早期胃癌の再発例

Recurrence of Early Gastric Cancer

要旨　早期胃癌の再発に関して，21論文を集め検討を加えた．術死・非治癒切除・残胃再発を除くと，12,481例中1.9％の再発死亡が報告されていた．他臓器の癌を含む他病死が，これを上回る10.9％にみられた．原発病変の深達度，組織型，リンパ節転移の有無が，再発に有意な関連を示した．特にリンパ節転移陽性の症例，および肉眼型が隆起・陥凹の混合型を呈する分化型癌症例は，比較的高い再発率を示しており，これらの特徴を有する早期胃癌に対しては，何らかの補助療法を行う価値があると考えられる．論文中に個々の症例提示がなされた109例について再発形式をみると，分化型癌では血行性転移が，未分化型癌では局所・腹膜再発が多かった．リンパ節転移の有無は，再発形式と無関係であった．

　Twenty one reports on recurrence of gastric cancer were reviewed. Death due to recurrence of early gastric cancer was reported in 1.9% of 12,481 resected cases excluding operative deaths, non-curative operations, and recurrence in the residual stomach. Deaths from other causes including non-gastric malignant disease were more frequent than recurrence of gastric cancer. Among various pathologic factors of primary tumors, invasivity, histological differentiation types, and lymph node involvement related significantly to recurrence of disease. In particular, cases with lymph node metastasis and cases of macroscopically elevated-depressed mixed type with a histologically highly differentiated type had the greatest likelihood of recurrence. The mode of recurrence was analyzed in 109 cases whose individual clinicopathological data were provided in their reports. Bloodborn recurrence was commonest in the differentiated histological type, and regional or peritoneal recurrence was most frequently seen in the undifferentiated type. Lymph node involvement did not associate with the mode of recurrence.