胃癌化学療法の現況と問題点

Chemotherapy of Stomach Cancer: Present status and problems posed

　1953年以降死亡順位の第2位を占めてきた癌は，1976年には死亡数140,893名で全死亡中の20％を占めている¹⁾．国民の癌対策への要望を契機に，1965年12月に国会において「がん対策の推進について」という決議がなされ，1966年度予算で28億円余の癌対策費が計上された．国立がんセンターを中心とする診療体制の整備，胃癌・子宮癌等を中心に集団検診の標準・術式の確立等を背景に，厚生省・文部省に1963年度からがん研究助成金制度が設けられ，各方面における癌対策の成果を上げる基礎となってきた．

　胃癌についてみると，部位別訂正死亡率（人口10万対）では1977年男性34.1および女性21.6と圧倒的に高率であるが，年次的推移をみると肺癌・白血病・膵癌および卵巣癌等の増加に比べても1950年の胃癌のそれは男性45.0および女性28.6であったわけであるから，胃癌は男女とも減少傾向を示している¹⁾．

　The mortality of stomach cancer has gradually decreased due to a replenishment of the system of early detection and treatment which evolves primarily around mass screening.

　Excellent findings have also been recorded at the National Cancer Center, as the ratio of 5-year survival has reached 95.3% and that of 10-year survival 93.1% for cancer with submucosal invasion.

　However, the deaths from cancer has remained second in order since 1953 with stomach cancer being the primary death cause both among males and females. The median of the survival time for inoperable and post-operatively recurrent stomach cancer is 2.4～4.3 months for the group without chemotherapy but 3.0～7.4 months for the group with chemotherapy. In the latter group, the ratio of one-year survival is reported as standing at 0～12.3% and that of twoyear survival at 0～2.8%.

　In spite of the development of chemotherapy with new anti-cancer agents and effective combination chemotherapies, it is a fact that the effects against tumors and those for longer life still remain unsatisfactory.

　With special reference to advanced and scirrhous gastric carcinoma, the author will attempt to dwell on the present status and problems posed for the clinical application and assessment of chemotherapy, factors producing an impact on the effects against tumors and those for longer life, and establishment of the criteria for an assessment of the effects of chemotherapy of stomach cancer is equipped with features of recurrence, comparativeness and practical use.