胃癌の5年生存率―とくに進行癌について

ON THE FIVE-YEAR SURVIVAL RATE OF STOMACH CANCER: With special reference to advanced cancer

緒言

　胃癌にはいろいろな型があり，まず表層進展を主とするもの，あるいは粘膜固有層（m），粘膜下層（sm）にとどまる表在癌（superficial ca.）と固有筋層以上に達する深達癌（deeply developed ca.）とにわけられる．

　現在一般に表在癌は早期癌（early ca.）深達癌は進行癌（advanced ca.）とよばれている．その妥当性については本誌胃と腸（Vol.3，No.8，1968）において早期胃癌と誤診した進行癌の症例を提示した時に，併せて早期癌と進行癌の相関を述べながら論及した．

　During the 17 years from 1946 to 1962, the number of patients with gastric cancer admitted to the surgery department of the Cancer Institute is 3167, and its five-year survivors are 881. The rate of five-year survival for all admitted cases is 27.8 per cent; for 3103 operated cases is 28.4 per cent, and for 2589 resected cases, 34 per cent.

　Of all operated cases, five-year survival rate of 157 cases of early gastric cancer is 88.5 per cent, while that of 2946 cases of advanced carcinoma is 25.2 per cent.

　Five-year survival rate of advanced carcinoma has also been studied, with the exception of 160 cases of multiple carcinoma, by comparing it with early one, dividing all cancer cases into four groups, namely, operated group, resected one, radically resected one and curatively resected one. Five-year survival rate of single advanced carcinoma safely operated on for 2800 operated cases is 25.9 per cent, and for 2289 resected cases is 31.3 per cent; for 1774 radically resected ones, 40.2%, and for 1488 curatively resected ones, 46.2 per cent. Five-year survival rate of the same variety of gastric cancer has also been correlated with such items as its localization, primary site, macroscopic type, size, histological findings, lymph node metastasis, degree of serosal invasion, classification according to its stage of advancement, operative procedures and the degree of resectability. Study has further been made regarding 28 cases of five-year survivors in non-curable resection.

　Five-year survival rate of gastric cancer, especially of advanced one, very much varies according to its criteria as well as to the number of denominator. The whole aspects of five-year survival rate of gastric cancer has thus been clarified through the study of variance which can be observed according to different criteria employed.

　The criteria in this report for radical cure of gastric cancer have not been based on those laid down by this department and all cases have been evaluated according to an agreement made by the Society for Gastric Cancer Study,Borrmann's classification having been more taken into consideration rather than macroscopically classified types of cancer such as localized type, intermediate one and infiltration one.