食道sm癌に対する食道温存治療の可能性―病理の立場からの検討

The Clinicopathological Features of sma2・3 Esophageal Carcinoma

要旨　食道表在癌手術症例（sm2・3癌）49例を対象に，臨床病型，病巣の縦径，横径，縦径と横径の積，癌巣厚，sm浸潤長，sm浸潤幅，sm浸潤長とsm浸潤幅の積，癌層から固有筋層までの距離，異型度，簇出，脈管侵襲，リンパ節転移および転移部位について検討した．横径（p＜0.05）以外の諸計測値にリンパ節転移陽性群と陰性群間に差は認められなかった．臨床病型では，純粋な隆起型9例ではリンパ節転移陰性であったが，0-Ⅲ型では3例全例にリンパ節転移を認め，臨床病型と転移との関連が示唆された．しかし，他にはリンパ節転移の有力な指標を認めなかった．sm2・3癌ではリンパ節転移と関連した因子が少ないため，EMRを主体とした食道温存治療の適応は低く，別の治療戦略が必要であると推察された．

　Endoscopic mucosal resection (EMR) is a less invasive treatment for patients with esophageal carcinoma. The aim of the current study was to clarify the clinicopathological features of sm2・3 esophageal carcinoma (invading to the submucosa more than 201μm vertically) and whether EMR was a suitable treatment for sm2・3 carcinoma. Forty-nine sm2・3 carcinomas of the esophagus resected between 1987 and 2001 were examined. Eighteen sm2・3 carcinomas showed lymph node metastasis (36.7%). Except for the transverse diameter (p＜0.05)and the macroscopic type(p＜0.02), the difference between the carcinomas accompanied by lymph node metastasis and those without it cannot be recognized by considering the various measured values and other factors involved. In the 0-Ⅲ type, lymph node metastasis was recognized in all 3 cases, while there was no lymph node metastasis in the protruding types such as 0-Ⅰp, 0-Ⅰpl and Ⅱa.

　In conclusion, different strategies are necessary for the treatment of sm2・3 carcinoma for the preservation of esophagus, since there are no features adequate to indicate the presence of lymph node metastasis.