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要旨 多発胃癌症例230症例の第1癌巣230病変と多発癌巣328病変の位置関係を検討した.多発癌巣の約60%は第1癌巣から4cm以内の近傍に存在しており,第1癌巣の肛門側に位置する傾向が認められた.組織型,粘液形質,癌巣周囲粘膜の種類,癌巣周囲粘膜の腸上皮化生の程度は,いずれも第1癌巣と多発癌巣の間で一致している傾向がみられた.また,早期多発胃癌の第1癌巣132病変と早期単発胃癌507病変の臨床病理学的因子を比較検討した.単変量解析では多発胃癌との有意な相関を示したのは性別(男性),年齢(65歳以上),深達度(SM),粘液形質(腸型),萎縮性胃炎の拡がりの程度(高度),癌巣周囲粘膜の腸上皮化生の程度(高度),粘膜下異所性胃腺であった.多変量解析にて独立性が認められたのは粘液形質(腸型),癌巣周囲粘膜の腸上皮化生の程度(高度),粘膜下異所性胃腺であった.これらの結果から,多発胃癌の危険度判定基準を作成した.この適応基準により,多発胃癌発生の高危険群の選別が可能であり,胃癌の縮小治療後のサーベイランス方針の決定に有用であると考えられた.
We investigated the clinicopathological differences between multiple early gastric carcinoma and solitary early gastric carcinoma in the present study.
Univariate analysis of clinicopathological factors in the present study showed that multiple gastric carcinomas significantly correlated to the male, old age(over or equal to 65 years), submucosal invasive carcinoma, mucin phenotypes(intestinal type), distribution of atrophic mucosa in the stomach(severe), degree of intestinal metaplasia in the surrounding mucosa(severe)and submucosal heterotopic glandular cysts. Furthermore, multivariate analysis using the stepwise method identified that mucin phenotypes(intestinal type), degree of intestinal metaplasia in the surrounding mucosa(severe)and submucosal heterotopic glandular cysts as significant independent risk factors for multiple gastric carcinomas.
Based on these findings, risks for multiple gastric carcinomas were classified into high, moderate and low. While studies have shown risk factors for multiple gastric carcinomas, the present study is unique in showing risk assessment criteria based on a combination of risk factors for multiple gastric carcinomas.
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