早期胃癌の変貌―高齢者群における胃癌の検討

Gastric Carcinoma in the Aged Population

　近年，本邦における平均寿命の延びは著しいものがあり，諸外国と対比しても男性が第1位（73.46歳），女性が第2位（78.89歳）を占めている¹⁾．

　他方，胃癌に対する検診の普及，診断能力の上昇もX線，内視鏡の進歩発展と相俟って目覚ましいものがある．しかし，本邦では依然として胃癌が高頻度であり，重要な疾患であることは論ずるまでもない．胃癌による死亡者は年間約5万人であり，全癌死亡者数の約32％に相当する²⁾．今後，ますます高齢者層が増大することを思うとき，高齢者群における胃癌の実態をみておくことはそれなりに重要な意義があるものと思われる．

　The incidence of gastric carcinoma is increasing in the aged people along with the increase of aged population due to elongation of mean life span.

　In the present paper, histopathological observation was made on gastric carcinoma of autopsy as well as operation materials obtained from patients over 60 years old in Tokyo Metropolitan Geriatric Hospital, with special reference to early gastric carcinoma, and the following results were obtained.

　(1) Gastric carcinoma observed in 15% of total autopsy cases performedd during past 9 years at Tokyo Metropolitan Geriatric Hospital.

　(2) Male/female ratio in terms of incidence of the carcinoma was quite different between the population of 7th and 8th decade, and those of 9th and 10th decade; i. e., it was about 3/1 in the former and 1/1 in the latter.

　(3) Early gastric carcinoma was found in 41% (87 cases) of total gastric carcinoma cases (212 cases) of autopsy materials and 36% (97 cases) of those (271 cases) of operation materials.

　(4) Most cases of early gastric carcinoma in the aged people were found in the middle or lower portion of stomach, macroscopically elevated type, especially type I and type Ⅱa, and histologically well-differentiated type.

　(5) Undifferentiated carcinoma was found in 43% of total cases of advanced gastric carcinoma and the incidence was quite different from that in early gastric carcinoma.

　(6) Multiple gastric carcinoma was found in 8% (18 cases) of autopsy materials and in 15% (41 cases) of operation materials. The incidence of multiple gastric carcinoma was apparently higher in the aged people, especially in male, than that in younger people.

　(7) So-called atypical epithelial lesion was found in 2.5% (47 cases and 52 lesions in total) of autopsy materials and 73% of these were found in the antral region.

　(8) Early gastric carcinoma was highly associated with intestinal metaplasia in the background.