4型胃癌の現状と推移

Modern Trend of Type 4 Carcinoma (So-called Scirrhous' Carcinoma) of the Stomach

要旨　最近15年間に切除された胃癌1,862例において，肉眼型，組織型を中心に年次的変化を検討し，胃癌病像の変化を調べた．進行癌において4型の減少と5型の増加，組織型で分化型の増加が著しく，スキルスの減少との関係が推測された．上中部における4型切除例95例において，giant fold型が60例，non-giant fold型35例であった．癌性腹膜炎による死亡は前者が73％，後者が46％，平均生存日数は前者が576日，後者が408日であった．5年以上生存の上中部4型胃癌は8例あり，体部後壁や大彎に限局したものが多く，スキルスにしては小型のものが多かった．このような部位におけるⅡcの早期発見が，スキルスの早期発見・治療に重要と考えられた．

　In 1,862 gastric cancer cases resected at our hospital during the past 15 years, we examined the chronological changes of the features of gastric cancers in view of the gross appearance or histological findings. The gross appearance has shown no particular change in early cancers, but there is a remarkable decrease of type 4 cancers. Histology has demonstrated an obviously increasing number of differentiated type adenocarcinoma, especially in the fundic area and in the younger age group. These two changes are supposed to be correlated mutually.

　Ninety-five resected cases among 120 cases of type 4 in the upper and middle thirds of the stomach were evaluated, including 60 cases of giant fold type (linitis plastica type) and 35 cases of non-giant fold type (Borrmann 4 type in the narrow sense). They were frequent in females, and the mean age of females was four years younger than the mean overall age of cases of this type of cancer. The frequency of peritonitis carcinomatosa was 73% in the giant fold type, and 46% in the non-giant fold type, and the mean survival periods were 576 and 408 days in each type respectively.

　Eight cases who had survived five years or longer of type 4 carcinomas were studied. The carcinomas were mainly located at the posterior wall or along the greater curvature of the corpus. Because linitis plastica type carcinomas have small ulcers in the center, it seems, from a histogenetic viewpoints, to be important to defect Ⅱc type carcinoma at such sites.