内視鏡的ポリペクトミーが行われた大腸sm癌患者の予後

Prognosis of Patients with Colon Cancer Limited to Submucosal Layer, Who Had Undergone Endoscopic Polypectomy

要旨　42施設へのアンケートで，内視鏡的ポリペクトミーでfollow-upしている大腸sm癌94例（A群）の予後を，ポリペクトミー後に引き続いて腸切除を行ったsm癌126例（B群）の予後と比較した．再発例はA群では7例（7.4％）で，すべて局所再発，B群では2例（1.6％）でリンパ節再発と肝転移であった．A群全例の5年生存率は87.8％，10年生存率は64.9％で，B群全例の93.5％と88.1％より低かったが，統計学的には有意差はなかった．予後を左右する因子別の生存率の検討では，腫瘍の大きさが2.0cm以上の場合および脈管侵襲陽性の場合，ポリペクトミー断端近傍に癌のmassive invasionがみられた場合には，それぞれA群の生存率はB群の生存率よりも統計学的に有意差をもって低かった．

　For a study on prognosis of patients who had undergone endoscopic polypectomy, the records of 220 patients with colon cancer limited to the submucosal layer were collected by “enquete” study from 42 universities or hospitals in Japan.

　Of these, 94 patients had been followed up without surgical intervention after endoscopic polypectomy (Group A). Remaining 126 patients had undergone colectomy after endoscopic polypectomy (Group B).

　Seven of 94 patients (7.4%) in group A had recurrence after endoscopic polypectomy, and in this all cases type of recurrence was local recurrence. Two patients (1.6%) in group B recurred after colectomy, one case showed lymph node metastasis and the other case showed liver metastasis (Table 8).

　Five years survival rate of all cases in Group A was 87.8%, and its ten years survival rate was 64.9%. In Group B, five years survival rate of all cases was 93.5%, and its ten year ssurvival rate was 88.1%. Between all cases in Group A and B there were no statistical difference in survival rate (Fig. 1).

　In cases with larger diameter than 20 mm in a tumor size, survival rate of the patients in Group A was statistically lower than survival rate in Group B (Fig. 3).

　In cases with vessel invasion or with massive invasion of cancer cells adjacent to the stump of polypectomy, ten years survival rate of the patients in Group A was statistically lower than survival rate in Group B (Figs. 4 and 5).

　In cases without vessel invasion and massive invasion of cancer cells, five or ten years survival rate of the patients in Group A was excellent, 92.2% or 85.4% respectively (Fig. 6).