食道m3・sm1癌の治療成績―EMRと手術の長期予後

Long Term Prognosis of m3, sm1 Cancer of the Esophagus: Comparison between EMR and Radical Surgery Cases

要旨　m3・sm1食道癌の予後は良好で，5年生存率はEMR施行例79例で88.0％，外科的根治術56例で95.2％であったが，他病死・他癌死を含めると，それぞれ62.2％，80.0％であった．ly（＋）が30.4％，n（＋）が15.5％に認められたが，外科的根治術施行例でみると，転移リンパ節1個のみが73.3％を占めた．EMR後の局所再発は8.2％に認められたが予後に影響しなかった．リンパ節再発は6.8％に認められ，発見時にはいずれも切除不能であった．EMR施行後の病理検索でly（＋）であったときn（＋）となる可能性は33.3％であった．m3・sm1癌でEMR可能と診断された症例でも，リンパ節転移を有している可能性が6.8％はあることを念頭に置き，6か月ごとのCTとEUSによる経過観察が必要であるとともにさらなるリンパ節転移診断能の向上が望まれる．

　Prognosis of m3, sm1 esophageal cancer is good after treatment either by EMR (79 cases) or by radical surgery (56 cases), the 5-year survival rate after each treatment being 88.0％ and 95.2％ respectively. The overall 5-year rate was 62.2％ and 80.0％ when deaths due to other causes were also counted. Lymphatic invasion was found in 30.4％ of the patients and lymph node metastasis was found in 15.5％, 73.3％ of whom had involvement of only one lymph node.

　In the patients treated by EMR, local recurrence rate was 8.2％ and the lymph node recurrence rate was 6.8％. Local recurrence was re-treated successfully by endoscopic maneuver except for one case involving lymph node recurrence. If lymphatic invasion is positive in the resected specimen after EMR, 33.3％ of these patients may possibly have lymph node metastasis. The patients of m3, sm1 esophageal cancer indicated as suitable for EMR have 6.8％ of lymph node metastasis. They should by followed up every 6 months after EMR by CT and EUS. Accurate preoperative diagnosis for lymph node metastasis is desirable.