵襲（lyまたはv），深達度，水平断端と最終根治度評価後の追加外科手術の有無が挙げられた．

　To clarify the long term outcome of endoscopic resection of undifferentiated adenocarcinoma of the stomach,107 patients （112 lesions） from a consecutive database of 2,012 patients （2,399 lesions） were enrolled. They had been treated with endoscopic resection from January,1999 to December,2005. All the enrolled lesions were pathologically evident as pure undifferentiated adenocarcinomas. We exclude cases with mixed-type adenocarcinoma of undifferentiated and differentiated adenocarcinoma. ‘Curative resection' was defined as the resection which satisfied the expanded criteria ; intramucosal tumor without ulcerative fibrosis, lymphatic or vascular involvement and free lateral or vertical margins.

　Four lesions were removed by the strip-biopsy method and 108 lesions were treated by endoscopic submucosal dissection （ESD）. Perforation rate was 1.8％（2/112） and there was no massive bleeding.

　In the pathological assessment, complete resection with negative margin was 85.7％（96/112）. The curative resection rate was 47.3％（53/112） and the non-curative resection rate was 52.7％. Among the population with non-curative resection （59 patients / 59 lesions）, 24 patients underwent additional surgery. The overall death rate was 15％（16/107）. Two patients, among the patients who refused to receive additional surgery in spite of non-curative resection, died of gastric cancer.

　In the overall survival estimation, there is significant differentiation between the group who received curative resection and the growp who received non-curative resection followed by surgery and the group who received non-curative resection without surgery. Concerning the multivariate analysis using the backward selection method, it was revealed that the evidence of sm-invasion, lymphatic or vascular involvement, margin positive and refusal of additional surgery in case of non-curative resection can be the predictive factors of overall survival.

　According to our study, endoscopic resection for undifferentiated adenocarcinoma of the stomach can be acceptable when it utilizes the expanded criteria.