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Stomach and Intestine(Tokyo) Volume 44, Issue 7 （June 2009）

胃と腸 44巻7号（2009年6月発行）

Japanese English

今月の主題食道胃接合部腺癌の診断

主題

食道胃接合部腺癌の内視鏡診断―通常内視鏡の立場から Endoscopic Diagnosis of Tumor Depth of Adenocarcinoma at the Esophagogastric Junction 小田一郎 ¹ , 草野央 ¹ , 阿部清一郎 ¹ , 竹中龍太 ¹ , 青山育雄 ¹ , 金城徹 ¹ , 多田和弘 ¹ , 瀧澤初 ¹ , 野中哲 ¹ , 平島徹朗 ¹ , 桐山真典 ¹ , 吉永繁高 ¹ , 谷口浩和 ² , 下田忠和 ² , 後藤田卓志 ¹ Ichiro Oda ¹ , Chika Kusano ¹ , Seiichiro Abe ¹ , Ryuta Takenaka ¹ , Ikuo Aoyama ¹ , Tetsu Kinjyo ¹ , Kazuhiro Tada ¹ , Hajime Takisawa ¹ , Satoru Nonaka ¹ , Tetsuro Hirashima ¹ , Shinsuke Kiriyama ¹ , Shigetaka Yoshinaga ¹ , Hirokazu Taniguchi ² , Tadakazu Shimoda ² , Takuji Gotoda ¹ ¹国立がんセンター中央病院内視鏡部 ²国立がんセンター中央病院臨床検査部 ¹Endoscopy Division, National Cancer Center Hospital, Tokyo ²Pathology of Clinical Laboratory Division National Cancer Center Hospital, Tokyo キーワード：食道胃接合部腺癌 , Barrett食道癌 , 深達度診断 , 内視鏡診断 Keyword: 食道胃接合部腺癌 , Barrett食道癌 , 深達度診断 , 内視鏡診断 pp.1155-1162

発行日 2009年6月25日 Published Date 2009/6/25

DOI https://doi.org/10.11477/mf.1403101707

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要旨　2000年から2008年までに当院で内視鏡切除あるいは外科切除が施行された早期食道胃接合部腺癌73症例（M：SM癌＝33：40症例）を対象に，臨床病理学的所見，通常内視鏡画像見直し診断による内視鏡所見と病理深達度の関連について検討した．年齢，性，Barrett食道癌の診断の有無，組織型，部位，肉眼型は，SM癌とM癌において有意差を認めなかった．一方，SM癌はM癌に比べ有意に大きく（M ; 14.5±7.5mm，SM ; 24.5±7.7mm，p＜0.01），発赤調病変が有意に多かった（SM率：発赤 ; 60％，正色・褪色調 ; 12％，p＜0.05）．また，0-Iと0-IIごとに検討すると，0-Iでは，0-Ip（SM率：0％）に比べ0-Is（SM率：92％，p＜0.05）で，0-IIでは0-IIa，0-IIc（SM率：31％）に比べ混在型（0-IIa＋IIc，0-IIc＋IIaなど，SM率：85％，p＜0.01）でSM癌が有意に多かった．

　Accurate endoscopic diagnosis of tumor depth for gastrointestinal cancer is essential for making a proper decision on treatment strategy. Although correlation of macroscopic type with tumor depth for gastric cancer has been reported, there have been only a few reports comparing the differential endoscopic diagnosis between mucosal（M）and submucosal（SM）adenocarcinoma located at the esophagogastric junction（EGJ）. We analyzed the relationship between macroscopic type and tumor depth for such EGJ cancer. We reviewed 73 EGJ adenocarcinomas（M/SM＝33/40 ; differentiated/undifferentiated type＝70/3）in 73 consecutive patients treated endoscopically and/or surgically between 2000 and 2008. Median age was 64 years（range, 37-85）and male/female ratio was 62/11. EGJ adenocarcinoma was defined as a “junctional carcinoma（type II）” according to the Siewert classification. Endoscopic macroscopic type was classified based on the Paris classification and divided into polypoid（0-I）and non-polypoid（0-IIa, 0-IIb, 0-IIc and 0-III）types. Polypoid types were subdivided into sessile and pedunculated types. Mixed type was diagnosed when a lesion was composed of two distinct macroscopic types. We found 0-I in 14, 0-IIa in eight, 0-IIc in 31, 0-IIa＋IIc in 17 and 0-IIc＋IIa in three patients. In 0-I, SM invasion was significantly more frequent for the sessile type than the pedunculated type（92％, 11/12 vs. 0％, 0/2 ; p＜0.05）. In the non-polypoid type, SM invasion was significantly more frequent for the mixed type than the total of 0-IIa and 0-IIc（85％, 17/20 vs. 31％, 12/39 ; p＜0.01）. SM lesions（24.5±7.7mm）were significantly larger than M lesions（14.5±7.5mm, p＜0.01）. In conclusion, determination of endoscopic macroscopic type is valuable in accurately diagnosing tumor depth for EGJ adenocarcinoma.